Neurology.

  • How did I feel when I got home?

As my last rotation, the taste of fourth year right around the corner was always on my tongue. But I put my head down, kept myself busy, and confirmed three things: 1) Neurologists are badasses. 2) I feel something deeply powerful with stroke patients (go figure) 3) I love critical care. For my 2 weeks in the Neuro ICU, I was probably in the hospital for 95% of it – sleeping for a few hours in the call room until the next organ harvest operation, central line placement, or stroke page. I loved placing central lines, popping through the dura for my first lumbar puncture, or emergently rushing a patient to the OR – this chaos is my ebb and flow.

  • Did I feel excited to look up the illnesses and diseases in the patients I was caring for, or to study for the shelf exam? Was there diversity in the conditions being treated?

I was surprised to find how interested I was learning about neurology. I truly think neurology is the last frontier in medicine. There are still so many questions to be answered, so many diseases without treatment, and so much we still don’t know about that squishy pulsing thing in our skull. I loved the way neurology forces you to localize the pathology on-the-spot, and truly think your way through the diagnosis. But my lessons came from the most unexpected places as well- such as working with an expert in multiple sclerosis who opened my eyes about the extent of financial swindling with pharmaceutical companies. Then there was my Sharon. She was the equivalent of my Mr. Castillo on my vascular surgery rotation. A young woman with fire in her eyes and enough vibrance to light up a room. My intern and I, only saplings in our medical training, sat down with her husband and daughter to spread the cards of her critical situation. We consulted every service in the hospital trying to figure out what was wrong with her, but ultimately despite hundreds of labs, imaging, and biopsies, we didn’t have an answer for her husband’s hopeful eyes. She had been in the hospital for a week. That’s when I got the page. I remember how awful and bizarre it was talking to her- reassuring her – for those few seconds we had as she bled into her brain. I pretended like I wasn’t crying and refused to break her gaze, repeating,”Jim is coming, hold on okay? He’ll be here. Hang on.” Dozens of people flurried around us and the corner of her mouth gave her little smirk like she always did, right before her brain sagged beneath it’s fascial tent. With my third year wrapping to an end, I know that moment will be carried in a chunk of my heart forever. I will never forget that beautiful soul, or any of the amazing patients who shared their stories with me and let my unexperienced hands poke them at all hours of the night. I was lucky enough to honor every clerkship during my clinical year, and I can honestly say that staying interested in every aspect of medicine and taking complete ownership for my patients were not only the keys to my clinical learning, but also to helping me avoid burnout. I’ll admit- often my intrigue in neurology was usually only sparked if it directly related to the patients I was treating. But that little spark of intrigue is all it takes. So I run with it.

  • How much direct patient contact was there? 

So much. I loved the critical care aspect, and the slower pace of outpatient clinic and getting to actually spend time with patients.

  • What were the humdrum aspects in the patient population or workflow that would have to be tolerated for the rest of your life?

Non-epileptiform seizures.

  • Does this specialty address one of the leading causes of death in the world?

Yes, definitely – cerebrovascular disease. Our treatments for it still suck, though.

  • How easily can motivational impact be integrated into a career in this specialty?

So easily. I feel pretty confident in saying now that this could be integrated into any specialty in medicine.

  • Does this specialty focus on preventing problems or fixing problems?

I’m not sure how to answer this, because I don’t feel like we currently do a very good job at either of these. But as I said, I think neurology is medicine’s last frontier. We just need someone to unravel it.

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