Friday, December 16, 2011

It's Not Rocket Science...

...but it is brain surgery! Neurosurgery has always seemed to have a certain aura and mystique about it as a specialty. It certainly was glamorous to me when I started out as a medical student. After all, neurosurgeons work in and around the brain, the seat of our very existence. In fact, we work more often on the spine than the brain, but nonetheless, we are "brain surgeons."

I was one of those annoying medical school classmates who started from Day 1 wanting to do neurosurgery, and who continued that path relentlessly, without second thoughts. Having walked the long and difficult road, I will say unequivocally that it is in NO WAY family friendly. It's hard to think of a less family friendly specialty. That's one reason why, even today, only 5% of about 3500 practicing neurosurgeons in the US are women.

There are oodles, scads, of reasons why this is the case.

1. Long and difficult training: Residency is an average of 7 years duration (usually not counting fellowship). Even so, it is hard to learn everything you need to know: patient evaluation, types of pathology, technical skills, reading your own radiographic studies, etc. The days are long and exhausting. I don't know how it is now, since the 80 hour work week, but I suspect it's still very demanding. It's difficult to carve out time and energy for your family. It's also hard to be pregnant during residency, the prime child bearing years.

2. Lots of emergencies: Problems like acute brain hemorrhages and cauda equina syndromes can't wait. In fact, sometimes half an hour makes all the difference. This makes planning your day impossible. As soon as you make plans to go out to the theater with your husband or go to your son's football game, the surgery gods conjure up a subdural. Curse you, surgery gods!

3. Unsympathetic colleagues: This specialty is full of men with stay at home wives who do everything for them. Nothing against SAHM's!! But don't expect your fellow residents or partners to understand taking breaks for breastfeeding. Don't expect them to help you in any way, because they have NO IDEA what your life is like outside work.

4. All or none: There is no such thing as a part time neurosurgeon. Trust me, I've seen it tried.

5. Physically demanding: This specialty demands long hours standing without a break. The sleep deprivation and stress are extremely taxing. Even after residency, there are times when you are so tired that you can't decide whether to eat or sleep first. This is after 24+ hours without a proper meal. Sex? Sleep is better when you haven't slept for 2 days! Add a crying baby to the nights you are home...

6. Culture: In neurosurgery, asking for any help is a sign of weakness. Call me if you need me... but don't call me. This culture is not conducive to supporting things like maternity leave.

7. Help wanted: Out in practice, when most of us are rearing teenagers, it would be great to have lots of partners to share call and PAs to help with the workload. Good luck with that. There is a chronic shortage of neurosurgeons; the ones that exist are difficult to recruit. It took us 4 years to find one to replace a partner who left. PAs are in high demand and would much rather take cushy dermatology jobs than difficult neurosurgical ones. I currently take call every 4th night and consider myself lucky.

8. Social isolation: I didn't expect this to be such a problem. Nonetheless, it has a large effect on our social life as a family. We don't get invited places because friends think I'm too busy. (Or maybe they just secretly don't like me, but this is what they tell me!) At church and school functions, people don't chat with us, they ask me about their aunt's brain tumor treatment. Even neurosurgeons like to talk about the weather and the upcoming football game, y'all!

So having said all that, you may well ask: "Why would anyone ever want to do this awful job?!"

There are oodles of reasons for that, too.

1. It's surgery! How could anyone not love doing surgery? I've said it before... fixing a problem by opening the body and closing it again, and having the patient survive the experience, is nothing short of a miracle to me. It still amazes me after 10 years of practice.

2. Control: As an extreme Type A, I love controlling everything about what I do. I own my practice with my partners, so I am my own boss. What I say in the OR and in the office, goes. My own decisions and actions determine my patients' outcomes, and that's the way I want it.

3. Impact: Every day, I see patients with life-threatening problems. Through my profession, I am able to save lives and keep people out of wheelchairs. Being able to make a real difference in just one person's life makes it all worthwhile. In neurosurgery, that impact on the patient is so often immediate and dramatic. It's high risk, but high reward.

4. Respect: This specialty still commands immense respect, both from patients and colleagues. Not that we deserve more respect than other professions, but there it is.

5. Financial security: It's still a good living, although politics may change that in years to come. Not having to always worry about money is one less strain on a marriage. Further, a neurosurgeon can always provide for herself and her kids should that become necessary.

6. The Challenge: This may be the thing I love most about my job. Every day, every patient, every case brings a new challenge. There are always new things to learn, envelopes to push. I never get bored or complacent, because it's just not possible. Towards the end of residency, I once thought I'd seen it all. Later that day, the nurse at the trauma desk popped her head up to ask, "Hey, are you seeing the guy that got assaulted by the ostrich?!" Never a dull moment!

I love neurosurgery and can't imagine doing anything else. Family friendly? Nooooo. Worth it? Yes! It can be done, although it's not easy. As others here have pointed out, no working mom has an easy time of it. All we can do as MiM's is give it our best and hope that the ones we love understand us and continue to love us back.


  1. You're completely bad-ass, GCS15. Neurosurgery is such an awesome field, but is way way too taxing for someone like me to even contemplate. You deserve every bit of the respect that you receive.

  2. So glad you wrote a piece for this week. I really enjoy your writing. Wishing you and your family a wonderful Christmas. You are a real inspiration to me as a mother of four and also someone who loves the surgical environment. I am still training but like you cannot imagine not being in the operating theatre. Looking forward to your next piece (no pressure :)).

  3. Great piece!

    When I first started reading this blog, one of the other contributors wrote a post about social isolation and the difficulty she had maintaining friendships due to the demands of her job. Based on that post, I have made a concerted effort to make time for friendships with other moms outside of medicine. Their friendship and support has been great.

    thanks for bringing attention again to this point.

  4. Thanks so much for the encouraging piece! I am a first year med student and am also annoyingly set on neurosurgery. I understand that life will always be a challenge, but I am very glad to hear from someone who is making it all work. You keep being amazing, and I will keep working my butt off to get there :)


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