What Being a Patient Taught Me About Being a Doctor

Source: Aaron Burden / Unsplash

As a doctor and a patient, I have experienced the compartmentalization that is necessary to function in both roles. However, this can lead to a fragmented sense of identity, making it difficult to connect with who I really am.

One day, my roles as a doctor and patient intersected. Writing about it revealed the complexities of my identity and the strength found in vulnerability.

My Story

“But the stars that marked our starting fall away. We must go deeper into greater pain, for it is not permitted that we stay.” —Dante Alighieri, Inferno

It was a Sunday morning at the hospital, and the CCU was brimming with critically ill patients. Clutching my coffee, I entered the unit and was greeted by the chart of Jack, a young man I had admitted just hours earlier.

His heart was besieged by his own immune system—a misguided assault triggered indirectly by the Coxsackie A virus, which had deceived his body into perceiving the heart as a foreign enemy. There he lay, a tube emerging from a distended vein in his neck, while a machine clicked in sync with his heartbeat at the foot of his bed. Yet it was Jack's countenance, not the machinery, that told the true story of his failing heart and dwindling hope.

Our team—residents, interns, and medical students—convened to commence morning rounds. The previous day had left us with 23 occupied beds out of 24, and it was Jack's critical condition that had secured the last available spot. The team awaited the arrival of its esteemed leader.

Dr. Michael Foster entered the unit with a presence that could have been lifted straight from a "Monty Python" sketch. His British accent, marked by a unique cadence and a selection of eccentric words, signaled to all within earshot that Dr. Foster had arrived—a fact that, in itself, was a positive start to the day.

We began our rounds just outside of Jack’s room. As the most unstable patient, he was the first on our list to discuss, and I was the presenter.

“The patient is a 29-year-old African American male with advanced heart failure due to viral myocarditis. He’s status one on the transplant list and has been in cardiogenic shock for five days, still requiring one-to-one support from his intra-aortic balloon pump.”

As I spoke, my thoughts were divided: presenting data about my patient and worrying about what everyone else thought. This second track of thought was deeply ingrained in my neuronal network. Did they wonder about my absence over the last three months? Did they know about my bipolar disorder? How did my face look? Could they understand me? Was I making sense? These thoughts felt as critical as life-and-death decisions.

The real question was: Why did I allow other people to occupy so much space in my mind?

As a child, I often wondered about my father's thoughts about me, largely due to his emotional and physical absence. I didn’t realize then that it was more about him than me. Unsurprisingly, this obsession with others' perceptions persisted into my adult life. However, in medical emergencies, my mind found a singular focus: save the patient.

Continuing my presentation on Jack’s cardiac status, I noticed several people rushing into his room. We were outside, without a direct view of the cardiac telemetry monitors, but I instinctively knew something serious was happening. Entering Jack’s room, I rapidly began assessing the situation and formulating a plan. Turning back, I saw many from the CCU team had dispersed, but it didn’t matter. Jack was my patient, and he needed my help.

In that moment, I had no choice but to let go of the self-flagellating thoughts. Despite my health challenges, I felt that I was more than my bipolar diagnosis. I was the yin and yang of healthcare—both doctor and patient. This realization gave me strength, insight, and empowerment. What I once viewed as a weakness had become my strength. I hadn’t realized it then, but my bipolar disorder enabled my brain to process information and draw connections rapidly.

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Years later, I came to understand that bipolar disorder isn't simply a black-and-white state of mind and mood. It's also a reservoir of unique talents and skills that can be nurtured, developed, and modulated within a comprehensive medical and psychotherapeutic regimen. There may be no cure for me, but I possess a special brain that still has much to contribute to the world. At that moment, it had much to offer Jack.

I looked around the room and saw the hospital code team, each member taking their position: ER doctor on the airway, respiratory therapist on bag ventilation, rapid response nurse administering meds, and pharmacist with even more meds. “I’m Dr. Desai, and this is my patient. What’s his status?” I asked with all the courage I could muster.

“He’s in heart block without a pulse!” exclaimed a member of the code team.

I quickly glanced at the rhythm. The P waves were rapid, and the QRS was wide and slow. This was infranodal heart block, and Jack urgently needed a temporary pacemaker to support his heart rate. I had only inserted one once before, but it was a year ago and I had help from a critical care fellow.

A decisive plan of action was needed. Normally, a cardiology fellow or attending would insert the temporary pacemaker but they were occupied with another patient coding down the hall. Unbeknownst to me, my empathy for Jack was fueled by my father's death from heart disease, connecting me to what Jack’s young son might endure if I couldn’t save his father. I was a patient like Jack once, in need of a hero doctor. I was fortunate to have one, and now it was my turn to be that for Jack.

“John, get the Swan-Ganz Paceport, size 7 ½ gloves, and a gown,” I instructed the medical student on our team. I washed my hands, donned the gown and gloves, and set up a sterile field. I applied betadine antiseptic around the central line in Jack’s internal jugular vein and inserted a wire through one of its ports which would be exchanged for a temporary pacemaker that could travel through his heart using an inflatable balloon.

“Michelle, can you set the pacing mode to asynchronous pacing, the output to 10 milliamps, and the rate to 80 bpm?” I asked Jack’s nurse.

I inflated the balloon with 10 cc of air, advancing it slowly as the pacemaker activated. Jack’s heart rate was less than 20 bpm, quickly heading for a cardiac arrest. His face turned ghastly pale and sweat poured from his forehead. Muffled by my mask, I attempted to speak reassuringly to Jack while working to restart his heart.

“Hang in there, my friend. I got you.”

Jack was barely conscious, so perhaps my words were more for my benefit than his, but I hoped his mind somehow sensed that someone was fighting for him. I wanted him to know he wasn’t alone and we were striving to get him home to his wife and son. Hearing Jack groan and feeling his stale breath, I recalled what my father must have looked like in a CCU bed during a heart attack. If there was a heaven, and my father was there, I wondered if he was watching as his son brought a heart back to life.

I advanced the pacing catheter until reaching the intended destination and the heart rate jumped from 20 to 80 bpm. The blood pressure rose by 40 points, signaling a stronger heart pump. In mere minutes, Jack transitioned from unintelligible groans to a soft whisper.

“Thanks for saving my life, doc,” Jack said, exhausted. “Can I ask you a question?”

“Of course, Jack. What is it?” I replied.

“What kind of wine do you like? I’m going to ask my wife to buy you the biggest bottle in the store.”

“Ha-ha, OK, my friend. I appreciate the gesture. This is about getting you better. Just close your eyes and rest.”

“OK, doc. But I’m getting you that bottle.” Jack took a deep breath and drifted off to sleep. My eyes welled up with tears and I knew in that moment I was destined to be a healer of hearts.

Excerpted from my forthcoming book, The 5 Life Rhythms: Achieve Balance and Harmony to Revive and Thrive.