God girl grill gridiron

Monday, March 17, 2008

Peds Neuro

So if all goes as planned, I'll be a pediatric neurologist in seven or eight years.


Seriously, pediatric neurology. Sort of a strange choice (judging by most people's reactions.) Of course the surgeons all asked what I want to be when I grow up, and every time I said peds neuro, I got pretty horrible reactions like "What makes you want to do that to yourself?" or "Oh God..." or simply "Why?" Most everybody else glazes over immediately - it's a hell of a conversation killer. Most people seem to be thinking, "What the hell is that?"

Well, I'll tell you (ha!)

Basically, it's anything to do with the brain, nerves, and muscles of kids. That can be anything from multiple sclerosis to traumatic injury to metabolic disorders to (rarely) even stroke. Cerebral palsy, neuromuscular disorders, headaches, tics - all these are part of neurology. It's a wide and fascinating field. The real fun is in the neuro exam. Most of the physical exam skills we learn are rather direct. You listen to the heart, you palpate the liver, you feel the pulse, or look at the pharynx. The neuro exam is different. It's much more like a conversation between you and the person's brain, in which you do something particular and see how the nervous system responds. And it's all quite arcane. For instance, there's a phenomenon called "pass-pointing." This shows up when the doctor holds up their finger, and asks you to touch it with the tip of your finger, then touch your nose. When you touch your nose, they move their finger and you have to touch it again, then your nose, then the finger which has moved again. People with dysfunction of their cerebellum will "pass-point," which means they'll miss when they try to touch the doctor's finger. So with that simple maneuver, I can talk to your cerebellum. There are a multitude of signs like this one, with which I can speak to all of the different portions of the fantastic apparatus that is your nervous system.

The really difficult aspect of peds neuro, though is that many of these disorders can't be effectively treated. The running joke about neurologists is that they can diagnose anything but can treat nothing, and as much as that's silly it's actually pretty true to life. MS sucks. Duchenne sucks. Myotonic dystrophy sucks. Metabolic disorders really, really suck. And as a peds neurologist, part of my job is going to be telling kids and their parents how life is going to be pretty hard, despite everything medicine has to offer. I won't lie - it's a daunting challenge that I can't claim to even understand yet.

There's hope, though. Scientific interest in neurology is blooming, and new advances are made every year. I've wanted for a long time to be on the cutting edge, to be discovering new ground - what better way than to enter a field with so much potential for new discovery?
Maybe that's kind of pie-in-the-sky. But there are downsides to any medical field. Surgeons sacrifice their entire lives on the altar of the OR. Dermatologists have to look at skin all day long. ER docs get dumped on by everyone in the hospital. And neurologists diagnose diseases for which there may be no effective treatment. But at the same time, they are the only people equipped to deal with those diseases in any meaningful way.

And if you're going to take on that kind of responsibility, you ought to love the work from the basics on up. And I do.

Had a bit of a scare today. I thought that I'd already missed the deadline to apply for peds neuro programs, as on the website the listed deadline is January 25, 2008. Boy did I feel like an idiot. But then I looked a little harder and saw that this deadline comes after the Dean's Letters are to have been released. So I'm guessing their website just isn't updated yet. Whew. I guess if I'm still going to be the Absent-Minded Professor, I can at least be proactively absent-minded. Or something.

No comments: