Spring 2021 (Volume 31, Number 1)
Saving Lives: Easier for Neurologists
Than for Rheumatologists?
By Philip A. Baer, MDCM, FRCPC, FACR
“There is no difference between saving lives and extending lives, because in
both cases we are giving people the chance of more life.”
– Aubrey de Grey, PhD, biomedical gerontologist
“Saving lives” sounds like a trite answer to the classic
medical school admission interview question
“Why do you want to be a doctor?”, along the
lines of the less dramatic phrase “Helping people.” Watchers
of medical dramas on television, such as ER, Chicago
Hope, Remedy, Grey’s Anatomy, Saving Hope, and countless
others could be forgiven for thinking we save three lives
per hour in dramatic fashion. Particularly in the cognitive
specialties, we know that is not the case. Rheumatology is
a specialty devoted to reducing morbidity, improving quality
of life and somewhat extending life expectancy, rather
than dramatically saving those on the verge of imminent
death. We are capable of the latter, dealing with vasculitis,
scleroderma renal crisis, severe lupus, and the like, but the
opportunities arise infrequently for most of us.
Two of my closest to life-saving interventions dealt with
people who were not even my patients, and whose problems
were neurological, not rheumatological. About twenty years
ago, someone I worked with in a non-practice setting told
me they were having headaches of new onset. As well, their
vision was less sharp, but changing their prescription glasses
had not helped. Their GP had requested a computed tomography
(CT) scan of the brain, but the wait was going to be
months and the person was having trouble functioning at
work. Could I expedite matters?
I replied that I was willing to submit a CT requisition at
my hospital, in the hopes that this waitlist would be shorter.
Under “clinical information and reason for testing,” I
mentioned new headaches and impaired vision, followed by
the phrase “rule out brain tumour.” I was totally unprepared
when my office was interrupted a few days later by one of
our hospital’s radiologists to tell me that the scan showed a
six cm mass! Calling the person to deliver the bad news was
one of my toughest moments in practice. With the help of
a neurology colleague married to a neurosurgeon, we arranged
for the patient to be promptly assessed at a tertiary
centre. Fortunately, this turned out to be a benign, fully resectable
tumour, and the long-term results were excellent.
More recently, another person I know through work seemed
a bit off. I enquired and found out they were worried
about their partner. Ten days earlier, this high-functioning
retiree had crashed their vehicle into a parked car on their
street in broad daylight, for no apparent reason. This was
attributed to a brief blackout, and there were no visible
injuries. Thereafter, the person was noted to be bumping
into furniture at home and having some word-finding difficulties.
The GP had been consulted virtually due to the
pandemic, and had ordered blood tests and a magnetic
resonance imaging (MRI) test, which was thought to be
weeks to months away.
Whatever spidey senses I have felt this was an emergency.
I suggested taking this person directly to a tertiary
centre emergency room, at a hospital with full neurosurgery
capabilities. The next day, the news was that they had
been urgently admitted. A CT scan and an MRI showed a
brain tumour. Unfortunately, this one was malignant and
not fully resectable. The prognosis is poor.
So, did I make a difference? Yes. Did I save any lives?
Probably not, though I may have prevented these two patients
from having a seizure before being accurately diagnosed.
I did not actually carry out any treatment on
either one. Maybe this type of problem is easier to act on in
neurology, where I am not an expert, but know just enough
to recognize a high-risk situation when it is described to
me, than in my own specialty.
I think I can safely say that I set in motion the work of
a multidisciplinary team, expedited the start of therapy,
and facilitated the best outcome possible under the circumstances.
Maybe that is the best answer to why someone
would want to be a doctor: “To work with a team of health
care professionals to improve patient outcomes, reduce
morbidity, pain and suffering, all while doing challenging,
interesting and well-paid work.” Forty years after being accepted
into medical school, based more on my grades and
Medical College Admission Test (MCAT) scores than any
brilliant interview answers, I know what I should have said.
Still, participating in saving an occasional life along the way
is personally and professionally very fulfilling, albeit rare.
Philip A. Baer, MDCM, FRCPC, FACR