The learning curve as a JAR (Junior Assistant Resident) is much steeper. Not to mention the added responsibilities we are tasked with, including teaching interns and medical students, running to stroke codes, providing guidance to medical teams that have requested our expert advice on their patients, etc.
As a PGY-2, I complete inpatient rotations such as Stroke, General Neurology, the Neurology consult service, the Neuroscience Intensive Care Unit, and outpatient rotations in neuroimmunology, headache, neurodegenerative (i.e. movement, memory disorders), and at the Durham VA Hospital. We also have a few weeks of elective time which we can use to complete rotations in certain sub-specialties and related areas such as neuro-ophthalmology, neuro-otology, sleep medicine, neuroradiology, and research.
2021 was overall a tough year, what with the demands of residency and the stress of the persistent COVID pandemic, but truthfully, I am so grateful for the challenging experiences because they have made me into an even stronger and more mature individual. I am also grateful for my achievements this year, which would not have been possible without the mentorship of incredible faculty. This includes the Duke R38 Research Grant to study some of the mechanisms underlying racial disparities in Alzheimer's Disease. I appreciate the opportunity to share more about my research interests on the Duke website through a Resident Spotlight interview. I've grown more passionate about cognitive impairment over the last few years and decided to take up volunteering as a Community Educator through the Alzheimer's Association.
I'm tired but these activities are fulfilling and honestly, they keep me going. Dr. Siddhartha Muckherjee's 2018 article in the NY Times entitled "For Doctors, Delving Deeper as a Way to Avoid Burnout" encapsulates how much the extracurricular pursuits we're passionate about can keep us engaged in our medical careers. Throughout the article, in discussing his and a few of his former medical school classmates' research pursuits, he states, "We survived, I think, by deepening our commitments to research. We tried to increase our mastery within peculiar medical niches. And powerful, autonomous interests kept us going." Importantly, however, the support of my family, friends, co-residents, and therapist has been critical for my mental health and overall survival in residency.
I cannot forget the sheer exhaustion I have experienced just over the past few months, especially during my time rotating through the Neurology consult service. I remember that one of my busiest nights was in early August 2021, a couple of months into my first year as a Neurology resident (PGY-2). Things got so crazy that I didn’t get the chance to eat for the entire night and I barely drank any water. (Truthfully, I could and should have taken a break but unwisely chose to power through). I only ate a raspberry cheesecake cookie from the Subway downstairs nearby our cafeteria. I’m not sure I even went to the bathroom. It was a busy night. We had about 5 stroke codes and 6 consults in 12 hours. I guess it could’ve been worse, but it was still bad.
By the way, just for reference, one consult alone takes a lot of time - it involves chart review, seeing the patient to chat with them about their illness and to do a physicial exam (or even contacting family members if the patient is not able to explain what brought them to the hospital), relaying recommendations to the primary team (main medical team that is taking care of the patient), assisting with the disposition (where the patient will end up, i.e. home, admission to the hospital, etc), and writing the consult note, which consists of documentation of the HPI (history of present illness: the patient's narrative), physical exam, and assessment and plan. All of this can take quite some time.
Regardless, when I am woken up out of sleep and have to drag myself out of the cozy, dark, and warm on-call room to see that 3AM seizure consult in the emergency room, I remind myself why I chose this career in the first place.... and all becomes right in the world once more. It's truly a privilege to see patients who are suffering from neurologic emergencies and conditions like stroke, seizure, acute demyelinating diseases in the brain or spinal cord, etc, and to be able to get them the treatment they need (i.e. thrombectomy to remove the clot that's causing the stroke, anti-seizure medication, steroids for the demyelinating diseases such as multiple sclerosis, etc).
Localization in neurology is also pretty cool (and scary, depending on how you look at it). Believe it or not, one very tiny stroke in a small part of the brain (i.e. brainstem) can cause multiple tremendously debilitating symptoms, such as eye problems, weakness, speech changes, sensory deficits, and/or other symptoms.
Stroke is certainly the biggest neurologic issue that we deal with and are consulted for in the hospital. What's the biggest risk factor for stroke? High blood pressure. Other risk factors include high cholesterol, diabetes, obesity, obstructive sleep apnea, heart disease, tobacco use, etc. We have to get our blood pressure under control! Let's also get that cholesterol under control by modifying what we consume on a regular basis. Let's try to be more active in our day-to-day as well. And the diabetes? We need to keep that in check too. If you snore and are overweight, you might consider asking your doctor to order a sleep study for you (keep in mind though that sleep apnea can also occur in people who are not overweight). If you have sleep apnea, that needs to be treated. Stop smoking! Go to your follow-up doctor visits. Take your medications. It's simple! An estimated 80% of strokes are preventable. Can you believe that?
Anyway, I'll get off my soapbox now. I will try to post another entry sometime this spring highlighting some interesting cases.
Thanks for reading! :)
