Showing posts with label neurology. Show all posts
Showing posts with label neurology. Show all posts

March 1, 2012

not yet dead

an actual consult for neurology while I was on the service:

phonecall directly from the operating room (OR):

Surgeon: My patient can't move his hand.  I think he had a stroke.  Do I call you guys for a consult?  Do I call the ED?
Neuro Resident: You call us, that's fine.  What happened?
Surgeon: Well I gave him a brachial plexus block and operated on his hand, but now the surgery's over and he can't move his hand.
Patient: (in the background of the call, really loudly)  I'm fine. I can move my hand!  Just untie me and I'll be fine!
Surgeon: oh.   I guess he's okay.
Neuro Resident: so you don't want that consult then?
Surgeon: yeah, probably not.  (hand up awkwardly)

We laughed so hard (though obviously, really good for the surgeon to call if he thought his patient was having a stroke) - but I just couldn't get Monty Python out of my head:


February 21, 2012

the president

amazing quote from a patient whose orientation I was assessing today - typically we ask all patients on the neurology service every day if they know who they are, where they are, what year it is, and something to orient them to the rest of the world, like who's the president.  It's a way of assessing sophisticated brain function.  So my patient (who has a chronic neurological disease and is never completely oriented) today says her name correctly, doesn't quite know where she is, states that the year is "definitely 2020" and when I ask her who the president is, she says, "Ohhh I totally forget her name.  Let me think. It's something like Joanne.  Yeah, Joanne.  I think it's Joanne."


Love it.

February 20, 2012

Darwinian Medicine


"I may not have gone where I intended to go, but I think I have ended up where I needed to be"
-Douglas Adams, The Long Dark Tea-Time of the Soul
~~~~~~~~~~~


I'm currently in my Neurology clerkship rotation - and it's totally fascinating, but I haven't been writing too much about it from sheer brain exhaustion from planning my fourth year.  Back to millions of forms to fill out and boxes to check and months to move around in my head and thinking about how to pay for all of it.  
So anyways, that's why you haven't heard about it until now.  

But this morning our Grand Rounds lecture was on migraines, and in part of her talk, the lecturer focused on whether there were some evolutionary reasons why migraines would still be around even though they cause a lot of pain.  

With migraines, she demonstrated that people who get migraines are more sensitive to their environments.  This takes the form of being more sensitive to light, to strange tastes, to strange smells - which one must admit could be evolutionarily advantageous if it means you can taste poison faster and drink less of it, or smell a toxic chemical sooner and steer clear of that cave.  She also discussed that people who do not get headaches - ever - are generally insensitive to their environment, and often have somewhat reckless behavior, which could preclude survival long enough to pass on genes.  

Her lecture was interesting, but as I was sitting there, drinking my coffee and trying to maintain focus, I was wondering if these concepts could be applied to not just diseases but all of our qualities that we perceive as negative - and if thinking about qualities this way would help me to better accept them - about myself and other people.  She offered these 5 explanations for why something that seems negative (like a migraine, or like being a worrier) could persist with evolution, despite its potentially negative consequences.  

Why Evolution Doesn't Cut Out All Negative Traits
(aka why you may have some characteristics that you're not necessarily thrilled about)

1. it's a defense mechanism 
(e.g. it literally helps with survival - not necessarily happiness, but survival)
2. it's an advantage in a conflict
- but it might not feel like an advantage in daily life
3. the trait is just too new, and it just takes time to adjust
or to realize that it's not going to work 
4. the benefits outweigh the losses
5. "design constraints" which really means you can only move forward 
(in evolution and in life)  by building on things, not backwards to erase them.  Something can dwindle and drop out with time, but it's impossible to go back three steps.  Character development is kind of like this too.

How does this apply to your character?