How I Got into Neurosurgery and Why You Should Forget About Pyruvate

In medical school, the pun I would hear most often when friends find out that I was interested in Neurosurgey was, “Vegetarian ka ba?” Used to the punch line that would come after (“Kasi lahat ng pasyente mo, gulay!” 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!” while still others would prefer to see the glass half-empty, “Ready ka na bang mawalan ng 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.”

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), 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 knowing 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,” “Mamamatay yata ako kung ganyan kadami ang pasyente araw-araw,” or “Ayoko na ng toxic na buhay.”

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.

 

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34 comments

  1. β€œWhat do you want to do every day for the rest of your life?” – yan din sir ang tanong ko sa sarili ko, at isa lang ang nahanap kong sagot. Kahit na ayaw ng parents ko, sabi ko sa kanila na “ito yung gusto ko gawin buong buhay ko, at kaya kong mahalin na trabaho.” πŸ™‚

  2. Sir, it’s like you are reading our minds! Thank you for this post. (And wow, 248 surgeries!) πŸ™‚

  3. Hi sir. I’m a 4th year med student from dasmarinas, cavite, and an avid fan of your blog.

    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, β€œWhat 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, …

    This is almost the the exact statement my aunt, a family physician practicing in LA for almost 20 years now, told me before i entered medical school 4 years ago. at that time, i was like a ‘pyruvate’: undecided of the path i should take. But bearing that message in mind and after being exposed to ‘Diabetes Mellitus Type 2’ and its complications (after my dearest grandmother suffered from the disease), I developed A DESIRE AND INTEREST to go into the said ‘subspecialty’ in the future – 2 qualities that, in my opinion, are important to invoke and empower us to carry on towards the path we would take. THank you for sharing this wonderful message to ‘starters’ like us πŸ™‚

  4. Sir ronnie, thank you for this! I was 13 when i told myself that i will be a brain surgeon someday. But after rotating in nss and the opportunities you gave me, i started asking myself if i want it so bad. Sometimes, when i see a big bleed or an aneurysm, i feel giddy and excited. Sometimes i don’t. I am not sure if by 2014, i will submit an application in ur department. I hope i will. πŸ™‚

    • Hi Joan! No need to rush just yet. Choosing a residency training program is one of the most crucial decisions you would have to make in your career as a physician, so think hard and think well. In the mean time, relish what remains of your medical school πŸ˜‰ And yes, you are welcome! The entire team is glad students are enjoying the rotation.

  5. Hay naku Ronnie, my thoughts exactly right now. Pwede talaga pumasok sa isang bagay na kaya mong matagalan for the rest of your life. I guess it applies naman to all professions. Thanks for this nice read.

  6. it is good that you realized what you wanted before applying for residency..so to all medical students, be open for anything..i initially wanted to get into General Medicine ( Int Med) and decided Family Medicine Training instead, and now as a full fledged Family Physician, i couldn’t imagine being a different one. I truly enjoy my work, counselling patients and their families, seeing varied cases everyday. It only needs you to realize what you want to do in your life everyday that will help you decide as to what kind of a doctor you want to become..but whether be it a generalist or specialist, as long as you put your heart into it and do it not for the sake of money, i assure you that you will find fulfillment in it. Happy discernment to all medical students lalo na yung kakatapos lang mag board exams!

  7. The refusal to remain pyruvate came on two nights: when i was dissecting my cat during zoology 10 and my first appendectomy. Both left a deep enough impression that no matter how late it was or how drunken with sleeplessness and exhaustion i was, i am happy with what i was doing. Thank you for reminding me, doc ronnie πŸ™‚

  8. Inspired! Thanks doc!

  9. Janellyn Orpilla

    Hi Doc! Inspired by this blog entry because I myself wanted to become a Neurosurgeon just like you. I’m currently a medical clerk at a government institution and I know how it feels to handle numerous amount of patients. ‘What do I want to do for the rest of my life?’ More than the fulfillment that each day would bring me, I think being in the same field like yours would continue to sustain that passion for me to serve our fellowmen. I’m getting excited as the years go by.

  10. very inspiring sir not to mention kung ano ang natapos ko paniniwala ko kapalan lang ng mukha lakasan ng loob, pagiging humble at tiwala kay God ayun nasa ibang lupalop ako ng Europa masaya sa propesyon ko ngaun kahit na araw araw humaharap at nag titreat ng mga neurologial and musculoskeletal problematic young patients araw araw ko din nararamdaman ang saya ng aking ginagawa habang unti unting tumatanda na ko im 29yo still kicking happy and keeping my feet on the ground living my life my profession to its fullest. and all of these i offer it to God.

  11. ROBERTO DAROY, JR.

    From all the articles you’ve written, wala pa ring tatalo sa five valedictorians. It is indeed truly inspiring. More luck to you Dok Ronnie.

  12. Hi sir! I really want to be a neurosurgeon someday. I’m a third year college student right now, and I already decided to take the challenges of Medicine after. Thank you for your inspiring stories! πŸ™‚

  13. wow. Ito iniisip ko gabi gabi sir! πŸ™‚ Ayoko ng maging pyruvate! Good read. thank you po!

  14. I agree with everything you have written, I have always believed that real success is happiness, and happiness is about doing what you love. And to know what you love, you just have to reject all the preconceived notions of success set by the society. Forget about the money, the fame, the title, and everything. Strip your field to its very core, and if you’re still passionate in it, then that’s it. I know a lot of med students who only want to be doctors because of the title and to feel that they are “smart”. Some of them are not aware that their reasons are like those, since their coping mechanisms made them believe that they really do love the career, even if they obviously don’t. Defining and following what you love is very difficult, but very worth it.

  15. Thank. You.

  16. I’m still like pyruvate at this point. Thank God I stumble upon your article Teacher. The next skill I want to imbibe from you is the clear sightedness and the goal – directedness that I couldn’t seem to grasp. I wonder what area in the brain is reaponsible for thAt. And Doctor, I want to thank you because its like you made the exam. Thank you for all your efforts!

  17. Veronica A. Galla

    I had kids who were like you. Am glad they are not pyruvates. I love this article. Nakakataba ng puso na hindi pala ako nag-iisa. More power to you, Doc!

  18. A great question to ask especially when you’re in a period of transition. πŸ™‚

  19. […] few days ago, I chanced upon this blog by Ronibats, a University of the Philippines College of Medicine graduate and a neurosurgery resident in […]

  20. […] is that even drops can ultimately alter a solution.Β  A few days ago, I chanced upon this blog by Ronibats, a University of the Philippines College of Medicine graduate and a neurosurgery resident in […]

  21. This is very inspiring and you are very inspiring sir. Thank you for sharing this. I hope we could invite you someday to speak in our school to inspire medical students like me. God bless you sir.

  22. Hi Ronnie! I went into Anesthesia despite my dad (who’s an anesthesiologist himself) insisting that this field is so inforgiving to females because our time is not flexible. I know he was just looking out for me, because he knows I wanted to raise a family of my own in the future. But I took a risk, anyway. Five years into the specialty, despite all the cuts and bruises I sustained along the way, I couldn’t imagine myself being in any other field. And I took it a step further by entering cardiothoracic anesthesia fellowship. My dad still remains to be my number one fan.

    My advice to fresh Med boards passers? Choose a residency program that you know you will love. Many times during residency training, I felt like I was in hell: the hypoglycemia from skipping meals, the sleepless nights, the war freak sugeons (haha!)–but what will get you going is your passion for your profession and the desire to become the best that you can be in your field. You really have to love what you’re doing to be able to withstand all the challenges of residency.

    What a mouthful. May #hugot pang kasama. Hahaha. Ronnie, thank you for this article. I just had a tough case today, and this one inspired me and reminded me of the reasons why we do the [crazy] things we do: all for the love of our specialties.

    God bless, dear colleague!

    • Hi Kaye! Sorry for the uber late reply. Thank you for reading. I can only imagine the pressure of having to live up to your Dad’s standards. See you when I get back πŸ™‚

  23. Hi sir ron! Sobrang avid fan ako ng blog mo.. I’m having a dilemma right now kaya binasa ko ulit itong article mo.

    I was having a hard time right now. I’m a fresh grad and decided to take neurosurgery. I applied in different hospitals (merong private and public). Nakapagpreres ako sa isang hospital and I quit! Sobrang nagkaroon ako ng doubts kaya ako nagquit.. Iniisip ko kung fantasy ko lang ba ang neurosrugery since ito talaga ang dream ko every since pumasok ng medicine. Sobrang nanibago ako sa sked kasi nga perpetual tapos naisip ko pa hindi ako matalino kaya parang nahihirapan ako magcope sa sobrang daming binabasa. But still, after a few days of thinking narealize ko na ito ang gusto ko. Sana pag pumasok ulit ako sa ibang hospital, kayanin ko na ang rigors na kailangan para sa program.. Ayoko na maging pyruvate! Neurosurgery all the way na!! πŸ™‚

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Names, dates, and events may have been changed to protect the identity of patients. The stories are not meant to provide medical advice for specific illnesses. The author neither accepts online consults nor gives medical advice online. Please consult your trusted physician.