Should I be a neurosurgeon?

The neurosurgery placement for the last four weeks was a perfect career taster, and I found it very palatable indeed.

Before my fifth year, I had swear I would never ever do surgery, mainly because I don't understand how I could enjoy it. But my perception has changed in my fifth year as I am allowed to do more in theatre, sometimes even performing part of the operation itself. Neurosurgery had been especially exciting. I have never enjoyed theatre sessions so much before. It's amazing to be able to see the dura, then the wet, shiny arachnoid mater so beautifully covering the brain. I love the rough part of the surgeries when they split the thick scalp and drill holes; and also the delicate part of dividing the arachnoid and dissecting out structures of the brain to make everything clear. The view under the microscope is exceptional. In spinal surgery I could see very clearly all the different layers of muscles in the back before the disc or spinal cord is reached. Utterly spectacular! I really want to learn all to do all those things even if it takes ages to train.

I was given lots of hands on opportunities in theatre. My registrar wasn't around on my last day, so my consultant said to me: 'You are not a medical student today, you are a surgeon' as I was his only assistant. I have assisted in craniotomy before, but never alone. I thought I would hinder more than help, but at the end I think I did well, knowing what to do at the right time with relatively little prompting. We discussed the operation like proper surgeons and he even accepted my suggestion of putting an extra clip for the aneurysm he was clipping. The operation went well, and there was a sense of pride when my consultant wrote my name under the 'surgeon' heading in the operation notes. My consultant was the nicest teacher who never stops encouraging, which was what I needed most as I was losing focus and initiative post-exam. I regained my enthusiasm and managed to get lots of procedures done during this placement - including my first ever cannula on the foot, removing drain from the brain, intubation, suturing the scalp and lots of catheters. I spent a week at the neuro HDU - a place where many of the neurosurgical patients end up, helping the team to review patients. I diagnosed a case of SIADH and another one of diabetes insipidus there - two conditions that we are expected to know quite well but rarely seen in real life. These complications of neurosurgery conditions (surgery with medical/endocrine interwoven) make me very excited indeed. I also did many days on-call, which was tiring (I was at hospital from 8am to 10pm on some days) but very fulfilling experience as they were literally rehearsals of my first job as a doctor. I enjoyed being helpful to other people. I was rewarded by a ride back home, a free lunch and being taught how to tie knots by two junior doctors for being helpful. I enjoy the variety of work as a neurosurgeon.   

I think I would find this job very rewarding because neurosurgery can change people's life for the better, whether it's evacuation of subdural haematoma or removal of meningioma. I fell in love neurology and the brain ever since the first time we met in our second year in medical school. It wasn't easy, I remember spending ages memorising the foramen on the base of the skull and what pass through them, but I loved it that at the end, when you understand the map and the routes (like formalae in math), you'd be able to solve clinical problems logically without the need of sophisticated tests or scans. 

I still can't believe it but I am seriously thinking about being a neurosurgeon.

Good points:

I love the neurosciences. I can spend all my life with neuro and still wouldn't get bored. I'd like to think that I am intelligent enough to pass all the exams, and if I'm not, I'm prepared to work hard for it. I am not at all put off by the long hours and heavy emergency work load because I like the rush.  

Bad points:

Neurosurgery can make a big difference to people's life, but things can go wrong - more often than other specialties, and when it does, it ruins people's life. Neurosurgeons make difficult life and death decisions everyday. The decision making process (most commonly - to operate or not) is interesting but you have to take risk ultimately and I know I don't like to. 

I don't mind not having a life at the moment but the time will come when my life becomes messy. Neurosurgery isn't necessary conducive to family life, they come in early and leave late almost on a daily basis. My registrar was on-call so often and always stays on in hospital until 10 pm on his normal days I wonder how he manages to maintain the relationship with his wife and children.   

Now that I have withdrawn from the UK foundation programme, I don't know how easy would it be for me to get on a training rotation for neurosurgery in the UK or indeed anywhere in the world. Other countries renown for training in neurosurgery tend to favour applicants from developed countries, at least that's the impression I get. In addition, I am also at a disadvantaged position from the competition point of view as I do not have any intercalated degree, publication or prize. I know I shouldn't give up just yet, but the FY1 whom I worked with at NHDU may be right - final year in medical school is probably too late to only start considering a career in neurosurgery.  

I'm feeling a little miserable now as I can't imagine how achieving this ambition is going to be possible. Any comment/advice? 

P/S Just want to draw your attention to this article that I read. I can relate to this guy very much. I too do not have a work life balance, much as I try to. And I too, wish that I wouldn't have to retire and would be able to carry on doctoring until I expire. I have seen him on TV and I like him. I hope to be like him or my consultant one day. 

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