a tail of neurologists

(i'm pleased to say bronwyn is somewhat improved today. now...)

surely the collective noun for neurologists is “a tail", because perhaps all you can ever do is to chase them from behind...

one of my jobs, about a third of my week, is doing assessments for neurologists, and one neurologist in particular is the key contract holder. on fridays he is at the regional neurosciences centre, the atkinson morley wing at st george's. i caught up with him mid-morning at the end of his ward round and let him know about bronwyn's admission and her current situation. he planned to contact her physician and look at either consulting on her case, or even perhaps moving her into the neurosciences wing.

today i set myself up in one of our offices in atkinson morley wing, so i could be nearby but still get some actual work done. i'd arranged with the staff on bronwyn's ward to phone me if any doctors turned up to see her, so i could make the three to four minute walk over to participate. late morning the call came. i logged off the computer, put my files in a locked office, and headed straight down.

i caught him coming the other way, just outside the ward—a neurologist i'd met perhaps twice before, but most recently (in passing) on wednesday. he'd seen bronwyn, and gave a rapid run-down of his opinion, supporting the viral meningitis hypothesis. he seemed to feel that the posture-related symptoms were related to the lumbar puncture (though i discussed that they preceded this) or perhaps just that they were not so important. he said we needed to wait for the final results of the tests, but that bronwyn should be able to be discharged home to be looked after. he accelerated away.

obviously the neurologist i correspond with had asked his colleague to see bronwyn. it was good he'd made the trip down to see her—the walk longer than the visit... later conversations with colleagues confirmed this doctor as brilliant, a good diagnostician, and famously brisk.

later bronwyn received a visit from the registrar and a couple of junior doctors on the medical team. still no sign of bug? they announce they will keep her for the weekend, to finish her course of IV antibiotics. they noted she had been seen by the neurologist—bronwyn felt they might have sounded a little peeved that he had visited. “so I won't be having an MRI scan then?” the reply, “well, he's the expert."

i sit in my office, feeling a sense of gnawing disquiet. it is good to have a neurologist's opinion, i tell myself. we clinicians make rapid diagnoses, can assimilate the necessary signs and facts much faster than patients usually think; he simply didn't waste time for extra talking. if he doesn't think an MRI is even necessary, that's excellent—he must be confident of his benign diagnosis. i return to my reports. [gnawing.] i am unconvinced.

it is late in the day. i sit in a consulting room, door closed, engaged sign, working on the computer. a knock. come in? my colleague, and neurologist number one. a story rewinds.

returning from his afternoon off-site clinic, neurologist number one contacts bronwyn's physician. “oh", says the physician (one extrapolates) “she was seen this morning by dr. brisk.” neurologist number two knew nothing of my visit to his colleague, had simply been referred bronwyn by the physician already.

what is supposition, what is fact. inferences of motivations melt in the warm sun of irrefutable contradictory evidence. the medics were not peeved the neurologists were brought in: they called in the marines themselves. no death by friendly fire. no blue-on-blue today. is the MRI cancelled? this itself no longer sure. neurologist number one retreats to Communicate, on our behalf.

i wait his call, content to know that should it be required: the tail will wag the bug.