AANS Neurosurgeon | Volume 28, Number 1, 2019


Seeking Humanity: Aviation and Neurosurgery

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Suspended above North Carolina’s emerald landscape, swathed in cobalt skies; I find heaven. The propeller, a blurred disk I obstinately chase, resonates a subtle steady hum into the otherwise muted ether. Photons, birds and the sparse media responsible for refraction of one and respiration of the other, are my only company; company that fades with a maturing day and growing altitude.

As a child, my dream was to become a pilot. For the first decade of my life, I meticulously studied aeronautics; from how aircrafts are engineered to the physics behind lift – I was insatiable. As a teenager, my infatuation with flying was supplanted by an emerging passion for neuroscience. I was absorbed by the beautiful symphony that is the healthy nervous system and the challenges of treating the vexing cacophony that is neurological disease. Around this same time, I was diagnosed with a juvenile form of macular degeneration. It was an incidental finding and I was asymptomatic. In most cases, visual acuity deteriorates to 20/200 by the second decade of life. By the third decade of life, visual disturbances are almost universal. However, I made a decision to never allow the diagnosis to dictate the things I love and pursue. I reasoned that I may be fortunate and never lose my sight. Moreover, if I did, my world will not instantly turn to black while deploying a clip or approaching a runway. As such, I decided to stay the course – to pursue a career in neurosurgery and fulfill my lifelong dream of flying.   

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While I find the cockpit to be the most peaceful place I know, it started out as one of the most unnerving. After just 85 minutes in the cockpit during my second ever flight instruction, my instructor had a generalized seizure. The seizure lasted just short of four minutes. Post-ictally, he was obtunded and disoriented. He had never had a seizure; I had never landed a plane. I had yet to learn proper air traffic communication, how to approach the airport, runway nomenclature or where to taxi the plane (should I be lucky enough to actually land). With the help of a phenomenal air traffic controller, we landed the plane safely. My instructor had his meningioma removed the next day and eventually returned to flight instruction. The next time I landed a plane alone was in Kitty Hawk, N.C. during my first solo flight, where, before returning to Raleigh, N.C., I was able to explore the dunes where Orville and Wilbur first defied gravity.

Unlike most seclusive activities where mutual invisibility between society and self is required, flying, and to a certain extent neurosurgery, affords a unique chance to be intimately aware of one’s thoughts, while, on the grandest of scales, scrutinizing what makes us who we are. In the case of flying, the immensely complex and vast amalgamation of nature, infrastructure and the constructs of humanity lie in plain view on the earth’s surface below. In neurosurgery, while never alone, a team works in solidarity, each member entrenched in thought, huddled over the single most sophisticated and perplexing entity known to man; the brain.

I imagine no matter how much I prepare for a life in neurosurgery, I will feel unsettled countless times throughout my career. As an intern, there will be a patient at 3 a.m. whose life depends on an answer that I do not immediately have. As a junior level attending, the safety net will vanish, leaving me to question whether my abilities warrant a human life to be entrusted to my hands. Throughout my entire career, there will be cases and outcomes that force me to ask whether I should have done something differently. And no matter how much experience I amass, there will never come a day when I am impervious to the insecurity of not knowing. At times, this will be because, as a field, the answer is yet to be found; other times, it will be a failure that lies squarely upon my shoulders. I imagine that in choosing to dedicate one’s career to neurosurgery there will inevitably be occasional feelings of failure and frequent feelings of unrest. But should this not be the case in choosing a life where consequences are not only mortal, but worse, enable someone to live as a mere shell of who he or she once was? I think it is just, and I refuse to allow mere prospects to stipulate the things I love or dictate the things I pursue. For, in the words of Helen Keller, “The only thing worse than being blind is having sight but no vision.”

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