For stroke fellow Matthew Ehrlich, MD, MPH, every new patient presents an opportunity to analyze important details and think outside of the box. In this week’s “Fellow Spotlight” interview Ehrlich talks to us about how stroke neurology combines his favorite aspects of radiology and internal medicine, his future at Durham Regional Hospital, and his passion for amateur car racing.
What are your responsibilities as a vascular neurology fellow? What does a typical day for you look like?
During my fellowship year I spend much of my time on the Stroke Service, but also rotate through the neuro-ICU, rehab at DRI, interventional neuroradiology, and spend some time on research and academic pursuits. On a typical day while on the stroke service, I help run morning rounds, guide diagnostic decisions and formulate treatment plans along with the residents; under the supervision of a stroke attending, of course.
In addition, I try to spend some time educating the residents and medical students on established vascular neurology science, and discussing the intricacies of care for this interesting patient population. Some of this education happens at bedside, and on rounds, but I also try to sit down with the team on some afternoons when I’m not in clinic to teach, or discuss an interesting case from the service. I also respond to all ED and in-house acute stroke codes throughout the day, and assist the on-call resident in navigating the acute stroke evaluation process; though they should get the credit for much of the hard work.
How did you decide to become a neurologist? How did you decide to join our vascular neurology fellowship program?
I majored in neurobiology at Purdue University, so it was not entirely a stretch, though I’ll admit I chose that biology track simply because it ‘sounded the most interesting’ at the time. I loved the physiology of the nervous system. In medical school, I also strongly considered internal medicine and radiology as careers, but ultimately came full circle back to my original love, neurology. I also started to realize at that time that neurology, and specifically stroke neurology, really combined a lot of the aspects of internal medicine and radiology that I enjoyed, along with the very ‘cerebral’ activity (forgive the pun) of localizing a lesion, which I think all neurologists cite as something that drew us to the field.
My decision to come to Duke was, as all major decisions, multifaceted. Aside from the usual location and family considerations, Duke is positioned in the center of the stroke belt. The patient population here is quite varied, pulling from the urban Durham center, and from very rural areas of North Carolina. It was also clear from my interviews here that the mentorship and guidance would be excellent, and I would have the ability to operate independently but with tremendous support. The fellowship has lived up to those first impressions and then some.
What’s been the most valuable part of the fellowship program so far? Can you describe a memory or experience that stands out in particular?
From the clinical standpoint, I think the complexity of the average case here at Duke has been really valuable for my education. There really is a “Duke normal,” and it’s very complex. It forces those of us in training to really think about every detail of a case, and sometimes, really think outside of the box, so to speak.
On the academic/professional side of things, the support and level of collegiality I’ve received from all of the stroke and critical care attendings, and really everyone in the department, has been overwhelming. I’ve been welcomed and treated like a colleague from day one, and that goes a long way to professional development at this stage in the game I think.
Unfortunately, a lot of the more memorable clinical cases are the ones that go unexpectedly or have poor outcomes, but provide a good learning opportunity. The first stroke code I ran at Duke Regional (as fellows we serve as neurohospitalist at DRH a few weeks per year) was one of those cases. I treated the patient, after a lengthy discussion with the patient’s family about risks, with tPA.
Unfortunately, he clinically declined in the ICU at DRH and a repeat CT showed he had had extensive hemorrhage in a surprisingly diffuse pattern throughout his brain. I, and my supervising attending at the time, reviewed that case with just about everyone in the division. They all agreed they would have treated him too, and there was likely some underlying predisposition to hemorrhage that couldn’t have been known at the time. Even the ICU attending at DRH, whom I had just met that evening, encouraged me not to become gun-shy in using a proven therapy. It was a humbling experience, for sure, but also reassuring that even the most experienced stroke physicians agreed with my actions at the time. As one of my residency mentors used to say, “that’s baseball” – you can do everything right, but sometimes that simple ground ball takes a funny bounce and hits you in the nose.
What do you hope to do after completing your fellowship? If you could have any job in the world, what would it be?
I’m thrilled to say that I’ll be staying and joining the neurology faculty here at Duke next year. My clinical time will be in a neurohospitalist role at Duke Regional Hospital where I’ll also be helping grow and refine the stroke program; meanwhile I’ll continue to develop my own research path as well, focusing on stroke systems of care and acute stroke management.
I love what I do, but I think if I could do anything I’d be a pro racecar driver and do some automotive journalism as well. More on that later.
In addition to your MD, you have an MPH from Tulane. What topic did you study for that degree, and how does it influence your current work?
For my MPH I concentrated in epidemiology. The program at Tulane was excellent, and really focused on research study design and methodology, understanding statistics and scientific data reporting. I use this knowledge virtually daily in my life as a physician, where understanding the primary literature, including the ability to identify weaknesses of studies, is absolutely essential. As my academic career moves forward, I will be revisiting this knowledge for my own study designs and research. Also, I got to live in New Orleans for two years, and that city will now always have a special place in my heart.
What’s one new thing you plan on trying in 2017?
I’m a new father – our daughter Adeline just turned 6 months old – so I feel like everything I’m doing this year is new. She’s really starting to show her own personality now, and I’m so excited to watch her grow this year. Every time I see her do something new, I feel like I’m doing it for the first time as well; it’s a lot of fun. There will be many, many firsts this spring and summer!
What passions or hobbies do you have outside of the Department?
Outside of neurology, my passion is cars and auto racing. I’ve participated in amateur level racing events (mostly a form of racing called autocross) for over 12 years, and hope to expand the frequency and types of events starting with this upcoming season. I like working on my own cars, modifying, and maintaining them in my home garage when time allows. I’ve raced Subarus for years, but just before my fellowship I had the opportunity to buy a 2006 Lotus Elise, which I’m still getting prepared for this upcoming season. I’m planning to participate in a few ‘track days’ (or High Performance Drivers Education events) at Virginia International Raceway this year, a beautiful and challenging racetrack that hosts a few professional level events each year, and is less than an hour from my house!