How I got into neurosurgery and why you should forget about pyruvate

Ronnie Enriquez Baticulon, MDFour Minutes

By Ronnie Enriquez Baticulon, MD

IN MEDICAL SCHOOL, the pun I would hear most often when friends find out that I was interested in Neurosurgey was, “Vegetarian ka ba?” (Are you vegetarian?) Used to the punch line that would come after “Kasi lahat ng pasyente mo, gulay!” (All your patients are vegetables) or any of its variations, I would just grin in response, without ever feeling the need to justify my career choice.

Some would hastily point out the monetary value of the subspecialty, “Naku, siguradong yayaman ka niyan!” (For sure, you’ll get rich!), while still others would prefer to see the glass half-empty, “Ready ka na bang mawalan ng social life?” (Are you ready to forget your social life?) alluding to our neurosurgery residents then who always seemed to be on perpetual duty. It didn’t help that the neurosurgery program of the hospital had gained infamy for kicking out residents, regardless of the number of years left in training.

But being the clear-sighted and goal directed individual I had always been—often to the point of being hardheaded—none of these opinions mattered when I submitted my residency application form four years ago.

From the time I learned the intricacies of the neurologic examination as a first year medical student, I discovered interest in unraveling the interconnections of the brain, the spinal cord, and the innumerable nerves in the body. It amazed me how a disruption in any of these connections would inevitably but quite predictably result in a deficit that would be readily detectable if you do a thorough enough examination.

A reasonable diagnosis could be made in the clinic, and I imagined the thrill of waiting for the CT or MRI that would either confirm or correct one’s assessment, not unlike anticipating a suspense novel’s ending, or hearing the solution to a mathematical problem that took pages and hours before finally arriving at what one hopes to be the correct answer.

Early on, I consciously devoted more time studying the neurosciences and fine-tuning my neurologic examination. The turning point came when I rotated in Neurosurgery during third year. Being exposed to patients requiring neurosurgical care for the first time and hearing life stories from my consultant lecturers during an intense two weeks that was when I said to myself, “Parang gusto ko yatang maging neurosurgeon balang araw” (I’m dreaming of becoming a neurosurgeon someday).

Once more, the universe conspired with me when I took an elective course in the United States just before I entered clerkship. Having been granted immigrant status just a year earlier (after more than a decade of being TNT [tago ng tago]), my paternal aunt and uncles living in New York offered to shoulder all expenses of my one-month stay abroad.

In my elective application form, I originally indicated six elective courses, in order of priority, from which the hospital would pick one. I put the Department of Neurosurgery last, behind courses in Internal Medicine and Otolaryngology. As fate would have it, only Neurosurgery could accommodate me. That was how I ended up spending summer observing craniotomies and spine surgeries in the morning, and walking around Central Park in the afternoon.

Rotating in Internal Medicine as a clerk and as an intern almost made me reconsider my decision. Taught by my diligent residents who effortlessly handled toxic patients by simplifying complex problems guided by evidence-based practices, and who seemed to know the answer to everything (and who could not be disputed during exam feedback sessions because they knew the exact page in Harrison’s where you could find the answer!), I almost wanted to become a nephrologist. The awards for being an outstanding clerk and outstanding intern of the department were tempting invitations, too.

I entertained doubt. Could I withstand first year as a general surgery resident? I knew I could memorize and analyze neurological cases, but did actually have the skill to operate?

On the flip side, did I have the patience to sit down and discuss at length a disease process and its consequences to my patients and their families, relying on their compliance to achieve clinical success?

Ultimately, it was the desire to do life-saving and life-changing neurosurgical operations that solidified my decision, knowing at the same time, that I should be prepared to face mistakes that could lead to permanent disability, or even death.

Among 17 applicants in 2009, I was one of the two doctors accepted in the best neurosurgical training program in the country. After 248 surgeries and a little over a year left in training, it is still with the enthusiasm of a young medical student that I look forward to the day when I would finally be able to call myself a neurosurgeon.

To the medical students who will become licensed colleagues in the next few days, the best advice I could give is this:

Be not like pyruvate, which could never decide if it should become acetyl CoA, oxaloacetate, ethanol, alanine, or lactate.

Where do you go when you don’t know where to go? If to this point you do not know which pathway to pursue, just ask yourself, “What do you want to do every day for the rest of your life?” Choose a field in which you will find fulfillment each day, no matter what, whether as a generalist or a specialist, here in the country or abroad, be it in the hospital or otherwise.

The crucial step is to know what you want, lest you waste time wandering aimlessly.

I have observed that the biggest pitfall among graduates considering residency training is to give too much weight on the amount of work entailed by the residency program. Often, I hear complaints such as “Hindi ko yata kayang mag-duty nang ganoon katagal” (I don’t think I can handle long hours of duty), “Mamamatay yata ako kung ganyan kadami ang pasyente araw-araw” (I think I’m going to die if I have too many patients everyday), or “Ayoko na ng toxic na buhay” (I don’t like a toxic life).

Remember that regardless of your chosen specialty or training hospital, there will be difficult times, especially as a first year and a senior resident. Look beyond the three to six years you will spend in training because that is the life you will eventually live. Our “miserable” time spent in residency is just a requisite. It is inevitable that we sacrifice a part of our selves to make lasting impact on the lives of our future patients.

Vital Signs Issue 70 Vol. 3, December 1-31 2014

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