Session 20 Dr. Stephen Grupke is an attending Neurosurgeon at the University of Kentucky. In our episode today, he discusses the residency path to neurosurgery, what makes you a competitive applicant, his typical day, the types of patients and cases he serves, what he likes best and least about his subspecialty, and more. Stephen and I went to New York Medical College together. Currently, he is a neurosurgeon in an academic facility and a new faculty being an assistant professor at the University of Kentucky. [01:30] Choosing the Specialty Stephen knew he wanted to be a neurosurgeon when he was in graduate school. Being a chem major in undergrad, he was working in a lab in grad school. A neurosurgery resident at New York Medical College did a research under his belt and took Stephen under his wing doing experiments and showing him different amazing stuff and he was just taken by it right there. That was actually the first time he saw what it's like to be a neurosurgeon and it was something he would love to do. That was what sold him to be a doctor. [04:33] Traits that Lead to Being a Good Neurosurgeon Stamina is a major key in being a good neurosurgeon since taking out a brain tumor can take hours and hours and that can be very physically and mentally taxing. You can have long clinic with a lot of people and a lot of varied problems so you have to think every one of them through, giving genuine, concerted effort to every single person considering they have very different pathology. Emotionally, the level of acuity in what they see is profound, having several highs and lows in one day. You could see pretty horrible things like abused children coming in with brain traumas and people being diagnosed with brain tumors. Then you have to relay this information to the family. On the same note, you can bring somebody from the brink of death in the operation and give somebody function back with a simple spine surgery that enables them to live without pain. In short, there is a lot of emotional highs and lows and to just deal with that day in and day out is kind of tough. You just have to focus on the highs in between and move on to the next thing and do the best you can for every person that comes to your door. The longest case Stephen has been in was a brain tumor case as a resident that went fourteen hours. Although they've also had spine operations that ended up being broken up in a couple of days such as a long, complex scoliosis case in multiple levels. Besides Neurosurgery, other specialties that crept into his mind was Neurology, being cerebral and focused on the central nervous system and everything that entails. He likes having to think of esoteric pathology you need to figure out. Internal medicine is another specialty of interest for Stephen, as it shares a lot of things with Neurosurgery in terms of the complexity and diversity of the cases you see. There's a lot of detective work involved and you get to see a lot of different specialties. One of the things that led Stephen to Neurosurgery is knowing a lot of varied information in a lot of different specialties such as Endocrinology for pituitary tumors or traumatic brain injury cases. You have to be adept at critical care management as well as fluid and electrolyte maintenance. There is so much intermingling of other sub-specialties since the brain is ultimately involved in every other system of the body. [10:10] Types of Patients and Typical Day for an Academic Neurosurgeon As a neurosurgeon, Stephen sees all sorts of pathology. In his practice, he tries to focus on cerebral and vascular neurosurgery like cases of aneurysm, arteriovenous malformations, etc. But when you're on call, you have to be willing to take whatever is thrown at you and treat everybody from premature babies all the way up to the very elderly, people from all different socioeconomic classes and all kinds of pathology from taking out a tumor in the peripheral nerve and spine surgeries to open surgeries