When a medical emergency strikes in grad school

Amy Berman, a PhD student in counseling psychology at Tennessee State University, compares her thyroid cancer scare this past spring to the game Jenga. Removing any one block — representing her good academic standing, good relationships with faculty and, in this case, good health — felt like it could bring her whole graduate career crashing down. "I was nervous," she says, about approaching her program director about her impending surgery.

Rebecca Graiber can commiserate. In 2004, as a master's candidate in psychology at Roosevelt University, she was halfway through her internship at a Chicago-area fire department when she was put on bed rest for a complicated pregnancy.

"There was nothing I could do" to continue the internship, she says. Six years after completing her degree through a non-accredited program online, Graiber is still searching for a way to work in the field without a license. "I am stuck," she says.

When a medical emergency strikes in graduate school, it can be devastating. Between scheduling doctors' appointments, recovering from treatments and making complicated health-care decisions with little energy or while in pain, staying on top of coursework can seem a near-impossible task. "When you're facing something like that, you're thinking about planning your living will" more than, say, your dissertation data collection, Berman says.

But graduate students can steady the metaphorical Jenga game, whether they're dealing with a health problem now or want to be prepared for one in the future.

Here's what to consider if a health crisis strikes you:

1. Know your rights.

Most universities have leave-of-absence policies. Find yours, and document your course of action along the way, advises Nabil El-Ghoroury, PhD, associate executive director of APAGS. That way you can report any violations, such as a professor allowing only a one-term leave when the policy stipulates two, to your program director, a higher-up at the university or the Commission on Accreditation, if applicable. "I would hope that programs are respectful and accommodating about these things, but I've heard sometimes they aren't," he says. "It's important to know your rights as a student."

It's even more important to know your rights as a U.S. citizen, says Penn State psychologist Dan Shapiro, PhD, who studies the patient-physician relationship — and who has personally experienced these issues. He was diagnosed with Hodgkin's lymphoma while in college and relapsed twice during graduate school. Under the federal Family Medical Leave Act, he says, most graduate students are considered employees. That means they can take up to 12 unpaid work weeks of leave a year for "a serious health condition that makes the employee unable to perform the essential functions of his or her job," according to the U.S. Department of Labor.

"As grad students, we get conned into believing the law of our department is the law of the land," Shapiro says. But in reality, FMLA should be heeded first. "If you're ill, you should know it."

2. Get the facts.

When Berman approached her program director one week before her surgery, she didn't know whether her tumor was cancerous, and if it was, whether it would be responsive to chemotherapy. She says one likely outcome was an untreatable cancer with a life expectancy of one to six years. "I wasn't sure how to navigate that [conversation] because there were so many question marks regarding the diagnosis," she says.

Berman's situation is not uncommon, says Shapiro. Depending on the disease and how your body responds to treatment, "there's a wide range of capability, and when you're first diagnosed, you just don't know" how much coursework you'll be able to handle, he says.

But it's important to get as much information as possible before you break the news to your program faculty, if you do so at all, Shapiro says. Ask your doctors about the length and effects of treatment, go through the various potential outcomes and remember that your health information is your business for as long as you want it to be. You may even want to refrain from telling your peers to prevent word from getting out before you want it to, Shapiro says. "[The faculty may] start making decisions before you have a chance to advocate for yourself."

3. Make a plan, or three.

In a situation with so many unknowns — What's wrong with me? How will I respond to treatment? Will I be OK? Can I still graduate on time, if at all? — maintaining some control can make a big difference, mentally and physically. "There's a relationship between perceived control and health," says Shapiro, who found that being assertive with his health-care team, such as by determining his own visiting hours, was empowering.

It can also help to make a plan, or several, Berman says. She wishes she had considered the best- and the worst-case scenarios, and developed academic plans based on each. "That can kind of help you feel a bit more in control when you don't have the concentration skills to pull it all together," she says.

4. Confide with caution.

Once you're equipped with facts and a plan, choose your confidants wisely, says Maribeth Walker, PhD, a psychology instructor at Tennessee State University who regularly checked in on Berman throughout her testing and recovery. "Recognize who student advocates are so that if you need to call on them, they'll be there," she says. With them, let your guard down as much as possible because, she adds, "If the faculty member doesn't know what's going on, it's hard for them to be as helpful, to negotiate your assignments and grades."

Finding a supportive faculty member will be easiest if you've already established yourself as a good student, Walker adds. El-Ghoroury agrees. "Those reports that you should have done a month ago? Those become problematic if you suddenly become incapacitated," he says. "Don't wait until the last minute."

Maintaining good academic standing was key for Shapiro, who says his advisor worked to have him reinstated after he was told to resign because his "health status was inconsistent with finishing the program." Up until that point, he'd had a successful academic career — his master's thesis was set to be published and he'd earned a grant based on the findings.

"I think if I had been a middling student or not had the good fortune of [having] Steve Boggs as my advisor … my future could have easily been in doubt," Shapiro says. "I was much more worried about losing my life than my graduate position."

5. Engage support.

Of course, having a support system is good for more than advocacy. For Berman, it meant the comfort of two classmates and the reassurance that Walker, the psychology instructor, cared about her health. "That made more of a difference than I can say," Berman says. "Dr. Walker is one of the reasons I think I persevered."

Indeed, social support has been linked to improved disease outcomes. In one recent study, for example, breast cancer survivors who felt more socially connected reported less pain, depression and fatigue than those who were lonely. Blood samples verified the connection between such feelings and immune function (Psychoneuroendocrinology, 2013). "That social support is a buffer for everybody," says Cynthia Belar, PhD, a health psychologist and executive director of APA's Education Directorate.

6. Know your limits.

Staying engaged with school during a health crisis can be a welcome distraction for many students. "Having a sense of purpose during an illness is very inoculating," says Shapiro, who developed a theory on coping with cancer while hospitalized. "It felt good for portions of the day not to live as a professional patient."

But it's also important to remember that your health comes first — something driven graduate students may forget. "I would find myself thinking, ‘Oh, I don't know if I should do this appointment because I have this exam,'" Berman remembers. She even planned to take her first-year qualifying exam from the hospital bed while recovering from surgery. "I just didn't realize what it would do to my energy," she says. When her condition turned out to be a benign tumor so rare it's one of only 30 cases worldwide, Berman decided to take an incomplete in one course, enroll in summer classes to catch up and sit for the exam this December.

"Knowing one's limits is important," Belar says, "and that's not something people can decide for you."

7. Find the silver lining.

Shapiro's fight with cancer fueled much of his career — he's consulted for medical TV shows, written books about his experience and developed expertise in patient-physician relationships inspired by his time in the hospital. Still, he's not glad to have had cancer. "If I could have had a chemotherapy-free lifetime, I would have made the trade in a heartbeat," he says.

But there are positives future health-care professionals can glean from a bout with a life-threatening disease. "There's personal growth that's available in the face of these stressors that make us stronger clinicians and probably better teachers," Shapiro says.

For Berman, who ultimately wants to do both clinical and policy work with survivors of torture and trauma, the experience gave her an ability to relate to future clients. "I gained the perspective well beyond what [an empathy] exercise could have shown me," she says.

It also gave her a new outlook. "It could have been a lot different for me," she says. "I feel very lucky."