Some of you may fondly remember the mid-80s TV show “St. Elsewhere,” probably the first program to show the gritty underbelly of residency training with any semblance of realism. One of the main characters was Dr. Mark Craig, a tough but fair (are there any others?) cardiac surgeon, played by William Daniels. In one episode, he proclaims “It is the nature of man to need repair!” This could be the motto of the trauma neurosurgeon.
Brain and spine surgery began with trauma since that was all that was visible to the premodern priest/shaman/physician/surgeon. The 4,500-year-old Smith papyrus from Egypt describes typical brain and spine injuries including related paralyses and the poor prognoses for those afflicted (“This is an ailment I will not treat.”) With almost no exception, head trauma was all that we might consider “neurosurgery” until the discovery of neurological localization some 140 years ago.
There is no hospital with a large neurosurgery service where trauma is not an important part of the program. Academic departments need faculty who want to focus on trauma to train residents, rationalize care, establish treatment protocols and do clinical (and maybe basic) research. Why, then, is this not a more popular part of neurosurgery in the U.S. at least?
Specializing in neurotrauma does not mean you are always on call for emergency surgery. You are overseeing a program in which your colleagues take part. But, trauma is perceived as inconvenient, laden with liability, not technically interesting and not a reflection of one’s ability to build a referral practice – i.e., not “sexy.” In fact, these perceptions do not bear scrutiny.
Sharing call makes it no less convenient than other aspects of neurosurgery; good medical practice will keep the lawyers away; there is plenty of technical surgery to do; and trauma provides a relatively quick way to establish a good surgical reputation and thereby build that referral network. Future work by neurotrauma surgeons may extend in unexpected directions, including augmented reality as discussed in the Feature article titled “Impact on Injury: Five Trends to Watch.” If public policy and the prospect of a media voice interest you, consider the unfinished debate over sports and head trauma while perusing “Point: Chronic Traumatic Encephalopathy: A Real Disease, but Not a New One” and “Counterpoint: The Pediatric Health Crisis is Not Concussions.” Who better to guide this discussion for the lay public and the media besides a neurosurgeon?
We have seen and will continue to see vaunted aspects of neurosurgery come and go. If you thought you would earn your keep by clipping aneurysms and resecting vestibular schwannomas, for instance, you might be considering alternate employment by this time. Will minimally invasive techniques have some similar impact on spine surgery? I hope not, but the point is so many parts of our discipline come and go, but even with prevention of all sorts (and may that only improve!), neurotrauma will always be with us. It is the nature of man to need repair – including of his nervous system.
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