Privilege
II.II.VIII
PRIVILEGE
Halfway through my rotation, I started to realise what neurosurgery really entails. All the bureaucratic and administrative nonsense we dealt with on a daily basis was just clouding the bigger picture. The work that truly matters is the work happening down in the operating room.
Neurosurgery is a specialty of extremes. When it goes well, the outcomes can feel miraculous – paralysis reversed, speech regained, pressure relieved, lives quite literally handed back to people who were slipping away. A well-timed operation can turn catastrophe into recovery, or at least buy precious time and dignity where none seemed possible.
But when things go wrong, they go wrong fast and often irreversibly. There is very little margin for error when you’re operating on the organ that makes someone who they are. A few millimetres can mean the difference between independence and disability, consciousness and coma, life and death.
I remember reading this book When the Air Hits Your Brain written by a neurosurgeon. Its title speaks volumes. In fact, it’s a saying you hear early on in neurosurgery. You see, the brain is meant to live in darkness, warmth, and fluid – bathed in cerebrospinal fluid, protected from temperature changes, pressure shifts, and exposure. Once air hits the brain, everything changes. Swelling increases, tissue becomes irritable, seizures become more likely, infection risk rises, and the brain responds in ways that are unpredictable and often unforgiving. That’s why neurosurgeons move with such reverence and restraint – minimising exposure, working efficiently, sealing everything back up as quickly and cleanly as possible.
It’s not superstition. It’s respect. Respect for an organ that doesn’t forgive carelessness, and one that reminds you, over and over again, just how fragile the line between recovery and disaster really is.
As always, lessons in hospital are usually handed to you case by case. In fact, it took this one particular case for me to fully understand the privilege that comes with our job.
Mr Miracle was a man in his fifties who came in with obstructive hydrocephalus. When he was nine years old, he’d been diagnosed with a severe case of meningitis that resulted in hydrocephalus – an abnormal accumulation of cerebrospinal fluid (CSF) in the brain. Although it was treated successfully at the time, he required a permanent shunt placed in his ventricles to prevent further CSF build-up. In addition, he was left with an intellectual impairment – his innocence and joie de vivre comparable to that of a child. Over the years, he suffered multiple complications, and now he was under our care once again because his shunt had become obstructed.
During his admission, the shunt was replaced, and initially, everything went smoothly. Then, at one point, he became minimally rousable. Of course, this had to happen at 6AM, while I was completely on my own. Thankfully, the departmental nurses were top-notch and knew exactly what they were doing. They followed my instructions to the letter and took the initiative to help stabilise him, all while arranging an urgent CT scan. It was all so dramatic – just like a scene on a medical drama.
Given the urgency of the situation, I didn’t have much time to think or communicate properly with Mr President – his consultant. I rushed him to CT myself, reviewed the scan, and saw that he had developed hydrocephalus yet again. Under Mr President’s guidance, who was still on his way to the hospital, I adjusted his shunt settings, temporarily relieving his symptoms. The second he woke up, I felt like I’d done the impossible. Of course, he still needed definitive management, but for the time being, he was alert, communicative, and stable.
That was when it truly hit me how serious all of this was. I was being forced to do things that were well beyond my level of expertise and responsibility, simply because the department was stretched so thin. I didn’t just want to step up my game – I had to. As terrifying as it was to be trusted with that kind of responsibility at my level, I can’t say I didn’t also feel proud and privileged.
What followed was an unlucky streak of sorts. Day in, day out, patients started dropping like flies – some expected, others completely out of the blue. Suddenly, it became all about damage control more than anything else.
And that’s when the real disaster struck. Christa – the amazing, incredible, formidable superhuman on whose shoulders the entire department rested – was forced into a week-long quarantine after operating on a COVID-positive patient (Mr Miracle’s external ventricular drain insertion). While this was probably the best possible news for her – given that she’d been the only senior covering the department for over a year – it was the absolute worst outcome for the rest of us.
Gary stepped up, and although he was still a bit green, he did a pretty solid job. Bob, on the other hand, lived up to his reputation – more of a hindrance than a supportive senior. It was painfully obvious that, for him, medicine was nothing more than a job, something he didn’t particularly care about. I went to work every day scared crapless, knowing that Jacqueline and I would have to pick up the slack of someone two job grades above us. Knowing that if we missed something, it would likely be missed altogether. And so, we had to be on top of things at all times.
That was real pressure. That was when things could truly go awry. That was when the stakes became dangerously high. We had to be at the top of our game 24/7. And as much as it sucked to be in that position while still being junior doctors, it was also, in a strange way, an honour and a privilege to be trusted with such responsibility. I figured this must be what it feels like to be a senior – that every single day, at any given moment, you’re the one responsible for making life-and-death decisions.
And just like that, our three month rotation in neurosurgery was coming to a close. I had wanted out from the very beginning, but when it was finally over, I couldn’t quite believe it. Mostly because I’d gotten used to the pressure. I kinda got off on it, actually.
Throughout those three months, I went from being a burn out ghost of a human who was on the brink of a mental breakdown, to a confident, more insightful doctor who could finally understand the privilege that comes with what we do. I’d come to realise that although I’m not indispensable and the hospital would go on with or without me, the role I played in the department and in my patient’s life does have a meaningful impact. And, that at the end of the day, my actions had genuinely saved lives.
It was three months of ups and many, many downs. But I still couldn’t believe I’d get to say goodbye to a specialty I’d fallen in love with all over again, to colleagues who had helped me grow in countless ways, and to patients who had shaped my life permanently and forever. Not to mention leaving the office I’d come to call home for three months – the very same one whose walls I’d plastered with CT and MRI scans showcasing the coolest neurosurgical pathologies we’d encountered along the way.
That said, it also came with a sense of relief. This had undoubtedly been the busiest period of my life, and I’d never known stress like it. But, admittedly, it was also the most rewarding. Thank you neurosurgery – till next time!