My Path

As a neurosurgeon who has been around for a while, when I get introduced to an audience before a lecture, my host usually describes the usual educational path with a listing of career accolades. Of course, it sounds great, and the niceties sort of create an out of body experience. Is that really me? I thought I would share the real story, as I see it. In some ways I am writing for the students interested in a neurosurgical career, but for those of you already heavily involved and up to your knees in it, you may see some similarities to your own journey (or not). Perhaps a little smile. Earlier this year I wrote about the concept of “Belonging,” and perhaps this tale fits in with that theme. I grew up in a suburb of Toronto called Scarborough. My mother was a teacher and my father an electrical engineer. There was no one in medicine, not even a trace. Their parents were both fairly poor but worked hard, their children were the first to get higher education, and that was key for us. I always remember my father paraphrasing the great Bernard Baruch, “never spare any expense when it comes to your education.” Having said that, being a kid in Canada, I played a lot of hockey. I was good, but not that good. It would not be a career! Like many a young overachiever, I was given music lessons early. I played clarinet and then saxophone, I was trained formally, and I was the best in my high school. But I was not that good. It would not be a career! However, if someone had showed me a path toward a career in music, or the business of music, I might have taken it. It was a big deal in my life, and still is. Almost every other book I read even now, is music-related. However, I am reading about other people's careers. In Canada it was not a tradition to “go away to college.” There were exceptions like my good friend Dr Jim Rutka who went off to Princeton. If you could go to a good school and still commute from home, well that was a common choice. So I went to the University of Toronto. For everything. I did not even leave my parents' house until the last year of medical school. I drove a 1969 Pontiac Parisienne, the size of a boat. We had 5 years of high school then, and after 2 years of undergraduate studies heavily based in science, you could apply to medical school. I did and was accepted. But unlike my many American friends, I did not have a broad 4-year undergraduate experience and broader exposure to the liberal arts. That was a deficiency and I still feel it even now. But the University of Toronto faculty of medicine was a great place indeed. I could continue to play hockey at university, and we did for all 4 years. My friends and I served as the med school disc jockeys at the pubs so we could control the music. Hockey, music, and medicine. My initial interest was actually infectious disease and tropical medicine. I had done fascinating research work in parasitology with an editor for the Journal of Parasitology. But through a hockey connection, I was offered a great summer job to be trained and serve as a “scrub nurse” and set up OB/GYN and then orthopedic surgeries for 2 summers. I quickly got the surgery bug. I liked all the surgeries, but neurosurgery seemed the most interesting when one was not in the OR. So that became the focus. My career goal was to be a neurosurgeon on the Toronto faculty. As a student I was exposed to neurosurgery by some interesting personalities. I will not name names, but my first mentor who helped me enter the residency was occasionally a little frightening and volatile. Behavior was erratic. I recall thinking—“you can act like that in public”? Perhaps this specialty is for me! For more exposure he sent me off to Boston and I did an elective at the Massachusetts General Hospital in 1984. It was fantastic, and I was introduced to so many giants in the field. When I was about to leave, they offered me a spot in their residency. But as the narrow thinking person I was, I was not interested in Harvard. I still laugh at that early decision, but I can tell you, I did not even consider it, not for a second. Toronto was everything to me. It was my town. I wanted to be a surgeon there and continue to work and play with my friends from medical school, who also played hockey and were to be surgeons. I wanted to wake up in the morning and read the Toronto Star and follow the Maple Leafs. It was not to be, and indeed none of us ended up there. To make myself even more attractive for a job, I went to the University of Pittsburgh to do a 2-year research and clinical fellowship with Dr Dade Lunsford and get a master's degree in neuroscience. I had been exposed to the proton beam program at Harvard as it pertained to arteriovenous malformation radiosurgery, when it really was the only game in town (for the United States, except for the Berkeley charged particle program). Radiosurgery was about as fringe as it got. But I really thought it was the future. So, after Pittsburgh started the first US gamma knife radiosurgery program in 1987, I got there fast. The plan was to bring what I learned back to Canada. I did not even care what visa I was on and got a J-1, with its many restrictions including having to leave the country. What did I care? I had no plans to stay in the United States. We published early outcomes on so many topics, had plenary session talks at so many meetings, and it seemed everyone wanted to hear what we had to say—usually to criticize it. That was ok. And then the bomb dropped. I was not offered a job in Toronto, nor anywhere else in Canada. In fact, I wrote letters to all the university programs outlining what I had learned that was different and how I could contribute. I did not get any response. In Toronto, I was told that perhaps if I went to Montreal and did a fellowship with Jules Hardy, then maybe. But I had done my work. I said no to that. The whole experience was unnerving. Why? Because I was being denied the opportunity to live and work and raise a family, in my town. But it was Dade Lunsford who was the light that created so many opportunities. Not only had he taught me, but he had already offered me a position as his partner, a concept I had not been interested in. Pittsburgh offered everything under Peter Jannetta, a great faculty, an innovative university, and medical center with the original skull base surgery programs, the first gamma knife, and of course the beginnings of organ transplantation under Dr Tom Starzl. It was only a 5-hour drive from Toronto and indeed the largest American university close to Toronto. It was my wife Susan who said that Pittsburgh was where we should be. And so, we moved. Indeed, later I was asked to join the medical staff of the Pittsburgh Penguins in 2002 and happily added hockey again to my life. My path was always about the people and not the location. I always wondered why it never occurred to me to think more about sunny climates and move to California for example. Nothing at all wrong with that. Indeed in 2012 we decided to make a move to the great city of New York and work with dear friends. I had seen highly collegial departments like Emory under Dr Dan Barrow and had considered a move there years before. There was a real element of fun along with the work. That was what I wanted. A well-run medical center, great collaborators, wonderful access to neurosurgical pathology, and the day-to-day opportunity to be among close friends. This is my real story and how I think about it. I love hearing about yours! Douglas Kondziolka, MD, MSc Editor-in-Chief, Neurosurgery Publications New York, New York, USA

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