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AANS Neurosurgeon | Volume 28, Number 1, 2019

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The Neurosurgeon Switching Gears

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Neurosurgery Gear

In the operating room, I am fully focused on the patient. I am the conductor of the orchestra comprised of the scrub tech, resident, circulating nurse, anesthetist, students, radiology tech, neuromonitoring tech along with various and sundry members of the operating team as we dance around the patient. I watch for bleeding, avoid a dural tear during dissection, triple check the localization with monitoring, inspect every corner of the tumor bed before closing, pull the stitches tight to prevent a leak. Then the beat of the Black Eyed Peas gets our feet moving during closure. I shift to planning for post-op disposition, hand off to the intensivist, special orders for nursing or imaging, potential complications to watch for, speak with the family and dictate the operative report. Now I can do a little multi-tasking: Plan for the next patient, triage any emergencies, figure out the dinner menu and determine if I have a present for the birthday party this weekend.

After the last case of the day, it is time to sign out with the resident and check on any patients with particular concerns or risks. It is important to try and prevent the phone call, which inevitably occurs just as I’m pulling into the driveway, prompting me to turn back around to the hospital. During the drive home, I can enjoy a little “me” time, for me this is listening to the radio. It is also useful for phone calls coordinating last minute changes to carpooling for the kids’ soccer practices, Taekwondo, play dates and deciding who is stopping for milk. Then, time to switch to chauffeur mode now. With five children, there are at least three events each evening. I love the nights I do not have carpool duty for anyone!

Home Gear

Mommy mode kicks in when the youngest complains about being bullied that day. We have a talk about standing up for yourself and not listening to what a bully says. The payoff comes the next week when she is proud of herself for telling the bully to stop when he was picking on another girl. Then, I put on the disciplinarian face to get the kids to practice music, do homework and finish folding the laundry. Sometimes, the rooms actually get cleaned as well. Dinner is squeezed in somewhere, so I can play nutritionist for the family, although it is rare that we all sit down at the same time anymore. I have at least made sure that the fridge is stocked with healthy food for the older ones to grab. We slow down during bedtime reading, adding a kiss and hug when I tuck them in.

When lucky, I have some “couple’s time” with my husband to talk about the day, vent frustrations, discuss solutions, laugh at the crazy things the kids said, share a glass of wine and snuggle on the couch before I pass out. Of course, as a friend, there is always a minute to lend an ear, give some advice (or ask for some) and provide support.

Merging Gears

As neurosurgeons, we all play multiple roles. The profession itself requires so much more than operating and outpatient visits – from documentation to outreach clinics and, for some, teaching and research. Perhaps, the path to becoming a neurosurgeon helps hone our gear-switching skills. First, we learned to manage class work and extracurricular activities. In medical school we participated in actual patient care and writing papers. As we rose through the residency program, we had more responsibility for oversight of junior residents. As chiefs we ran the entire service. Most of us also grew our families during this time and learned to juggle home and work. The steepest learning curve came as new staff, managing our practices, negotiating contracts, advocating for our programs with hospital administrators and making the final decisions for patient care – things we had never done. 

Anecdotal and scientific data support the idea that adding additional roles increases the cognitive load. We must expend energy to refocus attention on the given task, particularly when novel.1,2 With additional roles (tasks), we often need to divide our attention between them, with slower response times, less accuracy and poorer cognitive performance.3,4 Strategic adaption of automated versus high cognitive control for a specific task benefits individuals by reducing performance costs.5 Of course, the trick is knowing when a task becomes more complicated and needs more attention. My mistakes in patient care have occurred when I was attempting to manage multiple issues simultaneously. Practicing task-switching improves efficiency4. I’m getting lots of practice, still working towards perfection.

References

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1. Addante, F. (2015, October 5). Why You Pay a Price When You Shift Gears. Retrieved from https://www.inc.com/frank-addante/wearing-multiple-hats-what-would-darwin-do.html.

2. Steyvers, M., Hawkins, G. E., Karayanidis, F., & Brown, S. D. (2019). A large-scale analysis of task switching practice effects across the lifespan. Proceedings of the National Academy of Sciences116(36), 17735–17740.

3. Yan, J., Zhang, N.-N., & Xu, D.-X. (2018). Mindset switching increases the use of want-based over should-based behaviors. Plos One13(4).

4. Kray, J., & Fehér, B. (2017). Age Differences in the Transfer and Maintenance of Practice-Induced Improvements in Task Switching: The Impact of Working-Memory and Inhibition Demands. Frontiers in Psychology8

5. Zink, N., Stock, A.-K., Vahid, A., & Beste, C. (2018). On the Neurophysiological Mechanisms Underlying the Adaptability to Varying Cognitive Control Demands. Frontiers in Human Neuroscience12

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Vikram Prabhu | December 16, 2019 at 8:53 am

Dear Rachana,
I liked your essay very much. My wife and I have five children as well:) Hope you have a wonderful Christmas and holiday season.

I used to serve on the AANS neurosurgeon board and feel so happy to see how well it is doing. My best to Deb.
Vikram