You are viewing AANS Neurosurgeon Volume 25, Number 4, 2016. View our current issue, Volume 27, Number 3, 2018

AANS Neurosurgeon | Volume 25, Number 4, 2016


July 1

July 1 comes ‘round once again. I examine my practice and revisit my patients’ lives. I am transported back to an earlier July by the image of my former patient with a brain tumor. Unable to come to clinic, I drive to her home. The living area is converted into a hospital room, the atmosphere personal and medicinal. She is lying in a hospital bed near the sofa, paralyzed on her left side. The north light from the window is unkind and illuminates my healed craniotomy mark which her health aide has thoughtfully exposed with an orange hair ornament. I rush to my patient, she hesitates, says she has not bathed and apologizes for the odor. I hug her harder. Finally, she tells me about her funeral that I will not be able to attend. She understands and is not hurt. Soon her eyes shift to the blue sky framed by the window signaling the end of my final follow up. It is early in my career, and I am not yet aware that I will smell the air in this room for the rest of my life. In the moment, it is enough that my visit has eased her descent. 

On another July 1, the C2 quadriplegic patient I cared for through spinal shock, surgery and respiratory setbacks, reappears. We communicated by blinking once for yes, twice for no. After many uncertain months, he is stable enough to speak. His first words are a joke he has been silently rehearsing. We laugh then I retreat, ashamed that he is able to lift me. In the coming Julys, I re-experience the joke’s joy. By mid-career, I admit I will not develop the strength to match the weight of his gesture. 

There will be other memories. A failure will emerge to deflate me. No amount of magical thinking can conjure a cure. The most comforting shoulder is in the clinic or in the OR. They will know without words what to say, because next year, next month, tomorrow it will be them. Knowing these events will resurface encourages me to continue humbly.  

Each July 1, I will be changed. The day will not pass without an accounting. What I have become is because of the humanity that has come to my neurosurgical practice. When my minute lapses, I will bundle the souvenirs including that hug and that joke to ease my own exit. Come you back July 1; bring the offerings. 

For the short neurosurgery video, visit

Go Gentle. Acrylic on canvas.



2019 Mayo Clinic Advancements in Surgical & Medical Management of the Spine
Jan. 13-17, 2019; Kohala Coast, Big Island, Hawaii

Pituitary Education Day
Jan. 16-18, 2019; Orlando, Fla.

Innovations in Endoscopic Minimally Invasive Brain Surgery
Jan. 16-19, 2019; Celebration, Fla.

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