How can I best help this patient? For many neurosurgeons, this is the question that first brought us to neurosurgery. It is the question that accompanies us through long days, that intrudes on and occasionally haunts our dreams. At times, despite our best efforts, it is “the unanswered question,” echoing as plaintively as the trumpet in Charles Ives’ composition by that name.
For the most part and to an even greater extent than when I entered my neurosurgical residency, neurosurgeons today are able to help seriously ill patients live longer and enjoy a higher quality of life. Together with the increased body of knowledge engendered by continuing basic and clinical research in the neurological sciences, technological developments in large part have driven advances in patient care. Witness the use of deep brain stimulation for Parkinson’s disease, or, currently in trials, the use of artificial discs to treat degenerative disc disease, both therapies that hardly were envisioned 30 years ago.
Even while we appreciate the state-of-the-art tools we now have, there is no question that it is neither impressive technology nor any particular tool that defines the good doctor.
“Life is short, and art long; the crisis fleeting; experience perilous, and decision difficult,” Hippocrates noted around 400 BC. “The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate.”
My own thoughts on this subject echo those expressed by neurosurgery pioneer Harvey Cushing in a 1925 address at Yale University: “Experience is no less fallacious today; judgment no less difficult … the art, which is so long, demands experiences the laboratories cannot give: the ability to properly elicit a telling clinical history, to satisfy the importunings of the family, to gain a patient’s confidence, to make him comfortable in mind and body regardless of what is wrong. These things are not by any means incompatible with the most intense scientific interest as to the cause, nature, and extent of his malady, but they demand judgment of quite a different order.”
These sentiments notwithstanding, according to his medical notes Cushing thoroughly appreciated the “electrosurgical apparatus” without which he “doubt[ed] that enucleation [of a tumor] could ever have been possible,” as is reported in the premier issue of the Journal of Neurosurgery: Pediatrics, just released in February.
So it is that both technology and art are necessary facets of the neurosurgeon. But, one might ask, where does creativity come in? A hint is found in the following observation:
“People very rarely realize [that] the real happening in [medicine] comes out of the most enormous discipline because when you’ve disciplined yourself thoroughly you know what is possible. You let your imagination move because you know that by discipline and study and thought you’ve created the limits.”
These wise words actually are those not of a master of medicine, but of music: namely, violinist Isaac Stern, whose preferred “tool,” incidentally, was a 1740 Guarnerius. He was speaking not of science, but of the arts; the liberty of substituting “medicine” for “the arts” in his statement is intended to illustrate the real similarity between these two spheres, which often are seen by many as dichotomous.
As neurosurgeons, our extensive education, exhaustive training, and challenging continuing medical education coalesce into superlative care for our patients. Occasionally, a particularly difficult challenge inspires a sublime moment of clarity that allows us to help a patient in a way that did not seem possible the moment before.
While our profession offers many rewards, I think that such a moment is what we, perhaps privately, hope for as medical students, what we strive for at the outset of our careers, and what sustains us once it has occurred.
So it is no mere coincidence that this column is inspired by both eminent physicians and a master violinist. The strong connection between them, as well as the connection between technological advances and better patient care, in turn inspired the theme of the 2004 AANS Annual Meeting, “Advancing Patient Care Through Technology and Creativity.” While the AANS Annual Meeting has represented the pinnacle of neurosurgical education during the years I have been an AANS member, this Annual Meeting, which concludes my term as the 73nd AANS president, is intended to exemplify the ideal of the complete neurosurgeon: one who embodies the education, training, talent and knowledge of technology for the purpose of advancing patient care.
I am confident that this 72nd AANS Annual Meeting will exceed our expectations in every way. I sincerely thank all those who have had a hand in creating what promises to be a superlative scientific event, and I hope you will join me May 1-6 in Orlando.
This has been an extraordinary year for me personally and professionally, and I extend my wholehearted appreciation to all those who helped make it so. The foremost issue of my presidency has been to advance medical liability reform, and I think significant progress has been realized in that area through the Neurosurgeons to Preserve Health Care Access coalition and its work with Doctors for Medical Liability Reform to launch the ongoing nationwide Protect Patients Now public information campaign on Feb. 10. Like the 2004 AANS Annual Meeting, the campaign exemplifies the use of technology and creativity in reaching out to people, with the end goal of helping our patients.
How can I best help this patient? I submit that this question underlies everything we do as neurosurgeons. Despite the considerable pressures bearing upon our profession, it is this question that ignites within us the will to exceed even our own expectations.
A. John Popp, MD, is the 2003-2004 AANS president. He is Henry and Sally Schaffer Chair of Surgery at Albany Medical College in New York.