“I think I’m having a stroke.”
The words struggled to leave my mouth as I spoke to the 9-1-1 operator. Emotionally in disbelief, the words seemed so unusual to say in the first person. Ten minutes earlier, overwhelming nausea and drenching sweats woke me abruptly from sleep. Thinking it was something I ate, I immediately regretted the preceding meal that must have been responsible. My attempt to get to the bathroom was the first sign this was something more. The room relentlessly spun around me like the Graviton ride at a carnival. A magnetic-like force to my left pulled me to the wall. Vertigo.
In the bathroom I lay, still in a drenching sweat though now the moisture had succumbed to the coolness of the room around me. “What was happening?” The confusion circled in my head. The vomiting followed shortly thereafter. Between heaves, another sign something was amiss. “I can’t swallow.” I said these words out loud on the off chance the empty space of the room might respond. But even the escape of those words was abnormal. Dysphagia and dysarthria. Two terms we use frequently, not as diagnoses themselves, but pathologic signs of something underlying as the cause.
Once the retching seemed to have exhausted itself, the final sign became apparent. “Had I slept in a way to make my left arm fall asleep?” I wondered. If so, why would both my arm and leg feel this way? Confusion was replaced by the realization: I was having a stroke.
Making my way back to bed, the magnetic wall still exerting its force on me, I note the time – 2:23 a.m. If this was indeed a stroke, time would be important. Over the next two minutes, my mind weighed what to do next. “Do I call 9-1-1?” In retrospect, the question seems absurd, but, at the time, my disbelief made it seem like a reasonable ask. Thirty-seven. Among medical trainees, this number seemed so old. But in this instance, it was seen in the opposite sense: Aren’t I too young for this?
“Would you like us to take you to the hospital?” Emergency personnel asked this question after a quick evaluation. I assumed they ask this to most people they evaluate, but the question seemed so strange to me at the time. “Of course I need to go,” I thought. I wasn’t dying, but if stroke was on the cursory differential forming in my head, I knew I needed a more objective evaluation and immediate treatment. “How much will it cost?” I remember asking. The burden of debt did not escape me even in the midst of a medical urgency. It was a rhetorical question. I knew they wouldn’t have the answer and, if my destination was the emergency department and subsequent hospital admission, the cost of the short ambulance ride would be merely an afterthought.
Relief fell over me once in the ambulance. Though I had an idea of what was happening to my body, there was still uncertainty – uncertainty mainly fed by my disbelief of the entire experience. The company of fellow health care personnel was comfort in a time of unease. I asked to be taken to the best stroke center in the city – a place that also happened to be my own training hospital. Rolling through the halls of the emergency department, I spotted one of my residents on rotation but I said nothing knowing she wouldn’t recognize me on a stretcher at 3 a.m., disheveled, with a green emesis bag awaiting its next calling.
Nurses around me went through the routine of lines, monitors, and initial questioning. Their calmness brought reassurance to me. The doctor was soon at bedside to join them – her face I recognized from my own rotation in the department two years prior. I repeated the story and my own suspicions of what was going on. The scans soon followed.
Vertebral artery dissection. As the doctor explained the findings, initial confusion was replaced by a sense of clarity. In the preceding weeks, neck pain, paresthesias, and headaches pervaded my daily activities. Recurrent sleepless nights ensued as I tried to find comfort from the ache. I had assumed a pinched nerve and muscle strain were to blame. The symptoms seemed to be getting better (or I had merely developed a higher tolerance of them). Now, lying in the emergency department, the pieces fit. The small flap of an arterial wall deciding to divorce from its native position explained all of it.
Stroke. Unease. Disability. Debt. Gratitude. Perspective. The flood of thoughts and emotions over the next 48 hours was incessant. I had cared for many patients with acute or prior stroke. Never did I think I would be on their side of the experience. The affected part of my brain was small, and I was assured a full recovery. Still, the persistence of vertigo and dysarthria in the initial hours left me with uncertainty on the off chance a full recovery would not occur. With that unease came fears of disability. This career I’ve launched my energy, time, and heart into. Could it all be gone in an instant? Admitted to the intensive care unit for close monitoring and management brought financial implications and anxiety of debt – thoughts that did not escape me even in a time of such acuity. Gratitude grew with the outpouring of support from family, friends, and colleagues after reluctantly disclosing the events to my network. And perspective from the experience of loneliness and vulnerability faced in this unexpected turn of events. Loneliness lying in a hospital bed in the early morning hours before family and friends became aware of what had happened. Vulnerability in accepting my dependence on others and expressing my emotions of fear and anxiety – emotions held on my sleeve for so long but now forced to take shape in the open.
My experience is not unique. Our patients face similar circumstances every day. Unfortunately, patients’ emotional vulnerability too often goes underappreciated in the dizzying time of a hospitalization. I wonder if this is our own self-defense as physicians. By not acknowledging the patient’s vulnerabilities maybe this protects us from facing our own. Will this experience change the way I practice medicine? Probably not. Will it help me better appreciate the fear and uncertainty patients often face? I sure hope so. And maybe, just maybe, help them feel more at ease in whatever it is they are facing internally.
Joanne Loethen is an internal medicine-pediatrics physician.
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