One of the great things about neurology is that you see some really sick patients who need your help, and you also see some totally normal patients who just need some reassurance. Then, of course, there are a lot of plain crazy patients who think they have huge problems but don't want to hear that they do not, in fact, have a serious illness.

I had one patient brought to my Child Neurology clinic a few weeks ago by her father. Her parents were concerned that she had a left eye droop with an asymmetric smile. At first glance, when I heard about the problem, I had to think about a sudden stroke or some other serious brain lesion such as a tumor. I entered the room with curiosity only to find a beautiful little 6-year-old girl who appeared completely normal. I asked when the parents' concerns about her face had begun, and the father said they had noticed her problems since birth. The asymmetry in her eyes or smile had not worsened or changed in any way as she had grown older. I looked very hard to see if I could appreciate any neurologic deficit in her face, and if I REALLY tried, I could see that there might be the slightest asymmetry, maybe noticeable to a modeling agency but definitely not appreciable to any other person. I carefully reassured the father that I wasn't seeing any sign of a neurologic problem and delicately explained that this is simply his daughter's FACE. Nonetheless, my attending (after good-humoredly joking about the ridiculousness of this encounter prior to entering the patient room) proposed that we get a brain MRI (Cost: $2,500) to further reassure the parents and cover ourselves from a legal standpoint, even though we knew it would be completely normal. (It was.) I wonder if my attending would have been so supportive of getting this expensive, needless test if the family had not had private insurance. Hmmm. No wonder we have problems with the cost of healthcare!


I have really enjoyed working at the county hospital the past couple of months. It is the only hospital in the area that accepts Medicaid patients, so we get some pretty interesting characters. One 60-year-old man who looks like he is in his 80s was admitted after having seizures. He is apparently prettey demented at baseline, as evidenced by the following experience. On rounds one morning, we were talking to the patient with our entire Neurology team (4 medical students, 6 residents, and the attending). Mid-conversation, the patient reached over to the plastic urinal sitting on his bed tray and started drinking right out of it. My attending frantically tried to stop him, saying, "Wait, don't . . . Aggghh!" then turned away in disgust as we collectively cringed and took a few steps toward the door. Awesome.


One interesting thing about the county hospital is that there is a jail in the basement where prisoners who need inpatient admission for health issues reside. It is a fascinating place. The whole place is a lock-down ward with multiple police officers determining who enters and leaves. It is a little creepy. It's not uncommon for a prisoner to fake a medical problem on a nice Saturday afternoon just to get out of their usual prison cell and instead spend a few hours in the Emergency Department or in this hospital jail. We aren't allowed to tell the prisoners anything about their condition, when we think they will be able to leave the hospital (i.e. go back to jail/prison), or even what follow up appointments or tests we will be recommending. Even something as harmless as telling them that we will be arranging an MRI potentially gives them the opportunity to plan an escape. It's all very Hollywood. :)

The University Hospital also has its own set of bizarre cases and patients. I spent a month in the Epilepsy Monitoring Unit, which is a place where we electively admit patients with known or suspected seizure disorders in order to better understand the nature of their seizures. A typical patient stays for 3 to 7 days, during which time they are continuously hooked up to the EEG monitors and on 24-hour video surveillance so that we can try to capture one of their typical events and determine what it looks like, which areas of the brain are involved, and, for many patients, decide whether or not their seizures are truly epileptic or not. It is absolutely fascinating to see patients with extremely wild seizures, flopping all over the bed like a fish for hours at a time, with NO electrical correlate on the EEG. Now, we never tell the patient that they are "faking" seizures. We try to explain that these types of nonepileptic seizures are a real physical response to an internal stress or trauma, similar to your face blushing when you experience embarrassment. These types of seizures are best treated with psychotherapy rather than anti-epileptic drugs. I always enjoy seeing different attendings' approaches in discussing this delicate issue, and I think it is baffling to see how the majority of these patients refuse to accept the fact that they do NOT have epilepsy, even after we show them what we are seeing on EEG/video.


One of the more interesting patients we had in the Epilepsy Monitoring Unit recently (not while I was there, thank goodness!) was a young man, about 19 years old who had recently been kicked out of West Point for smoking pot. Apparently, he had been in drug rehab for marijuana use when the suspicion for seizures arose, and he was admitted to our EMU for monitoring. I won't go into all the details, but needless to say, there was quite the flurry of excitement from the nurses when they realized that he was having "intimate relations" in his hospital room with a girl. Keep in mind that these patients are on 24-hour continuous video monitoring, and this is no secret to them. To make the story even more interesting, it turns out this kid had called a prostitute to his hospital room as soon as his mother had left. Unbelievable. Well, the irony is that this guy did, in fact, have real seizures. He was started on treatment and discharged from the hospital directly to gambling addiction rehab.


Never a dull moment! And THAT's why I prefer treating children. :)