Epidemiology at 51: Life happens….

ILSHTM logot has been a long time since I last posted. Life has been happening…

I am (I hope!) in the final three months of my final (third) year of the MSc in Epidemiology (distance learning). This year I took my last elective, Epidemiology of Communicable Diseases (EPM301), and also signed up for the comprehensive exam (EPM400, the “compulsory additional paper”) and the MSc project (EPM500).

The reason I say “I hope” is that I had a bit of a setback with my MSc project. It is something I have been looking forward to since I began this course—a real project with real data that could potentially truly add to the body of knowledge about X! But… part of its being real-world is having to apply to the actual LSHTM Ethics Committee for permission prior to beginning the work. In a real-world twist, not only did the Ethics Committee give me an “unfavorable” (rejection of my application) but I didn’t end up finding out about the decision until a month and a half had passed, when I was deep in the throes of work deadlines and unable to take time off to revise and resubmit. (The email notifying me of the decision had gone to my spam folder where I deleted it without opening…Mistake!) I did not end up resubmitting until two months after the Committee’s decision. Now I am waiting again, possibly until the middle of July. If the decision is favorable, I will still need time to actually obtain the data before I can even start analysis. All this makes me rather worried about being able to meet the September 30 deadline.

But, this is the real world, and in the real world, these things happen. My proposed research question is whether socio-economic deprivation is associated with stillbirth over a 17-year period, within a geographical area of particular interest to me. The Committee’s decision was due to their concern that I had insufficiently ensured the confidentiality of study participants who are members of two vulnerable groups—pregnant women and fetuses.

It was thus rather sheepishly that I remembered, while studying for the comprehensive exam, that “facilitating ethically acceptable attempts to find new, better treatments from which everyone may benefit” is the second aim of an ethics committee. The first aim of an ethics committee is “to protect subjects from exposure to unethical risks or invasion of privacy.” I think I have that indelibly marked on my brain now! Whether I get to complete the project this year or must postpone, I don’t think I will ever be likely to inadvertently compromise subjects’ privacy again. Life happens…

The big thing is that 11 days after I turned 51 (exams always remind me of how old I am), I sat the ‘Compulsory Additional Paper’—possibly the last exam of my life. As always with LSHTM exams, I find that being forced to sit an exam truly does consolidate my knowledge. I don’t like ‘em (who does?!) but like a lot of things in life, I appreciate having had to go through ‘em. (Labor and delivery come to mind…)

My preparation for the exam was a combination of intellectual effort—repeatedly rereading the study booklets I’d created for the core courses, having my husband quiz me on them, writing all the old 400 exams, skyping with fellow students to talk over key issues, joining Blackboard Collaborate sessions, and posting on the Moodle to get guidance from tutors—plus mental and physical preparation. I live about two hours away from my testing center by public transportation, and decided to spend the night before the exam at a hotel in New York City so as not to have to worry about the invariably-delayed commuter rail. It was almost relaxing to wake up the morning of the exam and know I was just an hour away by subway. In the end, I think the exam went fine—straightforward, with no surprises. One of the hardest parts was just writing continuously for 3 hours and 15 minutes. I hope my handwriting held out!

Some of you may have read my last post in which I wrote about the sudden death of my sister, Alyson, at 49. July 9 would have been her 50th birthday, and July 28 will be the first anniversary of her death. They bracket July 13, which would have been my first son Wilder Daniel’s 16th birthday. I always say that when Wilder was stillborn at term (38½ weeks), I did not just lose an infant, but the man he would have become.

I began my studies at LSHTM because of the death of my first son. I sought a way to mix the professional—my background in poverty alleviation—with the personal—my loss; I found the answer in epidemiology. Truly the hardest part of the 400 exam was that as I sat in the reception room, waiting for the hands on the big wall clock to reach 10:00 am, thoughts of Wilder kept relentlessly pushing into my head. “I don’t want to sit this exam!” said one part of my brain. “You made the choice to sit it—you are here in honor of your son and it is your privilege to sit this exam!” said another part. I had to force myself to think of mundane stuff like the pile of dirty laundry at home in order to regain composure and focus on the task at hand.

Despite ever-present reminders of loss, epidemiology helps me to feel hopeful. Death happens, but so does life.

Susannah is studying the MSc Epidemiology at the London School of Hygiene & Tropical Medicine through the University of London International Programmes. She lives in the USA.

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