Lisa

Lisa was a 29-year old patient from the northern suburbs of Chicago who was admitted downtown following a massive stroke after she gave birth to a daughter the previous day. I had decided to do a neurology rotation to see if this was of interest to me for a potential specialty choice. It was early in my fourth year but the clock was ticking to make a final choice for residencies and specialties. I was going to do a clinical internship and was leaning towards pathology at this point but thought I should give neurology a more thorough look before ruling it out as a career option.

I had just finished a month-long rotation at the Cook County Medical Examiner’s office, during the Heat Wave of 1995, which all but convinced me forensic pathology probably would not suit me as a sub-specialty choice for pathology. Over 700 people died in the City of Chicago and surrounding suburbs as memory recalls in the course of about a week of what were ruled “heat related deaths”. Being there during a disaster combined with the daily homicide, suicide and accidental deaths convinced me forensics what interesting work, just not for me. A month long rotation in neurology would follow.

By this point, I had watched dozens of neurosurgical operations, cardiothoracic procedures, mastectomies, large sarcoma resections, delivered 18 babies, assisted in codes on the wards, traumas in the emergency room, prepared bodies after deaths for family viewings and watched or assisted in hundreds of autopsies in just the past month. There were thyroid operations, gallbladders, frozen sections, sudden deaths, prolonged deaths in the ICU and doing a hernia case at the Lakeside VA nearly from skin-to-skin with a second year surgery resident. Psychiatric patients at the same hospital spit on you, threw things at you and occasionally surprised me with moments of clarity and organized thoughts. From birth to death and quite a bit in between over the past 16 months I thought I had nearly seen it all.

Pain and suffering occasionally treated or cured and life occasionally saved from death or perhaps at least delayed. Moments of clarity interrupted by incoherence and aggressive behaviors. Pediatric wards filled with cases of cystic fibrosis, kidney disease and aggressive bone, soft tissue and brain tumors. There were moments of success and failure. Medicine doesn’t always come out on top. Sometimes the disease defeats medicine.

Third year of medical has a steep learning curve. You have to learn a lot about a lot, every 6 weeks changing to another specialty while trying to keep the financial aid coming in, sleep and eat in-between. You are tired and wondering what you are doing there. Some cried. Some ran or biked or rollerbladed miles along the lake to maintain a balance and one’s sanity. Anyways, I thought fourth year would be different. The patients and names would be different but the cases and the degree of human suffering would be the same.

Until I met Lisa.

She was admitted to our neurology service at 3 in the morning following a prolonged labor and stroke during childbirth. It was her first child and would be her only. The family was well known and though reluctant to be on the “teaching service”, the closest thing to a neurologist that Sunday morning at 3 AM was my third-year neurology resident.

He proceeded to examine her, starting with the cranial nerves and working his way down along her chest, abdomen and extremities. She had no motor function in her right arm or leg. She complained of numbness on her right side as well and had diminished responses to pain and loss of sensation.

Before my resident could lift up her gown to examine her thighs and knees, Lisa began to break down crying to leave her alone, to stop “poking” her and trying to move her arms and legs and testing for reflexes. At one point she grabbed the reflex hammer with her left hand tried to get it away from the resident.

She had been through a lot. Her baby was in the NICU. Some of her family was in the waiting room. Other members were in another hospital with the baby. It was a terrible situation for everyone. Standing in that room at 330 in the morning on a Sunday I could think of a lot of places I would rather be. She was overwhelmed. The resident became overwhelmed.   He started to get teary eyed and agreed to wait for her personal physician and an attending neurologist to finish examining her when they rounded in a few hours. We admitted one more patient that night.

After signing out our list of patients, including Lisa, we left the hospital as the post-call team to come back again that night and do it again. That Sunday morning I probably rode my bike then rollerbladed along the lake for longer and farther than I ever had before or since. I gather my resident went to his outlet as well or tried to go home and sleep.

While we were miles from the hospital, Lisa was getting an MRI of her brain which showed a large mass on the left side, likely a glioblastoma multiforme (GBM), an almost uniformly fatal type of brain cancer with a predicted survival of less than a year at that time. Lisa underwent a brain biopsy that week which confirmed the diagnosis of GBM. I waited in the pathology laboratory during the case to look at the frozen section. Her physician shared the news with Lisa, her husband and parents privately the following day then the final pathology report was issued.

After she was discharged the following week, I never saw Lisa again. I would learn that she passed away about 8 months after her diagnosis, shortly before our graduation in May of the following year.

People like to ask physicians how they chose their specialty. I think experiences like this – completely unassociated events where people cross each other’s paths lay some of the fabric. Perhaps we say we like “thinking” versus “doing” or “operating” versus using “medications” to treat but I think there are patients, known as “cases” that can mold those specialty decisions.

Neurology and psychiatry were considerations as was surgery or pediatrics but so was the interest in what that frozen section showed and dozens of others and how they impacted patients’ lives.

Lisa’s daughter would now be close to the age I was when I met her mother. Perhaps she is in medical school now. Perhaps she has children of her own.

Perhaps had I never met Lisa, had she not been admitted that night, or I had not decided to do a neurology rotation, or go to medical school there at all, or a thousand other things, I would be a neurologist.

Then again, would we not have met, seeing the clinical complications of her tumor, the actual tumor cells and the result of that diagnosis, I wouldn’t be a pathologist.