South Carolina Lawyers Weekly
By Julia Huston
BridgeTower Media Newswires
It was not the way I planned to end my career.
One day, in April 2019, I told my law firm colleagues that I was going to take a medical leave to address some health issues and that I would be out for at least a few weeks. I never came back.
I could not understand the symptoms that I was experiencing, and they were increasingly affecting my life. I had been experiencing increased sleepiness during the day and, as things worsened, I struggled to stay awake for any meeting that lasted more than 45 minutes.
During the final months, I probably had more “walking meetings” than meetings in my office (the local Starbucks was an indirect beneficiary of my condition).
What came later was even worse, and I ultimately lost the tools of our trade — the ability to reliably remember and process information.
It turns out that I have some pretty significant neurological conditions. I have been diagnosed with mild cognitive impairment (which feels anything but mild) and a disorder similar to narcolepsy. Managing this situation was without question the biggest challenge of my 27-year law career. I did everything I could think of to protect myself, my clients and my firm, as any of us would in this situation.
That said, there are some things I wish I knew and some things that I would do differently. While my focus is cognitive decline, I appreciate that many of my messages may resonate with people who have different challenges.
Build your health care team now
When my cognition began to noticeably decline, I wasted a lot of time trying to find the right health care professionals. I was particularly ignorant about the importance of having the right primary care physician.
Since I had never experienced a significant health issue before, and my insurance allowed me to see specialists without referrals, I didn’t really care who my PCP was. I didn’t realize that many specialists at the teaching hospitals require referrals from PCPs within their own network.
As a result, even though we have the best medical care in the world right here in Boston, I was not able to easily access psychiatrists and neurologists in the network of teaching hospitals. These people had waiting lists approaching a year — and that was before the pandemic!
Switching up my entire care team was a nightmare and could have been avoided if I had a PCP affiliated with a teaching hospital and consulted him or her at the outset of my problems.
Don’t assume depression or anxiety is to blame
When things started worsening, I experienced depression and a couple of episodes of anxiety. So naturally I assumed that was the cause of the problem and sought weekly therapy.
That was a mistake, and all it did was put more pressure on my schedule during an already difficult time and distract me from doing the thing that I should have done first — get a comprehensive evaluation from my PCP.
To be sure, I was experiencing depression and anxiety, but they were the result of, rather than the cause of, my underlying difficulties. Although my symptoms predated the COVID pandemic, if the timing had been different, I might have mistook my cognitive problems for COVID-related brain fog.
As strange as it is to say, I was hoping that my symptoms were caused by depression or anxiety because I know that people can often manage those things and, in some cases, even recover from them. My best-case scenario did not materialize, however, and once the depression and anxiety lifted, I was left with neurological conditions that are likely to decline rather than improve over time.
Go to your PCP at the first sign of a problem
The biggest thing I wish I had done differently is gone to my PCP much earlier than I did and put the effort into presenting a full picture of the issues I was experiencing — including itemizing the random medical things about myself that I had no reason to believe were related to cognition.
That would have helped my PCP determine whether I should be seeing a neurologist, rheumatologist, sleep specialist or someone else, and get the referral process started. My new PCP ultimately did that, and she was excellent, but I could have made it happen much earlier.
If you suspect you may be experiencing cognitive decline, or want to be proactive about it, ask your PCP to check your nutrition levels each year. Various vitamin deficiencies (such as vitamin B12) can cause cognitive decline and are easy to treat.
If you are experiencing symptoms, your PCP may also do a blood test to determine whether your body’s response to inflammation might be the cause.
Many people do not realize that they have sleep apnea, which can cause cognitive decline by depriving the brain of high-quality sleep. Lyme disease, thyroid issues and toxins in the home can also cause or contribute to cognitive impairment.
Unfortunately, these efforts did not pan out for me, and there is no easy solution to my cognitive decline. I should have ruled out the simple physical causes earlier, however, as I would have felt like an idiot if I took a medical leave, and it turned out to be something as easily treatable as sleep apnea.
An ounce of prevention
For anyone interested in maximizing their cognitive functioning, either before or after problems arise, I would recommend the book “The Alzheimer’s Solution” by neurologists Dean and Ayesha Sherzai.
The book recommends specific steps people can take to boost their cognitive health in the areas of nutrition, exercise, sleep, meditation and engagement. The authors recommend a primarily plant-based diet rich in superfoods like blueberries, flax and algae. They suggest what foods and other triggers to avoid and provide a list of supplements that help brain functioning, which I have vetted with my own neurologist and use regularly. It is a worthwhile read and is the most practical of all the resources I have seen so far. The authors also have a podcast and offer information and services through their website.
On a more pragmatic level, it would be prudent to prepare for a worst-case scenario by ensuring that another attorney is available to step in and take over your cases if you should become suddenly unavailable. This can be especially challenging for solo practitioners, who will need to be proactive about making arrangements with someone outside their own practice.
It is best to make such arrangements before you actually need to rely on them, of course, and it may be more comfortable at that point because the benefits can run both ways.
You might also consider long-term disability insurance. Some policies are occupation-specific and can therefore provide benefits if you can no longer practice law but could do manual or clerical work.
This can be a tremendous help, so that financial problems are not layered on top of the other problems you are experiencing, but this strategy only works if you apply in advance.
Timing is everything
I wish I took a medical leave earlier than I did. There is never a perfect time to take yourself out of the game, and I did act promptly in the larger scheme of things, but looking back it would have been better for me to leave earlier.
As my abilities diminished, it caused me no small amount of grief. I have accepted that the situation was not my fault, as my cognitive issues were caused by my brain and not my character, but it was a really difficult time.
If you are in a similar situation and suspect that you are at the beginning of a decline, I would advise you not to let it go too far. I recently counseled someone who was struggling with whether it was time to make some changes to accommodate cognitive impairment, and the following analogy proved helpful:
Like someone who is no longer capable of driving safely, you will probably experience several near misses and minor accidents before a major accident occurs. You might even experience a major accident but be lucky enough to avoid serious consequences. It would be wise to get off the road before a major, catastrophic accident occurs.
Where to go from here
Here are some steps you can take to get help and protect yourself and your clients if you think you may be experiencing cognitive impairment:
First, prioritize getting medical attention.
Second, manage your stress. Cognitive decline is greatly impacted by stress, and in order to maximize your functioning you are going to need to manage stress effectively. I appreciate that this is a difficult message for lawyers to hear, as many law jobs are inherently stressful, and significant changes to the way you work may be required. But, to build on the analogy above, it is better to get in the slow lane if it will lessen the chances of crashing through the guardrail.
Third, if you can, assign other people to your cases so that you have another set of eyes on your work. Or just reassign the work or the supervision of the work. Obviously, you will need to do right by the client in terms of not charging for any inefficiencies, but this is far easier than dealing with the fallout of mistakes. I used this strategy successfully, and it was so natural that I don’t think anyone even noticed that I was taking myself out of the game.
Fourth, don’t be afraid to ask to take a medical leave. I dreaded this part of the process, but it turned out to be so easy. Every workplace is different, of course, but I found my firm’s management to be gracious, caring and appreciative of my coming forward and proactively addressing the situation.
Fifth, build a new team. You may be entering a new stage of life, whether you perceive it that way or not, and you need the right team of people to help with your changing needs. Think about who you want on your team going forward, which may include various kinds of lawyers, financial advisors, trustees, bookkeepers and health care consultants. Think about who you want to help you manage your affairs and have your power of attorney. These decisions are not easy or pleasant, but they are likely to become even more difficult as time passes. It is best to be prepared.
Finally, seek emotional as well as professional support. Don’t underestimate the difficulty of the situation you are in, and don’t feel like you have to figure it out on your own. There is no shame in it. That said, there may be risk management issues in play, so you need to be careful about what you disclose and to whom. I was lucky to have a strong support network, both within and outside my organization. It would have been helpful to speak to someone who had navigated these circumstances before, but I did not know how to find such a person.
Which leads me to my last point …
Enough about me — what about you?
Even if you feel like you are stuck in an impossible situation, as I did, please know that it is possible to find a path forward and that you do not have to walk that path alone.
Julia Huston is retired from the practice of law. She previously served as president of the Boston Bar Association, Women’s Bar Association of Massachusetts and Greater Boston Legal Services. She is currently volunteering with the Massachusetts Statewide Mentorship Program of the Massachusetts Supreme Judicial Court Standing Committee on Lawyer Well-Being and can be contacted there or via LinkedIn at linkedin.com/in/juliahuston.
