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The last 3 months have been a flurry of 4am awakenings, drilling holes in skulls, taking care of Neurosurgical ICU patients and tasting what life as a Neurosurgery resident will look like. I spent a month each at Michigan, UCLA and Cedars Sinai doing a series of sub-internships. The intensity of the schedule and sleep deprivation often raised the question of who needed the physical exam more, me or the patient!? In all the haze of activity, it was sometimes tricky to extract the take home lessons or principles, but from these three months, I feel that answers have emerged to two questions I have wondered about:

How will I handle patients with devastating neurosurgical injuries such as severe spinal cord injury?

I had two patients in this exact situation. Here is what I observed; My strongest relationships were with these two patients. Why would that be? I realized that if any patient needed a sense of hope, of fighting to move forward, it was these guys. Each morning, there was a critical moment. I would ask the patients to move a limb that they had been unable to move. One patient made gradual improvement. The other made none. In the few seconds following failure to even wiggle a toe, the doctor’s or trainee’s words are crucial. If I communicate defeat, that’s where things are left and the patient can’t help but feel failure. Instead, I would praise any improvement and where there was none, I would applaud the effort. I would not walk out of the room without communicating that we would try this again and I was in their corner. It is an irony in life that the very thing we believe will be the most difficult, awkward and emotionally draining can then turn out to be the most rewarding, authentic and affirming experience. This is what my spinal cord injury patients taught me.

How do you get technically better while under the direct gaze of supervisors?

I have written before about the common expectation in theatre and surgery in regard to performance. There is a shared vulnerability. When I try something technical in the Operating Room and the resident or attending is watching me, my technique and my ability are on full display. There is no hiding my work or embellishing it. No Photoshop here, all is live. An instant judgment is then made, probably within thirty seconds. Thirty seconds is what most directors give actors in an audition before making a casting decision. That almost seems unfair; a surgeon and an actor are so much more than one moment. Indeed, this snapshot which I call a “performance biopsy” could, like an actual biopsy, be wildly unrepresentative, a limited gauge of actual ability. Yet that moment becomes the basis for a snap judgment. There is no easy solution. But in both spheres, this reality provokes a deeper commitment to thorough preparation which is ultimately a good thing. Because when you are ready and the moment asks you to reveal it . . . that’s where something beautiful can happen.

Neurosurgery is a great field. I am even more persuaded of that now. There are a variety of pathologies to work on from cranial to spine to peripheral nerves. Successful operations can restore normal vision, strength, sensation, the ability to walk, or relieve the most debilitating form of pain. As someone who likes toys, I have also appreciated the Stealth navigation equipment used to target tumors and other innovations. It takes 7 years to train a Neurosurgeon, a recognition of the complexity of the brain and nervous system. Some have wondered if three months of intense Neurosurgery sub-internships has done anything to diminish my drive to pursue this specialty. While I have been humbled by the scope of the specialty, I remain excited to train in this field. It is, in fact, brain surgery . . .

And so last week, I pulled the trigger and submitted my residency applications to Neurosurgery. Now, we will see . . .