Chiari And Me...by Rhodora K. Lee Ho, M.D.

Ed. Note: This article first appeared in the June, 2004 issue of the journal Family Medicine and is reprinted with the gracious permission of the Society of Teachers of Family Medicine.

During my third year as a family medicine resident, I was rather dramatically introduced to a companion who had been with me constantly from the day I was born. Though my companion went with me at all times to all places, and had even communicated with me on a routine basis, I had been totally unaware of his existence. Make no mistake; this companion was not my friend. However, confronting him and learning from him are signal events in my life, both personal and professional.

It is ironic that I met him when I did. I was becoming comfortable in my roles as senior resident and physician. I thought pregnancy and new motherhood taught me the special lessons I was intended to learn. The associated physical and emotional experiences put a new perspective on things for me as a physician. I thought I had met and overcome that challenge well and thus believed that I could easily handle whatever came my way. I was wrong.

Throughout my life, I had had headaches that I attributed to one benign cause or another. This was, of course, after surviving the hypochondriasis that all medical students endure in their medical career. Then, the headaches began to get a little scary. First, they became more intense, then they lasted longer, then I became presyncopal, then presyncopal when lifting my 8-month old son. That was when I finally sought help.

I consulted one of my attendings. He looked at me thoughtfully and said, "Let me think about this, Dora. I'll do some reading and get back to you in the morning." He called me just a few short hours later and said, "Dora, I think you need an MRI." So, the next day I got the MRI and, a few long hours later, I met my companion, Chiari.

I really didn't consider him a companion at first. I was rather offended at his presence, actually. I knew very little about him and was not particularly interested in getting to know him. However, the situation demanded that I become acquainted with him, so I did. My attending and my husband, Jeff (also a third-year family medicine resident) had read about him and had spoken with a neuroradiologist, neurologist, and neurosurgeon before they came to introduce me to Chiari. They came prepared, and I am grateful. After they broke the news to me and after my bawling unashamedly, I regained composure and faced the road ahead. Medical texts, Internet Web sites, and all the information that my husband and my attending gave me provided plenty of food for thought, which was good. My appetite for anything else was completely gone.

I was very angry at Chiari. He came to meet me at the start of a holiday weekend, so I had to wait to seek help from specialists. I spent the whole weekend ruminating over the negatives he was bringing to my life. With the knowledge I had, I knew that getting rid of him would have to involve surgery. I was angry at the restrictions he had placed on my life-I was not to do anything that might provoke my headaches, which meant pretty much everything, especially caring for my son. I hated it, and I hated him.

Thankfully, the holiday ended, and I was able to see the specialists. Chiari accompanied me to see a neurologist who found deficits of which I was not aware (NOT a good feeling), and, at her intercession, the neurosurgeon saw me 2 days later. He found yet more deficits, and I was livid, not with the surgeon, but with Chiari. Thanks to Chiari, I had to go through what the surgeon classified as "the most painful surgery I do." When my surgeon told me he was surprised I wasn't worse off than I was, and that the threat to my life was serious, I resolved at that moment to take my companion by the horns and kick him out of my life.

The next day, surgery rendered me too weak to do anything close to that. I could not even turn my own head without manually reaching up and turning it with both hands. This humbled me quickly; I realized Chiari was here to stay. So, I let him. And by doing so, I opened myself to the lessons he had for me to experience.

Recovery was an adventure in and of itself. I had to ask for help in doing the simplest things. I had to rely on everyone to carry me through. I hated asking for help but, when I reached out, help was everywhere to be found. My husband, my family, my in-laws, the attendings and residents in the Quincy Family Practice Residency Program, all the staff at the center- their support was a large part of the reason I was able to do what I had to do. My surgeon, his nurse practitioner, and the neurologist were always available to answer my questions and to reassure me that things were going to get better. Their continued presence throughout my recovery was also integral to my progress.

Humility was by no means the only lesson I learned. I experienced firsthand the extreme discomfort and restrictions of hospital support lines (IVs, Foleys, arterial lines, and central lines). The agony of narcotic withdrawal, the devastating effects of deconditioning, and the frustration and despair of complicated recovery are experiences I will always remember. The effect of my illness on my family was an aspect of medicine I had not truly grasped before this ordeal.

Returning to residency was a slow and painstaking process. I am blessed to be in a program with eternally patient and supportive fellow residents, attendings, and staff. I am also blessed with a wonderful husband and supportive family. I was only 6 weeks post-op, and returning to work was a challenge like none I had faced. Because of them, it was a challenge I was able to overcome.

As usual, my companion's ugly face was still in the picture, little reminders scattered through my days that he is always present. But, now I see he is not so ugly. His countenance is less severe. His presence, though prominent, is muted. His lessons are fresh and burned into my mind. I no longer tire easily, my headaches are fewer and farther between, I can play freely and comfortably with my son, and I can look to the future with a smile on my face. Chiari was not a welcome companion and never my friend, but the lessons I learned while getting to know him have made me, I hope, a better physician.


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