Read Online Another Day in the Frontal Lobe by Katrina Firlik - Free Book Online Page B
Authors: Katrina Firlik
Tags: Non-Fiction
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adviser. My father—a general surgeon who told me long ago that neurosurgeons are known for being megalomaniacs—likes to tell the following joke that circulated around Cleveland at one point. The joke goes: A crowd is gathered at the Vatican, with everyone looking up at the balcony, where two men can be seen. One random onlooker says to another: “Who is that guy standing next to Dr. White?”
You might think that neurosurgery as a profession is specialized enough, but we’ve managed to break it down into even smaller bits. And, as with any culture, stereotypes abound, some fair and some unfair. Vascular neurosurgeons, for example, are the “cowboys” whose lives revolve around aneurysms and other blood vessel–related brain abnormalities. Aneurysms are weakened bubbles on blood vessels that can burst, sometimes leaving neurological devastation in their wake. Emergencies are the norm. The vascular guys are known for having the worst lifestyle. Aneurysms seem to present themselves at the most inopportune times, like Friday evening or Thanksgiving afternoon. They often require a trip to the OR to prevent a rebleed. The spouses and children of these cowboys may file for neglect. On the bright side, vascular neurosurgeons do some of the greatest cases—intricate and technically demanding—the kinds of cases that attract young medical students to the field in the first place.
Spine specialists are a different breed. They work with screws, rods, and bones. They may be mistaken for orthopedic surgeons (some of whom do spine surgery also, but only if they’ve undergone special fellowship training). They are courted by instrumentation companies that hope to entice them with new products, like modified screws or updated screwdrivers. Spine surgeons are the ones who usually bring in the most cash, to put it bluntly. There are a few simple reasons for this: (1) the population is aging, (2) aging spines can be painful, (3) there’s a growing trend toward fusing painful, aging spines, and (4) fusions reimburse well (better than most brain operations).
Picture this. A haggard vascular neurosurgeon comes in at midnight, Friday night, to do an emergency aneurysm case on a deathly ill patient. He monitors the patient for a week or two in the ICU and another week or two on the floor. He fears the potentially devastating complications that can occur even several days after a flawless operation. He answers frantic phone calls in the middle of the night. He holds family conferences. He checks scan after scan. He will be compensated reasonably well for the operation itself, depending on the patient’s insurance plan, assuming that the patient actually has insurance. (Otherwise, he works for free.) However, he receives nothing additional for all the work required after surgery.
The spine surgeon, on the other hand, performs an elective spine fusion on a healthy patient on a Monday morning (after his office staff has confirmed insurance coverage). He checks on the patient once a day for a few days in the hospital, sends the patient home, and receives a multiple of what his vascular colleague received. This disparity, although seemingly unfair, has become an entrenched part of our culture. I introduce this disparity not as a crude exposé of our finances, but because these issues are on our minds all too often. Ask almost any neurosurgeon.
Neurosurgeons come in many other varieties: pediatric, functional (for movement disorders such as Parkinson’s disease), tumors, trauma, epilepsy, and peripheral nerves. A small subset of neurosurgeons focus on anything that requires surgery at the base of the skull. These “skull base” neurosurgeons are famous for their maximally invasive approaches. Their cases may take all day, sometimes extending into the next day. For the longest operations like large, complex tumors at the base of the brain, neurosurgeons sometimes work in shifts, so that one surgeon can leave to use the bathroom, eat, and
You might think that neurosurgery as a profession is specialized enough, but we’ve managed to break it down into even smaller bits. And, as with any culture, stereotypes abound, some fair and some unfair. Vascular neurosurgeons, for example, are the “cowboys” whose lives revolve around aneurysms and other blood vessel–related brain abnormalities. Aneurysms are weakened bubbles on blood vessels that can burst, sometimes leaving neurological devastation in their wake. Emergencies are the norm. The vascular guys are known for having the worst lifestyle. Aneurysms seem to present themselves at the most inopportune times, like Friday evening or Thanksgiving afternoon. They often require a trip to the OR to prevent a rebleed. The spouses and children of these cowboys may file for neglect. On the bright side, vascular neurosurgeons do some of the greatest cases—intricate and technically demanding—the kinds of cases that attract young medical students to the field in the first place.
Spine specialists are a different breed. They work with screws, rods, and bones. They may be mistaken for orthopedic surgeons (some of whom do spine surgery also, but only if they’ve undergone special fellowship training). They are courted by instrumentation companies that hope to entice them with new products, like modified screws or updated screwdrivers. Spine surgeons are the ones who usually bring in the most cash, to put it bluntly. There are a few simple reasons for this: (1) the population is aging, (2) aging spines can be painful, (3) there’s a growing trend toward fusing painful, aging spines, and (4) fusions reimburse well (better than most brain operations).
Picture this. A haggard vascular neurosurgeon comes in at midnight, Friday night, to do an emergency aneurysm case on a deathly ill patient. He monitors the patient for a week or two in the ICU and another week or two on the floor. He fears the potentially devastating complications that can occur even several days after a flawless operation. He answers frantic phone calls in the middle of the night. He holds family conferences. He checks scan after scan. He will be compensated reasonably well for the operation itself, depending on the patient’s insurance plan, assuming that the patient actually has insurance. (Otherwise, he works for free.) However, he receives nothing additional for all the work required after surgery.
The spine surgeon, on the other hand, performs an elective spine fusion on a healthy patient on a Monday morning (after his office staff has confirmed insurance coverage). He checks on the patient once a day for a few days in the hospital, sends the patient home, and receives a multiple of what his vascular colleague received. This disparity, although seemingly unfair, has become an entrenched part of our culture. I introduce this disparity not as a crude exposé of our finances, but because these issues are on our minds all too often. Ask almost any neurosurgeon.
Neurosurgeons come in many other varieties: pediatric, functional (for movement disorders such as Parkinson’s disease), tumors, trauma, epilepsy, and peripheral nerves. A small subset of neurosurgeons focus on anything that requires surgery at the base of the skull. These “skull base” neurosurgeons are famous for their maximally invasive approaches. Their cases may take all day, sometimes extending into the next day. For the longest operations like large, complex tumors at the base of the brain, neurosurgeons sometimes work in shifts, so that one surgeon can leave to use the bathroom, eat, and
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