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Renewal Is What We Need During Residency Training

Discussion in 'General Discussion' started by In Love With Medicine, Mar 13, 2020.

  1. In Love With Medicine

    In Love With Medicine Golden Member

    Jan 18, 2020
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    The need for a refreshed perspective on life and practice, a renewed sense of the concerns of our patients, and an appreciation for the subject matter: This is what so many of us need while in residency training. There are rare moments in the midst of it all when a renewing of sorts takes place, is noticed, and makes a small difference. Let me share one of those moments with you.

    It’s the last warm day of fall, and I (a neurology resident) and one of my professors of Neurology are standing in an old, renovated hotel in this grand old Rust Belt city of ours (Cleveland), arms crossed, hands tucked under our shoulders, catching up. We’re here to facilitate a lifelong learning class for our neighbors at an independent living home across the lake from the hospital. The place is quiet and beautiful and peaceful. It’s a far cry from the computers and pagers and intensity of the hospital.

    The topic today that we’ll address is the mind and the brain. What is the mind? And what is the brain? And how do the two interact? But first, we meet our neighbors and fellow students.

    A retired psychologist. An artist. An emeritus professor who worked with one of our emeritus professors. Grandmothers. Local folks. Handshakes and “hullos.” Coffee and hot water and cold water and tea bags to go along with the hot water. And cookies. Now voices are echoing in the hall. Young and old and in between. There are undergraduates here, too. It’s intergenerational. Connectomes, connecting.

    “So what is the mind?” one of us says, “And what is the brain?”

    There are various theories about the mind. Some adhere to physicalism: it’s all neurons and chemicals, and the neurons fire, and the mind is a sort of epiphenomenon. Others adhere to mind-body dualism: the mind and brain are distinct. There can be a bit of tension here.

    We then take our lay friends on a neuroanatomy tour. First, the frontal lobe, the motor cortex, and the language centers. Broca’s area, and Wernicke’s area.

    Then the temporal lobe, which is tonotopically organized. This means the neurons for C are right next to the neurons for C sharp. (Here the crowd audibly gasps, and I suddenly find myself thinking, Yes, indeed, this is rather marvelous.)

    And then there’s the parietal lobe, home to the sensory cortex, all nicely organized, except you get a lot more neurons for your fingers than your elbow. Because you run your fingers through your grandchild’s hair with your hands and fingers (not your elbow).

    And then there’s the occipital lobe, the vision center. Thanks to adjacent integrators nearby, we recognize faces and colors.

    And all this is so marvelously plastic! Routing and re-routing and learning up until the end. So be as self-determining as you can be. Go for a walk in the neighborhood as usual, but take a different route. Explore. Be outdoors. Learn to play a ditty on the piano. Sacks did.

    Distinctions between the mind and brain can become foggy and tense. Sometimes a blurring of distinctions takes place here that is genetic and early, non-sensical. An example, though, of how problems with the brain can change the mind. And perhaps the diagnosis could be a relief to some who wonder why their loved one is changing.

    Someone in the audience, an aging someone, asks about cognitive aging. The question is phrased in a fluent and intellectual manner, but the tone of voice betrays a more deep-seated concern (was the tone a hint tremulous?). This is clearly a concern of the larger cohort. What can prevent it? And so we discuss the importance, as a general rule, of not overmedicalizing the situation. If it seems common sense, it probably is. But of course, there’s a bit of tension here. (It’s easy to write a script for a pill.)

    And as we talk together, as threads of conversation come together, leave, then come back together again, I’m refreshed. Exposure to the concerns and wisdom of my neighbors is clarifying, a breath of fresh air in the midst of training. It provides insight into the path ahead.

    And I’m suddenly looking in on our group. Here we all are, a group of the most curious of creatures. Individuals, in the community. Some young and some old. Some naive and some wise with time. Some voicing fears and some understanding the fears of others. Wising up together.

    The room goes hush as one shares a concern. Then laughter ripples across the room in a lighter moment. This can all be explained quite nicely by the presentation we just had. Neurons, firing. Auditory input, received, processed, and properly computed. Integrators, integrating.

    But there’s a tension here. Because then I see a sparkle in the eye of a wise octogenarian. Eye contact. Fresh perspectives. New thoughts thought. Moments of unexpected optimism. Community. Wisdom passed down and back-and-forth and in-between. Tensions, breaking down. And we are together. At this moment, I begin to see that this is all very old and new, ancient and modern, timeless and novel, and very deeply mysterious. And a small renewing of sorts begins.

    Thank you to Dr. Peter Whitehouse (my professor) for the inspiration, wise advice, and proofreading help. Thank you to Rose Duncan (my fellow resident) for proofreading help from a resident perspective.

    Nicholas Brennecke is a neurology resident and can be reached on Twitter @nic_brennecke.


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