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    Viewpoint: Heart problems teach one doctor the difficulty of navigating the medical system


    Dr. Jonathan Roylance
    "Treat each patient as if they were your own mother," was my residency director's mantra. As an intern, I learned all I could and treated each patient compassionately. My mother expected compassionate treatment from her doctor, and she demanded that I treat my patients the same way. But my experience with my own illness during residency showed me what my patients really want from their doctor.

    My illness developed over many years. As a five-year-old, I was introduced to medicine through my preschool physical exam. My pediatrician put his stethoscope to my chest and got a worried look on his face. "You have a heart murmur. It's pretty big, and I am sending you to the pediatric cardiologist at the university hospital," he told my family. The cardiologist diagnosed a bicuspid aortic valve and ordered me to return to the university hospital every year for a follow-up. Each year I was told that all was well and to return the following year.

    My freshman year of college started normally, but that changed when my roommate couldn't wake me one morning. When I finally came around, I felt feverish, had trouble seeing, and trouble moving my left hand. The room was moving, and I was sick to my stomach. My roommates and dorm administrators felt I was ill enough to send me to the hospital, and so off I went. I was diagnosed with an embolic stroke and was set to have an aortic valve replacement two days later.

    I continued to have left-hand weakness, gait ataxia, and diplopia following surgery. Inpatient rehabilitation was difficult too, and it seemed I might not recover. I didn't like being in a place so foreign as a rehab unit, and didn't like being around old and incapacitated patients.

    But rehab was a great success. I walked out of the hospital without problems, saw without diplopia, and still had my lousy basketball jump shot. I was amazed to be alive and professed a mission in life: I would learn medicine and help the sick.

    I finished college, went to medical school, and entered internal medicine residency. My prothrombin time was good, and I felt great. I had a wife and three beautiful children. I was stressed, but I was following my passions—to be a doctor, a father, and a husband.

    As a second-year resident, I had a routine cardiology appointment to follow-up on the quality of my prosthetic cardiac valve. I worked with a few cardiologists at my residency hospital, and I asked one to help with my echocardiogram. During the study, I was asked one of those questions that patients hate to hear: "Do you have a problem with your aorta?" the technician said. "I need your doctor to see this."

    I knew this meant trouble. My cardiologist determined that my aorta measured 5.7 centimeters in the ascending portion. "I need you to get a CT scan of the chest," he said. I was going to be "an interesting clinical case," and I knew that was a very bad thing. I felt a strong desire to get my radiologic test completed, and I skipped my next noon conference for my CT scan. A day later, I underwent a transesophageal echocardiogram.

    The tests showed a 5.8 centimeter ascending aortic aneurysm. I knew this needed surgery. My cardiologist called the chief of cardiothoracic surgery at the local university hospital. He called the next day and set up an urgent appointment. I went to his office with my CT on disk and my echo tape in hand. We reviewed the results, and I stated my feelings. "I know what this all means—it means I need surgery urgently. I trust you, and I want the surgery as soon as possible."

    Two weeks from my echocardiogram, I was set for major surgery. As I waited in pre-op, I met an anesthesia resident with whom I had worked. I was scared, but I was familiar with the operating area, with the operating room staff, and with my attending.


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