Feeling thankful

When you are surrounded by people who believe in you, who root for you, who care about you; you feel blessed. I visited my work family from uptown today and here's my message for you-I learned so much from you and you played such a big role in making me the Neurointensivist that I am today. Thank you for your generosity of spirit and mind. Thank you for taking every aspiring trainee under your wing and helping them learn how to fly. You will always hold a special place in my heart and I hope you will remember me fondly for many, many years to come.
Keep on doing the amazing things you do-providing the best possible care for every patient you encounter, inspire generations of physicians to come...I feel blessed and honored that I had a chance to work with you!

In the evening, I attended my first graduation ceremony as an attending. It felt good and nostalgic. I was a resident not too long ago. Graduation day-is a day that stands testimony to all the promises of a wonderful future, to all the hopes and dreams of being the best that you can be for all your team members. It is a day of reckoning, a day filled with gratitude and a day which will remain etched in your memory for years to come. I am learning so much from all the residents and fellows I have an opportunity to teach. I can't feel thankful enough for this opportunity.

I love this feeling of gratitude and hope that my heart only grows more grateful each day. I want to keep paying it forward, today and everyday!

Something positive everyday

It's easy to get caught up in the daily hustle and bustle of life. I was rummaging through some of my old posts and I realized that I hadn't written for a while. But it didn't seem like a while...It's like catching up with an old friend, you pick up effortlessly from where you last left. Can't be thankful enough for that.

How can we think about something positive everyday? If we were able to make one positive change for every patient in the unit, that would be a start. It would be a tough start though but if we don't think it how will it actually happen, right? It could be as simple as stopping unnecessary gi prophylaxis or starting appropriate feeds or providing some sunlight to as as nuanced as mobilization on a ventilator, or timely extubation or spot-on resuscitation or relief from suffering...but something positive for each patient everyday.

A big thank you to my extended family!

When I was graduating from medical school in India and moving for residency to the United States, one of the things that I thought I would really miss would be the amazing connections I was able to establish with the nurses and ancillary staff I worked with. They cared about whether I had eaten something on call or not; helped me find scarce supplies in overcrowded wards; gave me insightful lessons on patient management or procedures using their years of wisdom; let me know how proud they were of me and they blessed me to become an awesome physician.Throughout medical school; I had seen some wonderful residents have that relationship with the staff and I knew when I grew up I wanted that to be a part of each day at work for me.

During internship I was able to transition into a new healthcare system with a few minor hiccups. The staff I worked with, the nurses, social workers, unit secretaries, cleaning crew, physical therapists, occupational therapists, speech therapists, nursing assistants were all so welcoming and ready to help a young intern learn the ropes. They made me feel at home. As I moved to another city and a new hospital to start my residency I was once again happy to find an extended family. Every single day at work, these people made me feel special, made me believe more than ever that I could be the best physician that I wanted to be. They worked with me through easy and difficult situations. I can't imagine stabilizing patients without all the nurses chipping in whether it was their patient or not, averting rapid responses, creating beds in step-down units, running around to get labs and meds, lending a hand for transporting patients to urgent scans or being the first responders when patients or families were not happy and bridging communication gaps and alerting me when communication needed to be bolstered. I miss them all. The NSU nurses played a huge role in helping me find my calling. As my first rotation in Neurology, no other rotation could have made for a more formidable first rotation. They were patient with me, they helped me learn the system, they taught me stuff that no textbook or journal could have, their work ethic put any signs of fatigue in me to shame. I loved working with each and everyone of them. Even when I was not in the unit, I would go hang out in the unit just because I found it to be the most comforting place in the hospital. Of course, the fact that the little break room in the middle of the unit would always have giant cookies, cupcakes, chocolate, coffee and great conversations were just added bonuses.

When it was time to move again, I couldn't help but feel sad. I was not going to see these amazing people for a long time. These people who inspired by taking pride in their jobs and brought hope and smiles as they cared for patients each day. But all the kindness and caring they shared with me made the transition easy and I was able to find another extension of my family as I started fellowship. This year has taught me a lot about myself. The first year of this fellowship has been intense both academically and philosophically and I am feeling a little introspective now as I start my second year. The nurses, unit secretaries, nurse assistants, physician assistants, respiratory therapists, cleaning crew, radiology technicians, eeg technicians, transfer center operators I am working with are a joy to work with. Through resuscitating crashing patients, running around like their lives depended on it to gather medications or blood products, to saying joyful farewells to patients who are getting transferred to the floor or rehab; to participating in some of the most difficult family discussions I have had to date..it almost feels like we have stories of triumph and tribulations together. Their work ethic is inspiring and the way they have all handled daily encounters with life and death is humbling. Their smiles, hugs, tear-filled eyes, drive and hard-work makes it a blessed experience coming to work each day.

As I write this piece, many vivid memories come to my mind, my heart is filled with gratitude and I want to say thank you to each and everyone of them. Just like any family that stays together, we have our disagreements, we have our differences, sometimes we take each other for granted, sometimes we just piss each other off but just like any family that stays together, every single time when someone needs us we have rallied together and given it our all. I feel we don't appreciate members in our families enough and don't say thank you enough. So, this blog post is a little thank you note and a little reminder that you all mean a lot to me as my extended family at work and make work fun and inspiring no matter how challenging the situations we face might be. I feel very lucky and want to thank God for giving me the privilege to work with such amazing people who believe in me :) 

Be kind to yourself

As a physician it is extremely easy being hard on oneself. We are perhaps our biggest critics; always striving to do better, to improve and to be perfect. It is difficult to distinguish between what is feeding our egos and what is boosting our self-esteem. Another tricky thing is trying to differentiate between what hurts our self- esteem and what hurts our egos; either way we find enough to be dissatisfied about. When I was in medical school I thought that a certain amount of dissatisfaction was a necessity; to egg me on; to prevent me from slacking, to help me achieve the impossible. As I am growing up as a physician, I am beginning to question this dissatisfaction. I don't know if that is what keeps me going or the sheer love for what I do and want to do. Medicine and death both humble me so much each day that if I were to let my ego take the brunt, then I'd perish because egos are fragile. Self esteem doesn't come from knowing everything; it comes from knowing that you will always strive to do the right thing; that you are not afraid to say I don't know but will always strive to find the right answer. Of course, not knowing the answer is annoying and being reminded that you don't know hurts but that doesn't mean that you hold on to that reminder and be harsh towards yourself. Instead those reminders are meant to make us grow in humility. I am only beginning to learn that I need to be kind to myself first if I wish to be kind to others. I need to forgive myself first for making a mistake before I can forgive others. As much as it's important to seek out knowledge, it's important to be kind to yourself and to others who are trying to do the same as physicians. 

Rounding with tablets and smart-phones

How is having all this knowledge at my finger tips going to change patient management? The power of reading and dissecting concepts and using the right tools at the right time will not change. Perhaps, the speed and accuracy of recall will. Perhaps, it's only fitting to have tablets and smart-phones at our disposal while rounding because the sheer volume of new literature is mind blowing and being able to answer that one pertinent question in a matter of a few seconds can make a difference. I am happy to say that I am part of a very connected world acutely tuned in to all that is new and all that is tried and tested. I can' help but feel proud of my generation for empowering all those who seek knowledge and help them apply their knowledge in timely manner.

Pride and Knowledge

Knowledge sure is power. It can make or break lives merely depending upon how it is used. Sometimes; I struggle to prevent knowledge from seeding unnecessary pride in me. It is a tricky slope. The higher you go, the mightier you feel and you can easily lose sight of the true purpose of gaining knowledge. I find learning medicine a very humbling experience. The more I learn; the more I feel there is to learn and perhaps; that keeps my pride in check. True greatness comes from humility and true knowledge should make you more humble rather than make your head swim in ill-founded pride. In medicine; knowing one's limitations and stemming ignorance which arises from those limitations is a constant challenge as much as fortifying and re-fortifying your strengths; thus medicine manages to always keep you grounded.

I ask fervently for the strength to always seek out new knowledge so I can use the best of my knowledge and skills to do the best for my patients and to tirelessly grow in humility and someday hope to emulate the great mentors I have been blessed to work with thus far and in the future.

My life really sin't that hard

I find myself feeling awful about complaining about small stuff in life whenever I see my patients. They are obviously suffering from much bigger problems than I could ever imagine and so many of them have an amazing attitude devoid of self-pity and bitterness. Then I wonder; what makes me crib about "small stuff"; stuff which I am sure anybody would love to trade for the bigger problems in their life. My patients are dealing with things I take for granted; like enjoying a bite of my favorite dessert (which incidentally has been changing quite rapidly; it used to be tiramisu; now it's creme brulee but my sweet tooth is becoming a little more than just fond of strawberry shortcake) because they can't swallow and will choke on their own saliva; a good night's sleep because they are too anxious or depressed about all the uncertainties of their future; they have to worry about even being able to transfer from a bed to a chair; about being able to have a bowel movement without an accident; they as much as I worry about being able to dream and live their dreams. I truly want to ask forgiveness for ever complaining about my life and want to be thankful to the powers that be for all that I have and will be blessed with now and in the future. May I never take anything in my life for granted.

Attachment

When you're throat's parched and words seem to dry up; when your eyes well up but you'd rather not cry; when you know you've got to be that pillar of strength which never gives way; how do you let yourself feel and yet be stoic; how do you show empathy and not die in pain; how do you show you care? The challenge is not about caring enough; it's about letting your heart feel that tug but not your tear glands; it's about giving it all you've got without losing your head; it's about doing the right thing over and over again without feeling that extra sense of pride; it's about remembering every step of the way that you're not great because of what you do but because of what you've been chosen to do for the people who matter the most; it's about doing your job and being humble about it for you've been blessed and it's time to share that blessing.
Being a physician can sometimes make you don a mantle of detachment. I don't think it's detachment which keeps us sane; it's attachment; it's that attachment to our patients which makes us go that extra mile every time we think we maybe fighting a losing battle and it's the same attachment which makes us want to provide a dignified death as much as a dignified life. It's that attachment which drives all research and the same attachment which makes us thirst for knowledge insatiable. I pray that I may never lose that attachment; I pray that I may be humble; I pray that I may give without wanting and work like I was meant to now and always.

I couldn't have done this!

I just completed my six interrupted weeks of Pediatric Neurology and needless to say the experience took its toll on me. The respect I have for Pediatric Neurologists has only increased manifold. Although I was fascinated by the amount of new stuff I was learning but all that learning was interspersed with way too many heart wrenching moments. You know that a field's not for you when you find yourself holding back tears at times more than you can actually keep a count of :(
As a medical student, I had enjoyed my Pediatric rotation for the sheer volume of knowledge I gained during those months but I had realized this very early on that I was not cut out for taking care of sick children in the hospital. I would get too lost in all the tears and all those smiles. I am so glad I made my choice early on. When I think of the contributions the field of Pediatric Neurology is making to the world, it's simply amazing for these physicians are caring for the sickest children and families and giving them so much to look forward to; giving them hope and perhaps their rights to live their dream again. When one of my attendings said that he found my enthusiasm for this field refreshing I couldn't help but tell him that I cannot even dream of doing what this teams's been doing and the least I can do is learn as much as I can as my tribute to this field!
Looking forward to my next six weeks as a PGY4 in Peds Neuro.

Each one teach one

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!

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.

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.

In medicine it is really better to have learnt and lost...

When I climbed up the two flights of stairs to reach the anatomy floor, the distinct pungent odour of formalin tickled my nostrils and as I looked up I found my eyes transfixed by a fresco of a human skeleton standing nonchalantly with a skeleton under his/her (I still don't know if that skeleton was a male/female :) )left hand with the words that would soon become a part of my life; "In anatomy it is better to have learnt and lost than never to have learnt at all." Obviously, I didn't realize how profound this statement was because I hadn't been confronted by anything like learning human anatomy. I later realized that no matter how much we studied in medicine not just anatomy, there were always going to be things which we would forget; things which we wouldn't use for years on end; concepts which would change everyday and life would only become more complex. I realized that a lot stuff we were studying was not going to appear on tests; would not affect patient care; would not make a difference to anyone but we studied it anyway! Then there was all that stuff which was going to make all the difference; stuff which was going to change lives and that was the kind of stuff you didn't want to ever forget. Unfortunately you realize a lot of this only in retrospect. This theme carries on to residency as well. I really wouldn't want to forget any of the stuff I am learning, reading, hearing everyday but if you don't use it; you lose it. The joy of understanding a concept and applying it probably surpasses any other; but what happens to all the other stuff? I hope I can keep learning for the joy of learning but at the same time not lose heart if I forget something but study it all over again like I will never forget!

I have a consult for you...

My beeper goes off at 3:30 pm and as I answer the page; I am hoping it's not a consult when my brain is trying get home but then the voice says, "I have a consult for you..." Hmm, why didn't you call me up earlier I wonder as I start scribbling some details. So, I go see the consult. I get paged again while I am gathering information on my consult patient and this time it's a voice from the ER and the voice says what I didn't want to hear at 5 minutes to 4; "I have an admission for you." Hmm; so here I am. I really enjoy seeing patients; they are a huge part of who I am. Then why do I feel like someone should've called a consult earlier or that I shouldn't be getting an admission so close to my time to sign off? I love what I'm doing; then why do I feel that tinge of resentment when I get paged late? Shouldn't I jump with enthusiasm at every opportunity I get for learning and applying what I have learned so far. There are a few things which I realized as I was thinking about these times...one was that when you are mentally prepared to go home or call it a day; something which upsets those plans just happens to create a little resentment; or if you had plans to do things which were part of life apart from being a physician; then you get a little upset or if you're just really tired; or if it just hasn't been your day and you want it to end sooner than later or if you just want to go home! But life as a physician will always be about those moments which can never be planned for. That is both the joy and bane of being a physician; you can have a life and you can have a life but whatever you do; the very essence of your existence will be in being a physician first. The late consults/admissions are perhaps meant to prepare us as residents for the world at large; to accustom us to the uncertainties of being called upon at any time; of having plans postponed; of having to cancel birthday celebrations; of having to miss some important moments in our families; of being there and yet not being there because you're really needed more somewhere else...
Then is it cool to feel the resentment? Nope. Obviously, it's easier said than done. Being able to maintain that eagerness to learn and the drive to give it your all irrespective of the time of day; irrespective of your situations is what being a physician is all about. Someday, I'll get there; for now my beeper can keep going off whenever I'm needed whether it's to save the world or just give my opinion; I'm in training and will take it all in my stride!

When your best is not enough...

I am currently training at a university hospital which not only has a busy Neurology service but happens to a big referral center for complicated cases. I am seeing patients with some of the most bizarre presentations which are defying known diagnoses. It's great to be doing all the things by the book, then thinking outside the box and knowing that you gave it your all. But what if that didn't work? What happens when your best is just not enough? You fight back anger and all emotion and let your patients know you tried. What makes it worse is that they know it too. They know it all too well, that you fought till the end for them. What makes it worse is when they console you; when they say, "I know doc, you tried your best but what's got to be will be." And I can't help but think that it doesn't have to be this way! It's just not fair. Some of the worst diseases strike some of the best people; people who have been living by the book of good health and should have been promised longevity because they were so honest and unwavering in their approach. It just makes you realize that we still don't have the answers to the question; "When I did everything right, why did this happen to me?" A lump arises in my throat every time a patient asks me this question and all the marvels of modern medicine just fade away and all humour fails to dissolve the pain. Why is my best not enough to let someone dream on; to let someone live on and not die an untimely death?

What needs to be done, needs to be done now!

I was telling one of my patients that they need to quit smoking and perhaps the best way to do it would be cold turkey; pick a date and kick (the) butt! He obviously had tried numerous times and had failed. We didn't even go into the details of his attempts to quit. This important piece of advice was only a small part of my extensive interview with him and I already had more patients waiting to be seen. I wasn't the first doctor asking him to give up a habit which had only caused him harm.
So many things I ask my patients to do, are easier said than done! I might be persuasive, authoritative, gentle or even nonchalant in my approach to giving patients advice. I might be timely in my approach or very untimely. How many of my bad habits have I been able to kick by the very same approach I ask my patients to adopt? They aren't heroes who can change the ways they think and act at the drop of a hat even if it means it’s a question of life and death; and what if it is more preventive than therapeutic; does that make it easier to postpone your plan to change? How do I tell my patients that this process is going to be tough and they have to stick it out? How do I tell them that I will be there every step of the way on their good days and bad days when they're raging a battle against smoking/ drinking or any other addictions when truly I am not going to be there with them every moment of their emotional turmoil. It's their families and friends who will be; people who have been affected by the process of their spiral down will be the people who will help them climb up step by step. Of course I'll be there to check on them once in a while. So, it’s only more important to speak to the patients and their support systems at the same time; so they’re both prepared, so they both understand.

But what needs to be done needs to be done. Why are things easier said than done? Why are habits so hard to break? Why are good habits so difficult to form and sustain? It's not always a lack of motivation. It's sometimes about timing. You need to receive or give good advice at the right time, be able to strike the right cord and at the right time. But sometimes you nor your patient have the luxury of time. So, do what needs to be done as honestly and as urgently it needs to be done and hope and pray that it works.

Moving on...

Dignity in death as much as in life is perhaps what we all want. How do we ensure that we die as well as we lived? Coming to terms with one's own mortality becomes easier when you see death up close everyday as a physician. We all know that as we come so must we go. What makes us fearful about death is perhaps not knowing what lies beyond but isn't that true for life as well? Do we really know what's going to happen next? You can plan and plan to be prepared for surprises.
When I see loving family members from generation one to four paying their little old grandma a visit, holding her hand and kissing her good bye; I know that even in her coma she's not that scared anymore of the inevitable and yet unknown. When they decide to make her comfortable and let us know that it was what she wanted and that she had a long and fulfilling life, I know that grandma is feeling proud of her legacy to the world; children she raised well; children who have loved her well and ensured that she passes on as effortlessly as she brought them into this world; holding her hand just as she held theirs and taught them how to walk and move on. Life comes around in a full circle. A warmth from the tears I am holding back and the ones they are shedding fills the room. We're thankful to grandma for making it easy for them; for making it is easy for us as her doctors...she must've been a brave woman to decide what she wanted her death to be like; she made her choice so we just followed. And then I can't help but wonder, how do I want to die? I get paged and the thought vanishes from my head; guess it's another thought for another day but sooner or later I'll have to decide; if I want it my way!

What is true learning?

The motivation for learning has changed. It had to. Every single thing I learn now can change someone's life including mine. The differentials, the treatment options, the management plans...it's a sense of ownership; a sense of responsibility beyond scores, ranks; the stuff that makes you want to make a difference, the stuff that makes the difference. There's so much and there's finite time. When there's no time to lose, how can I stop? Medicine is changing every moment but where are we headed? Prolonging life by the years but are we really adding quality to those years? What I learn today, will it be passé tomorrow? What I learn today, will it stand the test of time? What would I have to unlearn? What would I have to relearn because the human memory fails me? What will keep evolving, what will perish; wish there was some way of predicting.
Medicine is as much an art as a science. Let me not sacrifice art for science and let me not forget to objectify. Either way the more I practice the more I will learn and perfect my ways. Yes, some I will learn, and some I will forget but no matter what I will be a better person for I learned. A part of me will change perhaps forever; I guess that is what true learning is all about. Changing and learning how to change and how to be that change. Perturbing as it might be, making my peace and anticipating that my sense of peace will change too. And knowing well that I am not alone in this process, I can't be more thankful to those from whom I learn; my patients, my teachers, my books and lives...mine and that of so many others!

Playing God!

I find it difficult at times; to come to terms with how we predict prognosis in critically ill patients. There aren't any formulas to calculate the duration of survival and quality of life (QOL) with accuracy which take into account a patient’s personality or their will power to improve or their dreams, hopes and aspirations. A lot of perception, personal experience and surrogate decisions determine continuity of aggressive care. I find it difficult to say that if a 95 year old comes in with a massive intracerebral bleed and is comatosed; he shouldn't undergo surgical intervention perhaps because the likely complications and risks far outweigh the benefits in somebody who has perhaps lived their life. How do we know that someone has lived their lives; how can we be so sure that they didn't have unfinished business which they wanted to take care of before passing on; what I may perceive as poor QOL they might be perfectly at peace with and would want to live irrespective of how dependent they become. Perhaps, as doctors we need to enable patients and families to see beyond emotion; to see the physical, mental and emotional turmoil which lies ahead.
Medical treatments are fraught with dangers and letting well alone sometimes is the best strategy. You want to do the best for your patient and you want to be mindful of when it is best to let go and when you should go that extra mile. But the subjectivity of this process creates conflict. I have seen some patients who seemed to have no hope for survival do really well and others who I felt would pull it off with that extra push spiral down. When patients or their families talk about miracles, I don't want to be a naysayer because I don't know how these miracles happen but they sometimes do. I want to be able to give them hope but don't want them to lose all semblance of reality for I am perhaps; their only connection with reality in their time of impending loss of a loved one. I wish there was a better way to do this. Sometimes, I wish I didn't have to play God because I am so not!

Seeing is believing!

Sometime ago I met a very engaging, cheerful young lady three years after her stroke enrolled in one of the FES trials. We walked with her through her journey thus far. Being a swimmer and a marathon runner prior to her stroke put her in an advantegous position as she was a quick learner who worked very hard and knew the importance of regular exercise. As our instructor Mr. B pointed out she was someone they would have to ask to stop pushing herself so hard and slow down. She doesn't even live in this city but comes down for her therapy sessions four times every week. She was happy with her progress. When she related that she had developed an aphasia along with her weakness, I was amazed because she was speaking so normally! I have always known that a lot depends upon how much patients want to get better but since I hadn't seen many patients outside the acute inpatient setting, it was heartening to see reamarkable recovery and a testimony to will power. She had 5 implanted electrodes in the muscles of her rigth leg which weren't being used presently. I saw her work her way to almost normal components of gait with the help of FES. Having experienced the unpleasant sensations of FES, I was amazed to see how she was using it so effortlessly and beautifully! She would break into an easy smile with a compliment from Mr.B about how well she was doing and knew exactly when she wasn't doing a good job. I liked the way she was tuned in providing herself feedback! No wonder she was doing so well!
She told us about her brother who was in medical school and wanted to become a neurologist as well. As we parted ways, she wished me luck. I couldn't help but thank her for teaching us so much in just a couple of hours!