A One Man Army

One of the major benefits to joining a large, well established private practice neurology group is that there Is a wealth of experience surrounding me. If I have a difficult patient or tough question, there's 12 other neurologists who are just a phone call away. The grim spectre that hangs over our heads is that the mean age of our neurology department is probably around 60, and there are at least 2 neurologists who are 2 years away from retirement. If they leave, a surplus of patients will have to get redistributed, and the manageable 1 weekend per month call schedule could become a significantly less manageable 1 weekend every 3 weeks.

Dr. Z embodies the self-sufficient 1 man army. He reads EEGs, does EMGs, has botox clinic once a week, does his own blood draws, and thankfully for me, he takes weekend call at least 1 in four weekends, making my call schedule less. Of course, he has accumulated a well-deserved fortune for all his hard work. He has a daughter who followed in his foot steps and currently works as a neurologist at Northwestern.

He also has CNS lymphoma, which luckily, is in complete remission.

The first weekend I was supposed to take call, my hospital credentials got delayed. Dr. Z magnanimously stepped up and took my call that weekend, which was historically busy.

4 days later at the end of his botox clinic, he was unable to move his right arm. He convinced our MRI technician to get an MRI of his brain. Dr. Z read his own MRI, and saw a punctate area of diffusion restriction confirming a small acute ischemic stroke. He burned the image on to a CD, and drove himself to a nearby hospital with the CD in hand.

In the emergency room, a neurologist from the UC stroke team offered him IV tPA, a thrombolytic medication which can improve outcomes in acute ischemic stroke. Dr .Z declined. He was admitted to the ICU as a "precautionary measure" and because the rooms were bigger. He was evaluated by one of the neurologists in our practice the next day. At this point, he had made a good recovery and had regained almost all motor function of his right arm. About 12 hours after his admission, he signed out of the hospital against medical advice. He took one day off, and then returned to work 2 days after he was discharged from the hospital.

When he returned to work, it was slightly uncomfortable. Several of my partners and I entered his office to express our well-wishes. "I was very lucky," Dr. Z said. He explained his thought process very systematically. He figured that he needed to get an urgent MRI because it was unclear if his weakness was from his lymphoma or a stroke. He declined tPA because his stroke was small and he was optimistic he would make a good recovery on his own. He left the hospital early because he understood that the likelihood a prolonged hospitalization would find a hidden/cryptogenic cause of his stroke was low.

He is back to normal, seeing up to 20 patients a day in his busy neurology clinic, and he took weekend call again last weekend. I offered to work his Saturday (I already had plans to meet Lalitha's parents Sunday), but he declined and said he may take me up on a trade later. His call was yet again another historically busy weekend. He has decided that he will retire next year.

Dr. Z took an unconventional approach to his emergent stroke management, but he made a full recovery and you can't argue with results. I sometimes compare myself to him. My skill set is not nearly as broad. I get other people to do EMGs and blood draws that I order. I work about 10 hours a week less and probably make half as much money as he does. I have profound respect and admiration for physicians who can function as a one man army, but I acknowledge that I need help every day for virtually everything, and I'm very lucky that it is there most of the time.