Trial and error

It's been a crazy week on the general neurology service. During my mid-rotation feedback session with my attending yesterday (*mwah mwaaaah mwaah*), I cast about briefly for something -- anything -- positive to say about my experience so far. "We've seen a wide variety of patients since I came on service," is what I came up with.

"Well," he said, "it's not usually like this."

Have I mentioned that I just love in-patient neurology?

In any event, I really have seen a wide variety of patients since I came on service. There have been some good bread-and-butter cases: strokes and multiple sclerosis flares, a couple of people with seizure disorders, a case of neurocysticercosis. Two days ago, I admitted a man with glioblastoma multiforme, a devastating form of brain cancer. But there have also been some mysteries and even a few zebras: slurred speech caused by the same auto-antibodies that cause type 1 diabetes, progressive multifocal leukoencephalopahy in a patient with leukemia, weirdly chronic meningoencephalitis that didn't seem to be caused by an infection.

The upshot of all this variety has been surprisingly unvaried: brain MRIs and lumbar punctures for everybody; steroids for almost everybody. There were a couple days earlier this week when my team was a virtual lumbar puncture machine. There were so many LPs to go around that the residents let us medical students try our hands with the needle, which was simultaneously an opportunity (for me) and a torment (for both me and my patients -- and probably my resident too). I didn't succeed in finding the dural space a single time and at least once thrust my needle into a patient's spinal nerve root, sending a zing of electric pain down his leg. There's nothing quite like pulling a four inch needle out of someone's back, slightly adjusting the needle's angle and then shoving it back in. And then doing it again.

Good times, I tell ya.

Like every single medical student in the history of ever, I'm deeply ambivalent about practicing painful, invasive procdures on real live people. But I also understand that there's simply no way to learn medicine without practicing on patients. Other people have written more eloquently than I can hope to on this subject. For now, suffice it to say that I'm very grateful to my patients for trusting their medical student with something so precious.