Life Lessons

A recent post that has been edited and recently accepted for publication in The Human Touch, a literary publication by the University of Colorado School of Medicine. 

These are the parts of family medicine that I adore: the pink cheeks of a 3 year old I want to squeeze so badly I have to nearly restrain myself; a baby that isn’t mine I so desire to cradle; an old man with broken bones who still cries for the love he lost years ago. His advice to age gracefully is to pray for luck and patience. He says living to 96 years old has very little to do with humor, then chuckles.

There are the pauses in a story while a patient decides what to tell me...knowing I can tell even more from their silence sometimes. In this space is a soft whoosh of blood in an artery, the stammering persistence of an imperfect heart, a lymph node swollen like a speed bump to recovery. Here, there is pain. And patience. And salvation.

As PA students we are taught to think of common ailments and keep our differentials broad. A numb hand, to me, looks a lot like a pinched nerve, neuropathy, inflammation from micro trauma, carpal tunnel, or perhaps even something psychosomatic. Most of the differentials aren’t life threatening.

So when the woman arrived with the numb hand and foot, she didn’t “impress” me. Non-impressive ailments, I’ve been told, are good—it means they are probably benign. She was 47 years old, appeared in good health, but had been vomiting for days, the result of food poisoning, she thought. Then today she woke up with the numbness—“Like I fell asleep on my hand and foot and they are now waking up.” Almost as an afterthought, she mentioned some intermittent stabbing chest pain. As she described the chest pain to me she assumed Levine’s sign. My pulse quickened. “It’s the heart,” I thought, “her electrolytes are out of whack and she’s had an MI.”

Now I was impressed, especially when she began to describe a disconnect between her brain and her right hand. Just that morning she had difficulty putting her coat on, putting the key in the ignition, typing on her computer. Her right hand wouldn’t “behave,” she said, nervously, “like it had a mind of its own.”

Could it be a pinched nerve with some level of cognitive decline? An MI that was affecting perfusion to the limbs? I ordered an EKG, but it was clean. My preceptor, who now also looked worried, quizzed me: “What in the body could do that? Cause only one side—her right side—to be affected?” And it dawned on me, like so many subtleties of medicine do, that there is only one thing that could affect the body in that way: the brain.

I whispered her most likely diagnosis: A vaguely symptomatic cerebral infarction. In other words, a stroke. 

I was immediately thrilled with the finding, bearing witness to the symptoms manifesting before my eyes. And, moments later, I felt the heartbreak as my patient’s face crumbled, as I beheld fear in the eyes of another human being (probably mirroring the fear in my own) because we both finally realized that something was terribly wrong.

She was hospitalized that day with an acute cerebral infarction, at a young age, with no risk factors. It could happen to any of us. But when will it happen? And where? And, maybe even more importantly, why?

The day rambled on, as they all do. I diagnosed URI’s, asthma, performed physical exams through the afternoon, but I continued to think about that woman. In between the coughs and colds, the lumps and bumps, linger these extraordinary and humbling moments that are propelling me into the most challenging endeavor I have ever undertaken. Aside from the textbooks, endless studying, faculty guidance and exams, lie the most phenomenal teachers of all: the patients.

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