By Nalini Juthani
On a bright early morning while getting ready for work, suddenly, something went “Swoosh” in my head. I saw double and felt dizzy with eyes open. Horrified, I returned back to my bed. In a few moments I began to play out various scenarios in my mind. Each potential diagnosis that flashed in front of me had an ominous outcome although my mind was clear. I woke up my husband, a physician, who examined me and said “I am calling our neurosurgeon neighbor”. It was a remarkable Friday when the world seemed to be crashing down on me.
I was a 40-year-old, happily married doctor with three loving young children. Our family had just moved into a new home. I was also enjoying a successful academic career. I wanted to live. I was simply afraid to die!
My husband and I raced to the hospital. Dr. S, a neurosurgeon, promptly did a CT scan and MRI. The diagnosis was a small capillary brain hemorrhage, a condition called Medial Longitudinal Fasciculus (M.L.F.) Syndrome. Dr. S ordered a spinal tap even though he was almost certain that the brain hemorrhage was in the pons, a location where surgery was impossible.
I was under observation for the weekend. My resident on call was preparing for the spinal tap. While he had the long spinal tap needle inserted in my spine, I heard a female voice communicating with my resident. My ears perked up to this monologue. “Hey, I am on my way out, off for the weekend. Listen, in bed # 435 is a histrionic lady. Put her on a pace maker and she will be set for the weekend. Bed # 436, …….” and she went on and on giving report on every patient my resident was supposedly in charge of, and she left. My mind was wandering from the pain in my back, the anxiety of the procedure and patient care. My resident must have his mind in two places, I thought. The transition of care was happening. I felt vulnerable!
Then, something remarkable happened again. I fell into a state of trance. I had ceased to be a patient who was facing death. I was thinking like a responsible physician, an educator, whose prime role was to teach young trainees about good patient care.
The procedure went well. My resident looked at me with a smile. I also responded with a smile and said “the transfer of care of the patients in this hospital was very intriguing to me”. His smile disappeared. He quickly figured out what I was talking about. He pulled a chair and sat down. Expressing great regrets he apologized that he had not known I was a physician and the setting in which transfer of care occurred was totally inappropriate. We discussed several issues that our medical education system was facing. This experience brought to light that patient confidentiality should be maintained at all times. Discussion of one patient’s problems in front of another patient was disrespectful of both patients.
My doctor was a junior resident who recognized that his senior resident was wrong. The senior resident just wanted to leave and he could not stop her because of the fear of hierarchy in medical profession.
My state of trance was a healthy coping mechanism. I was preparing to use this experience to educate young doctors. I had hope; my fear of dying had temporarily disappeared. My observation and reflection upon what had happened had a deeper meaning for me which produced a ray of hope.
An amazing experience indeed! I had become more human and grateful that my doctors had kept me alive. I have returned back to my loving family and gratifying profession. The blood clot in my brain receded gradually and symptoms disappeared in three months. This experience brought all of us together, changing roles as a patient, a healing caregiver and an educator.
Nalini Juthani, MD, is a psychiatrist by training and a former Field Staff of the Accreditation Council on Graduate Medical Education (ACGME. She lives in NY after emigrating from India. She is the author of two books including An Uncompromising Activist: Memoir of an Immigrant, Educator, and Grandmother and Inspiration from my Travels: An Immigrant’s Eyes on The World
4 thoughts on “Switching Roles: A Physician, An Educator, A Patient”
Thank you Dr. Juthani for this moving piece and for your sharing your personal experience with us. It captures many meaningful and valuable messages as we all try to cultivate and inspire competent and compassionate medical care. “Good patient care” as you note is humanistic patient care. Think carefully about that patient undergoing a spinal tap, regardless of whether that patient is a physician or not…this is not routine for them and how scary it all can be with such vulnerability that illness and procedures render. This sacred work requires mindful, intentional presence/focus and yes patient confidentiality all around. Pause and reflect on your action or non-action and its potential impact on learners and patients! I hope this feedback was conveyed to the senior resident as we are all lifelong learners. Best wishes for continued good health!
Abba Felix said: To teach is to create a space in which obedience to truth is practiced. Nalini, you created such a space and did so under remarkable circumstances. As is typical of good teaching both parties benefitted from the encounter. Thank you for sharing this story. I have read both of your other books and can recommend them to others. I’m so glad you joined ACGME when you did, you added much to the community of those who take education seriously. David
Thank you ! As always you are an inspiration and a teacher . Good luck and best wishes . Please continue to enlighten us with your writing .
Thank you for addressing an instance which I think happens all too often in today’s medical care: forgetting the patient is actually present and a viable entity. As a lung cancer patient, my surgeon’s resident came in to my hospital room on Day 2 post-op, introduced herself to me and immediately ignored my question about how my surgery went; instead she talked over my back to the RN who had come in to assist her to remove one of the surgical tubes. “Dr. So and So did a really poor job on this tube. He hardly left any suture at all to tie off with,” resident said to RN.
Imagine how I felt being the patient. This callous care permeated my surgery avenue and afterwards. I continue to try to seek remedy for the callous, horrific care I received from this doctor, his staff, and the facility which culminated in PTSD and trauma for me. What would be your suggestion for me going forward to get this issue(s) addressed? I’ve tried contacting the surgeon, his staff, the cancer center and the hospital. Wrote letters to superiors, as well as administration avenues–all to little help. Thank you for any help.