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Blogtober at Montefiore
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Blogtober – an Exploration of Medicine, Research Innovation and Compassion



One month…filled with nearly 30 posts, lots of laughs, some tears and even more examples of why our associates love caring for our patients. Blogtober at Montefiore was our first foray into blogging and we loved it. Doctors, nurses, physician's assistants, nurse practitioners and many other members of our Montefiore family spoke from their heart and gave an inside look into their work, their passions and their favorite stories.

Having worked at Montefiore more than 30 years, I have my share of stories about special patients I've known. One such patient has remained part of not only my memory, but the memory of my entire family. This special patient, Sophie, was an 88-year-old widow who was hospitalized throughout the holiday season. There were few visitors, in fact, I don't recall ever seeing anyone at her bedside. To pass the time, she would crochet little items and give them to the nurses who cared for her. Certainly nothing fancy, but each stitch was perfect and thoughtfully made. 

As a young nurse working Christmas Eve, I can assure you I could think of nothing more important that getting home to enjoy a Christmas Eve dinner with my then boyfriend's family.  As I signed out for the day, I went into Sophie's room to check on her and wish her a "Merry Christmas."

She called me to her bedside and asked me to hold her hand for a moment. When I opened my hand, I saw she had placed a small package wrapped in tissue paper. She insisted I unwrap it on Christmas morning. I gave her a hug, thanked her and for some unknown reason, I promised her I would never forget her. The next day, I carefully unwrapped her gift to find a crocheted Christmas ornament of white ice skates, laced with red and green yarn and paper clips for the blades.

That was in 1981. The boyfriend became my husband. We had three wonderful children, all of whom were youth ice hockey players. And every year since 1981, I carefully unwrap the tissue paper that protects one of my most favorite ornaments and I talk about Sophie. She's part of our holiday tradition but most of all, her memory lives on through me and my family.

We each have so many opportunities to make a difference in patients' lives. I take great pride in nursing excellence and all the wonderful ways we impact patients. What I have come to realize is that nursing is a gift that goes both ways. As much as we give of ourselves to our patients, they often give us so much more.

Everyday special stories like mine are written at Montefiore. Through Blogtober we were able to offer a glimpse into the good work taking place at Montefiore. We joined this national movement to encourage the sharing of experiences and we consider it a success because we reached thousands of you looking to know more about us. As this month comes to a close, we hope you'll continue to visit our website to learn more about the inspiring, powerful and personal stories of our patients and staff. And our blog will be back in 2014, so get ready for more great stories!

Susan Green-Lorenzen, RN, is senior vice president of Operations at Montefiore Medical Center.

Posted by blogmoderator on 11/01/2013 at 2:32 PM
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Making a Difference by Saying Yes


He was her husband of 42 years.  His letter was passionate and pleading.  His wife was slowly dying of end stage heart failure and needed a transplant. But there was an issue – they are Jehovah's Witnesses and she would not accept blood transfusions based on her religious beliefs.

While many operations, including surgeries on the heart, can be performed safely without the need for blood transfusions, a heart transplant can be a rather complicated procedure. Recipient patients are usually quite ill, often anemic and the risk of bleeding during and immediately after the surgery is significant. Most transplant centers, therefore, will not perform these surgeries on Jehovah's Witness patients who refuse transfusions – which had been the case for this man and his wife.

 She had been denied life saving therapy at several institutions, and her husband was reaching out on her behalf.  I called him the day I read his letter and his relief and gratitude were palpable. While I did not promise him we could accept her as a transplant candidate, I did offer to see her as a patient.  And it gave them hope.

But things would not be so easy.  She lived several states away and need to overcome issues with her insurance. No matter what, her husband continued to champion her cause and eventually they were granted permission to see us in consultation. They found a local host family and traveled to our hospital in the Bronx. 

Over the next few days the patient met with several members of our transplant team, including a heart failure cardiologist, a psychiatrist, a social worker, a transplant coordinator and me.  After meeting her, our team was faced with an unanticipated and crucial decision.

As there are far fewer organs available than patients in need, we are obliged to make responsible decisions regarding their use. We looked at our results and discovered that blood transfusions were rarely necessary in patients that had not had prior surgery on the heart, so we decided would consider those Jehovah's Witness patients.

That said, it turned that more than thirty years ago this patient had undergone heart surgery to close a small hole, which connected two of her heart chambers.  Had we known this, we would not have agreed to an evaluation. But now we had met her, we had offered her hope and she had traveled several hundred miles for a chance to live.

In the end we developed a plan that gave us confidence to list her for transplantation. She spent many months in our hospital waiting for her lifesaving gift. When at last it came, I was on call and accepted the heart. 

I knew the stakes were high for her and for us. We were performing a complex procedure without a safety net. The operation proved difficult, but her blood count at the end of the operation was near normal despite some initial blood loss. 

The patient recovered well from the surgery and is enjoying her health and her new heart. She and her family have expressed their gratitude to our entire team and for the family that gave her that most precious gift. 

I am especially proud of my team of dedicated practitioners who do not shy away from challenges and who work with the singular purpose of improving the lives of our patients. Especially for this couple, who after 42 years of marriage will now have more time to spend together.

David D'Alessandro is surgical director of Cardiac Transplantation, Department of Cardiovascular & Thoracic Surgery at Montefiore. He also is associate professor of Clinical Cardiovascular & Thoracic Surgery at Albert Einstein College of Medicine of Yeshiva University.

Posted by blogmoderator on 11/01/2013 at 8:50 AM
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Balancing Emotions and Reason at the End of Life


Before you can even form a thought, emotions are influencing your judgments.
—Zimmerman and Lerner (2010)

It's 9 AM on a Monday, and our palliative care team circles a table to prepare for the workday. Before us is a list of names, each representing a patient and his or her needs, support system and care team. Many are referred to us because they are suffering – be it pain, agitation, emotional distress, existential crisis or decisional ambivalence. The suffering is directed to our team with two common requests for help: symptom support or goals of care.

A request to address goals of care implies uncertainty about the benefits "routine" medical care can offer. Someone in the circle of care, be it a doctor, a nurse, mid-level provider, a social worker, patient or the patient's family member, questions: "Is this path the right direction? Is this care helping or creating more suffering?"

This reflective moment often spurs a palliative care consult. We seek to understand each patient and their support system, identify needs and discover options to share with the patient, family and the medical team. Our contribution to routine hospital care can be eye-opening – new or atypical paths are revealed, like flying a patient to see loved ones in another country or performing a wedding ceremony in a hospital room. These experiences can revive a humanity that serious illness robs from patients and families.    

Other times our work is less dramatic. Instead of revealing paths, we bear witness to incomprehensible events and a myriad of difficult decisions faced by patients and families, especially related to end-of-life care. Years of this work helped me recognize the interplay of the emotional and rational intellect inherent in all decision-making.

When patients or families receive a poor prognosis, some quickly reconcile their rational and emotional intellect and seek a path to maximize the quality of time left. Others challenge the facts presented and are proven correct, but more often soon realize that the facts are accurate and it's time to focus on end-of-life care.

However, there also exists a small cohort of patients or families that can't resolve the tension between their rational and emotional intellects. They logically understand a patient's illnesses should lead to a dying process, but their emotional intellect won't let them believe it. Their minds race with thoughts of miracles, hope, just a little more time, just a little more fight, it just can't be—and with feelings of fear, sadness and hopelessness. 

This conflict between the emotional and rational intellect can lead to patient care decisions that fail to "make sense" to an outside observer.  However, it surprises me to think that our health systems present patients, or more often their families, with very complex decisions – should we try CPR, or life support, or stop these medical therapies – at a time when their emotions are in overdrive and their rational intellect is just trying to catch up. As providers we struggle when the responses to these questions fail to recognize a patient is dying, fail to allow for peaceful dying and moreover, force our hand to perform interventions that may actually prolong dying. 

I believe care providers perform at their best when they recognize these decisions require reconciliation of emotional and rational thought. If either component is missing, patients and families are unlikely to be able to make the decision to accept end-of-life care.

In our best moments, our health system, often aided by the palliative care team, truly supports patients and families when they are facing the most difficult decisions they will ever have to make.

James Fausto, MD, is Medical Director of the Palliative Care Program and Assistant Professor, Department of Family and Social Medicine at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/31/2013 at 10:39 AM
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Young Eyes, Devastated by Diabetes

Children who live with diabetes, like all children with chronic diseases, learn to grow up rather quickly.  In order to survive, they must learn how to manage a disease with which most adults struggle. In particular, not only must children completely change their diet, but they also have to deal with checking blood sugars daily, time and dose insulin shots, all while trying to fit into a world where they are different from  other children.

Their lives as care-free children or teenagers will be forever entwined with having a chronic, life-threatening disorder. Simply being able to manage sugars takes a huge psychological toll on these children, who have much higher rates of depression than non-diabetic children. Thankfully, with aggressive integrated medical and social care, many of these children do very well at dealing with this disease.

Last year I performed surgery to remove cataracts from both eyes of a teenaged patient. This was a young man who played  multiple sports, excelled at school and wanted to be an executive chef, all while managing the juvenile form of diabetes. He was sent to me because he noticed his vision had become blurry and he thought he only needed a pair of glasses. Instead he was told he had cataracts, which is the formation of a cloudy lens in the eye that is typically an age-related change in the eye. But in this case, it was an effect of childhood diabetes.

The only solution to improving his vision was to have surgery, which is certainly not without risk. Although cataract surgery is commonly performed in the adult population, in the pediatric population there are additional hurdles to a successful outcome, mostly due to the fact that the eye is still growing. Even after a successful surgery, like an adult, he would need to wear reading glasses to complete his homework.

Anyone who has cataract surgery needs extensive pre-operative counseling to prepare for rigorous post-operative care. This includes frequent visits to the doctor, laborious eye drop schedules to prevent infection, restriction in all physical activities, then returning to the operating room to do it all over again for the second eye. As you can imagine, most of my patients are quite relieved to only have two eyes at this point!

Unfortunately, the formation of cataracts is not the most feared vision-related complication of diabetes, since it can be surgically corrected. That would be diabetic retinopathy, which can cause permanent blindness due to abnormal blood vessels growing in the eye. While diabetic retinopathy rates are lower in children, if it starts early enough it can be tremendously difficult to manage. 

As an ophthalmologist, it is my job to be a part of the medical team that helps children with diabetes and their families understand the gravity of managing all aspects of this disease. There are many challenges, but I love what I do because of the success we have on a regular basis. The teenaged boy who I operated on last year? He is indeed attending culinary school and pursuing his dream to become an executive chef!

Erin K. Walsh, MD, is a pediatric ophthalmologist in the Department of Ophthalmology and Visual Sciences, and Assistant Professor of Ophthalmology & Visual Sciences and of Pediatrics at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/31/2013 at 10:31 AM
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The Diabetes Epidemic is Creating a Tsunami

I have been taking care of patients with diabetes for many years and have been able to see how this disease has intensified, especially here in the Bronx. Type 2 diabetes is now much more common; it is affecting younger people and causing damage to important organs such as the liver and the heart. It can cause much harm without people feeling sick, but when diagnosed, it can be treated.

When it isn't diagnosed or treated, it causes complications such as blindness, strokes, kidney failure, heart disease and amputations –often a loss of a foot or leg. Patients with complications aren't able to maintain a good quality of life, they become disabled and they become a burden for their entire family and the community.

I see many patients who are in this situation. One example is Dulce, a 40-year-old, single mother with poorly treated type 2 diabetes and high blood pressure. She was diagnosed at age 18, but never took her disease seriously and did not follow her doctors' recommendations. She was on welfare and had Medicaid , so she was able to see doctors and get her medications at a low cost.

She ultimately developed complications, starting with an infection in her foot that caused her to lose her left leg, and then her kidneys began to fail to the point that she needed dialysis. During the past two years, she had a stroke, lost vision of her right eye and was then hospitalized with chest pains. She had a heart attack and had to have heart surgery.

Diabetes and hypertension can be treated – why didn't she follow the medical recommendations? Unfortunately, this young patient is not a rare example. If cases like this continue, we will have a disaster in our society – what I call a tsunami effect on our health care system, society and our country.

Fortunately, the majority of patients with diabetes do well – they are diagnosed and treated early to prevent complications. These patients are "in charge of their disease," they know how the medications work, and make sure that their blood sugars, cholesterol and blood pressure are normal. They live a happy and productive life, and it is patients like these who encourage me and many other healthcare professionals to care for them every day! 

Joel Zonszein, MD, is director of the Clinical Diabetes Center – Weiler. He also is professor of clinical medicine, Department of Medicine and Division of Endocrinology at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/31/2013 at 10:23 AM
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Helping Children with Rare Conditions Beat the Odds

Having been at Montefiore for almost 30 years, I have seen my share of complex, intriguing and heartbreaking patient cases. As a pediatric neurosurgeon, I have treated children from around the world with conditions so rare that their own families have rejected them. Thankfully, this isn't often the case, but it does make our job that much more rewarding when we can help the child and the family overcome the medical problem and the associated cultural stigma that can come along with it.

Over the years, our craniofacial team has had to learn a great deal about various cultures and religions to be able to deal with the unique cases. Since our successful separation of twins joined at the head was carried out by our team nearly ten years ago, we have consulted on 14 more cases and been involved in the separation of three more sets of twins around the world; two in the United Kingdom and one in Australia.

We are currently involved with another set of twins in the Middle East who come from a tribe that lives in the desert collecting nuts, dates and wood. Because of the conjoining at the heads, these children are, sadly, viewed unsympathetically by their extended families and can't be taken back to their home unless successfully separated.

My passion for helping children with rare and complicated medical conditions has remained steadfast since I first came to Montefiore in the late 1980s. Not only am I proud of our surgical outcomes (less than five percent of our patients need to come back to us for reoperations), but I'm also extremely proud of the successes our patients make in their owns lives, despite the adversities.

One of my patients, who has been under my care for all of her 22 years, had such a unique and multifaceted illness that the hospital where she was born had no idea what advice to give her parents. By chance, her mother learned that I was working on a very complicated case and got in touch to see if I could help them. We have been through 15 surgeries in just over two decades and not only is this patient a bright, bubbly and happy person, she also is highly accomplished, having recently completed her master's degree in accounting.

Helping children beat the odds is a rewarding and fulfilling experience. Our team has earned an international reputation for our work and we are regularly asked to consult on cases, present lectures and host workshops. Our goal is to improve the medical outcomes for the children with complex needs so that they can go on to have successful, happy lives.

We're proud of what we've accomplished so far and we have a lot more work still to do.

James T. Goodrich, MD, PhD, DSc (Hon) is Director, Division of Pediatric Neurosurgery Leo Davidoff Department of Neurological Surgery at The Children's Hospital at Montefiore and Professor of Clinical Neurosurgery, Pediatrics, Plastic and Reconstructive Surgery at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/30/2013 at 1:59 PM
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The Role of Rehab – Uncertainty to Regained Strength

Maria is an active woman with a history of diabetes and high blood pressure who has a heart attack and, unfortunately, suffers a mild stroke during her hospitalization. She is determined to get back to her home, work and family, but is unsure if she can. Maria is unsteady on her feet and is afraid she may have another heart attack. As part of her care, she is seen by the rehabilitation physician – a physiatrist – who reassures her that she can get her life back and spends time with her to explain her path to recovery.

When Maria is admitted for inpatient rehabilitation, she is introduced to a team of dedicated therapists, nurses and other specialists who work closely with her to help her regain her strength and to walk steadily. With the help of her physical and occupational therapists, Maria learns how to walk, dress herself and make her own meals. Her regained independence allows her to return home, where she can continue the recovery process with exercises.

Once she is home, Maria starts her cardiac rehabilitation program that teaches her about her heart and how she can manage her diabetes and blood pressure. The program encourages Maria to have a healthier lifestyle, and she begins choosing a healthier breakfast of yogurt with a fresh piece of fruit – instead of the egg, bacon and cheese sandwich she used to eat. She continues her exercises, and soon she has enough confidence and strength to walk a mile every day.

This story defines some of what rehabilitation medicine does and why I decided to become a rehabilitation specialist. Growing up, my family lived next door to one of the founding fathers of rehabilitation medicine, Howard Rusk. His stories of patients' triumphs over their disabilities inspired me to pursue a career in medicine and specifically rehabilitation.

Rehabilitation medicine is made up of passionate physicians, therapists and nurses who are dedicated to restoring function for our patients, improving their quality of life, alleviating discomfort and pain. It is this shared work in restoring people to their lives and function within their community that is the goal of every member of our team.

We gain our satisfaction from being able to help our patients get back to their normal function, so they can live their lives to the fullest. That feeling of satisfaction and happiness was exactly how I felt when Maria came back for a follow-up appointment. Six months after her heart attack, she is back to work, feeling better than ever and fully involved in her care. She has her life back and continues to make healthy choices every day to help her avoid another heart attack or stroke.

This is why I love my job!

Matthew N. Bartels, MD, MPH, is the Chair of the Department of Rehabilitation and Physical Medicine Department. He also is Professor and Chair of Physical Medicine and Rehabilitation at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/30/2013 at 1:56 PM
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A Vision of Total Care for Adults with Sickle Cell Disease

This was not a very good week. Three of my patients, whom I have followed for more than 20 years, were in the hospital.

We all have these patients. Patients who have essentially grown older with us. We know their families well. We talk to their wives, husbands, siblings and children. We worry when their jobs fall apart. But mine are special patients – they have sickle cell disease, an inherited blood disorder that affects approximately 1,400 Bronx residents, most of them of African-American and Hispanic descent.  Many of them I have been seeing since I first came to Montefiore and Einstein as junior faculty in 1985. 

Sickle cell care has a unique historic connection to the Bronx. A clinic set up at Einstein in the 1960s was the first in the U.S. to focus on the condition. It was called the "Heredity Clinic" and was designed to take care of patients while exploring the interaction of genes and medicine –at that time a revolutionary goal. And the patients came. They came because they knew their doctors were people who cared about all aspects of sickle cell disease.

Some 20 years later, this idea of total care became the Bronx Comprehensive Sickle Cell Center at Montefiore.  It was one of only 10 NIH-funded centers in the country and its directive was to be all things to all people with sickle cell disease. Patients came with their complications such as leg ulcers, stroke, renal failure and sickle cell crises, severe painful episodes that occur when irregularly shaped red blood cells become lodged in small blood vessels and block the flow of blood and oxygen to the body. But in 2009, the NIH stopped funding the centers.  Devoid of this vital financial support, adult sickle cell care at Montefiore had to be scaled back.

Montefiore, with its long history of caring for these patients, realized something had to be done for adults with sickle cell disease.  Forty years ago we might not have had to worry, since sickle cell patients didn't live very long into adulthood. But today, we have patients in their 70s and a few in their 80s. What's more, they're now getting the diseases that other middle-aged and elderly people get – heart disease, diabetes and obesity. They need hip replacements, eye doctors, dentists and vascular surgeons. We help deliver their babies. I expect now to help deliver their grandchildren.

Very soon we will be able to look after all adult sickle cell patients in a much more complete way, from young adults who are "aging out" of pediatric care to the elderly. We are recruiting clinicians to treat adults of all ages with sickle cell disease --  nurse practitioners and physicians who will follow our patients in the clinic, in the ED, on inpatient units and even to the OR. The team for this updated service will manage the medical and social service needs of sickle cell patients, running clinical trials in order to get state-of-the-art therapy for patients and engaging subspecialists to handle sickle cell complications.

When my three patients returned to the hospital this week, I was reminded of how difficult life can be for many people with this disease. But change is underway, and I feel hopeful that better days are ahead for the hundreds of adult sickle cell patients my colleagues and I follow. Our vision to provide them with the total care they need is within our reach.

Henny Billett, MD, MSc is Chief of the Division of Hematology at Montefiore Medical Center, and Professor of Clinical Medicine and Clinical Pathology at Albert Einstein College of Medicine of Yeshiva University.

Posted by blogmoderator on 10/30/2013 at 8:52 AM
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Remembering Hurricane Sandy – One Year Later

For most of us, Hurricane Sandy is just a memory. But for the families that remain in shelters and the many others still displaced, the storm is an ever-present fact of life. Any reflection on Sandy must start by acknowledging that some of our colleagues are still living through the devastation left in its wake. In our neonatal intensive care unit (NICU) alone, two nurses are still putting their homes back together and a third hasn't returned to work after getting hurt cleaning up her home. Most of us, though, have recovered from the storm. 

October 29 is meaningful for me because it's also my birthday, though it's hard to celebrate when we're left shaking our heads in anguish because of what happened. The trauma of Hurricane Sandy tempers my day with sadness, but also gratitude. 

Disastrous as it was, Hurricane Sandy also provided our Weiler NICU staff an opportunity to show the world something I already knew – their strength and heart. The challenges of that Monday night were beyond any we expected. A year later, I still marvel at the staff's ability to care for those patients and families – no matter the obstacles.

Due to the storm, we were low on staff that night. When NYU Langone Medical Center called urgently requesting our assistance, Dr. Orna Rosen kept us on track with her absolute belief in the team and our ability to manage what seemed like an impossible task. She leaned on her army experience to help us mobilize forces. 

The phone call came around 1 a.m. from the NICU clinical director at NYU. Our medical team immediately accepted the babies over the phone and executed an admission plan. We were prepared for four babies, however six arrived. While providing care, our team worked to locate the families of the two additional babies so they knew to come to Montefiore – another transfer wasn't a good idea.

Eileen Cunnigham's leadership as the nurse in charge was indispensable. Her repeated reassurances – "We got this," "Ok, this is what we will do," and "It's gonna be ok" – were a balm to the team working that night.

I salute the three E's – Emily, Emily and Eileen – who came in early and stayed forever, as well as the nurses who slept over so they could be there in the morning. Awakened at 3 a.m. to help, they leapt into action - especially one nurse (who will remain nameless) who was so eager that she ran to support the team and had to be reminded to get dressed first!

I was touched by the sentiment of the mother-daughter team, labor and delivery nurse Ilana Bennet and NICU nurse Sharone Halperin, who could have gone home but chose to stay. When awakened, Ilana simply said, "I knew there was a reason we didn't go home last night. We needed to be here to help."

From the moment we got the call that patients from NYU were coming, every nurse, respiratory therapist, nurse practitioner, neonatologist, physician assistant and nurse's aide gave everything they had.

The families also arrived exhausted, worried and confused. Our NICU team provided food, drink and comfort while arranging for the safe care of six babies. In those hectic hours, we took care of the babies, their parents and the doctors and nurses who brought them.

So on my birthday this year, I reflect more than celebrate. Our NICU staff is often described as angels on earth, but for me it's so much more than that. They are caretakers of the highest caliber – they care for the infants, their parents and each other, unconditionally.

It was hard to live through the storm, but an honor to watch this team in action. I thank the nurses and doctors, NPs, PAs and nurse's aides who show their courage and commitment every day, and especially on October 29, 2012.

Zahava Cohen, RN, MSN, RNC-NIC is Administrative Nurse Manager in the NICU at Montefiore's Weiler Campus.

Posted by blogmoderator on 10/28/2013 at 5:02 PM
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Life is what happens when you're making other plans…

If life is what happens while you're busy making other plans, then stroke is what happens while you're living that life.

The morning sun streams through the stroke unit windows and across my resident's rumpled scrubs as he presents the overnight admissions. 

"The first patient is a 68 year-old retired construction worker who was eating dinner with his wife last night when his speech became slurred and his left arm fell to his side…" As the resident shuffles though papers and presents the pertinent parts of his medical history and neurological exam, my eyes gaze over his shoulder and at the patient, who fumbles with opening the contents of his breakfast tray. 

As we enter the room, Mr. W's face brightens as he recognizes me from the emergency department last night. 

"Hey doc," he says with a slightly crooked smile. "Look what I can do now." He lifts up his left arm and we both stare, amazed, as he slowly opens and closes his hand. I think back to last night, when we pushed his stretcher through the doors of the Emergency Department, rushing back from the CAT scan to start the infusion of a powerful blood thinner, which would restore blood flow to a blocked artery in his brain and bring his left arm back to life. In two weeks he'll return to my office, with a barely perceptible limp. He'll proudly tell me that he quit smoking since the stroke, and we'll joke about how he can take his wife to Atlantic City with all the money he's saved.

Our next patient is an 86-year-old retired librarian whose daughter found her on the living room floor, confused and unable to move her right side. Her daughter produces a meticulous list of her medications, but I know it's of little use – she won't be able to swallow them anyway. She asks me if she should look into hiring someone to help when her mother goes home, but she can tell by my downcast eyes, even before I answer, that she won't be coming home. "Mom?  Mom!  Who am I?  What's my name?" Her mother's eyes narrow slightly as she studies her daughter's face. "I…I don't know" she says softly. "Just talk to her," I try to comfort her. "She will recognize your voice."

Sometimes my residents ask me why I decided to become a stroke doctor and I try to remember back to five years ago when I took this path. Perhaps it was the fascinating anatomy and physiology of the blood vessels in the brain and the many ways in which a stroke can affect one's ability to speak, move and reason. It amazes me to this day. Maybe it was the assuredness of data from large clinical trials in a disease which is so common that it is the 4th leading cause of death in the U.S.

But with time, I have come to realize that the greatest thing about being a stroke doctor is my patients. They are struck with a life-altering event while going about their business. The determination, the strength, the dignity and the grace with which they recover from that stroke, or unfortunately sometimes succumb to it, is truly extraordinary.

It's late afternoon and it's the last patient of the day in the stroke clinic. A young mother is here with her newborn – two months after a brain hemorrhage during her pregnancy nearly took her and her baby's life. She shows me all the skills she has regained in rehabilitation, while her baby sleeps contentedly in her blanket. I know they will have a good life. I nod excitedly and then slip out of the room to blot my teary eyes.

Kathryn Kirchoff-TorresKathryn Kirchoff-Torres, MD, is a stroke expert in the Department of Neurology at Montefiore. She also is assistant professor of Neurology at Albert Einstein College of Medicine.

Posted by blogmoderator on 10/28/2013 at 10:27 AM
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