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.

Courtney with her son holding an award

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.

AD. American Heart Association logo. Know your blood pressure numbers. And what they mean. Gain Control.  Learn more.


 

Ad: American Heart Association Support Network. Facing recovery after a stroke or heart disease diagnosis can be overwhelming. You are not alone. Our community is here for you. Join us today. heart.org/SupportNetwork.


 

Stroke Connection. Get the app for free.


 

Edit ModuleShow Tags

Stroke Rehabilitation

Making the Best Decisions at Discharge After Stroke

The type of rehabilitation and support systems a survivor receives at discharge can strongly influence health outcomes and recovery. In this, the first part of a two-part series on stroke rehab, we offer guidance for the decision-making process required when it’s time to leave the hospital.

What to Expect from Outpatient Rehab

After stroke, about two-thirds of survivors receive some type of rehabilitation. Outpatient therapy may consist of Several types of therapy. Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required.

What to Expect in Stroke Rehab

Following a stroke, about two-thirds of survivors receive some type rehabilitation. In this second of our two-part series, we want to alleviate some of the mystery, fear and anxiety around the inpatient rehab part of the stroke recovery journey.
Edit ModuleShow Tags Edit ModuleShow Tags

AHA-ASA Resources

The Support Network

When faced with challenges recovering from heart disease or stroke, it’s important to have emotional support. That is why we created a network to connect patients and loved ones with others during their journey.

Caregiver Guide to Stroke

The Caregiver Guide to Stroke is meant to help caregivers better navigate the recovery process and the financial and social implications of a stroke.

Stroke Support Group Finder

To find a group near you, simply enter your ZIP code and a mile radius. If your initial search does not pull up any groups, try

Tips for Daily Living Library

This volunteer-powered library gathers tips and ideas from stroke survivors, caregivers and healthcare professionals all over the country who’ve created or discovered adaptive and often innovative ways to get things done!

Stroke Family Warmline

The Warmline connects stroke survivors and their families with an ASA team member who can provide support, helpful information or just a listening ear.

Let's Talk About Stroke Patient Information Sheets

Let's Talk About Stroke is a series of downloadable patient information sheets, created by the American Stroke Association, that presents information in a question-and-answer format that's brief, easy to follow and easy to read.

Request Free Stroke Information Packets

Fill out this online form to request free information about a variety of post-stroke topics.
Edit ModuleShow Tags

Stroke & Parts of the Brain

When Stroke Affects the Occipital Lobe

Our occipital lobe, the smallest of the four lobes of the cerebral cortex, controls how we visually interpret our world.

When Stroke Affects the Cerebellum

The cerebellum contains 80 percent of our neurons. Its job seems to be to make things better. We talked with neuroscientist Jeremy Schmahmann about how stroke affects the “little brain.”

When Stroke Affects the Parietal Lobe

The parietal lobe helps us make sense of sensory information, like where our bodies and body parts are in space, our sense of touch, and the part of our vision that deals with the location of objects.

When Stroke Affects the Frontal Lobe

Of the four lobes that make up the cerebral cortex, the frontal lobe is the largest. It plays a huge role in many of the functions that make us human — memory, language, movement, judgment, abstract thinking.

When Stroke Affects the Temporal Lobe

The temporal lobe has several functions, mainly involved with memory, perception and language.

When Stroke Affects the Brain Stem

The brain stem serves as a bridge in the nervous system. It sits at the top of the spinal column in the center of the brain. When a stroke happens there, it can cause a few different deficits and, in the most severe cases, can lead to locked-in syndrome.

When Stroke Affects the Thalamus

The thalamus can be thought of as a "relay station," receiving signals from the brain’s outer regions (cerebral cortex), interpreting them, then sending them to other areas of the brain to complete their job.
Edit ModuleShow Tags

Departments

Stroke Notes

Stroke-related news you can use about new scientific findings, public policy, programs and resources.

Readers Room

Articles, poems and art submitted by stroke survivors and their loved ones.

Life Is Why

Everyone has a reason to live a longer, healthier life. These stroke survivors, caregivers and others share their 'whys'. We'd love for you to share yours, too!

Everyday Survival

Practical tips and advice for day-to day living after stroke.

Life At The Curb

A unique perspective on survival by comedian and stroke survivor John Kawie.

Simple Cooking

Cooking at home can be a daunting task, but a rewarding one for your diet and lifestyle (and your wallet). Making small changes in your diet is important to your heart health. Here are simple, healthy and affordable recipes and cooking tips.

Helping Others Understand

Stroke affects people differently and many of the effects of stroke can be complicated. Helping friends and family understand how a stroke is affecting a survivor can help everyone involved.

Support Showcase

Our new department highlighting the good work being done by stroke support groups from around the nation. If you are part of a successful support group we should consider featuring, let us know!