AANS Neurosurgeon | Volume 26, Number 3, 2017

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1950s - Boom Time USA

Everything was booming in the U.S. in the 1950s – the economy, international influence and babies! This stood in stark contrast to the bleakness that shrouded most of Europe as rebuilding after World War II ensued. Neurosurgery in this decade left its infancy and experienced unprecedented growth and evolution. Those born during these years who would later become neurosurgeons would experience a remarkable transition in the subspecialty secondary to a technological revolution that impacted medicine and neurosurgery as well as pop culture. Two baby boomers followed the long and arduous path to neurosurgery and shared with David Houston Harter, MD, FAANS, their insights into that transformative time. Chandranath Sen, MD, FAANS, specializes in brain tumor and skull base surgery at New York University School of Medicine, Langone Medical Center.  John Rageb, MD, chose to focus on the littlest of neurosurgical patients in his career at the Miami Children’s Hospital.

David Houston Harter, MD, FAANS (DH) – What was your path to a career in Neurosurgery?

Chandranath Sen, MD, FAANS (CS) – Two of my relatives suffered from neurologic disorders while I was in middle school. An uncle suffered a postoperative hemorrhage after a bilateral thalamotomy in India for a movement disorder and died three days later. I also witnessed my aunt going blind and insane from hydrocephalus from a large pituitary tumor from which she eventually died, without treatment. It gave me a window into the state of neurosurgery in India in the 60s and inspired me. When I visited them in the hospital, I walked through the wards seeing patients strapped to the beds with dressings on their heads. I became very curious: What is this disease? Later on, I happened to read a condensed version of the biography of Wilder Penfield, and I realized, this is it, this is what I have to do.

John Rageb, MD (JR) – My undergraduate work at Johns Hopkins focused on biology with an emphasis on genetics. While in medical school at the University of Michigan (UM), I rotated on the neurosurgical service and met Joan Venes, MD. She was frighteningly stoic.  During my second year, I attended her presentation on hydrocephalus, which included not only the basic science and treatment options, but also direct illustrations of the impact that she had on patients. The faculty at UM was very impressive; Julian “Buzz” Hoff, MD; Edgar A. Kahn, MD; Richard C. Schneider, MD; and William F. Chandler, MD, FAANS(L), made conferences fascinating. I also had the opportunity to see the pediatric general surgeons including Robert H. Bartlett, MD, a pioneer in ECMO, apply concepts and developmental biology to the treatment of patients. My original plan was for a career in emergency medicine; however, after coming in contact with them, I chose a new path

DH – Where was college and medical school?

CS – College and medical school were in India, MS University in Baroda. Two thirds of my graduating class made it into residency in the U.S., although there were no other neurosurgeons.

DH – …and your neurosurgery training?

CS – I was lucky. I came to the U.S. in 1978 and got into residency. In those days before the Match, it was usually a job offer with a handshake. The chair at the University of Wisconsin in Madison, Wisc., Manucher J. Javid, MD, FAANS(L), liked me and offered me a position; he opened the door for me.

DH – Who were your mentors?

JR – Walker L. Robinson, MD, FAANS(L), was a superb technical neurosurgeon. He had the confidence, skill and courage to approach any neurosurgical problem. His presence and demeanor were extremely comforting to the patients and families; his attitude was “We will make it OK.” R. K. Thompson, MD, although retired from clinical practice, took a great interest in the residents, approaching not only the technical and educational concerns of becoming a neurosurgeon, but also other important life issues such as savings, insurance and family. We called these informal sessions the “Being an Adult” lectures. Daniel Rigamonte MD, took the time to teach me how to write an academic paper and also approach a clinical question in a thoughtful and rigorous fashion.

CS – James C. Tibbetts, MD, FAANS(L), was an excellent clinical neurosurgeon in private practice on the Clinical Faculty of the department in Wisconsin. He had also trained with Dr. Javid. I rotated with him during my fifth year of residency. He allowed me to do a lot in the operating room, and he was impressed. He told me, “You have to do a fellowship with this great man, Peter Jannetta, you must, that’s what you have to do.” After graduation, I completed an 18-month fellowship with Peter Jannetta, MD, at the University of Pittsburg (UPMC) and also learned from Laligam N. Sekhar. MD, FAANS. I stayed on the faculty there and continued to develop my skull base surgery skills and experience, working very closely with Dr. Sekhar.

DH – What is your favorite operation?

JR – Any operation with a good outcome is my favorite. As a pediatric neurosurgeon, I am able to do all sort of cases, from treating a tethered cord due to spinal lipoma, to performing a hemispherectomy. An endoscopic third ventriculostomy takes less than an hour, amazing anatomy is visualized and for the right patient, it may provide decades of relief.

CS – Microvascular decompression for hemifacial spasm.

DH – What do you enjoy most about the practice of neurosurgery?

CS – We treat disorders that can have a huge impact upon patient’s lives and their families. I am privileged to be able to do this. Most days when I go home, I feel I made a positive impact on someone’s life.

DH– How has your practice evolved since you started skull base surgery?

CS – In the early 2000s, I looked at the work coming out of UPMC with Dr. Jho and subsequently Dr. Kassam. It was so impressive, but I wasn’t convinced. At the kind invitation of Dr. Kassam, I visited UPMC a few times and knew that I had to learn this and be proficient. I needed to evolve with this technological shift. In 2004, I had a great partner in Peter Costantino, MD, who is a head and neck surgeon who worked with me, encouraged me and helped me adapt to working with the endoscope. Then of course, I had to go back to the cadaver lab and get my skills. I keep an open mind and use the endonasal endoscopic approach in as many situations I feel appropriate. There is truly a steep learning curve that I had to climb.

DH – Can you describe your current practice?

CS – I am extremely lucky. I work with great colleagues, I have a great practice. I can choose very interesting and demanding cases, usually high-risk and complex. I continue to enjoy the challenge.

DH – Do you have any advice for students interested in neurosurgery?

CS – Do not go into this field to make money. Go into it for the right reasons. If you are interested in helping people and working in a fascinating scientific field, you will have tremendous gratification and will love it. It is very easy to get burned out if you are in it for the wrong reasons.

JR – Chose carefully and pick what you love…and excel at it. Remain aware and open to the humanistic considerations. Our patients have serious conditions, and our interventions can have a huge impact. Neurosurgery training is long and personally demanding. I am reminded of a plaque that was posted near the call room in Maryland Shock Trauma:

                                         “quod non occidas me, fortior me.
                            That which does not kill me, makes me stronger.

DH – Do you have any family members also in medicine?

CS – Yes, my son graduated from medical school at NYU this year. He will start his neurosurgery residency training at the University of Washington in July. I am very happy about it, and I will encourage him to pursue a career in academics.

JR – Yes, however, my father was a Fulbright scholar in the 1950s, attended medical school and was ultimately a professor of Internal Medicine in Cairo, Egypt. We emigrated to the U.S. when I was 18 months old. My father repeated internal medicine residency at the University of Wisconsin. We moved to Michigan after he graduated. I attended public schools in Bloomfield, Mich., and he was in private practice in the area. I followed him as he made rounds at one of the local hospitals, and after a few years, I was able to get a part time job as a runner for $3.25/hr.

DH – Do you have any avocations outside of neurosurgery you wish to share?

JR – I enjoy sailing and road biking. My wife Kathy and I are training for a 200-mile tour between Seattle and Vancouver, with the Cascade Bike club. It is a great reason and inspiration to get out of bed early on the weekends. She continues to get up the hills ahead of me.

CS – Yes! Flying single engine propeller planes.

DH – Any interest in flying jets?

CS – No! Not only are they expensive to keep… To fly those high performance planes, you need to be flying lot more than I do.

DH – Anything else you would like to share?

CS – Neurosurgery is still an amazing field. We are surrounded by extremely bright colleagues and residents, and the field continues to evolve and challenge. It will remain interesting for a long, long time. In an academic setting, it seldom gets boring.

DH – You have done some volunteer work in Haiti?

JR –We are very fortunate in the U.S. I feel a responsibility to share our unique skill set with developing countries. In 2003, I helped to create a program in Haiti to treat hydrocephalus in children under the sponsorship of Project Medishare. An all-volunteer surgical team travels to Haiti every month to perform approximately 20 surgeries for these children. The program’s goal, in association with the Federation for International Education if Neurosurgery (FIENS), has evolved to develop a neurosurgery training program with Haiti’s Minister of Health and the Dean of the National School of Medicine in Port-Au-Prince, Haiti. The efforts have recruited pediatric neurosurgeons as well as other specialists from several U.S. programs.

DH – Have you also been active in organized neurosurgery?

JR – Yes, I currently sit on the American Board of Pediatric Neurological Surgery (ABPNS) Executive Board as treasurer and the American Society of Pediatric Neurosurgeons (ASPN) as secretary. I enjoy the opportunity to contribute to the educational, quality assurance and scientific missions.

Dr. Sen, professor, Department of Neurosurgery; vice chair of Resident Education Department of Neurosurgery; director Benign Brain Tumor and Cranial Nerve Disorders Programs New York University School of Medicine, Langone Medical Center

Dr. Ragheb, professor of neurosurgery, director of the Pediatric Neurosurgery Department, Miami Children’s Hospital; treasurer of the ABPNS and secretary of the ASPN

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