This piece is a combination of two assignments for my narrative medicine class—a patient illness narrative, and a “parallel chart,” detailing my thoughts and reactions as I interviewed the patient. Here, italics denote the parallel chart while the illness narrative is written in plain text.

"I had been healthy my whole life and then all of a sudden, I'm the patient."

As Dr. Steinweg begins his narrative, his voice is thick with something very specific. It almost sounds like embarrassment, or maybe the sound of someone explaining something they find obvious. I think another word to include is humility. Dr. Steinweg sounds like he is looking back on his former self like a child he loves.

It happened on a day when he was at work. As he typed, he started having pain. He felt it mostly in his back. He tried changing positions, but this didn't really help much. Dr. Steinweg went down the hall and got a drink of water. At this point in the story, he reflects on the stupid things people do when they can’t believe the obvious truth about what must be happening.


He begins the story in such a way that even though he hasn’t said heart attack, I know from the first sentence. I can hear the impending moment in his voice like he could feel the increasing pain in his chest.


Dr. Steinweg had been reassured by a normal cath two years previously after a new LBBB was discovered as an incidental finding. Beyond this reassurance, he had zero cardiac risk factors, so he soon left the hospital and walked into his clinic with a partner. He conversationally described his ongoing chest pain to his partner, whom Dr. Steinweg now believes must have been feeling awkward. Once upstairs, Dr. Steinweg asked a nurse to do a quick EKG to clear things up. The nurse got a physician involved before they started. The first EKG was normal, but they kept the leads on. The chest pain quickly receded soon after, which concerned the helping doctor even more. The normal EKG could have been reflective of the painless period, masking ischemia. But soon the elephant came back and sat on Dr. Steinweg’s chest again, and this time the EKG showed ST elevation in II, III, and aVF. The observing physician gently said, "Colonel, I think you need to go across the street. There's some trouble in the inferior wall."

All hell broke loose as the oxygen mask went on. A nurse called Dr. Steinweg’s wife, Nancy. He was transitioned to a stretcher and wheeled through his own waiting room.  Some of his patients noticed their doctor on the stretcher. He had a moment of reflection: "I really am a patient now." The pain reached a crescendo. Dr. Steinweg requested something to alleviate it, but the ambulance team said his pressure was too low. He quieted, reminding himself not to argue and try to be his own doctor. EMS drove him across the street to the hospital and called a heart alert. When they opened the back of the ambulance, there were six providers there waiting for him. The memory still moves him. There was a brief EKG in the emergency room, which immediately sent him to the cath lab. There, the physician reiterated that his low pressure barred the use of pain medication. Dr. Steinweg's internal monologue raced: "But why not try volume expansion to get my pressure up and then give me something?  An inferior wall injury pattern could mean a right ventricular infarct, which is very sensitive to volume." Instead, he said, "You're the doctor, whatever." The cardiologist dilated his radial artery, placed the stent, and the pain was gone. A cholesterol streak had ruptured, which can cause a patient to go from zero percent coronary obstruction to 100% just that fast. 


This moment should have been relieving: the placement of the stent and the resolution of pain. But I can hear hesitation in his voice like the other shoe is about to drop.


In his recovery, Dr. Steinweg was very well-supported. He received so many flowers they had to eventually close his room to visitors. He was in the hospital two days and then was allowed to return home. That was where "it got spiritual." Many years before, after having several patients die suddenly from coronary disease throughout his career, Dr. Steinweg had a conversation with God. He prayed, "If I have a choice, God, I'd rather die of cancer…this business of walking out the door and not coming back—" He saw the pain of families who experienced deaths like that and couldn't bear it for his family, so he bargained with God. "If it be your will, could my exit be cancer? That way, I have this precious time to bring my kids in and Nancy and have closure." That had been a prayer over many years. So when he got home from the hospital after his heart attack, he was angry. He sat on the couch, partly fuming, partly sad. "Why me? I was an athlete. Way out of bounds."


It’s demonstrative of Dr. Steinweg’s relationship with God that they can “feud.” I think a lot of people jump straight past having a tiff with God to “What kind of God would do this?” Dr. Steinweg really knows God’s character. They can disagree and Dr. Steinweg still knows who He is.


Ten days into that recuperation period, Dr. Steinweg realized something. "I think the message here is that when you leave the house to go to work, you ought to have everything taken care of, anyway. You shouldn't need to have cancer to remind you you're going to be leaving so that you can patch up your relationships. You're supposed to do that every day." He moved from being angry with God to being grateful, and mourning that it took a heart attack to understand this. When they began, Dr. Steinweg didn't know how he was going to spend his required two weeks at home. Soon, however, he found there was important head work to be done. He added, “Some people never get through that.” But the book isn’t closed on Dr. Steinweg’s story. He had a stent placed in the RCA that day, but the cath also showed that he has a 40% LAD lesion.


I now understand the doom that has persisted in his voice – he didn’t just survive an MI; he lives with coronary disease. 


That blockage occurs at a trifurcation that covers the entire left ventricle. “You can't stent that,” Dr. Steinweg reminds me. If that goes wrong, the story could be short. Even if he makes it to the hospital, he will receive coronary bypass. That rings around in his head. He is doing all the right things— statin, aspirin, and lots of exercise. For now, he is grateful the Lord has kept him here: To take care of his father, spend time with his "little brother" downtown, and to be with “Nan.” His hard-earned lessons stay with him, too, however. He now abides by the maxim, "Don't go to bed angry." He is better at maintaining relationships and he can now say, “I’m ready to die in that respect.”

His heart attack lingered in his practice, too. Dr. Steinweg told me about one of his patients, no more than 55 years old. He described a man (like himself) with no cardiac risk factors - buff, exercising, an attorney, everything going well for him. But about 15 months after his own heart attack, Dr. Steinweg got a call from the ED saying, "Your patient is here and he's infarcting."


Dr. Steinweg describes a patient just like he was – zero risk factors, and already he has so much empathy in his voice. He is already mourning his patient’s loss of self. He’s almost groaning as he describes the patient in his prime.


Dr. Steinweg went over to the hospital at the end of the day to see his patient. His goal was not to try to make him feel better; he just tried to be with him. Dr. Steinweg still remembers feeling disappointed in a friend who came to the CCU during his own infarct who couldn't listen. He just kept saying that everything would be okay. Dr. Steinweg says, “I was so disappointed in him because he was a good interviewer, but he couldn’t listen. He just kept telling me everything was going to be okay. I felt like saying, ‘Stop it. Why don’t you be where I am for a minute?’”  Then later, when his patient came into the office and sat in bewilderment, asking, "How could this happen?" Dr. Steinweg could feel this was an opportunity for true empathy. He didn't share that he had a similar story.


He intimately knows the brokenness this patient felt. But he didn’t tell him. A person can feel if you’re down in the hole with them. You don’t have to tell them how you got to be down there, too.


All Dr. Steinweg said was, "This sounds really hard, this sounds unbelievable." In telling me this, Dr. Steinweg paused and looked at his hands. "And I think he had a good doctor that day.” As he said this, he began to cry. 


As he says that, I appreciate medicine more than I have since I started medical school. I feel like a kid with a dream. We are both crying.


After a pause, he reaffirmed, "I was the perfect doctor for him." 


When I was applying to medical school, I was confronted with the idea that it isn’t necessarily the moral right for me to be a doctor because I want to be one, but only if I will be better than someone else who could have taken my spot in medical school. The fact that Dr. Steinweg has felt like the perfect doctor for one person gives me hope that I could have absolution like that someday.


Dr. Steinweg clarified that a physician doesn’t need to have any kind of disease to be a good doctor to every patient, but there is truth to sharing their experience. Most of all, it's helpful to know pain if you're going to help people in pain. And everyone has been in some pain.

At the end of our time together, when we were both done with tears, he charged me with parting words. “Think of the incredible gift of walking through life with your stethoscope around your neck, helping someone every 15 minutes. What an incredible profession, what a way to spend your life. You get to just be there for people.” Now, in retirement, Dr. Steinweg keeps doctoring, sans-stethoscope. He teaches medical students, he volunteers with a young man in foster care, he talks with veterans at the VA. He thanked me for giving him what he gives to those veterans, which is a chance to reflect on their own story. He says, “We are story telling machines. And they either shape us, or they define who we have become. Stories are so important.”


On the surface it seems like doctors are the mechanics running around keeping the gears greased and the cylinders pumping. But despite our best efforts, we’re going to fail at that. And then, what are we? But we only fail to hear the stories if we choose not to. That will happen sometimes, too, but on the days we do listen, we will be good doctors.