126 Healers

So far in Boundless Moments, we have heard from healthcare and mental healthcare providers who have shared their reflections on what it means to experience sacred moments with patients, clients, colleagues, or even mentees. It's time then to explore how sacred moments may unfold from the patient's perspective. And perhaps there's no more fitting segue than by hearing from a person who has experienced both the physician and the patient roles. 

Dr. Raj Mangrulkar shares with me the very personal moment he realized he was having a stroke, transitioning from caregiver to patient, from independent to relying on others. He shares parts of his health care journey in the hospital and later in the rehab center, reflecting on the value of being seen and heard in a holistic way, the emotional rollercoaster of recovery, and how the eyes can be a window to the soul. The sacred moments in his story are abundant and arise from his intense personal vulnerability and willingness to share his story with others, as well as his reliance on so many people in his community to heal and return to what he loves to do, and how his experience allowed him to grow closer to the Veterans for whom he cares. I left the conversation feeling uplifted and inspired, and I very much hope you do the same. 

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Transcript

Prelude

Raj Mangrulkar (00:00)

So we have someone that'll come in and do karaoke in like a couple 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 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.

Show Introduction

Nate Houchens (00:45)

Hi and welcome to Boundless Moments, the storytelling podcast that brings sacred moments to life through the voices of those who lived them. I'm Nathan Houchens. Support for Boundless Moments comes from the Sacred Moments Initiative. 

At Boundless Moments, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality.

All views expressed are those of the person speaking and not their employer.

Some stories featured on Boundless Moments may contain themes or content that could be upsetting for some listeners. We encourage you to use discretion and take care of yourself while listening.

Introduction: Rajesh Mangrulkar

Nate Houchens (01:29)

So far in Boundless Moments, we have heard from healthcare and mental healthcare providers who have shared their reflections on what it means to experience sacred moments with patients, clients, colleagues, or even mentees. It's time then to explore how sacred moments may unfold from the patient's perspective. And perhaps there's no more fitting segue than by hearing from a person who has experienced both the physician and the patient roles. So I sat down with Dr. Raj Mangulkar to hear his story. A bit about Raj…

Rajesh Mangrulkar is the Marguerite S. Roll Professor of Medical Education and Professor of Internal Medicine and Learning Health Sciences at the University of Michigan Medical School. He is a practicing primary care physician whose work centers on organizational leadership and innovation, transforming education at scale. Having served as Associate Dean for Medical Student Education for 10 years, he was then charged in 2021 with building an education innovation community of practice across three University of Michigan campuses. He now serves as Director of the Michigan Center for Interprofessional Education and RISE, an education innovation initiative that he founded. In 2022, he was awarded the Robert J. Glaser Award for Distinguished Medical Teaching by the Association of American Medical Colleges and the Alpha Omega Alpha Honor Medical Society. In 2024, he was inducted as a Distinguished Fellow in the National Academies of Practice. 

Introduction: 126 Healers

Nate Houchens (03:00)

Raj sits down and shares with me the very personal moment he realized he was having a stroke, transitioning from caregiver to patient, from independent to relying on others. He shares parts of his health care journey in the hospital and later in the rehab center, reflecting on the value of being seen and heard in a holistic way, the emotional rollercoaster of recovery, and how the eyes can be a window to the soul. The sacred moments in his story are abundant and arise from his intense personal vulnerability and willingness to share his story with others, as well as his reliance on so many people in his community to heal and return to what he loves to do, and how his experience allowed him to grow closer to the Veterans for whom he cares. I left the conversation feeling uplifted and inspired, and I very much hope you do the same. Enjoy.

The Story: 126 Healers

Raj Mangrulkar (04:15)

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. 

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.

Interview

Nate Houchens (32:17)

I'm here with Raj Mungrulkar, who just shared this incredibly powerful story of changing from a physician to the patient role and really experiencing firsthand the interprofessional team and the power of words and being with each other. Raj, thank you so much for sharing that really profound story. 

Raj Mangrulkar (32:39)

Oh, it was my honor.

Nate Houchens (32:40)

You know, a few things struck me about your story, Raj. First and foremost, it sure strikes me that you are a person that is generally full of gratitude and optimism. I think I heard that word a couple of times throughout your story. And I get that from my knowledge of who you are even before all of this. 

You mentioned a day in that sort of turning point on day four when you shifted from that gratitude and optimism to hopelessness and sort of despondence. And I'm reminded of just how powerful those feelings can be for so many people. And I think you mentioned that it didn't feel like logic, it didn't feel rational to you. I wonder if you can reflect on that for a moment.

Raj Mangrulkar (33:34)

It was both sudden, and I couldn't explain it. It mirrored my stroke. I'd gone to bed normal and woke up profoundly affected. And the night before I felt so sad, I'd gone to bed optimistic. I'd made progress during that day. My body was healing. I felt full and I felt grateful and just charged about what the next few days were going to be like, because I was just starting to get into the rhythm of being at the rehab hospital. There's a rhythm that you just get into. It's like going to work. And so I'm like, okay, I got it. I can do this. And people were giving me such positive feedback about the work I was doing. And they were showing me objectively how my strength was starting to come back. I was starting to be able to, you know, walk pretty well with a walker and to be able to start to do some of the balance exercises. Everything felt great. 

And then that next morning I awoke and there wasn't, and it was like for the stroke, I had had the searing eye pain and head pain. This was like I woke up with psychic pain and I couldn't explain it. It was, and I'm a logical person also. I try to be a problem solver. I was a computer science major and a computer scientist programmer before I went to medical school. So everything was broken down into algorithms and I could explain things with rules. I couldn't explain this at all. 

And as someone who's naturally, I am known to be more on the optimistic side. It was a paradox I was wrestling with, like almost like a psychic paradox. And I couldn't explain it. And I felt ashamed, honestly. Early in that morning, I felt like embarrassed. I didn't want to reveal to people that I was feeling so sad. You almost like, I was telling myself you don't have a right to feel sad. This shouldn't be what you feel. What's wrong with you? 

I think, I wonder whether there was something in my eyes that the person who was working with me on speech therapy saw when they came into my room. I, to this day, wonder if she saw something in my eyes that said, no, it's not exhaustion because she pulled the chair and sat by my side. She immediately normalized it with the first words that came out of her mouth. People have up days, people have down days. Is this a down day? She said, everyone, I think she even used the word everyone, has up days and down days. So that relief followed by an explosion of emotion, which was sobbing at that point, I think she knew that she was onto something or she, she tapped into it. 

And she wasn't afraid of it. Cause if she asked that question to other people… I mean, I imagine I'm not the first person that she said that to. She must be saying that to the hundreds of patients that she encounters in a year where they're having a stroke. I'm sure many of them have an emotional reaction to that question. So she wasn't afraid of it, of whatever was going to come on the back end of that.

And I was just so like, that's where I felt relief and honestly, gratitude that she opened the door. Cause I was going to walk into, I was going to definitely, I needed that connection in order to really just find my way out of this. 

And I didn't want to be alone. And I think, you can get really lonely when you have an illness. I mean, my family was incredible and just so supportive and so present on the phone, texting, visiting, everyone. And yet there's like this loneliness that you feel that you don't feel at other points in your life. When you're going through something that you know nobody else in your immediate environment is going through at the same time. And she immediately like had a connection with me through that word, through those words, that I'm like, I didn't feel alone by her saying that.

Nate Houchens (37:46)

That is exactly what she was saying. She's saying that other people go through this, that you are not alone. Even though you were and are this independent person, you were learning to walk again. And to be able to put that into words and to recognize the profound ups and downs that come with that realization and to be there with you during those moments are profound.

Raj Mangrulkar (38:20)

And you know what's amazing, Nate. You said it beautifully. The profundity is also the disconnect between me as a care provider who has said those exact words to other patients. I have said, people have up and down days. I have a patient that is, you know, I have lots of patients that have recovered from stroke, cardiovascular disease. We're trained to be sensitized to the mood undulations that happen to them. I've had patients that have been postpartum, we’re trained to look for depression, to look for mood alterations, and we normalize it for them. Yet I couldn't normalize it for myself. I couldn't, like when you're inside, it was a very, it was completely different. It is as if I had never gone to medical school or I had never had the 25 years of being part of a caregiving team. That was like a, it was like a, it was severed from my, from my reality. I needed her to be the care provider, the caregiver, at that time, because I wasn't gonna do it for myself.

Nate Houchens (39:24)

She, yeah, I mean it strikes me that perhaps she said the right words that allowed you to give yourself some grace.

Raj Mangrulkar (39:32)

Oh yeah, that's absolutely right. She gave the permission structure through those, through that language. It really was a pivotal moment because I still to this day don't know what happens on that day without her coming to my bedside. I don't know.

Nate Houchens (39:49)

Yeah, and I just want to highlight, as medical educators, we speak a lot about communication skills and the ability to connect with individuals of all different walks of life and in very acute and sometimes very short interactions. What I heard from you that the interprofessional team did was they got to know you and spend time beyond just the immediate details that are going to help them take care of you: The motivations, the loves, what do you love doing outside of these walls? 

It becomes clear to me when I hear you talk that so much is communicated with your eyes as well. I heard you say my eyes lit up when we were talking about music and sports. And later on, when she talks about, you know, maybe we can do some music therapy, you said my eyes opened up and then she saw something in my eyes those days. And I just am struck by how much, if we are willing to pay attention to what a person's eyes are saying, how much they can communicate even without words.

Raj Mangrulkar (41:00)

Yeah, I think that's really beautiful, Nate. My language earlier in the day was I was exhausted or I was in pain. But my nonverbal cues were actually telling the real story of what was going on. And she sensed into it much as she had probably sensed into when I talked to her a few days earlier about the joy. She saw it in my face that it was real. It was authentic. 

And I think sometimes I always wonder, like, are we really living our most congruent life. Are we saying what we believe? Are we doing what we believe? That sort of sense of congruence and how much of our time is spent trying to, you know, for the sake of survival or protection, say things that are different than what we're truly going through, do things that we really aren't, our heart’s not into it. Sometimes we have to do those things, but in our most vulnerable moments, I think those all go away and you just see who the person is. 

And the thing that was like so profound to me was how, you had mentioned this, like how quick, you know, these aren't people that I had known my whole life, or they weren't my primary care physicians that had been following me for 20 years. These were people I had met three days ago, two days ago. And yet there was, you can sense into using the complexities of just how we talk to each other as people. With the right words, with the right values, with the right openness, you can have a deep relationship with someone that can make a profound difference, even after just getting to know them or just interacting with them once. 

I'm a primary care physician, and so I feel like sometimes it's luxurious the amount of time we have with people where I can get to know their whole life. And then I think about people who work predominantly in hospital or ER settings, and that luxury is gone. Yet, you can really in the same but different way profoundly develop a connection that is spiritual and is healing-centered, about the whole person. Just because you're there for an instant doesn't mean that can't happen. It absolutely can happen.

Nate Houchens (43:25)

We talk about those moments of transcendence, particularly in times of great grief or joy or really acute situations. And so I imagine that what we lack, I'm talking as a hospitalist now, what we lack in the longitudinal relationship, the longstanding understanding of the other person, we make up for in acuity and significance. So these moments that are sometimes the worst and hardest moments of a person's life no doubt lend themselves to these incredible moments of human connection.

Raj Mangrulkar (44:06)

Yeah, I'm trying to take myself back to what that was like on the inside when, you know, and I try to, I always try to come up with like mood language. So I definitely had moods of fear. Fear was a big driver. Fear can close you off and be constraining. Anger can be, can be a negative emotion at that time. And I definitely had anger at the time. Like, but sometimes leaning into sadness can be opening. I think the opening, most of the time, I think the reason why we focus on this with our learners is because little words can create an opening. I don't think we just want to help me walk. I don't think that's anyone's only goal when I was in the rehab hospital. Their goal was, yeah, we want him to walk, but we want him to feel the power of his healing so that when he leaves, that continues.

I can't tell you the number of practitioners who sat with me and said, you know, you're going to be about 70% of the way there when you leave, but that last 30% is so hard, Raj. I hope you give yourself the grace in the next six months. That's really hard work, the last 30%. And it struck me again, that's language I use, but what they were doing was sort of creating an opening for me to then educate me and train me for that last 30%. And that doesn't happen without the language. I wasn't, I don't think I was capable of doing it myself. I'm not self-actualized enough to be able to just find it in me without help.

Nate Houchens (45:48)

And I wonder if they hadn't offered a roadmap of what to expect, if perhaps that would have had an impact on you emotionally as well as physically.

Raj Mangrulkar (45:59)

I can tell you there were numerous instances. There were three instances where people had to slow me down. And I will tell you, one of them came from one of my friends who was a chair of a department at Michigan Medicine who came to visit me and just said, Raj, I've had a lot of faculty who have had strokes and they all think they can come back quicker than they can. So I'm here, as your friend, but I'm also here to tell you to not do that. So that was that was chapter one. I'm like, oh, good advice. Then my PM&R doc, who was taking care of me, said exactly the same thing. 

Then I'll share with you the most profound one. And, you know, when you when you go on leave, you have to work with HR. And, you know, that was a new experience for me. And I had been working to kind of figure out, all right, what was my return to work plan going to be? I can't even put in words how immensely impactful it was when my HR representative called me on a Friday afternoon and said, Raj, this is not a good plan and said, I don't think you understand what's coming, but I'm here to tell you that I don't support your plan. This is someone who worked for Michigan Medicine, who worked for the Office of Human Resources, didn't know me from boo, but had the courage to say, I don't believe in your plan. I don't think you want this. Can we stretch this out a lot? And that like was, that was the third chapter of like people saying this. 

So I think what I'm saying, Nate, is I needed so much help. This was not going to happen from just me alone. And you know, maybe there are people that are out there that could do this, could summon it up, could find a way to go through. But I, what I was most profoundly impacted by was just how so many people mattered so much to me being here, full-time physician, still, still in higher ed, able to walk, minimal residual deficits, able to be a husband and a father and a son and a brother and a friend and a teacher and an administrator and a physician in all of the most fullest senses of the word. And someone who still loves music and still loves baseball. That doesn't happen without so many people. 

So those little moments matter. So to the extent like you, I know you spend so much time educating learners and that's a passion. Getting them into that space where they recognize the power of what they could do. I now have seen it on the inside, and I know what that power is.

Nate Houchens (48:56)

To be able to tap into your own experience and to recognize the value of what others did for you. That's therapy, of course, but it's also, you know, giving you the words that unlock the ability to extend things and to take it easy on yourself at times. It seemed like they really had an impact on you.

Raj Mangrulkar (49:20)

Oh, just incredible. Yeah, really incredible.

Nate Houchens (49:23)

Would it be okay if I asked you, after this entire experience, what it was like to step back into the role as a caregiver, as a physician? How did you sort of navigate that in terms of vulnerability with this sort of new reality that you had?

Raj Mangrulkar (49:42)

I think I love being a physician so much because I love being an educator. Like I didn't, I hadn't really recognized that. I thought it was my love of science that brought me to being a physician, but I recognized over time that it was my love of communication and relationship building. And that drew me to realize I can have a career as a physician educator. I'll do that. And then I realized that the education side of me is the dominant phenotype. My passion and my mission is being an educator. 

Soon after I was discharged from the hospital, I, you know, I went on leave. There was one thing that I had committed to, which I kept, which was to give a speech to the School of Dentistry graduates 20 days after this whole thing had happened. And while I was on leave, I canceled every other commitment I had, but I said, I want to keep this one thing. A, I had committed to it a year ago, but B, I felt like I needed to rewrite it. Like I had my speech written. I said, oh, but there's more. And I had felt this burning yearning to share like an educator would. And when, after I did that talk and after I just started, I recognized like how much like there were endorphins in me that were released by sharing. Like I felt, not pleasure, but I felt like there was positive emotions that came from that. Not just whatever reached the audience, but I felt better. I was healing by sharing. 

And it struck me that as I was starting to get ready to go back to work as a physician, as a primary care physician, and I practice at the VA, which is an amazing place for interprofessional care and an amazing place because I'm always, I'm so in awe of my patients. Like that's the thing, that's the feeling I usually have when I'm with them. I'm both in awe and in understanding because they had given military service. They'd been in a, in a war. I realized that this awe that I had was almost like a, it almost put me a little bit at a distance from them. And I was yearning for a more, even more closeness to them. 

So it started me wondering, what would it be like if I just shared with them what I went through? I know sometimes people would say, hey, I'm back from leave. I'm glad to be back. What's going on with you, Mrs. Jones? But I actually started, after giving my speech and after sharing it more and more with kind of the community and realizing how much I needed everyone to heal, I kind of just said, I'm going to go out on a limb and see who wants that, among my patients. And I'm not going to tell the big story, but I'm going to tell them what I went through. 

But it was my first in-person visit, that I came back, and my first patients was one of my patients that I'd had a long, one of the longest relationships with, over 20 years. And he saw me and just hugged me tight. And I broke down, like immediately, like he knew I was out on leave. He didn't know exactly what it was. He didn't know what to expect. And he just went out and just gave me the, like such a huge hug and didn't let go, almost like a fierce, like didn't want to let go, thought maybe he had lost me as a physician. Which so many of my patients subsequent to that had said. They said, we didn't know if you were coming back. They weren't giving us details. I just didn't know, did I lose someone who was in my life? 

It was that first hug that gave me the courage and I said, I'm going to tell you what happened. And it was met with incredible, just, you know, openness and kindness and love, honestly, that I felt from him. It gave me courage. I'm like, all right, I'm just going to tell people. And if they don't want to talk about it, that's totally fine. 

But I realized that what I was saying was, you know, I've gone through something and you're going through something. Don't ever worry about sharing the intimate parts of how this affects your whole life. That's what I wanted to convey to them is that, if this is making you sad or if this is affecting your relationship or if the one thing you want to do, I have a patient who is an umpire and had horrible COPD. The motivation for her to quit smoking, she was a softball umpire during the summer, was to be an ump again. I leaned into that. I knew she was an umpire, but I was like, okay, let's talk about how this affecting your whole life. And it was the most motivating thing for her was to think about how this was affecting her ability to do what she loved, which is to be a baseball umpire during the summer. And there's like countless examples of these things.

But I felt like this, if I could share this authentically with patients, not how, you know, I went to school in the 80s and 90s in medical school, where very much the teaching was you have to figure out how you can turn off your home and your outside self so that you can be fully present with your patients. And that's really well intended. And it's also, I think, misguided, because I think our patients yearn to be seen as a whole person. And I think many of them yearn to see us as a whole person, based on the reactions I've had subsequent to having my stroke, to this story.

Nate Houchens (55:41)

That big bear hug says it all. You know.

Nate Houchens (56:01)

I'm reminded of that phrase that you used, I’m paraphrasing, but healing through sharing can be so freeing, can be so, can unlock parts of us that didn't even know needed to be released.

Raj Mangrulkar (56:19)

Yeah. It's so powerful because I think about like, what's all the inner monologue that's going through when we are actively not sharing? And I'm not saying this is for everyone, at all, like if we, when we choose not to share, when we're going through something, we choose not to share, and we shouldn't be sharing with everyone, but there is a choice. Then there is a whole series of what I think are negative, negative emotions that go along with that, which include shame and embarrassment. But also include rigidity and inflexibility and a closed-ness. 

And I have recognized that by sharing it taps into more open emotions that I think help promote others’ healing as well. I can't tell you, I mean, even some of it is just transactional, Nate. Like I had as part of the routine workup of having a stroke, I was diagnosed with very severe sleep apnea. It was just sort of the routine checklist. I snored a little bit, never stopped breathing, least per my wife, but had a, had a sleep study. They say, we just do this. It's part of the routine stroke workup. Make sure there isn't other things going on. Severe sleep apnea. I had to go through the whole thing of learning how to use CPAP, which has been brilliant and life-changing for me. And now I can talk about it with my patients in a way that comes from experience. Cause 30 to 40% of my patients have sleep apnea. All of them are struggling with CPAP, and I can tell them tips. I can tell them what works. I can, from a point of, from a point of experience, not from a point of I'm a physician. Okay. This is what's next on our to-do list. That's just one of many things that I now can share from a different lens. And that's an opening. I got to believe it makes me a better physician for them, for those that want that lean into this and want this.

Nate Houchens (58:21)

Looking back on that pivotal moment with the therapist suggesting music and karaoke, what message would you want therapists or caregivers, perhaps even patients themselves, to take away about these small acts of hearing and compassion?

Raj Mangrulkar (58:43)

How we feel at a moment is more enduring, far more enduring, I think, than us remembering what was said. And I know there are the cliches about they'll never remember what you said but they'll always remember how you felt, how they felt when you said it. But I think what it taps into is our ability to capture our moods, to understand our moods, is part of communication and it is part of our healing. And I think we have to lean into that. Sometimes we're afraid of moods. But I think if we can really capture the vocabulary, if we can be better, more fluent in the vocabulary of our moods and we can recognize them, and then we can sit with them in ways that, that's what I think people mean when they said they felt heard. I don't think it's that the person listened and heard and could recite exactly what was said. But when someone says, I felt heard, I think it's about the moods that were interacting at that time, the emotions that were going around at that time. 

And I think that relates to every member of the interprofessional team. If we include patients as part of that team, then they are more likely to feel heard in ways that I think would help their, help our healing, our joint mission towards healing. 

I don't know exactly how to do that, Nate, but I think it requires a different way that we think about illness, health, and what happens in the dyad or triads of our relationships. It's got to be more than the differential diagnosis or the treatment plan. Those are incredibly essential ingredients of it. And I don't mean to diminish it. But I think there's an and to it. It's the mood emotional context within which that whole thing is happening. I think that really matters.

Nate Houchens (1:00:55)

People don't say, I know I was heard. People say, I felt heard.

Raj Mangrulkar (1:00:59)

I felt heard, yeah.

Nate Houchens (1:01:01)

And there's so much power behind those feelings and emotions. And what a joy it is to be able to share these really profound moments with other people and to be able to experience these with them.

Raj Mangrulkar (1:01:18)

It's amazing, Nate. I'm just in awe of this. These stories that you're collecting, how it's affecting you, but also how it's, how you're channeling that, as a teacher to say, I think others might benefit from this story. I'm just so grateful that you asked me to be on this and to tell this story. And I just love what you're doing.

Nate Houchens (1:01:43)

I really appreciate that. Our hope is that with your story and others that wish to contribute them, people realize that this human experience is normalized, just like the therapist gave you permission to give yourself grace and to normalize it. We hope to be able to share these stories and to be able to spark memories of others that had similar experiences. So I really appreciate you sharing that with me.

Raj Mangrulkar (1:02:12)

Absolutely. It's my honor and it's really beautiful. Thank you so much.

Nate Houchens (1:02:17)

Thank you, Raj. 

Raj Mangrulkar (1:02:18)

Take care.

Postlude

Nate Houchens (1:02:37)

We would love for you to be a part of this movement, and we would be honored to hear your story. If you have experienced a moment of grace, connection, or empathy that changed you, we invite you to submit it for consideration to be shared on Boundless Moments by sharing, you not only contribute to a collective celebration of human connection, you may also inspire others to recognize and cherish the sacred moments in their own lives. To discover more about sacred moments and to share your own story, please visit sacredmomentsinitiative.org.

This episode of boundless moments was produced, edited, and mixed by Nathan Houchens. Our program manager is Jessica Ameling, and our publishing and social media manager is Rachel Ehrlinger. Our podcast is made possible by the Sacred Moments Initiative, a humanistic project whose aim is to study, catalog, and share sacred moments. Learn more at sacredmomentsinitiative.org. Boundless Moments is also made possible by donations from listeners like you. Thank you so much for supporting our work in sharing sacred moment stories. If you enjoyed this episode, please subscribe to the show wherever you get your podcasts and drop us a rating or review to help others connect with us. I'm your host, Nathan Houchens. Thank you for joining and until next time, be well.