Holy sh*t, neurology is hard.
(I’m off the soapbox to give y’all a break. Don’t worry, I’ll be back with more faux-righteous anger, probably about how white coats are pretentious germ blankets that we should categorically ban from medicine, next week or so.)
We’ve just concluded Week One of our neurology rotation, which at my med school is called “Neuro Boot Camp.” If you remember back to my neuro unit from last year, called “Brain, Behavior and Movement,” my primary experience during those twelve weeks was as follows:
- Neurology is hard, and putting “neuro” in front of anything makes it more difficult by default;
- The neuro exam is elegant;
- I got a concussion from artfully slamming into a tree headfirst while jogging;
- If you get familial fatal insomnia, you will die.
Note that it appears I did not learn any actual neurology during this unit. The clerkship director for neurology knows this, and so he teaches us neuroanatomy during the first week. Boot Camp was born.
We spent the morning in lecture learning the convoluted pathways through which your brain communicates with your body, then saw patients with deficits in the afternoon. Pretty cool, if we’re being honest.
And neurology is cool. The exam truly is “elegant,” as I wrote before. If you know your stuff, it is possible in many cases to narrow down the location of a stroke to an exact location – say, the left lateral rostral medulla. That’s pretty specific and sounds impressive, although I have no idea what is there.
Well, it’s also cool because:
- Neurology has WAY fun toys such as tuning forks, complicated reflex hammers, and nerve stimulators. One of my friends is so obsessed with the tuning fork thing that she walks around all day with it stuck on her head, vibrating, performing the Weber test;
- EEG’s are pretty cool even though they are kinda totally useless
- Their teams don’t start rounding until 8, which is a tremendously undervalued aspect of any field.
Of course, there are downsides.
- No toys have buttons, which if you know me is a huge and potentially fatal flaw
- You must be fairly comfortable using four-point restraints (may also be a plus if you really like 50 Shades of Grey)
- There are twelve cranial nerves, you have to memorize everything about all of them, and none of it makes any sense.
So again, you have to know your stuff, but of course it certainly helps to have an aptitude. It turns out that aptitudes for medical fields, just like other talents, are largely random. For example, I am gifted at quickly picking up most musical instruments (except for a failed experiment with a banjo in college) and have a decent ear.
On the flip side, I have no aptitude whatsoever for art despite the fact that approximately 50% of my blood relative blog readership (dad, grandma) possess impressive talent. To wit: today in lecture I drew the following picture to remind myself of the pupillary reflex:
This is the maximum I am capable of producing, art-wise.
(As an aside, getting a Surface has been the greatest thing for my terrible drawings since I discovered stick figures.)
It’s the same in medicine. I am pretty good, for an idiot medical student,* at two things: taking standardized tests, which is honestly how I got here in the first place, and handling emergency situations well. I am apt at these things.
*Mom/Grandma, before you get angry at me for calling myself an idiot, know that there is no other kind of medical student. A medical student is, by default, an idiot medical student. Anyone who has completed their surgery rotation knows this as a scientific fact. The earth is round, F=ma, and all medical students are idiots.
I am not apt at neurology. Learning the pathway of the dorsal spinocerebellar tract, or where the nucleus for the abducens nerve sits, is like trying to learn Russian from scratch. In Braille. As a double arm amputee. While… oh, you get the point. It’s hard.
I don’t even know the (Cyrillic?) alphabet yet. Today we played “where’s the lesion?” and after everyone else had shouted out the answer, I finally arrived at the same conclusion and blurted it out… a good six seconds after the rest of the group. I was Borat learning “not” jokes.
Besides being an uphill battle to acquire competency, neuro can also be a frustrating field. We saw a patient yesterday who came to the hospital unable to move her legs. Two students, under the guidance of an attending, performed the neuro exam as the rest of us watched. Then we played the only game in neuro: “where’s the lesion?”
(There is literally no other game. Do you have friends that are obsessed with and will only play Scrabble? That’s neurology.)
We localized her issue to a particular level of the spinal cord. Success.
Satisfied, we left the room and pulled up her MRI results. They revealed some fluid collections around the level we had nailed down, so, someone asked the attending physician, “So, what did she have?”
He looked back at the student strangely. “What do you mean?”
“Well, we localized the lesion to T5, and I see it on the imaging… but what is it?”
“I have no idea,” he replied. “Hopefully she gets better.”
Hmm. So there’s a famous South Park episode where the boys, working on a school project, realize that tiny gnomes are stealing people’s underwear and warehousing them at a gnome factory. The boys track down the factory and confront the boss. “Why are you stealing underpants?” they ask.
In case you aren’t a fan of clicking through to videos:
Okay, why am I telling you this? Incoming! Nate art:
I think you get the point.