COMMENTARY

Why I Chose Neurology

Matthew J. Barrett, MD, MSc

Disclosures

May 11, 2021

Matthew Barrett, MD

Oliver Sacks, at least in part, owed his entire career to migraine headaches.

The famed neurologist and author, who passed away in 2015, attributed his early fascination with the brain to the visual auras he experienced during his periodic headache episodes.

For neurologists, this attribution may have a familiar ring. A long-held convention in the field is that we are more likely to suffer from migraines. And a 2003 study published in Neurology suggests as much.

This could, of course, be due to the fact that suffering from a neurologic disorder simply exposes some people to the field in the first place. But I think it's more nuanced than that.

In my role as a neurologist at Virginia Commonwealth University, in which I regularly interview residency applicants, I have heard many stories that parallel that of Sacks. But equally influential in choosing neurology as a profession — in my clinical experience anyway — seems to be witnessing a friend or family member endure a neurologic disease. A sibling with epilepsy. A parent with stroke. A grandparent with a neurodegenerative disease.

Figure 1. The author's grandparents in Vermillion, South Dakota, circa 1945

When I was 14 years old, my 70-year-old grandmother was diagnosed with Parkinson's disease. Even before seeing a neurologist, she'd suspected the cause of her malady. When she walked, one of her arms failed to swing, a symptom she'd witnessed in her mother, who also suffered from Parkinson's disease many years before.

I'm not sure whether processing my grandmother's experience fated me to become a movement disorders neurologist. But watching a disease slowly siphon the vigor and life from a woman I revered left a deep impression.

As I grew older, I began to appreciate my grandmother's curiosity about the world. After being raised on a rural South Dakota farm — where her playgrounds were corn silos and her life idyllic, or so I imagine — she went on to have a rich and creative life. She bred and sold parakeets out of her home and later became an accomplished photographer. She loved art and music. She even, I learned at her funeral, founded a local Montessori school.

She had an unceasing energy she devoted to everything. I recall her always moving about from room to room…

She had an unceasing energy she devoted to everything. I recall her always moving about from room to room, even in her assisted living facility toward the end of her life. Her mind was intent on seeking out new interests.

As with most individuals with Parkinson's disease in the post-levodopa era, my grandmother did well for years on medication. She maintained her interests and made personalized quilts for all 20 of her grandchildren. And on her 80th birthday she was still full of vigor.

Even after levodopa-induced dyskinesias set in — movement abnormalities commonly associated with the medication — she still sent birthday cards to her family, albeit with the diminished handwriting that comes with Parkinson's disease. Eventually she had to relocate to an assisted living facility, and after age 90, there was a fall, a hip fracture.

Near the end of her life, when she slept for much of the day, there were still glimpses of her vitality. The last time I visited her she was in a hospice facility. It was late spring in Wisconsin. The new building sat in the middle of a freshly mowed field dotted with dandelions. When she was up for it, I wheeled her to the day room, cocooned in blankets. We talked a little and she would doze off. She listened as I played the piano, thanking me, and fell asleep again.

The truism about a Parkinson's disease prognosis is that you don't die from the disease but you die with it. Parkinson's disease won't kill you. But this obscures what every person knows and dreads at the time of their diagnosis: the eventual draining away of independence and the slow loss of self. Diagnosis with Parkinson's disease marks the moment that the hourglass is flipped over and the sand begins to drain. Of course, we all age and sometime during our third decade our brain's hourglass starts losing sand, but Parkinson's disease accelerates this loss. It forces those who have been diagnosed to recognize what has been happening all along and is now hastening.

When I entered medical school, I didn't fully understand what neurology was. During my first year, when I most needed a focus, I picked up an Oliver Sacks book on a friend's coffee table. After reading his tales of unusual deficits and revealed abilities, I knew I wanted to be a neurologist. I would later go on to see many memorable movement disorder patients and work in a neurodegenerative disease lab, both experiences that cemented my decision.

But I can't ignore that my grandmother's Parkinson's disease was there as an undercurrent, pushing and pulling me throughout each stage of medical training. My grandmother died at 92, a couple years after I started my first faculty position. Even now, 7 years later, and having treated hundreds of Parkinson's disease patients, some encounters in the clinic remind me of her.

I welcome these reminders, the pause between clinical tasks, and the thought that by providing care to patients I am honoring my grandmother's memory.

Matthew J. Barrett is associate professor of neurology and a movement disorders specialist at the Parkinson's and Movement Disorders Center at Virginia Commonwealth University in Richmond, Virginia.

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