Fretting and fear

No post last week.  Hawai’i takes precedence over silly, trifle-ish things like blogging.  Case in point:

So yes.  It’s been nice.  But now we’re back to neurology.  Cranial nerves, anyone? [gag me]

I had a bit of a revelation during a clinical skills session recently; I didn’t just pick a challenging or difficult career, I picked a terrifying one.  At least, sometimes.

(Note:  Every blog post I start out wondering what the hell to type.  But it’s always interesting to note that not a week goes by that I don’t have some new idea about what medicine really is.)

A few weeks back, we all had a lecture on seizures.  Started out pretty much as your standard, didactic lecture.  Well-organized, some useful little clinical pearls strewn here and there… but then our lecturer tells us he has some videos for us.  Different seizure types, different severities.  Everything from temporal lobe seizures to absence seizures (you might know them as petit mal seizures).

While interesting and incredibly useful, the videos were also extremely unsettling.  For anyone who has never seen a true frontal lobe seizure… well, to give you a rough idea, Anneleise Michel, the young girl whose story was the basis for The Exorcism of Emily Rose, was diagnosed with frontal lobe epilepsy.  They can cause extreme changes in behaviour, thrashing, performing strange tasks, etc.  In some ways, it’s no different than an absence seizure since both involve (in either a small or large area, respectively) neurons in the brain firing together for no reason.

I’ve seen a lot of things in medicine, including a patient whose heart stopped for quite some time, but nothing quite unsettled me like these videos did.  It’s alarming to see someone completely transform in such a dramatic way.  Of course, it’s only made me more empathetic to the social stigmas these patients carry with them at all times.  If you saw someone staggering down the street, shouting at the sky and compulsively rubbing their fingers together, is a seizure really the first thing you’d think of?  It’s nearly unforgivable, the way some of these people are treated, considering they have a condition outside their control.

Anyway, needless to say I was a bit upset by the whole thing.

Fast forward to a few days later, off to clinical skills to practice our neurological exam.  My patient was having quite the nasty headache, so we let her be.  Myself and my partner waited outside another room while our preceptor explained to her why we were there.  I happened to peek inside.  A padded bed.  Telemetry hooked up for an EEG (which measures brain activity).  A call button right by her hand.  Pretty sure my blood pressure shot up 50 points in less than a second.

Sure enough, our patient was being assessed for seizures.  I remember sitting for an hour, every muscle in my neck and shoulders tense, just waiting for her to push the button and seize right then and there.  Being afraid of even asking her to walk or move her head.  Fortunately, she didn’t have an episode, and to this day I still wonder about her.  I genuinely hope she’s doing well.  Lovely lady.

It wasn’t until then that I realized how afraid I am of medicine.  Of some parts of it, anyway.  I think a large chunk of that fear comes from feeling unprepared, especially for emergencies.  I’ve never really been put on the spot in something like a car accident or even someone breaking their leg, so I’m still unsure of how I’ll react.  Will I freeze?  Will I run the other direction (hopefully for help)?  Will I calm everyone and take charge?

Not only that, but I also lack the hands-on skills at this point, which is terrifying in and of itself.  For those of you outside medicine, imagine knowing exactly what the mechanism behind a stroke is.  Imagine knowing that every minute it goes untreated, nearly 2 million neurons can die. (Time is brain!) Now, you know that a drug called tPA has magical properties of some sort and is usually great to give for the more common type of strokes.  Now imagine you don’t know where the hell one finds tPA.  Who to talk to to get it.  How to administer it.  How much to give.  Where tha bag goes when it’s done.  How to order a follow-up CT scan.  You have a ton of information stuffed in your brain, but no tools to use it with.  You feel a bit helpless.

I guess my point is, if you’re scared silly sometimes like me, follow two simple rules and you should be successful no matter what field of medicine you’re in:

  1. Learn lots.
  2. Don’t freak out.

You may also find it helpful to eat chocolate.  Delicious and contains caffeine – what more can you ask for?

 – Atalanta

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