“Helmet, helmet!” squealed my daughter, excitedly. I followed behind as she ran to the back door, ready to start the day. The bike ride to her daycare center had become our shared morning ritual, a ritual that I had started long before she entered the world 16 months ago. The bike ride to the research laboratory or hospital had become one of the most cherished parts of my days. The ride gave me time to reflect on the day ahead and to be present. Now it is something that my daughter has come to love as much as I do.
I watched my daughter run inside and then hopped back on my bicycle, heading to the hospital on my first day as a third-year medical student. To say I was nervous was an understatement. I timidly found the neurology resident in the crowded work room. Together with another medical student, resident, and attending physician, we made up the team that treated patients who had been admitted with strokes. The senior resident told me I would be caring for JoAnne, a 92-year-old woman with a left posterior circulation stroke, resulting in almost complete loss of movement, sensation, and pain in the right side of her body.
As a medical student, I was expected to perform a full neurologic examination on this patient in the presence of the entire stroke team. Because I had just been thrust into the medical school clinical period after 4 years of working on my PhD thesis in a basic science laboratory, my confidence in my clinical skills was meager. I internally recited the neurologic examination as I trotted to JoAnne’s room followed by the rest of the team and the patient’s nurse. Am I sweating? What’s the first part of the neuro exam again? I walked in to find a small, frail-appearing woman lying on the bed. She looked somber with glassy blue eyes staring off into the distance. I introduced myself as the third-year medical student who would be taking care of her. She turned to me and gave me the smallest nod. Was that a smile? I started the examination with what I knew best, the cranial nerves. I watched her eyes move slowly from side to side and then up and down. Did I see neglect of the right side? Now to the deep tendon reflexes. As I swung the reflex hammer and met her biceps tendon, she winced in pain. Should I keep going or should I stop? I needed the information… right? I stopped with the reflex hammer in mid-air and looked to my attending physician for an answer as I cut the reflex examination short.
JoAnne had trouble forming words even though she could comprehend my words—nonfluent aphasia. She could barely say her name and fumbled and stuttered when attempting to answer my questions. It was difficult to watch her struggle for words. She became frustrated and then gave up as questions breached the simple “yes” and “no” boundary. I had recently learned that speech and music are on opposite sides of the brain, so when I asked her to sing my daughter’s favorite lullaby “Twinkle, Twinkle, Little Star,” JoAnne’s eyes lit up and we sang together, slightly off-key. It felt as though that moment lasted forever and, even though I had 5 sets of eyes on me, the weight of them faded away and all that mattered was this brief moment during which we both forgot about her circumstance.
Later in the day, as I went to check in on JoAnne, I walked in to see her daughter huddled over her. Before making my presence known, I just observed. I watched JoAnne’s daughter gently cradling her mother’s head in her hands. They were nose to nose, their faces covered in tears. “My mom has made her decision, a brave decision. She would like to start comfort care.” That meant that all interventions would be stopped and only treatments to make the patient comfortable would be used, such as pain medications. As we discussed what this would mean for JoAnne, her daughter’s eyes lit up and she said, “You’re telling me I can bring my mom’s favorite food, lutefisk?” Then I saw a real smile spread across JoAnne’s face. Her daughter told me of JoAnne’s former active lifestyle, that she would walk up and down the stairs in her apartment and walked 2 miles every day, even in the dead of winter. This is an impressive feat in Minnesota, and this resonated with me. I lead an active lifestyle. What happens when that is taken away? What would my life be?
The following day, JoAnne was moved to a spacious room overlooking the Mississippi River. The river curves around the hospital, as if pulling it in for an embrace. The maple trees were swaying in the wind. Her daughter was there again, this time with a family friend. Outside of the room was a fresh pot of coffee and a plate of chocolate chip cookies, untouched. Inside the room JoAnne was lying in bed and there was gentle music playing.
As I left the hospital and hopped on my bike, tears fell down my face. As I pedaled, the tears slowly faded, and a smile came to my face as I approached my daughter’s daycare. When she ran up to me, I hugged her extra tight, as if I had been gone for weeks. I took her face in my hands and pressed our noses together, cherishing this moment knowing that someday the roles will be reversed.
Conflict of Interest Disclosures: None reported.
Additional Contributions: I thank the patient’s family for allowing me to publish this story and Ben Trappey, MD; Bryce Binstadt, MD, PhD; and Iris Borowsky, MD, PhD, for their editorial feedback. None of these individuals were compensated for their assistance.
This content was originally published here.