It IS Brain Surgery with Neurosurgeon Dr. Ralph Dacey
Neurosurgery is one of the most demanding medical fields, with practically no margin for error when operating. One small miscalculation can have profound effects on the patient. As a neurosurgeon and former chair of the Washington University Department of Neurosurgery, today’s guest, Dr. Ralph Dacey, knows all about this pressure and responsibility. He begins the episode by outlining the demanding and competitive route into neurosurgery, including the surprisingly low attrition rate and how emergency care is incorporated into training. Sandy then asks Dr. Dacey how he deals with risk, and he points out that neurosurgeons don’t risk their own lives but those of their patients, meaning that the burden must be shared by establishing a relationship built on medical ethics.
Next, Dr. Dacey discusses the discipline of neurosurgery, including the state of current knowledge on the brain, the main sub-specialties, and the conditions that cannot yet be successfully treated. He also goes into detail on what happens in the operating room, describing the process of fixing an unruptured aneurysm, how neurosurgeons navigate inside the brain, and how forceful backup has become a more prominent part of the operating process. And finally, Dr. Dacey discusses the great highs and lows of being a neurosurgeon, emphasizing that it’s ultimately a very rewarding life, with the highs definitely outnumbering the lows.
Resources:
Additional Resources (Intense/NSFW imagery below)
If you enjoyed this episode of The Adrenaline Zone, hit the subscribe button so you never miss another thrilling conversation, and be sure to leave a review to help get the word out to fellow adrenaline junkies.
Transcript:
.Dr. Sandra Magnus: It lies somewhere between the pit of your stomach, your racing heart, and your brain; somehow, trying to keep it all together. It's an area we call The Adrenaline Zone.
I'm retired astronaut, Dr. Sandra Magnus.
Sandy Winnefeld: And I'm retired Navy pilot, Admiral Sandy Winnefeld.
We're two adrenaline junkies who love spending time with people who are really passionate about pushing their boundaries as far as possible.
The brain is the body's most complex organism, one we have yet to fully understand. But like all of our body's systems, it can either be injured or manifest disease that has to be treated.
Dr. Sandra Magnus: Neurosurgery is one of the most demanding fields in Medicine, with practically no margin for error when operating. One small miscalculation can have profound effects on the patient.
Sandy Winnefeld: Our guest today is Dr. Ralph Dacey. He's the former Chair of the Washington University Department of Neurosurgery, with decades of experience, and hundreds of surgeons he's personally trained.
Dr. Sandra Magnus: We're delighted to have Culligan Water as our sponsor for this season of The Adrenaline Zone.
Sandy Winnefeld: With Culligan's drinking water systems, you can get the ultra-filtered water you need to fuel your high-performance lifestyle, right on tap. Learn more at: culligan.com.
Dr. Sandra Magnus: We caught up with Dr. Dacey at his home in St. Louis.
Sandy Winnefeld: Dr. Ralph Dacey, what a pleasure to have you on The Adrenaline Zone with us. We've wanted to interview somebody in the medical field for a long time and especially a complex discipline like neurosurgery. So, thanks for being with us today.
Dr. Ralph Dacey: Thank you very much. It's really an honor to be with you, Sandy and Sandra.
Sandy Winnefeld: You've been a neurosurgeon for decades, and have trained well over 100 other neurosurgeons yourself. So, let's start at the beginning. Tell us about the track to enter this amazing specialty - brain surgery. How long does it take, and what does a neurosurgery resident experience while pursuing it? It has to be difficult.
Dr. Ralph Dacey: Well, for most of us it's four years of medical school, and then seven years of residency after that, and then most people do a fellowship for one or two years. So, it's about eight to nine years after medical school.
I was at the University of Virginia for medical school, and then I stayed on and did my residency there. So, you know, it's a long time, but I look back on that now as some of the best parts of my life. It was very stimulating. You're never so broadly competent and, and interested in so many different parts of something. So, it's really good.
Generally, residents start out sort of accruing a huge amount of information about the brain, about the diseases that affect the brain, and initially, there's a lot of emphasis on them learning how to take care of patients who are sick. Then, we gradually introduce them to more and more complex surgical procedures, and by the time they're done, they really are capable to be practicing independently. You still learn, obviously, after your residency is completed, and I think you continue to learn for your whole life, with that regard.
But the residency is really stimulating and it's fun to participate in a residency training program, and I think it's very stimulating to be a resident in neurosurgery.
Dr. Sandra Magnus: It must be pretty selective though; when you receive interest from a potential resident, is there a certain aptitude test that you're putting them through, or how do you know someone's poised to succeed in a program like that which is so demanding?
Dr. Ralph Dacey: Well, we have a pretty rigorous application process, and we can see what they've done in terms of their grades and the scores on tests that they take. Most of the residents that we interview have a number of publications in peer-reviewed literature. It is pretty competitive - we have about 330 applications this year, for three slots. So, it is competitive. Neurosurgeons make up about 0.4% of all the physicians in the United States, so it's a competitive process. But mostly, what we're looking for are people who are capable of working very hard and intensely, people who are capable of absorbing and processing a lot of technical and scientific information, we also want people that have, you know, fine character - like they're looking for in the Navy, and to be astronauts. So, those are all the things that we're looking for.
Sandy Winnefeld: Like Naval Aviation, you know, I'm sure not everybody makes it through the program. You never know whether somebody can land an airplane or an aircraft carrier at night until they actually have to do it. What is your retention in the program? And what are the sorts of reasons why somebody might either elect to leave the program or they just don't make it through?
Dr. Ralph Dacey: Studies have been done about this, and the attrition rate is probably about 8-12% in the most competitive programs. Overall, it's somewhat lower, maybe closer to 4. I think the reason for that is that medical students have a good opportunity to test the water, in terms of how they're going to do in neurosurgery, so they're pretty well informed when they go to enter the program. But some people don't stay in the program; I think the most common reason for that is that they just learn that the intensity, and the degree of work, and long hours, is not for them. That's probably the most common thing - and they usually decide that in the first couple of years of residency.
Sometimes, we find some people who just are not capable of managing very critically ill patients and managing a lot of information, and they can't process it all; that's less common. Occasionally, we have people who don't have the technical manual skills to perform surgery well; that's relatively uncommon, I think. But the attrition probably is overall about, you know, 8-10%.
Dr. Sandra Magnus: That's actually not that bad for such a demanding program.
Sandy Winnefeld: Yeah. By the time you get in, you probably have been pretty carefully screened.
Dr. Sandra Magnus: Real committed. Yeah.
So, you commented that during the training, you're slowly introducing people to more and more complicated types of surgeries. So, these are the kind of planned events where people can think through the whole thing. But of course, if you're taking patients out of the emergency room, there's unplanned, and you have to sort of react on the spur of the moment and, you know, dive right in. So, do you incorporate that as part of the training? Because those are two completely different situations, right?
Dr. Ralph Dacey: Right. We do. For example, a typical emergency would be that you know, a young boy struck in the temporal area of his head by a baseball and has a fracture of his temporal bone, and develops a blood clot right under the fracture - an epidural hematoma. That needs to go to the operating room immediately. And the residents understand that from the beginning, and they learn that quickly, and everybody on the team promotes that rapid evaluation and treatment of a patient like that.
On the other hand, if someone has a large meningioma, like a benign brain tumor that's growing slowly and has maybe produced some neurological problems, we have plenty of time to talk about that and plan it in meticulous detail, and discuss it with the patient, so that they're completely on board, and they know what's involved. So, they're quite different, but the residents are incorporated into that kind of care all the time from the beginning.
Sandy Winnefeld: And I would imagine that towards the end of a residency, if you have an emergent case such as you described with a young boy hit by a baseball, that the resident would actually perform that surgery and the attending would be there, I suppose, supervising and making sure that it goes well, but at that point, the residents are pretty fully capable of performing a surgery like that.
Dr. Ralph Dacey: They are. We are required to supervise them all the time, but yes, as they become more senior and more autonomous, they do much more of the procedure, and we're right there with them. And it's actually a very enjoyable part of our jobs as teachers of that because it's fun to teach that, and we're right there sort of shoulder to shoulder.
Sandy Winnefeld: So, Dr. Dacey, as you know, The Adrenaline Zone is about people who take risk, and I can't imagine anything riskier than opening up someone's brain and performing surgery on it. So, all of these surgeries have a considerable amount of risk. You lent me an amazing book by pediatric neurosurgeon, Jay Wellons, titled, All That Moves Us. I pull a quote out of that book that to me, captures the unique nature of neurosurgery, and it's, "Did we walk the exact fine line necessary to rid them of whatever menace brought them here, yet also manage to keep all the higher brain functions intact so the family can take home someone similar to the person they brought to me?"
To me, that was a gut-wrenching quote. Tell us how you're trained as a neurosurgeon to approach that risk, and how it's governed by knowledge, ethics, practicality, and the like.
Dr. Ralph Dacey: There is a difference between people like you two and neurosurgeons with regard to how we deal with risk. When you did your risky and challenging things, you were risking your lives. It's different for us because we don't risk our lives - the patient is at risk, and we have to share the burden of that risk with the patient. So, to do that, we have to set up a relationship with them. And that relationship is built based on the foundations of medical ethics. And the four principles that we pay attention to are: autonomy - in other words, that the patient has to have complete control over what's happening to his or her body; beneficence - in other words, that we must do good; non-maleficence - that we must avoid harming the patient at all costs; and then justice or equality.
So, let me give you an example of how we take a patient through that. About seven or eight years ago, a young woman who was a very accomplished professional woman came to me, and she had known that she had an arterial venous malformation in her brain. She had just become married and she was trying to plan a family. And we know, and she knew, that the risk of having a hemorrhage from an arteriovenous malformation when you're pregnant is probably increased by a factor of about eight. So, it's a significant risk and we've just recently found that out. So, what I did with her is we first defined that risk - what we call the natural history. In other words, what would happen if we did nothing for the patient and for this arteriovenous malformation?
And after going through that and all the options for various forms of treatment for that, she and I came to the conclusion that the best thing would be for her to have the lesion removed; and that's what we did. We first embolized the arteriovenous malformation where we put a catheter inside the artery that supplied it, and injected some particles or material to block off some of the blood vessels. And then, we go in, and with the microscope, we remove the arteriovenous malformation by dividing little blood vessels that feed it, and eventually, just taking it out. And when we do that, we really diminish or pretty much eliminate the risk of hemorrhage.
And in her case, it was very rewarding for all of us, because about three or four years later, she had two beautiful children. And that was, you know, an example of a risky situation potentially, that worked out well. And the whole principle was that she was, with me helping her, she was managing that risk. And, you know, I keep in touch with her, and I'm just always so impressed by her courage and the way she dealt with that whole thing. So, that's one of the nice things about being a neurosurgeon too - you get to witness that courage.
[Advertisement]
Dr. Sandra Magnus: Water is the ultimate health drink. With Culligan's filtration systems, you'll get the superior quality and pure-tasting, ultra-refreshing hydration you can count on to power your performance.
Sandy Winnefeld: Culligan's smart reverse osmosis systems take it to the next level; helping you set hydration goals, track how much you're drinking, and even see what contaminants are reduced in your water.
Dr. Sandra Magnus: That means you're always getting the exceptional water you need to feel truly good inside and out, ready to face the day, and whatever challenges it brings. Learn more at: culligan.com.
[End of Advertisement]
In your experiences, you're helping these patients manage risk because the point is the patients are managing the risk. Do you find that people struggle with this, or they can rise to the occasion? Because this is very emotional as well. You know, trying to look at this clinically as the patient, is, I imagine, really difficult.
Dr. Ralph Dacey: It is stressful, and it is very emotional. What we try to do is get to a situation where the treatment that we're recommending and conducting is much, much more favorable at changing the natural history than the potential for risk. In other words, we want to get that ratio of benefit to risk as high as we can. When we do that, and we take the patient through it slowly and continuously, generally, people can get through amazing struggles. And I think in general, most people are able to do that.
Sandy Winnefeld: Ralph, it's interesting you talk about different senses of risk between what you do and what Sandra and I did, but I think we both experienced both of those. I know not only, you know, doing dangerous things myself, but you know, sending young men and women into combat and Sandra was the deputy of the astronaut office, having to, you know, decide who's going to ride the next shuttle. And I would tell you, and I think Sandra might agree, that it's actually harder to do it for somebody else than it is for yourself. It just increases my level of respect that you would take such an awesome responsibility to make sure the person understands the risk, and then you actually carry it through. So, my hat's off to you for that.
And if I'm not mistaken, we actually will have some videos with the permission of a couple of people you are going to talk about, that we'll put on our website if people are interested in learning more about this fascinating look at what it is like to actually do neurosurgery. So, our listeners should be ready for that.
Dr. Sandra Magnus: You know, at the core of all this, and explaining the risk level to the patients, there has to be a pretty good understanding about the brain and how it works, so you understand the nature of the impact of different kinds of operations you're doing. So, I've always been fascinated with the brain and how it's structured. So, you know, for sure, what sections of the brain you can touch or not touch in any given operation, how does that work? How does that amazing organ do its job? It's so mysterious.
Dr. Ralph Dacey: Yeah. Well, it is wonderful and mysterious, and there's so much research going on right now about that, that our knowledge base changes daily really. But, you know, the brain weighs about three pounds. It is made up of about 86 million neurons or nerve cells, and there are electrochemical events that occur in the nerve cells that cause the impulses to be propagated through the networks of nerve cells that form as we develop as children, and then as we learn. And we've really learned a lot about these networks, most recently, about how that represents the way we can achieve things either with movement, or speech, or using our senses. The main parts of the nervous system are the cerebral hemispheres, the cerebellum, the brainstem, and the spinal cord. And then, the peripheral nerves carry impulses to the muscles, and back from the sensory receptors.
So, it's all integrated. It, obviously, is an extremely complex thing, and neurosurgeons and neurobiologists, and neurologists, are constantly increasing our ability to understand how it works, and how the diseases that affect it can be treated more effectively. So, it is fascinating, and you know, something you can get interested in for a lifetime, that's for sure.
Dr. Sandra Magnus: Yeah, no kidding.
Sandy Winnefeld: In researching for this amazing discussion we're having, I was really impressed by the sort of dazzling different types of operations you can actually perform on the brain. There's just so many of them out there, I can't imagine how you could even learn them all in seven years as a resident. But can you sort of walk our listeners through the broad sort of generic types of things that you do in neurosurgery when you're operating on a patient?
Dr. Ralph Dacey: Well, the most common things that we take care of are head and spinal cord injuries - various kinds of stroke, especially strokes that are characterized by bleeding into the brain. A variety of different kinds of brain tumors - there are many, many kinds of brain tumors, and they can occur in many different locations. And so, that can be a very complicated thing.
Neurosurgeons also work on the spine and peripheral nerves. And that's a lot of what we do - decompressing the spinal cord and the nerves that relate to it. And then there's a whole bunch of things that affect children. Like Jay Wellons does that kind of work with congenital malformations and tumors and injuries just like that.
So, those are sort of the five major disciplines within our specialty, and there's a tendency for neurosurgeons to subspecialize in those areas. Like, some neurosurgeons principally do spinal neurosurgery, some neurosurgeons concentrate on tumors, other neurosurgeons concentrate on diseases of the vascular system - the blood vessels. So, it is a very broad field, but I think in general, when we learn to focus on one area, we can really become very skilled at doing that.
Dr. Sandra Magnus: There are situations where surgery is not available. For example, my father had progressive supranuclear palsy, which is, as you know, a neurodegenerative disease. And so, I imagine there's some other types of diseases like that which come across your desk that you just can't help with. What happens with those people?
Dr. Ralph Dacey: Well, there are a lot of neurological diseases that now cannot be treated effectively by either drugs or surgery. But we're trying to change that in our specialty. For example, there's some evidence that by very specific paradigms of stimulation of the brain with minimally invasive stimulating devices, that we may be able to improve memory and treat people with refractory depression. So, we are working constantly with the neurologists on trying to expand our ability to take care of all the diseases that affect the brain. But, you know, there are many that we can't successfully treat now, like progressive supranuclear palsy.
Dr. Sandra Magnus: It's just so complicated, isn't it? It's just amazing.
Sandy Winnefeld: So, speaking of complicated, Sandra and I lived in a world where there was a process, right? If you're going to launch a spacecraft, or you're going to launch and recover an airplane, you go through a process. I think it might be interesting for our listeners to kind of hear from you, from start to finish, how does this work? Obviously, you're studying the operation that needs to be performed, if it's, you know, a deliberate one rather than an emergent one. But walk us through what happens in the operating room.
Dr. Ralph Dacey: Sure. Well, the team in the operating room consists of a surgeon, an assistant surgeon, a circulating nurse, a scrub nurse, or technician, and an anesthesiologist or a certified nurse anesthetist. So, that's the team. You know, let's say we were going to fix an aneurysm in someone's brain - one that had not yet ruptured, but we were going to fix it. The way we would do that is that the surgeon and the assistant surgeon would go out to the preparation area, that the sort of the ready room, and talk to the patient, make sure that we have identified the patient, that we know what operation the patient thinks he's going to have done, and we actually then take out a marking pen and write on their skin, "yes", for the site of the surgery, because, obviously, we're very, very careful about making sure we do the right surgery on the right patient in the right location.
So, once that's done, we then bring the patient back to the operating room, we put the patient very carefully on the operating room table, the anesthesiologist would then induce the appropriate kind of anesthesia, and then we take a lot of time positioning the patient very carefully, because, for example, if the lesion is at the back of the head behind the ear, we want to have optimal access to that area, and we have to put the patient sometimes in some complicated positions to do that and we take a lot of time doing that, and we're very careful.
So, once that's all done, we do a sterile preparation of the skin and drape it off with sterile drapes, and then we stop. And we have this thing called a timeout where everyone agrees that the surgery is going to be done in this way, at this location, or this problem. And the operation can't go forward unless we do that, and everybody has to stop what they're doing and pay attention to that.
Then, you know, the surgeon will begin the operation by making an incision in the skin. If it's an operation like I said, on an aneurysm in the head, we would pull the scalp back out of the way, move some of the muscles, like the temporalis muscle that clenches our jaw, and then open the skull with some power tools that are specially designed for that-- and that whole opening process takes about a half an hour or so. Then we bring in the operating microscope, and we carefully open up the fissures of the brain - especially, what we call the Sylvian fissure, the lateral fisher between the temporal lobe and the frontal lobe, and then we go down and identify the artery which is bearing the aneurysm. And we spend time understanding the anatomy of the aneurysm based on the pre-operative X-rays, and then we very carefully define the vessels that are going into the aneurysm and the ones that are coming out.
Once we've done that, we place a clip across the neck of the aneurysm to make sure that it doesn't rupture, then we make sure that there's no more bleeding going on around the operative site, and then we close the dura, which is the thick leather-like membrane that's over the brain. And then we plate the skull back in place with some little microplates that are often made of titanium. And then we close the muscle and scalp in layers, put a dressing on the patient, and then wake them up.
We then have a post-operative brief - our debriefing with the whole team, and then the patient is taken back to the recovery room. And again, at that point, the surgeon and the anesthesiologist will communicate with the nurses and other people in the recovery area so there's continuity of care.
So, there's a big emphasis on safety, a big emphasis on communication, and of course, we've learned that from the aviation community, and the Navy, Sandy, as we've talked about. And so, it's much better now than I think it used to be, because of this emphasis on safety and clear communication.
[Advertisement]
Sandy Winnefeld: You live to embrace risk in the air, on the slopes, and anywhere your determination takes you. But when it comes to the drinking water that fuels your adventures, you're not looking to take chances.
Dr. Sandra Magnus: With cutting-edge filtration that can target contaminants as small as a single atom, Culligan's reverse osmosis filtration systems deliver the next-level hydration you need to keep working at peak performance, whatever the day brings.
Sandy Winnefeld: Get started by scheduling your free water test at: culligan.com.
[End of Advertisement]
It had to be amazing to operate on a three-dimensional object into which you really can't see easily, you know, the tumor you're going after or whatever, and you're doing it in proximity to some really important and vulnerable structures in the brain that if you don't get to the right place and do the right thing, you could end up really hindering that person's future life. That kind of concentration seems like it's intense, it's of a different type. Landing on an aircraft carrier at night seems very similar, but how do you find your way around inside the brain?
Dr. Ralph Dacey: I think there's two aspects of that: one - we have some great technology, which is stereotactic guidance, which is basically similar to a GPS that we'd use on our phone or a car, and that allows us to triangulate the position in three-dimensional space of the instruments that we're using. For example, attacking something like a colloid cyst near a ventricle right in the middle of the brain, we can go right to that using this stereotactic guidance introduced through a very small hole in the skull, and we can get where we need to be.
But in addition to that technical support, we also have to have a good visual spatial orientation to where we are in the brain at any point. And that comes by doing many operations and studying the anatomy in extreme detail, so we can know exactly where we are at any one moment. And I think it is similar to what I've heard described about landing a jet on a carrier, and that you constantly have to be oriented not only to flying the ball, for example, but also to where you are, and what's going on, and how it feels. So, it's both the technical and the sensory aspect of it.
Dr. Sandra Magnus: You know, we fly the station robot arm in a similar way before the workstation moved to a window. We had to put three different camera views together to understand where we were in three-dimensional space, and we actually trained in virtual-- well at the time, it was not as advanced as now, but virtual reality, to try and get some of that spatial awareness built into us. Do you guys use technology like that for training?
Dr. Ralph Dacey: Increasingly, we're doing that. Sandra, that's a very good point. I've looked at some of those videos of how those devices work in the space program, and so, we have a lot of great simulation devices which are being developed now. One thing about that, that's interesting is that the sensory feedback, or the haptic feedback we get from holding the instrument, even though we're making very small moves and everything, with microsurgery, that's hard to simulate right now, but it's getting better and better all the time. And that's a big part of what we do. There are great simulators now for teaching neurosurgeons how to do endovascular procedures where it's all through a catheter introduced, let's say, in the radial artery in the wrist to go up and fix an aneurysm, or another lesion in the brain circulation. So, simulators are very, very good for that.
Sandy Winnefeld: Ralph, you and I have talked in the past, about the comparison of the operational excellence principles that we use in the nuclear navy and what you do in the operating room. You know, things like integrity, level of knowledge, procedural compliance, formal communications, forceful backup, being able to say stop at any particular point, and a questioning attitude. We've already sort of alluded to a few of those already, but talk to me a little bit about the formal communications and the sort of forceful backup. You've got a surgeon and an assistant surgeon, is there a cadence going back and forth between the two of you, or, "I'm about to do this.” “Okay. I understand you're about to do that." How does that work?
Dr. Ralph Dacey: Yeah. There is, and, you know, we've really learned that Sandy, from the aviation community, and, you know, we're all exposed to the communications that occur in the space program too. You know, we've really learned from you about that, we are very deliberate about how we communicate before the operation and during the operation. And I think it's kind of an art to learn how to develop that rhythm or tempo between the surgeon, and the scrub nurse, and scrub tech. Some of the scrub techs I've worked with are really athletes - they can be looking, for example, at the monitor of the microsurgery, and they know what instrument we need before we need it, and they've got it in our hands before we even ask for it sometime.So, that kind of, sort of syncing of objectives is really a good thing.
But we're also very, very deliberate about using clear-cut and simple communication to make the whole thing work because if we don't communicate well, we increase the risk. The forceful backup is definitely something that's much more prominent now in the operating room, and in any kind of medical situation. So, any member of the team is encouraged to speak up if they don't think something is going properly, or there's a problem. And if someone does that, we basically stop and try to figure out what the problem is. And that has been a great improvement in the way we do things in surgery, and in medical care in general.
So, we've learned from both of you, and thanks for that.
Dr. Sandra Magnus: You know, you mentioned earlier that you do a post-debrief in the operating room afterwards, just like we do because you learn things when you have such a highly technical and risky process. So, how do you take the next step or what you've learned from an operation, good or bad - technique-wise or communication-wise, and share that across the whole community so that those lessons learned are not just within the surgical team that you happen to be managing, but across the whole neurosurgical community? Do you have processes for that?
Dr. Ralph Dacey: We do. We have multiple ways in which we do that. We have quality and improvement conferences every month, where every case is reviewed, and lessons are learned, are provided and discussed in detail with the group, right within our practice group. We spend a lot of time doing exactly that at our national meetings, where we all get together and talk about how to do things better, new discoveries, new ways of doing things, and there's a big emphasis on that. And there's a big premium placed on being honest and forthright in talking about our complications.
I have a great friend down in Miami, his name is Roberto Heros, and he's known throughout the world as being an incredible neurosurgeon and teacher, because he is able to just in a very forthright way, discuss the complications he's had, and turn that into lessons for the rest of us. So, there's a big premium on that among the leaders of our specialty, and it's an important thing for us to do, obviously, as it is for you.
Sandy Winnefeld: Dr. Dacey, as we come to a sort of a closing point here, I just have to say that highs in this business must be really, really high, and the lows have to be very low. What's that like, and how do you handle that personally, knowing that you've either, you know, really, really, helped somebody to carry forward with their life, or that there might not have been much you could do?
Dr. Ralph Dacey: Well, the highs are great, and there's no question about it. And it's very, very exciting when you can help a person through a dangerous situation, and they survive and thrive after that. And that's what we live for. But as you said, there also is a situation where we have lows in those where we haven't been able to help a patient, or procedure hasn't gone exactly as we would've hoped it would've gone. And you remember those cases, and you know, you remember them for years, and you really never forget about them. I think one way that we deal with that is that in any practice group, the senior people talk to the people who are now coming up and we discuss that. And over the years, I've been in position to help surgeons get through that after they're dealing with a complication or an adverse outcome.
And it's important that we support each other, and at the same time, learn from our mistakes and learn from the things that we haven't done as well as we could have. But overall, I would say, it's a very rewarding life as a neurosurgeon because I think the highs definitely outnumber the lows.
Dr. Sandra Magnus: Well, Dr. Dacey, thank you so much for joining us today. I feel like I could talk to you for hours about this amazingly complex profession that you've had. And congratulations on a wonderful career, and most especially, on the mentoring that you've done over the years, and all of the other neurosurgeons you've trained in your position there at Washington University while you were heading that organization.
But again, thank you so much for joining us. This has been really amazing to listen to your stories.
Sandy Winnefeld: Again, really good to see you, my friend, and thanks for spending time with us today. It's been terrific.
Dr. Ralph Dacey: I really enjoyed it. Thank you very much.
Dr. Sandra Magnus: That was Dr. Ralph Dacey, former Chair of Neurosurgery at Washington University, in St. Louis, Missouri.
I'm Sandra Magnus.
Sandy Winnefeld: And I'm Sandy Winnefeld.
Don't forget to check out the additional videos we're posting about how neurosurgery really looks and feels, at our website: theadrenalinezone.com.
Dr. Sandra Magnus: Thanks again to Culligan Water for sponsoring this episode. Get exceptional water for exceptional performance. Learn more at: culligan.com
Sandy Winnefeld: And check us out on social media, including a short video of our interview with Dr. Dacey on TikTok. Our handle is very simple: @theadrenalinezone.
