Some call it intuition. Others might call it a “gut” feeling.  And for those who believe in a higher power, “a direct message from God”.  You know, that little voice that prompts you to take action. Yeah, that voice.

In the past 20 years, I have had the pleasure of working with patients who have, quite literally, transformed me into a better version of myself. Don’t get me wrong, almost every patient stretches me. Teaches me.  Grows me. But the list is short of those who have permanently transformed me.

Enter “John”, mid 30s, father of 4 young children, seeking physical therapy for a recent onset of “weakness”…

In the world of neuro rehab, a “new” patient is always “bitter-sweet”. On one hand, I am excited for the opportunity to help, and on the other hand, I am hit with the reality of just how unfair life can be…….

I always spend the first several minutes of an evaluation getting to know a new patient. John is a “believer”. I can make this assumption almost immediately. I listen to him talk about scripture, his faith, and his personal relationship with God. As we talk, I notice I hear very little about his physical problems.  This continues for several sessions. I have learned to ask better questions so I can learn more about his physical problems and provide the best and most appropriate care.

Now, roughly six weeks and several sessions together, I feel like I know John. I have learned more about his faith, his kids, where he went to high school, and among other things, how he met and married his high school sweetheart. But not until today, do I learn how a healthy 30 year old man came to discover he had ALS.

It started with a tremor in his hand. He chalked it up to stress. However, when “traditional stress management strategies” were not working, he solicited the opinion of a neurologist. After several tests, the neurologist came up empty and advised John to return in six months.

In John’s, own words, “this is when God stepped in”. John, an engineer with no medical background explains “the word ALS just started showing up”. In sermons, on t-shirts (Yes, he said he started to see people wearing those free fundraising t-shirts that just happened to have ALS on the back).  This led him to look up a disease he literally knew nothing about. And to his shock…… “I had almost every one of the symptoms”. That lead him to the Mayo Clinic and within a day an official diagnosis that confirmed what he already knew. ALS…….

“Come back in six months”. Those words are burning their way into my long-term memory. Not by accident, by shear will (in an effort to never forget this moment).  “Return in six months”. “Return in six months”. “Return in six months”. John had classic signs. Muscle wasting in the hands, unexplained muscle fasciculations, unexplained new onset of weakness….. “Return in six months”. The average life span of someone who is diagnosed with ALS is 3-5 years.  This father of four children (ranging in age from 7 years old to 6 months old) was advised to return in 6 months…..

As a medical provider, I am often humbled by the times I need to be reminded to stop and listen.  Today is a reminder of how important listening truly is. Listen. Such a simple skill we are taught from an early age.  Yes, listen to “hear”, listen to “understand”.  This is extremely important. But today I am reminded of something else.  It is not taught in school and you will not find it in a text book.  Listen to “that voice”. That voice that whispers……”something is not right”. But it is even bigger than that.  John listened.  John really listened and what he heard were medical answers that he never learned in a text book.  Call it faith, call it intuition, call it a “gut feeling”.  Whatever the case may be, as a healthcare provider, it is not just a skill to be pulled out every now and again. It is a responsibility. It is a responsibility to the patients we serve. It is something I have always held dear to my heart. However today, and every day moving forward when I hear that small voice “that something is not quite right”, I will also remember “John”.