The EAN Student Task Force is pleased to present the winners of this year’s ‘Why Neurology?’ essay competition. The aims of the competition are to understand the incentives of choosing neurology as a subspecialty and to get to know EAN Student members better, whilst also making neurology more visible among undergraduate medical students.
EAN sees great importance in recruiting young and driven future neurologists, who could later become leaders and mentors in neurology, and in better engaging medical students in EAN activities. To capture the ideas expressed by the future neurologists and to provide an exciting opportunity for undergraduate students, the winners will be invited to present their work during the congress.
Please find our five winning essays below. Congratulations to the authors!
- Hadi Abbas, Lebanon, 6th year student
H Areas and Neurology
Three concepts drive me to live: the heartful love to help people, the uniqueness of choice, and the endless passion to know and discover. All the stated motifs are being fed by one another. In neuroanatomy, we learn that each area in our brain has a specific function. Hence, still waiting for the right moment to uncover the exact areas of my brain that control each concept. I like to call the previously stated areas H 1, 2, and 3. The H stands for my name which can’t be included to ensure anonymity (not to be confused with Brodmann areas).
Area H1: It encourages me to be kind and help others. The area that is responsible for helping people, improving their quality of life, and feeling the pleasure of seeing them walking away with a smile played a major role in my decision to join medical school. Throughout my medical years, I noticed that neurologic disorders have a major impact on the quality of life. Treating a patient who has a motor deficit, sensory deficit, or aphasia will be life changing. Imagine the joy of healing a patient suffering from motor dysfunction or who can’t speak. In brief, I felt that this connection with neurology as a future specialty paves the way to have a massive influence on the life of my patients.
Area H2: It controls the feeling of satisfaction of being unique. We always do things and make decisions that aim to make us special whether intentionally or unintentionally. Since joining the medical school I have felt the need to be different, to choose the domain that liberates my inner powers that push me to my “optimal” condition that can exhaust me without making me regret the time I spent discovering it. I found it: neurology. I sensed the complexity and ‘the sacred halo’ surrounding neurology and its connected topics. One thing that intrigued me, is the fact that neuroanatomy was separated from other anatomy courses. This made me think about neurology as being somehow special. Then, I studied neurophysiology and noticed the various connections that need to be memorised and understood. Reaching pathology, where I learned how a small lesion in a pathway manifests with loss of sensation, motor function, and a change in mental status. The agony that many students suffered from studying neurology was a joy to me. Choosing neurology means choosing the domain that makes me stand out. Selecting the path that most people abstain from. Combining my pre-clinical knowledge with clinical experience made me cherish the nervous system and neurology as a specialty.
It taught me that neurology is simply a special specialty. That’s what I aim for.
Area H3: It forces me to investigate mysteries. It is simply what I like to call the sense of discovery, and passion to know. Thomas Edison once said, “The chief function of the body is to carry the brain around”. The brain and nervous system are what define us as human beings. Since the beginning of medical school, I got used to hearing the phrase “the cause is unknown”. Frankly, this phrase accompanies the vast majority of neurology sessions. Some people might get demotivated by that, but not me. The secrets and mysteries challenge me to think and search for solutions and explanations. That’s why I aim to dive more into this specialty, into the domain that as we go deeper in, we learn how far we are from decoding the secrets of our existence. Neil DeGrasse Tyson once said “Exactly how [the brain] operates remains one of the biggest mysteries, and it seems the more we probe its secrets, the more surprises we find”. My motivation stems from here, from the mysterious specialty that needs passion and patience. I’ll wake up every day wondering where to find the exact location of H areas in my brain!
Becoming a neurologist means activating my H areas to the maximum. It means helping people, enjoying my life, and always looking for more.
I chose neurology because it is the goal through which I can achieve all other goals that lead to a more prosperous future for humankind.
- Surobhi Chatterjee, India, 5th year
Why Neurology? – Reflections From My Diary
Being a first-generation physician, one often gets caught up in paddling through the storm of med school. My encounter with neurology, however, has a long history. I have described a few anecdotes that answer ‘why neurology’.
My earliest experience with neurology dates back to a six-year-old me who didn’t even know how to spell it. I saw my grandma with dementia, a strong, courageous immigrant who deteriorated right in front of my eyes. I vividly remember that early summer morning when she woke up with a high fever and ran barefoot in our courtyard, calling out for her little son, all while my father was standing right next to her. That hopeful gaze of my grandma who could no longer remember my dad and my dad’s tears while clutching her tight. That is why neurology.
On our first clinical ward round in the second year of med school, our senior presented the case of a 13-year-old boy who had an ascending progressive lower limb weakness after three episodes of diarrhoea a week ago. I saw the agony of his father and the mother’s silent prayers, all while listening to how he was the classical case of Guillain Barre syndrome. In the next few days, he was brought back to his feet with the concoction of IV Immunoglobulin. That is why neurology.
While tending to my bedbound maternal uncle, who had suffered two strokes after having COVID-19, I have felt the joy of making the correct diagnosis and experienced the wrath of living with one. I have visualised the beauty in learning and treating a patient with Bell’s palsy to the deathly gaze of a manual labourer when informed of his ALS diagnosis. The horrendous cries of a twenty-year-old with bacterial meningitis to the distraught builder with transverse myelitis. The brilliant myriad of learning the tracts and the synaptic connection of millions of neurons. That is why neurology.
The life lessons I had learned from an army veteran with Alzheimer’s during my final-year rotation will still be the turning point in my life. He was my oasis in the dry tropical summer afternoon after a tiring day filled with classes, ward rounds, and exams. With tears in his eyes and gratitude in his last words, in him, I saw the reason for doing what we do, to understand the human behind the patient. To empathise in someone’s final days, days filled with appreciation for life and death, a branch enamoured with a lifetime of clinical and humane learning. He still is the much-needed inspiration when everyone around me discourages me about the economic hardships of practicing neurology. How I would never be able to cure most people or how I would watch them wasting away helplessly. To this day, I remind myself yet again – that is why neurology.
- Molly Abbott, United Kingdom, 5th year student
There have been moments in medical school where I have reflected on why I chose a degree and career path so different to my peers. These feelings have been particularly pertinent during certain clinical attachments where I have seen the challenges that doctors face while often not being remunerated or appreciated for the sacrifices required from them. In these moments I think back to the answer I nervously stuttered out at interviews. My three principles that drove my answer to “why medicine?” continue to dependably resolve any doubts:
- Continual problem-solving.
- To have meaningful interactions with people.
- Encouraged academic curiosity and learning.
To explain why, for me, these goals are satisfied best by neurology, I think back to a week on my placement on the neurology ward.
As I walked onto the ward, two buzzers went off, evidently coming from the adjacent rooms that doctors were shuttling over to. Patient 1’s hand was twitching, then his whole arm jerked, and soon his whole body. Patient 2, he stared intensely at the wall, with a perplexed expression and strange movements of his lips. Patient 2 explained he had felt a “weird rollercoaster feeling” in his stomach and a strange taste in his mouth during the seizure. While both classified as seizures, the clear disparities in each presentation were remarkable. They served as attestations to the pioneers who hypothesised the functions of the different lobes that each seizure arose from. To be able to problem solve the causes of signs and symptoms at an anatomical level is fascinating.
My phone then buzzed with a call from my mum. In floods of tears, she remarked “I’ve lost my driving license darling, it doesn’t make any sense.” It transpired she had been diagnosed with epilepsy. The consultant hurried mum’s questions about how such a diagnosis could arise from solely abnormal EEG activity and persisted to inform her she must not drive and should begin medication. Mum requested a second opinion. For a whole year she was isolated in our remote village, losing her social life, and risking her job due to a lack of public transport. Finally, the second appointment came through and as instantaneous as before, the words of a neurologist changed her life again. “I would not deduce that you have epilepsy. Not all cortical dysfunctions are epileptogenic. You are fit to drive”. This served as a potent reminder of the complexities of neurological diagnoses, but also the requirements of a neurologist when often managing life-changing or life-limiting conditions. Firstly, compassion is key since each diagnosis carries unpredictable burdens on each patient’s life. Secondly, thoroughness and attention to detail. When considering for example the presentations of pseudoseizures and functional neurological weakness, these could be significantly misdiagnosed if extracted from their context and interpreted from symptoms alone. Hence while neurology offers fascinating science, it is unique in its requirement to apply this to the nuances of each patient’s history, examination, and investigations. This encourages meaningful interactions with people, which I hope to emulate as a future neurologist.
Later in the week the team reviewed a patient with Lewy body dementia. The patient pointed at the gap in the curtain with a terrified expression. The doctor explained these hallucinations had been frustratingly treatment resistant. I was curious as to how the brain could generate complex hallucinations that one could perceive as real. I thought of what could be learned from using Neuropixels, electrode probes that simultaneously record several hundred neurons, to record activity during a hallucination. Using rodent models this brain-wide recording could elucidate the excitatory and inhibitory activity at individual neurons within several lobes simultaneously. Hence the mechanism by which neural interactions from several input regions input to the visual cortex to create these phenomena could be investigated. The significant advances combined with the expanse of discovery and therapeutic targets still to be explored encourages me to specialise in this field that fosters academic curiosity, for a lifelong career of learning.
With each example in turn, my aspirations for a career of problem solving, interactions with people and academic challenges, are all met. I want to be a neurologist to encounter the fascinating manifestations of the malfunctions of the nervous system. I want the daily privilege to attempt to treat the patients behind these malfunctions or be a positive impact amongst difficult diagnoses. My reasons for “why medicine?” are fulfilled by my answers to “why neurology?”.
- Faruk Gutic, Bosnia and Herzegovina, 5th year student
February 5th. Neuroanatomy. Day one. 7am. A sickening wave of déjà vu flooded over me as I looked at the doors to the anatomy cabinet. I had an impulse to fight or flee, but I decided to fight, so I opened a door and took a seat in the first row. It was a cold, rainy, dark morning in Sarajevo that day. I was wondering if nature is telling me something that I don’t know, maybe to hide under my bed until it all went away. At that moment our professor came in, put his cup of tea on his desk, and with his deep voice started the lecture with words: “We know approximately about 5% of the function and morphology of our brains. I hope that some of you will solve a mystery that my generation couldn’t”. The light-bulb moment came as I was listening to him. I couldn’t stop thinking about what will happen when we unlock 100% of brain potential. Will that be like Lucy, from the Lucy movie or something else?
When I started to study atrophy and embryonal migration of neurons I was fascinated with this process. So, I asked myself “What will happen one day when we’ll be able to measure, navigate and predict this process?”. After this question, on the next page was the headline “Neuroplasticity”. Wait, we can adjust our brains in early childhood. One more mystery in the row.
After three years I was in the same spot, but now I was on my clinical rotation at the Department of Neurology and Neuropediatrics. First patient and first multiple sclerosis that I saw. It was so unknown to me. I came home and immediately started to question myself. “Do we really know everything about the myelinisation process? Is there something new that we can discover? What will happen if we could prevent multiple sclerosis in the future? What new ways of technology development will solve this mystery that I can’t stop questioning?” After the first patient came another one with another diagnosis. Alzheimer disease. I felt every emotion of this patient and I was thinking a lot about the lives they were living, people they were loving, food they were eating, places they were visiting, and faces they couldn’t recognize now. With every patient and every diagnosis, I had more and more questions on my list that needed to be answered. And then, I realized that only neurology and neurosurgery will allow me to question myself and push academic boundaries beyond the limits.
After two weeks on my clinical rotation, I met one patient that I will never forget. That patient was taking Nusinersen, the drug that is used to treat a rare childhood disease called spinal muscular atrophy (SMA). Everything I knew about this special drug at that moment was the price. But now, I can see the results of this drug in front of my eyes. The result was standing himself and talking to me.
Since this event, I started to study careers of Adrian R. Krainer and Frank Bennett, the inventors, and developers of a drug. I was fascinated with their dose of imagination and innovation for understanding RNA splicing and development of antisense oligonucleotide technology. So, I conclude. These amazing people developed technology and a new academic approach to curing a genetic disorder. Wait. Again. We can cure genetic disorders. Unbelievable. I asked myself, which genetic or neurological disease will be next and who will have the same dose of imagination and innovation? Who will have the same courage, knowledge, and idea to push academic boundaries beyond the limits? Maybe it’s someone who read this, maybe it’s someone who is not born yet, but maybe it’s someone who wrote this.
- Emilijus Žilinskas, Lithuania, 5th year student
As a medical student I am very often being asked: “Have you already decided on the subject you will specialise in after medical school?“ Luckily, today, during my 5th year of studies, I can honestly answer: “Yessss! I want to be a neurologist!“ However, the following question – “Why Neurology?“ – still strikes me a bit. Is it a wide diversity of complex, not sufficiently understood and even a bit mysterious illnesses that distinguish Neurology from other specialties of medicine? Is it the newly arising concept of gut-brain axis and its potential to change the way medicine is being taught? Is it the feeling of near-future progressive and ground-breaking changes in the perception of the nature of dementias, migraine, epilepsy? Despite many favourable characteristics of the field per se, something was still missing. Something deeper has let neurology take its place in my heart (or should I say – in the cerebral cortex of my brain?).
Encouraged by this essay competition, I decided to dive into the origins of my inclination towards neurology. At the end of the day, two features have crystallised in my mind and I am very pleased to share those short stories with all the readers of this text.
Firstly, I would like to thank neurology that it inspired me to study medicine. Quite unusual, right? Let me explain. During my last year of middle school, thoughts about future career were bothering me extremely: what‘s next? Luckily, one day a book called The Man Who Mistook His Wife for a Hat appeared in my hands. Written by a well-known British neurologist Oliver Sacks, it consisted of extraordinary stories about neurological patients and hardly comprehensible manifestations of their illnesses. Despite not understanding most of the medical terms at that time (visual agnosia, aphasia, anterograde amnesia, somatoparaphrenia, hemispatial neglect all sounded as abracadabras), I was fascinated by how we as human beings think or see, or feel, or sense, and that it depends mainly on how does the cerebral cortex work and how do the impulses spread through the highways of the nerves in the body. Those astonishing case studies have awakened my inner love and respect for the complex and sophisticated mechanism – the human nervous system. The idea of being able to comprehend and even intervene to that mechanism as a physician was astonishing. In order to materialise such dreams, no other way than to become a medical student was possible. And here I am – finishing my fifth year of medical studies!
The second story reflects the reason of shifting my mindset from being ‘medical student’ to being ‘future neurologist’. I can strongly state that Audrius V. Plioplys, a neurologist and neuroscientist of Lithuanian descent, is the person I look up to. A. V. Plioplys is famous due to his clinical practice that dealt with children with autism. Moreover, his research focused on potential causes for the development of Alzheimer‘s disease. Besides, he has pioneered vest and inhalation therapies to prevent pneumonia in children with severe cerebral palsy. However, what strikes me even more, is the fact that Plioplys managed to merge two seemingly incompatible practices – medicine and art – throughout his life. I guess, only a minority knows that the front cover of Neurology the most widely read neuroscience journal in the world – is adorned with the works of Plioplys; indeed, his art has become an unofficial logo of the AAN. I was able to appreciate some of his artworks during the annual meeting of neurologists in the summer of 2019 in Lithuania. His artwork, as the author claims himself, is a metaphorical investigation of thinking and consciousness. Indeed, I felt as if I watched something cosmic, yet inherent to all human beings. Those bold, bright canvases that depicted neurons tangled up with each other have enchanted me. At that time I could only agree with the comment made by one of the art critics that Plioplys‘s works “cause a fire in a viewer‘s mind“. I remember thinking: being a neurologist is great – you can see one‘s consciousness and depict it. In other words, that mystery of human entity delineated in form of bouquets of neurons inspired me to become a neurologist.
So… why neurology? Because of the great mystery of the human nervous system that encouraged me to choose medicine; wouldn‘t it be fair to pay tribute and become a neurologist as well? And because neurology is deep enough to reach one‘s consciousness – wouldn‘t it be wonderful to reach it on my own?