A Fireman Looks at Sharp Waves

Satish C. Rao, M.D.

Mayo Clinic neurology resident Satish Rao says one author who influenced him was Kurt Vonnegut. “He would write the most brief phrase or sentence, and it would jump off the page and speak to the reader.”

Satish C. Rao, M.D., is in his final year of a neurology residency at Mayo Clinic and is subspecializing in electroencephalography (EEG), epilepsy, and sleep medicine—hence the grist for his piece, “A Fireman Looks at Sharp Waves.” A native of Louisville, Kentucky, and a graduate of the medical school there, Rao started writing as a college sophomore. He kept notebooks of stories and observations, and in doing so, discovered the fun of putting words on paper. He penned his winning story after an experience he had as senior resident in the neurologic ICU in 2006.

Why did you write about this patient?
It was really the husband who was compelling. It hit me all at once that he was looking at the EEG as a connection with his wife, the mother of his children, this woman he clearly loved so much. It was simultaneously desperate and beautiful.

What was it about the man that set him apart from other family members you encountered?
He was such a selfless guy. He would bring in breakfast for the nurses who took care of his wife. He was taking care of everyone—the people who were caring for his wife.

You talk about how hypervigilant family members can be a burden. Why wasn’t he?
Sometimes a family member gets completely focused on, say, blood pressure, and they’re pushing the call light for the nurse every time it drops slightly. This equipment is not perfect, and there are normal fluctuations in physiology. This man’s questions were borne out of curiosity: What was her brain producing? I love talking about the EEG, and it was fun being able to explain things about it.

What did he look for in the EEG?
He was an optimistic guy. He was looking for hope.

What happened in the end?
After I left the service, I kept the woman on my patient list and would check on her periodically. Four months later, she was moved to rehab. I went to visit her and saw she wasn’t in her room. I looked down the hall, and she was walking toward me. My jaw dropped. She was walking with help. She was awake and could speak but was very disoriented and confused. Still, she had made huge strides and had started the long road to recovery.

July 2007 | Back to Table of Contents

Writing Contest

Winning Entry-Student/Resident Catergory

A Fireman Looks at Sharp Waves

By Satish C. Rao, M.D.

She was 31 years old, the mother of two boys, and completely unresponsive. She had a one-year history of relapsing-remitting cerebral vasculitis.

The inflammation of the blood vessels in her brain had come and gone twice in the past. With each attack, one side of her body was temporarily rendered weak. But this time was different. The inflammation had returned and was unyielding. She was getting worse each day despite treatments.

When she arrived at the neurosciences intensive care unit with her husband, a fireman, she was awake and speaking, but confused. She had been seen in the clinic initially, and then admitted to the hospital when it was discovered, on her outpatient electroencephalogram (EEG), that she was having frequent subclinical seizures. Her husband, lean and athletic, held her hand and brushed the locks of brunette hair from her face. Over the next 14 days, she became progressively apathetic and quiet until all she could do was lie in bed, staring and silent. She had lost her ability to act on her volition. More likely, she had no volition at all.

Expanding lesions in her brain along with the intractable focal seizures caused her deterioration, the lesions damaging cognitive centers in her cerebral cortex and disconnecting areas of cortex from one another by injuring tracts of white matter. It was as if someone had removed one-quarter of the musicians from an orchestra, then put ear plugs in half of the remaining players. The symphony of consciousness was shut down.

She was placed on continuous EEG monitoring to help guide our aggressive anti-seizure treatments.

Each morning and afternoon, I would stop in to assess the EEG tracings. Usually, her husband would stand next to me and ask questions about what the waveforms meant. I explained a variety of phenomenon from seizure discharges to muscle artifacts.

Every day, we would stand together quietly, arms folded across our chests, and scrutinize the tracing. At first, I placed him in the category of those family members who become focused on some physiologic monitoring—EKG telemetry, pulse oximetry, blood pressure, etc. Their hypervigilance can sometimes create an unnecessary burden on the medical team, but not in this case.

Toward the end of my rotation, it struck me why that was so. He, having lost all conventional means of communicating with his wife, looked at the EEG as the final and sole window into her mind. I, as a neurology resident, also look at the tracings as a window into a person’s mind. We had a similar view; my vantage intellectual, his tragic.