The EEG made easy
We - the Blue Team - were not receiving new consults today, and the swirling snow over the weekend had deterred all but the sickest patients from even turning up in hospital. as neurology is not exactly an acute specialty, we had only one admission - a small boy presenting with his first fit: status epilepticus for 27 minutes. but this entry is not about him.

last friday i took my first consult in the ER - a pretty 8 year old girl with a 2 week history of weird spells. these consisted of a brief headache, "a rollercoaster full of pins going down [her] body" and a vision of "scary shapes.... witches, vampires..." her mother had a rather more prosaic version of the events - J. would sit up, grimace, and then her arms would jerk. she would cling to her mother, saying she was frightened. so the question was - were these seizures? and if they were, what was causing them, and should she be treated? a CT scan was normal (good, no brain tumours), but the EEG was strange.

EEGs (to me, at least) are cryptic at the best of times. here is everything i know: even numbers right side of brain, odd numbers left. o=occipital, p=parietal, t=temporal etc. normal background frequency in hertz=age of child in years until age 8. so far so good.... BUT, upward deflections are positive, and downwards negative. then theres alpha, beta, theta and delta waves, the influence of sleep, eye-opening, benzos etc. from there it begins to get very hazy...

today being as quiet as it was, Viraj (one of the neurology Fellows on our team) dug out some old EEGs on his latest patient, and we all had a look at them. it seems that every time i think i understand something about EEGs, we look at a new one, and i can tell nothing. am starting to get worried that neurology is (excuse the bad pun) over my head.

anyway, about J: later on friday the whole team went to see her, and Viraj asked her to draw what she said she was seeing. considering that she only had a lead pencil an some lined paper, it was a superlative effort. "these shapes," she said, as she sketched," are all different colours, and they spin around and confuse me." The background was next, and as she scribbled, she said, "this is different colours too, different than the shapes." in the middle, she drew a face with a tall pointed hat, then coloured it in furiously. "this," she said, "is black. it's a witch." she handed it to me with a flourish. for a moment, i felt like oliver sacks.

(...to be continued)

so much to do, so little time
it feels like it should be friday. i've had more things happen to me in the last few days than i have some months.

it was one of those daytime flights where you can't keep the sunlight out, and they're constantly bringing you lunch - for eight hours. I appear to have befriended the lady who was seated beside me, a french octagenarian with an interest in healthcare systems, who speaks five languages, and lives in winnipeg. we exchanged email addresses. she hasn't written yet, though. hope she's not a spammer(!)

sick kids in toronto is huge. here's the comparison: sick kids in edinburgh has 7 wards, but sick kids in toronto has 7 floors of wards. nevertheless, it must be said that the bigger hospital is much easier to navigate, because like the streets here, it is arranged in a grid-like manner. toronto somehow manages to be cosmopolitan without the usual scariness and grime. anyone from anywhere in the world would blend right in here. well, as long as they didn't smoke. i guess it could be the sub-zero temperature, but i haven't caught even a whiff of smoke since i landed here. in edinburgh the entrances of hospitals are always graced with fag-wielding amputees. am feeling a little under pressure as i seem to be expected to know lots of things that i have never even heard of (e.g. the natural history of Landau-Kleffner syndrome), to be confident writing in patients' notes (or 'charts' as they are called here) and to have my own tendon hammer. (bought one at the Uof T bookstore for $6.50 today) Back in edinburgh, the entire neurology department appears to share a single, elusive tendon hammer. and you're lucky if they let you within 2 metres of a patient, particularly if they actually have something wrong with them. yesterday i found myself examing a comatose 15-month old with his chest left open (pending a decision about heart transplant), and the parents watching!

went along to Eric's wedding reception last night. was rather overwhelming meeting all the relatives on my second night in toronto. oh, and not to mention a bit of a surprise as i didn't even know he had gotten married. everyone seems to want to meet up with me, but they don't seem to realise that i'm not on holiday. if anything, i am working harder than i do in edinburgh, and am tired out by having to commute. argh i need some energy. oh, forgot to mention that i had a wonderful, simple home-cooked dinner today. with sai-yong choi tong. but without dates and carrots. i guess living in a real home fora change is worth getting up at 6 every day for.

nothing much happened today. or am i just getting jaded? saw a 5 month old with a rash and an 11 year old with periorbital cellulitis. funny that, it's exactly what i thought i had (epidemiology notwithstanding) a few months ago. i was on my opthalmology attachment, when i developed a swollen-shut eye overnight. it was sunday, and i must have walked several miles to get to the out-of-hours GP, only to be told it was a stye. The doctor was right, of course. It was a classical case of medical student syndrome. argh have got writers block. two essays and i cant even string an inspired sentence together. better stop now.