Friday, November 19, 2010

In the Comfort Zone

There are few things I enjoy more than talking about the spine and the brain.

Therefore, it stands to reason that I enjoyed our state neurosurgical society meeting last weekend. I don't like big national meetings, being an introvert at heart. Our state meeting, however, is small; this makes for a more intimate atmosphere and more outspoken dialogue. Colleagues from across the state can exchange ideas, new techniques, and opinions. We also discuss issues of importance to us locally, such as our lack of a motorcycle helmet law (UGH!).

I generally come away from these meetings with a new idea or two to implement in my practice. I fear becoming a "dinosaur," stuck in the rut of old techniques and outdated technology. My patients deserve my best efforts to stay current, as difficult as that sometimes is. Looking back at the last 9 years, I think I've done a pretty good job with keeping up to date, particularly as related to the spine (my professional passion).

This weekend, I sat in that chilly conference room second-guessing myself.

My colleagues are astonishing. One academic cerebrovascular surgeon showed a video depicting the results of the new non-profit organization he founded recently. Neurosurgeons travel to East Africa in groups to train local doctors in basic and emergency neurosurgery. He envisions such a training network all over Africa, bringing ongoing lifesaving care to thousands. They operate on brain tumors without microscopes, power drills, even electric lights. And the outcomes are remarkably good.

Another colleague, a skull base specialist, presented a series of "eyebrow craniotomies" in which he removes tumors through a single eyebrow incision and an endoscope. It's hard to get less invasive than that. Yet another brought me up to date on the neurophysiology of consciousness and the two biological definitions of time, all over dinner.

I had looked forward to seeing the only other woman neurosurgeon in our state, but she wasn't there. She was in another state doing a fellowship in interventional neuroradiology, learning to coil aneurysms. She already has a fellowship in neurotrauma, and she is laying the groundwork for a new residency program at her hospital system.

Driving back across the state, I tried to envision how my colleagues do all these marvelous things. I don't know how they find the time and energy. I admit that I struggle just to keep juggling all the basic balls: raising a kid, running a practice, taking care of a house and husband, the things we all do as routine. I am doing my dead-level best to just stay current in my field. Professionally, I am inspired by all the possibilities out there; I would love, for instance, to learn to do an eyebrow craniotomy. I probably should learn. Practically, I can't imagine taking time for more training or an overseas mission trip, or anything on top of my current load. I understand Bilbo Baggins when he said, "I feel thin, sort of stretched, like butter scraped over too much bread."

So, this week, despite my glimpse of the shining frontier, I feel myself inevitably settling back into my comfort zone. My familiar routines embrace me like a warm, cozy bed. Just as it's hard to get out of bed in the early dark, it's so hard to contemplate changing the patterns of my practice and my life in a dramatic way. I'm actually alarmed at how much harder it is as the years go by. Maybe it's time to push myself out of the zone and see how much more I can do.

On the other hand, perhaps it's wiser to stick with what I do best, as opposed to scraping myself over even more bread. How important do you think it is to keep stepping out of the comfort zone?


  1. I think by default we already step out of the comfort zone all the time in medicine.

    I remember when I was in a choir many years ago, the choir director was an amazing woman who composed gospel music by singing it and trying different tunes and harmonies. She would sing something aloud, make us learn it, and then afterwards decide that it didn't sound right and something else sounded better. I would get so frustrated at having to learn different variations again and again until she was satisfied that it sounded right.

    I think medicine is much the same way. I get in a comfort zone, and do things one way, and then suddenly have to start doing things a different way when new studies come out or recommedations change.

    You can of course step out of the box even further by pursuing new techniques and research. You can invent new ways of doing things. You can come up with studies to investigate new ideas and theories. You can learn cutting edge technology or medicine.

    I'm just content to practice primary care for right now, and leave the inventing to other more ambitious and creative colleagues. Of course I still have to get out of my comfort zone every day in smaller ways, but that's what makes medicine so interesting, isn't it?

  2. I went to two state meetings in the last two months - I have worried so much with all that is going on in my personal life this year that I am letting my professional life slack. I was comforted to learn that I've pretty well kept up (nice side effect of being in a large group where we all go to meetings and bring new things in) and got some nice brushing up in areas. I love going to meetings after being in training 3 years - such a different experience than as a resident.

    One of my partners is going on a mission trip to Haiti in January. Her first. Her kids are both married. I also know a neurosurgeon who goes to Africa and does surgery. His kids are out of the house.

    I think our natural instinct, as humans but especially moms in medicine, is to compare ourselves to everyone else and always come up short. I'm trying to do a little less of that these days. You are enough! Enjoy the business of your full house and career, keep up with important things, and plan that trip to Africa when your son goes off to college (if you want to!).

  3. Your post made me think of this article:

  4. I love this post. First, GCS15, what you are doing is more than enough. And, like Gizabeth wrote, you are only 9 yrs out... you have a whole lifetime to achieve these other dreams and ambitions (if you want to)...

    I think the slate article above is interesting, but I'll be honest, it makes me a little angry. Why can't WE (women) have it all? Why can't we work full time, change the world, and have amazing home lives? To me, being told "just don't work" (or "work less, like the Dutch") isn't an option. I really do love what I do (most of the time) even if it does (like GCS15) often leave me feeling spread too thin.

    The only women I know that "do it all" are ones who are not responsible for a lot of the traditional female tasks --- e.g., they have money to pay for amazing housekeepers/cooks/nannies, or they have a stay-at-home-husband, or they have tons of family at their beck-and-call.

    Many folks say that we should just be patient. They say that women physicians come into their own when they're in their early 50s -- that we ramp up as men are starting to ramp down. But that doesn't feel right either. Why should we be expected to put my dreams/ambitions on hold simply because we're women?

    But on the other hand... boy oh boy, these early years with our kids pass so fast, and I'd rather cut back on my career than miss the precious time with my 2 year old.

    So I guess in the end, my answer is: we are all doing the best we can, and making whatever calculation feels right for us at the moment. I think that that is what is important, not some external calculus/standard of "what counts" or "what's enough".

    The challenge, of course, is defining what is an internal drive versus what is an external pressure. But that's a topic for another comment ;).

  5. First of all I must say gcs15 I am a big fan, think you are terrific and am so glad you have become a regular contributor on this blog.

    I was recently introduced to the concept of "seasons" in life. That over the years we are able to focus on different interests, all in different seasons. There is no need to do it all at once.

    It is great that you have dreams for what you may like to do someday- something to look forward to.

    And just how in the world can you reach the base of the brain from the eyebrow?!!

  6. It's important always to step outside your comfort zone so that you keep growing as a person and a professional. That said, nobody said that only work counted. You sound like you're doing great already professionally. I wouldn't rake myself over the coals about this one.

  7. I like the idea of "seasons of life." I don't much care for the Dutch modus operandi. I would not get along well there at all. I wonder what these women would do if something happened to their supporting spouse? And I do wonder why this phenomenon seems to be isolated to the Dutch? Interesting...

    Thanks, JC! I'm enjoying being part of this community, and I appreciate the welcome.

    Oh,and you have a straight shot to the optic apparatus, sella, and anterior skull base through the eyebrow; just have to lift up the frontal lobes a bit. Can't get much more posterior than the membrane of Liliequist from this approach, though. Fascinating anatomy! :-)

  8. Kellie (General Surgeon)November 26, 2010 at 4:41 PM

    GCS, being a mother and a physician/surgeon is very difficult. Learning something new once you are out of residency is scary because you get to "try" it on real patients that are YOUR patients.

    Just wanted to relate a story. WHen I was in residency I was dictating a lap chole. As I was nodding off, I heard myself say "and the gallbladder was removed via the left eyebrow port". Now that there is ACTUAL surgery done via an eyebrow port, I'm scared!

    Thanks for the giggle.


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