2013-11-29 22:18![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png)
melluransa
melluransaI'm currently reading Brain on Fire: My month of madness by Susannah Cahalan. It tells of the endless search for a diagnosis of a rare disease of which Susannah suffers. It took one neurologist to try something unthought of and then follow the clues to the true etiology of her disease. Once the cause was found, effective treatment and recovery could begin. It's an amazing story in itself.
Reading it and reflecting on the success of the neurologist to finally figure it out, I thought about my own connection to neurology. It's kind of lengthy, but I've been thinking on it a lot lately and wanted to share it. It's impacted my life a lot in the past couple of years.
In grad school for speech-language pathology, I greatly greatly enjoyed the neurology class I took. It was so interesting to me. And my excitement increased when an actual neurologist who worked at Washington University Medical Center came to speak. She does all sorts of brain scans on people trying to find pathologies in brains and document brain activity for various studies.
I really loved this class and experience and talked about it to my mom. She took my enthusiasm very seriously and decided all she wanted to do anymore was endlessly inquire/pester about me becoming a neurologist.
I said no from the beginning, because I was at the time pursuing my degree in speech-language pathology. I was learning how to be a therapist to help people recover and rehabilitate. Plus it would have meant a bazillion years of medical school because neurologists are doctors. I didn't and still don't want to go to school more than I already did. (Plus I suck at chemistry).
She didn't understand. She thought I'd be doing brain scans and working with people in studies like that speaker who came to the one lecture. She thought I was already like halfway there to becoming a neurologist and that it'd only take two more years of school.
What's crazy about my mom and me is that we both don't listen well. In this instance, that trait reared its head; no matter how many times I told my mom I want to be a therapist and that it's not two simple more years of school, she wouldn't hear me. She stuck with her beliefs for a couple years.
It hurt that she didn't listen and understand. It also hurt in a new way. I felt like I wasn't good enough and that she didn't approve of my career choice as an SLP. I felt like I could relate to others whose parents had impossibly high standards of being the top lawyer in a law firm or the best doctor in the country.
It was a new feeling to have a sense that I wasn't good enough. Up till then, I was totally set and supported in my choice in becoming an SLP. I'm a high-achiever by nature, and it's not like I was disappointing anybody by doing really well in college, getting high grades, and landing a spot in a competitive graduate school program.
After going through grad school more and completing an internship at a rehab, I got a little more insight into what more neurologists do. I was the student speech therapist to many patients suffering from strokes, multiple sclerosis, ALS/Lou Gherig's Disease, Parkinsons and other basal ganglia disorders, and brain tumors of all sorts.
Sometimes during speech therapy, the neurologist would rush in and hurriedly ask the patient about how they're doing, about what their disorder is and what was happening to them, and about their projected recovery. This was the hardest to see, because patients are so desperate for answers....or angry....or confused.... or just lost, lost in that they're sick and in the hospital -- a terrible place to be. Seeing the doctor talk about what happens when bloodflow is occluded in the brain by a traveling blood clot, burst vessel, or brain tumor; that was particularly hard.
The horror and wonder the patient must have felt upon hearing his words, trying to understand what happened and just sort through everything.... she cried. When the doctor left, I couldn't really continue speech therapy. I put the stimulus cards down and focused on calming her down and explaining the doctor's medical jargon into words she could understand. I was there for her emotionally then, and I was for other patients too. Later this particular woman thanked me for all I'd done; I told her in good humor and with a smile that I never wanted to see her again in this hospital and that I wanted her to stay healthy for a very long time.
That was the most vivid impression I had of the role of a neurologist. Other times, I saw the neurologist rapid-fire medicine names to the head nurse about what patient X needs, and then patient Y. The doctors were on the phone all the time too during the rest of the day, sitting there with all the charts in front of them and dictating or I don't even know, for a long time.
Then there were weekly meetings as a team, in which the neurologist took part too. We therapists -- physical therapists, occupational therapists, and SLPs -- were there, reporting the therapy and recovery side of the patient. The nurses reported the medical status of the patient. Psychology reported the mental status. Social work reported the family, emotional, insurance, and after-hospital care plans for the patient. The neurologist would usually always sit there, taking it all in and concluding, "Continue with the current plan of care," and we'd move on to the next patient.
And then there were different doctors every day. It was like Doctor Someone on Monday, Wednesday, Friday....And then Doctor Other Person on Tuesday and Thursday. With different doctors on the floor different days of the week, consistency and knowledge of a patient varied. One would order this, the other would order that. It was hard for nursing and therapists to go forward with things sometimes because the two doctors would switch up something, or order two different conflicting things, or one doctor would refuse to give clear direction about a patient because it was more the other doctor's patient. I don't know. It was confusing for us... and I imaging it was hard for the doctors too, going to so many different hospitals in the area and trying to keep all the patients straight.
Tying this back to my mom and her persistence I become a neurologist, I have to say that after my experience in the hospital that I was even more firm about not becoming a neurologist. Now in addition to the parts backing up my argument before ("I want to be a therapist, it's so much more school"), I had more parts to my argument.
The hardest-hitting lesson I'd learned about neurologists are doctors in the end, and they just specialize in my favorite area, the central and peripherial nervous system. Being a doctor, regardless of specialty area, means a certain doctorly, medical approach to a patient.
1. Diagnose. Diagnose.
2. Once a diagnosis is reached, prescribe. Prescribe any med, just prescribe something because our culture is one that automatically goes for the quick and expensive fix of a med to cure all ills. Big drug companies and all. Giving a patient like twelve different meds for all his or her symptoms (symptoms caused by the actual illness, and/or side-effects of the meds to treat the illness) is common.
3. Prognosis. During the hospital stay, the doctor monitors the plan of care and recovery, and develops a prognosis. "You have _____ left to live," kind of statements, or more optimistically, "You are expected to make a ___ % recovery."
Realizing that doctors have a different method of operation than a therapist gave me a lot of insight about what I do, and what doctors do. Doctors don't get to know the patient, usually. Doctors know the case and the charts. Therapists and nurses, who work with patients everyday, get to know the patient personally.
Therapists are there for session after session -- usually weeks of sessions -- and are the ones to teach the patient the skills s/he needs to function again. How to talk, how to walk, how to bathe, how to eat, how to swallow, how to use prosthetic limbs, how to remember, how to plan, how to compensate for areas that will never be the same...
Bonds are built between patients and therapists during the hard path to recovery. Not that a doctor's work isn't meaningful, but personally I feel more meaning in being there to help a patient with her emotion, and helping her learn to say her phone number again, and her children's names, and giving her her language and speech back. That's what a therapist does.
Therapists can benefit from knowing the patient's diagnosis. Say it's a lesion in the parietal lobe, right side, just anterior and deep to Heschel's gyrus. Sure, that's an exact area of lesion and injury, but since brains and people are all different, that means something but not everything. Two patients can have the exact same injury and present differently.
In the end, a therapist treats the areas that are impaired. If it's a low skill, we work on raising it back up as high as it can get. We work on raising the patient's level of functioning. That's very meaningful and fulfilling to me, to know I've helped a person that way. I've helped them get better, get back to living a daily life again.
It's a different kind of way of helping a patient get better than what a doctor does. A doctor identifies the cause of the illness and treats the symptoms. Doctors save lives, stabilize medical conditions, pull patients out of their illness, and order and coordinate short- and long-term plans of care to help the patient get better. Doctors are there for people who are suffering and even on the brink of death.
Doctors are heroes. But it comes with a heavy price; doctors are the ones who have to tell a patient that s/he has cancer. And also telling the prognosis. That's news that is sometimes very hard to give. Talk about having to develop a kind and empathetic bedside manner. Heck, it's such a big part of a doctor's job that they give it a name -- bedside manner.
Finally, finally finally over the summer, I was able to articulate all of this clearly to my mom. She had called after I moved to my new town, just about ready to start my new job as an SLP a mere 3 months after graduating summa cum laude with my master's degree. I'd made it all that way and gotten hired, and was excited to begin....and I hear, "So when you gonna become a neurologist?"
I lost it. Shaking, I gritted out that I couldn't bear to tell someone they have a brain tumor or something like that. I'm not the type of person who can give news like that as an aspect of my job, and I will never be. That's something neurologists have to do, and I can't do that. What I can do, what my calling is, is working with people who need help with speech and language.
She sounded shaken on the other end of the line. She apologized quietly, the spirit gone completely out of her argument. We've not spoken of it since, and it's a relief. Such, such a relief. I'm so glad that it's not that she's unhappy with me and my career, but that she wants me to reach the highest level because reaching high levels is what I do. It's like she's pushing me for my own benefit sometimes.
Now, her new goal for me is for me to get my Ph.D. in speech-language pathology. Now this, this I can do. :) It's the natural next step for me, I think. I want to do research and be a college professor one day. Maybe I can even do research and teach in the area of neurology as related to speech-language, since that's my favorite area and that which I have the most interest in. Maybe one day, but not now.
Now, I'm focusing on the nearly-40-something kiddos on my caseload at my primary school and teaching them speech and language. :) It's not neurology, but that's ok. Right now, where I am now is fine by me.
--
Reading it and reflecting on the success of the neurologist to finally figure it out, I thought about my own connection to neurology. It's kind of lengthy, but I've been thinking on it a lot lately and wanted to share it. It's impacted my life a lot in the past couple of years.
In grad school for speech-language pathology, I greatly greatly enjoyed the neurology class I took. It was so interesting to me. And my excitement increased when an actual neurologist who worked at Washington University Medical Center came to speak. She does all sorts of brain scans on people trying to find pathologies in brains and document brain activity for various studies.
I really loved this class and experience and talked about it to my mom. She took my enthusiasm very seriously and decided all she wanted to do anymore was endlessly inquire/pester about me becoming a neurologist.
I said no from the beginning, because I was at the time pursuing my degree in speech-language pathology. I was learning how to be a therapist to help people recover and rehabilitate. Plus it would have meant a bazillion years of medical school because neurologists are doctors. I didn't and still don't want to go to school more than I already did. (Plus I suck at chemistry).
She didn't understand. She thought I'd be doing brain scans and working with people in studies like that speaker who came to the one lecture. She thought I was already like halfway there to becoming a neurologist and that it'd only take two more years of school.
What's crazy about my mom and me is that we both don't listen well. In this instance, that trait reared its head; no matter how many times I told my mom I want to be a therapist and that it's not two simple more years of school, she wouldn't hear me. She stuck with her beliefs for a couple years.
It hurt that she didn't listen and understand. It also hurt in a new way. I felt like I wasn't good enough and that she didn't approve of my career choice as an SLP. I felt like I could relate to others whose parents had impossibly high standards of being the top lawyer in a law firm or the best doctor in the country.
It was a new feeling to have a sense that I wasn't good enough. Up till then, I was totally set and supported in my choice in becoming an SLP. I'm a high-achiever by nature, and it's not like I was disappointing anybody by doing really well in college, getting high grades, and landing a spot in a competitive graduate school program.
After going through grad school more and completing an internship at a rehab, I got a little more insight into what more neurologists do. I was the student speech therapist to many patients suffering from strokes, multiple sclerosis, ALS/Lou Gherig's Disease, Parkinsons and other basal ganglia disorders, and brain tumors of all sorts.
Sometimes during speech therapy, the neurologist would rush in and hurriedly ask the patient about how they're doing, about what their disorder is and what was happening to them, and about their projected recovery. This was the hardest to see, because patients are so desperate for answers....or angry....or confused.... or just lost, lost in that they're sick and in the hospital -- a terrible place to be. Seeing the doctor talk about what happens when bloodflow is occluded in the brain by a traveling blood clot, burst vessel, or brain tumor; that was particularly hard.
The horror and wonder the patient must have felt upon hearing his words, trying to understand what happened and just sort through everything.... she cried. When the doctor left, I couldn't really continue speech therapy. I put the stimulus cards down and focused on calming her down and explaining the doctor's medical jargon into words she could understand. I was there for her emotionally then, and I was for other patients too. Later this particular woman thanked me for all I'd done; I told her in good humor and with a smile that I never wanted to see her again in this hospital and that I wanted her to stay healthy for a very long time.
That was the most vivid impression I had of the role of a neurologist. Other times, I saw the neurologist rapid-fire medicine names to the head nurse about what patient X needs, and then patient Y. The doctors were on the phone all the time too during the rest of the day, sitting there with all the charts in front of them and dictating or I don't even know, for a long time.
Then there were weekly meetings as a team, in which the neurologist took part too. We therapists -- physical therapists, occupational therapists, and SLPs -- were there, reporting the therapy and recovery side of the patient. The nurses reported the medical status of the patient. Psychology reported the mental status. Social work reported the family, emotional, insurance, and after-hospital care plans for the patient. The neurologist would usually always sit there, taking it all in and concluding, "Continue with the current plan of care," and we'd move on to the next patient.
And then there were different doctors every day. It was like Doctor Someone on Monday, Wednesday, Friday....And then Doctor Other Person on Tuesday and Thursday. With different doctors on the floor different days of the week, consistency and knowledge of a patient varied. One would order this, the other would order that. It was hard for nursing and therapists to go forward with things sometimes because the two doctors would switch up something, or order two different conflicting things, or one doctor would refuse to give clear direction about a patient because it was more the other doctor's patient. I don't know. It was confusing for us... and I imaging it was hard for the doctors too, going to so many different hospitals in the area and trying to keep all the patients straight.
Tying this back to my mom and her persistence I become a neurologist, I have to say that after my experience in the hospital that I was even more firm about not becoming a neurologist. Now in addition to the parts backing up my argument before ("I want to be a therapist, it's so much more school"), I had more parts to my argument.
The hardest-hitting lesson I'd learned about neurologists are doctors in the end, and they just specialize in my favorite area, the central and peripherial nervous system. Being a doctor, regardless of specialty area, means a certain doctorly, medical approach to a patient.
1. Diagnose. Diagnose.
2. Once a diagnosis is reached, prescribe. Prescribe any med, just prescribe something because our culture is one that automatically goes for the quick and expensive fix of a med to cure all ills. Big drug companies and all. Giving a patient like twelve different meds for all his or her symptoms (symptoms caused by the actual illness, and/or side-effects of the meds to treat the illness) is common.
3. Prognosis. During the hospital stay, the doctor monitors the plan of care and recovery, and develops a prognosis. "You have _____ left to live," kind of statements, or more optimistically, "You are expected to make a ___ % recovery."
Realizing that doctors have a different method of operation than a therapist gave me a lot of insight about what I do, and what doctors do. Doctors don't get to know the patient, usually. Doctors know the case and the charts. Therapists and nurses, who work with patients everyday, get to know the patient personally.
Therapists are there for session after session -- usually weeks of sessions -- and are the ones to teach the patient the skills s/he needs to function again. How to talk, how to walk, how to bathe, how to eat, how to swallow, how to use prosthetic limbs, how to remember, how to plan, how to compensate for areas that will never be the same...
Bonds are built between patients and therapists during the hard path to recovery. Not that a doctor's work isn't meaningful, but personally I feel more meaning in being there to help a patient with her emotion, and helping her learn to say her phone number again, and her children's names, and giving her her language and speech back. That's what a therapist does.
Therapists can benefit from knowing the patient's diagnosis. Say it's a lesion in the parietal lobe, right side, just anterior and deep to Heschel's gyrus. Sure, that's an exact area of lesion and injury, but since brains and people are all different, that means something but not everything. Two patients can have the exact same injury and present differently.
In the end, a therapist treats the areas that are impaired. If it's a low skill, we work on raising it back up as high as it can get. We work on raising the patient's level of functioning. That's very meaningful and fulfilling to me, to know I've helped a person that way. I've helped them get better, get back to living a daily life again.
It's a different kind of way of helping a patient get better than what a doctor does. A doctor identifies the cause of the illness and treats the symptoms. Doctors save lives, stabilize medical conditions, pull patients out of their illness, and order and coordinate short- and long-term plans of care to help the patient get better. Doctors are there for people who are suffering and even on the brink of death.
Doctors are heroes. But it comes with a heavy price; doctors are the ones who have to tell a patient that s/he has cancer. And also telling the prognosis. That's news that is sometimes very hard to give. Talk about having to develop a kind and empathetic bedside manner. Heck, it's such a big part of a doctor's job that they give it a name -- bedside manner.
Finally, finally finally over the summer, I was able to articulate all of this clearly to my mom. She had called after I moved to my new town, just about ready to start my new job as an SLP a mere 3 months after graduating summa cum laude with my master's degree. I'd made it all that way and gotten hired, and was excited to begin....and I hear, "So when you gonna become a neurologist?"
I lost it. Shaking, I gritted out that I couldn't bear to tell someone they have a brain tumor or something like that. I'm not the type of person who can give news like that as an aspect of my job, and I will never be. That's something neurologists have to do, and I can't do that. What I can do, what my calling is, is working with people who need help with speech and language.
She sounded shaken on the other end of the line. She apologized quietly, the spirit gone completely out of her argument. We've not spoken of it since, and it's a relief. Such, such a relief. I'm so glad that it's not that she's unhappy with me and my career, but that she wants me to reach the highest level because reaching high levels is what I do. It's like she's pushing me for my own benefit sometimes.
Now, her new goal for me is for me to get my Ph.D. in speech-language pathology. Now this, this I can do. :) It's the natural next step for me, I think. I want to do research and be a college professor one day. Maybe I can even do research and teach in the area of neurology as related to speech-language, since that's my favorite area and that which I have the most interest in. Maybe one day, but not now.
Now, I'm focusing on the nearly-40-something kiddos on my caseload at my primary school and teaching them speech and language. :) It's not neurology, but that's ok. Right now, where I am now is fine by me.
--
