The Anatomy of the Brain Artist: Sir Charles Bell

“’Helmet, helmet!’ squealed my daughter, excitedly. I followed behind as she ran to the back door, ready to start the day. The bike ride to her daycare center had become our shared morning ritual, a ritual that I had started long before she entered the world 16 months ago. The bike ride to the research laboratory or hospital had become one of the most cherished parts of my days. The ride gave me time to reflect on the day ahead and to be present. Now it is something that my daughter has come to love as much as I do.

I watched my daughter run inside and then hopped back on my bicycle, heading to the hospital on my first day as a third-year medical student. To say I was nervous was an understatement. I timidly found the neurology resident in the crowded work room. Together with another medical student, resident, and attending physician, we made up the team that treated patients who had been admitted with strokes. The senior resident told me I would be caring for JoAnne, a 92-year-old woman with a left posterior circulation stroke, resulting in almost complete loss of movement, sensation, and pain in the right side of her body.

As a medical student, I was expected to perform a full neurologic examination on this patient in the presence of the entire stroke team. Because I had just been thrust into the medical school clinical period after 4 years of working on my PhD thesis in a basic science laboratory, my confidence in my clinical skills was meager. I internally recited the neurologic examination as I trotted to JoAnne’s room followed by the rest of the team and the patient’s nurse. Am I sweating? What’s the first part of the neuro exam again? I walked in to find a small, frail-appearing woman lying on the bed. She looked somber with glassy blue eyes staring off into the distance. I introduced myself as the third-year medical student who would be taking care of her. She turned to me and gave me the smallest nod. Was that a smile? I started the examination with what I knew best, the cranial nerves. I watched her eyes move slowly from side to side and then up and down. Did I see neglect of the right side? Now to the deep tendon reflexes. As I swung the reflex hammer and met her biceps tendon, she winced in pain. Should I keep going or should I stop? I needed the information… right? I stopped with the reflex hammer in mid-air and looked to my attending physician for an answer as I cut the reflex examination short.”

Read more on Role Reversal via JAMA A Piece of My Mind.

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