A Journey to Kale and Quinoa

Michael, a man in his late fifties, presented to my emergency department with left-sided arm and leg weakness suggesting a stroke. The symptoms began the night before, but he was still able to walk. He got himself to bed, neglecting to mention anything to his wife Dana. The next morning, he woke with a headache and his weakness had worsened. He was no longer able to escape his wife’s attention. On presentation, his blood pressure was markedly elevated at 207/112. His exam demonstrated mild left arm and leg weakness and subtle sensory changes. His workup was normal except a head and neck CT angiogram with scattered atherosclerotic disease, with no stenosis or brain ischemia. An aspirin was given and his blood pressure managed.

Michael had only visited with a physician twice in twelve years. His misconception of health as the absence of a named disease led him to avoid doctors. He, like so many of our patients, had central obesity, the result of a typical American diet and lack of exercise. He admitted to stress related to work. I learned weeks later that the source of much of his stress ran layers deep.

Convincing him to be admitted to the hospital that night was a challenge. Providers often approach this issue with a lecture about the horrors of what might happen should they go home, followed by an equally useless AMA (against medical advice) form to sign. Patients’ reluctance to be admitted is often based on a lack of trust and fear. By listening and engaging him in a dialogue, Mike ultimately made the prudent decision to stay.
Michael and his wife approached me during this initial visit regarding a practice outside the emergency department. Still to complete my Fellowship in Integrative Medicine and with a new consulting practice in its infancy, I offered them nutritional education gratis. Several weeks later, I received a call from Dana. I learned that Michael woke up the day after admission with profound left sided deficits. He was eventually discharged to the Elks Rehabilitation where he regained enough strength on his left side to walk and grip a cup.  

Michael was now home. When I arrived at their house, he was walking slowly and wearing a gigantic smile. Despite the obvious deficits due to his stroke, he appeared healthier than I remembered him. First his wife gave him a giant nudge.

“What did you want to tell her?” she repeated several times.

“Thank you for making me stay the night in the hospital.”

He was eager to tell me the valuable insights he had gained as a result of his stroke. He was working on greater self-acceptance and openness. He was “learning to let go.” Previously, his work as a construction supervisor required travel out of state. He possessed a fierce caretaker mentality, worried about the workers on his team and his wife, who was home alone on their Idaho ranch. Now he allowed himself to be cared for and, under the dutiful watch of his loving wife, he had returned home earlier than his physician had planned.

He told me that, before his stroke, he never would have considered kale or quinoa or any of the foods I prepared for him that day. He confessed that he had not slept well the night before my visit, fearing beets.

We stood around the Brazilian granite island in their kitchen while I prepped five different dishes, all containing functional foods: vegetables and fruits including kale, spinach, zucchini, sweet potatoes, micro-greens, berries, grapes, beets, whole grains including farro and quinoa, EVOO, beans, omega-3 enriched whole eggs and organic chicken sausage. Mike approached each dish like a young child trying a new food. He’d take a spoonful and then think about it for a bit. “It’s not not good” he’d say. He then would eat eagerly, just shy of licking his plate clean.

Over the course of those three hours, we shared stories.

Mike acknowledged that he had only one beer since his stroke. Prior to the stroke, three to four beers in the evening was the norm. “Alcohol was not a problem.” I got that knowing look from Dana and a loving, “We’ve talked about that.” Visits with friends had been few, with the most noticeable absence being his drinking buddies. He acknowledged that this was difficult for him. But without the elixir of alcohol and this community of friends, the emptiness had made room for a deeper relationship with himself and with his wife.

I shared my own experience of losing my partner to an alcohol-related motorcycle accident. Mike then shared that he had lost his daughter, a mother of young twins, to a combination of alcohol and opiates two years ago. This loss was further magnified when their son-in-law decided to move with the children a distance away to be closer to his family. The twins had been frequent visitors on the weekends. Since their mother’s passing, Mike and Dana had only seen them a handful of times.

Carolyn Myss, a medical intuitive, said, “Biography–that is, the experiences that make up your life–becomes your biology.” I suspected Mike, the dutiful caregiver and consumed with work, hadn’t allowed himself to truly grieve the loss of his daughter. Intuitive Medicine, along with the world health traditions, including Chinese and Ayurvedic medicine, would support a connection between that loss and the development of a stroke. Mike made me more mindful of my own grieving process and the importance of self-compassion and self-care.

When Mike was still in rehabilitation, his wife would frequently take him outside in his wheelchair. One day he met a man who was there for a follow up visit, waiting for his ride home. During their short conversation, the man shared that he had had a stroke just like him. This man was standing before him, without any functional deficits. Before this, Mike lacked optimism about his future. No encouragement from a physician or nurse was as powerful as that of this stranger who had been in his own shoes.

Michael is one of many Buddhas that have come into my life. Like Herman Hesse’s Siddhartha, our best journeys often take place close to home and our best teachers are often the most unsuspecting. “Life is not measured in time, but in progress,” a line I adopted from a dear friend, “We can know someone for ten minutes and they can affect our lives forever and we can know someone for thirty years that doesn’t even come close.”

I continue to challenge my personal beliefs as they relate to how we communicate and care for  patients. Traditional medical training provides physicians with the tools to care for patients with acute disease processes. Many of our patients do not have measurable causes to explain their symptoms, and often there are no easy solutions. Learning a more integrative approach to patient care, patient-centered, addressing the mind, body and spirit, has the real potential to fill this void.

 

Amy S. Baruch, MD (@amy_baruch) practices Emergency Medicine at St. Luke’s Hospital in Boise, Idaho. She is currently completing the Fellowship in Integrative Medicine at The Arizona Center for Integrative Medicine through the University of Arizona College of Medicine. Amy continues to be inspired by her older brother, Jay.

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