Peace, love and neurology

So I'm one week into my neurology rotation and I have to say, I hate it exactly as much as I expected to. Neuroanatomy was by far my weakest subject during the preclinical years of medical school and even now, I get a little jumpy when I hear words like thalamus and medial lemniscus. Scanning through a brain -- or worse -- spine MRI is enough to make me feel queasy and I panic slightly when the conversation turns to cranial nerves. The upside I suppose is that this reaction confirms my decision to go into (internal) medicine. One of my patients, admitted following a small stroke, had the decency to muster up a little chest pain overnight and as a result I spent a few happy hours reading EKGs and checking troponins. Fotunately for her and unfortunately for me, her angina resolved after a single dose of sublingual nitroglycerin and hasn't been heard from since, so now I'm back to counting down the days until neurology is over.

One of the aspects of neurology that's particularly difficult is that it's damn depressing. One patient recently discharged from our service is a young woman with a history of leukemia for which she received chemotherapy injected directly into her spinal canal. The chemotherapy cured her cancer, but also caused a rare and catastrophic neurological toxicity. Apparently when she was admitted to the neurology service a few days before I began my rotation, she had completely ceased to speak or move. After a week or so of our able care (!), she was talking in one and two word sentences, following simple commands very slowly and copying her own name with a pencil. The left side of her body remains profoundly weak. Her husband has kept a vigil at her bedside, feeding her and encouraging her, taking her for slow walks around the hospital. She is expected to recover some additional function, but will almost certainly never regain her full self. I'm not even sure what to say about this couple. When I think about them, loneliness and disappointment wash over me. This can't be the way they expected life to go.

I've been thinking about disappointment in general lately, in part because I submitted my rank order list for the match a couple of weeks ago. In the end, I ranked Stanford first; staying here in Palo Alto is what's best for my little family and I'm deeply grateful to be in a position where I have the luxury to simply choose what's best for my husband and son. Plenty of medical students every year feel lucky to match anywhere, let alone to a program as excellent as Stanford's. But I'm also disappointed, maybe more than I'm willing to admit, that I'm giving up BWH. The truth is, that's where I want to be next year and I suppose I'll always wonder how my career might have been different had I trained there. Of course, this is a very small disappointment, and already I feel more wistful than resentful. But I've vicariously encounted a few other disappointments lately, much larger than the little scratch I'm currently nursing. So I'm thinking about disappointment.

And, of course, we're in Lent, the season of loneliness and disappointment. Last week, my priest caught up to me at coffee hour and handed me a printed packet of poetry, left over from a Lenten concert. The poems, she said, were for the part of me that's "neither a doctor nor a mother."

"That part is very small," I told her.

"Of course it is," she said. "But don't worry. It's there, just waiting for when you're 60."

Inside the packet were poems by Shakespeare, Auden and two poems by Wendell Berry, new to me. Here are a few lines from 'A Timbered Choir':

The clearning rests in song and shade.
It is a creature made
By old light held in soil and leaf,
By human joy and grief,
By human work,
Fidelity of sight and stroke,
By rain, by water on
The parent stone.

We join our work to Heaven's gift,
Our hope to what is left,
That field and woods at last agree
In an economy
Of widest worth.
High Heaven's Kingdom come on earth.
Imagine Paradise.
O dust, arise!

And suddenly, I think I can see that the cure for disappointment is anticipation. So as my Lenten observance this year, I'm looking forward. Looking forward to Easter, to being an intern at Stanford, to being 60.