When we were growing up in Bombay, India; my dad decided to contribute to a charity called "Each one teach one". I had always found the name fascinating because it expresses the concept of individual responsibility with such simple elegance.
The reason why I thought about the phrase again was quite different from the underlying guiding principle of this charity which extols each family to adopt a child educationally. I was playing the role of the assistant senior on the Stroke service with one of the most luminary attendings around and needless to say I got inspired. I have been looking for the perfect way to learn and teach Neurology; and it just dawned upon me now; that if we simply learned one concept from each of our patients everyday; we'd perhaps learn that concept forever. It's not like I hadn't heard of this method before and somehow in the zeal to cover at least one whole topic in its entirety the simple elegance of learning at least one concept from each of my patients somehow got lost; much to my dismay. Nevertheless, having discovered it in practice now; I feel a sense of fulfillment!
When one of my most admired attendings related to me that she absolutely loves the concept of "what did this patient teach me today" I couldn't help but confess I had fallen in love too; quite simply!
Saturday, November 20, 2010
Saturday, March 20, 2010
NSU and beyond
When you start dreaming about work; does it mean that you actually have your dream-job? The last two weeks have been not just amazing but very inspiring. The long hours didn't matter, the lack of sleep didn't matter but every time my head hit the pillow I felt happy and content that I'd given it my best. Neuro-critical care is such a young field and full of hope. There's a lot of work which needs to be done but we're moving along.
I love the pace in the NSU. I love the procedures-the lines, the tubes, the monitors, the ventilators; the physiology...because somewhere beyond all that machinery life lives;sometimes snatching the last breath from death's hands and sometimes just waiting patiently for the right time to bounce back. Stuff happens. Both good and bad. Somebody symptomatic from their VBI undergoes an angioplasty and stops vomiting every time they sit up; somebody with a ruptured aneurysm undergoes clipping and responds to your voice and moves their hands and legs; someone with a SDH wakes up after a burr-hole; someone with status epilepticus stops seizing and wakes up to get extubated...
And then there are those who get locked in inspite of all heroic measures-ia tpa, stenting, hypothermia...and there are those with brain tumors who stroke out from tissue shifts after you tide over their septic shock heroically; there are those with SAH who keep developing vasospasm no matter how much of HHH you try...
But; the bottom line is you try and try with all your might, with all your resources, with all your heart.
The brain is not as homogeneous as the heart; so resuscitating the brain is not as elegantly simple as CPR. Before we see damage on our currently available radiologic modalities like CT/MRI, much has happened to cause both reversible and irreversible damage. We have a long way to go but we are on our way; that's what it felt like when I stepped into the NSU everyday.
I love the pace in the NSU. I love the procedures-the lines, the tubes, the monitors, the ventilators; the physiology...because somewhere beyond all that machinery life lives;sometimes snatching the last breath from death's hands and sometimes just waiting patiently for the right time to bounce back. Stuff happens. Both good and bad. Somebody symptomatic from their VBI undergoes an angioplasty and stops vomiting every time they sit up; somebody with a ruptured aneurysm undergoes clipping and responds to your voice and moves their hands and legs; someone with a SDH wakes up after a burr-hole; someone with status epilepticus stops seizing and wakes up to get extubated...
And then there are those who get locked in inspite of all heroic measures-ia tpa, stenting, hypothermia...and there are those with brain tumors who stroke out from tissue shifts after you tide over their septic shock heroically; there are those with SAH who keep developing vasospasm no matter how much of HHH you try...
But; the bottom line is you try and try with all your might, with all your resources, with all your heart.
The brain is not as homogeneous as the heart; so resuscitating the brain is not as elegantly simple as CPR. Before we see damage on our currently available radiologic modalities like CT/MRI, much has happened to cause both reversible and irreversible damage. We have a long way to go but we are on our way; that's what it felt like when I stepped into the NSU everyday.
Thursday, February 11, 2010
Dreams
I don't know where I am going but I'm on my way. There are many promises I have made to myself; didn't know much when I made those promises and now I find myself wondering; thinking about those promises...
Being able to live a dream is one thing; being able to build a dream as you're living is another; being able to dream when you'd rather not sleep and think of all that could be and all that was and all that is. On call nights; when I stay up fielding questions about tylenol and Milk of Magnesia; I wonder what would the world be like without sleep; would the world be dreamless; does hope stem from dreams or do dreams come from hope? And what happens to people who sleep but can't dream you know like people with PCA territory occipital infarcts? My eyes grow weary but my mind wanders. My beeper goes off and I come back to life as I know it.
What is the purpose of it all? I don't know how many times I have asked this question and how many times I fail to get an answer. But I keep trying.
There are questions that we feel we know the answers to. To angio or not to angio; to stent or not to stent; to aspirin or to plavix but what about to dream or not to dream? Is there really a finite number of dreams out there (out there, I don't know where!) which we are all entitled to; just like the air we breathe or the beats that our hearts don't skip...Could I ever prescribe those? As my head touches a pillow at an hour I'd rather wake up; I'm too tired to think; I am just happy to to be able to sleep for a few minutes and at that point in time I couldn't care less about not dreaming and even if I did; I'm sure I wouldn't remember it when I wake up.
Being able to live a dream is one thing; being able to build a dream as you're living is another; being able to dream when you'd rather not sleep and think of all that could be and all that was and all that is. On call nights; when I stay up fielding questions about tylenol and Milk of Magnesia; I wonder what would the world be like without sleep; would the world be dreamless; does hope stem from dreams or do dreams come from hope? And what happens to people who sleep but can't dream you know like people with PCA territory occipital infarcts? My eyes grow weary but my mind wanders. My beeper goes off and I come back to life as I know it.
What is the purpose of it all? I don't know how many times I have asked this question and how many times I fail to get an answer. But I keep trying.
There are questions that we feel we know the answers to. To angio or not to angio; to stent or not to stent; to aspirin or to plavix but what about to dream or not to dream? Is there really a finite number of dreams out there (out there, I don't know where!) which we are all entitled to; just like the air we breathe or the beats that our hearts don't skip...Could I ever prescribe those? As my head touches a pillow at an hour I'd rather wake up; I'm too tired to think; I am just happy to to be able to sleep for a few minutes and at that point in time I couldn't care less about not dreaming and even if I did; I'm sure I wouldn't remember it when I wake up.
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