The Experience
A s my neurology residency in California was coming to an end, I had a sinking feeling that there was a lot more I needed to learn. Over the course of 3 busy years I had managed hundreds of cases ranging from lifethreatening neurological deterioration to diagnostic quandaries lasting several months. Yet after all this I had been exposed to a significant, but incomplete, fraction of the neurological diseases that I had read about in medical school. Once common illnesses such as neurosyphilis, B12 deficiency, and subacute sclerosing panencephalitis (SSPE) were frequently discussed on teaching rounds, but were almost never diagnosed. I knew that this was primarily due to the success of public health and dietary measures implemented over the past 50 years in the United States. Still, these diagnoses are prevalent worldwide and it wasn't clear that I could easily diagnose them on my own.
To remedy this I arranged to spend a month at a University hospital in South India. I planned to join a group of neurology residents at the Nizam's Institute of Medical Sciences (NIMS) in the bustling city of Hyderabad (Fig 1). In doing so I hoped to increase the breadth of my clinical experience. I looked forward to comparing my own residency experience with those of my colleagues in India and gain an appreciation for neurology as it is practiced in a country with a different spectrum of disease.
When I arrived in Hyderabad I was jet-lagged but too excited to sleep. I immediately joined the residents and discovered a familiar style of bedside rounding. Senior residents lead the team through the wards and a neurointensive care unit (NICU) while the attendings aggressively peppered the junior residents with questions. I was comforted to see a well-worn copy of Harrison's Principles