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In Child neurology we are required to do a year of adult neurology. This is a year of complete culture shock. Children’s hospitals and adult hospitals are two completely different worlds. It is interesting to see the adult neurology residents complain about how chipper and upbeat the pediatrics people are. This is an odd complaint, until you realize adult neurology residents feel completely out of their comfort zone in knowing how to manage the patient. fear and discomfort are only augmented by sleep deprivation and being pulled in several directions at once, as you tend to be on call, Perhaps they can be forgiven when they really find it difficult to draw enthusiasm when awoken at 3am to hear about some “kiddo.” For me, being out of my element with adult patients is an even greater culture shock. Going from chipper to somewhat cynical and demanding is worse than the other way around.

The culture shock is particularly profound the Neuro ICU. For one thing, it is a prime site for so many spectacularly horrific things. While children with neurlogic problems can be heartbreaking, somehow I manage to deal with it. There is something about dealing with severe traumatic brain injury, brain tumors, stroke and brain hemorrhage all day that is particularly soul killing. The place is just saturated with death and loss. It was here I came to understand the phenomenon in medicine that is gallows humor.

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6 He that ascended up on high, as also he descended below all things, in that he comprehended all things, that he might be in all and through all things, the light of truth;

7 Which truth shineth. This is the light of Christ. As also he is in the sun, and the light of the sun, and the power thereof by which it was made.

32 And ye shall know the truth, and the truth shall make you free
John 8:32

We are emerging from an age that put value above all else upon the ideal of truth. But what exactly is truth? Is it absolute? beauty? freedom? enlightenment? facts? data? reason? principles? unchanging? Is something that is true for one person necessarily true for another? Is truth for ourselves at one point in time necessarily true to ourselves at another point? The terms modernism and post-modernism are used and abused in these kinds of arguments all the time. I am not sure what these terms mean exactly. To a certain type of person post-modernism is moral relativism and the devil, while to another type, modernism is rigid, unyielding, black and white thinking in absolutes. In the end I think both sides are largely talking past one another and caricaturing the other side. This is not my desire. I just want the truth.

What’s that you say Jack, “The truth!? You can’t handle the truth!” Perhaps.

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One of the first lessons a physician gets in caring for patients is the virtue of objectivity. “Doctors can’t afford to be too close to their patients.” They pound this into our heads. “It will cloud your clinical judgement.” “You will burn out.” “Your problems are not their problems.”

Something about that always seemed a little off with me. What doctor goes into medicine with NO expectation of knowing, connecting with and helping patients?

They claim it central to becoming a clinician. While critical thinking, pattern recognition and problem solving are central to the science of medicine, taken alone they neglect its soul. Read the rest of this entry »

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