Lessons taught by Bell’s palsy

Recently, after a week of a viral illness that I most likely picked up from one of my patients as a pediatrician, I noticed that one side of my tongue felt as though I had dental anesthesia. During the day, this slowly progressed, but as night came, the progression rapidly intensified with my lips and eyelids on this same side now drooping. While I suspected Bell’s palsy, considering that I’m now middle-aged, my wife took the prudent precaution of taking me to the ER, where I would spend several hours getting worked up. I know that there have been plenty of articles on this site discussing what it feels like when the doctor becomes a patient, but I still thought it was worthwhile sharing a few lessons learned since these can never be overstated.

Those extra seconds count. Let’s be honest; being in a situation like this, where you think that you may be having a stroke, is stressful and any little thing can be a trigger for even more stress. Several of the staff in the ER, from the nurse who told me what to expect with the IV and blood draw (“This will feel like a pinch”) to the radiology tech who gently warned me about my body soon to turn warm when contrast was injected during the CT angiogram (and had I not known this, it would have freaked me out), to the MA who told me why they were placing cardiac monitors on me (“We do this for anyone in the ER” … while I initially thought that they knew I was having a stroke!), and finally the ER physician who came by several times to check on me. Those very short interactions that from a time perspective were negligible were the most impactful of the entire visit. May I always remember to do the same with a nervous patient or parent.

Treat me as a human. Acknowledging me as a person and not a diagnosis, or a patient, or another number to be seen on a busy Friday night was so amazingly impactful though all of these took mere seconds to be done. From the registration staff who smiled at my wife and acknowledged her, to the security guard who greeted us at the ER, to the triage nurse who went out of the way to calm me down, and so many other very quick interactions that made my wife and me feel cared about. Working in a system that is so focused on efficiency, the fact remains that our patients are not machines or puzzles to be solved, but a complex mix of physical, emotional, and spiritual aspects that all work together. A simple smile can acknowledge this, and something we can all do easily.

Keep me updated. Between the ER attending and the nurse, I was not only given frequent updates about results but, as importantly, how much longer some things would take to come back. For someone worried about having a stroke, hearing “My prelim read looks fine, but I will get the final read from radiology in about 20 …” was a life changer, and those 20 minutes were spent chit-chatting with my wife instead of being painfully long moments of worry. Again, these moments took little time but were so impactful. May I let my families/patients know such things as how much longer of a wait or when some labs will be back.

Plain language counts. Health literacy is a topic that is of great interest to me (for example, two colleagues and I have done a whole series of podcasts on this topic), and while always taught to medical students, it is commonly a lost art. Yet it can be done and makes such a huge difference. Start off with what the ER attending did using the classic “three things you must know” approach: 1. Diagnosis and why: “You have non-Lyme’s, but post-viral Bell’s palsy without any stroke, and these are the results that show that,” 2. The management plan: “Based on this I am starting you on two meds,” and 3. When to come back: “Bell’s takes some time to clear, but you will see improvements in a few days. I want you to come back if you feel worse, things get worse, or if you have no improvements by the end of the week.” Simple, to the point, and yet it contained all of the information that my wife and I needed to hear. Something that I need to do more with my patients and families.

Empathy. As a seasoned physician, I have seen Bell’s plenty of times, and diagnosed it probably a dozen times, but have never personally had it before. This event allowed me to experience the symptoms that my patients must be going through which I honestly did not think about much before. The last time I diagnosed Bell’s was in a child with autism, and while my diagnostician brain was very pleased with itself to diagnose this, in retrospect, I failed in explaining what to expect to this family. I can’t imagine how a child with sensory issues will now cope with having one eye patched up or losing taste or feeling numb for days on end. Now I can at least think of this, and while I cannot explain everything to a family, I can at least try and empathize with them and warn them of what to expect. That is a solid start and one that will not be forgotten by a patient or family.

None of us enjoy getting sick, but I am convinced that many things happen so as to teach us to be better people and better doctors. I do have to say that Bell’s palsy has been quite the professor!

Alexander Rakowsky is a pediatrician.


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