As people have learned that Surgical Neurology as a journal will end, I have received many notes and comments from our readers about how much the journal has meant to them. I am overwhelmed by these comments and most appreciative.
My gratitude is to you the readers for the opportunity to bring new information to you. I was able to teach many neurosurgeons things I have learned over the years from my mentors and from my experiences in medicine and neurosurgery—and to learn from you, from your comments from visiting with you, and from your papers over the years.
To be an informed Editor, I read or scanned 60 medical journals a month, and read 9 newspapers each day from around the world to keep abreast of the changes that were happening in the many countries we visited. I read many financial publications because I found that the most interesting ideas were supported by a creative and entrepreneurial business community as sources of investment. I read countless books on different subjects and became familiar with the political changes worldwide, stimulated by being in so many countries and talking with colleagues from all over. For this education I am very grateful to every one of you, for it is an education of immense value to me, and one that is priceless.
In my opinion, neurosurgery is not about being a technician—for if the specialty of surgery or neurosurgery descends to a mere technical enterprise, these professions will become mindless occupations. I used to read reports of surgeons doing hundreds of operations, which I found boring. What is interesting to me is the challenge of solving the complex problems that patients present to us, creatively using all of our intelligence and character to produce successful outcomes and the patient's happiness. I am interested in the creative and innovative answers to life's problems. Those answers know no geographical boundaries.
There is no room for complications in taking care of patients. What we do, we must do with thought, knowledge, skill, and most of all, superior judgment. I have often said that I can teach a monkey to operate, but teaching judgment is the key to a fine surgeon and a fine physician. Not all people with back pain require surgery, nor do all people with a GBM require a resection. A teacher of mine, Dr A.B. Baker, a famous neurologist in the United States, said, “Treat the patient, do not treat the disease.” And he is correct, for each patient requires a treatment that fits that patient. So, we must understand our patients deeply and thoroughly before we operate, and while we operate. Before I operate on a patient, I visit with them and ask about their family. I am not operating on one patient but on the whole family. That interview haunts me during the operation, so that I do what is best for all.
I have read many papers and studies that supposedly guide us as to what choices to make in medicine. Randomized studies are meaningless as in most cases they do not represent the patient I am seeing. These studies can be a guide at most. Yet, there is one rule that, to me, is the simplest rule of them all: ask yourself what you would do if the patient were your brother, sister, mother, or father. Then, that is the treatment you choose for the patient. Because every patient is our father, mother, sister, or brother, and the patient deserves no different treatment than any member of our family. That is my basic rule in medicine. That is fundamentally what I have against socialized medicine, because the state is more important than the individual. I do not agree with that philosophy.
I remember a farmer in Minnesota I operated on who had a glioblastoma. His daughter asked him, “Why you Daddy?” His answer was, “Why not me?” His answer was humbling. I have never forgotten that answer. It was from a person with truly fine character. We all learn from the greatness of our patients.
In medicine, we are encouraged to develop standard approaches and treatments to problems, but to me there is a higher principle. Does this treatment make sense? Does the patient's story make sense? I wrote an editorial some years ago (Surg Neurol 60:274, 2003) which stated that the most important question in life is “why?" Not “what?" or “how?" or “when?." For when you know the answer to “why?" you know “how?," “what?," and “when?." That is the fundamental question of science: Why?
What we do must make common sense, or why are we doing it? We must examine everything we do, and have a good reason why we do it—from every step we take in surgery to every other thing we do in life. We should not do things simply because others are doing them; that does not make sense.
Our experience in neurosurgery is a guide for life. The questions and challenges we face in life are no different than those we face in the operating room or in solving a patient's problem. The stakes are high as the patient's life is in the balance, and they depend on how wisely we have prepared the diagnosis and treatment. I have seen physicians and surgeons who leave the hospital only to function in committees or life without the logic and sense they learned taking care of patients. There is no difference where you confront a problem; the problems must be solved in the same manner whether they are faced in the operating room, in your family, or in business. Solving problems in medicine and neurosurgery teaches us great discipline, and this is superb training for which we should all be grateful. We should use this knowledge and discipline to solve all the problems we face.
So, in many ways, Surgical Neurology is about “Why?" and “Does it Make Sense?" and also the principles of medicine and life. All of these are necessary to be a good neurosurgeon.
So, for the opportunity of being able to teach you and to learn from you, I am most grateful.
Thank you all.
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