Ruling out neurosurgery? Ruling in Hospital Medicine?

So last week I finally shadowed a neurosurgeon. I went into it thinking that I would like to do neurosurg for the following reasons

1) The brain is my fav organ system
2) I like working with sick patients (neurology patients tend to be more chronic outpatient care which I don’t like so much)
3) Neuro is a wide open field with a lot of growth potential and where the potential for technology innovation is HUGE in the coming decades
4) The idea of doing something where you really have a chance to help people in a profound way (I saw a neurosurgery patient with a DBS device who literally demonstrated turning on and turning off a debilitating tremor)

However, my experience was somewhat less satisfying. Although Dr. R, the Chairman of Neurosurg here graciously offered to let me shadow him and is one of the most dynamic docs I’ve met so far here, I found myself being a bit appalled at the culture. For example the chief resident, upon learning that the intern was post-call (which means that he had been up for 30 hours already and was leaving that morning to go home) referred to the intern as part of the “new generation that has to go home”. As for the surgeries themselves (I got to watch a temporal lobectomy and a DBS placement), I found myself not enjoying standing (very) still in one place breathing through my mask and not looking forward to 2-3 years of doing suturing as an “assistant” in the early years of residency before actually performing surgeries. I also didn’t like that the surgeons are so bound in one place and one function by their patients and that the residents all seemed really hard core and uni-dimensional. Overall, I think its a fantastic field but the adrenaline rush of doing these very long and very precise and methodical procedures has to be such a high that you forget what time it is, forget your need to go outside, go home, and have a life outside the hospital for you to really be able to even survive the training for something like neurosurg or any surgery for that matter. Unfortunately, I think for me, its really not enough and I found myself missing the constant excitement and diversity of patients, managing expectations and communicating and leading the hospital team activities of my inpatient rounds with Dr. Perras in Hospital medicine.

One highlight from the day though was our second patient who coded (likely due to some error in anesthesia) during a routine procedure and the ensuing chaos of trying to resuscitate him, thinking at one point that he was gone and feeling an eery tingly feeling go from my head down to my spine through my arms and legs. It was like one part shock, one part excitement, one part helplessness and I think it made me want to go into ER or ICU medicine even more than neurosurg!