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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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