Think freely. Write freely.

I am a medical student who is (at least now) very interested in neurosurgery, and it is no secret to my friends and people around me. I was asked by some of them, pretty frequently, “why neurosurgery?’, they asked. I have no quick answer or response to that question. I, after thinking for like 30 seconds, answered like “because it is interesting”, “it interests me very much”, or something similar with that. I realized that the question must be one of the most common questions asked in an interview for residency. That means, I have to come up with a better answer than that.

After thinking for some time, I have no better answer. The answer which came up every time I was asked the question, is the honest answer. The nervous system, especially the brain, the magnum opus of evolution, if I might say, fascinates me. It is a mystery, an enigma. It is what defines what we are, who we are. It is the producer of our consciousness. In other word, our essence. Should we have a soul (I doubt it), the brain must be where it lies. 

The mystery of the brain is obvious from the moment we asked ourselves questions like: how does it work?. Neuroscientists have researched about how the brain works for a long time, and managed to come up with many interesting answers. They concluded that some part/ location of our brain specializes in certain task. The motor cortex, for example, is the part of the brain which commands what muscle to move. The signal is transmitted by a chemical substance called neurotransmitter, which generates electrical activity in the target muscle (or other nerves), the electrical activity then makes our muscle contracts. Damage of the cortex causes our muscles to become paralyzed, because the muscles can receive no command from our brain. Some parts of our brain, is responsible for our senses’ perception. Signals are received by peripheral nerves, and transmitted (again by neurotransmitter) to our brain to be perceived (either as sound, visual, touch, or other stimuli). Until here, it is pretty simple. But from now on, this gets ridiculously complicated. A part of our brain, called the frontal lobe, is where our ability to plan and to predict something might happen in the future, come from. The neuroscientists can only conclude this by observing that the frontal lobe is the part where our brain is most active (by generating electrical activity with the help of neurotransmitter) when we plan to do something in the future. But in what form exactly our ability to plan and predict is stored? When the frontal lobe is damaged, people may lose the ability to plan or to think ahead, and they lost their ability to think what might be the consequences of their actions, hence they also lose their ability to act in appropriate way. That is just one example. Then, our mind. How can something as physical as our brain, creates something like our mind? How about our memory? In what form is it stored? And our consciousness? I will not explain further as it will be a very long explanation and it might fail to satisfy. The neuroscientists have come up with some interesting ideas, and theories, and evidence, but still, most of the answers to the questions are still mysteries. I am going to explain how does a heart work, for the sake of comparison. The heart is, basically, a set of muscle which work together. It works by rhythmical contraction which generates blood pressure so that it may deliver blood throughout the body. The contraction itself is controlled by an autonomous nervous system, so our heart contracts without us voluntarily controlling it. Explaining how the heart works is simple in comparison with explaining how the brain works. I do not discredit the heart (or any other organ) or any other people interested in studying the heart at all. In fact, it is still a fascinating organ, and not even our brain can work without a functioning heart. I am just saying that the heart (or any other organ in our body) is not a mystery box, as the brain is. So, there is my point. Our brain, is an enigma.

Like I said earlier, the brain must be the essence (if there is an essence) of a human. Let me try to convince you. First, I will explain the definition of essence to avoid confusion. In philosophy, essence is the attribute or set of attributes that make an object or substance what it fundamentally is, without which it loses its identity. There was a paradox about whether anything has an essence or not called the Theseus’ ship paradox. The paradox asked whether a ship which was restored by replacing all its wooden parts remained the same ship. If it is not, when did it become a different ship? Which part defines the identity of the ship? And what if all the replaced wooden parts are assembled again into another ship at another place? Which is the original Theseus’ ship? The answer to these questions are difficult, even philosophers from ancient times argued about them. It can be asked in various ways, and the object is not limited to ship. It can be applied to a sock (there is a hole in the sock, then a patch is applied to it, overtime the whole sock is made of patch; is it still the same sock?), or a car, or a computer, or anything. But such confusion do not apply if the object in question is a human (not necessarily a human, but anything which happen to have a brain) body. A friend asked me whether it had been possible or not to do a brain transplant. I said that it would have been technically impossible with current medical technology and science. After I gave myself sometime to think about it, it is not just technically impossible. It would also be an incorrect term. Rather than a brain transplant, it would be called body transplant. Why? Let us imagine two persons. Let us call her Lucy and Peter. Let us say that the medical technology is already so advanced that it is easy to harvest an organ from someone’s body and to assemble them into another body. What if Lucy’s body parts are exchanged, one by one, with Peter’s body part. Lucy’s body parts are harvested to be transplanted into Peter’s body, and vice versa. So that Lucy’s hands were Peter’s hands and Peter hands were Lucy’s, and Lucy’s heart was Peter’s and Peter’s was Lucy’s, and so on. Which is Lucy? Which is Peter? When did Lucy stop being Lucy and become Peter? Do you see where I am going? I think, the most logical answer is Lucy stop being Lucy exactly when her brain is transplanted into Peter’s body. And Peter stop being Peter when his brain is transplanted into Lucy’s body. So Lucy is having a body transplant, rather than Peter getting a brain (of Lucy) transplant. Our brain is our identity, our essence.

The opportunity to treat the diseases and the pathology of the brain and the rest of the nervous system (from congenital anomalies to tumors) by manipulating them, is certainly intriguing. The delicate, complex technique to manipulate the nervous system, interests me very much. The only profession in the world who can (and legally) manipulate the brain and other nervous system, is the neurosurgeon. That is why I want to become one.

So, there you are. Those are some reasons why I am interested in neurosurgery. I hope I can explain it to the interviewer should I be asked this question someday. And last of all (maybe the least, maybe not), let’s face it, neurosurgery and neurosurgeon, are cool. Period. There is an old neurosurgery joke: most people will know that the difference between God and a neurosurgeon is that God does not think he is a neurosurgeon although I suggest that many neurosurgeons would ‘see that as one of God’s failings’. And another: “How many neurosurgeons does it take to change a light bulb?” “One: they hold it still while the world revolves around them!” How cool is that? :D