Not Just Band-aids

bals1          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


Patients First

clevelandclinicJust a couple miles north of the Las Vegas strip sits one of legendary architect Frank Gehry’s most recent projects. A framework of undulating metal wraps over the crisp, modular northern face of the building—the steel almost melting under the scorching desert heat. Though this eclectically styled building may seem like an unlikely home for a medical research facility, the work done at this facility rivals the impressiveness of its architecture. As a part of the Cleveland Clinic, the Lou Ruvo Center for Brain Health treats a wide variety of neurodegenerative diseases such as (but not limited to) Alzheimer’s, ALS, Parkinson’s, and MS.

In my first two weeks as summer intern here at the Ruvo Center, I’ve had the opportunity to work in the physical and occupational therapy departments, taking vitals for incoming patients, assisting in exercise classes specifically designed for the movement impaired, and helping therapists administer various treatments and exercises. Though PT and OT formally have different types of goals—PT seeks improve physical function, and OT aims to help patients with activities of daily living—both departments work closely with each other to establish and work towards care goals.

The highly collaborative environment and the ever-present maxim of “patients first” here at the Ruvo Center reminds me of the Ignatian ideal of cura personalis. In my interactions with patients and therapists, it is abundantly clear that many of the problems faced by these patients go beyond their neurological diagnosis; frequently, economic and social factors pose serious barriers to adequate healthcare. Although one may not often consider Jesuit principles as skills that can be used in the workplace, I believe that my understanding of cura personalis has helped me to better understand the multi-faceted approach to care practiced by the Ruvo Center. It’s easy to say that giving a patient carbidopa-levodopa may help ameliorate their Parkinson’s symptoms, or that rivastigmine can slow the progression of Alzheimer’s. However, in working with the care providers here, I’ve come to truly appreciate the type of compassion and approach needed to work in the healthcare profession.

In the following weeks I will be transitioning away from PT/OT and into the actual clinic itself. It is my hope that I will continue to be able to apply the lessons and ideals that I’ve gained from Boston College in my interactions with the physicians and their patients.
Stay tuned!

Written by Julia Bals, BC Class of 2017