2023 RICHARD SPEAR , MD , MEMORIAL ESSAY CONTEST
2023 RICHARD SPEAR , MD , MEMORIAL ESSAY CONTEST
In-Training Member Category Winner
CHANCE MEETINGS by ERIN MCCOY , MD
“
Given what I ’ ve just told you , do you give consent for us to proceed with the procedure ?”
“ Yes .”
She signs shakily . I sign , the witness signs and then the cascade is triggered . The IV poles were already unplugged , the lines untangled , the brakes of the bed unlocked , with a nurse positioned at the head , ready to steer . With the last flourish of the pen , the patient is whisked away . One second the room is full of frenetic motion , the next second , empty .
She holds the pen to her chest , which is beginning to heave up and down as the tears threaten to spill out . They are the soundless kind of tears that come in the presence of a stranger , when emotion is keenly felt but not able to be fully expressed . She is worried she just signed her mother ’ s life away . We stand there in the sudden silence , her in her sweatpants , me in my scrubs .
“ That was a lot ,” I say finally . I am Doctor Obvious . “ She ’ s in good hands . We have a great team .”
She nods , looking at the wall instead of me . Then she holds out her arms , and we embrace for a moment . She has known me for about six minutes , but I feel as if I ’ m holding her together .
I leave her in the hands of a chaplain as other family members arrive with their questions and concerns , and they are conducted to a waiting room , unable to do anything but sit and worry .
The evaluation of a suspected stroke is a well-choreographed but time-sensitive and stressful dance . By my eighth month in adult neurology , I could reliably perform all the steps , though sometimes they lumber instead of gracefully flow . Everything has a time limit : vitals-taking , examining , CT-scanning . There ’ s even a stopwatch ticking out how fast I scurry from my call room to the ER . Everyone has a crucial role . Mine terrified me , at first ; my word was law . If I said there was a “ cortical sign ”– aphasia , neglect , visual field loss , among others – then important people began to assemble for intervention , crawling out of their beds at midnight , if needed . If I said the patient qualified for tPA , the clot-buster that can stop a stroke in its tracks , then the medication was mixed and the IV bag spiked and ready to go . If I said “ this isn ’ t a stroke ,” and I was wrong , a patient could be left with life-changing deficits after the time limit had run out for us to intervene . As a child neurology resident , my apprehension was often doubled . Plucked from the world of newborn visits and asthmatic adolescents after my two years of general pediatrics training , I was thrust into the merciless realm of adults for an entire year .
This dance was sometimes the worst part of my day . It was 30 minutes to an hour of madness , and sometimes for naught . Not infrequently , I see a stroke but I can ’ t do anything .
“ Diagnose and Adios ,” that ’ s what I was once told was neurology ’ s motto . Medical students are still told this , but it couldn ’ t be more incorrect . We have treatments and technology that can take a diagnosis that was once a death sentence and eliminate it , or at least make it treatable . A mechanical thrombectomy , the procedure my patient was just whisked away to undergo , can find a clot and remove it , restoring blood flow to the brain . It could , if she is lucky , reverse the paralysis of the entire right side of her body , and allow her to speak , when before she could only stare at me with bulging eyes , mouth opening mutely , like a fish out of water . Everyone on the stroke team is hoping that the patient will walk out of the hospital without deficits , but we will take any improvement . Being able to speak some words , to have some movement of the arm or leg , is better than nothing .
The procedure goes well . The clot is removed , and blood flow restored . The post-procedure imaging looks promising ; there is a small stroke , much smaller than expected from her original presentation . I look forward to the next day , when I can know for sure what my haste and hustle to get her through the complex stroke evaluation
20 LOUISVILLE MEDICINE