AANS Neurosurgeon | Volume 28, Number 4, 2019


Life in Neurosurgery: All In?

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Editorial License v25no1Neurosurgery: the jealous mistress, the essence of delayed gratification. Percival Bailey was Harvey Cushing’s longest-serving and arguably most devoted resident. When Bailey was considering marriage, Cushing told him that doing brain surgery required “putting one’s affections on ice.” Nowadays, we enter into long-term relationships at will and work-hour regulations blunt the rigors of the training process. Although being “limited” to 80 hours a week (or more?) should not qualify as slacking. We expect residents to use this “gift” of oh so much time off to read and write neurosurgery, but this commitment does not end after seven years of training — as an attending neurosurgeon you are expected to do much of the same thing.

And yet, we are often told of the need to maintain balance, “to have a life.” So when does that gratification finally come, and how much? The answer is not simple. If you do not strive to keep up with technical and cognitive change in our field, you will soon be out of work.

There is also a practical – even ethical – component to this. Can you justify seeing patients and discussing their treatment options without being absolutely sure your knowledge is up to date? You might recommend the wrong management otherwise. But staying current requires time, commitment, and…delayed gratification.

On the other hand…what if time runs out and gratification never comes? If you have not heard the story of our late colleague, Paul Kalanithi, MD, read this review, and then read his book.

Is retirement the final gratification, the time to sleep late, play golf, sail or do whatever you like? Or do you want to stay “a player” in our demanding and interesting field as long as you can? Here are two very different views on that question: Point: Retirement and the Myth of Sisyphus and Counterpoint: Just Walk Away.

The truth is all of us (I hope) do manage to maintain some work-life balance: Neurosurgeons: Life. More than it being our right, we need to do so. That is how we can best serve our patients. We — you — need to “have a life” so you can devote all of your energies to your patients and others at work (nurses, PAs, office staff, residents) who rely on you.

A mentor of mine used to say, “you can do more work in 11 months than in 12.” Remember that, and use your finite time in ways that are wise, useful…and fun.

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John Iwanski | March 14, 2016 at 2:16 pm

Well said Dr. Schulder. It’s never an easy thing to do, balance the drive to succeed professionally with the need to have that same success on a personal level. The articles in this quarter’s issue really illustrate just how important – and difficult – it is to both find and maintain that balance.