Tuesday, January 03, 2006


I just started my neurology rotation today, after a luscious month-long hiatus from the hospital. I was going to say that it was a hiatus from being a medical student, but I somehow managed, while "on vacation", to (1) diagnose a non-displaced fracture of the radial head (aka broken elbow) by x-ray, (2) evaluate a cluster of acute onset extraorbital pustules of probable insect origin, (3) appreciate a 5/6 systolic ejection murmur radiating to the carotids likely attributable to a congenital bicuspid aortic valve, and (4) dispense various bits of unguaranteed "advice" on various health and medicine related topics. Ok, I didn't just "somehow manage"--I was almost ashamedly excited to try my new knowledge and skills on my family and friends, and they just happened to have some rather acute issues while I was visiting. I also successfully nursed my own nasty bruises from my first (of many, I hope) snowboarding adventures. But more on that another time.

So today, I saw two patients, both of whom were suffering from strokes that have left them aphasic. Meaning a loss of language. But what exactly is lost and what remains is, as neurologists like Oliver Sacks have long noted, quite curious. Why is it that patient #1, we'll call her Mrs. George, could carry on what seemed like a normal conversation--hi, how are you, I'm fine, where do you live, oh hamden, do you have kids, yes three, are you in any pain, oh no I'm feeling fine--until you held up a pen in front of her and asked her simply to name what she saw.

"Mrs. George, do you know what this thing is that I'm holding in my hand?"
"Oh, yes!"
"What is it?"

Patient #2 did sort of better, in that when she said she knew what "it" was, she delivered.

"Mrs. Weiss, do you know what this is?"
"What is it?"
"What's that?"
"It's love?"

Well, there you have it folks, Mrs. Weiss has discovered what love is. It's a pen.

But I kid. Ischemic events are no fun anywhere in the body, and certainly not in the brain, where they can--as instantly as a "stroke" of lightning--wipe out a person's ability to walk, talk, identify objects, feed themself....

Hmm...see, that's what's so fascinating. Just a week ago, I was down in Savannah blissfully spending time with my newest little cousins, and marveling at the facility with which my 2-year-old cousin Jessa has adapted to life as we know it after just 24 post-womb months on the planet. She can now walk, talk, identify objects, feed herself... Show her a pen, and she'd say "it's a pen!" In fact, forget the pen--Jessa can name everything from eyebrows to stethoscopes! She spontaneously comes out with responses like "No, I have plenty" and "I'll cooperate". How does she do that??


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