Moments of Clarity: Looking into a Mirror (Tic Disorders and Heart Attacks)


I don’t think a lot of us think we are, I think a lot of people sometimes don’t think we are, but, we definitely are, mostly against our own free will, Only Human. Just like an angsty teenager going on a joyride in their parents’ car when they turn 16 to take on the world, sometimes we feel invincible. Sometimes we feel as if illness does not affect us. Sometimes we are in denial. Sometimes we are bad patients. But, we are not God/gods. We get sick, we experience remorse, we break, we fall and eventually, we die.

I thought about this particular post several months ago when I had two patients, in the same day, come into clinic for things that were all too familiar to me: New onset of facial grimacing and winking, for one, and a father that had just died from a heart attack, for the other. The old adage of only being able to really know someone after walking a mile in their shoes was not lost on me in these small interactions. My medical assistant roomed the patients back to back and came out and told me, “Trevor, this one’s perfect for you, he has some sort of new tic!” “Trevor… This is this one’s first visit in a long time, his grandma brought him today and told me that his dad just died over the summer, just dropped dead when they were at work together.”


The first boy in middle school had suddenly started doing an abnormal thing with his face. He would turn and wink, without really paying a lot of attention to it and it would only happen when he was awake. As is common for new onset tics like this, it bothered his mother more than it bothered him. She would notice that it would get worse throughout the day as he got tired, that it didn’t happen during sleep and that really he was otherwise fine; but, she was still concerned. I walked in cautiously, sat across the room and watched as he surely would blink his eye and his face would move on one side with a quick minor movement of his head to the side. It wasn’t a seizure, his neurologic exam was normal and he otherwise looked like a healthy energetic middle schooler.

I paused. I reassured. I told them the same thing that my doctor had told my mom when I was the same age and my eye started to twitch, when my throat clearing became worse, “It’s nothing to worry about. Drink lots of water. Most of the time kids will grow out of this.” For me, I never did. As I went through highschool and the stress from rigorous college preparatory Jesuit education subconsciously molded my development, it got worse. One year as a camp counselor at Muscular Dystrophy Camp, some of the younger campers unabashedly even pointed it out, “Hey. Why is your face doing this? *mimics twitch.*” By the time I got to college, I would turn my neck and move my hands in a weird snapping motion. Once, it got so bad after a night of little sleep that I was twitching so aggressively I could barely keep my eyes focused on the road to drive. I saw a Neurologist at the time who recommended an antipsychotic versus a serious blood pressure medicine – both off label for my Tic Disorder. Given the strong side effects at the time, I declined. In my 4th year of medical school, my tics got worse – it surfaced as a possible breathing disorder and I would hyperventilate at night-time without noticeable life stressors or changes at the time, ha, other than becoming a doctor. One physician told me to rush to the ED, he thought I had a pulmonary embolism! I was terrified. In retrospect, as a physician now, I realize how asinine of a diagnosis that had been, but at the time I didn’t know what to do. Luckily, it obviously wasn’t. I got a second opinion from someone that took a very thorough history and was shifted towards a new Neurologist that told me that it wasn’t just a Tic Disorder but that I had Tourette’s Syndrome (the latter being differentiated by my throat clearing vocal tic + the motor tic). At this time, I decided things were affecting my life enough to start medication and although things have gotten better, it still hasn’t gone away. Worse in times of stress or sleep deprivation (aka being a Doctor) and better with alcohol and distraction (aka focusing on procedures), it’s become something I live with. Only Human.


The second boy, a teenager, came in for a check-up since he hadn’t been in years – yeah, believe it or not, you’re supposed to go yearly to the doctor… I think it’s even recommended for adults! Even adjusting for being over 6 ft tall, he still fit the criteria for being morbidly obese and having extremely elevated blood pressure and likely Metabolic Syndrome. He had been brought in because ~1-2 months prior he had been working with his dad in the field (to remain discrete, i’ll narrow the job to something outdoors in the summertime), he watched him suddenly drop to the ground and stop breathing… He was stranded and isolated far in the countryside and it took over 45 minutes until the ambulance even made it to him. Forty-five minutes clutching him in his arms.

I paused. I remember waking up on a Saturday morning my junior year in college to hearing my sister hyperventilate on the phone that, on the way to my brother’s high school graduation, my father sitting in the passenger seat turned to my mom and said, “I think i’m going to pass out.” The last words I’d heard he’d ever said, I rushed as fast as I could to the airport in San Diego to fly back to Sacramento, but despite an hour and a half of rigorous attempts at resuscitation, I got a phone call from my mom while waiting for the flight that, “… he didn’t make it.”

A Cardiologist dying from a heart attack is one of the most ironic things. Only Human.

So, against our will, it is important and more and more recognized as time goes on, that Doctors are first and foremost humans. I share my long list of vices just like everyone else. I’m not perfect. I get sick. And, someday, I will die. As much as I wish I was Superman, an invincible human masquerading as a human, I am much closer to Batman, a human masquerading as a hero – thanks to Kill Bill for the concept. I am not above the law, I am not special and I have a healthy respect for Mortality.


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