Rheanna Bulten, c2022
“We have your MRI scan results. I have some news for you, and I think it might be best if you sit down.”
Growing up, I’d heard people say that the big moments in their lives – moments where everything changed – they remembered with crystal clarity. I remember every detail of this moment, down to the clothes my neurologist was wearing.
“We need to send you for a second MRI scan.”
He was scrolling now, through a series of black and white MRI films on the computer screen.
“We found two lesions on your scans. One here,” he says as he points to the bottom left side of the screen to a white circle that looks like a half moon, “and one here,” as he points to the bottom right. “You’ve had two strokes, one on either side of your cerebellum. To get a better idea of what we’re dealing with, we need to do another MRI, and we need to run some more tests.”
I was alone in the hospital. I’d lost consciousness several days before and had been referred to neurology by the emergency department. My neurologist thought the problem might be in my heart.
“I’d like to send you for blood work, and I’d like cardiology to see you to check for congenital abnormalities.”
I nodded, numb. My neurologist had other patients to see. He directed me to the waiting room, where I sat alone for several hours before calling friends and family. I was 19.
I had a second scan that day, and 23 vials of blood drawn – the most the lab technician had ever been asked to take. I was referred to cardiology and went through more tests than I can remember; ECGs, echocardiograms, bubble tests, transesophageal echocardiograms, and Holter monitors.
I was diagnosed with an atrial septal defect, a hole in my heart that allowed clots to travel straight to my brain. I remember every detail of the subsequent surgery – my anesthetic was light, and I felt a tugging sensation deep in my chest when the catheter, threaded through my femoral artery, placed the closure device. I felt the bleeding when they pulled the catheter out. I remember hearing the clock ticking on the wall before I fell asleep in recovery.
I believe there are certain things we aren’t taught in medical school; things that can’t be learned from books, and stories you won’t hear in lectures. The taste of saline in the back of your throat, the way contrast dye makes you feel like you’ve lost control of your bladder the moment it’s injected, how little you care when your hospital gown isn’t tied up at the back. When I decided to apply to medical school, four years after my stroke, I promised myself that I would make every effort to hear my patient’s stories. I would remember being on the other side of the table. Every patient we will ever encounter has a narrative, an understanding of the world that we can’t possibly grasp. Our job is to be there, to walk with them and support them, to serve them, and only in rare circumstances, to heal them. I promised myself the day I was admitted to medical school that I would be the physician the patient in me would have wanted.
And for the record, those big moments – for your patients, those moments will be defined by you.