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Since first-year anatomy class, I found myself adopting a coping
mechanism of distancing myself from my patients and my emotions. As
my education progressed, I developed a false belief that my medical
training would provide me with personal immunity from being the
victim of disease or injury. Patients were "them", and I could
never be one. Despite these internal beliefs, I was constantly
praised for my compassionate communication skills. While rotating
through the Intensive Care Units (ICU), I enjoyed piecing together
the complexity of the multitude of the clinical complications of
the patients I saw, psychologically separating the person from the
Then, on approximately April 18 of my fourth year, I awoke in an
unfamiliar place in New Jersey, unable to move the left side of my
body. When I awoke, I asked my mother (who should have been 418
miles away, but instead was in the same room) for an explanation. I
was supposed to be in Maryland as a student researcher in the
Clinical Research Training Program at the National Institutes of
"You were in a very serious bicycle accident," she replied.
"What happened?" I asked, unable to remember even agreeing to go
for a bike ride recently.
"You were going downhill, and fell off your bike. Thankfully you
were wearing your helmet" she added.
Eventually, I was able to piece the story together. On March 21,
2011, three days after accepting my fiancée's marriage proposal, I
was traveling about 40mph downhill on a road bicycle, and fell,
while negotiating a curve in the Skyline Drive of Shenandoah
National Park. This was part of a half-ironman training bike ride,
and I was with my fiancée, who did not see me fall because I was
too far ahead. The diagnoses of traumatic brain injury/diffuse
axonal injury, aspiration pneumonia (Serratia marcescens), and left
sided zygomatic, and maxillary micro-fractures, as well as a
complex left clavicle fracture led to two weeks in the ICU at the
University of Virginia Hospital, one week in a step-down unit, and
six weeks at Kessler Institute for Rehabilitation as an inpatient,
during which my post-traumatic amnesia ended. Fortunately for my
relationship, I still remembered the proposal.
During my recovery I tried to be a model patient and prided
myself on being obedient, hard-working, goal-driven, and
self-motivated. Once I became fully oriented, I resumed the
responsibility of becoming my own advocate, much to my mother's
relief. The inpatient therapists teased me for having conversations
with the physician rounding, particularly about my medications. I
was unlike any patient they had ever treated. While being
transported to see an orthopaedist, I was ecstatic that the
winged-scapula/serratus anterior connection which I had memorized
the semester prior (for a USMLE exam) surfaced in my memory. While
I was struggling with the fine motor function of my left arm, I
used the "trick" aspiring surgeons often use to acquire
ambidexterity: moving a computer mouse with my left hand. When
given a left ankle foot orthosis (AFO), I wore it religiously, to
the extent that a physician asked if I wore it frequently to avoid
pain, or because I was "just good at following directions".
I naively believed that my medical student experiences would
make being a patient easier, but at times it made things harder.
When I had an episode of epistaxis, I was thrilled at the prospect
of discontinuing the horrific, painful heparin shots; until I
remembered that the epistaxis was likely the result of the
fluticasone propionate I was using for severe seasonal allergies,
and heparin was probably saving my life, while I was confined to a
wheelchair. While practicing walking independently next to my
physical therapist, I sneezed and immediately lost my balance. I
had to learn to shower, dress, and urinate with an audience of
strangers, without losing my dignity. And, I never knew just how
long axillary hair could grow.
At five months post-injury, I returned as a part-time medical
student volunteer in an urgent care clinic, while still continuing
my own therapy and living at my parents' house. The first patient
whom I evaluated was a man with a mild concussion; the day prior,
he had slipped in his bathtub and hit his head. Seeing this man
with a mild head injury, and having been treated for my own head
injury by many physicians (sometimes alongside medical students),
completely destroyed any invincibility beliefs I had acquired
during my first year of medical school. I am now one of "them". WE
However, the most prominent lesson I learned is that compassion
is what patients (and families) will remember most. When my parents
were coming to terms with the fact that their daughter was a trauma
victim who was experiencing autonomic instability and neural
storming, a resident's worst-case scenario response to their
question, "Will it ever end?" was painful. "Well, it could be
replaced with paralysis" he said, destroying their sliver of hope
for my complete recovery. Yet, that recovery did happen. I am not
advocating giving a patient's family false hope. But there is a
very fine line that we, as physicians, must walk. It is possible to
walk that line elegantly. The statement from an attending physician
that my return to medical school would be difficult, and
"realistically not tomorrow" gave my parents a small beacon of hope
to which they clung.
I spent the semester before I returned to school taking an
introductory Spanish course at a community college, continuing
outpatient physical/occupational/speech therapy, completing my
research project, volunteering in an urgent care center and at my
local Church, learning to knit, and living dependently. I returned
to medical school for an extra semester, for an elective in a field
with which I am very familiar, physical medicine and rehabilitation
and experienced life from the "other side" of the stethoscope. I
will graduate from medical school a year late with my most valuable
lesson not having been a formal part of the curriculum. I am
actively engaged in learning to navigate the emotional landscape of
medicine balancing the healing power of compassion with the
practical need for some emotional distance. This is a much harder
approach than my earlier coping strategy but is infinitely more
rewarding. In my spare time, I am planning a wedding that will
occur soon after graduation. As one of my mentors wisely said,
"Life is therapy."
Heather M. Scoffone
Cleveland Clinic Lerner College of Medicine of Case Western Reserve
MD/MS Candidate, Class of 2013
December 2011 Issue of IMpact
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