Pediatric neurology as a possible career path

I enjoyed pediatric neurology much more than I thought I would. Since I have a background in neuroscience, and hold a special curiosity for the workings of the nervous system, neurology has always seemed a logical career choice. But "logical career choice" doesn't necessarily mean that it's the right one for me.

My hesitancy with respect to neurology dates back more than 10 years when I watched my grandfather slowly deteriorate from Parkinson's Disease. Like a teenager's epiphany that Mom and Dad are just human beings, too, I realized that neurology couldn't cure my grandfather. This disillusionment with neurology in part steered me toward neuroscience research instead of medicine. At the time, I didn't appreciate that, through levodopa and other wonder drugs, neurology had given my grandfather and me a full decade of time together during which I didn't even know he had Parkinson's disease.

The pain of his passing dissipated, and so too did the grudge I held against neurology. This freed me emotionally to choose medicine as a career, late as I did, and now, to even seriously consider neurology as a possible career path.

Regardless, the extent to which I as a neurologist could "cure" a patient, versus treating symptoms or improving quality of life, is a real concern at this point in my education when I am deciding to what specialty I will devote my career in medicine. A close family friend who is a physician strongly urged me to keep in mind the emotional toll of caring for patients who will not get better despite all medical interventions. My colleagues on the Student Doctor Network neurology forums have grappled with this issue before me. One perspective that I find especially helpful comes from Dr. Rodger Elble, Neurology Professor and Department Chair at Southern Illinois University School of Medicine, in a June 2006 department newsletter (I love the internet!):

People become neurologists because they are fascinated by the nervous system, and they are not intimidated by disabling diseases that have no cure. Like Sherlock Holmes, neurologists love to use careful systematic investigation and deductive reasoning to tackle problems that are mysterious to others. Most importantly, neurologists understand that they can help people even when there is no cure. [PDF]

This will be the crux of my decision of whether to pursue a career in neurology. Can I find a fulfilling career caring for patients who have diseases with no quick fix, who will deteriorate and sometimes die despite my best efforts to treat them?

This is a particular concern if I go into pediatric neurology because the patients are even more heart-wrenching. I went into my neurology clerkship at Children's skeptical that the emotional burden of caring for such sick children would be too much for me; I left my neurology clerkship reasonably well assured that I could handle such a burden. Moreover, given my neuroscience background and my INTJ personality with a twist of goofiness, I think that I'm well suited to the task and that I'd be good at it.

What I like about pediatric neurology:

• First and most importantly, I enjoyed working with children. This surprised me. Those who know me know that I like children, but it's another matter entirely to do a physical exam on a sick kiddo.
• I like the challenge of figuring out how to get a good physical exam on children of various ages. For example, you can't ask a 6 month-old to touch your finger then its nose and back again to test for dysmetria, so instead I get the baby to reach for a toy. Examining a three year-old, I will bust out a tennis ball and play catch; toss the ball down the hallway to observe gait. Tons of fun.
• I like the observational and intuitive nature of pediatric neurology.
• I enjoyed working with all of my attendings and residents. This counts for a lot. Many doctors who I've talked with have said that they chose their specialty based heavily on where they felt they fit in best.

Having just a hair more than half of my third year of medical school under my belt, I'm still reluctant to pigeonhole myself into a specialty. At this point, though, I'm comfortable saying that neurology, possibly pediatric neurology, is at the top of The List.