For many years, we have had a fellowship
program. Under the guidance of the consultant,
the fellow is directly responsible for the care of
patients with acute neurological emergencies. Our
fellows have exposure to all forms of neurologic
emergencies such as traumatic brain injury at
a level 1 trauma center, acute ischemic stroke,
including endovascular treatment, intracerebral
hemorrhage, subarachnoid hemorrhage, coma,
status epilepticus and acute neuromuscular
diseases, among many other challenging complex
disorders. Our fellows learn to manage systemic
consequences of complications from acute
neurologic injury but also receive full training in
general critical care working with other critical
care fellows during their several rotations in
other surgical and medical ICUs. Before starting
their clinical rotations, our fellows participate in
a mandatory “boot camp” to learn all necessary
procedures and the basics of ICU care. The
fellows must also direct end-of-life care
conferences and family communications.
Moreover, they are asked to lead the
consultative neurocritical care service
when not serving as the fellow in the
neuro-ICU or rotating through the other
ICUs. Fellows also staff acute neurology
cases seen by senior residents in the
emergency department throughout
the second year of fellowship and lead
rounds. We have deliberately decided
to open only one position per year
to ensure that our fellows receive the
best possible training and the optimal
degree of mentorship. (Eager and
energetic fellows can expect a good
boost to their CV.)
We enjoy a cordial, collegial
relationship with the nursing staff
and other allied healthcare workers;
all of us are fully congruent to Mayo
model of care. We all tremendously
enjoy our work, treasure our
long friendships, and strive
to provide the best outcome
for patients in the midst
of a major acute event. We
closely support distressed
families whose loved ones
are admitted to the unit and
prepare them for possible
secondary complications and
offer realistic predictions of
the recovery trajectory. When
recovery is unachievable, we
facilitate palliative and pastoral
care. We have all the proven
and tested technology available
to us, but we stay true to our
neurology roots, which drives
our decisions. At Mayo Clinic,
the practice of neurocritical
care is part of our fabric, it is
something that is always there,
and we are proud to do it.
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