A Recount of Historical Events

Unlike most other residencies that took three years after internship, neurosurgery took four years after one initial year of general surgical training, which was devoted to basics such as laboratory, neurology, pathology, or some form of electives. Because of my previous three years of training in neurology at the University of Wisconsin, one year of which was in neurophysiology and EEG, my neurosurgery training took three years; of which the first six months was arranged as surgical internship because my internship at Mount Sinai Hospital in Chicago was a rotating one.

The arrangement was done through the kind recommendation of Dr. Evans and was acceptable to the Board of Neurosurgery. While at that time the duration of residency was shorter in years, it was longer in hours. Dr. Hernando Torres (who was one year ahead of me) and I were on-call every other day, except each of us could go off every other night provided that the daily work was finished and there was no operation during the night. Dr. Antony Raimondi, the chief resident, was on-call on Saturday nights. The chief resident was to come at nights if there was an emergency admission or operation.

It was common knowledge that neurosurgery residency was hard, but it was a sign of physical and mental weakness if a resident mentioned it. If one made the mistake to say “yes” if asked “are you working hard”, the response was “good, this means that you are learning." Two residents before me had left after one year. It was perhaps easier for me because of my previous training, for the first year is usually the hardest. Despite a salary of $100 a month, money was not an issue. The most valuable commodity was an hour of uninterrupted sleep.

Through adaptation, working hard, and even lack of sleep, all became much easier in the following years as we learned to operate and found our purpose for being there. Just the realization of having the privilege and pleasure to go to the operating room for a few hours to prevent death, paralysis, and blindness was enough. For in every endeavor in life, every task or every circumstance becomes easier to do or to go through, only if in it one finds good purpose.

The training was not limited to what one learned in neurosurgery. We, as residents, did pneumoencephalography (PEG), ventriculography, and angiography not only for neurosurgery, but also for neurology. We had combined neurosurgery and neurology conferences and learned from outstanding adult neurologists like Dr. Richard Richter and Dr. Sidney Schulman, and from pediatric neurologist Dr. Douglas Buchanan.

Neurology was a section of the Department of Medicine. In 1976 it became a department with Dr. Barry Arnason as its first chairperson. In July 1976, he rapidly advanced the center by bringing clinically and laboratory-trained faculties in immunology, multiple sclerosis, neuroinflammation, and epilepsy. As with neurosurgery, he was followed by several chairpersons who remain active, the list of whom can be found in the Department of Neurology's website. Today, the department is nationally known and chaired by Dr. Shyam Prabhakaran, who has heightened interest in the neurovascular diseased.

During our residency, we found the so-called “surgeons’ lounge," not just for dictating operation notes and for a cup of coffee, it was an intellectual atmosphere where one learned from surgeons with impeccable honesty and integrity, like Dr. Donald Ferguson, and got ideas for research from surgeons like Dr. Paul Harper, with his ingenious scientific and innovating knowledge for research. Dr. Paul Harper was a pioneer in using radioactive implant for local radiation treatment. After work, some even learned judo from him in the Bartlett athletic center. The doctors’ dining room was another area where the faculty could go to meet each other, talk about their work, and sometimes have unofficial curbside consults.

Two years after my faculty appointment as an assistant professor, I received the McClintock Award for what was called the teacher of the year. In a celebration in which Dr. Charles Huggins was recognized for his Nobel prize, and others for their accomplishment, I felt humbled, yet I was happy and proud that the students had recognized my teaching. Suddenly, I felt a tap on my shoulder. When I turned around, it was Dr. Sean Mullan, my mentor. “Don’t let that get to your head” he said. “If you want to get further in this place you ought to do research.” He himself had the same prize a few years earlier.

He was right. Research was an essential academic task at the University of Chicago. In medicine, laboratory research was important and had to be recognized nationally for any significance. Without national recognition, one seldom was promoted to associate professorship, since the promotion was associated with tenure-ship. Outstanding clinicians were often not promoted and they left. Later in time, the significance and the need for such clinicians with scholarly clinical research was recognized and other term-limited promotions were established.

While laboratory research was essential, innovation and discovery of new treatments were equally important. The lack of an Internal Review Board (IRB) requirement, as it is needed today in any research, made revisions in surgical treatment and innovation easier. Dr. Mullan’s innovations did not take place in the laboratory. Despite being a superb neurosurgeon, he was obsessed with constant improvement. It was not unusual for him to suddenly, without previous laboratory experience, start an entirely new way of operating: stereotactic cordotomy, insertion of needles and coils in the aneurysm, vertebrectomy, and stereotactic balloon compression for trigeminal nerve are some examples. Except for the balloon compression, he seldom brought an innovation to completion. As soon as an innovation showed the prospect for treatment, he left it to others to complete it and picked up another project.

Dr. Mullan stayed as chairman for 25 years until he retired in 1992 when Dr. Bryce Weir took over as chairman, followed by Dr. Frederick Brown (as interim), Dr. Richard Fessler, and Dr. David Frim. Almost one year before his retirement in 2001, Dr. Weir became the Interim Dean. He accepted the job on condition that it would be for one year. To be sure that it was only for one year he had asked, what would happen if no new dean was found by one year. He apparently was told “if that happened, we all leave”! All the chairmen who came after Dr. Mullan are fortunately alive and well. It would be up to the residents to write something about them.

While Dr. Bailey remains unique, and as Dr. Bucy predicted “the likes of which we shall probably never see again,” based on individual personal mission and based on possibilities and circumstances of the time, each chairman, in collaboration with the faculty and staff of the time, kept the tradition of scholarly and educational activities. Research and pursuit of scientific discovery, for which the University of Chicago was established, remains. As with the rest of the institution and Neurosurgery, research remains one of the top priorities, for it is basically the research through which good teaching and good patient care come.

Once, Dr. John Jane, the late Chairman of Neurosurgery at the University of Virginia and Editor of the Journal of Neurosurgery, told me that he believed the University of Chicago was one of the few places where they genuinely support academic research. Indeed, the development of a large research lab center, like that of Dr. Issam Awad's Lab, and that of Dr. Matt Lesniak's, before leaving to become Chairman of Neurosurgery at Northwestern University, are examples of institutional support and possibilities.

In January 2021, the Section of Neurosurgery became a department, primarily through the effort and the vision of Dr. Kenneth Polonsky, the Dean. He believed that, with today’s possibilities, Neurosurgery can become even more productive. Dr. Bakhtiar Yamini was appointed as the interim chairman. Interim or permanent, with Dr. Yamini’s intellect and background in scientific research and surgical ability, together with the present (and future) faculty who each actively attempt to advance scientific approaches to vascular diseases, tumor biology, functional neurosurgery, basal skull tumors, and trauma, the probability is high that Dean Polonsky’s vision will come true.

Today, while Dr. Bailey's dream to establish a neuroscience institute has not yet come true, there are active interdepartmental collaborations and combined conferences in neurovascular, pediatric neurosurgery, neuro-oncology, and functional neurosurgery.