Medicine for the brain is incredibly complex. Yet, the joke goes around medical circles that Neurologists are admirers of disease, not treater’s of it. This is far less true now than forty years ago, and is rapidly becoming less and less true everyday, but that small kernel of truth does say something about we who are drawn to the field. I really do find the disease processes that affect brain function seriously fascinating.
We learn almost everything we know about the brain from what happens when things go wrong. Genetic diseases become our laboratory, nature the experimenter, allowing us to learn things we would be monsters for trying to recreate in the lab with people. In fact, Nazi physicians are generally hailed as monsters for doing precisely this, reducing the person to lab rat.
Sometimes I wonder at what point am I supposed to feel guilty about my morbid curiousity. In conversation with each other, making a rare diagnosis, even if incurable, is an exciting development that we discuss with our peers. I am quite certain that the patient does not ever see it quite the same way. It is our curiousity that leads so many into the field of neuroscience. Finding the subject matter fascinating is critical to having robust science.
It has also on occasion caused twinges, or in worse cases, spasms of guilt in myself. This is true of medicine and doctors in general, but neurologists at the extreme. There have been many occasions when I have had to remind myself, I get to do what I love and enjoy for a living because it can be of lifechanging value to other people.
So it is out of a guilt born of an enthusiasm that leaves me struggling to always, always, remember my patients are not their disease. They are not interesting cases. They are human beings first and foremost. So if I ever seem a little self righteous in my fervency advocating for disability rights, please understand it is rooted in my own personal shortcomings.
Lest anyone go away believing the stereotype that Neurology is for people who don’t treat stuff, here is a word in defense of my field. It is very exciting and gratifying to belong to a field where the incurable is becoming curable. We are starting to unravel secrets of the brain and come up for treatments for the incurable or untreatable faster than any other field I know of. Neurology is the frontier, where medicine has work to do. To be a neurologist is to be a pioneer.
It is a great day, when we get someone in the office we can actually treat and fix. I recently saw an absence (Petit Mal) seizure patient in my clinic that made my day. It isn’t often we can take someone who has serious learning difficulties in school, slap them on antiseizure medication and completely turn their academic future around. I can actually say I gave someone’s life back that day. It keeps me going, with a cautious optimism for all the ones for whom I can’t say the same.
Mind, Soul, and Body 
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August 9, 2008 at 8:41 am
Catatonic Kid
Truly fascinating insights.
I think perhaps it’s a problem faced by many in their professional lives. Journalists, say, often see only the story and not the reality of the people behind it. In medicine, particularly neurology where you are dealing with what makes a person a person the dichotomy is made stark. More so perhaps than in many other fields.
But that seems to mean you are more likely to be aware of it, and that is only to the good. It’s those who travel that road blind I’d worry about.
August 15, 2008 at 5:55 pm
Apollo
As you know, that stereotype engrained by my prior experiences with neuroscience coursework was recently confronted by my Neurology rotation experiences. My fiancée, a potential future pediatric neurologist, is a huge fan of mystery stories (a la Hercule Poirot) and puzzles (Sudoku, crossword puzzles, etc), and she strikes me as fitting the Sherlock Holmes-esque “detective” archetype I associate with Neurology. I’m not sure I entirely fit into that role (yet). I think of my personality type as being more of a “defender” or “warrior” styling (probably from playing too many “Legend of Zelda” video games as a kid), which is why the newness and potential for interventional treatments in Neurology really excites me.
I think CK is right on: the brain has such an dominant role in the determination of a person’s identity, and our existence as social beings feeds into one’s interest in neurology. What do you think about the level of aggressiveness and assertiveness of research into treatment in Neurology? Do you think that Neurology will be able to recruit and harness the same (or similar, or equal but different) drive to drastically improve treatment across the board for neurological diseases as have other fields like Cardiology? What does the field need to do to keep pushing forward toward treatment advancements?
August 16, 2008 at 9:30 am
Doc
CK,
You are right that you are much more aware of it. My own ability to do pretty well with patients that have personal tragedy so deep that it disturbs many others in the medical field was actually a big part of the draw of the field for me. I guess this post just kind of caught me in a down moment. It is seeing the whole person disintegrate in front of you that tinges my fascination and curiosity with guilt. At times it is depressing, but it happens and I’m doing what I can to fight it.
Apollo,
In stroke it is already happening. It is a matter of organizing registries to the big multicenter trials can take place. This is what has pushed both cardiology and Heme/Onc forward. Multiple sclerosis is one of the most researched diseases today as well. As far as preventive health, just check out Sharp Brains and you’ll find out quickly that dementia prevention studies are taking off.
For all the treatments we have for epilepsy we are still just scratching the surface of what a seizure actually is. I think the drive is there from all angles, rehabilitation, prevention and moving existing treatments forward.. It does take a certain kind of person to do neurology and because of preconceptions, so there is something of a manpower shortage of people in fields like rehabilitation or Child Neurology. This doesn’t help matters. The other problem is of course that things are trickier because the brain is so complex. This just tells me it means the progress that has happened in the past in other fields is on the horizon in Neurology and I think that is ultra cool.