CEREBROSPINALECTOMYThings every one of us has done and never once admitted. Four of them. The second one is the one nobody says out loud. SEND this to the one person who is all of them. 'Altered from baseline.' Doctor — it's 3am. Nobody on this unit has a baseline. Not the patient, not the intern, not me, not the vending machine that's been beeping since Tuesday. We're all altered now. Massage therapist: "Wow, your neck is so tight." Me: "Left more than right?" Therapist: "...yes?" Me: "Interesting." Therapist: "Please stop." The first question a neurologic examination asks is not how bad, it is which side. Asymmetry localizes; symmetry usually does not. Which is a wonderful instinct in a hospital and an unbearable one on a massage table, where the correct answer to "your neck is tight" is "mm" and not a differential. Friend: "What did you actually do today?" Me: "Localised a lesion to a couple of millimetres of brainstem using a stick and a light." Friend: "Cool. And then?" Me: "Then I typed about it for three hours." Sleep intake: "How many hours do you sleep?" Patient: "Six." Me: "And you feel terrible." Patient: "Yes." Me: "Same. I am writing this at midnight."
EXPLAINED (ACCURACY-CHECKED)
(1) Experiential clinician-life gag; no factual medical claim to verify. (2) Side-to-side asymmetry is the primary organizing question of the neurologic examination — a consistent left-right difference in tone, bulk, reflex or strength carries localizing value in a way that a symmetric finding generally does not. (3) A careful bedside neurologic examination can localise a lesion to a brainstem structure only a few millimetres across — the pattern of cranial nerve findings versus long-tract findings identifies the level — before any imaging is obtained. (4) Chronic insufficient sleep is the most common cause of excessive daytime sleepiness and is diagnosed by sleep history before any testing is considered.
PERMANENT LINK
https://cerebrospinalectomy.com/jokes/altered-from-baseline-doctor-its-3am-nobody-on-this-unit-has-a-2/
https://cerebrospinalectomy.com/jokes/altered-from-baseline-doctor-its-3am-nobody-on-this-unit-has-a-2/
Reprint anywhere, non-commercially, with attribution to cerebrospinalectomy.com. We punch at specialties, the system, and ourselves — never at patients.