Operator: "Please hold for the stroke neurologist." Me: "I am the stroke neurologist." Four of these. If you know, you know. SEND this to the person who will get every one. Operator: "Please hold for the stroke neurologist." Me: "I am the stroke neurologist." Operator: "Please hold." [four minutes of hold music] Operator: "He is not picking up." Me: "I know. I have been on the phone with you." Acute stroke systems are measured in door-to-needle minutes, and the guideline target is sixty, with many centers now running under thirty. Four of those minutes were hold music. I would like those four minutes entered into the registry under the correct heading. Send this to whoever runs your call tree. Student: "The report says benign." Me: "Benign means it will not kill you." Student: "So he is fine." Me: "It also means we do not know what it is." Student: "Which one is it here?" Me: "Yes." Half the benign labels in neurology describe a course, not a cause. Benign paroxysmal positional vertigo. Benign essential tremor. Benign fasciculation syndrome. Every one of them is a promise about the ending and a shrug about the middle. Tag the student who is about to learn this the hard way. Resident: "He wiped his nose right after the seizure." Me: "Which hand?" Resident: "...His right." Me: "Then look at the right temporal lobe first." Resident: "You are localizing off a nose." Me: "I am localizing off a nose." Postictal nose wiping is a real lateralizing sign — the wiping hand usually points to the side the seizure came from. Resident: "There are spikes." Me: "Those are wickets." Resident: "They look exactly like spikes." Me: "They do." Resident: "So how do you know?" Me: "Because a wicket has never taken anybody's driver's license." Wicket waves are a normal EEG variant and the single most common one misread as epileptiform — and the misread is not harmless.