[As a member of the aristocracy of the mind, also known as the legal profession, I tend to talk trash about doctors a lot. It turns out they do some pretty cool stuff and have some smart things to say, too. The piece below was written by my sister, a neurologist specializing in epilepsy in the U.S. --Dan]
What a week. Started call on Monday. Admitted 3 unrelated men, all obtunded, minimally responsive, with EEG monitoring showing continual electrographic seizure activity. Dozens of decisions---trying this, trying that, adjusting this, adjusting that---all day, all night---seizures would stop, then recur. ...figuring out ways to stop the seizures without having to give them so much medicine that they would need ventilatory support....seizures stopped but they didn't wake up...more adjustments....reassuring families that they WOULD wake up...."Just wait. Their brains need time to recover.".....
All the while taking care of my other patients....documenting EVERYTHING for posterity and so that insurance would pay the hospital....doing administrative crap in my "Medical Director" capacity....and dealing with personal inconveniences (thunderstorm shut down electricity at my house and I had to check into a hotel so I could watch the EEGs at night, only to find that the hotel's server was "not secure"----AAARGH!) and limping after I slipped in the bathroom at work and damaged my left knee (!).........
I overslept this morning to find my alarm clock blinking "12:00". Another power outage while I slept, or did I forget to reset it after the first one? I had set my phone alarm, but it had died during the night....OMG, had the hospital been trying to reach me? Apparently not, because....
When I finally got to the hospital, the guys in 716, 717, and 718 were all AWAKE, and talking, and happy. None of them had any idea what had happened over the past week. They just wanted to go home.
The 22 year old in 717 did indeed go home, after promising to take his meds religiously. He now knows that he has a tiny congenital lesion in his right frontal lobe just waiting to generate a big seizure if he misses any doses. He's going back to work on Monday. His Dad, who started the week saying he never, ever wanted his son to see a St.Luke's doctor again, grabbed my hand as I was walking out of the room, and said, "....so can we call your office on Monday and make an appointment...?"
I missed the parents of the schizophrenic 59-year-old in 718. All week, they had been keeping vigil over their son, concerned because he barely spoke and kept doing weird things. When I asked him to lift up his arms, he would make pedaling movements with his legs as if he were on a bicycle. His recovery was gradual, but today, apparently, his parents were so pleased that he was back to normal that they left early. "They went to Hellertown to watch my cousin perform," the patient said. "He plays guitar. I used to play the violin..." and went on to describe the talents of various members of his extended family. His parents had said that he was normally "very talkative". I guess they were right. :)
...and, it turns out the gentleman in 716 has degrees from Temple University in Electrical and Mechanical Engineering. All week, we had just known him as the guy who kept complaining about his nurses taking too long to respond when he needed to go to the bathroom. The meds he came in on had been making him grumpy and, in his words, "stupid". We discovered that what he thought were daily seizures because he had trouble thinking were, in fact, not seizures, but a side effect of one of his seizure meds. I stopped the zonisamide, replaced it with something else, and decreased the dose of the levetiracetam that was making him irritable. Today, after a week of seeing me everyday, he said, "Nice to meet you, Dr. de Padua. Thank you for giving me back my brain."
This week, getting so little sleep that I "lost" my glasses and drove around for 3 days without them (turned out I put them in my sewing box for some reason), I started questioning my life choices. My Wells Fargo app told me that I had just received a fat bonus. Our department chairman told me this week that I was "the best epileptologist" he had ever met (but I still had to catch up on my notes--ugh).
But is it worth it?
No matter what I do, the rich will get richer, the poor will get poorer, people will vote for candidates who don't give a shit about them, civilizations will rise and collapse, and new ones will take their place. The oceans will rise, and humanity will adapt. And the universe will continue to expand.
In the grand scheme of things, what is life all about? Hell if I know, but each of us is given a set of skills, derived from the pairing of a series of nucleotides and honed by whatever experiences we have the privilege to encounter. All I know is that I have had the good fortune to have been born with good genes, and just enough privilege to learn how to make use of them to help some of the people I encounter.
This week, I encountered three of them, and for me, for now, that's enough.