Reaching Down the Rabbit Hole by Ropper Allan Burrell Brian David

Author:Ropper, Allan, Burrell, Brian David
Language: eng
Format: epub
Publisher: Atlantic Books Ltd

7. THE BRAIN MAKES POETRY

In those days, medical students tended to be down on neurology. They called it a masturbatory specialty. You couldn’t do much of anything in the way of cure or even prevention, so you just sent patients back out on the street (“treat-’em-and-street-’em,” is how they put it). Everybody in my internal medicine residency program was appalled when I announced my intention to go into neurology. “What a waste of time! There’s nothing that you can treat.” Then I went to a talk given by my future mentor, who happened to be visiting the hospital. Raymond Adams, one of the greatest clinical neurologists of the twentieth century, gave an overview of where neurology stood in medicine, and, more importantly, where it was headed. I can remember his advice to this day:

Think about it: There are more diseases of the muscle, just the muscle, which is a tiny sliver of neurology, than there are all diseases of the lungs. There are more diseases of the spinal cord than there are of all diseases of the heart. There are more diseases of the white matter, not the whole brain, but just the white matter, than there are of all the rheumatologic and joint diseases. Neurology has more diseases and more complexity and more need for exquisite clinical analysis than any other branch of medicine. Take one little piece of neurology: there is more to it than in the totality of any other medical specialty. And yet lung disease and heart disease dominate our collective fears. Dermatology is the only field that has more diseases than neurology. There are a billion skin diseases, but only ten of them occur with any regularity. Whereas in neurology people may say, “Oh, it’s just a stroke,” well, strokes are a big proportion of neurological cases, but there’s so much else to it: What kind of stroke? Where did it occur? What caused it? To master all that is a lifetime effort. So if you really want to be challenged instead of being bored in seven years, when you know all there is to know in your specialty, you may wish to consider neurology.

The brain-mind connection attracts many people to neurology initially, but that’s too facile a motivation. When I hear a student say, “I want to understand the mind,” I suggest they try psychoanalysis. Neurology is much bigger. Neurology isn’t a system that was invented to understand the mind, like psychodynamics. It’s the goddamned brain in all its messy glory. As another wise neurologist told me early on, “You want to be a nephrologist or a urologist? C’mon! The kidney? It makes urine! Who gives a shit? Now the brain—the brain makes poetry.”

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