Priya Chattopadhyay - Patient-centered Ethics: Pathography

Jul 16, 2022 at 04:22 pm by pj

I was rushing into the next patient’s room when I first met Teresa Northrup. I quickly recited the routine monologue that we were trained to say at the beginning of a patient encounter and walked directly towards the computer to login into the chart. I was surprised by a prolonged silence after I had asked her what brought her in today. When I looked up from the computer, she looked confused and then said that she did not know that I was talking to her. She said she was used to people just seeing right through her and talking directly to her husband about her instead. Now I was confused because all I saw was a tall, sporty, older woman with beautiful, short straight gray hair. However, as she removed her mask, I began to see that her face was asymmetric. The left side of her mouth and her left eye drooped downward and would not move as she spoke. She said that she was diagnosed with a brain aneurysm 6 years ago and her neurosurgeon said there was a one in a million chance that it would rupture. A few months later, her aneurysm ruptured, and her life changed forever.

At first, she struggled to accept her new reality. She had been healthy her whole life. She had done everything right. She maintained a healthy body weight, exercised regularly, had a nutritious diet, and never smoked. This was not supposed to happen. Especially not to her. Not only had she been very healthy her whole life, but she was also extremely independent and took pride in her work as an educator. After her aneurysm, half of her body was paralyzed from the left side of her face to the right side of her body that left her unable to even walk. Her husband chimed in and said how he remembers how he could see the discouragement on her face when she was unable to complete simple physical tasks that were so easy for her to do before. She was unable to write, speak clearly, and her doctors even told her she would most likely never be able to walk again. However, she was completely cognitively intact. She said that she absolutely hated hearing how terrible her prognosis was, and this is what served as an impetus for her remarkable recovery.

She went through months of grueling rehabilitation with the goal of living life as she once had, and she made great progress. She could speak clearly without any slurring of her words, hold a pencil with her right hand to draw, and even walk with minimal assistance! I admired her tenacity since she did not accept her prognosis at face value and worked hard to be able to do these physical movements again. She had made so much progress, but it was not enough. As hard as she tried, she never returned to her baseline, and she divulged how this caused her a lot of distress. She lamented about her struggles to her neurosurgeon with which her neurosurgeon responded with, “Do you see anything behind you?” She looked back and saw nothing, and he replied, “Exactly. Stop looking back and look forward.” He recognized that it was hard for Mrs. Northrup to forget all the physical capabilities she once had, but to heal she had to accept her new situation. The neurosurgeon’s candor took Mrs. Northrup by surprise. She had not considered how comparison to her old self could be a thief to her own joy.  

Even with her new outlook on her condition, Mrs. Northrup continued to face unforeseen obstacles. When she would run into an old friend, she was stunned how they spoke to her. Since her face was distorted, they would talk to her as if she was intellectually disabled or ignore her completely and talk to her husband instead. All she wanted to do was scream, “I am still here! I may not look the same, but I am still the same on the inside!” In that moment, I realized why it was so special that I spoke to Mrs. Northrup directly when I originally entered the room. She had gotten so used to people ignoring her existence. As time went on, Mrs. Northrup started to miss her work in education as well. When her grandchildren entered middle school, she wanted to volunteer at their school to help teach. However, she decided against it for fear that other kids may be cruel to her grandchildren because their grandmother’s appearance.

Once I heard this my heart shattered. Mrs. Northrup was an incredible individual. The way she spoke was so captivating. She was so articulate at explaining not only her condition, but also how her condition affected her life. She deserved to live life to the fullest and on her own terms. She did do everything right and continued to do everything right. I felt like I had discovered a rare gem that needed to be shared with world. She did not deserve to be locked away and never be seen again. She had too much life experience to share! I decided to ask Mrs. Northrup if she would be willing to speak to my medical school class. I wanted my classmates to meet her and hear her powerful story. She was surprised by my request, but I could also tell she was flattered and agreed to come.

The day Mrs. Northrup came to speak to my class, she told us that she was both nervous and excited because it had been 6 years since she had spoken to a group of people. I was honored that she felt comfortable to speak to my class. Mrs. Northrup began to tell her story with the same openness and honesty that she had when she first told me her story.

I saw Mrs. Northrup and her husband at the office a few months later for a follow-up appointment. Mrs. Northrup was so cheerful. Her husband told me that he had not seen Mrs. Northrup’s eye twinkle with such excitement since before her accident, but he saw it the day she spoke to my class. He was so grateful that she was given a chance to teach just like she used to. She was overjoyed to hear that my campus dean wanted her to come back and speak every year to the medical and PA students. Her and her husband were going to celebrate there 40th wedding anniversary in a few days. As her husband helped her walk out the door, he let go of her hips as she was walking and winked at me. She did not need anyone to keep her balance, all her power came from within.