Wednesday, August 22, 2012

Student Innovators: Neurology Inpatient Rounds

As part of the institute’s commitment to education, each year we host a class of Student Innovators who spend the summer working side by side with our investigators. Larry Kim, one of those student innovators, periodically shares commentary about his time with us.
By Larry Kim

Recently, I was afforded an amazing opportunity to shadow the Neurology team at Children’s National Medical Center. Even as a public health guru, these intimate opportunities to shadow physicians and visit patients are exceptionally rare. Experiences such as this are typically reserved for third-year medical students and above. At the Summer Student Innovators Program at the Sheikh Zayed Institute, you get to skip all three years of medical school and jump right in! Jealous? I would be too. Here are a few highlights and interesting notes from my morning rounds with the neurology team:
  • Pre-Round Meeting: Prior to the neurology team’s morning rounds, they have a pre-round meeting where all the patient cases are discussed. It was a lot like the television show, “House,” where Dr. House asks his terrified residents tough questions about the cases. It has been about 4 years since I have taken medical terminology, so I understood about every 4th word he said. If you think you are on top of your medical terminology game, try to figure these words out:
  1. Subfalcine herniation
  2. Parenchyma
  3. Diencephalon
  4. Homonymous Hemianopsia 
  5.  Cortical homunculus

  • Patient Rounds: The majority of the patients we encountered had suffered from various types of seizures. The patients ranged in age from 15 months to 18 years old. Here are some interesting observations: 
    •  Patients who had a history of seizures were attached to a machine that measured their brain activity. The device also had a camera mount, similar to a web cam, which recorded the physical/psychological symptoms of the patient as they experienced an “episode.”
      • The most interesting aspect of the camera is that physicians can review a patient’s brain activity during a seizure and watch the physical/psychological changes that occur. During our morning round, the neurology team was able to identify a previously undetected seizure in a patient.
    • Collaboration was highly emphasized in the treatment and diagnosis of the patients. At one point, I counted 15 people involved in diagnosing a patient. The collaboration between neurologists, residents, pharmacists, nurses, case workers, and primary care physicians ensures that all parties are fully informed of the treatment plan. 
    • In one patient room, a child was to be discharged from the hospital later in the evening. As we were leaving, the nurse made a comment to the parent of a training video that would be streamed directly to their in-room television. From a public health perspective, Children’s National Medical Center gets a big thumbs-up for post-hospitalization patient/parent education. 
    • The field of neurology is interesting in that the symptoms of neurological disorders affect personality, mood, temperament, etc. Neurological disorders have less definitive symptoms, unlike other illnesses where you can physically identify a runny nose, a fever, or a cough. To see the effects of these neurological conditions first-hand made a lasting impression upon me and really fortified my passion for improving pediatric health.
  • Lasting Impressions: There were a few patients that I visited that made a lasting impression. I was touched by the strength and bravery that these children displayed despite their health condition. As a society, we characterize bravery as individuals who exhibit courage in the face of danger. If this definition holds true, then I have just met 6 of the bravest people I’ve ever had the honor of meeting. Here’s one such example of bravery: We visited one young patient who was recovering from a recent seizure. The attending physician asked her to smile to determine if her facial muscles had been affected by her seizure. I’ve seen a lot of amazing smiles over the years, but her smile was something special. It was the most beautiful smile that I have ever seen, period. Don’t mind the squadron of physicians hovering around her or the dozens of monitors and IV’s attached to her arm. For just a second, nothing was more tangible then her beautiful smile.

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