My sister is doing a degree in music.  I listen, fascinated, to her stories; music school isn’t like med school.  Their days begin around noon, fellow students sport wild hair colours and outfits (tutus anyone?), and the last exam she sat was held upstairs in the local pub.  

Image credit: http://www.keepcalm-o-matic.co.uk/p/study-your-exam-and-have-a-beer–1/

Most people enjoy listening to music; it enriches life, provides comfort, pleasure, intellectual stimulus, and show-cases the capability and creativity of human-kind.  And I wonder, is there something apart from relentless practice that separates the orchestra pit from the audience?   Are our brains wired differently?

I don’t know if I can answer these questions, but I will share with you a fascinating case study.  To paraphrase:

A 35 year old music connoisseur and composer reported a musical hallucinosis, which occurred about an hour after listening to Wagner’s ‘Siegfried’.    This auditory hallucination was a piece of music, familiar yet not quite like any other he had heard before, involving drums and other percussion instruments, interspersed with string instruments.  The music itself was frightening, terrifying, and yet at the same time, fascinating and exciting – music that he wished he could compose.    

Brilliant and yet uncanny.

Sometimes I get auditory hallucinations.  Hallucinations of my pager ringing.  It happens to a lot of doctors (I’ve cautiously asked around).  No one has volunteered hearing an unknown symphony though.

I’m very curious – have you encountered any seriously developed musical hallucinations in your patients?

It’s 1.30am, Friday morning.  I’m struggling to keep awake on the first night shift of the year.  One down (well half of it anyway), six more to go.  I’m a light sleeper at the best of times, however, after a busy med reg night shift, it’s a different story.  I’ve slept through our smoke alarm going off (husband cooking dinner).  I’ve slept through fire engines running outside our house (husband cooking dinner).  Once heavy duty trucks came and dug up the road in front of our house to replace a cracked water pipe (unrelated to husband cooking dinner) – slept through that too.

Some people handle night shifts a bit better.  But on the whole, it’s not a favourite time for doctors, and not a favourite time for patients either.

How do night shifts impact on our neurological function?

How does this in turn impact our patients?

Ogbu et al commented that there was a higher mortality for ischemic stroke patients who were admitted over night, and on weekends, compared within business hours.  This may be to do with resources and staffing as much as the inherent tiredness that accompanies night shift.

In med school we learnt that being over-tired impairs you as much as having a few too many alcoholic drinks.  You’re able to recall information such as doses of antibiotics, but struggle to recognise patterns and diagnose / treat appropriately.

How do we fix sleepiness due to night shift?

According to Dr Douglas, shift work is a major cause of sleepiness.  “Treatment with bright lights has been tried with some success”.  Not so for the slumbering surgical residents right behind me, but an interesting thought that I’d love to hear more about from those of you who have tried this (for patients or yourselves).

From a neurologic point of view, does frequent shift work have a negative impact on our cognitive function?

Do you see certain neurologic illnesses in patients who do shift-work?

What sort of neurologic conditions often are accompanied by sleepiness?

And how do you go about treating this?

There are moments in life for which most of us have shared a history – events that brought us together as a human collective: where were you when Neil Armstrong landed on the moon? Or when Elvis died? Or when you got that first glimpse of Borat’s electric lime mankini?

With few exceptions, everyone would have an answer.

However, can you remember what you did last Tuesday – not so easy, is it? And I suspect this is because last Tuesday was not a shared experience – not part of a collective conscious. It was merely one in a line of déjà vu experiences – a jumble of newspapers and breakfast bowls, traffic snarls, half-finished jobs and conversations.

How did I get here?

But there is a question that has been pondered by almost everyone who has walked this earth and drawn breath – one that interrogates the very root of our consciousness:

What am I doing with my life?

 For some, the question comes early, and in a select minority may precipitate profound change. Einstein, for instance, was driven to his annus mirabilis at the precocious age of 27 years, when he published four articles that solved quantum theory, Brownian motion, the special theory of relativity, and climaxed with E = mc², works that lay the foundation of modern physics and changed views on space, time, and matter. One wonders what was at play in Einstein’s consciousness that made his early angst so productive?

One may imagine that in the present era of technological advance and translational medicine, the job of locating the origins of consciousness could be easily achieved. With combined neuroimaging, electrophysiological, philosophical, mathematical and clinical approaches,   it should be possible to understand the computations that occur between sensory input and motor outputs, and further, to pinpoint the differences between a stimulus that is consciously perceived, or not.And yet, we lack a coherent model.

Perhaps the brain and mind are different.

And perhaps it is here that consciousness exists – in this nebulous space between science and beauty, the real and imagined. Which of course brings us to Proust and his considerations about objects of beauty. Perhaps there can be no better example of true beauty than the brain and mind, moving freely from philosophy, incorporating the senses and considering the clinical realities.

I came across this article the other night, and wanted to share it.  I enjoy art (probably like lots of us), and although I possess no talents in the field (possibly also like a lot of us), I always enjoy the chance to go look at it.  I even did a ‘Diploma of Art’ while at uni, in between medical subjects, which although has not added much to my medical career, definitely added something on a personal front.

‘Engraved hexagons on an Ice Age ivory’1 (click here!) analyses art in a way that never was covered in ‘Visual Culture 101’.  Dr Schott looks at the engraved hexagons on a mammoth tusk from a neurological perspective.   What do you need, brain-wise, to be able to come up with the idea to make a pattern?  What motor skills do you need to carve it?   Did Ice Age man, sitting on a freezing cold moor, copy this pattern from nature?  Was it remembered from a migraneous aura?  Was it created in a groggy hallucinogenic induced trance?  Or was it simply created, ‘de novo’?

This piece of mammoth tusk, carved in such a way, speaks volumes about the person who did it.  One of the most fascinating things, I think, is that it truly is a peak into the workings of a ‘modern’ brain, capable of the thoughts and artistic thinking that we have today.

Neurology – there’s no end to the ways it can be applied!

(and I’ll never look at Ice Age art the same…)

1 – Engraved hexagons on an Ice Age ivory: a neurological perspective on an anthropological debate.  Schott, D G.   

J Neurol Neurosurg Psychiatry doi:10.1136/jnnp-2013-307044