By Kenneth M. Heilman, MD, James E. Rooks Jr. Professor of Neurology, University of Florida Department of Neurology
After Dr. Merino asked me to write an essay about what led me to be an academician, I reflected on what was the most important factor. I concluded it was a passion fueled by an addiction . . . . Let me explain.
When I was a boy, like most people, I was aware of disease, disability-suffering and death—and hated these 3 Ds. Realizing that medical research was the means by which humans can fight these 3 Ds, I decided to do medical research. Even my high school senior yearbook said, "Kenny wants to perform medical research." I decided to go to medical school for idealistic purposes. Idealism, however, does not cause addiction. My addiction started when I rotated onto the neurology service.
One day, while I was walking through the ward, a patient called me. I went over to his bed and asked, "How can I help you?"
He replied, "Why do they only serve vegetables for dinner?"
I looked down at his plate and noticed that he had eaten all the vegetables off the right side of the plate, and hadn't eaten any of the meat on the left side nor did he appear to know it was present. I thought he might have a hemianopia and thus rotated his plate 180°, after which he said, "Thanks, Doc, for getting me that meat." After he finished eating I tested him for a hemianopia by asking him to detect my hand movements in his left visual field. He did not have a hemianopia. I did not know to test him for extinction. When I walked away from his bed I asked myself, how is it that this man can see in both visual fields but not see his food on the left?
The next day the man called for me again: This time he lifted his left arm with his right and asked me why they put someone else in his bed. I tried to convince him that this was his own left arm. He then attempted to throw the arm out of his bed. He also asked me why they were keeping him in the hospital, and I told him he had a stroke. He said, "No! I never had a stroke." I asked him why then was his left arm weak and he replied, "It's not weak." Finally, I asked him why he thought he was in the hospital and he replied, "My wife brought me."
I was in awe, the first symptom of my addiction. Here was a man who could see but not see, could feel me touch his arm but deny the arm belonged to him, and, despite a severe hemiplegia, was unaware of his weakness. I had developed the second symptom of my addiction: curiosity. I asked my attending, Dr. Dreyfuss, why this patient had these symptoms, and he told me this man had spatial neglect, asomatognosia, and anosognosia. "How could his stroke have caused these symptoms?" I asked. He responded that he was an epileptologist and did not know, but advised me to read Denny-Brown's paper about "Amorphosynthesis." Even after I'd read it I couldn't understand the man's symptoms, and decided that I would like to understand the phenomena I had witnessed.
During my post-residency fellowship I started performing research on the neglect syndrome with Dr. Deepak Pandya. I did not realize my growing addiction to performing research, however, until Drs. Watson, Valenstein, and I posited that, whereas a parietal lesion would primarily cause contralesional sensory-attentional neglect, frontal lesions might cause a contralesional action-intentional neglect: a failure to act in the absence of weakness.
To test this hypothesis, monkeys were trained to respond with their left arm if they were touched on the right side and vice versa. After several animals received frontal lesions, we analyzed their behavioral data and found that they had a failure to move the contralesional arm when touched on the ipsilesional side, but no failure to move the ipsilesional arm when touched on the contralateral side, or contralesional intentional neglect.
I said to Bob, "Wow! Seeing these results gives me a great thrill."
Bob said, "A thrill from data? You are weird." Bob's facial expressions, however, revealed he was also "high" from seeing this data. We had just gotten our "fix" and, like substance abuse addicts, our mesolimbic dopamine system was probably activating our nucleus accumbens.
Several years later we applied to the Institutional Review Board (IRB) to receive approval for dementia research. The IRB wanted me to appear before the committee. A lay member refused to accept this IRB because the letter of consent did not state that the participant had Alzheimer's disease.
I attended this IRB meeting and after I explained this research, a committee woman pointed her finger at me and, in an angry voice, said, "Every patient has a right to know their diagnosis."
I replied, in a very gentle voice, "Yes, but many patients do not want to know their diagnosis and they have the right not to be told."
She saw that the other committee members nodded in agreement with me. She again pointed her finger at me and said, "You people! All you are really interested in is being promoted."
I softly replied, "I am a distinguished professor with an endowed chair. I do not need to be promoted. We want to help people."
The IRB approved this project. After leaving this meeting one of my co-investigators said, "I've never seen you be so nice to someone attacking you. How come the Brooklyn didn't come out?"
I replied, "Addicts will do almost anything to make certain they can get their 'fix.'"
Had I elected a career where I sucked out cataracts or performed cosmetic surgery, my family would be much wealthier. I would have also been able to spend more time with my family.
Research addicts, however, have no choice: they need their fix. I have even considered starting "Research Addicts Anonymous," but I have too little time. After more than 40 years I still enjoy the wonderful rewards brought on by means of a research "fix."
Within the past 24 months, Dr. Heilman has served on the editorial boards of several journals, and has given expert testimony regarding malpractice and cognitive dysfunction caused by neurologic disorders. He was the H. Houston Merritt lecturer at the 2009 Annual Meeting in Seattle. Read his current list of disclosures or his publications list.