At the age of nine, he wanted to be an astronaut. Instead, he became a neurologist.
Dr. Andrew Kirk
"I think it's the most interesting thing. I can't imagine why anyone would want to do anything else," says Dr. Andrew Kirk of cognitive neurology – his field of specialty for almost three decades.
"Cognitive neurology is about how we think, how we feel, how we interpret the world, how we express ourselves," he explains. "The brain is what you are. It's endlessly fascinating to see someone with aphasia or dementia or hemispatial neglect."
He recalls one patient in particular with left hemispatial neglect, a neuropsychological condition in which people become unable to process and perceive stimuli on the left side of their body after experiencing damage to their brain.
"This was an elderly woman who lived with her sister. She had had a stroke that affected the left side of her body and developed left hemispatial neglect. She pulled me aside one day and said, 'I don't know why my sister would do something so sick, but she's found an arm somewhere and she keeps putting it in my bed.'
"It was her own arm, but she didn't recognize it as her own arm," Dr. Kirk says. "It made more sense to her that her sister was putting an arm in her bed. So, she kept throwing it out but her sister kept putting it back as far as she could tell.
"When people tell you things like that, it can be fascinating," he continues, explaining that in addition to ignoring things on the left side, people with left hemispatial neglect can't even imagine that there is a left side to consider – for them, it simply ceases to exist.
As a medical student, Dr. Kirk says he gravitated towards neurology precisely because it was difficult.
"It's complex," he says admiringly of the human brain.
"We don't really know of anything in the universe more complicated than the mind. We're never going to fully understand the brain – I'm never going to anyway," he says with a good-natured chuckle.
"I don't want to do something where I understand it all," he continues. "It's like when John F. Kennedy said, in 1962, that we should land on the moon – 'We choose to do these things not because they are easy, but because they are hard.' I think all of us have to try and rise to the occasion and do the hard thing, not take the easy route, but do the difficult things that need to be done."
The neurologist and former Division Head of Neurology with Saskatoon Health Region says he's not an ambitious man, but his professional accomplishments say otherwise. Before he began as Division Head 16 years ago, there were only three neurologists in the department. Over the past decade and a half, he's helped to more than quadruple that number, bringing it to 14.
"And we could still use more!" he exclaims, adding that it's been great to have had the opportunity to be a part of the division's evolution.
During his time as Division Head, he also co-founded, with Drs. Margaret Crossley and Debra Morgan, the world's first rural and remote memory clinic at Royal University Hospital in 2004.
"It's a multi-disciplinary, one-stop clinic with telehealth follow up," he says, explaining that the province's telehealth network links patients at a distance to health care in the city using live two-way videoconferencing.
Patients, most often those with atypical or complex cases of suspected dementia who live at least 100km away from Saskatoon or Regina, are referred to the clinic. They come to Saskatoon for one day to meet with an interprofessional team that includes a neurologist (Dr. Kirk), a neuropsychologist, a physiotherapist and a dietician. They also get a CT scan (computerized tomography). The scan allows the team to see a special X-ray image of the patient's brain.
"The goal, by the end of the day, is to give the patient a diagnosis and plan for the management of their dementia," he says. "Then, I see them in follow up over telehealth, so they don't have to travel back to Saskatoon. I'm here in the hospital, and they're in their local healthcare centre, and we can see each other on a TV screen – it's very high quality video and audio. I had my doubts about it when we started – I wondered if our elderly patients with dementia would really understand it – but they do. It works really well.
"It's not only more convenient, it's also saving patients money in terms of travel," he adds.
A study in 2015 estimated that the clinic had saved patients 582,330 kilometres in travel, equivalent to 14 trips around the earth's circumference since it opened. It has also been adapted to local needs in other parts of the world, including Australia and Scotland.
"In Canada, the baby boomers are just starting to get into the dementia age range, so we're going to see huge numbers of people with dementia over the next 20 years or so," says Dr. Kirk. "That's one of the reasons we started the memory clinic and are working with primary care teams in southeastern Saskatchewan to improve their ability to manage dementia. Not everybody can or should be seen in specialty clinics, so family doctors and nurse practitioners are going to have to be on the frontline."
According to a Canadian study, one in 12 people over the age of 65 has some form of dementia (e.g., Alzheimer's disease), and one in three people over the age of 85 has dementia.
"Projections suggest that by the early 2030s, society may be paying more to look after people with dementia than it spends on the entire healthcare system right now," he says. "If you look at the amount of money currently spent worldwide on dementia – if it were the Gross Domestic Product of a country – it would be the 17th largest economy in the world."
Once a month, he also works in a multi-disciplinary clinic for people with Huntington's disease, a hereditary condition that affects physical movements, emotions and cognitive abilities as the brain's nerve cells gradually break down.
Dr. Kirk has received numerous awards for his work in neurology, including the 2012 Queen Elizabeth Diamond Jubilee Medal, which honours significant contributions and achievements by Canadians.
When not meeting with patients in clinics and in hospital – he also spends time in the emergency department and rounding on wards to meet with patients who have had a stroke or are suffering from other neurological conditions – he can be found in the classroom.
"My favourite thing – one of my passions – is teaching," he says enthusiastically. "To see a resident when they're new and don't know much, and then to see them after five years when they know more than I do, is great."
Dr. Kirk says one of the most important lessons he teaches his students are the three questions a neurologist must ask with every single patient: Where in the nervous system is the lesion? What is the lesion? What are you going to do about it?
"If a patient comes in with weak legs, it could be a problem with their muscles, nerve, spinal cord or brain, so that's the first question we need to ask: Where in the nervous system is the lesion?' he explains. "Once you know where the lesion is, you can start to think about what it is, because if it's in the nerves, you don't have to think about multiple sclerosis or a brain tumor. Then, you can start to think about what you're going to do about it. The whole approach to neurology is trying to answer these three questions."
Although these are the big questions to ask, Dr. Kirk says the little things are important too.
"Some days, my goal is to try and make every patient laugh," he says. "I remember many years ago seeing an elderly woman with ALS (Amyotrophic Lateral Sclerosis, also known as Lou Gehrig's Disease), a horrible disease that kills people over the course of a couple of years. I was seeing her in my office in follow up with her husband. We were joking and she was laughing. After we finished, her husband came up to me with tears in his eyes and said, 'Thank you, doctor. That was the first time I've seen her laugh in months.' Then, I had tears in my eyes too."
Another little thing Dr. Kirk always tries to do is to see patients on time.
"When I was a medical student, I read this article in Reader's Digest about people's complaints about the last time they went to the doctor. I thought it would be things like, 'They didn't listen,' or 'Give me a prescription,' but the number one complaint was to have to wait to see a doctor. So, right from the start of my practice, I endeavoured not to make people wait. I would say that 99 per cent of the time I don't make people wait, and when I do it's usually because the patient after them came in early and I saw them first.
"The thing to remember about health care," he continues, "is that we're a service industry. In some ways, it's the same as working in a restaurant or a hotel – you're providing a service for people, so you have to provide it well."
Dr. Kirk says the best advice he's ever received is to 'Just go for it.'
"I think that's good advice – just go for it," he says, "and choose things that are hard. You're not going to make your mark doing something that's easy or that everyone else has done. You have to choose things that are difficult."
The need to be challenged is one of the reasons Dr. Kirk also writes fiction. He has had a number of short stories published in various magazines and journals – most recently, he was the 2017 SCRIPT Award winner for The Last Temptation of Icarus. One of his short stories, 7A and 7B about two people sitting adjacent to each other on a flight and their different perspectives, was also turned into a dramatization and broadcast on CBC radio.
"A great work of fiction is much more important than anything I can do as a neurologist in the grand scheme of things," he says, "because people can immerse themselves in that world you've created and you can reach so many more people."
The themes he writes about most often range from topics related to medicine or travel – he's been to 92 countries and territories, and he hopes to reach his goal of 100 as early as next year.
"I love seeing the world," he says enthusiastically. "It's a passion and always has been. When I was a kid, we didn't have much money and didn't travel much aside from camping on weekends."
His first big vacation was a family road trip to Vancouver from Ontario, where he grew up from the age of six when he moved to Canada from Scotland with his family. He didn't return to Scotland until the age of 18 when his father won $10,000 in a lottery.
Not surprisingly, Dr. Kirk is also an avid reader.
"I read everything under the sun. When I go on a trip somewhere, I have to take several books with me, because I have this dread of being stuck on a plane for four hours with nothing to read. I just finished reading a book by a South Korean author because I'm going to Korea. Often, I'll read novels set in a place that I'm going to get a better feel for the country."
He's also a "huge, world-class" Beatles fan.
"My wife Shannon and I went to Liverpool last year, so I'm thinking of writing a piece about it. I have everything the Beatles ever released except for one promo record for a movie Ringo Star was in that I still haven't been able to find. I've seen Paul McCartney in concert eight times and Ringo twice. They talk about Jerusalem syndrome – people who go to Jerusalem for the first time and go psychotic. My wife and I joked that I'd have Jerusalem syndrome in Liverpool with the Beatles," he says, chuckling at the memory.
He and his wife have been married for six years (together for nine) and have eight children between the two of them, four each.
Dr. Kirk says that of all his accomplishments, his children and grandchild (with a second on the way) are what he's most proud of.
"When you're old and retired, your job is over, but you've still got your kids, and that's your biggest accomplishment in life –trying to make sure they turn out as good people, and I think they have," he says fondly of his children.