As a healthy 30-year-old intern with an infant, I never expected to land in the ICU on a random Thursday at 10 a.m. As I prepared to start my first precepted thoracentesis at the VA, I suddenly began to experience double vision. Assuming it to be a weird manifestation of anxiety, I politely stepped out to try to gather myself. I ran some cold water and splashed it on my face, at which point I realized the entire left side was numb; I could not feel the water or the temperature of the water. Realizing this was something serious, I covered one eye and stumbled down the hallway to the ED. Normally I visit patients I am caring for in the ED and begin by inquiring about their room number. This time I started with: “I think I actually need some help.” An urgent CT scan revealed a small hemorrhage to my dorsal brainstem – an area of precious real estate, to say the least. I was immediately transferred to the neuro ICU.
It was a vulnerable experience to be cared for in the ICU and on the floor by attending physicians – the ones I’ve been working all year to impress – during the scariest moments of my life. I am usually buttoned up and professional in front of these esteemed doctors. Now I am in a hospital gown with multiple lines being placed, trying to calm myself with my Spotify playlist and bawling my eyes out, asking them if I am going to die. Will I survive to see my son grow up? Will I ever be able to see you normally again? If I survive, how many of these deficits will be permanent? I am sure it was hard for them to look me in the eye and have to say “I don’t know” to all my questions.
My future neurology attending, now my ICU neurologist, sitting with me and telling me that they may have to shave my head to place an extra ventricular drain was not how I expected to meet her for the first time. It was peculiar to simultaneously discuss my career aspirations in pulmonary and critical care and my personal critical illness with the team at the bedside, as everyone was aware of my interest in the field. Meeting my colleagues during these moments of vulnerability seemed uncomfortable initially, but being cared for by familiar people became a source of comfort in the scary moments. Just as correct diagnosis and treatment plan are my priorities, creating this safe and comfortable place is now a high priority for all my patient care.
I have a habit of sharing with patients all aspects of the care plan for them in the hospital and making sure they don’t have any unanswered questions before I leave the room. Still, until now, I did not understand the importance of trying to answer questions for patients that they may be too petrified to ask. Even as a medical professional, I had no idea what was happening with me. Having my physicians pre-emptively explain things to me truly was a gift. While in shock, reasonable questions are difficult to formulate, as if my team anticipated this, they regularly took the time to tell me everything they knew or thought about my symptoms and prognosis.
My neurologist, unprompted, stated something along the lines of, “Because you are young and previously healthy, I think you have a cavernoma. Even if it doesn’t show up on imaging, that is what I think it is because of X, Y, and Z. I think your risk of rebleeding is very low.”
She answered all my possible questions (that I didn’t even know I had) with just that sentence. That insight is what is special about being a physician, and it is important to share that insight with patients even if they don’t know how to ask the question. Moving forward, I always want to share my thoughts about their condition with patients and guide the conversation from there. It is easy to fall into the habit of assuming patients don’t want to know those things if they don’t ask. Still, I am confident that sharing my thoughts and insights with patients is always better to help them feel more knowledgeable and comfortable about what is happening. I think it also builds a layer of trust to share your insight with patients- I certainly felt much safer being cared for by physicians that shared their insight with me instead of just spelling out the plan for me- it almost felt like they were sharing secrets from behind the curtain just for me, which made me trust (and like) them more!
Of course, an inborn empathy for patients comes from being a patient yourself. I walk away from this experience with genuine new skills to have more purposeful, meaningful interactions with all my patients and their families.
I am grateful to have been able to reprioritize everything in my life at such a young age. Motivated by my innate desire to overachieve, I attempted to return to work a month after discharge, but my body insisted that I continue to rest. I have been forcefully humbled into accepting that I am not a superhuman. I have had to give the reigns of life and just let things happen as they may, which is a refreshingly welcome change of pace for someone who has been shackled by her own drive and sense of control.
Although I never needed and won’t need treatment, and my bleed resolved on its own, I still have frustrating double vision that constantly reminds me of what I went through. But it also makes me grateful that with the help of a Fresnel prism, I can still come to work and see my patients face-to-face. I value the fact that this near-death experience hasn’t robbed me of the ability to see, hear, and talk to my patients. I am a different physician with a new skill set that I will continue to hone. And most of all, I am grateful that I can continue to go home to my family at the end of the day and still see my little boy grow up.
Olivia Tomasco is an internal medicine resident.
