In the second episode of Brain Talk, Adrian Wills interviews Consultant neurointensivist Eelco Wijdicks.
Eelco Wijdicks is an internationally renowned neurointensivist at the Mayo Clinic in Rochester, Minnesota (USA). He is the author and editor of many books on various topics in acute neurology and neurocritical care, including The Comatose Patient and Brain Death. He also wrote Neurocinema: When Film Meets Neurology, a collection of essays on the representation of major neurologic syndromes and clinical signs in cinema.
Eelco grew up in Leiden, Holland, into what he describes as a ‘GP family’. His father was a GP, and in the Netherlands at that time this meant having a practice and his own pharmacy. Very quickly the young Eelco became familiar with how medicine worked through accompanying his father to house calls, including experiencing the at-home deliveries of triplets.
He earned his MD from Leiden University and completed his residency and PhD at Erasmus University in Rotterdam. This included a year of psychiatry – which he spent in an institution taking care of patients with severe psychosis – and a full year of internal medicine. He then completed his neurology training and moved to University Medical Center Utrecht, as an attending neurologist.
When Eelco moved to Boston everything became possible. He went to the Massachusetts General Hospital for an initial 3 months to look at how intensive care was working there at the time. In the podcast, he describes how many European medics go to the US because the opportunities there are far greater, and neurointensive care did not exist in the UK and Europe back then. It was easier to build a new speciality in the US and he was given the chance to stay longer – for 18 months that became 30 years.
He joined the Department of Neurology at the Mayo Clinic in Minnesota in 1992 and rapidly established a team of neurointensivists. This team is based around two major services – one where his staff see all the consults in the ICU and one that takes care of patients in a combined neurology and neurointensive care unit. These services are covered by staff 24/7 – an intense task, particularly now with the extra burden of covid.
His typical working day consists of a ward round in the morning and afternoon. For the rest of the day and night his team take care of patients; for example, they will attend the ER for acute stroke interventions and these patients may be later admitted to the neurointensive care unit. It’s a tough job to do but full of excitement and quick decisions, and it’s gratifying to help patients who have come in with life-threatening illnesses. Patients can face a multitude of little dangers once they enter the ICU with an acute brain injury and a large part of what the team do is treating these patients to prevent secondary damage. No patient is routine, but he describes how recently a patient with cerebral malaria proved particularly challenging (see Wijdicks and Park, 2018).
Eelco is most proud of establishing neurointensive care services at the Mayo Clinic and building the team there, working very well with other specialists. He has helped establish the field, guiding what it looks like and how to best train neurologists to become neurointensivists.
Eelco is known for his interest in film and how filmmakers depict neurological conditions. His book Neurocinema: When Film Meets Neurology is a collection of essays that summarise the portrayal of major neurologic syndromes in cinema. These films contain a history of medicine; many approach the reality of disease and, equally importantly, can portray the consequences and how families respond to the disorder.
His advice for trainee neurologists?
- Once you have identified your specialty, see as many patients as you can!
- Find a mentor – he was fortunate to have spectacular mentors who helped build his career and guide him through neurointensive care.
- Finally: don’t ever assume that everything has already been described and that everything is known.
Eelco F.M. Wijdicks, MD, PhD, and John G. Park, MD Neurology® 2018;91:978-979. doi:10.1212/WNL.0000000000006557