This is Why We Do What We Do

This week we received some great news. One of our patients, who started as a 14-year-old boy with a hemorrhage from a right thalamic AVM, had an angiogram confirming complete obliteration of the malformation. His father is a neurosurgeon. He understands. As he told me, "this is the best day of my life." Our teenager is now a little three years after his intraventricular hemorrhage from which he made an excellent recovery, now 6 foot 5 inches tall, and pursuing his future. I did stereotactic radiosurgery for his AVM, and when we identified an intranidal aneurysm, Dr Howard Riina embolized that feeding vessel and safely eliminated it. We all have such stories, and some touch us more than others. His father's words really struck me. We get good news from our patient outcomes virtually every day, and of course, the outcomes may not be as hoped. That is the nature of neurosurgery and the nature of the nervous system. Sadly, we spend more time dwelling on our patients who not do so well, and who may suffer, than on those who recover as hoped. Personally, I probably spend about 5 minutes thinking about the great outcomes and then move on to the next patient. But for the others, I often think about them for months. This balance is not healthy, and this dichotomy has been well characterized by many in the social sciences. I am not sure how to fix it, and perhaps it is just the nature of neurosurgeons. I have discussed this with my close friends, and in many ways, it has been a career-long issue. We live in a world of expected excellence, all the time. The wonders of the nervous system, and the coverings that protect it, are of course still much under study. Every issue of this journal represents our global commitment to that effort. When one conducts research and it is published, it also creates a sense of academic pride. We realize that our work may help others in the care of their own patients, perhaps leading to more and more good outcomes, with endearing patient stories. What we all do is based on the courage of others, those who came and published before us, and provided the confidence to forge ahead. As I write this, I am flying to Norway to serve as the primary opponent in a PhD defense for a neurosurgical trainee who has spent years doing clinical research, including randomized trials in vestibular schwannoma care. It was an honor to be asked. Personally, I believe that such a doctoral defense is one of the most important processes in university life. Now, here is a secret—the work was well done and this person will receive their PhD. He just does not know it yet, and so tonight, perhaps he is quite nervous. But since this happened a number of months ago, the good news was already delivered in person! Being a small part of this process brings me joy, and that is also a part of the joy of a neurosurgical career. Today, I received four requests, two from students here in the United States and two from Europe looking for summer or year-long research opportunities. It is just the time of year that students prepare for their future, hoping to make themselves better suited to the neurosurgery residency application process. So many of us get such requests, whether in academic or community practices. Sadly, I had to tell them that my research positions were full for July 2024 and that I was now planning for the next year. But this is actually my loss. I always wonder if these are the ones that will be the next game changers, the ones that "think different" and will bring an energy to my own practice and career that I did not expect. I always get more from them than I seem to give. Recent students have tackled new concepts for brain metastases, AVM flow dynamics, data analytics, thinking about different multiple sclerosis subtypes and how that affects trigeminal neuralgia (that never occurred to me), tumor volumetrics, skull base tumors and hydrocephalus risks, and so much more. Their work allows us to create, write, and inform. Again, another sense of personal joy. When one describes a neurosurgical career and its different elements, one thinks of patient care, research, and teaching. All of these can bring tremendous gratification. They are why we all do what we do. Neurosurgery is hard. My suggestion is to think often and more deeply of this gift and the personal satisfaction it can bring. Douglas Kondziolka, MD, MSc Editor-in-Chief, Neurosurgery Publications New York, New York, USA