Crazy Day

I think, or at least I hope that I always remember my first patient. On neurology inservice I was assigned one patient, Bob, a man with a recent stroke and global aphasia. Every morning at 6:45 I go into his room, talk to his nurses and then wake him up to make sure the neurologic exam has not changed. Some mornings he cooperates, but most mornings he is just too sleepy. There is something endearing and tragic about a grown man that is returning to the ways of a child. Sometimes the deficits of the stroke frustrate Bob to no end, and other times, it seems like he barely notices them. I wonder what he was like before the stroke, b/c it seems to me that he has been altered in more than just physical defecits.
I also saw another patient this morning- classic Hispanic older guy. As I was getting his knee reflexes he told me I would have made a good Geisha. I told him I was not in that line of service. Note to self- never get on knees to test ankle jerks or knee reflexes.
One of our patients is homeless and recently diagnosed with a progressive terminal illness. He has no contact with his family, although he does have several kids, he does not know much about them including where they might possibly be living. It's very difficult for me to imagine facing death alone like he must. And, since he is homeless, he really does not have any options of places to go. Very tragic...

Tacos

Some days demand a long sweaty cathartic run to help let go of the stress and sadness that filled the day. Today was one of those days. Probably the first of many of my 'hospital' days. People die and people get bad news, but to be merely linked to the bad news, really just passing by in the corridor, can weigh down the soul. Cathartic runs help.

Altered

In neurology, we get a lot of consults on mental status changes. Once the metabolic stuff has checked out, the patient is checked for infections and toxins, they call in the neuro team to see if maybe the patient has something going on with their brain to explain why they are still 'out of it.' On Friday our team saw two patients with altered mental status. Both had loved ones watching over them, and in both situations, the patient could not completely remember who their loved one was. Like in that Nicholas Sparks novel about the lady with Alzheimer's, except this was such an abrupt change in the patients. Just a few days prior they could recognize their spouse, their daughter, and now, they were lost. I know people can muster courage in these situations, but they must be experiencing the worst kind of sadness and loneliness to suffer such an abrupt abandonment. These patients certainly made me sad.

Naive

Yes I am naive- when a patient comes in with symptoms, then they have something wrong with them; seems logical enough for me. But what if they are faking, and what if on top of that, they don't even know they are faking? double yikes! A much more complicated situation than my mind is ready for. I'm also very shocked and sheltered. I saw a woman today with numerous children, a husband she regretted and an 8th grade education- she was almost 40! In America?!?! How can this be- education is virtually free (well at least through 12th grade, after that it costs more than a middle class persons home.) Just baffles my mind! Not everyone is meant to be a doctor or an astrophysicists, but some level of education is important just to be a productive, contributing citizen or at least people able to participate in society(and this in no way is a slight at the MR and special needs populations.) How will she be able to prepare her own children for the world when she cannot hold a job that requires one to do complex calculations or construct a well written paragraph? Today I was shocked and I believe this will be a year of uncovering how little I know about people and the world in which I live.
Also, something wonderful is happening....perhaps...

Quotables

Consult service really is like the ideal service for skeptics- the entire day our small team- two residents and two medical students- went case by case ruling out our patients as neurology cases. Does this patient have Parkinson's, or is his tremor just a side effect of his severe liver failure- not a tough one there! Is this lady having an unusual headache/stroke or are her symptoms merely a manifestation of the stress of unemployment and her upcoming divorce- also pretty obvious!

We did have one interesting case, well I suppose that is relative to who you talk to. A lady came into the ER and her family was afraid she had suffered a stroke- however, she presented with none of the classical symptoms, no strength deficits, no language impairment, just a short history of tingling in her face that she denied upon admittance, because she did not want to be in the ER any longer. Her nephew helped translate and then filled in some missing pieces to her story- he started by telling us, "Oh, she's just being Mexican about the whole thing." Yes- he said that! I almost started laughing, but did not, luckily. In the end, she probably did not have a stroke, but it was nice to see how close families are here. The nephew came, probably because he knew his own mother could not emotionally or physically bring her sister to the ER for what might of been a very scary diagnosis. It's so wonderful to see families so close!

There might be a PVS case...yikes!

Day 1

So maybe it wont be that bad...ha! Well at least today was not bad- start at 8am, orient myself to the newness of third year, then off to observe pediatric neurology clinic for the afternoon. And not just any pedi neuro clinic, this place was like 'the place' that people get referred to when they have an unusual or difficult case. For example- I would think I had a highly unusual afternoon, just based on the fact that I saw two children with Lesch Nyhan syndrome, a child with severe tourettes AND a child with epilepsy actually have a seizure in the clinic!!! But for this clinic, it was just a typical day.

I'm expecting that tomorrow will involve more activity on my part, but today was a fun introduction and a nice way to get my feet wet before I am pushed off into the deep end.