Wednesday morning, October 10, 2018. I was standing in an operating room, 2,500 km away from my home and my medical school, trying to recall the five layers of the scalp to answer the question posed by Dr. L., a seasoned neurosurgeon who was the leading physician in my first ever observation of a neurosurgical procedure. It was my starting day as a clinical attachment student in the neurosurgical oncology department of a National Health Service Hospital in the United Kingdom, and I was waiting to participate in a craniotomy for the removal of a malignant brain tumor.
Are you sure you want to become a neurosurgeon?
I have heard that question a myriad of times during my preclinical years from people in and out of the medical profession. In fact, I have heard it so often that I started doubting myself. I aspired to become a neurosurgeon from the get-go of medical school even before I was exposed to a single anatomy lesson. In all my years of medical school, I have been making an effort to recognize the factors that influenced the birth of that aspiration in my mind.
This effort is what led me to that operating room where I, of course, failed to recall the five scalp layers of the scalp, (skin, connective tissue, epicranial aponeurosis, loose areolar tissue and pericranium), as lapses in memory usually happen when one is asked a question by a professor while one is stressed and has not studied neuroanatomy in over two years. Most medical students and young neurosurgical trainees describe their first experience watching a neurosurgical operation as some kind of fascinating and surreal revelation. On the contrary, what struck me the most was that it all seemed kind of normal to me. The drilling through the skull bone, the pulsating brain covered by its thin veins and the dusky tumor piercing through the dura mater all looked familiar to me; yet, it was my first time participating in a neurosurgical procedure.
Don’t get me wrong, I really enjoyed my time in the operating room, and the operations were very exciting. Looking through the neurosurgical microscope, I discovered a new, complex world composed of bone, nerves, vessels and connective tissue in which the neurosurgeon live and operates. But, I didn’t experience that long-awaited revelation.
At first, I admit that I was disappointed and worried that neurosurgery wasn’t right for me after all; I was beating myself up for being naive and telling everyone that this was what I wanted to pursue as a career. However, after spending more days in the operating room with some amazing neurosurgeons, it hit me. That revelation didn’t happen because it wasn’t supposed to happen. All looked normal because I was meant to be there, and I belonged there with those neurosurgeons operating on a person’s own center of existence without fear or hesitation. And as I was realizing that, a different kind of revelation — a more important and decisive one — occurred to me. I was destined to become a neurosurgeon exactly because all seemed so conventional in my eyes. I have never been one to react with overwhelming emotions during certain situations so, looking back, my reaction was fitting after all.
I don’t know if all of the above make sense, but it is my own story about my own kind of revelation and the reason why I am pursuing neurosurgery as a career. I have still to identify the initiating factors that gave birth to my aspiration of becoming a neurosurgeon, but I have without a doubt answered the aforementioned question:
Are you sure you want to become a neurosurgeon?
The answer is, “Yes!” I am overwhelmingly sure that I want to become a neurosurgeon.
Author’s note: The title of this article is inspired by the novel, When the Air Hits Your Brain: Tales from Neurosurgery, by Frank T. Vertosick, Jr.
Image credit: Brain II (CC BY-NC 2.0) by Andrea Kirkby
Contributing Writer
University of Thessaly
Georgios is an international medical student in Greece where medical school and college are combined into a six-year program. George is in his fifth year of medical school and is in the class of 2020. He attends the University of Thessaly, Medical School of Larissa, Greece. He enjoys American pool, basketball, astronomy, and movies. After medical school, he aims to become a neurosurgeon and wants to combine the clinical aspect of medicine with basic research in neuroplasticity.