EXPECTATION IS PREDICTABLE REALITY IS A LEAP

By- Dr. Geeta Sundar, Senior Resident, Dept of Neurosurgery

I am yet to become a neurosurgeon. And I will, someday, surely; the path is already writing itself. But from my imagination that runs wild to bridging to an actual world in neurosurgery, the gap is more than a cup slip from the lip.

It is filled with wizardry, miracles, tears, humor, honor, vitality and teaches lessons in humility, stress management and essential life principles.

A reality when it matches the expectation, that is ground zero, that is happiness par zenith and probably what is called luck. But when the expectation is so far fetched from the reality, it is in essence all that life teaches us. I face a ton of subjective emotions in this roller coaster of a journey to becoming a neurosurgeon. These are my own expectations intermingled with the reality that I see, I understand and perceive. It is my very own ocean of prejudice and my own realm of universe

There is fear. A lot of fear hovers. Confusion, trepidation, uneasiness. All accompanied as I handle new cases for the first time. How much should the angulation of an EVD be? How much deeper must the drain be placed? Am I going to make it bleed more? Can I achieve haemostasis? When I hit the dura, will I know? What if I don’t get it in the first attempt? How do I explain the mistakes I made? So many more and so many more. Persistent, nagging, obstacles of doubts, of worry, of self-deprecation, of decreased confidence in an ability to perform a given technical skill. There is also fear in informing bad news to a senior consultant, or owning a mistake, fear for calling a senior multiple times for help, fear in stepping up to accepting your under-preparedness and knowledge for an OT case, fear of presenting an important seminar, or simply put, fear of facing patient relatives who won’t understand you did all you could.

While in expectation, a picture-perfect Instagram post or news article will usually depict a victorious neurosurgeon. Unknown to the outside world, that surgeon’s nagging doubts are pushed to the side, to the back of the bitter pill as it gets swallowed down by an exuberant confidence portrayed to the patient and his family. He knows the fear, he understands the fear, and he can overcome it with experience and the wield of his cutting hand.

There is sadness. Almost like dissociation. That sometimes you feel an out of body sensation within your own systems. Like the words you speak are someone else’s. Or the words you hear are being experienced in an alternate universe. You feel a connect and disconnect at the same time with each of your patients and their families. You lose touch with reality, that morbidity can hinder your functionality to a low spirit, that sometimes all you can offer when they weep is a broken-hearted lip twitch, hoping to convey each ounce of wretched feeling you experience.

In expectation, you are every positive, hopeful, kind, compassionate and can cater in every way to aid the patients and their families. Its all smiles, all the way. And there are no sad or bad outcomes. And there is always of a super inflated ego you bolster and carry in your stride, for you can do no wrong and you are above all the opinions and people. You are not a coward and there is nothing you can’t master. You are not affected by pain, or suffering and can walk away from all your see with the coolness of a samurai.

Frustration. Irritation. Impatience. Stress. Annoyance when someone wastes your time as if its their to borrow. Especially when you have a million more seconds you need a day to just care for your own health, your food, or even sleep. Voluntary impatience becomes a part of the routine all too nicely. The triggers are often too easy, too many and too superficial. Anything can set you off, sometimes the anger is a friend, torching your throat and words just so people would lay off you and give you seconds to breathe and catch a minute of pristine silence. The calls are too many, too often and too silly. The duties are too long, too packed and stressful. And when one domino falls, the succession drops to the ground with chain reaction in all the little things you take part in that day.

In expectation, a call is a sweet reflection of orders and advice from a doctor to his patient or nurse, instructing them in an amicable voice. The virtue assumed is that patience is an inbuilt nature for a neurosurgeon, since he/she needs to know when to exercise finesse in his dissection and haemostasis, and it won’t be so hard to bother a neurosurgeon with repeated calls, texts and information.

You make friends in the most unlikely places. Cats, dogs, are the best friends at the end of a long day. They offer more nonverbal love than a friend in your own department. The nurses, the hospital help are far more sympathetic towards you than your own colleagues, and seniors, for they offer a semblance of motivation that can get you going so you can cross the finish. Family is always a call away, but you refrain from their words since they can smother you with so much love that you get homesick and forlorn. There is rarely anyone large hearted enough to help you, provide you a safe haven. Unfortunately, there are people who go out of their way to needle you, boss you around, just to prick the bubble and see if you burst out flat. And then there million new people you meet each day who are not friendly, on your wavelength and refuse to see your view which ultimately causes friction in the wrong direction.

In expectation, its assumed that you are people pleaser, a people person and the fantastic people working with you are a team and will care for you, respect and help you. It’s considered a given that there is no I in Team, and there is a very large number of people a neurosurgeon enlists with – anaesthetists, OT techs, nurses, patients, other consultants, neurologists, and each interaction is always fruitful, and full of mutual amicability.

Sleep and food are luxury. Each meal is a token of gratitude; the moment the food enters your mouth to the minute you feel a happy stomach, is actually an honest solitude of precious tranquillity. Food becomes a goal, but sleep is the ultimate love interest in a resident’s life. I’d choose sleep over food any day. I’d sleep on any surface large enough to hold me, if I could.

In reality, you are not considered to be human. They assume you are a god, or some version of a superpower who can function with no food and sleep and they refuse to understand that a feeling of hunger in them is the same in you, and maybe worse if you consider all the stress that you weave. It’s as if they expect that someone this capable of complex brain surgery should have no human requirements, at all.

Being a woman in this field is not simple. There are niches, crevices already carved out in stone and carved out in ages of peoples’ minds on how women are or have to be, and whilst the narrative may change in some years to come, the seniors from generations ago, are yet to fully permit women to explore this world. I am no damsel in distress, but I see how their mind works – only if I act like one, and cry, or weep, have a husband, or act feminine enough to behave as per their definition of a woman, or show my weakness, are they more forgiving to let me make mistakes, and let me into their little tight knit circle. But if I am aloof, introverted, silent, tomboyish, I don’t fit their bill and so I am excluded from conversations they would normally openly have. They won’t understand the multitasking ability required for a woman to handle a child and her own intense passionate interests. They will often say – everyone does it, why are you so different, and push away your struggle like it means nothing.

Expectation of a woman in this field is yet in its formative years, largely situational, although for many decades women have had representation, although meager. A superwoman is someone who can handle the life of her professional neurosurgery and her home with finite, intricate balance and be an ideal hero in the perfect version of ‘work-life balance’.

Family, is family, warts and all. But sadly, often forgotten, and victims of my daily negligence. I care too much about my family, but I can’t be there for them, physically, or even spend a whole 5 minutes talking to them, listening to their woes, before someone interrupts with a ring on my phone. I am unable to provide for them completely in any which way I can. And most importantly, long distance love can’t be maintained; it crumbles under the sheer unavailability of one of its main beings, and it’s often fight over argument or even avoidance that leads astray.

In expectation, love and family always finds a way, and you appear out of thin air, where all the boxes are ticked in clear succession – your OT is done in time, there are no complications, you are able to drive fast, the traffic works for you in unison, and you can still make it your son’s cricket match in school or your wife’s friend’s birthday party! And the person you love looks up at you in adoration, pleased, beaming at the feat you accomplished.

Learning is part evolution, part instinct. But learning is also highly dependent on the environment you are put in. Morale is very much a need for studying. And so is camaraderie. When friendship fails, or competition is high, favoritism is palpable, and there is a lot of distinction between residents, working and learning together gets affected. Learning is not spoon-fed, no one tells you where to look up something, or how to approach a concept, or how to strengthen your base in a subject; and sometimes one is thrown into the ocean and has to learn to survive despite the sharks. Makes one tougher, probably, but getting thrown under the bus isn’t easy to adjust to. There is no protection, no embrace like family, and exposure is grossly blatant. There is much permutation and combination around personalities, that understanding each other is a problem, ultimately affecting patient care.

In expectation, residents move around like a pack of wolves, each protecting the other and being there for the other in times of need. And there is no animosity between them. And they work in unison, and work for the betterment of the patient.

The above may have reflected lot of hard, cold facts, and bordered on blue, but being open to all possibilities, refraining from visualizing another’s reality, avoid believing much in the hyped media, with having no serious expectations, can go a long way in creating an atmosphere where one can function with the least drudgery. The same holds true for all fields. Reality can be as beautiful as you believe it to be. Reality can be as amazing as you feel on that particular day. Reality is a product of you, and yours to claim when you label it!