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Tuesday, October 27, 2015


I guess it's been almost five years since I've written anything here. Plenty of time for it to cool down. We'll see what happens.

Medical training has ended, and ten years of my life are past. Beyond a shadow of a doubt, I am grateful to my mentors, peers, and patients, for making me who I am. But nothing is without its cost. It was the hardest thing I've ever done.

It's amazing, events in your life that are minor in and of themselves, but have indelible impact. I've never been a movie guy. But my hero is Maximilan Cohen, from Darren Aronofsky's film "Pi." (I hope you've seen it - because it's fantastic, and also because, if you haven't, reading the rest of this post will ruin the movie.)

For a long time, I thought it was for his brilliance. For his ability to push through intense difficulty in order to pursue the secrets underlying the universe. For his willingness to live by a set of clear, simple axioms :
11:15, restate my assumptions : 1. Mathematics is the language of nature. 2. Everything around us can be represented and understood through numbers. 3. If you graph these numbers, patterns emerge. Therefore: There are patterns everywhere in nature.
And he succeeds, wildly. He and Euclid find the mysterious number, the name of God, an epiphanic principle underlying human activity. With it, he is able to clearly visualize the spiraling patterns in the stock market, to make sense of that great disordered mass of chaotic, motive-driven human behavior. His asceticism and sacrifice, his willingness to endure estrangement, they have paid off. He sees deep into the source code of existence, recognizes what others were afraid to contemplate. However, his whole life is blown to smithereens. Sol rediscovers the number and is killed by the reignition of his previous obsessions. Max's ability to see the patterns comes at the cost of worsening headaches - he is staring into the sun all over again. Until he trepanns himself.

Initially, I was disappointed at the end of the movie, when Jenna asks him what 55 x 183 is, and he says "I don't know." To come so far, to realize such a profound truth, and then... to see that victory annihilated? Horrible. If only he could have stood it, just a little longer. If only someone with a stiffer constitution had been chosen the vessel. I didn't understand. I was sad.

Neurology fits me well because I have a strong analytical streak - the same force that makes me a poet, makes me an engineer, makes me a neurologist. I'm driven to seek out the principles running underneath everyday experiences, to unite them, to run along them like swift rails. And, I'm proud of what I've accomplished over the past ten years. Even my hobbies have been doggedly analytical - we all cut channels into ourselves - and I've accomplished a lot. But that ability / drive to analyze can be very isolating. Max could barely tolerate affectionate human contact from his well-meaning neighbor. He dragged his mentor back into an obsessive spiral that Sol's brain could no longer withstand (right MCA?). Max couldn't even smile at a child's frivolous delight in his talents.

It's maladaptive, especially when so much is demanded of you for so long. This is often the nature of our training. It is a brutal heuristic. There are reasons why, reasons that are hard to argue with and difficult to explain - in particular that mastery only comes with countless hours of exposure. Like a metamorphosizing insect, we are melted down into bare constituents, and allowed to rebuild.

It is the way of a profession, a priesthood - and medicine is a priesthood. It burns you out on purpose. It works.

But maybe this sort of monasticism is unhealthy. Maybe what killed Sol and nearly killed Max wasn't the number, maybe it was the recursive contemplation of the abstract patterns in natural life usurping that natural life. Maybe this amalgam of manic scrutiny and clinical detachment is a storm the brain can't weather. Max incarnated the contradiction, able to predict and measure humanity at the cost of trusting and embracing it. Sol's brain lesioned itself. Max had to get the drill. To escape the trap, he had to relinquish something. He had to realize what's important.

It certainly burned me out. I distinctly remember when I started feeling like a person again - the first time, and the second.

Now, I am a neurologist, and always will be, and for good reason. I'm not leaving medicine. But for the first time in as long as I can remember, with time on my hands, with the pressures of med school, residency, fellowship, all lifted... I'm starting to rediscover what's important. I'm starting to embrace a different heuristic.

"I don't know." It feels good.

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