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Brain gain

The head is a sacred space that only a very skilled specialist like a neurosurgeon is allowed to invade, says Ayesha Banerjee

education Updated: May 26, 2010 10:39 IST
Ayesha Banerjee

Think about the brain. It is the seat of learning, the sanctum sanctorum of wisdom. It is that one critical organ which ensures man’s superiority over other creatures. Our memories, our thoughts, our survival, all our innovations, experimentations and explorations that have taken us from the deepest levels of the blue oceans to the farthest blurred limits of outer space, are controlled and regulated by the brain.

And it takes a highly specialised man or woman to tinker with this super delicate and superpowerful organ – no bagatelle definitely.

“A neurosurgeon, who is often thought of as being next to God, faces the challenge of getting it right every time, hence the stress,” explains Dr Rajendra Prasad, FRCS (neurosurgery), senior consultant neurosurgeon, Indraprastha Apollo Hospital, New Delhi.

Dr Prasad was attracted to the profession because of the aura of exclusivity, “and a certain romance surrounding neurosurgeons”, little realising that it would take him “on the road of hard work, long hours, extreme discipline and a lot of personal sacrifice”.

A romantic at heart who was “predestined” to follow in his father’s (the first neurosurgeon of Bihar) footsteps, Dr Prasad was “heavily into stage acting at one time.” His mother ensured he picked up the scalpel. After graduation from Ranchi University, Dr Prasad went to the UK to specialise in neurosurgery after obtaining the Fellowship of the Royal College of Surgeons. “I trained and worked at the University Hospitals of London, Nottingham and Bristol over a 10-year period, returning to India in 1996 when the state -of- the-art Apollo Hospital, New Delhi was set up by Dr Prathap C Reddy. I am now proud to be part of this hospital, which has one of the best neurosciences centre in the country,” he adds.

Be prepared for a long, arduous haul before you get to don your scrubs. You’ll have to first pass MBBS and then do MS general surgery through an entrance examination. Says Dr Alok Gupta, senior neurosurgeon and unit head, VIMHANS, New Delhi, “There are just 25-30 neurosurgery seats and candidates appearing would not be less than 40,000 to 50,000. The course itself is very difficult. It is a 24-hour-seven-day job for three years. Throughout this period you have to be on your toes and hardly get any time to sleep. I remember at PGI Chandigarh we used to sleep after three days for one night.”

Medical science, says Dr Gupta, who was chief neurosurgeon at Escorts hospital Faridabad before joining VIMHANS, has made amazing progress since the 19th century, when it was said that bed rest was better than neurosurgery. Now, doctors are aiming for zero mortality in surgery. All brain tumours, spinal tumours and cervical disc problems, brain haemorrhage, head injuries etc, are treated by neurosurgery.

When he was young, says Dr Gupta, a tutor’s younger brother suffering from Parkinson’s disease was reportedly cured after surgery in a London hospital. “That was fascinating and I started and revived the same surgery for Parkinson’s disease in India,” adds the man who did his MBBS and MS in general neurosurgery from GR Medical College Gwalior and later on an M Ch in neurosurgery from G.B. Pant Hospital in New Delhi. He has also done extensive training in stereotactic (requiring minimally invasive interventions) neurosurgery in A.M.C Netherlands, Karolinska Hospital Stockholm and the Singapore General Hospital. At VIMHANS, he says, “we are doing surgery for Parkinson’s disease and gamma knife surgery for selected tumour by high beam of radiation. Epilepsy surgery and surgery for psychiatric patients is also going to start shortly.”

There is need for more neurosurgeons in the country. “At present there are only 2,000 in the country. Many districts don’t have a single neurosurgeon. The number should increase. The problem is that we do not have the required number of teaching institutes,” says Dr Gupta.

There is urgent need in this country for skilled practitioners to work on minimally invasive neurosurgery, stereotactic neurosurgery, surgery for behavioral disorder, stem cell surgery for disabling illnesses like Parkinson’s, multiple sclerosis spinal trauma stroke, etc, he adds,

Doctors Prasad and Gupta and Dr Rana Patir of Max Healthcare admit their work is very stressful. Despite the tensions, however, there are equally great moments daily, says Dr Prasad. “I see miracles happen when a paralysed patient is able to walk again. Like all surgeons I thank God for these ‘gifted hands’.”

Through the course of his career he has also developed an interesting philosophy on the existence of a greater force. “The deeper I got into the study of the human brain,” says Dr Prasad, “my conviction grew that there was a God. The perfection with which the brain and spinal cord was created strengthened my belief in the Divine Creator.”

What's it about?
Neurosurgeons operate for problems related to the spine and brain. Spinal surgery is done for slipped discs, dislocations, fractures, tumours, vascular malformations and congenital deformities. The brain is operated upon for tumours, head injuries, brain haemorrhage, brain bypass surgery, aneurysm and vascular malfor-mation. Neurosurgeons also perform various endoscopic (with small incisions) surgeries within the ventricles or the skull base

Clock Work
This is what Dr Rana Patir’s day is like
8.30 am: Reach hospital, check patient in operation theatre who is being prepared for anaesthesia, check position of patient on operating table and discuss approach (to surgery) with assistant
9 am: Attend academic session
10 am: Do a round of the patients wards
11.30: Return to theatre to complete the operation (surgical time can take anything from one to 12 hours – sometimes more). Accordingly, do one operation, or more
5 pm: Complete all surgery
5.15 pm: See patients in the outpatient’s department (OPD)
8 pm: Finish OPD
8.15 pm: Spend time in office answering patients’/hospital staff’s queries
9 pm: Quick round of operated cases
9.30: Leave for home

The Payoff
.
In the government sector, with the Sixth Pay Commission hikes, you can earn around Rs 60,000 to Rs 1 lakh a month and above Rs 2 lakh in the private sector

Skills
. Skilled pair of hands
. Excellent operative knowledge, ability to stay informed about breakthroughs in the field and apply them in day-to-day working
. Ability to stay unflustered in times of crisis

How do i get there?
AEnsure you take up biology at the plus-two level. Apply for admission to medical college (entrance through All-India Pre-Medical/Pre-Dental Entrance Examination, etc) after Class XII to study for MBBS. You have follow this up with an MS in general neurosurgery and later an M Ch in neurosurgery

Institutes & urls
. AIIMS Delhi
www.aiims.edu
. G.B.Pant Hospital Delhi
http://health.delhigovt.nic.in/Hospitals/GBP/default.html
. PGI Chandigarh
pgimer.nic.in
. Sanjay Gandhi PG Institute of Medical Sciences, Lucknow
www.sgpgi.ac.in
. Christian Medical College Vellore
http://www.cmch-vellore.edu
. Sri Chitra Tirunal Institute for Medical Sciences and Technology Trivandrum
http://www.sctimst.ac.in/

Pros & Cons


.

Highly respected profession For some people you are ‘next to God’


.

You get to save lives


.

Very stressful work


.

The high mortality rates can be disturbing unless you learn to detach


.

You get to study the brain — a fascinating field

Fine line between safety and catastrophe

A neurosurgeon talks about the highs, the lows and the challenges

Please tell us something about your training.
My entire medical education was at the All India Institute of Medical Science (AIIMS). After some years of doing my senior residency in general surgery I decided then to start neurosurgical training.

What is neurosurgery beneficial for?
A vast number of diseases are corrected by surgery. Starting with the spine, we have slipped discs, dislocations, fractures, tumours, vascular malformations, congenital deformities, to name a few. For the brain there is surgery for tumours, head injuries, brain haemorrhage, brain bypass surgery, aneurysm etc, various endoscopic surgeries within the ventricles or the skull base, neuromodulation as for treating Parkinson’s disease, pain management, incontinence management, epilepsy treatment, depression, obsessive compulsive neurosis.

What should the mindset of young people wanting to get into this profession be like?
It is a long haul. It takes one 11-12 years after school to become a neurosurgeon. There are many hurdles on the way, many exams and many entrance tests. Be prepared for disappointment. You have to study hard for MBBS. The rest is an apprentice system and, therefore, far more interesting and gratifying.

The growth prospects?
Endless. We also need to continue to update our skills and knowledge. But for me that is the attraction. I am on a high when I have done something new, however small or simple it may be.

The challenges?
That there is a very fine line between safety and catastrophe, the sometimes almost instantaneous interval between life and death. Challenging operations which one wanted to do when younger, do not hold as much attraction, but with your experience, these are the very cases which land at your doorsteps, like it or not

Dr Rana Patir, director - Neurosurgery, Max Healthcare interviewed by Ayesha Banerjee