Inspirations and Epiphanies

Before there were worries of high medical liability rates, shrinking reimbursement and a plethora of unfunded federal mandates, there was an ideal, an individual, a moment of clarity, or an event that motivated you to apply for neurosurgical residency and that perhaps sustained you during practice of this most challenging of professions. During the AANS 75th anniversary year, when neurosurgery’s origins and organizers will be recognized and remembered, accounts of inspiration and epiphany by today’s neurosurgeons will be published in the AANS Bulletin. Consider your own career. What attracted you to neurosurgery? Who inspired you in this profession? What would you tell a medical student about your experience as a neurosurgeon? What do you still love about your daily work? Send your account (300-word maximum) by e-mail to [email protected]. You will receive an automatic confirmation of receipt, and you will be contacted if your item is selected for publication in an upcoming issue of the Bulletin.

The threads that led me to become a neurosurgeon took years to be woven, seemingly without my conscious awareness until a single moment of epiphany. As a sophomore in college I was drawn to but dissatisfied with both engineering and literature. One morning I came late into a darkened psychology class to a movie on brain lateralization in “split brain” patients. Suddenly I was transported into the operating room and an open craniotomy for corpus callosotomy. This was the first thread.

I enrolled immediately in Topics in Neural Science and became one of the first neural science concentrators at my university. Still, it was pharmacology and psychiatry that attracted me at this stage. I entered the MD/PhD program intending to become a biological psychiatrist. Yet I clearly remember sitting in the lab the first summer and conjuring up the idea that I would do brain transplantation for Parkinson’s patients (a new idea in 1982), and fund my research doing so. How naive!

Still, it did not occur to me to become an actual neurosurgeon. In fact, by the time I was supposed to enter the wards at the completion of my graduate research — by then on molecular biology of signal transduction in worms (!) — I wanted to leave medical school and concentrate on basic research. However, I was convinced to finish what I started, and so I chose the hardest rotation first: surgery. After operating on trauma the whole first night of the rotation, I realized how dissatisfied I’d become with the pace of research, and that surgery was my calling. It was only natural that it would be neurosurgery. And here I am now: “splitting” the brains of patients with epilepsy, and helping to fund my research doing brain transplantation for Parkinson’s patients!
Robert E. Gross, MD, PhD
Atlanta, Ga.

Wilder Penfield, MD

Montreal, the city where I grew up, was a city of medical giants. I didn’t know all the names, as I didn’t come from a medical family. But my father and his best friend, who also was my pediatrician, did a good job of instilling in me a sense of awe and reverence for the medical profession. The Royal Victoria Hospital, which resembles a castle and overlooks the campus of McGill University and the commercial center of Montreal, was for me an icon representing the highest attainment of human skill and learning. The Montreal Neurological Institute, housed in smaller though architecturally complimentary adjacent buildings, was on the same topographic level but even more exalted in its culture of achievement. Wilder Penfield was a living legend. I was growing up in what was then the commercial and intellectual capital of Canada, and medicine/neurosurgery was at the top, at least in my mind.

Some images from my formative years are still with me: curiosity piqued by a photograph of a team performing brain surgery in a children’s encyclopedia given to me on my fifth birthday; seeing Wilder Penfield on the street (he lived a few blocks away); the shock of seeing a soon-to-be-deceased young schoolmate’s shaved and recently stitched head (a medulloblastoma, I now suppose, given the location of the incision and the outcome).

I never thought that I had it in me to wage heroic battles against hopeless disease. And perhaps I don’t. Neurosurgery has certainly changed in the last 40 years. But I was, and still am, impressed by the brave men who worked with limited tools and imaging in such an important place and made me want to be a neurosurgeon.
Ian B. Ross, MD
Pasadena, Calif.

John M. Tew Jr., MD

I had always wanted to be a vascular surgeon. In college I did research with a vascular surgeon in Cleveland. My role involved using PTFE grafts on the femoral artery on dogs. I continued with that focus in medical school in Cincinnati where I did research on endothelial cells within the vascular surgery division. When I was a third year student, the chair of the department of surgery threw me out of his OR and swore I’d never match in a surgery program. I had done a neurosurgery rotation with John Tew, and I was very favorably impressed with him as a gentleman, not just as a fantastic surgeon. I changed my focus and never looked back. Incidentally, my clinical focus in neurosurgery is aneurysms and AVMs.
Robert J. Gewirtz,
MD Columbus, Ohio

Howard A. Brown, MD

Since Howard A. Brown, former Harvey Cushing Society president, was my father, one could invoke the following of footsteps as my reason for becoming a neurosurgeon. But, by age 19, I had seen the impacts on family life of being on call and having family occasions disrupted. Medicine was the one thing I would not do.

After two years of college I had no specific direction and paged through the college catalog making notes of the interesting possibilities. I also made a list of nonacademic time spent and was somewhat disturbed to realize that I enjoyed asking my father about neurosurgical matters. I took a series of aptitude tests and was horrified when they applied the label “doctor” to me.

But reason prevailed; I took some premed courses and found them interesting. I thought medical school might be worth a shot. I was successful in being admitted and enjoyed the curriculum. And I took a fourth year elective at Boston Children’s with Don Matson, whom I had admired throughout medical school. That sealed the deal. I returned to San Francisco and had the privilege of being a resident for my father, O.W. Jones, and Ed Boldrey. What a great group of clinicians and teachers! I became a partner of my father in what could be considered a lifelong teaching arrangement. I had the advantage of his counsel for many years after his retirement.

Since I am now retired, I can look back on my training and practice with great satisfaction. I had inspiring teachers, a great specialty, and the career-long pleasure of being able to help patients. It’s hard to beat that combination!

Congratulations to the AANS (aka Harvey Cushing Society) on its 75th anniversary! And good wishes to all the young neurosurgeons who are pursuing ever more challenging problems in our field.
Barton A. Brown, MD
Mariposa, Calif.

I was a sophomore medical student at the University of Pennsylvania during the winter of 1973. My intention at the time was to do full-time research after graduation, but I became disenchanted with the basic sciences, and captivated by the clinical aspects of medicine. I did not know which specialty would be a good fit, but I knew that I could never be an ob-gyn (too much howling during labor), a pediatrician (too much howling by the children), or a psychiatrist (the patients were just too crazy, and everybody smoked cigarettes).

One Saturday, I attended a large group lecture in clinical neuroscience given by Thomas Langfitt, who was the chair of neurosurgery. He is now deceased, but he was a very tall, imposing figure with a full head of silver hair and a deep, sonorous voice. He brought onto the stage a gentleman in a wheelchair with a head dressing and elicited a history: He had been a high-powered executive at a Fortune 500 company when he suffered mental status changes. A CT scan, which was a new technique at that time, showed a frontal lobe malignant glioma, which was confirmed at surgery.

Dr. Langfitt bantered with the man a little bit while demonstrating the neurological findings, and then the patient was excused. He then addressed the group of students. He explained what a GBM was, and that it would be fatal within six months regardless of treatment. But he went on to say that despite the hopeless prognosis, the true physician still had a vital role to ease pain, prolong useful life, and allow death with dignity. His plan for this patient was to give palliative radiation, escalate steroids as needed, and, when the patient was so disabled that life was burdensome, admit him to the hospital, and with the consent of the patient and his family, abruptly stop the steroids. I was absolutely blown away by this display of compassion. As a student, I felt that my role as a physician would be to fight disease, and that if the patient died it was my failure. This was my first introduction to the idea that ultimately, our patients always die. But that this knowledge does not free us from our responsibility to provide care. Caring for a dying glioma patient is every bit as rewarding and valuable as curing a convexity meningioma. I decided on a career in neurosurgery that same day.

I suspect that most of us chose our career path because of some mentor, some larger than life figure that we encountered by chance and wished to emulate. In my case, it was a neurosurgeon, but it could equally well have been a gastroenterologist or urologist. But, for me, not an ob-gyn, a pediatrician, or a psychiatrist.
Leslie N. Sutton, MD
Philadelphia, Pa.

Edward R. Laws Jr., MD

My grandfather was great friends with Garber Galbraith. When I was in college, my father, a physician, told Dr. Galbraith I was interested in neurosurgery. He invited me to the OR to watch a case; I was mesmerized. Later that year my college friend, Margaret Laws, invited me to New York to stay with her parents at the annual CNS meeting. She said, “My dad is the president, it should be fun.”

Hanging out with Ed Laws and family sealed my fate. If I could join a profession that attracted people like Garber Galbraith and Ed Laws, then I knew I would be forever grateful and challenged.

Later when I was in medical school and I told Dr. Galbraith I might want to go into neurosurgery, he said, “Where do I send the letters?” Case closed.
CharlesCobbs, MD
San Francisco, Calif. ]]>