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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My personality

Your view on yourself:
Other people find you very interesting, but you are really hiding your true self. Your friends love you because you are a good listener. They'll probably still love you if you learn to be yourself with them.

The type of girlfriend/boyfriend you are looking for:
You like serious, smart and determined people. You don't judge a book by its cover, so good-looking people aren't necessarily your style. This makes you an attractive person in many people's eyes.

Your readiness to commit to a relationship:
You prefer to get to know a person very well before deciding whether you will commit to the relationship.

The seriousness of your love:
Your have very sensible tactics when approaching the opposite sex. In many ways people find your straightforwardness attractive, so you will find yourself with plenty of dates.

Your views on education
You may not like to study but you have many practical ideas. You listen to your own instincts and tend to follow your heart, so you will probably end up with an unusual job.

The right job for you:
You're a practical person and will choose a secure job with a steady income. Knowing what you like to do is important. Find a regular job doing just that and you'll be set for life.

How do you view success:
You are afraid of failure and scared to have a go at the career you would like to have in case you don't succeed. Don't give up when you haven't yet even started! Be courageous.

What are you most afraid of:
You are concerned about your image and the way others see you. This means that you try very hard to be accepted by other people. It's time for you to believe in who you are, not what you wear.

Who is your true self:

You like privacy very much because you enjoy spending time with your own thoughts. You like to disappear when you cannot find solutions to your own problems, but you would feel better if you learned to share your thoughts with a person you trust.

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Poor surgeons

News are running wild in my hospital regarding a surgeon, when performing an operation for ectopic pregnancy, ruptured the aorta accidentally, resulting in a rather disastrous bleed. I have heard various groups of people talking about this over coffee/lunch. With medical students and the surgeons, we generally want to know what happened, how's the patient and how's the surgeon as when things like this occur, it is as traumatic an experience for the surgeon as it is for the patient. Today, in the middle of our little chat, a theatre manager came in and her gossip agenda couldn't be more different. She wanted to know who the surgeon was, whether he or she's usually good or not and who is to blamed - very inflammatory. There was no concern for the wellbeing of the surgeon at all. This just goes to show how little sympathy lay people have for the medical profession and it is up to us to support each other. In this day and age when suing doctor is the norm, we are especially cautious and spend far too much time documenting things, filling in various forms so we are able to defend ourselves. I know it is people's right to complain or sue when they are unsatisfied, but no doctor is ever intentionally negligent. 

Surgeons work extremely hard. Most of them go out of their way to acquire skills. Take my registrar for example: he turned up in theatre this morning after only an hour rest as he has been on-call all night last night just so he could operate in theatre today. He is not alone. I know of many trainees who come in during their free time or stay behind late just for the opportunity to practise and operate. If you want to be good, you have to make this sort of sacrifice especially in surgery.    

Doctors are conscientious. It is generally against our intuition to do things that we are not confident of. When I am asked to do a difficult cannula, I am usually reluctant.  The easy thing to do would be to hand it over to the senior doctor and say 'You do it, it's too difficult and I don't want to stab the patient too many times'. But in fact that is the wrong thing to do. The right thing to do would be to just go for it, and if I fail to try again, and again until I get it. But by then the patient would have had three needle pricks already. However, thanks to this patient, I am more competent of doing cannula. The same with surgery. Reluctant and unsure as the trainee may be, there is no point just watching the same things over and over again. The best way to learn is to get your hands dirty and actually start doing it. But is this fair to the patient? Maybe not at the moment. But if you want you or your children and grandchildren to be treated by the best doctors and surgeons, then the answer is absolutely yes.

Doctors make mistake. In my fourth year, I watched my consultant calmly deal with a bleed from the uterine artery that the registrar accidentally cut. Of course, he had made all the mistakes while he was training already and was therefore confident to deal with anything. In surgery, surgeons generally prefer everything to be well controlled (or boring in the eyes of the medical student). But, a trainee surgeon generally has to do lots and lots of the same operation to achieve this relatively god-like state, which means that the first couple of patients will inevitably suffer as the surgeon hones his surgical skills. The more junior we are, the more supervision we get. The patient is usually not informed if the a trainee is operating instead of the consultant (but it's always documented in the operating notes). Is this ethical? You tell me. I think it is. No surgeon should become consultant until they have encountered and dealt with mistakes. If we tell the patient it would provoke too much unnecessary anxiety and training opportunities for surgeons will decline even further.   

Back to my point of lay people not being very sympathetic to the surgeons. I am really sad to see an eminent surgeon go down this road. I have been to her clinic once. She is an excellent surgeon and no doubt have saved many lives before. Unfortunately because of this adverse incident she is brought to disrepute. Such a waste of a highly trained surgeon. I don't think she deserves this. I hope this post has shed some light from the surgeon's perspective. I'm not saying that surgeons shouldn't take responsibility for the complications from the operations. Every operation carries risk, (and it is unrealistic for the surgeon to list every single one while consenting), so when you the patients agree to an operation, you should have agreed to accept the risks. Surgeons do every operation very carefully and would never have intended to do any harm. And when things go wrong, they don't deserve to be criticized and condemned as if they are some ignorant and incompetent second rated doctor. Have a heart for the poor surgeons.

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