Q) So, Dr. Cohen, you’re a practicing neurosurgeon. In my estimation, neurosurgery must be one of the most demanding and stressful professions in the history of mankind. How do you sleep at night?
A ) All in all, actually pretty well. The workdays are usually pretty full and by the time I finish and transition to evening activities, I usually pass out pretty quickly. The only issue is being awakened when I am on-call, which is half the month.
Q) No seriously speaking. I’ve always been fascinated as to how a person decides to dedicate themselves to such a challenging craft. Was it a deep sense of spirituality that made you want to pull people back from the brink of death on a daily basis? Or perhaps it’s an adrenaline thing?
A) Good question. I actually went into medicine with the hopes of being a plastic surgeon. I was a tennis pro, and was teaching 2 prominent neurosurgeons which helped push me in this direction. My mother was a neurosurgical scrub nurse and I made her a promise I would watch a case during my surgical rotations. I was instantly fascinated by the first craniotomy. In all candor, it was the only discipline that truly scared me in terms of the risk and reward. Knowing myself to an extent, that type of work environment I knew would constantly challenge me and keep me on my toes and would prevent the potential of complacency.
Q) Got it. But do you think there are other neurosurgeons who chose to become neurosurgeons because society puts you up on a pedestal? Perhaps the ego, or a G-d complex, really is a prime motivator? Be honest.
A) Ha, there is the old joke that the difference between God and a neurosurgeon is that God does not think he is a neurosurgeon. There is always ego in medicine, and enhanced ego in surgical subspecialties. My theory is that the surgeon who tells you that he does not have an ego is usually the surgeon with the biggest ego. I have quite an ego, but I think I am self-aware and that I try to balance it with my superego and a little bit of id. I have always been uneasy with the concept of someone demanding his social status by his job title. This goes throughout all different types of jobs. Patient satisfaction and kind words from patient’s and family are one of the best aspects of the job. I would say for myself though that regardless of any feedback, solving the patient’s specific problem AKA a puzzle, and leaving them in a better condition then I found them, is the ultimate satisfaction.
Q) How can Sanjay Gupta practice neurosurgery when he’s always on CNN? Is that safe? Do we know if he actually still goes to the OR?
A) I am not sure how much clinical work Dr. Gupta actually does during his work week or month. It is possible to have outside interests that can be balanced against one’s surgical workload. It would be very challenging to have a full-time job outside of the OR and still be able to give a sufficient effort inside the OR.
Q) What is the most technically challenging neurosurgical procedure and why?
A) Among the varying neurosurgical procedures that I perform, tumors on the skull base, in the posterior fossa as well as the spinal cord pose the stiffest challenges. In a field that has very little margin of error, these are the procedures that offer you literally no margin of error.
Q) It seems to me that today people are constantly rethinking their career choices and recalibrating their work life balance. However, it takes so long to become a neurosurgeon and I would imagine one’s identity gets really wrapped up in it. Do you know of any colleagues that have taken long sabbaticals? Or have made career pivots?
A) I do know of a few. Early in my training, a senior neurosurgeon took a year off and went to Australia to study the skulls of early humans. It was not uncommon to see residents in
neurosurgical training that would hit the wall and decide to move into other disciplines. I applaud the ones who did because if it was not the right lifestyle/work style, they would have had a miserable career. In my first year of residency, I contemplated multiple times whether this was the right course for me. I am glad that I stuck with it.
Q) What about dating or being in a relationship with a neurosurgeon? Any advice?
A) Well, during my residency, there was a 100% divorce rate amongst the residents and junior attendings. My best advice to someone in a relationship with a neurosurgeon is to have patience with an ongoing long, schizophrenic work week. It is imperative that they have their own interests and activities that can keep them occupied while their spouse is at work.
Q) If you were reincarnated with the same intellectual abilities what would you do in a subsequent life? Would you still crack skulls open for a living?
A) Not necessarily, but I would not be surprised if I came back doing the same type of work. This ultimately is my third career and there were a lot of twists and turns that ultimately led me to where I am today. My father wanted to be a doctor when he was 5 years old and he took a straight course to it. My course was more serpentine, but I would say that if it was not neurosurgery, it would be some other parallel career that was not 9 to 5, had enhanced stakes in the outcomes, and would leave something in a better condition than it found. I would also add that my life experiences and work experiences prior to my training in neurosurgery were tremendous enhancers to my career. You do not experience the world and see the world in medical school. You do not read Shakespeare in medical school. Until recently, you did not learn bedside manner in medical school. You do not learn a foreign language in medical school, except a little Latin and Greek. So my parting advice to anyone thinking about this as a career is to get a little life experience and flavor before you dive in.
Dr. Cohen is the Chief of Neurosurgery at The Brooklyn Hospital Center.
Interview conducted by Eric Dessner MD.