Neurosurgery is a difficult discipline, and the road a young man or woman must take to practice this profession properly is a long one. The difficulties encountered and to be conquered during the training period, initially, and in practice later are numerous and burdensome, and the satisfactions are unfailingly mixed with troubles, both at work and within the family, which inevitably suffers because of the intense life of a neurosurgeon. It may be helpful for a young person just starting out to be a neurosurgeon to become acquainted with some of the situations he or she will be facing in the future, situations that exceed anything he or she may expect or imagine on his/her own.
The young neurosurgeon about to embark upon this path must have a project (see Table 1), one that can provide an intrinsic structural basis and logic and thus a better likelihood of success. This program should include:
1.A plan, an agenda, a sequence of partial results that can lead to the ultimate goal through a series of interim achievements, just like the laps in a race or the different phases of a treasure hunt;
2.A method, that is, a mental and material itinerary that must be followed from beginning to end when the daily work is done, when a patient is studied or a surgical procedure is performed, a particular task or research project is selected and executed, when he/she communicates with others, and so on;
3.An objective to be reached so that professional exploration has a purpose. Besides formulating the diagnosis, not just a diagnosis, the neurosurgeon must also care for the patient and direct the therapy, not just a therapy. It is not enough that he/she knows how to perform a certain number of surgical procedures, he/she must also have the will to transmit his/her knowledge to others, to know how to organize a working group with a can-do attitude, to develop an area within his/her particular discipline that provides a scientific perspective to at least one field of research, and so on;
4.A specific period to be observed, one that precludes those “inevitable delays” that typify the most ineffectual realities in which missing elements and constitutive and environmental difficulties move the ultimate objective even further away, making that objective less satisfactory than one achieved at the appropriate pace and using the appropriate methods. Time is also important in deciding if it is the right moment to undertake a particular initiative or not or whether the general and specific conditions leading to a desired objective actually exist.
 | A) Project | |
|  1. Plan | |
| 2. Method | |
| 3. Objective | |
| 4. Time | |
| B) The 5 senses | |
| 1. Sight | |
| 2. Smell | |
| 3. Hearing | |
| 4. Taste | |
| 5. Touch | |
| C) Characteristics | |
| 1. Character | |
| 2. Passion | |
| 3. Dedication | |
| 4. Curiosity | |
| 5. Critical capability | |
| 6. Intellectual honesty | |
| 7. Flexibility | |
| 8. Diplomacy | |
| 9. Imagination | |
| 10. Respect for the rules | |
| D) Training | |
| | |
For a young physician to succeed in achieving the goal he/she has set for himself/herself, full use of the 5 senses must be made (see Table 1):
1.Sight: “the eyes are everything” was the title of a work by a Neapolitan artist. The neurosurgeon must “see” quickly, calmly, and precisely what he/she meets along his/her diagnostic and surgical path. But to see, he/she must also “know,” otherwise he/she will be looking without seeing, because one usually sees only what one actually knows. He/she must be fully and completely knowledgeable regarding anatomy and pathology so that anything that departs from the norm can be recognized and distinguished. Our knowledge of neuroanatomy is at the very crossroads of several disciplines in continuous evolution, and the neurosurgeon cannot, in his/her continuing education, neglect a thorough study of anatomic dissection using a surgical microscope and endoscope nor can he/she avoid learning and using modern methods of neuroradiological imaging and biomolecular analysis that will soon lead us to understand and visualize the minutest element of living matter. He/she must learn to anticipate, to the extent possible, clinical and surgical events. He/she must learn to view his/her work with a caustic eye, so that he/she may improve, correct, exult, and so that he/she may absorb and assimilate the individual case as part of a whole;
2.Smell: the neurosurgeon must have a “nose.” This is a quality that is not made, but that can be refined through experience, learning to recognize “risky” or unusual situations that clearly depart from the routine that, however, must also be managed scrupulously;
3.Hearing: the neurosurgeon must have ears—rather large ones, in fact. Ears to conduct an harmonious music, measured, with no superfluous gestures. Large ears to listen to the patient, to the colleagues in other specialties and to lessons taught by experience or fate;
4.Taste: to “taste” a decision that turns out to be right, or the success of an action or an operation, without dwelling upon self-satisfaction or excess that, just like excessive eating that may lead to an ailment or obesity, may equally lead to disappointment or failure;
5.Touch: one must be able to touch, both literally and figuratively. In a real sense, the feeling of touch as such, even through an instrument, is often a rich source of precious information (eg, consistency of a tumor, recognizing a blood vessel). In more general terms, the neurosurgeon must have a good hand, that is, dexterity; the hand as the ultimate contact, as that indispensable element that completes the thought-action process. That special touch of the neurosurgeon is also important in the figurative sense, when he/she communicates with the patients or with their family, persons who may not always be of the same sociocultural level, in providing information on the illness, on the risks of choices to be taken jointly, on unknown factors of the illness, and on possible surgical options.
The young neurosurgeon must also have a sense of direction to establish bearings, both at home and afar. First, he/she must find and select a center with qualified and up-to-date practicing neurosurgeons and teachers, one in which a great number of procedures are carried out in a specific sector or sectors. He/she must then find a teacher as a guide and upon whom to be able to rely. Then a point of reference is necessary, which is also anagraphically close, a sort of personal trainer who can lead him/her, day by day, through the fundamentals of the discipline, from studying, to research, to the unit, and into the operating room, someone able to encourage and direct, who can be a safe harbor in the complex geography of the daily neurosurgical archipelago, from the perspective of the future professional navigation. He/she must also be ready, at regular intervals and for rather long periods, to participate in courses, conferences, and further training at various centers. All these will enrich the young neurosurgeon's cultural baggage and teach techniques that may not be in use in his/her own center, so that he/she may make a personal contribution once he/she returns home, making him/her valuable and valued within his/her own structure. Part of this sense of direction is the concept of life-long learning and a continuing thirst for knowledge.
It is also important to possess some characteristics (see Table 1) that are in a certain sense component parts of what he/she is to become: a true talent is not learned, either you have it or you do not. The characteristics mentioned below, therefore, cannot be made or constructed, but we can help them to emerge and to flourish, rather than repress them. Specifically, these qualities are the following:
1.Character, which is not simply determination, no doubt beneficial, but also different positive attributes such as optimism, persistence, ability to mediate, all qualities that can guide events toward a positive conclusion. Character helps tremendously in overcoming those obstacles that always seem to get in the way of clear sailing, because after a successful day, just like after a calm sea voyage, rough seas usually follow—a patient who is not well, an operation with complications, a colleague who does not cooperate as we would like, and so on;
2.Passion, an inexhaustible spring that urges one inexorably and ceaselessly forward, making it possible to overcome obstacles and difficulties;
3.Dedication, viewed as enthusiasm, generosity of spirit, complete willingness. Neurosurgery is not a discipline that can be performed tangential to a life focused on other objectives. Neurosurgery requires an all-encompassing commitment. The neurosurgeon, and especially the young neurosurgeon in training, must immerse him/herself completely, without reservation, into the professional world: the years of education are those in which the foundation of one's own building are constructed, a period in which he/she must be as a sponge soaking up knowledge, behavior, memories;
4.Curiosity, understood as interest in and desire to acquire new knowledge. In this particular instance, it implies attention to neurologic disorders as a whole, rather than to the individual illness removed from its context. To cite Plato, “…that as you ought not to attempt to cure the eyes without the head, or the head without the body, so neither ought you to attempt to cure the body without the soul; and this,” he said, “ is the reason why the cure of many diseases is unknown to the physicians of Hellas, because they are ignorant of the whole, which ought to be studied also; for the part can never be well unless the whole is well…” Curiosity also can include sense of evolution of the scientific disciplines, without yielding to evanescent trends but without holding fast to and defending outmoded positions superseded by time or by new techniques, for the young must study these with determination and diligence;
5.Critical capability, because whatever happens must always be understood and at times interpreted, so that it may be replicated in the same manner or, in the case of error, so that it may in the future be avoided or handled appropriately. It is important to have a scheme, one in which all events inherent to the profession may find a place: this evaluation of facts such as choosing one technique over another or the decision to undertake the radical removal of a difficult lesion from numerous alternative therapeutic options does not always put the same events into the same slot, for decisions are greatly influenced by age and experience. What is important is the constant and repeated attempt not to assign events to an isolated case, but rather to a categorical setting, for this is the prelude to lucidity;
6.Intellectual honesty, or the freedom to understand something without being conditioned by other factors, be they of opportunity or of principle;
7.Flexibility, as the capacity of not continuing obtusely in a one-way direction if that direction does not lead to the hoped for results. Prof Manfred Taschabitscher from the University of Vienna, friend and anatomist of reference, once said regarding a long-standing dispute between users of rigid endoscopes (usually better for viewing quality) and flexible endoscopes, that we should rather prefer flexible neurosurgeons, believing that this, rather than the instrument, is the key to solving the problem;
8.Diplomacy, as the ability to reconcile the different needs manifested within a group of people, is innate to the person and a sign of maturity and stability;
9.Imagination, often useful to avoid falling into the trap of established routine and at times indispensable for certain pathologies and conditions that have multiple facets and that cannot always be resolved by using the identical solution;
10.Respect for the rules, to be in harmony with the daily neurosurgical reality, typically carried out as teamwork. Knowledge of and respect for the rules are indispensable also to understand when it is necessary to make exceptions to the rules.
Practice (see Table 1) or training also improves the quality and the quantity of the work performed, the speed, and the precision with which it is accomplished and builds up resistance to physical and mental strain. This aspect of the profession can be highly influenced by appropriate practice and progressively heavier workloads that, over time, will be carried out with greater deftness and efficiency. To this end, the young person must care for his/her physical condition and learn to alternate vigorous work with adequate rest, determine the number of hours of sleep needed, and find time for hobbies and other recreational activities.
This article is designed as a checklist to assist the young trainee in analyzing his/her objectives as well as one's own potential. It is certainly not intended to create a bionic neurosurgeon, but rather a young neurosurgeon who is conscientious, efficient, and well trained, open to learning, progress, development, and innovation. Science, as we well know, enriches the mind and can improve the life of man. For many, it is faith that provides the ultimate answers.
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