A Radiologist Who Held Space

Posted by Devendra Tayade on Feb 15, 2018
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[Last week, we had a stirring call with doctors. It was the third of our six weekly calls as part of our Laddership Circle for doctors, and the theme we explored more deeply was on "holding space". Venu Julapalli, a gastroenterologist who's co-conspiring a Health 3.0 movement and a thoughtful member of our circle, shared a stirring encounter with an "old-timer " radiologist who simply held space. Below is a transcript of his story.]

My friend had an experience around the death of his father. He had a decision to make in terms of withdrawing support and his family convinced him to withdraw it. Medically, after he told me the details, I think it was the only decision he could have made. But he had never forgiven himself for essentially -- in his perception -- giving up on his father. By pulling the plug, he destroyed himself for it for years.

As he was telling me about this, it hurt me, because, I mean, it called to mind my story of my mother who had ruptured a brain aneurysm and she survived. She's slowly recovering now, but she had moments where we didn't know if she was gonna make it. You know, talk about uncertainty and impermanence. I mean, I think so much of medicine is uncertainty and we have to, as professionals, grapple with how we handle that uncertainty. I wouldn't wish this on anybody, but it was not until I actually had to go through that personally -- you know, beyond professionally, with my own family member -- that it really comes to home. It's like, ok, bam! Ruptured brain aneurysm. Within one hour, unresponsive. Has emergency surgery. Survives. But now is in a coma. What's next? There are no immediate answers forthcoming.

In one dark situation we had a scan. It was an angiogram that she had had done, and we wanted to get a second opinion on it. So I called up a friend of mine who knew a very prominent interventional neuroradiologist in town. So we sent these films -- or these digitized images -- to him. We called him back in the afternoon, after he had looked at him. My brother was on the phone talking to him. I just hear my brother's side of that conversation. My brother's a pretty stoic guy, but at the end of that conversation, he just hangs up and collapses to the ground, just in tears.

I said, "What's going on?

He said this neuroradiologist told us he looked at the images and there was, in his eyes, this total lack of perfusion in one area of my mom's brain, in the pons area. And he told us, in his opinion, even if my mom survived, she was going to be essentially like Sleeping Beauty. She wouldn't be able to move, and in the end, she would mostly be asleep. In the moments where she might wake up, she wouldn't be able to move. And then she would just fall back asleep. This man said that was the way it was just going to be for the rest of her days.

So I mean, I collapsed along with my brother. It's just like, what do you do now? How do you go past this?

There was a very trusted radiologist in our own hospital, who's like an old timer radiologist an old-school guy who had known my dad for 25 plus years at this hospital. This was our hospital. We were like family there. I called him up and it was kind of a bizarre conversation, because I knew that he had already talked to the radiologist who we spoke with on the phone, that we got the second opinion from. So I knew that our local, old-timer radiologist, knew what he had already said. He didn't want to say that to me, but I already knew that they had had that conversation. And, in tears, I asked what we all get asked to as physicians at some point, sooner or later. But this was now very literal.

I asked him, "If this were your mom, what would you do? What do you do?"

And I will never forget how he handled that. He paused, he held space with me and he goes, "Your mom has the face of an angel and you know, you're a good kid." He likes to call me a kid. "Because you're a good kid. I would do this. I would do this procedure."

There was a procedure that he had the technical skills to do, but he'd never done it. So we were debating whether my mom should go through with this procedure. So that's what I asked him, I said, "Would you do this if this were your mom?" And he said, I would do it if this were my mom, I would do it. I want to do it for you because you're a good kid and, and I want to honor your dad."

You know, in that moment, he helped me. He helped me and, in terms of that topic of treating vs. healing, he did the procedure. I could say that, medically, it probably did nothing. Just the act of him pausing, reflecting and giving that treatment -- it was not about the specific treatment that he did (which he did, and he had the technical skills to do it). It was just that he held us. He held us and that was the healing that we needed to get past that dark moment.

In time, my mom recovered. She's still not walking, but she is awake and alert and has conversations with us. She can hold our kids, her grandkids.

I saw in that moment -- with this radiologist, this godsend of a human being -- the power of just holding space, regardless of whatever ends up getting decided. It was such a touching moment to me. And I take that now to my own interactions with the patients that I see it. It was just a gift.

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Comments (5)

  • Larry Hulbert wrote ...

    Thank you Venu for this truly inspiring story. I'm sending a smile that comes from way deep in my heart!

  • Hasmukh Sapnawala wrote ...

    Venu - Wow! Wow! Wow! What an amazingly memorable gift you shared with us. Thank you for sharing.

  • Birju Pandya wrote ...

    wow!!

  • Guri Mehta wrote ...

    Thank you for this deeply profound share.

  • Ariel Nessel wrote ...

    Thank you for providing a kinder context that allows me to see the positive side of patriotism, of which I have felt judgment. Much other wisdom for me to chew on!