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AANS Neurosurgeon | Volume 28, Number 3, 2019

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Stress in Neurosurgery: Taking Control Along the Neurosurgery Continuum of Training

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Often in neurosurgery, the stakes are high, the pressure is immense and the stress can be overwhelming.

Erol Veznedaroglu, MD, FAANS, neurosurgeon at Drexel University and chair of the Global Neurosciences Institute, LLC, said:

“There are no small complications in neurosurgery. One misstep … can lead to permanent disability for the patient. An infection in most cases is curable with antibiotics and recovery time, but in the brain, this can result in loss of speech, sight or paralysis.”

Handling the great responsibility that he describes seems almost impossible. As medical students interested in neurosurgery, we are not naïve to stress; it has been a consistent part of our lives since deciding on a career in medicine. Having tactics to overcome stress is an essential trait of successful students and professionals.

We have learned that a large part of overcoming stress relies on refocusing one’s perspective. Hobbies that let us engage in something outside of medicine can be grounding and expand one’s perception. Being involved in activities that matter to us outside of classes motivates us to get through the hard work of medical school, where we may veer toward feeling burned out and exhausted. Personally, we utilize a variety of avenues for stress-relief and resilience.

A major hobby of Charles Fencil’s, co-author of this piece, is hiking and backpacking. Spending time in the beautiful wilderness and connecting with the natural world lets him recharge and feel at peace. Stepping back melts away the strands of chronic stress that accompany the medical school journey and provide clarity for his day-to-day activities.

Zane Kaleem, this piece’s other author, involves himself in advocacy regarding national issues. He is a fellow of Physicians for Criminal Justice Reform (PfCJR) and has called for action on reform policies multiple times through its Writer’s Bureau. Engagement with PfCJR renews his sense of purpose beyond his daily studying.

Kristin Huntoon, PhD, DO, a neurosurgeon with PfCJR, highlights the significance of her involvement by saying,

 “[those who have faced imprisonment or trauma] have been abandoned by other physician groups and it is our duty to ensure they are receiving both health … and mental health [care].”

Outside of surgery, she loves “interacting with like-minded physicians [who] care about more progressive issues” through PfCJR.

Dr. Veznedaroglu also describes the importance of being an advocate for his patients in maintaining his own resilience.

“The close relationship with the patient is an investment [in] yourself. This can become very difficult to maintain with a large workload, sick patients and, oftentimes, lack of sleep. There must be a constant reminder that our role is to serve patients in their time of need.”

Robert Harbaugh, MD, FAANS, chair of the department of neurosurgery at Penn State Hershey Medical Center, echoes this sentiment:

 “It is essential to know that you are part of a greater whole and working for something much greater than yourself.”

The intrinsic sense of working for a greater good makes embracing the stress of life a truly meaningful and enriching part of the experience. This mindset may be the reason neurosurgeon work-life balance and burnout rates show a seemingly-paradoxical relationship. Dr. Harbaugh explains that a comprehensive study of U.S. physicians in 2012 found that neurosurgeons’ “work-life balance was dreadful, but their burnout rates were relatively low.”

Dr. Harbaugh embraces stress and says it isn’t always a bad thing. “Most accomplished neurosurgeons want to demonstrate their ability to rise to a challenge. As I tell our residents, it wouldn’t be fun if it were easy.” Dr. Veznedaroglu comments that, “the patient and family expect you to be the ’captain of the ship.’ Stress is necessary to make sure you are always vigilant.”

It also seems that the stress fosters camaraderie and is what makes neurosurgery uniquely special. Dr. Veznedaroglu explains:

 “… Having colleagues that you can rely on and [who] rely on you is essential. The only one who can truly understand the feeling of telling a parent their child is brain dead or a husband that his wife will never walk/talk/be the same again is your partner. We lift each other from the lowest lows and celebrate the highest highs.”

“Don’t be intimidated by [stress],” we are assured. “But also understand what it really means to be a neurosurgeon by spending time shadowing and on rotations. It is cool to say, ‘I’m a brain surgeon,’ but if this is your goal, you will be very miserable. The road is long and very hard, and the job remains demanding every day.”

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