Sympathy Becomes Empathy
Stroke of luck places physician on other side of the stethescope
Survivor Courtney Magdalene Moore with husband Ryan, son Alexander, and the family's newest member, Anderson
Speechless. Motionless. Helpless
Three rare qualities in physicians. But on one particular night these characteristics described me and rendered me terrified. My son, Alexander, was tucked snuggly in his bed, and my husband, Ryan, slept soundly next to me. I sensed numbness and heaviness in my right arm and hand. Perhaps it was the way I was positioned? ”Surely it will dissipate,” I thought. But no, as I lay flat on my back, my symptoms progressed. After 30 minutes of telling myself the symptoms were probably nothing, I woke my husband with my unaffected arm and tried to speak, but only jumbled sounds escaped.
I could see the urgency in his eyes. Tears welled up in mine. We both knew. Time is brain. 11:37 p.m. now held a very specific significance as “time of symptom onset.”
My dominant arm and leg grew weaker, and my speech worsened. I wasn’t able to grip my husband’s hand when he reached to hold mine and told me he loved me. My response was a mumbled mess. Without a word his eyes conveyed so much. It was the look I see when I deliver bad news to patients.
As physicians we have the honor and privilege of caring for others while doing the work we love. But on this night, my medical knowledge worked in conflicting ways to aid me one moment and terrify me the next.
As my symptoms accumulated, my personal illness script developed. Characteristics of a stroke overwhelmed me with thoughts of what was occurring in my blood vessels and manifesting neurologically. Psychologically, I struggled with facing the consequences a stroke could have and how little influence I had over them.
As my brain struggled, my heart broke. Each moment of the 20-minute commute to the hospital, I worried I was losing a little bit more of myself. Time is brain.
We arrived at the hospital where I serve as medical resident. I couldn’t walk in as I had each day before, adorned with my white coat and stethoscope. Instead I was wheeled into the resuscitation bay as a medical code and placed into a blue hospital gown while others in white coats confidently worked as my physicians.
Drip. Drip. Drip. As the “clot-buster” tPA flowed through my IV, I wondered if I would be among the minority of patients treated with tPA who experience substantial complications. I knew the statistics, and I was on the wrong side of the them.
But in the intensive care unit, my deficits improved. Tears of joy ran down my face, triggered by inexpressible gratitude. I was able to wipe my tears away, clumsily, with my right hand. This was the beginning of my recovery and transformation into an empathetic physician.
I’ve lived the struggle of revitalizing my neuromuscular pathways devastated by stroke. This new perspective was a game changer in my career. As an internist, I frequently treat heart attacks and strokes using medical guidelines. But a critical part of my approach includes tailoring medical care based on patient-driven goals.
Tasks that were once a part of my daily practice have a new context. I can recall feeling like a pin cushion while experiencing multiple blood draws a day. Being unceremoniously wheeled to an investigational study with the curious eyes of others looking at my disheveled, uneven appearance. Although I understood the purpose of each test and study, I know that’s not the case for some patients and that it could exacerbate feelings of isolation, marginalization and vulnerability.
I make a concerted effort to discuss the purpose of each test and their results, and I review imaging findings. I recognize that it’s important to ask patients if they would like to hear this information, because sometimes they’d rather discuss the details later.
I talk about the tough stuff. I sometimes wonder if my recovery might have been different if someone discussed the difficult road stroke survivors and their loved ones often face during recovery. I recall feeling frustration, disappointment and defeat when my recovery seemed to take longer than I thought it should.
When treating patients, I initiate conversations about unplanned adjustments in daily life following a stroke. We discuss the warning signs of depression and PTSD, which can result as the brain recovers, and how to manage these symptoms. Grief, fear and worry are topics I broach with a patient’s family and friends as they have suffered a loss, too. I provide guidance about the uncertainty and lack of closure patients might feel while undergoing a full workup investigating the cause of their stroke. Sometimes we discover a contributing condition (often heart-related), but often no clear cause is evident. This reality can be unsettling for patients and practitioners.
Would I have practiced medicine this way before I had a stroke? I’d like to think I would, and I’m confident many physicians do. Demonstrating this holistic approach has now become significantly more than simply doing my job. It’s my mission.
Putting my family first meant putting myself first. In the years since my experience on the other side of the stethoscope, I have made several changes to help ensure work-life balance and a healthier lifestyle. The 80-hour workweeks of residency are in my rearview mirror. I made a calculated decision to forego further training. I was very fortunate to become a faculty member in an academic internal medicine program whose nonprofit, faith-based approach brings a great deal of meaning to my work.
I am learning how to put my family, my health and my purpose first. Ryan, Alexander and I recently welcomed baby Anderson into our family. And Alexander wants to be a doctor when he grows up.
Our mission continues.