>April 10 2002

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It has been a long week so far. Normally we don’t begin on Monday mornings until 10:00, which is outstanding, but this week was my turn for CPR skills review. I had to report at 8:00 for a practice session on the mannequins and I have an individual skills exam on Friday that I have to complete to get my certification in Basic Life Support. One of the requirements of this course is that we buy a “pocket mask” to use when ventilating a person in need of resuscitation. They cost an outrageous $24 in our bookstore. I can’t see dropping that kind of cash for something I will use for a 20-minute test once in my life. I sure won’t be carrying it around with me in the future as I await a real-world situation to put my CPR skills to the test. If I see someone in need, I am sure I will be able to suck it up and do the direct mouth-to-mouth resuscitation that has sufficed for years. For the test I am hoping to borrow someone else’s mask.

Monday in Psychiatry we had another case study. We met a patient who suffered from bipolar disorder and he openly discussed it with us. This guy was a super high-achiever. Athlete, scholar, big-time corporate lawyer by his mid-thirties and money out the wazoo. Unfortuantely, he managed to completely screw his life up before he was diagnosed at age 51. Now in his sixties he told about being involuntarily hospitalized 7 times in the last decade. Once, in a pair of handcuffs. While the true depressive and manic phases of bipolar disorder last for days or weeks at a time, I could see pretty impressive mood shifts in this man right in front of my eyes as he spoke. He talked at 90-miles-an-hour and jumped from thought to thought like an old man doing a triple jump in a checkers game. He would have a gleam in his eye while he told us about totaling his Porsche and the next minute would be near tears when he told how badly his actions had hurt his family. I am very impressed at the courage he and our previous anxiety disorder patient showed in standing up before our class of 100 plus and spelling out there psychiatric illnesses. This particular case was perhaps the most powerful thing I have witnessed so far this year. I was pretty moved by this man in some way that I don’t yet really understand. He was so smart and eloquent and yet so lonely and defeated. He obviously has studied his disorder in great detail and understands it well. He brought up noted artists and writers who were probably bipolar. Vincent Van Gogh, Ernest Hemingway, and Virginia Woolf all had periods of incredible creative output and eventually committed suicide. Quite common in bipolar disorder. In fact during a hypomanic an individual can get a lot of things done and be wildly productive. It is sad and ironic that the condition which can help to produce so much can be so destructive to the individual. I don’t think I want to go into psychiatry but I have to admit that this stuff does fascinate me.

Monday and Wednesday are the ling days in our spring schedule. We are in lecture or neuro lab until 4:00 with only an hour for lunch. Tuesday afternoon are open however and I was excited about going to neurology grand rounds this week. The neurology department had posted an open invitation on our lecture hall door a few weeks ago to any students who were interested in attending. The format is a conference room session wherein the neurology residents present their patients to the department chief who then helps with differential diagnosis. I had gone home after morning lectures and started getting ready to return to the hospital for the 4:00 rounds. Following the instructions on the invite I put on my white coat, for only the second time. My nine going on nineteen-year-old daughter saw me and said, “Aw, Daddy is growing up! Getting to wear his doctor coat!” Even with her patronizing, I was still excited about going. Unfortunately I sat in the conference room alone for 30 minutes studying my neuro atlas before a real doctor came in and told me the grand rounds had been cancelled this week. “All dressed up and nowhere to go!” she told me sympathetically. I guess I looked kind of pitiful.

I had class notes today for our 9:00 AM physiology lecture. Because our test is on Friday I have to have the notes distributed by 5:00 PM tomorrow instead of the normal 48 hours allowed. I have spent the evening preparing those instead of studying, but at least I should not miss any of the exam questions from my lecture. Tomorrow I will spend all of the non-lecture hours cramming for our respiratory exam in physiology Friday morning. Once that is over, it will be nothing but neuro for a week. The next exam is on the sensory pathways. Pretty neat stuff.

About Marcus Lee

Child Neurologist
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