Vulnerability and Where to Find It: A Doctor’s Tale

Medicine

Some patients we never forget.

She was a middle-aged white woman with brown hair and arms only a frequent gym-goer could possess. She walked through the clinic doors accompanied by her newfound love—newlyweds. My attending physician introduced himself and then it was my turn as the third-year medical student on the rotation.

She smiled in response, followed by a courteous, “Nice to meet you.” 

I had perched myself at the corner of the room against the sink at the base of what appeared to be an isosceles triangle. I was one of the bases, the neurology attending the other, and the patient and her husband represented the tip.

Here, I observed from my perch.

In her next few sentences she described how one morning, upon awakening, she noticed she was slurring her words of which she attributed to the notion of having suffered a mild stroke. In her mind, how could it be anything else? She was in her early 50s and unlike many of her friends she maintained a strict diet, a daily gym routine and a mentality to match. 

After multiple questions, some mild laughing with intermittent smiling even, the neurologist paused. He clasped his hands together as he let out a slow breath of air. 

“I firmly believe you have Amyotrophic Lateral Sclerosis (ALS), and the slurred speech is the beginning of this process. This is not a stroke, I’m sorry.” 

I do not know which came first—the hopeless shriek or the cascade of tears. She knew she had just been given a death sentence and despite her husband’s best efforts there was no consoling her. A tear fell from my left eye as I quickly tilted my head back looking up towards the ceiling hoping gravity would play an effect and somehow the tears would roll back into my head rather than onto my white coat. From the actions and demeanor of my attending physician it was evident he had given this news before—one too many times. Two thoughts filled my mind as sadness filled the room. 

First, I thought about the disease process itself, which I had read about the night prior characterized by “a progressive loss of motor neurons in the brain and spinal cord.” ALS is a progressive, disabling, and ultimately fatal disease of unknown cause starting with a gradual muscle weakness and wasting in the upper and lower extremities, muscle fasciculations and inevitably difficulty swallowing, phonating and breathing.1 This degenerative process continues until respiratory failure will most likely claim her life as it has so many before her.1

As my attending and I stood there watching her cry, the clock stood still. 

Why her? As time stood still, I kept asking myself. Why not her husband? Why not my attending? How would she spend her remaining months before the disease would cripple her into a wheelchair and the permanent requirement of mechanical ventilation would ensue? 

As physicians, too often, we are sculpted to believe we are invincible. We care for others at their most vulnerable time and it is always them—that is the vernacular. The patient’s tears made it clear she was not ready for such a diagnosis; she was not ready to die. I do not know if in the moment she was frightened by the certainty of death or death was far superior to the alternative life that awaited her. 

I, too, am scared of death. I am scared of being forgotten. After an obituary in a newspaper, a funeral, stories shared, beautiful words produced and dark clothing worn with covered eyes, life continues for everyone except the deceased. I wonder if any of these thoughts coursed through her mind at a rate similar to her tears.

Once her tear ducts seemingly dried up, she asked how she could obtain a second opinion. The attending told her he recommended she go to the Cleveland Clinic if she desired. She gathered her things with one tissue in hand and bloodshot eyes. As she stood up, my attending, gave her a hug she most deserved. A hug I will never forget. Once we were alone, he asked me if I was ok? “Yes, I’m ok. Thank you for asking,” I promptly replied. I thanked him for allowing me to join him in clinic then quickly left. 

I went to my car and I cried. 

I had lied. 

I was not ok. 

References:

  1. Zeller JL, Lynm C, Glass RM. Amyotrophic Lateral Sclerosis. JAMA. 2007;298(2):248. doi:10.1001/jama.298.2.248

I’m a Black Student-Athlete Turned Physician: What Colin Kaepernick and Nike Really Mean

Race, Uncategorized

Please see below for my Op Ed published on 9/14/18 in THE OREGONIAN.

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I sat in a football stadium for the Ohio State Buckeyes vs the Nebraska Cornhuskers game on Nov. 5, 2016, three days before the presidential election. About 108,000 screaming fans surrounded me, but I only remember three.

To my right were two white gentlemen wearing “Make America Great Again” baseball caps. This was the first sporting event I attended since Colin Kaepernick, former San Francisco 49ers player began kneeling during the anthem in protest against police brutality against African-Americans.

I stood up. I removed my hat. These actions were done not because I didn’t vehemently stand against police brutality, but because I felt standing for the anthem was the ‘right thing to do’ for me.

Yet all the while, I could imagine all eyes on me.

As I stood, there came laughter from behind, a few seats to my left. An older white gentleman, likely in his 50s, yelled over at one of his buddies, “Hey, hey, look at me. I’m going to kneel,” mocking me and all of what Kaepernick represented. I suddenly felt alone and exposed, maybe even a little afraid. Being there, supporting a team and university that had given me so much, no longer felt like home. The sporting event took a new form as my attention turned from the football game to the underlying game.

The same man who mocked Colin Kaepernick’s kneeling cheered for each move the young black male athletes made. The same men, celebrating their support of then-presidential candidate Donald Trump, clapped enthusiastically as the young black male athletes scored point after point for their beloved team.

Supporting and voting for President-elect Donald Trump is not supposed to be incompatible with supporting black athletes, but with recent events, one naturally must question the growing disconnection. The truth is, many of us black males cannot feel calm as we have to constantly look outside of ourselves in order to visualize how our present and future actions might be perceived by others. It’s part of growing up as a black male in America.

Growing up as a black male athlete in America adds more complexity — and becoming a black male physician even more.

As a black male I am unnerved by the stories I read about current or former athletes sustaining injuries leading to a fall from grace. That leads to a harsh realization that they are no longer “needed,” with little to account for all of their hours of dedication. Basketball courts, tracks, football fields and athletic arenas are bursting with black men excelling every day, rain or shine.

The time has come for us to redefine our own values and to focus our potential in different ways. With the right direction and guidance, that same excellence and discipline can easily transition into the libraries, research laboratories and clinical rooms where we are currently sparse.

The beauty lies not in the fact that we have to choose one over the other, but in what I believe and personally know to be true: Black men can excel in both realms. It is time that we stop letting others limit us as we move forward.

That’s what Nike and Colin Kaepernick mean.