Archive for the ‘Neurosurgery’ Category

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One of the interesting things about being in medicine is that friends and family consult you with all kinds of medical questions at any time. The questions span speciality (I was asked about a brain tumor, cramping and a bad cough in the same week!) Honestly, I enjoy it: it’s like an unplanned case of the day, and it’s a chance to be helpful. In many cases, I can simply put someone at ease. The movie “Dead Poet’s Socity” spoke about two kinds of professions, the “life sustaining” ones like medicine and engineering and the “life enriching” ones like literature, music and the fine arts. My reward in Acting was to (ideally) give my audiences a meaningful emotional experience by the end of the play through the life of my character, that is enrichment. In medicine, my reward is to use medical knowledge and skills to help patients feel better, sustainment. So, I appreciate the inquiring phone calls and texts and I would like to take you back to one in particular . . .

Last week, my sister texted me, concerned that her daughter (my ridiculously cute niece:) had a high fever and a cough. As I gathered the history and started working through the mental algorithms for what could be wrong, I happened to catch my niece’s voice in the background. She simply asked “What is that?” I think I have may have gotten more information from that audio signal than almost anything else in her story. Why? People who feel very sick are not curious. One of the things we learned in evaluating pediatric fever is that the exact tempertature is not as important as how the child appears. That takes observation, attention. I appreciate that because it feels clinical. A computer can work through algorithms but a only a clinician can be a medical Sherlock Holmes and notice personal, intangible atrributes that crack the “case.”

Paying attention matters not only in diagnosis but treatment. While on a neurosurgery service last year, I encountered a patient who required an operation to remove a brain tumor. Due to the tumor size and location, the patient had a devastating choice, to either lose the ability to read or to hear on that side, depending on which surgical approach was taken. Losing hearing or reading is more than a medical choice, it is a human one. One must ask the difficult question of which option would reduce one’s sense of self more profoundly. This question is approached by a patient who pays real attention to who she is, as well as family members and yes, doctors, who have done the same. No matter our profession, we will learn the same algorithms: law students learn the law, pharmacy students learn the drug mechanisms, but effective decision making in the grey areas seems to reward those who pay close attention to the nuances that no curriculum can adequately capture. Even in the enrichment professions, the actor who not only knows the lines but pays attention to the demands of the performance moment will respond with that spontaneous artistic choice that we recognize as brilliance . . .

By the way, I think we made the right call on my niece. She is doing well . . .

 

Tom MboyaHow is he holding it together? I asked this question often while Tom Mboya was being grilled by a panel of veteran journalists on Meet the Press. I stumbled across an audio recording of this 56 year-old interview and I was riveted, not just by the content but by the poise of Mr. Mboya, a mere 28 years old at the time. Tom Mboya is widely regarded as one of Kenya’s greatest losses, an articulate and intelligent politician, gunned down by an assassin’s bullet at the age of 39. He was one of the fearless architects of Kenya’s independence, but what was there to learn from a 56 year old audio recording of this interview in the US? As it turns out, a lot.

One by one, each journalist asked Tom Mboya pointed questions essentially asking one question “Was Kenya really ready to govern itself.” Some of the questions were at best paternalistic and at worst condescending. Yet, Mr. Mboya remained calm and responded with thoughtful logic, well-crafted arguments and measured passion. It was such a refreshing change from the loud but often empty arguments that present themselves on many modern talk-shows where you wonder if anyone is really listening.

Mboya’s poise in this interview is a further example of something that has been on my mind lately, “bold humility.” I think of it as the sweet spot between confidence and deference. We have all witnessed (or perhaps even perpetrated) the ambitious and confident but ultimately obnoxious personality, with no awareness of personal limitations. On the other hand, we can be humble and deferential to the point that we neglect truth and justice for the sake of not “rocking the boat” or “keeping the peace.” And that is what struck me as so impressive in Mboya’s interview: Even though certain questions called into question the very intelligence of his people, he respectfully, yet boldly and without apology stated his goal, a free Kenya, now. I would submit (to use Mboya’s phrasing) that professional excellence arises from the mastery of the tension between humility and confidence or “bold humility”

In acting for example, the actor must be bold, walking onstage in front on thousands of people with thousands of lines in his head, memorized patterns of movement all over the stage and possibly lyrics, music and dance steps as well. All this is expected to be performed with precision, emotional availability and, where appropriate, flair and pomp. This can be done timidly, but to truly communicate the character, the actor has to risk everything, including public failure to truly shine. That takes boldness. And yet, the most accomplished actors know that the moment the performance becomes about them, the moment they lose the humility that puts the character first, the performance loses its truth and its power and rings false. And this line is so thin!

In medicine, patients expect a certain degree of confidence from their doctors. And yet, there are also those moments that require humility. Consider when the neurosurgeon has courageously taken on a difficult tumor surgery but pauses during the surgery and concludes it’s time to stop the operation. She is too close to a nerve, a vessel or language center. She has the humility to stop the operation there, but also had the boldness which allowed the patient a chance and perhaps bought more time to be around family. Again a thin line exists. How close is too close?

How does “bold humility” play into your choices?