Neurologist, The Nerd

My current rotation is neurology and, honestly, I am loving it. Not because I am especially good at neuro, because I am not. I always forget that brainstem lesions have crossed findings on physical exam, I mix up the differences between spinothalamic tracts and the dorsal column and I've been told a million times that the medial longitudinal fasciculus is a commonly hit lesion in multiple sclerosis and presents with an afferent pupillary defect. Doesn't mean it'll stick. I envy my classmates with perfect memories and GPAs who always have the ready answer because I am always stumbling along like a blind bat in a white coat constantly tapping at people's knees...

Anyway, pity party aside, I love neurology because of the constant research. Papers are always being brought to the rounding table to discuss, all my attendings and residents ask, "What does the research say?" and in no other field is there such a big, blank canvas over the most important organ in the body (so say the neurologists, of course, but they're not biased). (The other day my resident called the heart, "such a dumbass organ").

I do enjoy developing a whole new vocabulary, too. Neurology feels like a speciality within the specialties. Very intellectual, very nerdy. I'll bet the average height of a neurologist is 5'4" to the 6'2" of the average orthopod. Neurologists geek out about localizing lesions on physical exam and lesions on diffusion-weighted image MRIs while orthopedic surgeons discuss their work-out routines.

It's fascinating stuff. I've seen patients with sporadic mad cow disease, rare autoimmune encephalitis (NMDA receptor positive encephalitis), and other crazy syndromes.

The flip side, of course, is how devastating all of this is. Perhaps that's the one downfall of neurology so far. I see very few remarkable outcomes and a lot of people spending a few weeks on the neuro service only to be shuttled off to hospice and nursing homes after. Lives devastated by multiple sclerosis and rapid dementias, leaving their families reeling. Meanwhile the neurologist dances around the bedside showing off the patient's horizontal right-beating nystagmus and 3/4 biceps, triceps, and brachioradialis reflexes with spread and clonus. You get the picture.

It's a fascinating field. The good thing is, we can only progress from where current research stands. Take even MS: the first FDA approved drug for MS didn't come out until the 90's. There was so much demand for the treatment that MS patients had to enter a lottery to determine who got the medicines first. If I were a research person, neurology would be the place to be, IMHO.