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Finding Balance in the Wake of My First Code Stroke

While sitting in my preceptor’s office during an exceptionally slow afternoon, I listened as he lectured about sleep medicine to the gathered group of trainees. As we talked about the Epworth Sleepiness Scale, I was ready to doze off.

BEEP BEEP BEEP. Four pagers went off at once. Their harsh beeping jolted me back to attention. A few seconds passed as I sat in confusion, waiting for someone to say something. My preceptor finally spoke up: “Not a slow afternoon anymore. Guess what? Code stroke!”

As I quietly hustled close behind my preceptor, two third-year medical students, a PA student and a resident, I felt excitement about this new experience; I had never seen a stroke patient before. We rushed down several flights of stairs, my mind racing with anticipation and thoughts about how things might go once we made it to the emergency department (ED). As we got closer to the ED, the excitement evolved into a feeling of discomfort. It was uncomfortable to feel even briefly excited by another person’s misfortune. I felt a sense of disequilibrium as I realized I had strayed from the delicate balance medical students and physicians continually try to find. 

Our fascination with human physiology fights in perpetuity with our role as healers of fellow humans. At my medical school, we are constantly reminded of the human side of this spectrum. We are taught that if we are to experience this imbalance, we should let ourselves be skewed to the caretaking, healer role. As a medical student, it is easy to desire exposure to rare and exciting medical conditions. Our mentors, aware of this, challenge us to consider compassionate care and humanity in all parts of medicine. Despite this, I found myself momentarily leaning into the enthralling details of acute stroke pathophysiology and management. When we arrived in the ED and identified the patient, I found myself readjusting in the face of my internal struggle. Laying eyes on this confused and vulnerable patient provided a counterweight to bring me back to the center. My perspective immediately shifted to remembering and even focusing on the notion that this could be the patient’s worst moment.

My preceptor quickly obtained the patient’s history and learned she had multiple recent presentations to the ED for altered mental status — but never a stroke. He spoke to and examined the patient, finding her neurologically intact. He synthesized all the information available to him and discussed the presentation with the ED team. They concluded this was fortunately a false alarm; the patient was not having a stroke. Nonetheless, the ten-minute whirlwind was a thought-provoking experience. Specifically, I wondered about how to not only find balance but also maintain it in every clinical situation. Furthermore, I wanted to consider these situations from the other side: how are patients affected when their doctor loses their balance?

My dad receives his cancer care at one of the top academic medical centers in the United States. It is a center I had the opportunity to work in before medical school, where I witnessed both good and bad models of compassionate care — balanced and unbalanced physicians alike.

Now, in these moments where I am backstage, behind the curtain of medicine as a privilege of my own training, I wonder if my dad has ever felt dehumanized or neglected by his physicians. I have watched bad news be crudely delivered to him, highlighting the lack of empathy that can seep into our profession. Does the curtain ever slip open with his care team? Does it ever reveal the crude jargon and slang that medical professionals sometimes use to discuss patients in private, often reflecting their internal imbalance? Do the conversations ever happen around him rather than with him? I wonder if he ever feels like he is being treated as just another set of metastases to shrink and symptoms to palliate. I fear this loss of humanity in his care and in my own future practice.

This entire journey has undoubtedly been one of the most emotionally stressful and difficult parts of his life. I have accompanied him to many appointments and heard him express gratitude for his care on several occasions, but I consider the possibility that there are unsavory moments and encounters he keeps from me. Whether he ever shares those with me or not, my dad and his strength are the forces that help keep me centered and give me balance.

These concerns make me pause. I am transported back to the code stroke. I vividly remember watching the conversations happening around the patient in the ED. The neurology team hurriedly discussed the case with the ED attending physician as I timidly stood in the back of the small crowd, gleaning snippets of information the third-year medical students relayed back to me. I struggle now to remember if anyone gathered around the patient tried to offer her any genuine comfort or reassurance. In that moment, she was hardly more than a problem to solve for everyone standing at her bedside.

In my role as a first-year medical student, I regrettably did not feel any capacity to intercede in this dehumanizing moment. Even the third-years were standing several feet from the stretcher; who was I to insert myself into the chaos? Would my preceptor have admonished me for overstepping? I consider this another manifestation of my imbalance; my own comfort and fear took priority over comforting the patient. Next time, I will not let it.

I know I will not need a single adjustment to correct this imbalance and the feelings of hesitancy and moral failure underlying it. I must find the middle ground between my eagerness to treat and my duty to heal in each clinical encounter as I go forth in my training. No matter how many patients I see or how acute the situation, I must always keep my dad in mind, and treat my patients with the compassionate balance I hope for in his care. 

Acknowledgments: First and foremost, I must thank my dad for allowing me to share his story and the questions about medicine it provokes in me. Sadly, he has passed away since I initially wrote this piece, but my memories of him and his journey continue to illuminate my training.  Additionally, I owe much gratitude to Dr. Hugh Silk and Dr. Mike Ennis, who have provided support and feedback as I explore reflective writing as part of my career in medicine.

Image Credit: “Tightrope walker” (CC BY-SA 2.0) by Jason Peper

Rohan Bhat Rohan Bhat (1 Posts)

Contributing Writer

University of Massachusetts Chan Medical School

Rohan is a medical student at the University of Massachusetts Chan Medical School in Worcester, Massachusetts, Class of 2025. In 2019, he graduated from Northeastern University with a Bachelor of Science in bioengineering. He enjoys bicycling, hiking, rock climbing, and reading in his free time. After graduating medical school, Rohan would like to pursue a career in cardiovascular medicine.