I have been doing the Neurology clinical rotation since August 19. It was a very easy but intense 3 and half weeks. I had started the first day on the wrong foot. For one, The Chinese students I have been doing the rotations with in the previous 6 weeks had all chosen one department to intern for the rest of the year, and sadly the Neurology department wasn’t one of them. The other reason was for every teacher I had called, I was passed to another one, sometimes to another floor and worse to another building. I finally found the teacher who was responsible for all the students interning at that department, both residents and medical students. The teacher had successively assigned us to two senior students who helped us the first week.
This was a good week, All the student had the enthusiasm, energy and the drive to attend all morning rounds. Some of us had even stayed as late as 6 PM. I did most of the morning rounds and my teacher had assigned me to a stroke patient. The patient was a 55 year old female who had come in with blurred vision, dizziness and hemiparesis ( weakness on one side of the body). She had prominent hemiplegia ( paralysis of the arm, leg, and trunk on the same side of the body), hemisensory loss, Homonymous hemianopsia on physical examination. The teacher had ordered CT scan without contrast, the findings was infarction at cerebrum (cerebral infarction). The teacher had also ordered PET scan in which I didn’t know, The scan showed a prominent stenosis at Middle Cerebral artery. The patient was referred to the Neurosurgery department. I didn’t see her again mainly because of the bureaucracy involved, the Neurology department is huge and that means a lot of staff. This week, I have seen around 20 cases. 10 stroke, 4 trauma, 4 Demyelination disorders and Encephalitis.
A new week, new students and new friends. What seemed a promising week turned into boring one. Monday morning rounds brought only five new faces. It was good to see improvement from some patients, I even saw one patient walking in the corridor. A young patient with myasthenia gravis who a few days earlier couldn’t open his eyes was now texting on his phone. This is the reason I came to study Medicine.
I missed the Tuesday morning rounds because I went to help a friend with Visa problem. On Wednesdays, the hospital hosts an expert who comes to solve a difficult case. The presentation today was about Brain Imaging in Multiple Sclerosis. There were a lot of spinal and brain MRI scans, the presentation was quite good and I have polished up my anatomical knowledge of brain regions on MRI scans. The rest of the week was pretty predictable since there was no residents to show us around. I mostly studied with my friend after morning rounds.
I expected very little from this week. I had seen most of the cases in the first two weeks, the same patients were still there with few new patients coming in. There was a 32 year old patient with stroke. I was pretty surprised to see such a young patient. I spent the first two days at the hospital with very little to learn. So I decided my time is better spent learning at home. I spent five hours studying brain anatomy on Wednesday, I ended up studying little over five hours on Thursday, studied very little on Friday because I went to play football in the afternoon. On Saturday and Sunday, I was making up for lost time.
I’m not sure what to expect these last three days, The morning rounds had brought more patients and things seem a little hectic. I am feeling thrilled but at the same time overwhelmed because no one has the time to teach or explain anything to me. I feel I have learnt enough to be a competent doctor, not enough to be an excellent one. Tomorrow will be the last day, and I’m already looking forward to the pediatric rotation.
The Neurology clinical rotation was a very good experience for me. I feel I hadn’t learnt that much but I saw how a large hospital system works, the daily proceedings, and how large group of doctors work together in an efficient system. This bureaucracy may not be everyone’s cup of tea, but Oh My God, does it work.