Transition

At my first follow up appointment with my neuroroligist after my stroke, I ran into one of the other neurologists in his group. They all knew me because I was a local primary care doctor who had been sending them patients for years, before, at the age of 47, I became one.

He asked if I planned to go next Tuesday to the Schwartz Rounds. This is a monthly conference led by the head of psychiatry to discuss a medical case that had an emotionally challenging element. It is a mixed group of nurses, therapists, and doctors supporting each other and acknowledging their own human emotions. I asked him why.

"They're doing your case. The flier says, 'When it's one of our own, and the outcome is tough.'" I was speechless.

I had nothing else to do that day. I had been out on a "medical leave of absence" for almost two months. I was walking with a cane, and used Uber because I couldn't drive. It would be nice to put on a button up shirt, jacket and tie and go to a lunch time conference after a month of sitting in a wheelchair in sweatpants and slip on shoes. So, I decided to go.

I was early, due to my distrust of Uber, and I prepared my lunch from the buffet single-handed, making multiple trips because my right arm was paralyzed, so I couldn't carry a plate of food and also a drink.

The psychiatrist who organized this conference to care for the physicians who might need emotional support after caring for me arrived to set things up. To complete the circle, he is a patient of mine. I care for him.

"Hugh," he blurted out, "Can I talk to you?" I grabbed my cane and stepped outside the room where other attendees had begun to arrive and efficiently prepare their plates.

"Did you know we're going to be discussing your case?" he asked urgently.

"Yes, that's why I'm here."

"Okay. Okay. That's okay. We've never had the patient here, so that's a surprise, but I like surprises, Surprises are good," he was doing his psychiatrist self-soothing.

"Do you want me to introduce you so that everyone knows you're here?"

"I'm not sure that would improve the discussion," I said.

"You're right. You're right. If you have something to add, you can out yourself."

We both agreed multiple times that this was a good plan, and I returned to my food as the room filled with people who were going to discuss what it was like, emotionally, to see a once vibrant colleague, stricken half paralyzed and slurring his speech, unsure if treatment was an option.

The presentation began like so many others - clinically sterile - a laundry list of descriptors intended to dissect the story from the patient's humanity.

"This 47 year old male with a history of mild hyperlipidemia that was untreated due to statin intolerance... who was on staff at Overlook... Presented at Overlook's Emergency Department with right sided hemiplegia, slurred speech with no aphasia or cognitive defects ..."

I recognized the N.P. doing the presentation. She followed me until I was discharged. I also recognized my Neurologist; he had returned and ordered a second CT when my paralysis worsened. I thought that was probably unnecessary.

But there was another dark haired N.P. seated with them whom I didn't recall.

The first N.P. recounted how I had modified my history as | realized | was placing myself outside the window for tPa. (tPA (tissue plasminogen activator is a medication used to treat ischemic stroke, which is caused by a blood clot blocking blood flow to the brain.) "So you've been unobserved for 8 hours?"

"I think maybe my arm was fine when I hit SNOOZE, but was paralyzed when my alarm rang again." I was transparently bargaining with the truth, for a different truth with a happier ending. Hearing her describe it, I realized that ! had remembered that differently.

The neurologist confessed that the second CT wasn't necessary, and that he had been tempted to give tPa outside the window, but didn't. (Did he interpret my modified story, with the snooze button to be my giving him cover to "roll the dice?")

Then the dark haired N.P. spoke. She saw the situation fully for what it was: a physician cognizant enough to diagnose his own brain injury and knowledgeable enough to try to fudge his own tragedy. She shared that it upset her so much that she removed herself from the situation. She cried as she retold it. "I didn't want him to see me crying."

Then I understood why I didn't remember her taking care of me. She was in the hallway crying. I wondered if being at this conference was a mistake.

Then, the moderator encouraged others in the audience to share any similar experiences.

And they did, and I recognized the stories from the work I had done for 20 years before this event. I recalled my emotions when a good friend whose CT reading for the appendicitis I diagnosed included, " ... thickening of the colon, cannot rule out neoplasia." I remembered how my psychologist mother told me about what she learned in her training: you can't actually cry, that's your limit as a professional. But, if you ever stop feeling like you might, you've lost the empathy you need to care for people.

I wanted to raise my hand and take the microphone and share that. But, would my dangling right arm and unsteady gait reveal that I was the patient being discussed and distract people from my attempt to share my professional strategies for dealing with the uncomfortable challenges they experienced caring for me?

I realized that despite my sudden transition from doctor to patient, what I had to contribute at this conference was not my experiences as a patient, but my experiences as a doctor.

That conference reminded me that I had been a patient for only two months, but I had been a doctor for 20 years, and despite my stroke, that's who I still am.