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Brain surgeon: Not Your Everyday Job series

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Dr VarmaName: Dr. Thelekat Varma

Age: 65

Job title: Consultant Neurosurgeon. Yes, a “Brain Surgeon”.

Time in occupation: 14 years as a trainee doctor, and 23 years as a Consultant Neurosurgeon. Retired for five years

First job: An “intern” at Safdarjung Hospital in New Delhi, India

Education: Bangalore Medical College, University of Bangalore, India. Postgraduate training at various hospitals in New Delhi, Liverpool, Sheffield and Cardiff. Fellow of the Royal College of Surgeons of Edinburgh

Chloe: A well-known phrase often said to people is that “you don’t have to be a brain surgeon to figure something out”, clearly inferring just how difficult a job being a neurosurgeon is. When you reduce it down to the actual tasks at hand though, what is it that you did on a daily basis?

Dr Varma: As a neurosurgeon your routine varies from day to day. Two to three days a week were spent in the operating theatre and these were both the most enjoyable and the most stressful. They can be very long days depending on the type and number of operations to be undertaken. Operations that take 10 to 12 hours are not unusual.

Chloe: How about when you’re not operating, is there a lot of behind-the-scenes work?

Dr Varma: Yes, not all days are spent in the operating theatre; there are out-patient clinics, ward rounds and endless amounts of paperwork to keep a neurosurgeon busy. You also have teaching responsibilities – both to undergraduates and postSurgery graduates. Training young doctors who then go on to become leaders in their field is so rewarding that it makes all the effort one puts in worthwhile. There was also research to do, papers to write, books to review and journals to edit – all of which went to making it a career that I enjoyed immensely and have no regrets about choosing.

Chloe: As a field, is neurosurgery solely about work on the brain?

Dr Varma: Well, the great attraction of neurosurgery is the sheer variety of conditions that one has to deal with. Most people think neurosurgeons only operate on the brain but in fact a considerable proportion of your time is spent operating on problems in the spine. Indeed there are some neurosurgeons who only operate on the spinal column.

In the latter part of my career I was fortunate enough to be able to concentrate on a field of neurosurgery called “Functional Neurosurgery”. This involves operating on patients to treat conditions like Parkinson’s Disease, Epilepsy and Chronic Pain. Many of these patients are now treated by using electrical stimulators that are implanted in very tiny areas in the brain. The operations are usually undertaken with the patient awake as this may be the only way of being sure the electrode is in exactly the right position. These operations are very stressful for the surgeon – and even more so for the patient but the satisfaction of seeing the patient’s tremor (involuntary shaking) stop suddenly as the stimulator is turned on is the most rewarding feeling in neurosurgery.

Chloe: I had no idea that you could do such a surgery with the patient awake!

Dr Varma: Yes, I guess one of the strangest experiences is operating on patients when they are awake – even stranger for the patient. Once you are past the skin, the skull and the brain feel no pain or discomfort. Holding conversations with patients while I explored parts of their brain was something I got used to, but in the beginning it seemed unreal. I am amazed and in awe of most of the patients who coped with this so well. In Liverpool the ‘scouse’ humour always came through and some of the best – and some of the worst (but unrepeatable) – jokes came from patients who were wide awake while I passed electrodes into their brain!

Brain AnatomyChloe: That’s completely bizarre. Neurosurgery sounds hugely rewarding, then. Just how gratifying was it?

Dr Varma: The negatives of it are balanced by the pleasure of being able to help many patients with some of the most life threatening and disabling conditions that humans face. I will always remember the first time I implanted an electrical stimulator in the brain of a patient with a severe disabling tremor – she had not been able to hold a glass to her mouth and needed a straw to help her drink. The stimulator stopped her tremor and when I saw her several weeks later her greatest happiness was that she had after many years been able to write the Christmas cards to her grandchildren.

Chloe: I can imagine that such a role does have as many negatives as it does positives, however.

Dr Varma: Many think it is a glamour job – believe me it isn’t. It is a lot of hard work, a lot of sadness and a great destroyer of family life. There is no glamour in telling parents that their lovely child has an incurable brain tumour or another that their loved one will be paralysed for life.

Chloe: That aspect of careers in medicine seems one of the hardest. How is it that you ended up in this difficult yet immense post?

Dr Varma: I got into neurosurgery by sheer chance – I was between jobs as a junior doctor in India and I was offered a temporary post in neurosurgery. I loved the job and immediately knew that this was what I wanted as a career.

Chloe: So this wasn’t a career path you chased from being a child?

Dr Varma: I’m not sure if as a child I had any great aspirations. I came from a family of engineers and though my maternal grandfather was a doctor I am not sure he influenced my career path.  I was brought up next door to a factory that built jet fighters and my father was in charge of the airport there. Many a childhood hour was spent watching the planes. So, I suppose if you had asked me at that time I would have said I wanted to be a fighter pilot!

Chloe: What advice would you pass on to students, medical or otherwise, following your lengthy career as a Consultant Neurosurgeon?

Dr Varma: I have always maintained that the best neurosurgeons I have met or have worked with are the ones who stumbled upon the speciality and then fell in love with it. I have always been wary of young doctors who ‘always wanted to be a Brain Surgeon’; they are often in it for the wrong reasons. So, keep an open mind, look at all options and experience as many as possible – chances are that you will stumble upon a career you will enjoy and also excel at!

Photos: photologue_np / Flickr (featured), Dr. Varma (top), Medico de Roma / Flickr (middle), Storm / Flickr (bottom)

Chloe WynneBrain surgeon: Not Your Everyday Job series

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