Cerebrum Article

The Value of Vulnerability

Clinical Corner
Published: July 15, 2021

While on the ski team a few weeks into my second semester of college, a failed backflip off a jump resulted in me waking up two days later paralyzed from the chest down. I faced my new reality with feelings of terror, depression, confusion, frustration, and anger as a medical team graciously put up with my sullen mood and answered endless questions. Eventually, I channeled my energy into my inpatient rehabilitation, motivated by defying the odds of never walking again.

During a year off, I did a lot of soul-searching, trying to hold off negative thoughts while contemplating the road ahead. Loved ones suggested that I attend a community college close to where I grew up in New Jersey. But I was determined to return to the University of Virginia (UVA), where I had been an engineering major. Further inspiring me were my two younger, teenage brothers who carried me up the stairs to bathe, to the beach to swim, and to hit the ski slopes again. They showed me that I could live a fulfilling life from a wheelchair.

I eventually graduated from UVA with a double degree in cognitive science and biology, then took a year off to work with spinal cord injury patients and on exoskeleton research at the James J. Peters VA Medical Center in the Bronx. Those experiences put me on a path to pursue a career in medicine, not just to help people with spinal cord injuries, but people with other diseases as well.

Fast-forward 14 years as I embark on a neurology residency after having completed an M.D./Ph.D. program at the New Jersey Medical School in May. Although each patient experience is different, I have found that sharing my own story with patients on an almost daily basis and providing a practical, honest assessment (especially to stubborn, adolescent males who have just been told that they have lost use of about half their body) has made me a better doctor—and helped a variety of patients in their own journey to recovery.

Since I use a manual wheelchair, my challenges are obvious to patients, and this can often be used to facilitate empathy and rapport. I met a man in his 40s who was in outpatient rehab several months after having a spinal cord infarction that left him paralyzed from the chest down. Like me, he was forced to also use a manual wheelchair. After his outpatient psychiatry visit, I shared my story with him. His anxiety about navigating the world in a wheelchair, future relationships, and various other issues came pouring out.

But I have found that sharing my experience and showing vulnerability also helps other kinds of patients. A woman in her 60s who was suffering from partial paralysis a few days after a stroke was angry at the world. She responded to questions with short, curt answers, unwilling to disclose what she was thinking or feeling. I again shared my story, telling her about the myriad of emotions I had felt and how, even though our circumstances were different, there is a life after a hospital bed—a life that can be immensely fulfilling if you’re willing to stay positive. Slowly, over the next few days, she started to open up to her family members and caregivers and begin the road to recovery.

Although not every medical provider has a re-defining story like mine, most have internal motivations for getting into medicine, be it from personal struggles or via family members’ challenges. Common medical wisdom is to maintain professionalism, and in certain cases, distance is needed to sustain oneself from the many heartbreaks and crushing outcomes a physician can experience. But a delicate balance must be struck between complete detachment and over-sympathizing. This balance requires continuous reassessment to make sure the equilibrium is maintained between the two in order to keep humanity in medicine.

I know firsthand that, after a new diagnosis, it takes time for a patient to realign their internal representation with their new external reality. Whether it’s grasping unfamiliar circumstances, expressing feelings, or accepting the isolation that often accompanies an unexpected condition—all factor into the equation. Merely signaling to a patient that you are aware of the difficulties builds a connection and encourages healing. It is human nature to want our experiences validated.

Next time you’re given the chance, consider sharing a story that shows your own vulnerability. Whether or not it’s medically related, you just might find those few minutes to be well worth it.

Tom Pisano, 33, recently graduated from the Robert Wood Johnson Medical School and New Jersey Medical School with both a medical degree and doctoral degree in neuroscience. He will spend his intern year at Mount Sinai Morningside-West, followed by a residency at the University of Pennsylvania’s Department of Neurology.

This article first appeared in the Summer 2021 issue of our Cerebrum magazine. Click the cover for the full e-magazine.