126 Healers

My memory begins in April of 2023. I am a practicing physician, a general internist in primary care at the University of Michigan. And my whole life has really been in both the care of patients in interprofessional teams that I work with at the VA, and also as a leader in higher education at the university. I've had roles in the internal medicine residency program and as Associate Dean for Medical Student Education for over a decade. In April of 2023, I had been 18 months into a new job where I started directing a center that focuses on interprofessional education and teamwork.

And so my story begins after I had come home after being with my friends at a Detroit Tigers baseball game where we had just beaten the San Francisco Giants on a walk off hit in the bottom of the 11th inning, and it was super exciting. It was about midnight when I got into bed. 

What I remember is that around three o'clock in the morning, I felt like I was dreaming, but in retrospect, I don't think I was because I had this incredible searing, piercing pain right behind my right eye and my right forehead. What I do remember is around six o'clock in the morning, so about three hours later, I woke up. The room was spinning. It was dark still as it is at six o'clock in the morning in the middle of April, and the room was absolutely spinning. And I was feeling nauseous and I fell out of bed. I didn't know exactly what was happening, but I had had a vague understanding of what was happening because I had been diagnosed many years previously with a disorder called Meniere's disease where I would get occasionally periodic bouts of vertigo. And it felt just like that. And I hadn't had an episode in a number of years, but it felt very familiar to that.

So I crawled, I had to use the restroom, so I crawled to the bathroom and crawled back because I could not stand up at all. And I didn't know exactly why, except I knew the room was spinning. So I felt it was that. And in my head, I was thinking, oh dear, this is what I, I guess I'm having another attack. I hadn't had one in a while. And I said, you know, I just wanted to not deal with it. So I said, okay, I'm just going to go back to bed. 

I guess I was able to fall asleep because then I woke up at nine o'clock in the morning. But it was still there. The vertigo was still there. It was really, it was really intense. And I looked out the window and I could not see anything. I was still lying in my bed. My wife was at my side and I told her, I said I think I'm having a Meniere's attack. And she immediately sprung into action and dusted off medications that I would take for that, which included antihistamine. At times I would need a Valium in order to try and break the episode. She remembered it even though it had been probably maybe seven, eight years since I had had a previous episode. 

I found my way downstairs, but I still couldn't walk. I had had this sort of weird ringing in my right ear, which was a lot worse than it usually was. I was taking my medications, and it just wasn't working. Nothing was getting better. And I was turning to her and saying, you know, this is really long for a Meniere’s attack. I started feeling something weird in my face. The right side of my face started going numb and the left, my left leg started going numb as well. And as a physician, and my wife is a physician as well, I asked her to come into the room and I looked at her and I must've had this real look of fear. And I said, I don't think this is Meniere’s. I think I might be having a stroke. 

Rajesh Mangrulkar, MD, FNAP

So we activated all of our, you know, activated all of our resources at that point. I said, I have to get to the hospital. And in my mind, I was now thinking, my goodness, this had started at least 12 hours ago. And part of me was just petrified because we're always taught that minutes make the difference in people with strokes because you want to open up the vessel as soon as possible. And I was already 12 hours into that.

They, my son had to carry me to our car, put me in the car, and then drove me to the hospital where the stroke team was activated, and I underwent an emergent workup. And I'll never forget, it was sort of two o'clock in the morning when everything had come back and I didn't know exactly what to expect, but my worst fears were confirmed. It was a, it was a brainstem stroke. They also saw that I had what looked to be a vertebral artery dissection where part of my vertebral artery in the back of my head had torn and had clotted off. They could see the vessel, the brainstem, that was the medullary part of the brainstem that was involved, was very much in the territory of where this blood vessel was going. 

So they admitted me into the university hospital onto the stroke floor. You know, everything was kind of a blur at the time, but I do remember the next morning when I started getting evaluated, how like incredibly affected my physical exam was because I was also a student of the clinical diagnosis, but I had horrendous, not just vertigo, but I had incredible… I had diplopia at the time. I was seeing double vision. I couldn't walk without any kind of just, I needed to be propped upright. And occupational therapy was starting to evaluate me. Physical therapy was starting to evaluate me. The nurses were there. I'd already had a social work visit that first morning and the physicians were there. Residents, just so many, so many different professions. And I realized at the time, it was that next morning where the irony struck me. I said I'm getting care by an interprofessional team. And that was my job, was training people to work in interprofessional teams. So some part of me was sort of like dissociated from my body and what it was going through and thinking, wow, this is a really interesting experience for me. I'm seeing what it's like on the inside and I'm seeing exactly what I'm trying to work on with my team and helping students and learners learn how to work in these teams.

And it became very clear that after 24 hours, I just started, I remember saying this, I said to my physician, I said, I feel like I'm extraordinarily lucky based on where this blood vessel is, where my stroke is, and where it could have been. Just with like a millimeter difference. And my neurologist said, you're absolutely right. This could have affected your speech. It could have affected swallowing. It could have affected breathing. It could have affected so much. What was also, I was starting to feel grateful about was, I was healing and my body was like reconnecting faster than I ever expected it to. In fact, there was debate around day four of my hospitalization, whether I could just go home to recover as opposed to what a lot of people who have had a brainstem stroke get, which is going to an inpatient rehabilitation unit. Now, inside, I desperately wanted to go to rehab. I did not want to go home. I didn't feel equipped. I still, I had just barely started to use a walker. I wanted to commit myself to intensive work now as opposed to less intensive work over a longer period of time. I just had this sense that I was gonna be able to heal so much better with that. 

At that point on day five, I was sent to the rehab hospital. So I'd moved from University of Michigan where I had gotten such amazing interprofessional care. And then I moved to Chelsea rehab where I felt great. I felt so optimistic. I felt grateful, optimistic. I was committed to doing the rehab. I was admitted there. It's a beautiful place, there were gardens, it was spring. You can imagine now what April sort of 19th and 20th felt like. With supervision, people could wheel me around. I had to be supervised for everything. And when I say everything, I mean everything. That included bathing. I had to be supervised and I could barely sort of keep myself upright early on. But I was definitely getting my strength back. But changing bathing, all of these things, I needed supervision. And anytime I would go to do my rehab, I had to be taken there. 

I remember those first two days because I'm, it was a bewildering array when I was in the rehab hospital of people that I met and each of them spent time with me and tried to get to know me from my rehabilitation physicians to the residents and to the students, to our every nurse that came on shift, to nursing students, to our social workers, to physical therapists and occupational therapists, to the front desk staff, to the transporters, to the people who brought in meals for me, to the people who cleaned the rooms for me, to my speech and language therapist and my recreational therapist. Everyone would spend time in those first two days really asking me questions about who I was, not only what brought me there, but what motivated me and what kind of work do I do, and what's my family like, and what do I love doing? And I found those questions, like really both jarring because I started asking myself, how often do I ask those questions of my patients? And as a primary care physician, you do get to know your patients over time. But I realize these folks were trying to develop a relationship with me about my whole self, not just my stroke self. And by doing that, I felt heard and seen as a whole person. So I started talking a lot about my life as a physician, but also… As a person who cares deeply about education and training. As a husband to a phenomenal physician and woman who is a family physician. To my kids, my four adult kids, who are like incredible souls and amazing people to be with. And I would tell stories about them and what my life was like. To my parents who are immigrants to this country. To my sister who visited me frequently, lives in Ann Arbor and is also sort of an educator. Anyway, I got to share all of this with them.

And I'll always remember that one of my… both my recreational therapist and my speech therapist asked me questions like, well, what do you love to do? And I said, well, I love baseball. The very last fun thing I did before I had a stroke was I was at a Tigers game, and I just deeply love teams, and I love baseball as a sport. 

And then I also said, I really love music. I'm not a musician myself, but I absolutely love music. My four children are all musicians, professionals. Two of them are… two to three of them are professional musicians or have gone to music or musical theater school. I don't have talent, but I love music. It's always been around in our family. We've always been playing it. So anyway, I talked about it I think they saw that like my eyes lit up when I talked about. That was, that was notable to me, and other people asked me other questions about my life. And I really… those moments really stuck with me. 

But where it really kind of came to a head, I remember thinking and this was kind of on day two in the rehab hospital. My first day was just exhausting. My second day, I was so committed. Second, third day, I was just doing the rehab work, and I just saw my body was kind of getting better. But I was also really fatigued. And as someone who has sort of made his way as a physician, I have a pretty strong work ethic. And I was just, I just said, I'm going to apply it to me. And I was trying to be, I'm also sort of naturally an optimist. And when I was interacting with my kids who were, I'm sure terrified of what was happening to their father, who was only 55 years old at the time. And my wife, who's probably scared, but trying to channel her optimism, I felt like I wanted to be in that vibe of optimism and commitment and just being, I'm going to do this. I'm going to lick this. I'm going to get through this. I'm going to do the work of the rehab because I know that works and I'm already seeing improvement. 

But in the back of my mind, I was also remembering how strokes and heart attacks often lead to depression. I had that in the back of my mind. Like there's an association and it's not, the understanding is that it's not purely that you're sad about what you're going through, that there's actually an endogenous neuro-cardiovascular link that puts people who have these conditions at a higher risk of depression and anxiety. And I didn't know if I was going to have that, but it was in the back of my mind and I kind of felt like, I'm going to channel my optimism. I didn't feel like that was going to be relevant to me

But it was day four, and I remember waking up completely, not just exhausted, but in tears, sobbing and completely unmotivated. I felt so much of a sort of a complete opposite feeling when I had woken up that morning than what I had felt going to bed that night before, which is I felt exhausted, but fulfilled the night before. I was making progress. That morning, I was unexplainedly exhausted and sad. And sad isn't even the right word. I was really almost despondent and hopeless at the time. 

I sort of made up some excuse that morning why I wasn't going to go to physical therapy. I sort of said, you know, I'm just really exhausted. But I realized that I had been exhausted before, but I wasn't sad. This time I was exhausted and depressed. And I told them I'm not going to go to physical therapy because I'm just exhausted and can I have a break? And they said, of course, we can do some bedside stuff later on in the day. And so I said, okay, that would be good. Because I was expecting it to pass. 

And then the afternoon was going to be bedside speech therapy. They had, I don't think they had known that I had canceled my morning therapies because I would, I thought I had said, I'm just canceling everything today. And so they walked in and I remember looking at her and I just started saying, you know, I'm just not up to it right now. And she said, oh, can you tell me what's going on? And I just started saying, you know, I'm just really exhausted and I'm not really up for any kind of therapy right now. 

And I remember she was the one who was kind of the first one that day who kind of normalized what I was feeling. Because I hadn't really known what to expect. But she said, very clearly, she said, you know, there are up and down days for all of our patients in the stroke rehab unit. Does this feel like a down day to you? And immediately I cried. Like it was like, it was lingering right at the surface at that time. It was, it was just there. I just was kind of putting it off and I was trying to be optimistic or just brushing it aside, but it was right there. And I just, I just started crying. It was hard to find words as to what I was feeling because it felt so irrational, what I was going through because I had felt so good the day before and I was making so much progress. 

So I said, you know, I had, was breaking up and I said, yeah, it's a horrible day. I feel like my whole identity is threatened. I'm a physician. I'm a father. I'm a spouse and I'm a son and I'm a brother and I'm a higher ed administrator and I'm a teacher and I feel like I'm, I don't know if I'm going to be able to be any of those things. It just, and I know I'm making progress. I even like, I think I expressed, I felt, it felt irrational. 

And I was saying this to my speech therapist and just, she just opened the door and it, I walked into the door. I walked into that open door. I'll never forget. She was just there. She had her hands on her lap and then she put her hand on my left hand. She was sitting on my left side. I was lying in bed. She put her hand on my left hand. And she said, this does sound like a really down day for you. I just want you to know everyone goes through this. You and everyone has an up day soon after a down day, but we're here to be with you when you are up and when you're down.

And that just was, I felt like the mood I felt at that point was just profound relief, because it almost felt as painful as the stroke had been itself. Like it had been since seven in the morning till like two in the afternoon. I was feeling this intense pain, but it was like a psychic pain that I couldn't put words to. 

And so then she said something that I'll just never forget. She said, you know, Raj, when I first met you just a few days ago, you said that the thing that brings you joy is sports and music. What if our speech therapy today was music? My eyes kind of opened up. Like I remember feeling a little inside startled by the suggestion, but like immediately I wanted to hear more. It wasn't like a rejection out of hand. I said, oh, because it was going to take me from where I was into a space that I knew gave me joy. Cause she had asked that question of me a few days ago and she remembered it. And I said, can you do that? And she said, we have a karaoke machine. It's actually karaoke day today. So we have someone that'll come in and do karaoke in like a couple of hours if you want to do that.

And I immediately, like tears welled up in my eyes and I knew, I like knew it in my heart that that was gonna help me. It wasn't a, like a logical thing. I just knew it was tapping into a part of my heart and my psyche that I just knew was gonna help. And I just like immediately said, oh yes, yeah, let's do that. 

And you know, I, we actually have a karaoke machine at home, and we had hosted karaoke nights. It was like one of my most favorite memories of being when I was Dean for Medical Student Education at the school. I had put as an auction item karaoke night at our house for the medical students to bid on. And so they bid on it and four students won it. And then they brought six other students and we had 10 medical students in my family room with my kids, with my wife, and we were all doing karaoke together. And it was like such a magical, amazing night.

So karaoke was like in me, like I knew it. And so she somehow, and I had never mentioned karaoke. So I don't know that it was like, it wasn't like I had said, I love doing karaoke. I just talked about my kids and how much we love music and how music is already always a part. But the karaoke part in her mind was not only what was in my heart and she knew would tap into what I love doing, but also it was speech therapy. And I can imagine, it was like voice therapy. I can imagine if you're a voice therapist, that singing is, you know, mobilizing the vocal cords and mobilizing everything that's needed, the lungs, the lung capacity, if you do it correctly. 

So two hours later, she came by and the recreational therapist came with her and they wheeled me down to this wing in Chelsea Hospital on the stroke unit where there were other people that were there, other patients. There was like three or four other patients, all of whom had had some form of a stroke. And I realized at that time, I think I knew it, but I hadn't recognized it. Just how young I was compared to the other patients there. They were all in their seventies and eighties. And here I was 55 years old in that same room with them. But we connected on this music.

I had already, my mood had lifted looking forward in those two hours, but then they thrust that microphone in my hand. They said, what song do you want to sing? And I like love classic country music, and I love music that tells stories. So I chose one of my favorite songs of all time, which is Kenny Rogers’s, The Gambler. 

And so then I sang it. It was, you know, I had had what was called, I had had diplophonia also, like I had, because of the stroke, I had had sort of some wavering, some laryngeal, some problems with my larynx that was just not coordinated well. So that's why I was going through voice therapy. I had had profound hoarseness, but also two sounds coming out when I would sing or when I would speak and sing. My vocal voice wasn't, my singing voice wasn't that great, but I was on key and it was almost Kenny Rogers-esque. I was recognizing I'm like, I'm kind of singing like him because I'm sort of gruff and hoarse and he's got that gruff hoarse voice that immediately endears you to him as a storyteller. 

And I sang the whole song. There was no more tears at that point. It was just pure joy. It was a pivotal moment. I, you know, my mood elevated so much and it stayed there. And I honestly didn't have another down day. I did karaoke during that hospital. I was in the rehab hospital for 12 days. I did it four more times, three or four more times while I was there. 

My birthday is on April 25th. So I celebrated my birthday in the hospital and my kids knew that I was doing karaoke, and so they gifted me a small harmonica as a birthday present in the hospital. So then, one of the karaoke sessions, I brought my harmonica cause I can play just a little bit and played it to Piano Man that Billy Joel sings. We did Piano Man and I would play the harmonica solo and sing. 

And it was just like, it is the most searing enduring moments of my time there. I can't imagine what I would have had happen had a few things not happen. 

The first is this incredible interprofessional team that took care of me listened to me and saw me as a whole person and asked questions with curiosity as to what made me whole. 

Second, they remembered.

And third, they then acted and nudged me when they could just as easily have said, you know, maybe next time when we do karaoke, you might want to do it and we'll pause. We don't have to do speech therapy today. She said, Nope, two hours, we're doing it. Do you want to do it? Leaned in and asked me that question. It was so powerful and then followed through. And it was, it was like a magical moment for me. 

And it has really kind of left indelible marks on me in so many different ways. But the most important thing that I think I took away is, I wasn't there as a patient. I was there as a person who had a stroke. That's very different than being a stroke patient. 

And I know we adjust language. We've been trying, and this is sort of as my role as an educator. You're not a heart attack patient. You're a person who has heart disease or had a heart attack. But that language pivot has to be, like I didn't quite feel it as much as a physician as I felt why we have made that language pivot than when I felt it as a, as a person in the hospital. Like I was, I was a whole person. I encountered, I kept track of everybody that I met during my four days at U of M and my 12 days at Chelsea. And over 16 days, I met 125 people, and I still have their names in a notebook. And I had their roles and they were from, they had 26 different roles or professions. Those were the people that healed me. I did a little, I did work myself and of course my community, my family, my friends, they supported me immeasurably. But those 126 people, I just am, like grateful isn't the right word. They didn't realize what small things they did made such a massive difference in my life at that time. And I wouldn't have healed the way I healed without them.