Neurology in Question

Emily felt the excitement in the air as she first entered the neurology service. This was Emily's fourth year in medical university, and her first doing clinical medicine, with real patients.

It was different from pulmonology and infectiology. It felt more logical than cardiology for her, but maybe it was because she had studied more neurology in her free time during COVID confinement.

Emily had learned that medicine is not maths. It's not 1 plus 1 equals 2. It was difficult for the student to fathom such a reality.

Some of her classmates had more hardships communicating with patients and colleagues. It was exciting seeing new parts of everyone, of her classmates, new residents, general doctors, assistants, and professors.

Emily couldn't help but stare in awe.

Her eyes weren't the only ones filled with curiosity. The eyes of everyone who strived for the medical path there mirrored a thirst for knowledge.

The classmates exchanged a conversation about the Willis Polygon.

Another classmate stated, "A lesion of the third cranial nerve can lead to homolateral mydriasis."

The classmate beside her added, "A temporal brain herniation, specifically uncal herniation, can compress the third cranial nerve and cause a homolateral mydriasis as well."

"It usually occurs on the side of the mass effect, although severe intracranial pressure can produce more complex patterns. Brainherniation is a medical emergency and can be fatal if untreated."

"As the herniation progresses, it can compress the brainstem and affect consciousness, respiration, and cardiovascular function."

She paused.

"A unilateral mydriasis is therefore a warning sign that requires urgent evaluation. In an acute setting, we first look for a dangerous intracranial cause, usually with urgent brain imaging such as a non-contrast CT."

"If a third-nerve palsy is suspected, we then determine whether the cause is compression, vascular disease, an aneurysm, trauma, or another lesion."

Emily listened carefully.

The service chief obliged us externs, medical students who hadn't yet begun internship and weren't officially treating patients, to attend the morning handover.

It seemed I was the first student to attend the morning handover.

I was late as there was traffic, the usual.

I admit I actually woke up late, at 6:30 a.m., and rode the bus at 7 a.m. If I had woken up at 6 a.m. and ridden the bus at 6:30 a.m., I'd have reached the hospital before 8:30 a.m., when the morning handover actually began.

As I sat in a chair near the round table, the doctors, including my meticulous, quiet neurology stage master, were preparing the patient folders.

The strict service chief looked at me.

Then the other doctors looked at me.

Which made me wonder if I was an alien.

My self-esteem hit rock bottom as I thought I had turned into a wiggling worm.

One of the doctors, Dr. Fernand, smiled at me. "Good job."

She was the replacement for our stage master when our stage master was on vacation during our first week of studying neurology.

I thought Dr. Fernand was our stage master at first.

She emanated an aura of a strong personality.

Luckily, the doctors' attention shifted back to the