What is it that makes pediatric neurosurgery such a unique and fulfilling specialty? There are a number of wonderful and rewarding aspects in the field, and the patients are a joy to take care of, so why doesn’t everyone pursue a career in this area? The answers may lie in the factors that don’t shine in the light, that are not the most glamorous… in other words the dark corners of pediatric neurosurgery. Even the most renowned of neurosurgeons will admit that they simply do not like taking care of pediatric patients. There are several reasons one might offer this sentiment, but in the end, the most likely explanation is that it is hard to watch the suffering of such a vulnerable and innocent population.
Taking care of pediatric patients requires a great deal of emotional and psychological stability and strength. While there is no doubt that adult neurosurgeons possess these traits, it can be difficult to translate these skills to such a sensitive population. For example, some may find it hard to take care of this population due to their inherent empathy for their own children. Some find that having children prepares them to properly empathize with the patients and their families, to “get on their level”. Others may find that they are unable to properly care for pediatric patients because they see their own children within them. In few other areas of neurosurgery does this internal struggle become more pronounced than in pediatrics.
Pediatric neurosurgical pathology can be extremely taxing on the psyche; surgeons caring for children with fatal brain tumors will attest to the difficulty of such a situation. It is hard to see a child succumb to the horrors of malignant neoplasms and their treatment. Even more unimaginable is that some will suffer without being able to understand what is happening to them. Still, sometimes the hardest part is caring for the parents of these children, having to give them the worst news they will ever receive and trying to help them cope with the morbid reality. Even more emotionally burdensome is the unfortunate certainty of having complications in some of these defenseless patients. Even the most benign surgeries can have disastrous complications, and the possibility of harming a child is always looming. Finally, there are few things in medicine that are as horrifying and emotionally, physiologically and physically challenging as taking care of victims of non-accidental trauma. In few other realms of neurosurgery is the physician required to be more than just a surgeon, but also a counselor, psychiatrist and social worker. This applies not only to the patients, but also to the parents and family who often require more time and energy than the children themselves.
So how do we deal with the dark corners of our world? The power of the de-brief cannot be underestimated. In the setting of tragedy, trauma, suffering or death of a child, it is imperative that we be open and communicate with our care teams. Sharing and validating experiences and emotions is a key to the human element of healing. There is a special bond among pediatric care providers that is unique to this subspecialty, and it results from the strong emotional investment in the care of this vulnerable population. As neurosurgeons we must remain not only the medical leader of our care teams, but also the emotional leaders, and provide stability and strength in the setting of tragedy and chaos. These challenges that face the pediatric neurosurgeon are what make this subspecialty such a unique calling in an already unique area of medicine.
