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Ross Carne

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Apprenticeship to Waiting

Leave a Comment / Finding Balance /

I write this in a gap in the clinic. My patient, Ms. A, a recurrent non-attender, is running late.

The last time she came, Ms. A sat very still while I watched the tremor in her left hand. “Is it Parkinson’s?” she asked, before we had really begun.

Now, I wait for her return, for her test results, for her disease to reveal itself. In neurology it sometimes feels as though I am in apprenticeship to waiting, learning its rhythms from the patients I see.

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Hand Hygiene

Leave a Comment / Longing /

I work in three public hospitals. Each has its own mandatory training process. I completed the hand hygiene modules at two of them and submitted those certifications to the third. I was told that the training is site-specific, that I’d need to also do the training at the third hospital.

At first, I felt frustrated. How can hand hygiene be site specific? Is my flu vaccination site specific?

Then I realized my feelings ran deeper than frustration. They spoke of longing.

I came to this work to help people.

My hope is to be supported by a system that enables care rather than obstructs it.

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The Extra Mile

2 Comments / How Can I Help? /

The test referral reads: “Hand weakness. Carpal tunnel syndrome?”

With the patient, I proceed through the history, the examination, the testing.

It soon becomes clear their condition is much worse than carpal tunnel syndrome. Instead, it is a motor neuron disease, a group of rare, progressive, neurodegenerative disorders.

The diagnosis will be unexpected. Devastating.

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When I Dream, Do I Misbehave?

1 Comment / Awaiting a Diagnosis /

Normally, rapid eye movement (REM) sleep is associated with dreams and physiologic muscle atonia—aka paralysis. But in patients with REM sleep behaviour disorder (RBD), the normal suppression of motor activity is lost, leading people to move in response to their dreams; this so-called “dream enactment behaviour” can often be violent.

The vast majority of patients with RBD eventually demonstrate signs and symptoms of Parkinson’s disease or a related disorder, often after a prolonged interval. In one study, the risk rose by about 6% each year, with three-quarters of participants converting within 12 years. Even in cases that appear not to follow that progression, imaging and autopsy studies often demonstrate changes otherwise associated with Parkinsonism.

There is no known treatment to prevent the onset or progression of Parkinson’s.

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What Don’t I Know that I Know?

Leave a Comment / Bravery /

She arrives in a flurry of fabric and frills, whisking her mask away as she gazes out the window. “Oh, I’m not wearing this. I can’t breathe.”

My registrar and I share a brief glance through our goggles, over our N95s. She huffs onto the bed.

“And what is it that brings you here?”

“Oh, it’s too tedious to go over that again. What are you doing today?”

“We’ve been asked to do a nerve conduction study of your arms and hands to assess for neuropathy and carpal tunnel syndrome.”

“Actually, I have symptoms all over.”

What Don’t I Know that I Know? Read More »

The Guest House

Leave a Comment / The Exam Room /

Rumi had it right in his poem that begins “This being human is a guest house / Every morning a new arrival.” I hope that my medical practice is a guest house and I its welcoming host, offering all that’s at my disposal to fulfill the needs of my guests: the distant, noble intention of a younger self; the years of study; the slow distilling of long hours of experience; hopeful trials, shamefaced errors; the battering by the inexorability of death.

“And how can I help you today?” I ask this morning’s first “guest.”

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