Personal history

The practice of neurology is a stressful occupation, at least if you do it right, but the chance to change someone’s life for the better is a reward that is hard to top. Fortunately, the tides of stress ebb long enough for us to think a little about our patients, and our daydreams can be rewarding too. I was privileged to see a patient whose story reminded me of a poetic tale of reward, metamorphosis and literary immortality. A 31-year-old man attended my neurology clinic, accompanied by his wife and his bubbling 3-year-old son. The man had caused a minor traffic accident when he fell asleep at the wheel. An emergency physician diagnosed epilepsy, reported him to the traffic authorities, and advised him not to drive until he had consulted a neurologist. My patient had no trouble falling asleep at night, and did not wake up once asleep. He awoke feeling refreshed, and did not fall asleep while working at his job as a construction foreman. However, he frequently felt drowsy while driving home from work and often found himself falling asleep momentarily. On closer questioning, my patient said that he lived in Modesto, a small agricultural city in the central valley of California, and worked 90 miles away in San Jose. He had moved to Modesto because, as a construction worker, he could not afford to buy a house in the San Francisco Bay area. Many other middle-class Californians face the same problem, resulting in severe traffic congestion on the only major highway between the two cities. The commuter’s day is a long one in many parts …