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How Vulnerability Allowed My Patient to Make a Life-Altering Decision

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I had just finished an hour-long high-intensity interval training session when my beeper went off. As I rushed to my car to return the call, I saw the green beeper screen flash an unfamiliar number. I drove in the direction of the hospital and leveraged modern technology to facilitate a hands-free dial-in. A surgical PA answered the phone call. “What’s up, Matt?” I inquired. 

“Thanks for answering my page, Dr. Kalra. Sorry to bother you this evening, but we have a predicament.” 

“Is everything alright? Tell me how I can help,” I said, yearning to comfort a fellow caregiver. 

“There’s a patient on our service who is scheduled for coronary artery bypass grafting (CABG) with Dr. Stanley tomorrow morning. However, he wants a second opinion from an interventional cardiologist. He is very uncertain. Will you be able to come in to talk to him? His wife is by his side too, and they have a lot of questions.” 

“Sure,” I said, “I’ll be there in a few minutes — just page me the exact location of the patient in the hospital.” I eased in a few deep breaths and pondered over what may have ensued. I received another phone call from my colleague interventional cardiologist, who was generous to update me regarding the situation at hand. I arrived and visited the cardiac catheterization laboratory reading room to review the patient’s angiographic films. I wanted to compute a synergy between percutaneous coronary intervention with taxus and cardiac surgery score to prepare myself with all the tools for evidence-based, or shared, decision-making.

“Good evening, Mr. Samuels. I am Dr. Kalra. I am one of the interventional cardiologists, and I work with Dr. Stanley. How are you doing?” 

Mr. Samuels and his wife greeted me with a hesitant smile; their eyes searched for comfort and trust in mine. “Thank you so much for coming in to talk to us this late in the evening, Dr. Kalra,” said Mr. Samuels as he assumed a more upright posture in the hospital bed.

As I gathered a few non-verbal cues that suggested I must sit down by the patient’s bedside, Mr. Samuels garnered more focus into the proceedings. I asked, “What do you know about your disease condition?” 

“Well, Doc, I have several blockages in the heart arteries, and it is my understanding that stents can’t get to them. I have a relative who is an interventional cardiologist just like yourself, and I am confused as to why I have to undergo open-heart surgery.” 

I nodded in appreciation and understanding of the predicament Mr. Samuels was in and began to draw the coronary anatomy on a piece of paper. I explained to him how the burdens and extent of atherosclerotic epicardial obstructive coronary disease were severe. I relayed why open-heart surgery is a superior revascularization strategy to perform CABG for someone like him compared to stenting and went on to describe that although there is significant morbidity upfront, he will require fewer repeat procedures in the long term. He seemed to understand the scientific rationale behind our recommendation. 

He looked into his wife’s eyes and then looked back into mine and said, “Well, thanks for the explanation, Doc. That was very well explained to us. But, you know, you don’t know how it feels like to undergo open-heart surgery.” I could sense Mr. Samuel’s vulnerability as he opened up to me, becoming more comfortable with our newly-found doctor-patient relationship. He started talking about his family — his boys that he raised, and that how proud he was about who they have become. He wanted to live for them and his grandchildren; he yearned to make more meaningful memories with his family. His eyes welled up as he held my hands. “Doc, I mean, this is open-heart surgery — do you understand?”

As I looked into his eyes while my other hand rested on top of his, I said, “Yes, Mr. Samuels, I do understand. I understand the emotions that are overwhelming your thoughts. I understand them extremely well. I carry them with me in every breath of my existence.” 

His eyes gazed into mine, inquisitive and in anticipation of further explanation. I looked away in an attempt to hide my emotions and tears. “My 3 1/2-year-old son is also contemplating open-heart repair for his leaky valve,” I muttered through my pressured breath. 

“Say what again, Doc? Your little baby boy?” he inquired, almost in denial of what I had just shared with him. “Oh, Doc, come here, give me a hug, Doc,” he said, almost instantly wanting to relieve me of my emotional burden. 

At that instant, it was as if I had seamlessly permeated through an imaginary hierarchical wall between us. It was as if I had found a home in his heart, a special place that he may only share with his next of kin. Through our open, vulnerable, and wounded hearts, our doctor-patient roles had evanesced, and the two fathers had bonded. 

He comforted me through his words and ordained his choicest blessings upon my son and me. “You’re family, Doc. God bless you and the little guy,” he showered me with praises. “I will undergo open-heart surgery as you have recommended, Doc. Sign me up.” He picked up his phone, called his son. He requested that I speak with him to deliver an update on his father's condition and our team’s recommendation for surgical revascularization. “Thank you so much for being so humble, open, and vulnerable, Doc,” he concluded our interaction. “From now on, you’re my cardiologist.”

As I bade them good night, and faded into the hospital hallways, I processed the soul-enriching interaction I had experienced with a fellow human being. When I walked into this conversation, I had not contemplated bringing my vulnerabilities into a shared decision-making process for my patient. However, it was our shared emotional intelligence and our perception of each other’s vulnerabilities as fathers that studded our doctor-patient interaction. It was a vulnerable father convincing his counterpart and patient to make the best and most evidence-based decision for himself.

How has your vulnerability affected patient care? Share your experiences.

Ankur Kalra, MD, is a cardiologist in the Section of Invasive and Interventional Cardiology at Cleveland Clinic’s Robert and Suzanne Tomsich Department of Cardiovascular Medicine. He is also Section Head of Cardiovascular Research at Cleveland Clinic Akron General.

All names and identifying information have been modified to protect patient privacy.

Illustration by April Brust

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