Dysarthria: Remembering the humanity in medicine

It is my second week on my neurology rotation. I pick up a new patient who was admitted overnight. Mr. C is an elderly male with sudden onset dysarthria (a motor speech disorder caused by neurological injury) and right-sided motor weakness; he has most likely had a stroke.

I use the hand sanitizer on the wall, enter his room, introduce myself, and begin to take our patient’s history. As a third-year medical student, this process has now become routine. I have combed through Mr. C’s chart, and I know which questions to ask and which parts of the physical exam to target. However, I soon discovered that I was emotionally underprepared to meet Mr. C.

“Can you tell me what brought you into the hospital yesterday?” He answers, but his speech is slurred. I do my best to understand him. I lean in closer, and make a more conscious effort to listen. My ears strain. However, his tongue wanders countless paths of guttural, labial, and palatal sounds, unable to link together the consonants and vowels that form the words of existence.

I ask him to repeat himself. I can only comprehend a handful of his words. So, I start asking him questions that can be answered with a yes or no. “Have the symptoms improved overnight?” He shakes his head no. “Are you feeling any numbness or tingling?” No. “Headache?” No. In this manner, we proceed.

“Any dizziness?” He ignores this question, and instead starts speaking passionately about something, his body language is intense, his tone of voice is pleading. I can tell that he is trying to communicate something that is important to him. “I’m sorry Mr. C, I do not understand.” He repeats himself.

“Mr. C, do you want a piece of paper to write on?” No. He is right handed, and now cannot move that entire side. His right arm has remained resting limply next to him since I entered his room. His motor strength is 0/5.

He continues to speak, but the meaning is caught somewhere between my sympathy and his frustration. He soon begins to tap on his head fervently with his left hand, showing me what he wants. There is a combination of rage and defeat in his eyes. I finally realize what he is saying. “Stimulate my nerves. Fix this.” He wants a surgery to regain his strength and speech.

His request hangs in the air, eagerly awaiting a response. I am heartbroken; how do I explain to him that there is no procedure we can do? He is out of the window for therapy.

On my application to medical school, the last sentence of my personal statement was, “I hope to one day learn the art of compassion that makes being a physician so rewarding.” Over the past three years of medical school, I have realized how easy it can be to focus on lab and imaging results, complicated medical histories, differential diagnoses, and preparing the perfect presentation for my attendings.

It has become too easy to forget what that starry-eyed pre-med three years ago really wanted out of her career. By listening to Mr. C’s dysarthric words, I relearned that the humanity in medicine is what drew me to the field in the first place. I never want to forget that patients are not just a set of medical symptoms and physical exam findings again.

-By Preeya Bhavsar, third-year medical student at Baylor College of Medicine