Episode 7 - The Personality of a Neurosurgeon

Being deep in somebody's head is an unnatural place to be, like you're not really allowed to go there normally. Welcome to the Nursery Podcast. I'm Mike Wang and I'm here with my co-host, J.P. Colson. We are here to discuss all things nursery school. Hi, this is J.P. Colson, a resident in neurosurgery at Rush University. Please note that this is not a CME event, and the opinions and statements made in this podcast do not reflect those of any institution or professional organization. Now, let's get started. So, today we're very lucky to be joined by Nick Bullis. Nick Bullis is really what I would call micro celebrity and that's not an insult. That's a high compliment. A micro celebrity is someone who within their field or specialty is really a celebrity. Nick has been a friend for years and really, I mean, one of the most riveting aspects about Nick is you can't get over his personality, which is just huge. Welcome to the podcast, Nick. Thanks, Mike. So, you're really an interesting person who tries to do so many different things, and I wanted to talk to you about psychology, and I know you know a lot about a lot of things, and we could talk about any topic, but I kind of wanted to delve into this concept like what is the psychology of a neurosurgeon? And what would you say is like the quintessential profile? Like, do you fit it? I think that I fit parts of that profile. I mean, I think if we dive into the quintessential characteristics of the neurosurgeon, number one, I think that we require immediate consequence of action to validate the value of any action in particular. That is, we're not good on deferring the feedback, right? There's something inherent about operating that you know whether you did good or did bad, did well or bad immediately, and I think that's part of it. I think the other emphasis there is the consequence of action. We crave a very heavy consequence. We crave durable consequence, and I think for me, that's incredibly important because I was searching for something, a lifestyle that would make my actions matter in that moment. So that I believe it enhances our level of experience because, quite frankly, we pay attention or you're forced to pay attention, and in particular with me, I grew up with raging ADD, I have a very hard time paying attention to things, and neurosurgeon was one of the very few things that captured my attention. I don't think that's true of all neurosurgeons. I think many neurosurgeons are far more inherently focused, but I do think that we all crave that heavy immediate consequence of action to validate our experience. So one of the better validated models in psychological literature to look at and analyze personality on an individual level and populations is the big five personality traits. Those are openness to new experiences, conscientiousness, which you kind of touched on there with the ability to focus in on a single task, extroversion, agreeableness, and neuroticism. In your thoughts about yourself, about your colleagues in neurosurgery, about young trainees coming up from the field, which of those would you hone in on as maybe the most important aspect when considering this field? Well, first of all, could you write them down and I'll go through the list. I mean, neuroticism, I don't think, is important, but I think it's, it is a, what I would call a covariant, I think, people that are drawn to neurosurgery tend to be outliers, because it takes a certain person to accept all this consequence of action, all this, for want of a better word, just stress, but we're drawn to it. And we can explore why people are drawn to it, but I think we're in general outliers, and I think whenever you take a group of outliers, you're going to find a higher titer of neuroticism in that mix, so I don't think the best causal. You keep returning to this concept of the consequence of action, too often in life, and especially in a high-stake surgery and a trauma, that consequence is negative, but you find satisfaction or fulfillment just being in a scenario that has immediate consequence, whether or not it's good or bad. Correct, in fact, I think it's important that either valence is possible, and I say that, you know, there's a huge reward, and there's a huge punishment when things go wrong, and we're not always in control, but we're always responsible, right? So, again, it comes back to what I originally said, which is it elevates the intensity of experience, because what's going to happen matters, you know, it's going to be really great, and you're going to own that, what's going to be really bad, and you have to own that also. So, coming back to the list or your list, I just, I don't think extroversion isn't necessarily important for neurosurgery. I haven't been extroverted, my cap is to be extremely extroverted, it's one of the ways we get along, but I don't think it bears on our capacity to act as surgeons. It may bear on our ability to interface with patients, it certainly bears on our ability to engage in leadership in the field. As for agreeableness, I put that in the same category, I don't think it's, I don't, I think it can be disagreeable, and still be a highly effective neurosurgeon. In fact, many of our role models took pride in not having to be agreeable or extroverted, they believed I think that their capacity to deliver in these high-stress situations was enough, and it was sort of part of what was really important was a high level of confidence, and that sometimes that confidence, that perhaps narcissism worked against. I think that's less true now, I think that in medical training, there's an expectation that you connect with people, but I think at the end of the day, it's going on is how we perform when we're in the operating room, and our capacity make good decisions about who goes to the operating room, and be decisive about in both spheres. So openness to experience and conscientiousness, conscientiousness is absolutely critical, I just think right now on this list, that's topping a list for me for being a good neurosurgeon, although I don't think it's good enough to be conscientious, but perhaps it may be because we, I think we can agree that with regard to the issue of technical virtuosity in our ability to execute. It's highly complicated, dextrous activity under pressure, that we recognize in the samurai of our field, not everybody is going to be a samurai, but I think people can choose where along that continuum they want to be, at the end of the day, you still have to be conscientious. I do a lot of deep brain stimulation, that requires almost no virtuosity with regard to this dextrous capacity to execute under pressure, which I think is one of the core value systems of our field, but it really requires conscientiousness. I mean, I tell people, you know, this is not me being a fighter pilot, I have other operations for that, this is me being the captain of a super tanker, where you got to be attention to the details, and ultimately you own the same kinds of horrible outcomes if you're not going to do that. So I put that at the top of the list, I think the openness to experience, I would put that number two in this list, because I think where that lies is the difference between some of us. Some of us being a good neurosurgeon and being an exceptional neurosurgeon, because no matter what, you can't be timid, you have to be willing to go places which are going to be novel, and coming back to the ADD thing with me, I would never be able to sustain a career where the experiences weren't renewed and new. Doing the same thing over and over again would be nearly impossible for me. So Nick, I mean, you have a very interesting life history, and I don't want to rehash it all, but like you went to College of Yale, right? And one of the really interesting things about she was that your roommate is also very well-known neurosurgeon, right? Well actually in the Lawrence Hall, which was the dorm facility for Ezra Style's College of Yale, it contained, well it housed me, Arunamar, who was one of your co-residents and frankly how we got to be such good friends, who was my roommate and very close friend, Andy Parsa. Oh wow, that close. The late Andy Parsa, yeah, that's correct. I was not that close to Andy at Yale, but I grew to be close to him. And during the residency, even though we ended up in different residencies, because we were pursuing such a similar core value of becoming a clinician scientist and their benchmarks for that. So I want to take you back 30 years, okay? You're back at Yale now, okay? I know it's scary. You're looking around at your class, what? Two thousand kids, fifteen hundred kids, whatever it is. Everybody there pretty much is very bright, right? They've got promising futures, they're very accomplished. Do you think you could go back and pick out the people that would A, B, come neurosurgeons, and B, the ones that would be good at it? Like just by knowing who they are. I, you know, this is one of those, you know, when a room announced, probably during his time at UCSF, of course, we're really close. This is his medical story. Yeah, he went off, he did a fellowship in pathology, and then went to UCSF, I went off to Harvard, and we were of course communicating. At Yale, I was absolutely obsessed by the mechanics of consciousness. I did a major in biology in their psychology track, which was then a neurobiology. I did another major in philosophy in the psychology track. Basically, it was mind and brain studies. I was completely obsessed with this stuff. A room was more interested in broad philosophy, phenomenology, et cetera. But when he got to medical school, began professing desire to become a brain surgeon. And I thought to myself, I remember this, this guy who frankly was fairly timid when it came to say, going sledding on the cafeteria trays that we go to the disco and go crashing down this hill, which had like raw iron fence at the bottom. And room was like the last person lining up to do that. And I was like, obviously, going ho. And I, I just thought about that and thought, he doesn't seem like he's brave enough to do this. And yet, he became a vascular neurosurgeon. I became the functional nerve pain guy. So, I mean, any day of the week, it takes more testosterone to take on aneurysms than the kind of stuff I do. You know, that's a great follow-up podcast is how you could determine what your best, especially if your neurosurgeon should be. Right? You could, we could even advise a test for that, like a little percent. So, so it's interesting to me because you know, a lot of our listeners, we believe, are people who are interested in neurosurgery as a phenomenon, but are not actually neurosurgeons. Maybe people who want to be neurosurgeons aspiring people of high school kid, medical school resident, sorry, not a resident, but the college kids. And, you know, I certainly have my sort of prototypical big five personality trait of a neurosurgeon of what you need and what you what you don't need. But, you know, you and I both run into lots of folks who come to fermentorship and they don't seem to have the, I don't want to say the right because there's not just one right personality, but they don't seem to fit that bill. Right? Right? Do you think those people, A, should change to become the quintessential neurosurgeon and B, are capable of changing who they are? Again, there is a continuum within neurosurgery that can allow for variants in personality types. I think that it's people are far more likely to be happy and successful if they can find activity and category that matches with their personality. I think, I think you're going to attempt to change your personality by the time you're ready to choose a medical discipline, let alone some specialty. I think that ship sailed. Well, you know, and I think if you try to adapt because you are trying to achieve some label or, you know, put yourself into a mold that weren't meant for, I think that's psychologically discordant. I think you're destined for trouble. So I, you know, I'm sure you have the analog at Emory in Atlanta, but we have this like Camp Neuro for high schoolers and all these high school kids, they're all beaming bright eye. They come in and then, you know, and half of them, full half, say they want to be a brain searching. And, you know, maybe they don't know the difference between a neurologist and a neurosurgeon or whatever because they couldn't be any more different, right? But, but they come to you and they're asking for this advice. And I keep thinking to myself, I don't know if you saw that movie Rocketman about about it. Elton John, it's really good. It's, it's very well done. And there's this great part where someone's talking to the young Elton John, the pre-famous. Right. No, it's not even a micro celebrity yet. And they say to him, the guy says more experienced rock star says, in order to be the person you want to be, you have to kill the person you are. And I sometimes think, and I don't know if this is true. It's a theory of mine, that residency is in some ways killing off like the neural pruning, you know, when you're killing off a part of you that's not acceptable in our field or not conducive to good outcomes, whatever you want to label, put on it, right? It's changing you to be something that's proven to be more effective. Okay. So I have two immediate responses. Yes, please. Hopefully I can, I can get these out before I lose track. But number one, I believe very strongly in that this is a, that neurosurgery training is just that it's training. It's not an education. It's, it is embedding motor memory. It is, it is a molding and adaptation of our identities. And in particular part of that, and it's pertinent to the old 80 hour work week thing, when I became a neurosurgeon, I wanted to be part of an elite core. And I was willing to sacrifice for that. And without the sacrifice, it would not be an elite core. And I wanted, so I wanted to make that sacrifice. I mean, I wanted to bleed for it. And, and it's hard, I think, having come through that era to relinquish the idea that there's something about our identity that, that is earned through that suffering, for example. And it, that hardening, per se, I mean, I view neurosurgery training appropriately to be like the forging of a katana where, you know, the blade is heated and hammered, bolted one thousand times and heated and hammered to the military level where it is a sharp honed tool. And that's what we ought to be. And I think we should, in the process of making the decision to be a neurosurgeon, we surrender to that. And we're going to miss a lot of, for example, enlightened experiences because we need to be focused in that process of hammering and folding. Okay. So I think that that's the way it ought to be. Frankly, I don't hear anybody clamoring for kinder and gentler duty hours for our seals. And I feel like we're the seals of medicine and it ought to be that. I have a great line. You know, what I, I'm sorry to interrupt you, but when I come to see my patients in admitting for surgery, they always ask the same question. Dr. Wayne, did you get a good night's rest? And I always give them the same answer. If you have to ask that question, you picked the wrong surgeon because it doesn't matter. They don't ask the seals. We just interviewed a seal earlier today. Do you feel like killing yourself? I've been a lot of day. It's not up to you. You're trained to not, it doesn't. That's right. You need to, you need to be able to deliver regardless of your state. So that's thought number one. Okay. Thought number two gets to the point that I, I'm listening to you and it's interesting because when I started my career wanting to be a clinician scientist, I mean, what's the pinnacle of success as a clinician scientist academic neurosurgeon? No, about price. Well, how many neurosurgeons, no price have been awarded to neurosurgeons? Not many. And I think that's a good one, too. But to me, it's becoming the chairman of a program. So, and frankly, when you commit yourself to spending a lot of your actual working hours killing rats instead of killing people, you're gonna get paid less. But when you get, you know, you get to the top of the food chain as a chairman. Well, then other people are, or have, do the operating. And that's you know, you're not benchmarked necessarily RV use. Now, that may not be true everywhere. But it also was a good financial model for me. So, so when I set out on my goal to become the very best clinician scientist that I could, to me, the hallmark of success was becoming a chairman. But the closer I got to that and the more I interviewed for those positions, the more I realized, first of all, as a chairman, I would have to actually reinforce or enforce rules. And I am proud. worse person to enforce rules because I love breaking rules, that being essentially middle management in a university would be like the absolute worst job for me and that ultimately I want to express and achieve my own agenda, not like embrace the agenda of the group, a whole lot. So what I realized was I was trying to do to be and become something that wasn't me and I went a totally different direction which was, you know, adapt my expectations to fit who I realized I was. So you know, I've kind of gone into different direction. So I want to ask because you mentioned that because we were just talking about this recently Dr. Wayne, shooting from the hip, are neurosurgeons rule followers or rule breakers? That is a great question, the quintessential neurosurgeon we're discussing. Okay, so there was a moment in my residency where a guy named Mike Polensky was one of my senior residents, chief resident at the time, I think I was a junior, you know, that junior chief relationship that's really closely, really respect that person. I can't quite remember what he said but what I realized was that part of why I absolutely loved neurosurgery is being deep in somebody's head is an unnatural place to be. Like you're not really allowed to go there normally and yet we can. So it was like at the heart of breaking some really fundamental rules about human behavior like taking the back, something's head off and going down in there and, you know, having work around. What I realized was that for Polensky, you know, neurosurgery had nothing to do with breaking the rules and that the risk that was involved, I mean to him, it was about orderly obeying the rules such that he could carry out the task. So I know where I stand on that continuum but I don't necessarily think all neurosurgeons need to be, you know, in federate. But you know, I think, you know, that's a great question because I think that if you look at our DNA, it's Harvey Cushion, right, or Dan. And these were guys that were taking on stuff that nobody would touch because it was basically a death sentence to go through a surgery, right? So that part of the rule breaking, right, that those guys created the field, right? They were the innovators, right? But we're going to be interviewing a lot of innovators like yourself like John Adler, neurosurgeons invented basically like half the stuff that's out there, right? I mean, it's crazy the amount of innovation for 1% of doctors. So I think at the high level where the rule breakers, but I think that in order to engage and not have errant results, you have to be very disciplined at the micro detail, like a Navy SEAL. Navy SEAL has to be absolutely detailed on how they execute their rifle maneuvers or shooting. But then the big picture, they have to be flexible. And they wear veerards, right? And so it's a very parallel, I think, it's very much a parallel. Yeah, I mean, I, you know, listen, depends on your practice, depends on where you want to go. It's somebody, somebody has said that the creativity and surgery, there's, you don't need creativity and surgery when things are going right, you need to be creative when things start to go wrong. Just like to see. And yeah, it's when it's when the you're planning doesn't account for what is happening and it can't always, that's when you need to be creative. And it's a particular type of creativity, right? Because you got to execute it on the spot and have confidence in your actions, right? We'll see the solution and follow it and stand by it. Nick, we could talk for hours about politics, talk about drugs, we talk about burning man, we talk about anything, right? And your science and the great work you're doing in ALS, and I hope you find the cure or part of the cure, maybe an arm of it. And congratulations on all your innovations and we really want to thank you for the time you took to come talk to us today, right on? Anytime.