Standing in an empty exam room, the doctor pulls up the next patient’s scan. He quickly pans through the slices, pointing out the obvious anomalies. Even as a lowly premed, it isn’t hard to appreciate the striking amount of deterioration present. Gone were the rolling curves and compacted ripples of gyri and sulci. Black, empty spaces take the place of normal tissue—his ventricles nearly double their normal size. Years of degeneration and atrophy are exceedingly apparent on this man’s MRI and the effects of insidious disease unmistakable.
“This patient is a follow-up of mine. Late fifties. Initial MRI was relatively normal. Later imaging, neuropsychological testing, and clinical assessment suggest otherwise. Suspected FTD with primary progressive aphasia.” said the doctor.
Despite being one of the most common causes of presenile dementia, individuals with frontotemporal degeneration (FTD) are often misdiagnosed as having Alzheimer’s disease or a psychiatric disorder. As one of Nevada’s few medical centers devoted solely to neurological diseases, the Cleveland Clinic Lou Ruvo Center for Brain Health frequently receives complex cases such as this one, and is often a last resort for many patients and families.
These past four weeks in clinic, I had the opportunity to follow several neurologists of various sub-specialties and gain valuable insight into the fields of behavioral neurology, movement disorders, and neuroimmunology. From attending weekly Grand Rounds to watching doctors adjust the settings on a patient’s deep brain stimulator, there wasn’t a single day where I did not come home with a deeper understanding of neurological disorders or a new perspective on healthcare in America.
Even so, the things that impressed upon me the most were not the scientific principles behind these diseases or their medications. One of the biggest lessons I came away with was that being a doctor doesn’t always mean ridding people of their illnesses or giving definite diagnoses. Being a doctor goes beyond frank “cures” and in such a field where there are often more questions than answers, compassionate care takes on many forms. Slowing down an inevitable disease process to give families more time with their loved ones may seem like mere bandaids over a gushing wound; to patients and their caregivers, however, such small comforts mean the world.
My experiences as a summer intern have undoubtedly cemented my interest in neurology. While it may be premature to say that after six weeks of working with patients and following doctors that this is the field where I belong, this internship has absolutely made me even more passionate about studying the brain than when I began. Within the next few years I hope to use this passion to continue pursuing a career in medicine, with the definite goal of becoming a behavioral neurologist.
Written by Julia Bals, BC Class of 2017