Attending: So! Dr Action Potential, what AED would you like to initiate?
Attending: Correct. And why?
Me: Because… because the answer is always Keppra.
Attending: So we all agree that the patient’s seizures are not well-controlled on Keppra. Dr Action Potential, what is at the top of your differential diagnosis?
Me: … not enough Keppra.
Attending: Interesting! So what would be your recommended course of action?
Me: … give more Keppra.
Attending: Aha! You see, in THIS patient, we find ourselves confronting a new clinical conundrum, do we not? End-stage renal failure! Dr Action Potential, why is that a problem for our team?
Me: When the patient is in renal failure, one generally tries to avoid renally-excreted AEDs.
Attending: Correct. Clinical neurology is variable and exciting. Dr Action Potential, dare I ask, what antiepileptic would you recommend for this renal-failure patient?
Me: …the type of… Keppra… which is… renally-dosed.
Med Students: …
Attending: Correct. You know, if you didn’t tell me you spent the last 2 years in Pediatrics, I never would have guessed it. You’ve got this adult neurology thing in the bag.
Me: … Thank you, sir.
Attending: It’s quite remarkable.
Me: … I try, sir.