Reflecting on this period, I’m reminded of the highs and lows that come with such an intense training environment. Residency was rigorous in ways I hadn’t anticipated, but it was also deeply rewarding. I faced moments of exhaustion and frustration, but there were also times filled with laughter, fulfillment, and a renewed passion for patient care. The program's structure pushed me to grow as both a clinician and a person, and for that, I am immensely grateful. My fiancé, family, friends, and mentors played a crucial role in helping me navigate the ups and downs along the way.
As I conclude this chapter, I’m excited to share a few clinical stories and key experiences from residency in a later post. But first, I’d like to walk through some of the travel experiences that have shaped this past year—each trip a learning adventure in its own right. From professional conferences to workshops, these opportunities not only broadened my horizons in neurology but also gave me a chance to explore new cities and enjoy some incredible food.
January 2024: Clinical Neurological Society of America Annual Meeting, Key Largo, Florida
At the Clinical Neurological Society of America (CNSA) meeting, I experienced the unique value of a small, close-knit community. Despite each person’s specialized focus, there was a shared passion for comprehensive neurological care. The focused learning sessions, particularly the "Meet the Professor" sessions, were immensely valuable. I felt like I was not only learning but also growing into a better general neurologist with each small group interaction. The organization’s commitment to diversifying its members and speakers was another significant highlight for me.
One of the personal highlights of the trip was grabbing a Baja Beach Chicken Burger at The Burger Den—it was delicious and definitely added to the positive experience.
March 2024: Diversifying CNS meeting in San Francisco, and Workshop on Contextual Data Resources for Understanding the Role of the Exposome in Aging, USC in Los Angeles, CA
March took me to San Francisco, where I, as a member of Diversifying CNS (a group dedicated to nurturing underrepresented neuroscience researchers), attended a powerful event focused on diversifying the field of clinical neuroscience. It was incredibly moving to hear the stories of researchers who have taken nonlinear paths, overcoming not only academic but also personal challenges, such as racism and self-doubt. One moment that stuck with me was a black male faculty member being mistaken for a cleaner—a stark reminder of the work still needed in our field. However, seeing these individuals rise through it all was nothing short of inspiring. The practical advice on setting up a lab, negotiating in academia, and even statistical coding made this trip invaluable.
Outside of the academic experience, the reality of San Francisco’s homelessness crisis was impossible to ignore. Walking/driving through the city, I was struck by the sheer scale of the issue—tents lined many streets, and people experiencing homelessness were a visible part of many parts that we passed through. The contrast between the bustling academic discussions inside the conference rooms, where we spoke about research and professional advancement, and the profound social inequities just outside the doors was jarring. It was a sobering reminder of the challenges that exist beyond our academic bubble, and how disconnected the worlds of research and policy can sometimes feel from the pressing human crises happening in real time. It left me reflecting deeply on the broader social determinants of health that are inextricably linked to the very issues we're studying in our fields—how can we adequately address one's health without acknowledging the fundamental need for stable housing and social support?April 2024
North Carolina Central University (NCCU) Career Day
At the NCCU Neurosciences Career Exploration Day, hosted by Duke and held at the JB Duke Hotel in Durham, I had the chance to speak with undergraduate students interested in neuroscience. Sharing my journey and watching their excitement as they learned about the field was incredibly rewarding. It reminded me how important it is to inspire the next generation of neurologists and researchers.
AAN Conference - Denver, Colorado
The American Academy of Neurology (AAN) conference in Denver was, as always, an incredible experience. With a massive array of lectures, networking events, and career development opportunities, it remains one of my favorite professional gatherings. I appreciated the opportunity to connect with colleagues and mentors, and there was no shortage of knowledge to be gained in the various learning tracks.
Physicians Foundation Board Meeting - Boston Harbor Hotel
As a 2024 Physicians Foundation Drivers of Health fellow, attending the Physicians Foundation Board meeting at the Boston Harbor Hotel was a highlight of my spring. The discussions focused on improving physician well-being, fostering leadership, and addressing social drivers of health. It was a productive and energizing experience that left me motivated to continue advocating for the voices of physicians.
June 2024: Boston - Stress Neurobiology Workshop
In June, I attended and gave an oral presentation about my work at the Stress Neurobiology Workshop in Boston, a pivotal opportunity to learn about the latest research in the field. It provided a deeper understanding of the mechanisms behind stress-related neurological conditions, and I came away with fresh ideas for future projects.
July 2024: Wedding Day
On July 13, 2024, Derrick and I were married! I can write an entirely separate entry on this. After months of tireless planning, it was finally our big day. It was truly one of the best days of our lives. The day wasn't without its challenges, but the support of our family and friends made everything perfect. The joy and love we felt were immeasurable, and we’re grateful for everyone who shared the day with us.
August 2024: Broadmoor (Physicians Foundation Board Meeting), Seattle (APA Convention & LEAP Bootcamp)
In August, I attended the Physicians Foundation board meeting at the Broadmoor in Colorado Springs. This picturesque setting was the perfect backdrop for discussions on physician well-being and leadership. Shortly after, I traveled to Seattle for the American Psychological Association (APA) Convention and LEAP (Leadership and Education Advancement Program) Grant Writing Bootcamp. The bootcamp provided countless practical tips on grant writing, negotiation, and other important professional topics. A couple of topics that resonated deeply with me were discussions on imposter syndrome and dealing with difficult leaders. Also, I had the chance to fly Alaska Airlines straight from Baltimore to Seattle—it was a surprisingly pleasant and restful experience!
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As I reflect on my journey through residency, the academic experiences and conferences were certainly pivotal, but some of the most profound lessons came directly from the clinical cases I encountered. The transition from textbooks to real-life patients revealed the complexity of treating neurological disorders, where psychological, emotional, and social factors often play as much of a role as the medical symptoms themselves. In this next section, I’d like to share two particularly memorable cases involving pediatric patients that deeply impacted my approach to medicine. These cases not only challenged my clinical knowledge but also highlighted the importance of treating the patient as a whole—beyond just their symptoms—and understanding the broader context of their lives.
I can distinctly recall two pediatric cases that had a profound impact on my clinical practice and personal growth. These cases not only tested my medical knowledge but also taught me invaluable lessons about the importance of holistic patient care and the critical role of psychological and social factors in health.
The Complexity of Symptoms Beyond Diagnosis
While I was covering the Pediatric Neurology consultant pager overnight, the ED contacted me about an 8-year-old girl with a history of anxiety and migraines. Let's call her Lisa. She presented to the ED with a range of symptoms, including shortness of breath, dysphagia, muscle weakness, sensory disturbances (burning sensations in her hands and feet), and urinary urgency that prompted the use of a diaper. Her symptoms were further complicated by many episodes of stridor that resolved in the blink of an eye with heliox treatment, suggesting a possible stress-related component.
"Can you help us put her together and figure out if there may be a neurological cause of these symptoms?"
There wasn't. I knew this immediately. The history the ED provided already gave me the answer.
Lisa's parents described her as a very "sensitive" child, and their high levels of stress were palpable during our interactions. They had lost another child to cancer when they were 8 years old, the same age Lisa was now. This tragic loss undoubtedly contributed to their anxiety and hypervigilance regarding Lisa's health.
Despite extensive diagnostic workups, including an MRI of the brain and respiratory evaluations, her symptoms did not localize to a specific neurological territory. The MRI only showed minor changes consistent with migraines, which did not explain the breadth of her symptoms. Her episodes of stridor, which resolved with distraction, further pointed to a psychosomatic component.
The impact of her sibling's death on the family dynamics was profound. Her parents' stress and anxiety likely exacerbated Lisa's symptoms, creating a cycle where their concern intensified her anxiety and physical manifestations. It was clear that Lisa's health issues could not be addressed through medical interventions alone; her psychological well-being and the family's emotional health needed to be integral parts of the care plan.
From this case, I realized the importance of addressing the psychological and emotional aspects of patient care. Lisa's situation underscored the need for a multidisciplinary approach, involving not only neurologic evaluation but also psychiatric support.
Family Dynamics and Social Context
I was contacted about a 14-year-old boy with a history of ADHD and depression—let's call him J. His presentation was a puzzle, filled with a myriad of symptoms that required a deep dive into both his medical history and social context to fully understand. J was admitted with severe hypersomnia and memory changes. His mother brought him to the ED due to increased episodes of urinary incontinence while sleeping, palpitations, numbness across the chest, and orthostasis. Additionally, he exhibited strange movements described as non-rhythmic jerking and rolling around in bed, which resolved immediately after the use of smelling salts. His hypersomnia was profound, with him sleeping up to 20 hours a day and experiencing hypnagogic (occurring when falling asleep) hallucinations.
Despite undergoing an extensive workup, including MRI, lumbar puncture, and testing for autoimmune encephalitis, no clear etiology emerged. The primary team suspected Klinefelter-Levine syndrome, but this diagnosis didn’t fully account for the range of his symptoms. His case presented a challenge that required looking beyond the typical medical explanations and considering other dimensions of his life.
One of the most critical, yet initially overlooked, aspects of J’s case was his family dynamics and social environment. His father had a history of schizophrenia and bipolar disorder, and J had reportedly been a victim of bullying at school. These factors were glaringly absent from the initial chart notes, and it was only after digging deeper into his background that we began to piece together the emotional and psychological influences that were likely contributing to his physical symptoms.
When I reviewed J’s chart, I was struck by the lack of attention to these crucial social stressors. Understanding the impact of his father’s psychiatric conditions and the bullying he endured at school was essential for creating a holistic approach to his care. It was perplexing that such significant aspects of his life had been overlooked in his medical records, underscoring the importance of considering the psychological and social context in patient care. This case highlighted the need to look beyond the purely clinical and to take into account the broader circumstances affecting the patient's health.
