Matter, Energy, and Life of Michaela A. Castello.

Never-ending Grind

I keep attempting to wrest my medical trajectory closer to the engineering career I should have pursued all along…

Something is seriously wrong with me: I can’t stop training. Perhaps more accurately, I keep attempting to wrest my medical trajectory closer to the engineering career I should have pursued all along.

Enter epilepsy. On my first day of dedicated EEG training we talked about differential amplifiers, and it was as though some long-forgotten area of my brain woke up, motes of dust flying up into a ray of sunlight. “I love this stuff!” I thought, and proceeded to be absolutely horrible at reading EEGs for the rest of the month. I wanted to get good at them, though, and the idea of doing an epilepsy fellowship began to take root.

It’s an EEG! But not a seizure.

I didn’t want to do a fellowship. By the end of child neuro residency I’ll have been at this for thirteen years, eighteen if you count undergrad and the year I spent working afterward. I wanted to be done, to stop trading more years of my life for levels.

I got more information. If you want to run an epilepsy monitoring unit (EMU), you need to do the fellowship. If you want to work with fancy invasive electrode setups and surgical planning and treatment-resistant seizures, you need to add that “Epileptologist” specialization to the character sheet. In 2021, I spent two months at the beginning of PGY-4 on the EMU trying to convince myself I didn’t like epilepsy. It was about as effective as my cat-proofing strategies: I loved it.

Unfortunately, epilepsy fellowships were somehow competitive enough that positions filled a full eighteen months in advance, in a wild free-for-all of deadlines, dates, interviews, and offers (they’ve since moved to a Match, which trades this for an algorithmic selection process like residency). When the dust settled, I emerged to find I had a position at Stanford University.

Technically, only one year of fellowship is needed to become an Epileptologist, but with my dreams of research in EEG analysis and desire to lead presurgical workups, I am planning on two years. That’ll bring me to a nice twenty years since high school in some form or another of advanced education or training. Plus, with an extra two years of practice, I might finally become as proficient at reading EEGs as an average neurology resident!

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