A Tale of Two Cities

Dickens' famous opening line is "It was the best of times, it was the worst of times."

That applies to a day I had recently. It started with a young 15-year old boy who had come to the ER for some vague shoulder tingling and pain as well as some thigh numbness. He had a history of a stroke in the past due to a congenital heart problem that had required a heart transplant earlier in the year. So even though his symptoms did not resemble any stroke syndrome I know of, I admitted him to the hospital because of his history. The MRI showed no evidence of a new stroke, so I told the boy and his family that he would be going home. I went to prepare the discharge paperwork when I got a call from the heart transplant coordinator saying that the doses of his anti-rejection medications he said he was taking were not the same as what they had recorded that he was supposed to be taking. So she asked that I keep him overnight and check levels of his medications in the morning as well as check an echocardiogram to make sure the heart was doing okay. The next morning, I was again ready to send the patient home when I got another call from the transplant coordinator. She said that the echocardiogram I had ordered showed that he was rejecting his heart and that he would have to go straight to the cath lab and then have some special procedures done. Oh, and by the way, since she had to arrange all that, could I go and tell the boy and his mom. As I walked into his room, he had his bags packed and was expecting me to say that he was finally going home. Instead, I was the bearer of the worst possible news...

Later that day, I went to discharge a patient to rehab who had initially come in with a stroke causing weakness of the left side of his body. When I had first met this 70 year old man in the ER, he admitted that he had been smoking 2-3 packs of cigarettes a day in addition to 3-4 pints of liquor a day, and smoking crack. I told him that though he had had a stroke, it was a small stroke, and he should recover well. I also told him that this was his second chance at life. God had given him a wake up call to change his lifestyle, and he needed to do just that and quit all of the bad things he was doing. I give some permutation of that speech to many of my patients, but this particular patient really took it to heart. Every day, he would tell me all of the things that he had praying about and that God was laying on his heart that he still needed to do before his life was through. So when I went to discharge him and say goodbye, he thanked me from the bottom of his heart for "shooting it straight" with him and changing his life in doing so. He cried, and as we shook hands, I cried a little too, both for him and for my 15-year old patient too. I am humbled every day at what I get to do and call it my profession.