Beau

I know there is a lot of discourse (tm) around this right now but listen to me

If I were lean down and say “unfortunately the big beach ball for some reason fills you with such an unadulterated rage that is beyond human comprehension that you scream until you pass out, so mama had to remove the beach ball from the premises until you can better regulate your emotions” she would simply stare at me like I had 3 heads full of equal betrayal.

First some context about her seizure disorder and its treatment.

In 2x15 Baran mentions having temporal lobe epilepsy. She mentions having drug-resistant epilepsy (meaning continued seizures despite trials of two appropriate anti-seizure medications at appropriate doses). And she mentions that twelve years ago she had laser ablation and that her seizure focus was in her left temporal lobe.

First a mention of her having had viral meningitis at five and that her illness was severe and prolonged. This means that she likely had a fairly traumatic experience at that age involving an LP and an ICU admission. ICU means being sedated and restrained for safety very frequently. Studies show that about twenty percent of people who survive ICU admissions have PTSD following that event.

As far as what her seizures are like, we know she has focal seizures, meaning originating in one part of the brain. We see her have two focal seizures with impaired awareness which is exactly what it sounds like, a seizure beginning in one part of the brain causing the person to be unaware of their surroundings. Typically these last 30 seconds to two minutes. What they look like depends on the part of the brain they occur in and what we see from her is common for a temporal lobe seizure - behavioral arrest for about 30 seconds without awareness and maybe with some eye blinking.

Context from an interview with Moafi was that the scene before Baran calls her neurologist she had a focal aware seizure or aura. This is a seizure where someone retains awareness. For temporal lobe epilepsy this aura (which often proceeds having a focal unaware seizure) often takes the form of a feeling of deja vu, a rising feeling in the stomach, olfactory or gustatory hallucinations, though these are many other manifestations.

The third type of focal seizure is a focal seizure that then generalizes to bilateral tonic-clonic (tonic-clonic seizures being the type you commonly see depicted in media with stiffening of the body then rhythmic shaking and a prolonged period of confusion after). This is not something we see but is something that it would be reasonable to imagine might have occurred at some point in her history when her epilepsy was less well controlled.

A note on drug-resistant epilepsy. For people who have failed two anti-seizure medications the chance of having seizure freedom with a medication change is only about five percent. So it’s very telling that Baran spent decades trialing and failing many medications. That’s a long and frustrating process. And most of these medications have a lot of side effects. People often change medicines due to side effects and often people are accepting the least bad option when it comes to side effects rather than choosing a medication with no side effects.

She mentions her current medication is levetiracetam. This is a medication she might have been changed to prior to getting pregnant as it’s one of the two preferred medications in pregnancy due to its safety for the fetus. It has a lot of potential side effects including a high risk of psychiatric side effects and is not used in patients with concomitant mental health conditions. Commonly this medication can cause dizziness, fatigue, and cognitive impairment (common with most anti-seizure medications and surely something a physician would weigh strongly / worry about when changing medications). Other common side effects with this medication are nausea and loss of appetite.

For people with drug-resistant epilepsy who have a focal lesion amenable to surgery about half of people who have surgery will be seizure free after a year (though some people have later recurrence of seizures, which is what I think we’re meant to assume happened to Baran after ablation). It sounds like she has a seizure focus close to an area of the brain related to speech which made surgery a risky choice. We can think about how for this woman whose career is very dependent on cognitive ability this would be a difficult choice.

What this means is from age five to 28, Baran was having somewhat regular seizures. She says before ablation it was every few months. Likely given the repeated med changes it was much worse when she was younger and the best they got to with meds was reasonably well controlled with seizures every few months. And while that’s infrequent there are still serious limitations to how she would be able to live her life. Think of the safety of things like driving, swimming, running on a treadmill, cooking, if you might have a lapse in consciousness for two minutes. And think of the dangers of having a very young child.

Surgery became fairly standard about twenty years ago. Ablation, the procedure she did have, which is accomplished with a less invasive type of procedure, only about ten years ago. So it sounds like she probably would have had a surgical evaluation as a teen and her parents then Baran herself decided this was too risky. She ultimately decided on an ablation 12 years ago which would have been around the end of med school/ beginning of residency. Interesting to think about this too as a choice that really impacted her career and her choice to pursue an emergency medicine residency.

Thinking about her career timeline:

If she went straight through school without time off:

Graduates college at 22, med school at 26, and residency at 29 or 30 (depending on if she did a three or four year program). This would mean she chose a speciality she couldn’t practice in fully as she was still having active seizures at 26.

Alternately we can shift things to her taking time off between college and med school, graduating at 29, which would have allowed her to have seen that the ablation made her seizure free and then chose emergency medicine as her speciality. This makes more sense to me. Ablation was still a choice with risks but she pursued it possibly in part to allow her to follow a career path in medicine that was important to her.

If she did a three year residency that means she finished at 32 in 2018. MSF typically wants two years of work experience, so she worked somewhere domestically for two years. We know she was in Afghanistan in 2020, so perhaps abroad 2020-2022. She returns to the US at 36, works at the VA for four years, then taken the job at the Pitt.

We know she had a seizure a year ago. We don’t know if she had others between then and the ablation in 2014. And we can probably assume she had a child after returning to the US so her kid would be two or three. That means she’s probably fairly recently divorced.