Free Everything I Learned in Medical School: Besides All the Book Stuff by Sujay M. Kansagra Md

her hospital stay. It sounds silly, but it did hurt a little when she didn’t recognize me. Perhaps it would be better to not get attached to patients, I told myself.
    The second patient encounter was during my final year of medical school, during a pediatric neurology rotation. We were consulted by the general pediatrics team to come evaluate a patient with headache and ataxia (which means difficulty walking and coordinating movement). He was a 9 year old, and it was obvious from the first glance that something was terribly wrong with him. His eyes were constantly moving rapidly from side to side. When he got up to go to the bathroom, his limbs moved in unsteady, jerking motions, and his own legs could barely support his weight. We asked him to touch our finger with his, then touch his nose, a test of coordination. It took him a few seconds to actually get his arm moving, as if he wanted to move it, but it just wouldn’t move. And when it did, it flew out as if it was out of his control. We thought that he had likely developed an infection, and that the immune system had made antibodies to fight off the infection. Unfortunately, sometimes the body makes antibodies that also accidentally attack parts of the human body’s own cells, known as auto-immune disease. For him, his antibodies were also attacking his brain. In essence, his brain was becoming inflamed from the attack of his body’s antibodies. His brain was slowly losing more and more of its function. The attending pediatric neurologist said he had seen cases like this before, and they often get very sick before they get better, but luckily, they do usually get better.
    Unfortunately, he kept getting sicker. By day 3, he couldn’t walk at all, and within a week, he had slipped into a coma and had to be placed in the intensive care unit, where a breathing tube was placed to keep him alive. When the brain loses enough of its function, the parts that control breathing can also stop working, resulting in death unless artificial ventilation can be started, as was the case here. For the next three weeks, we would come into his room every day, and check various aspects of neurologic function, such as his reflexes and how his pupils responded to light. We would comment on the small changes that were happening from day to day, with no real progress, despite trying a variety of therapies such as steroids and plasmapheresis (which filters out many of the antibodies floating around in your blood), in hopes that if his body truly were attacking itself, this would get rid of some of the attackers. Progress was slow and on some days, non-existent. The parents were obviously distraught at having a son that was completely normal one minute, and now a step away from dying. Truly every parent’s nightmare.
    My month with pediatric neurology came to an end, and still he remained in the intensive care unit. I left, not knowing what would happen with him, but praying for the best. It was once again a case where I had become attached to a patient and a family over the course of the month.
    Four months later, as I strolled through the lobby of the hospital on my way home, I saw a familiar face. It was his mother. My brain quickly tried to remember the context of how I knew her. When I realized who she was, the next question was how to go about asking about her son. After all, he may have died, or may be suffering from brain damage, or may still be in the intensive care unit in a coma. I had no idea. Hospital regulations forbade us from looking at patient records other than for those patients who we are directly involved with at the time, so as soon as I had left the pediatric neurology service, I did not look into his files to see what had happened. So, I posed the neutral question, “How is everything going?” Her face lit up, and she said everything was going well. She was just waiting for Cody to get out of the bathroom. They were in the hospital for a follow-up visit. My smile