A Change in Personality

seatedmanWe often think of ourselves as our personalities, as personality is often the one thing we feel we can control. We cannot change the color of the skin we are born into, nor can we change the genetic dice that was rolled onto us. However, we can work on cultivating good character and choose how we express ourselves. But meeting John in the neurology clinic made me realize how vulnerable and uncontrollable our personalities can become sometimes.

John was once the manager of a construction company, and was the man to go to get things done. He supervised numerous employees, and had great organizational abilities. At home, he was a family man with good values. However, five years ago, John suffered an aneurysm rupture in his anterior cerebral artery in his brain. It led to bleeding and subsequent damage to the frontal lobe, the part of the brain known to control our ability to judge what’s good and bad, to reason, and to control our impulses. Ever since then, nothing was the same for John nor his family. John didn’t become paralyzed or lose the ability to speak like many stroke patients do. In fact, he was quite active and spoke fluently and quite a lot. John, however, was a different person, and the man his wife and family knew is no longer there.

Ever since the incident, John became very uninhibited as if he no longer cared about what he said anymore or how people perceived him. During our encounter, John was restless, excited, and happy, but he often blurted out very inappropriate comments, sometimes offensive or politically incorrect. Despite being at a medical office for his condition, he often spoke off-topic and joked around a lot. His attention was short, and his memory was spotty. According to his wife, he no longer feels the need to brush his teeth, shower, and do other daily routine activities unless he’s told to do so, and his wife finds herself managing him as if he were a child needing to be told everything that needs to be done. This is quite unexpected from a man who was once managing a large company and raising a family with children. Today, he no longer works, and is being taken care of by his loving wife who never forgot the man who he was.

I’ve seen many patients who had strokes during my rotation in Neurology. Of those who survive, some people may lose their ability to walk, while others may lose their sight. But my encounter with John made me realize that the most heart-breaking for me to see are those who lose their personalities, which makes us who we are.

13 comments to A Change in Personality

  • Demi

    Hi! I love your blog and how you share your experiences as a med student. I am also considering medicine in the Caribbean. Can I contact you with questions regarding to your experiences? Thanks.

    • Benji

      Hi Demi, thanks for visiting my blog. I prefer visitors to leave questions as comments under the posts as this would allow anyone the opportunity to contribute to the answer, and the answers we get may benefit others as well. Feel free to leave comments. 🙂

  • peace

    Priceless. I had similar moments in psychiatry rotation. I saw a couple of patients with personality change ( even psychosis) persisting years after road traffic accident. Some were once leading icon in their community. Heart breaking indeed. Make me active in promoting road safety. I can’t imagine the pain thier family and friend suffer.

  • Shobz

    Firstly, thank you for taking time to write this blog and making it public, this will serve many pre-med students, including me the opportunity to learn and imagine the experiences undertaken by med students like you.

    I had a question regarding your rotations. Could it so happen that a student studying medicine at a school like AUC lands up a residency in the UK instead of the US?

    • Benji

      Hi Shobz,
      AUC is geared towards preparing students for residencies in the US, and possibly Canada as well. Since the UK has a very different system for medical school (med school is 5 years and you do it as an undergrad there), it’s not very likely AUC grads would do residency in the UK. Best of luck.

  • Hey Benji!
    Just love your blog! Can you please tell me how medical education is in the caribbean??
    And also can you help me spread word about this website my friends started to help us med students with mind maps?? it’s http://breezymaps.webs.com/….check it out… please! 😀

  • Fred

    Hi Benji,
    Thank you for posting your blogs. I am writing because I am currently applying to begin AUC in the Spring. When I read that you were in Gainesville at Shands, I was very surprised because that’s where I currently work. I’ve really wanted to sit down and hash out some concerns/questions about moving to the Caribbean, but I haven’t met anyone. I know that this is awkardly informal, but is it at all possible that I could buy you Starbucks on campus and pick your head for 15 minutes maybe? If not, I definitely understand! Thanks for the consideration, and glad you’re enjoying Gainesville 🙂

  • Fred

    And in case you prefer not to meet, some of the questions are have (for the benefit of others who read as well I hope) are:
    1.) What was the most difficult part of med school at AUC?
    2.) Was it difficult or incredibly expensive finding a place to live, and getting around?
    3.) Is it any harder to obtain clinical rotations/residency positions coming from the Caribbean than going to school in the US?
    4.) How were you able to do rotations in the UK, and was it difficult to make happen?

    If you could answer, I would be most grateful. Thank you!

    • Benji

      Hi Fred,
      Thanks for visiting my blog, and cool to hear from someone at Shands! I love your town btw, and think Shands is an excellent place to do rotations. I prefer to answer questions on this site, as like you mentioned, the information may be beneficial to others. I’ll try my best to answer them here!

      1. I think the most difficult part of med school at AUC is the discipline needed to keep up with your studies. It really is a struggle that challenges your limits of patience, focus, desire, and optimism, things you need to survive med school and beyond. Some people are more prepared than others in this mentality when they start med school. There is a lot of material to learn in a short period, and because of this, it’s imperative to keep up with the material everyday.

      2. I lived on campus my first semester and started looking for off-campus housing after my second block exams, and it wasn’t too difficult. There are plenty of options. Generally, things are more expensive in St. Maarten, so your perception of what’s considered “expensive” will change. The accommodations within walking distance of campus can range between $700-1500. When I first started living in St. Maarten, after living in small-town Georgia for $200/month rent, housing was inexplicably expensive tome. But after living in St. Maarten, then Miami, London, and New York for rotations, $700 sounds like a bargain to me now. In terms of getting around, I survived 2 years on the island without ever getting a car, since I lived close to the school, grocery store, and beach, and generally had little need to travel beyond that. And when I did, I’d either rent a car, catch a ride with a friend, or take the public bus. Owning a car is not necessary, but it is certainly more convenient, and I would’ve been happy with that option as well.

      3. If you are flexible as to where you want to go for rotations, then you’ll have no difficulty obtaining clinical rotations, as there is always somewhere among AUC’s affiliated hospitals that have a spot for you. You schedule your rotations through your clinical advisor. You tell them the region or specific hospitals you prefer to rotate at, and they do their best to get you scheduled there. As for getting residency positions after you graduate, that’s a different story. Many of the more prestigious hospital residency programs may not take foreign graduates, or at least prefer to take US graduates over foreign graduates. But there are also many programs that are very IMG-friendly (with some even taking mostly foreign grads) or do pre-matching. Family Medicine residencies are often more IMG-friendly while others like orthopedics are often more competitive. From what I hear, in AUC’s 30+ history, there have only been 8 graduates that have matched into orthopedics. While it may not be Mass General, most graduates coming from the Big 3 Caribbean schools do get some sort of residency spot. It all depends on how well you do in med school, your scores, what specialty you want to do, and how broadly you apply for residency.

      4. AUC is the only one of the Big 3 Caribbean med schools that have affiliated hospitals in the UK where you could do your clinical training. In my experience, this was an excellent opportunity as the attendings in the UK love teaching and they love American students (maybe it’s our accents?), I got to experience working in a different system of healthcare and different culture, and I got to travel and explore Europe during the weekends. Since the UK hospitals are affiliated with the school, you schedule them directly through your clinical advisor at AUC. It’s pretty easy to do.

      Hope this helps! Best of luck in your applications!

  • curious

    Hi Benji! I love and greatly appreciate your blog. I have a further question for you regarding residency: is internal medicine also IMG friendly? And its it IMG friendly in California? Can you describe the characteristics of those mentally prepared for med school? How do they (and you!) maintain their optimism, focus, and desire during school? Have you faced any stigma during your rotations? How do you feel about your chances of getting a residency spot after you graduate? Do you think that receiving a few B’s in med school courses will reduce your chances of getting a residency spot?

    I hope I’m not bombarding you with too many questions, and Thank you! Best of luck to you!

  • Chet

    Hi Benji, thank you for this piece. It is insightful and helps people understand stroke patients like your subject, better. My wife is such a case; she is mirrored in many ways in John’s case. I will share this with the children.

    I just have to put forward that I honestly cannot share your sentiment in the last paragraph: “…the most heart-breaking for me to see are those who lose their personalities, which makes us who we are.” But those are your feelings.

    It takes a constant effort to cope with the changes in my wife’s personality. But the person I married is very much there. I’m not always prepared to hear out-of-turn comments or even inappropriate expressions, but for the most part her antics have been very endearing and most importantly, some personal traits are even enviable.

    In many ways quite difficult to explain here, she exhibits the childlike character we all ought to be aspiring for. Makes life a lot simpler and more pleasant for everybody; puts the value of things around us in the right perspective.

    Again, thank you for your piece.

    • Benji

      Hi Chet,
      Thank you for sharing your wife’s story. It takes a lot of courage, strength, and positivity on both your part and her part to cope with these changes. I wish you the best, and thank you for reading.

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