Six years ago, David Lerner, MD, was just a few months shy of completing his neurology residency at Duke. Now, a clinician educator at the Lahey Hospital and Tufts University School of Medicine, he’ll soon be attending the graduation of a new class of residents he’s worked with since their intern year. In his “Alumni Spotlight” interview, Lerner talks to us about his loves of the whirlwind rush of working on Lahey’s Neuro ICU and medical education. He also shares some of his own experiences as a resident at Duke and offers advice for medical students or residents interested in neurology.
What are your current work responsibilities? What does a typical workday look like for you?
I am currently the Associate Director of the Neurocritical Division at Lahey Hospital, Assistant Professor of Neurology at Tufts University School of Medicine, and Associate Director Neurology Residency Program. Despite that long-winded introduction, I get to practice clinical neurology and neurocritical care in a tertiary referral hospital surrounded by trainees mainly in neurology, neurosurgery, internal medicine, and anesthesia.
As I learned in my Duke neurology residency, I am a clinician first and foremost. There are two main inpatient services I cover - a closed neuroICU - and an ICU consultation service that co-manages overflow neuroICU patients and medical/cardiac/surgical ICU patients with neurologic issues. Lahey is a Level 1 trauma center and active transplantation center so there are a lot of interesting cases to see. We have just finished building a small telestroke service with the sister hospitals in the medical system and will be soon taking part in telestroke consultation service. In addition to the inpatient service, I dabble in a little outpatient ICU/vascular neurology followup clinics.
Although I really enjoy clinical care, I have long held a passion for medical education. At Tufts, I teach small group sessions in clinical reasoning, neuroanatomy/neurology reasoning, and give course lectures for the neuroscience course. I am honored to work with a great group of neurology trainees from around the world through the Tufts neurology residency. This year's graduating class will be the first class I have worked with from intern year through their chief year. To be a part of these residents' growth from uncertainty about basic medical treatments to managing complex neurologic issues has been humbling and gratifying.
There isn't really a typical day in the ICU or doing ICU consults. My favorite parts of the work week are our interesting case conferences, staffing/teaching residents bedside skills on overnight consults, and supporting the great group of nurse practitioners that staff much of the neuroICU.
How and when did you first get interested in neurology? How did you decide to specialize in neurocritical care?
I have been interested in neuroscience for a long time. My favorite undergraduate class was a neurobiology course, and after that course I was hooked. I did dry and wet lab research during undergrad in neuroscience. After only a few hours in the lab, I realized that basic science research wasn't for me. I wanted a more "social" profession and medicine made sense. Starting medical training, I was still very much interested in neuroscience which led me to consider psychiatry, neurosurgery and neurology. The physician in my mind's eye was always those depicted in Norman Rockwell's paintings. At the bedside, face-to-face with a patient, and laying hands. During clinical rotations, I felt that neurology is one of the last specialties where we still lay hands on our patients. Also, the thought process of neurology has always made sense - anatomic localization followed by etiologic differential diagnosis.
I'm not an adrenaline junkie, but the fast-paced ICU has always called to me. ICU was one of my first weeks of clinical rotations as a 3rd year medical student. I know the residents, fellow, attending, and most importantly the nurses shaped my interest in ICU care. I spent two weeks of elective time as a third year medical student at Duke performing an observership . . . AND LOVED IT! Rounds seemed like an effortless whirlwind of patient care, family updates, procedures, and teaching. Through residency, I continued to have an inpatient and ICU focus and found the ICU to really suit my personality.
What’s one experience (or aspect of the residency program) from your time as a resident that stands out as being especially memorable or useful to you?
One time, a co-resident called Dr. Morgenlander "Joel" very nonchalantly and told him that he could go home for the day and that "he's got this." He thought he was talking to the intern on the service at the time, but Dr. Morgenlander didn't seem to bat an eye. The confidence the attendings had in us as residents resonated with me. They trusted patients under their care in our/my hands. As an attending with house-staff, only now can I fully appreciate the vote of confidence they had in our ability to practice neurology.
What advice or words of wisdom do you have for current residents or medical students interested in neurology?
So many people will look at you funny when you say you want to be a neurologist, and nearly all those people have "neurophobia." Possessing an atlas of neuroanatomy in your mind to localize a lesion and generate a clear, concise explanation for what can seem like odd symptoms is like a magic trick to others. The skills we hone during training help so many - patients, nurses, and other physicians.
With that in mind, days in the hospital or clinic as a trainee are long, but the four years of medical school, four years of residency and potentially year(s) of fellowship fly by. Take every opportunity to learn from the master clinicians at Duke (and beyond) on the nuances of neurology. I wish I could have seen more neurology so nothing would be a first-time experience as an attending.
What do you enjoy most about your work?
The team of residents, advanced practitioners, nurses, physicians, respiratory therapists, dietitians, etc. that I work with on a daily basis. Going through the match, I was told "feel" is a really important part of the match process. This also holds true for fellowship and beyond. Finding a position where you are friends with your co-workers makes an already great profession that much more fulfilling.
What’s the hardest part of your job?
Neurocritical care in particular has a significant amount of sad outcomes. It is nearly a daily basis that I am having a "family meeting" discussing devastating neurologic injury. I get to hear stories from family - he was the flirt at bingo night, she peaked every mountain in the White Mountains, just got to do the final snowmobiling run of the season - but I don't get to meet them.
What passions or hobbies do you have outside of work?
COVID has clearly changed the world. My wife, Liz, and I previously enjoyed traveling and eating out, and of course we can't do that now. Although we have outdoor dining as an option in Boston, the weather is frequently not conducive to that. We have taken up cooking at home and I spend most nights experimenting with NY Times meal recommendations. Our two person Thanksgiving this year was a great success! In the before COVID times, we would frequently travel around the world. Now, we stick to New England. The trips are shorter, but we are still enjoying staying in AirBnBs throughout the area where we can easily hike the mountains, walk on the beaches and generally relax.
In the photo above, Lerner and his wife hike in the New Hampshire White Mountains; below, Lerner takes a pre-COVID adventure at the Museum of Contemporary Art in Boston.
