11 Things I Wish I Knew Before I Became a Neurosurgeon
1. Neurosurgery is more art than science. When I was in medical school, I understood everything in medicine as evidence-based. You have clinical trials, which you randomize, and you draw scientific conclusions. But in many cases, you're not able to do clinical trials because it's not ethical. For example, you'd never be able to run a clinical trial comparing surgery versus no surgery for removing a brain tumor, because no patient would want to be in the "no surgery" group (and most doctors and research review boards would be uncomfortable "experimenting" on patients this way). So the practice of neurosurgery involves more educated guesswork than most people would expect. Because the stakes are higher in neurosurgery than in some other fields, there is less likely to be a clinical trial establishing superiority of some treatments over others, which can lead to variability in practice. Every surgeon ends up doing what they think is best for the patient, but there isn't always one "right answer."
2. If you're working with brain trauma, be prepared to handle life-or-death decisions every day. I work at the largest level-one trauma center in the Midwest. Level-one centers are hospitals that are equipped to handle the most severe total body emergencies, so as a trauma neurosurgeon, I treat whatever comes in the door, and generally on very short notice. The first question the family asks when someone's had a traumatic incident is, "Are they going to live?" And if they are, the second question is, "Are they going to really live?" Meaning, will they be able to speak and interact and function the way they could before? Will they drive? Will they work? For many families, it's the most harrowing experience they'll ever have; for neurosurgeons, this is just the daily routine. Nearly every patient is a high-stakes case, which can make this work feel incredibly important but also nerve-wracking.
3. Delivering bad news never gets easier. In a microsecond, things can change for the worse, and it makes you realize that life is so precious and so short. Telling people that their loved one won't be the same is very difficult and very draining. Most adult neurosurgery involves things like older people falling or car accidents, and with that kind of stuff, people already expect a poor outcome. So if you can save somebody, they're so grateful. The good outcomes definitely outweigh the bad ones, by about 10 to one.
4. When someone else's brain health is in your hands, you have to take exceptionally good care of yourself. If I'm operating, I make sure to go to bed early the night before, eat a hearty breakfast, and drink tons of water. I'm vigilant about that stuff, because you never want to be in a situation when you're not at your best. The one time I tried to exercise in the morning before a surgery, I had to leave the operating room because I was dehydrated from not drinking enough water after working out, so now I only exercise in the evenings. You absolutely cannot be sloppy about your own health, because doing so could affect your patient's health.
5. A scientific study can be interpreted to say anything you want it to say. Here's a good example: A recently published study said 30 percent of men who played contact sports would develop a form of dementia in adulthood. That conclusion was all over the media, but when you actually read the paper, it turned out that they were asymptomatic from this form of dementia, meaning it's not clear that they had dementia at all. As a scientist and a clinician, I have to read the data from other people's research myself and draw my own conclusion to inform my practice.
6. Neurosurgery is heavily male-dominated, so don't expect to always have mentors who look like you. Finding female mentors in neurosurgery can be tough. Only about 6 percent of all board-certified neurosurgeons in the country are women, and in academia, it's even fewer. Some of the women ahead of me have provided me with great mentorship, but I've also had fantastic male mentors. The best mentors are people who have a vested interest in your success - often, the people who hired you - and if you emulate the behavior of people you admire, you will succeed.
7. Often, you'll have to make a choice between being a surgeon and doing research. I've been very lucky to work in a hospital system that values my work as a researcher, so I'm able to work in a clinical setting three days a week and work on research two days a week. It's a fantastic arrangement, and we just started one of the largest brain studies in the country. That said, it's becoming less common for hospitals to allow their neurosurgeons to work on research, since it's more economical for a hospital to have them operating all the time.
8. Try a bunch of different things before you commit to a specialty. It's very common now to choose a subspecialty of neurosurgery during residency. This could be focusing on something like cerebrovascular surgery, spine surgery, neurotrauma, or pediatric neurosurgery. When I first started out, I planned on doing pediatric neurosurgery, but then I had a kid of my own and realized I was not emotionally capable of doing it. It was too upsetting to see a negative outcome with a child. So now I specialize in trauma, and I'm much happier.
9. There's no "good time" to have a kid. After medical school, you have seven years of residency and then one or two additional years of fellowship before you can even become a neurosurgeon. I had a baby when I was a resident, and it was really hard, even with an extraordinarily supportive family. I was working about 140 hours a week during my pregnancy. When I gave birth, I took 12 weeks off and when I returned, I was senior enough to cut down my hours to a very leisurely 90 hours a week. I missed out on so many things - my son's first steps, his first day of preschool, his classroom presentations. Now, I work about 70 hours a week, but I still miss a lot, which can be very hard as a parent.
10. Surgery is all about teamwork. People tend to think of operating rooms as very austere, isolated places, but you're always working with a team, and everyone plays an important role. I work with neurosurgery residents, a scrub nurse, and an anesthesiologist; as with any team, you're only as strong as your weakest member. No one person can make or break the operation, but if one person makes a mistake, another person needs to catch it. Something as trivial as failing to check a preoperative laboratory value can have fatal consequences. The stronger your team, the easier it is to avoid that situation.
11. Each day at work feels like solving a complicated, beautiful puzzle. I often tell my friends I have the highest job satisfaction of anyone I know. It's challenging work, yes, but when I'm operating, it feels like the whole world melts away because I'm so engrossed in what I'm doing. I don't look at the clock, ever. And when I leave the operating room, I'm hungry and exhausted, but I'm also so satisfied. I think I work a little bit too much - usually 12-hour days, and I tend to go in on the weekends - but that's my own doing. The gratitude you see in people's eyes when you tell them an operation went well and their loved one wakes up from surgery - that's not something you can replicate in the typical 9-to-5 job.
Uzma Samadani, PhD, MD, FACS, FAANS, is an attending neurosurgeon at the Hennepin County Medical Center, where she serves as Rockswold Kaplan endowed chair. She is also an associate professor of neurosurgery at the University of Minnesota and is currently leading the largest single-center traumatic brain injury study in the country.
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