May you Live in Interesting Times

I'm fairly certain Neurlogy is not for me. It is, as my attending declares, a field of nerds. And while I indulge myself with the label of nerd, he is referring to a very specific brand of nerds who are meticulous in their pursuit of the diagnosis. It is not just the highly specific diagnosis that they enjoy, they also love the pattern used to acquire that diagnosis. The art of physical pursuit is exemplified in neurology. The science of futility is also exemplified by neurology. While the diagnoses are specific and intricate, it is rare that something can be done to treat the condition (prevention of progression they can do, treatments of symptoms they can sort of do, but curing the disorder - rarely achievable). Neurologists define the label "academic," (as in he practices a very academic form of medicine).

The patient interview usually involves the doctor asking some questions and the patient answering them. The doctor nods his head, the patient looks concerned. The doctor then turns to me, says about 20 words, only 15 of which I understand (only 5 of them are comprehensible to the patient, and those are: the, it, but, because, and patient). He then proceeds to nod a bit more, perhaps ask me an unanswerable question, tell an unrelated story about Chamberlain and the Battle of Gettysburg, and then say:
"Isn't this an interesting case. You know, the Chinese have a curse. . 'may you live in interesting times.' The medical equivalent of this is 'may you be an interesting patient.' Man, you never want to be interesting to medical students. Nope."

He then turns back to the patient (who is looking confused, concerned, and petrified) and says, "there's just not that much we can do for you," maybe writes a prescription for some medicine that may or may not relieve symptoms, and wishes the patient a good day.

OR, my other favorite patient interaction is by the bedside:
Imagine a patient, recovering from a very severe stroke, who can barely move the right side of her body, is confused about where she is, and can't get her words out very well.
Dr: "Wow. .you are doing much better than your MRI would lead us to believe."
P: Mmdfnek kitten throws?
Dr: Hmm. . well, really, believe you me, you are doing great. . Just great. I mean, you can move your arm on the right side. . that's just amazing. Yes, I would expect you to have some difficulty talking, but really, you are just doing awesome.
P: Mdhadfk group trial of words?
Dr: Ok, well. . we'll be back to check on you tomorrow. Have a great day. . I'm really quite impressed.

And that's about it.
In fairness to the doctors. . these are certainly exaggerated stories. There are many wonderful things that Neurologists do (seizure control, headache management, peripheral neuropathy management, MS treatment, etc - the list is endless). Their physical exam is a beautiful thing. And they do a good job of delivering (continually) bad news - they do it day in and day out, and they are better at it than most doctors.

So that's a bit of neuro. May you never have to see a neurologist.