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I was spending a couple of days in neurology where the residents were kind enough to let me take histories of some of the patients and use their diagnostic imaging to try to diagnose them.

One of the patients I was seeing was describing his symptoms as weakness. As I spoke to him, I realized he had a slightly less pronounced naso-labial fold on the one side, as well as a slight slurring of his words. As I had him raise his hands and close his eyes, he had a slight drift of one of those hands.

A feeling of excitement grew within me as I realized that this could be a stroke. I looked at his MRI and noticed from it that he had a Middle Cerebral Artery infarct. Basically, the MRI showed me where his stroke was.

With a hint of a smile on my face and excitement in my voice, I told the resident who’d just entered the room that I thought our patient had a stroke. As he looked at my outstretched finger pointing to a spot on the image and heard my concise history, he nods and says good job. The self congratulation begins, as I chuckle that I remember something from my neuro block.

Then, I catch sight of my patient. My patient who heard my tone of voice (he didn’t understand English, which is how I was communicating to the resident) and the excitement within was hopeful of a cure. My excitement at taking a step forwards in my medical education came at a cost to my patient. The fact that I had done something of medical significance suddenly paled in the realization that my delight came from another person’s misery, that a step in my education involved perhaps the toughest time in this persons life.

It was sobering to be returned to Earth at that moment and to realize that I was facing the conundrum countless medical students had faced before. Every learning experience, each disease etiology we identify, each finding we learn to identify on imaging comes from a patient suffering the consequences of that disease. The more bizarre or rare a condition is the “cooler” it is for us, and the more heart rending it is for the patient.

Perhaps the resident understood my dilemma, or perhaps he was overworked. Getting up, he told me to start explaining it to the patient. So, sitting in that office I began to explain to my patient that his life was going to be forever altered. And I hoped that my perceived glee at making the discovery would be tempered by the gentle way I was trying to break it to him. That’s something I’m afraid I’ll never know.

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