And a new poem about getting old

 I’m Getting Old

 

I’m getting old

I miss my mother and my  father

I miss sitting in front of the television set in the den

With my parents and my brother all close together

On the green sofa, bodies touching

Laughing at some program I don’t recall

I don’t feel old, I feel fine

I’m still quick on the singles court

I get up early and work a long day

My Darling and I still dance for hours

We still get tangled up in each other at night

We travel as we wish, there’s really nothing we cannot do

And I’m happy my kids are now adults

Creating their own offspring, their own lives

Yet, fuck, there is that inescapable sense

Of aging out of this young world

Perhaps we will be the lucky ones, slow to decay

Perhaps not

I thought I had lusted so when I was young

But it’s now that I find myself

Greedy for more of what my life

Has yet to offer

 

Ezriel Kornel

Feb.20, 2025

Announcing my new blog and website

Dr. Kornel's new website and blog!

My blog 'Neurosurgery and Other Ruminations' has moved to its new home on the web: brainandspinesurgeon.com

BrainandSpineSurgeon.com is your source for breaking medical news, educational podcasts and my new blog home.

Get curated medical news updates. Watch my educational video series. Listen to past episodes of my radio show 'Back Talk Live.'  Follow my new blog. 

Join the mailing list for curated email updates.

Check it out now: brainandspinesurgeon.com

Leave a comment on my new site and tell me what you think and want to hear about in the future.

I'd love to hear from you!

– Dr. Ezriel Kornel

Right-brain or left-brain, which are you?

The idea that there are right-brain individuals and left-brain individuals has been an accepted concept for many years.  Right-brain individuals are supposed to be more aware of their spatial environment, more emotionally tuned in and more creative.  There has been a generally held belief that these individuals function more with the right side of their brain.  Left-brain individuals are those who are more intellectual,  those for whom words and language are central to their being, those who think more than feel.  Of course, there are no absolutes, no individuals who are purely one or the other. What a research team at the University of Utah has proven as described in an article recently published in PLOS ONE is that individuals do not use one side of their brain preferentially over the other side. There are definitely many areas within the brain that associate most closely with other proximate areas on the same side.  However,  individuals use these functional zones about equally on both sides of the brain. So, what this says is simply that we use our brain in its totally.  What it does not say is how we use those areas in becoming the people we are. The more we learn of the brain the less we understand of its actual workings. If individuals do use both side of their brain about equally and we do know that there are important functions predominately on one side versus the other than why are some individuals more adept at complex intellectual problem solving and others more creative? Why are some people great at spatial relationships and others get lost in their own back yard?  Why are some people great with colors and others write beautiful music and others write sonnets and others perform mathematical wizardry?  Why are some great athletes and others trip over their feet?  These are still the great mysteries of the human brain.  They are what define us. Perhaps tomorrow someone will publish a study that explains it all but for now what we know is that we all tend to use both sides of our brain in being the unique individuals we are.

Time for a poem

Writing a poem #1

It has to be like alternating tightropes.
You're either balancing on the one of sorrow
Or on the one of elation
Hopping from one to the other
One misstep and you fall
Into that swamp of nothing really matters
Seems easier to balance on the tightrope of sorrow
Everyone standing so still and all
Harder to balance on the tightrope of elation
What with trying to bring everyone over
Makes it tough to gain a foothold

March 29, 2012
Ezriel Kornel

The BigBrain Project and the 3-D Brain Map

The BigBrain project has just been published in most the recent issue of the journal "Science". It is a major project carried out by a team of neuroscientists from different institutions that created a 3-D atlas of the brain in exquisite detail. It was created by painstakingly stacking thousands of very fine slices from the brain of a "neurologically normal" sixty-five year old female who had donated her brain for scientific research. This model allows anyone to view any portion of the brain in microscopic detail so as to understand the various cell to cell connections in each part of the brain and the differences in these connections among the various parts of the brain. It will give us a better understanding of how information is routed throughout the brain and by understanding the "normal" brain we can see how these connections differ in a pathological or "abnormal" brain. In a way, it is like understanding the internal wiring of a computer or how the parts of a car engine fit together to work as a whole. However, the brain, in its exquisite complexity, carries out many functions simultaneously. It informs us of all our sensory inputs such as the ambient temperature, the firmness of the ground on which we are walking, the sounds of the birds near by, all the sights we behold around us, the position of our limbs in space, the condition of our gut. At the same time it manages among many things, our respiration, our heart beat, our blood pressure, our internal fluid status and our biological clock. While doing all this it controls our muscles so that we can achieve coordinated, purposeful movement in response to our thoughts and our vocal cords and muscles of our hands so that we may express ourselves. And most remarkably of all, in the midst of all this it allows us to make sense of what is going on around us, recognize our relationship to the world around us, formulate thoughts by which we interact with the world and formulate thoughts in which we can plan what we will do in the next moments, minutes, hours, days, weeks or even years. While all this is occurring the brain generates emotions that permit us to feel our existence on this planet and in this universe and these feelings drive us to interact with the world in the ways of our choosing. Most remarkably, perhaps, while all this is going on it generates thoughts and feelings, generally inseparable from each other,in response to the thoughts and feelings expressed by others. There is nothing concrete or tangible about a thought or a feeling. We all know what they are but how difficult to truly define. Yet these thoughts/feelings are what human beings are all about. It is through the exchange of thought and feeling, spoken and unspoken, that we create bonds which lead to families and societies and the myriad consequences that result from these. The BigBrain project can not show us "thought/feeling." It may show us pathways that "thought/feeling" uses and where breakdowns in these pathways can lead to a wide array of problems. We may be able to better understand the relay stations that allow the brains many functions to work in concert. But this 3-D model can not show us how feeling and thought is generated and transformed. Perhaps we will discover where a song originates but it will not explain how a song originates. The answers to the most profound questions explaining how our brain makes us who we are lies in the biochemistry of the brain and the key is in the way the energy of the world outside of us interacts with the chemicals in our brain to generate further energy waves that create the most amazing interplay of energy, the dance of the human brain with universe in which it resides.

Do we have the backbone to confront the problem of the aging spine?

We should all be happy that through advances in science, health-care and personal health management more and more Americans are living into their 80's and 90's and even reaching 100. The best news about this extension of life expectancy is that more and more of our "super" seniors continue to lead active life-styles. We have been very good at managing heart disease and vascular disease. Lung disease has significantly diminished as smoking has become much less common. Diabetes is more well-controlled and the treatment of cancers improves every day. What has not improved and, in fact, has yet to be addressed is degenerative disease of the spine. It is inevitable that everyone experiences some degeneration of the spine as we age. For many the degeneration can become severe with pain secondary to nerve compression and pain secondary to spinal deformity. These infirmities lead to profound life-style changes. Chronic pain leads to depression and limited mobility. No one wants to live their lives afflicted by pain, unable to participate in the normal activities of daily living, let alone unable to play sports, take walks with family and friends, go to the movies, go out for dinner or play with grandchildren . So as these individuals start to become intolerant of their pain and limitations they seek out help within our health-care system. There are certainly non-surgical approaches that can help, especially if treatment is instituted before the structural abnormalities become too severe. These include chiropractic, physical therapy, acupuncture, massage, Alexander training, injection therapy, and many more. All cost money and stress the finances of our health-care system but these treatments are relatively inexpensive and there are a large number of practitioners who offer these treatment. However, many individuals will require surgery to alleviate symptoms. This is were things become very confounding. Bigger, more complex surgeries have higher risks. Should "super" seniors be allowed to subject themselves to these increased risks which can add substantially to health-care costs when complications do occur? Furthermore, there are relatively few spine surgeons with the capability of performing complex spine procedures in the elderly. It will become more difficult for those who are prepared to go through extensive operations to even find a surgeon who can place them on their operative schedule. What greatly compounds this problem is that medicare payments for these procedures are exceedingly low. These operations also take many hours to perform. It will be very difficult to encourage surgeons to perform more of these procedures when they take up a large amount of their work time with very limited reimbursement. From a practical business point of view it is simply impractical and unaffordable. Those surgeons receiving a salary have little motivation to perform these extensive operations when they could in the same amount of surgical time be performing more operations with less risk, helping more individuals. So those suffering from severe spine problems may well need to find surgeons who do not participate in medicare and who will perform the surgery for an appropriate usual and customary fee. Even with a limited number of seniors able to proceed with a surgical option, the costs to the health-care system will be high. Do those controlling the health-care dollars want to spend them on seniors with bad backs? There is no question that the criteria for proceeding with this kind of surgery will be so extensive that few will ultimately be able to meet those criteria. What are possible solutions? First of all, individuals need, from an early age, to be taught how to take care of their spine, including exercise, body mechanics and weight control. We need to put money into research that can lead to treatments in the early stages of spinal disease such as stem cell injections to regenerate damaged discs. However, there will always be those who will fail all non-surgical treatments. For them, spine surgery may indeed be life-saving. New surgical techniques are being developed that are less risky. Minimal access spine surgery now is able to correct spine disorders with less trauma to the spine and surrounding tissues and less risk in general. Most importantly, the specific problem that is causing the pain and limitation needs to be identified and addressed with minimal access techniques. The entire spine does not need to be rebuilt. It doesn't matter what the spine looks like on an MRI or xray as long as the individual does not suffer from incapacitating pain and neurological dysfunction. More spine surgeons will be needed who are able to assess these problems accurately and perform these focused minimal access techniques. Finally, patients should be able to see surgeons who do not participate in medicare and receive the allowable medicare reimbursement that they can apply to their out-of-pocket costs, which currently is not allowed by federal law. Spine disorders in an aging population needs to be an issue that is carefully analyzed by our politicians, our health-care pundits and the medical community. We are currently very much behind the eight ball.

I say, tax the insomniacs!

The Supreme Court of the United States, in a decision written by Chief Justice Roberts has made it clear, if we were yet unaware, that Congress has the right to tax anything it sees fit to tax. Therefore, Congress may tax individuals who fail to purchase health insurance. These scoundrels who are avoiding purchasing health insurance clearly are harming society at large. As best as I understand it, insurance companies won't make enough money to keep sick people in their health plans unless more healthy people join the plans. I suppose the assumption is that people who choose not to buy health insurance are healthier as a group than those who buy insurance. So make the healthy ones pay up for the good of the sick. This is good for society in general, it seems. Well, we need to think about taxing others who are interfering with the general well-being of society. I say, tax the insomniacs (here referred to as "the awake.") Why do such a thing, you may ask. There are several good reasons too-awake members of society should be paying for their sleeplessness ("Sleepless in Seatle"? tax the bum.) First of all, it is a well-know medical fact that people are healthier if they sleep eight hours a night. So those who sleep less are less healthy which means they are sicker which means they use more health-care resources. These resources, as we have been told time and again, are extremely costly to our society. Does it not therefore make sense that these more "awake" individuals need to ante up to cover their less healthy life-style? Secondly, we all know that we can acheive more when we have more energy and that we have more energy the more rested we are. Clearly those with a good eight hours of sleep a night will have more energy thereby being more productive than those sleeping less than eight hours(the"awake") thus less energetic and less productive. Reduced productivity is harmful to society, it lowers our GDP and has lots of other bad consequences such as making the "sleepers" have to work harder and be more productive. It may even push the "sleepers" into the "awake." "The awake" clearly need to cover the cost of this reduction in productivity. Hence, the tax. Thirdly, the "sleepers" use precious few resources when asleep, far less electricity, far less heat and no gasoline at all (unless they are asleep at the wheel). The planet and society are well-served by those using less resources. This clearly reflects well on the "sleepers" and poorly on the "awake." We are paying a heavy price for the resources being used by the "awake."

Will you have your choice of doctors?

The face of medicine in the United States is about to change dramatically. For many years now, individuals have had choices regarding their healthcare insurance, they could choose an HMO plan or a plan that offered out-of-network benefits. The HMO plan requires subscribers to use contracted physicians who are "in plan" or else you have to pay the full doctor's fee yourself. With a PPO plan, one that offers out-of-network benefits you can choose to see a physician who does not contract with the insurance company. The insurance company will pay 70-80% of the usual customary fee for the doctor's services and you will be responsible for the 30-40% difference. You can always still use an "in network" physician to have 90-100% of the fee covered. You have the choice of paying a bit more for the opportunity to be cared for by a non-participating doctor who you may prefer. When insurance companies base their out-of-network reimbursements on usual and customary rates then not only do consumers have choice but physicians have a choice whether to be in-network or out-of-network. This means that insurance companies have to negotiate rates that some physicians will consider acceptable because those physicians otherwise can decide to stay out-of-network. This helps maintains a free market model in medicine, choices for the consumers and choices for the providers. This model is on the verge of changing profoundly. Health insurance companies want to peg out-of-network reimbursement to medicare rates. Physicians, especially surgeons and other proceduralists, can not remain in private practice with reimbursements based on 140-200% of medicare. Private practice physicians will go out-of-business and be forced to either leave medicine or become an employee of a large medical group or hospital. Only a small handful of physicians will remain in private practice and patients who choose to have these physicians care for them will have to pay the lion's share of that doctor's fee out-of-pocket. Those who can afford to do so will still have a choice, the remainder won't so this will immediately create a two-tier medical system. Once the majority of physicians are driven into large groups and hospitals that contract on behalf of the doctors, the insurance companies will ratchet down the reimbursements because physicians will have no option left but to accept whatever payment is offered. The large medical groups and hospitals will, of course, limit the number of physicians they employ to provide enough income for the physicians in their group. In order to make a marginally adequate income these health-care providers will have to see a very high volume of patients. This all translates into long waits for patients and very short visits. The quality you expect just won't be there. The coup de grace is that these clearly inferior insurance policies are still costing the consumers more, the insurance companies aren't lowering the cost of these plans, they are raising them. Make no mistake about it, the money that does not stay in your pocket or go to your health-care providers goes into the pockets of the executives of the health insurance companies and then to the company's shareholders. So if you care more about your investment then your health-care, buy stock in the health insurance companies. If you care more about your health-care, contact your legislators and insist that the private practice of medicine be allowed to flourish in the United States.

The Poem

I am blogging once again and expect that I will keep it up on a regular basis for a while. I will, at least, add a poem a week. Today it is a poem entitled,

The Poem

It's always either about death or love
The mundane or the extraordinary
Whether about celestial bodies or earthly matters
The progenitors or the offspring
The sibling, friend or lover
The pet or the beast
The sorrow, the elation
The depravity, the divine
In the end, when all is said and done
With meager understanding
It's about
The word

Ezriel Kornel

I read an article about the rap group Das Rascist today in New York magazine. Das Rascist is a group of three non-pure-white rappers who interject humor about race that is often intended to offend whites. Of course, it ends up working just the opposite and the group is gaining popularity. Their dilemna, is seems, is that they are striving to obliterate rascism, making race an inconsequential issue. Yet they are making a name for themselves by playing on rascism. So, it got me to thinking, is rascism passe? It is indeed becoming more difficult to identify those who are pure white, much to the anger of a few extemist psychopaths and sociopaths. But as "pure white" disappears, fear and anger will not. That is because there will always be "otherness" and it seems to be in the nature of humans to have to distinguish other from self. The more "other" someone appears to be, the more fear it evokes in some. So why is "other" so fear-inducing? It is because "other" challenges our sense of "self." Can an "other" devour us? Can we sustain our personal beliefs, our understanding of how we should behave, of how we should interact with others, who we allow ourselves to love, where we wish to live, how we wish to earn a living, if others approach all of these issues differently, especially if far differently? It is this fear that drives people to cruel acts, whether it is bullying a child in school or taken to the extreme, flying passenger-filled airplanes into occupied buildings. The question that has confounded humanity for millenia is how to erradicate this fear which leads to hatred and violence. The answer may be too simple for many to accept but it may be the answer, none-the-less, one that many great men and women have offered: to respect life above all else and to respect every individual's right to pursue their own happiness without infringing on other's equal right to the same. This is a challenge that requires understanding and compromise and above all, love. It is the foundation upon which every personal relationship is built and upon which this great country was built.

Flora and Fauna

The cactus blossoms
From the parched desert earth
As the seedling stretches blue-ward
From the dank forest floor
In my hand I hold a tooth
Pushed out by the one behind it
A man must grow
Where he has been planted
His pain not penance
But a passing rain

Casey Anthony and Belief

Apparently two thirds of Americans believe that Casey Anthony murdered her daughter. The jury did not believe this to be the case. That is because the jury understood that belief is not a basis on which to make decisions that profoundly affect another person's life. In order to make a judgement about another person, especially when it comes to imprisoning that person, restricting their freedom or even taking their life, belief is insufficient. Fact, or evidence is needed to make a determination as to the validity of a claim. As a matter of fact, no pun intended, this is what science is all about. People wish to believe a whole host of things especially when it is meant to make their life better in some way. When it remains purely personal, each individual can maintain their belief no matter how outlandish but when it comes to imposing it on others, we run into huge problems. The same is true in the healing arts. Lots of people offer remedies and treatments that they say is helpful and often may even try to benefit financially from offering these treatments but most often these are based on beliefs at best. Though it is true that experience may precede scientific proof and anecdotal experience may certainly be true for the one having the experience, offering it to others in a authoritative manner requires science and science is complicated and labor intensive and sometimes excruciatingly time-consuming but it will ultimately offer an answer that goes beyond belief. This is what, in effect, the Casey Anthony jury did in coming to it's verdict. It did not decide that she had not killed her daughter but rather that the evidence was not there to make a truthful determination that she had and it is what most of us would have concluded if we had gone through the same rigorous scientific process. It is a principle we should always apply to things that matter in our lives.

Osama Bin Laden Headshots

Yesterday American Forces found and killed Osama Bin Laden. Of course, throughout the world there are always skeptics, those who doubt that he was really found and that it was really he who was shot and killed. Well, apparently there are photographs taken after he was shot in the head that show his face recognizably but also show the bullet wound through or close to his eye that reveals blood and brain oozing out of the wound. Officials now question whether it would be too disturbing to the public to see these images. Even after years of having seen individuals with open head injuries with brain exposed, I am always disturbed by the sight. However, in my opinion it is less disturbing than the videos of beheadings, than the sight of young soldiers with dismembered limbs and life-long disfigurements, than the sight of innocent people having to jump to their certain death out of burning, collapsing buildings. We were forced to witness horrific carnage on September 11, 2001 and beyond. Seeing the mortal wounds of the mastermind behind all this demonic terror is far less disturbing than that which was witnessed by many millions on September 11, 2001. Those who do not want to see the image of Osama Bin Laden's mortal wounds don't have to look at them but for those who doubt and those who need confirmation to be able to move on with their lives, seeing is believing.

Serena Branson and complex migraines

It turns out that after two days of extensive testing, Serena Branson's aphasia was diagnoses as a complex migraine. What she has stated in an interview is that she had not been feeling well with a sense of tiredness and the onset of a headache before the speech disturbance began. That was a big clue. Never-the-less a full work-up needed to be done, including MRI of the brain, MRA (MR angiography, looking at the blood vessels) of the neck and the brain, EKG and echocardiogram as well as blood tests. When it was found that all of these tests were normal than the symptoms could be utilized to make the final diagnosis.

So how could a migraine cause the symptome of speech dysfunction? First, the phenomenon of migraines needs to be understood. Fundamentaly, the arteries in the brain constrict in the first phase (prodromal phase) and then dilated. Though the constriction may cause some headache, the dilation phase is generally what causes the severe headache. When the blood vessels dilate, there can be a reduction in blood flow to the area of the brain most affected. Depending on which area is affected, symptoms related to that area develop. This is referred to as an aura. If it occurs in the occipital area which has to do with vision, then the aura will included symptoms such as seeing spots, flashing lights, zigzags or moving lines, like blades of a fan. This usually lasts minutes but can last up to almost an hour. If it affects the prefrontal gyrus which controls movement then there may be problems with movement of a limb or with the face. When it effects Broca's area in the base of the posterior frontal lobe, then, though the individual may know what they want to say, they can not get it out coherently. This is exactly what happened with Serena Branson. Many other symptoms may also occur such as tingling, confusion, even hallucinations. Following this aura, the migraine headache usually ensues but it may not always occur so when it is only the aura which is the significant symptom, it may be difficult to diagnose until other causes of the neurologic dysfunction are excluded. Rarely, the vasospasm and reduction in bloodflow can be so severe that a stroke can occur. When auras occur regularly and can be temporarily disabling then medication can be used such as inderal to limit these troubling events.

Those who suffer from these symptoms should meet with a neurologist to find the right treatment including avoiding triggers such as certain foods or even odors or scents.

Serena Branson's Speech Arrest

America witnessed a dramatic ezample of speech arrest or expressive aphasia when Serena Branson began speaking incoherently when reporting on the Grammies while on- air. According to news reports, her symptoms resolved within a few minutes at the most and she refused further medical assistance after the paramedics found her vital signs to be stable. There is great interest in knowing what could have caused a dramatic and sudden but thankfully brief loss of speech.

There are numerous possible causes of sudden aphasia that fully resolves. These include transient ischemic attacks, seizures, brain hemorrhages, low blood pressure, low blood sugar, multiple sclerosis and inflammatory conditions of the brain and blood vessels.

What comes to mind first is a transient ischemic attack (TIA). This is due to a brief reduction of blood flow to a portion of the brain but with resumption of adequate blood flow before damage to that area occurs. The reduction in blood flow can be due to a piece of "debris" breaking off a plaque in a narrowed, diseased artery in the neck or when there is such a high degree of narrowing of an artery in the neck or brain that briefly the blood flow through that artery is profoundly reduced. These events usually occur in individuals over the age of sixty. Another cause of TIA can be due to an abnormality in the heart such as an infection in the heart or an abnormal heart rhythm. In these instances a small piece of "debris" can be released from the heart into the blood stream and then into the brain. A TIA can also be caused by birth control pills, blood disorders and drugs such a cocaine. Inflammation of arteries, refered to as arteritis is another cause of TIAs.
TIAs are highly significant because they are often precurors of major strokes leading to permanent neurologic dysfunction. Therefore, it is important to diagnose the cause of a TIA and treat it appropriately and rapidly.

A focal seizure can present as a brief loss of neurologic dysfunction including a brief episode of aphasia as Serena Branson experienced. Again, there are numerous possible causes for the new onset of a seizure. A brain tumor, drug reaction, brain hemorrhage or low blood sugar are all possible causes of a focal seizure.

Even when someone recovers fully and feels well after an brief episode of aphasia, as apparently was the case with Serena Branson, the individual needs a full and careful medical evaluation. Not only do they need an MRI of the brain, which may, in fact, be normal but the arteries in the neck and the heart need to be fully evaluated. Additionally blood tests need to be performed. Without appropriate diagnosis and treatment, a permanent stroke could ensue or a minor hemorrhage in the brain could lead to a major hemorrhage. If a seizure has occured, a subsequent seizure might be more profound. The early stage of an infection such as encephalitis could become a life-threatening infection of the brain.

Certainly Ms. Branson will have a thorough medical evaluation and hopefully the cause of her episode of aphasia will be found to be readily treatable and she will not suffer future neurologic dysfunction.

Whiplash and Brain Injury, Part 1

Whiplash can cause brain injuries
Part 1 of 2 Part blog

I am proud to be a co-author of an study published in the medical journal, Brain Injury that describes a change in the brain of a significant number of individuals who have suffered a whiplash injury.


Patients who have not suffered demonstrable injury to their spine often, over time, have been considered to have no clear cause of their symptoms. Many have been felt to have unsubstantiated injuries and that their symptoms were either psychological or for secondary/monetary gain.


In 95% of normal individuals, the cerebeller tonsils, a part of the brain that sits in the back of the skull and controls coordination, rests above the opening at the bottom of the skull (where the spinal cord passes from the brain into the spine). In 5% of individuals, these cerebeller tonsils can project through the opening (foramen magnum)--essentially meaning that part of the brain dips into the top part of the neck. This condition is know as cerebeller ectopia or Chiari malformation. This may cause multiple symptoms including headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.


20% who have whiplash have Chiari malformation, study says.


This study has demonstrated that over 20% of individuals who experienced a whiplash injury have cerebeller tonsils below the foramen magnum when an MRI is performed with the individuals in the sitting position. Individuals who do not have a whiplash injury do not show a drop of the cerebeller tonsils in the sitting position.


It is uncertain whether this finding is a causative factor for any of the symptoms of the whiplash syndrome or if the same trauma that caused this brain injury can caused other, yet to be defined injuries that lead to the painful symptoms.
Further study is needed before we can say whether surgical intervention is warranted in these cases of cerebeller ectopia.


Speak to your doctor if you've had whiplash, or suffer from persistent headache, neck pain, numbness and weakness in arms and hands, weakness in legs and bladder dysfunction.

Cross-word

Cross-word

After the craniotomy to remove the enormous
Blood clot in the brain of this octogenarian
The children remained in the waiting room,
Allowing their parents a moment of privacy.
As he remained unresponsive,
His wife approached his side and spoke to him,
“I have been doing the cross-word puzzle without you.
It’s a good thing it’s Monday.”
He awoke on Tuesday.
A blood-clot to his lungs killed him on Friday.
Sunday the cross-word puzzle was no doubt
Excruciatingly difficult
But she certainly completed it
For what else was she to do?



Ezriel Kornel
2/8/05

What it takes to be an excellent neurosurgeon

I proctor pre-med students during winter and summer breaks and one of the students asked me an interesting question the other day, what does it take to be a good neurosurgeon? Well, first of all, you want, not a good neurosurgeon but an excellent one. So, what does it take to be an excellent neurosurgeon?


The first thing that is crucial and without which the rest would not matter, is judgment. A neurosurgeon needs to be able to establish a diagnosis and then determine when surgery is necessary, when it is not and what other treatment options are available. Once that is established they need to decide what operation is best for each individual patient and their particular condition. It is also of great importance and a matter of judgment that a surgeon be confident in their decision and in their capability in performing a particular procedure. They should be willing to confer with colleagues to help with decision-making and should be able to turn to other colleagues to assist with surgery. Should another colleague have greater expertise in a particular operation, the excellent neurosurgeon should refer the patient to that physician.

Secondly, the neurosurgeon needs to have the surgical skills to be able to perform these operations. Generally, well-trained neurosurgeons who have completed an accredited training program and have become board-certified possess the requisite skills. But, in truth, just as some professional musicians are greater virtuosos then others, the same applies to surgeons. It is a strange gift that skilled surgeons possess, just as certain musicians, artists, mathematicians and writers are more gifted. In fact, I believe everyone has a gift, they just need to recognize where that gift lies, acknowledge it and express it.

Thirdly, an excellent neurosurgeon needs to have great confidence without manifesting a huge ego. They need to know that they can do the job. Anxiety in surgery can interfere with the best results. However, a big ego will prevent anyone from obtaining advice from others and will make them incapable of listening to constructive criticism. They are less likely to learn from their mistakes (and everyone makes mistakes at one time or other, being human after all and not divine.)

Being patient is another skill that neurosurgeons need to possess. If they make a decision too quickly they may perform unnecessary or even dangerous surgery. Sometimes patience allows a problem to manifest or resolve itself in a different manner. With prudent waiting surgery may not be necessary or a different procedure may be deemed appropriate.


Respect and compassion for their patients is another quality that an excellent neurosurgeon should possess. When this is present, a good bed-side manner is always manifest. This needs no further amplification.


Finally, an excellent neurosurgeon must have love and passion for their work. Nobody wants a neurosurgeon who is eager to get you out of the door, or rush to leave their side when lying in a hospital bed or to rush to get through the day. Though neurosurgeons have a life outside of the operating room with families, friends and other interests they should always feel a deep gratification when performing their work. When they are in the operating room all their attention and focus should be on the surgery they are performing.

When all these qualities are evident, you are most likely to experience the best results possible and the quickest and most complete resolution of your illness.

Quiet Hero

Rita Cosby was my special guest on BackTalkLive this past Sunday. Though the show deviated a bit from its usual format, I found what Rita had to share with us about her Dad and his experiences in WWII to be profoundly significant. Of course, since my father, like hers, was from Poland and experienced the horrors of the Nazi invasion, we felt an immediate bond. However, her father and mine had very different experiences. While my father at sixteen fled his small town with his uncle towards Russia and survived in a labor camp there, Rita's father, living in Warsaw joined the underground as a resistance fighter. His story is fascinating and among other things, reveals how people can tolerate great pain when they have a higher, meaningful goal. However, the long-term effects of that pain can lead to psychological problems later in life. I found the book "Quiet Hero, Secrets of my Father's Past" hard to put down, enlightening about a very dark time in the world's history (not so long ago) and profoundly moving. It is beautifully written in a very engaging manner. I urge you to pick up a copy of this book right away. I have no doubt you will find it to be an important addition to your library.

barcelona and england

The photo album of a great vacation.