Pamela Jones, MD, MS, MPH: Forging a Path to Neurosurgery

Q: My guest on this episode is Pamela Jones, who is a neurosurgeon here at Mass General. And I'm also joined by Aswita Tan McGrory, who is the Deputy Director of the Disparities Solutions Center, who will be joining us for this conversation.

Q2: Hi.

A: Hi. Thank you so much.

Q: Can you just start by telling us a little bit about what your job is here?

A: Sure. So I'm one of the neurosurgeons here at Mass General, within the Mass. General Department of Neurosurgery. And I specialize in brain tumors of all types, mainly in adults, though. And I have, within brain tumors, a particular interest in pituitary disease and pituitary tumors.

Q: All I know about the pituitary gland is it has something to do with growing up and becoming an adult.

A: Sure.

Q: And what does it do?

A: Yeah.

Q: What are the—How do you know if there's a problem with it?

A: So the pituitary gland is like the master hormone regulator. It sends off its little chemical messengers to the other glands at the body, to tell them what to make. It instructs our thyroid gland to make thyroid hormone, our adrenal glands to make cortisol. It secretes growth hormone to regulate our bone growth. You know, prolactin, which helps with breastfeeding after pregnancy. So it’s really just this tiny little gland that sits right under the brain, and it has a very critical importance with the body.

Q: So it sounds like it’s sort of like a signal center, almost, within the brain?

A: Exactly. It has a various mechanism of feedback. So it gets a signal to send out hormones to say, our adrenal glands, our stress hormones. And they secrete, cortisol when it needs to. But if there's an excess of cortisol, then the pituitary gland gets that notice. And then, you know, tells the adrenal glands to release less. And that’s in, you know, a perfect kind of state of homeostasis. But, of course, we deal with, when things are awry.

Q: So you work with the pituitary gland. Deep down within the brain, it talks to the body. But sometimes I think it’s scary with brains, because how do you know when something is wrong with your brain?

A: Sure. So patients with a pituitary problem will present in several ways. Nowadays, with imaging being so common, a lot of times we deal with things that are incidentally found. So a person gets in a car accident, gets a head scan, and they had this finding. Obviously, the last thing you want after, you know, getting your head bumped, and getting a scan, is to find out something—they found a tumor. Patients will come to my office and be pretty scared about that. But luckily, we’re able to reassure them that the vast majority of these, over 99 percent, are benign tumors. You know, depending on size and—and characteristics of how close they are to the optic nerves, how much they're damaging the normal pituitary gland. Those are factors we have to consider when we offer treatment, or just observation. But either way, we can reassure them that, you know, this is not something that’s going to be life-ending,

A: We do it all through the nose, so the procedure is done through the nose. So that’s another thing that we can reassure them when they come to the office, yes, you have a tumor. we can do the surgery all through the nose. No scars on the face. So patients don’t have to worry about looking different. They don’t have any, you know, bruising externally.

Q2: You were just blowing up all my preconceived notions of brain tumors and surgery.

A: So pituitary tumors are their own entity, just because of where they sit, you know, right under the brain. Patients may come in with an incidental finding. But then, in a more serious condition, they may have a tumor that’s grown pretty silently, because it may not be secreting hormones. There are types that secrete hormones, and kind of get picked up sooner because of the systemic changes they cause. But ones that aren’t secreting a hormone may grow and grow until people have a significant visual problem. There's kind of a range of presentations of the patients. But, by and large, they're benign tumors.

Q2: Oh, wow.

A: The ones that produce hormones are the most challenging ones. The tumors that do cause an excess of cortisol throughout the body, causing diabetes, hypertension, cardiovascular problems, causing people to become very, very sick, or growth hormone-secreting tumors, so gigantism, or acromegaly.

It causes people to, very slowly over time, so they don’t notice it, actually, but their hands and feet might grow. Their jaw will grow. They’ll get TMJ problems. They’ll have some sleep apnea. Overgrowth of—of, you know, the tissue at their tongue, and their throat. And cardiovascular problems, diabetes, so significant problems.

Q2: Yeah.

A: But it just kind of can go along pretty indolent for a while, until you know, they might see someone—You know, the classic story is that you ask them—ask to see their driver’s license, because not many people have an updated driver’s license picture. Or you ask them to bring in, you know, pictures from their wedding day or something.

A: Exactly. So we have asked, you know, “Oh, do you have a picture?” And sure enough, you know, you’ll be able to recognize that, you know, their forehead shape is different. Their jaw shape is different. And, “Oh, have you—You know, do you wear your wedding rings anymore?” “No. Those don’t fit anymore. I stopped wearing those.” So you know, just—

Q: So they're like symptoms that a patient might not think of as a symptom.

A: Right. Everyone’s busy, and you're going through your life. And you know, “Oh, the ring doesn’t fit. You know, I'm not going to call my primary care and tell them my ring doesn’t fit.” But, you know, it can be a problem. But eventually it’s picked up.

Q: Yeah. You mentioned vision problems and blindness. So if someone comes in, you know, with that kind of problem, and you operate, does it—does it fix the blindness? Or is that a permanent problem?

A: Yeah. So it depends on how long they’ve had the problem. But you know, oftentimes it improves, even within hours after surgery. And certainly, you look for improvement within the day after, and a couple days after. It’s pretty amazing, and really rewarding. I had a young gentleman come into my clinic a couple months ago, and he just said, “Oh, I hadn’t noticed, but I wasn’t seeing out of my left eye.” I mean almost blind.

Q2: Wow.

A: And so—

Q2: He was just over-compensating with his right eye?

A: Yes, I guess so. So he was at his doctor’s office. And he decided to look at the eye chart. And he finally did one eye each individually. And that’s when he realized how bad the left eye was. And so primary care did the appropriate things. Sent him to an ophthalmologist, who appropriately, you know, said, “This—This pattern of vision loss isn't normal. So we need—you need a brain MRI.” And then he came to me.

And then, after surgery, he’s seeing in that eye, you know. He was right the day after surgery, and then it’s just improved since surgery.

Q: I know that you didn’t quite take a straight path from, you know, college into medical school. So can you talk a little bit about that?

A: Sure. That’s right. So I went into undergrad at Stanford thinking I wanted to do chemistry major, and be a doctor. I had already shadowed an endocrinologist in high school, who specialized in diabetes, and gestational diabetes. And thought it was awesome. I volunteered at the hospital. I really liked science. So I really wanted to be a doctor. And then I came—went to college. And 50% of the starting class also wanted to be a doctor. [laughter] And they're all in your—And so it’s overwhelming. But it’s good, because it challenges you to think, okay, are we—do we all want to be doctors for the right reasons? And do I want to be a doctor? Or is that just because that’s just like, you know, an obvious career path, right, if you like science, and you know, you like people, and you like problem solving.

And so I did all my premed requirements. But I did, you know, let myself explore. I did computer programming. I continued to pursue my interests in dance and ballet. And I had been an editor of my—of my high school newspaper. I loved science, and I loved dance, and then I loved writing and journalism. And so I was just searching, kind of in senior year, and found this one program in biomedical journalism at New York University, NYU. And so I applied to that and got in. And moved to New York and started that program. Just the idea that, you know, one, there were a lot of doctors who were kind of down on medicine at that time. Or maybe that’s just who I interacted with or met.

And I think it was actually good advice, that if you really—if you think that’s the path for you, you have to really know. And so that challenged me to say, “Well, if there's something else I want to do, then, you know, that’s a long road to go down, if that’s not the right path.” So yeah, so I went to journalism school.

Q2: You know, I think it’s interesting, because I used to do ballet a lot when I was younger. So how do you think ballet, you know, sort of the discipline of that, the repetitiveness, do you see some of that sort of helping you with surgical part. And maybe even the journalism, to some extent.

A: Yeah, it was—it’s definitely the activity in my life that has shaped it the most. I mean I absolutely love dance, and ballet in particular. I love the aesthetic of it, obviously. I can, you know, watch it for hours and hours. I love the musicality. It’s so athletic. I mean the dancers at the top of their field are just amazing athletes. And so, while to pursue ballet as intense—intensively as I did, I had to give up on sports. I still feel like I got—It’s kind of that combination of an individual sport and a team sport, I thought, because it’s very personal. You know, well one, you do solo roles, and then you do corps roles, where you have to be totally in sync with the other dancers. Or it’s all on you. And just the kind of mental preparation and the—you know, you're—one, you're going to class every day in front of a mirror. So it holds you to that. Like, “Oh, is the pointe right? Is the line right? Is, you know, is this dance step looking good or not?” So that ties into surgery. It’s just every, you know, is every move as—you know, as good as it can be? Is that not as perfect as it can be? Is, you know—And then you're—you're actually, literally doing it under a microscope. So I think the—the discipline and the kind of perfectionism, although that’s kind of a dirty word sometimes, but the perfectionism it requires is similar.

Q2: Do you play classical music during surgery?

A: I love classical music. But I don’t play it a lot in surgery, no.

Q2: I guess maybe it’s not as stress relieving. [laughter]

Q: You got your degree in biomedical journalism.

A: Yes.

Q: Can you talk a little bit more about, you know, what have you learned?

A: Sure.

Q: You know, kind of, you did that. And now you're a doctor. Is there a connection between those?

A: Yeah. I loved journalism school. It had a huge impact on my life. It, you know, is going to continue to. One, it got me to open up a little bit. I was excited to live in New York City. But the—our teacher of newspaper and magazine writing core one, which was the first semester—Mrs. Quigley. She would just say, “Okay, today’s assignment is to go out and talk about the smoking ban.” Because New York City’s smoking ban was going into effect in the bars. And so I went down to the Financial District, and I just had to, like, find people to start talking to about it on the street, or like go into a bar and just find someone to ask. And it was hard to just come out of your shell and get other people to come out of their shell, although most people are really ready and eager to talk about something. So—And once I got over my own fear, they were—they made it easy. And then it’s just having all of this information, and then compiling it into a story. And what is the—what’s the real story behind things? And so that is completely, you know, what medicine is. It’s problem-solving. The patient is telling you what's wrong with them, they just don’t know they're telling you what their story is, so that you can take their story and say, “Okay, this is what's wrong.” You get clues with imaging and lab tests and stuff. But it’s pretty amazing how much of the diagnosis comes from the patient’s story.

I loved journalism school. I was realizing how kind of challenging it was to build a journalism career. You know, I wanted to go into health writing, science writing. And so I was in my health writing class, and I was—I thought of a story that kind of combined everything, which was osteoporosis in dancers. Dancers’ health. And so I contacted the office of an endocrinologist at Columbia who was an expert in this area, and was running clinical trials. And I got her on the phone. And she kept talking about her patients. “Oh, well this one patient this, and this one patient that.” And I was taking all the quotes down. And we ended our conversation. And I just thought, “Well, that’s not fair. If I just become a medical writer, I'm never going to be able to be that quote that says, “My patient this, my patient that.” And that’s what I really want. So I said, “Well, I can always be a medical writer as a doctor, but I can never be a doctor as a medical writer.” So that solved it.

Q: I love that idea that, you know, sort of the patient is a story. And you have to kind of collect the pieces. And, as you're writing the story, you're trying to figure out the outcome, and sort of a similar skill.

A: Absolutely. You know just like I was saying, with the patients that come in and—Yeah, I mean you kind of already know—You know the spoiler. Because if they're coming in to see me, I know they have a pituitary tumor, and that it’s—but sometimes you see them before they’ve seen the endocrinologist. And they haven't had that growth hormone level. And you're looking at them, and you know, you're noticing features about them. And then they're telling you, “Oh yeah, I do snore. Or I did start using a CPAP machine. And I did stop wearing my rings. And I did buy new shoes in June.” You know. So you know, sometimes the—you know the punch line, but not always. And so, in those cases where you don’t, it’s really rewarding. And that’s, that’s the beauty of medicine, is just teasing out the details from the patient, and then through the exam.

Q: I think it’s cool, too, that you're able to connect things that the patient might not realize are connected. You know, they just have maybe a sleep problem, or a foot problem, or something feels weird. And to the person, those are different parts of the body, you know. But you can kind of draw them together.

A: Yes. That’s—I mean that’s the fun part of medicine, is a person comes in with lots of worries and complaints, and you're able to be that person that pieces them together, and then hopefully help them. Obviously, with the advent of the internet and everything, a lot of people do their own searches. But luckily, so far, we’re not replaceable. [laughter]

Q2: Did you think your gender helps you in your field?

Q: We are socialized often, I think, to relate to people, in a way that maybe a lot of men haven't been, or haven't grown up kind of having those skills encouraged.

A: That’s right. Yeah, as much as there's talk about encouraging women to not fear the term “boss” or not fear the term “ambition,” you know, there's a growing voice that’s saying that, “Well, we shouldn’t teach men that they always have to be tough, or they can't let their guard down or show weakness. And that it’s okay to be vulnerable.” And so I think, looking human, which looking human is showing emotion, and you know, you don’t want to show weakness, you want to show strength for them, but a compassionate strength. So I think, yeah, just being open with emotions.

Q2: And then you wonder, in the patient satisfaction surveys, what’s important for the patient is probably sort of more the bedside manner, when they think about that. They don’t really get exposed to the technical piece, unless something goes wrong.

A: Right. And things, unfortunately, can go—you know, can go wrong, whether you're, you know, the most experienced and best surgeon on the planet, or, you know, rather new. But I think, you know, by and large, we all want to be the best technical surgeon that we can be. And I think that a good bedside manner, and being your patient’s advocate, and—is bonus. Yeah.

Q2: Yeah, I was just thinking that, it’s a bonus.

Q: Yeah, you want them to have confidence.

A: Right, exactly. So I think, you know, there's a balance that is the right balance of being humble, but also knowing that you have the chops. That’s what training was about. It was about getting the experience to have that confidence. And—And MGH was amazing for that. I mean the faculty here, because they don’t need to put on airs, because you know, they don’t—the proof—the proof is in the outcomes. And you know, when your patients are doing well, then that just builds the confidence. And then even less reason to have to fake something, or you know, try and prove to other people that you're great.

Q2: Well surgeons are kind of the superstar in medicine. [laughter] Besides the anesthesiologist. So you know, I think patients probably like seeing you as a surgeon, because you're very relatable. And that kind of helps alleviate some of the anxiety when they come in to see you.

A: It’s funny, because, you know, we’ll talk, especially the ones that come into the hospital. And if I'm on call, and then I go meet them in their hospital room, which is a very vulnerable setting to be in. One, they’ve just learned, you know, coming to the hospital has been the worst experience of their life, because they’ve been told they have a brain tumor. And so, when I finally—when I get to meet them, there's already that anxiety, and that stress. And so I do get a lot of comments after we’re done talking, “Well, you know, it’s reassuring to meet you. I feel a lot better having met you,” you know. They just want to put a human and a face to that, to this news that they’ve received, and whose hands they can put their stress into now. Because, yeah, that’s what I'm entering the picture to do, is, you know, “I'm sorry you're here. I'm sorry this is what we found. But we’re going to take care of you. And you just need to know that. And we have put the best team together for you. And we’re going to get you through this.”

Q: I love that. It’s kind of like you physically hold their brain your hands, and then kind of metaphorically hold their worry and stress at the same time.

I have read that your father is a neurosurgeon. And I'm curious how that’s impacted your career as a neurosurgeon.

A: Yeah. So I didn’t go into neurosurgery because my dad’s a neurosurgeon. And so people ask me, then, “Oh, did he dissuade you?” But he did not. It just happened. I mean I think you—you get exposure to things when you're young. And I think, actually, our young selves know a lot more about where our lives are going to go than we remember. I mean I have a book I wrote when I was, you know, like the little story I wrote when I was eight. And I wrote about the author. And about the author says, “Pamela Jones is an eight year old at Marymount School. And this is her birthday. And when she grows up, she’s going to be a doctor and a writer.” So, you know.

Q2: Oh wow.

A: And then I didn’t—After I was like in med school, and had done my journalism degree, I was like, “Well, how did I know that back then?” But it took me this circuitous route to get here. But I knew it the whole time. Anyway, I had been, you know, I would go into the—or to his office with him. And I always—kind of knew what he did. And I would hear stories. I knew he did surgeries through the nose, and took out tumors through the nose. I knew about brain tumors. I knew about traumas. I knew about the spine surgeries. But I just—I also knew how hard he worked, and how busy he was, and, you know, how much he relied on my mom to do so much.

Although I knew I wanted to do medicine, I thought endocrinology and hormones was really cool. But then, when I got to med school, I loved working with my hands. And I thought, “Okay, well I'm going to want to do surgery. Let me figure out a different type of surgery than what my dad does.” So I looked into pediatrics. I looked—I wanted to do orthopedics. And that’s what I had signed up to do. But there were 20 other guys in the class who wanted to do ortho, and they got all—they got assigned the two-week rotation, and neurosurgery was like third on my list. And everyone else had it at the bottom. So I got neurosurgery instead. And that two weeks, I mean I never looked at the clock. I thought every patient we had come in was fascinating. Because I kind of absorbed things secondhand as a kid. It was pretty glaringly obvious to me that that’s what I wanted to do. And so I told my mom, and she was like, “Well yeah, that makes sense.” [laughter]

Q2: I was just waiting for you to get to that conclusion.

A: And I told my oldest sister, I said—she is 11 years older, so she—and she had been really, you know, amazing, and—and in her 20s, building this big career. And so she had that kind of perspective of—of a very fulfilling and busy career. And so I said, “Well, what do you think about going into neurosurgery, which was going to be biting off a job that’s going to be very demanding, and a long road?” And she was like, “You know, but if that’s what you want, it’s worth it. Go for it.” And then I told my dad I was going to Mass General for a sub-internship. And he said, “Oh, in what?” And I said, “In neurosurgery.” And he said, “Oh. What have I spawned?” [laughter] And I think he was like, yeah.

Q2: Was he hoping that the journalism career would take off? [laughter]

A: He still is. [laughter] No, I think he—he just obviously knew how much he had sacrificed for his job. And so I think he just knew that I was biting off a lot, in terms of the stress of the job, and the hours of the job, and like the demands.

Q1: I'm curious, what kind of dad he is. And is he the kind of dad who, you know, did he give you a lot of advice?

A: He doesn’t give advice, if I don’t ask for it. Yeah. So he’s never going to say, “Oh, you should do this, or you shouldn’t do that.” Never. Neither of my parents are going to do that. But I come—I call him about—I mean he’s usually my first call about any patient issue, for sure. And because I just—he’s worked so hard. And I mean, he’s still—he works so hard. He’s just extremely smart and hardworking, and I think an excellent, excellent doctor all around. And he knows so much more than I do about just the whole body.

Q: You’ve got some time to catch up to him. Do you think, you know, following your dad into this career, and a really demanding career, and then it’s cool that you have this relationship now, where he’s kind of like a consult. Has it changed your relationship with your dad?

A: Yeah, I think so. I mean we were always close. He would pick me up from ballet at night, and we’d play music and talk about our day. And he’d always help me with my science projects, or essays. He’s the person who I can just go to with—for, you know, if something bad has happened, which unfortunately, in this field, things do, you know, mostly with traumas and things that you can't—a lot of it’s out of your control. Then you have someone in your family who with, you know, an unconditional love, you can talk to about things.

And then, so he and my mom have been together since they were in college. And so my mom went through it all as well. So, you know, my mom feels like she’s actually gone through it twice. And so—

Q2: Is she good with that?

A: Mm-hmm, yeah.

Q2: She’s like, “I've been down this road before. [laughter]

A: Yeah. And so it’s just, you know, someone who’s been through it themselves in their own shoes, and then someone who’s been the supporter now twice. So yeah, they have been amazing support, because they just—they actually truly get what I'm going through. But yeah. I mean he calls me and asks me for advice on his patients, or you know.

Q: There are very few women in neurosurgery. In fact, one in 20, if you want to look at the stats. And I'm curious, were there points where you know, did you ever question it? Or did other people question what you were doing outside of your family?

A: Yes. I think my—I mean my friends from medical school are awesome. But I think they thought it was a little crazy, yeah. Because I—you know, I like to—to dance, and hang out with friends, and enjoy life. And I think they thought that, “Oh, neurosurgeons are automatically are not going to—don’t have a life. And you know, never see the light of day. And all they do is work.” You know, we work a lot. But I think part of—I think the people that do this job are able to do a stressful job because they know—you know, they have the opposite side of levity, and ways to relax, and—and are very dedicated to what they do, but are, you know, have a lot of interests outside of medicine, really amazing interests. There is positive movement, in terms of women in neurosurgery. I think when I started, it was about 10 to 12 percent of women were entering neurosurgery as residents. I think we’re up to about 15 percent, but I know it’s somewhere around there. So it’s—it’s increased. The number of Board-certified female neurosurgeons has increased. And each decade, we’re getting more and more. So in the decade of, you know, the 2000s, there were over 100 female neurosurgeons that became Board-certified, which was the first time, you know, there was more than 100 in a ten-year span. And, you know, now that we’re in the teens, I think we’re already on pace to, you know, surpass that. So certainly, the numbers are improving.

Academic medicine, the same amount of women as men kind of choose the academic path, about one-third. Unfortunately, most of them are assistant professors. Fewer are associate professors. And only three—less than four percent are full professors. Now we have to take that into the context of, you know, the field of women in neurosurgery is a little bit younger. It’s smaller and younger, because women have only more recently started to go into the field. Yeah, they haven't had the time to become full professors yet. So I think we’ll see improvement in that number, too. But it’s still, you know, way less than the men. And—And at females at the top, there are about 100 academic programs. And up until last year, there was one female chair. So there are now two more, so there's one at University of Michigan, Karin Muraszko. And then there's one at UCLA, Linda Liau. And then there's one at Memorial Sloan Kettering, Viviane Tabar.

Q2: What do you think the barriers are, then, for women to get into this field?

A: Well, I think if they love surgery, and they love neurosurgery, specifically, so they see themselves doing something in functional neurosurgery, and helping patients with neurologic disorders, like Parkinson’s disease, or psychiatric disorders, like obsessive/compulsive disorder, and are interested in, you know, being in surgery, and studying the brain, and helping people with a disease from a surgical perspective. Or, they are interested in oncology, and like myself, and they want to help people with brain tumors, or they're interested in spine disease. I mean I think that they, if they're really interested in the field of neurosurgery, then—then they should pursue it. Just like this—My advice to the women is the same as the men. It’s just I think before, women assumed that there wasn’t a place for them, because they didn’t see women doing the job. You know, they only saw in the department the men doing the job. And so they didn’t know— you wonder, okay, why are there no women? And then you just think, “Oh, well, maybe everyone’s really mean in the field. And, you know, women are, like—I could be in a nicer field. I don’t want to do this.” That’s, you know, not the case. Or maybe they assume that it’s just the worst hours ever, and they're never going to be able to do things like have a family when they want to. And there are women who are doing that. So I think the more that they see that—I mean it’s not going to be easy. And I don’t ever encourage people to tell med students or people aspiring to be a neurosurgeon that, “Oh, don’t worry. It’ll be fine.” [laughter]

No, you have to really want it, and work really hard. And it’s not going to be a normal life. But if that’s what you want to do, then it’s worth the sacrifices, and you know, you just need supportive people in your life.

A: I want them to follow their passions within medicine. And so I don’t want them to turn away from what they think is interesting in medicine, just because they're scared of reasons why they shouldn’t do it. So, you know, if they get into the field and decide they don’t like it, that’s one thing. I mean the attrition rate—so the rate of women dropping out of residency is quite higher than men. In the mid-2000s You know, the attrition rate was about 17%, versus men, it was 5%. So that’s one thing to look at, is why—So we’re—you know, we want more women in the field, because we don’t want—you know, it’s—because diversity in the workplace is just better. And we—we want to reach the state at which we’re attracting the women who want to go into the field, and you know, however many that is. We also don’t want to lose people for the wrong reasons. You know, we might attract people for the wrong reasons, and they—people get into situations, and they realize it’s not for them. That happens. But seeing that disparity of 17 versus 5, we have to think about, you know, how much of it is their expectation? And then, how much of it was the system and lack of support?

Q2: So what do you think a place like MGH could do to attract more women?

A: I think having women on faculty, so that people in training can see, you know, that we love our job, that we’re fulfilled with our career choice and our lives, and then just to be a sounding board for questions they may not feel comfortable talking to the male faculty about, to serve as mentors.
So I think bringing in a different perspective, and different, diversity in the workforce is a pro, in any way you look at it. Because otherwise, it’s just people who are very, very similar, interchanging—or exchanging very similar ideas. And so it takes, you know, people from different backgrounds, different genders, and—and to kind of create a more dynamic, interesting workplace. And I think patients appreciate that, too.

Q2: You know, when I was in my MBA program, it was heavily dominated by men. And, you know, it was there, and it didn’t bother me. But when it came out is when I decided to get pregnant, sort of towards the end of my program. And then, I realized, now I'm doing something that most—well, okay, men aren’t doing. They're not getting pregnant. But the expectation of performance is still the same.

A: You can't make it a totally equal playing field. The question is, is how do we, as a profession, prepare for, you know, things like women getting pregnant, and having to go on maternity leave? How do you incorporate that into training? How do you incorporate that into, you know, they should all do the same months of clinical training, and come out with the same experience. So, you know, how does it all even out in the end? So you know, there are real barriers. We can't make them go away, but we just have to be more vocal about things, and you know, have—you know, know that the system has thought about the—thought about this scenario. And said there's no kind of shame or guilt about, you know, needing to do something very natural, take time off for a newborn. I think, you know, there are its own challenges of having, you know, a busy career like neurosurgery. And so I think every situation is pretty individualized about, you know, how much help you have, or kind of how you tailor your practice, and things like that. You know, a lot of—a lot of things to think about. And I don’t encourage women to get—you know, who are interested in neurosurgery to get too into their head about those things. You know, you just follow your passion and what you want to do.

Q: Yeah, that’s good advice.

A: Because you never know what life is going to bring. And so the most important thing is that you're following what you want to do. And then, you know, life works out how life is going to work out.

Q: You can figure it out when you get there.

A: Yeah. But this idea that you can plan things and have it all planned out, or be in control, is not—not going to work out that way. What you can control is, you know, putting one step in front of the—one foot in front of the other, and you know, pursuing a career with as much energy as you can.

Q: It’s almost like doing surgery, right. You can control certain things, but things are going to happen, I imagine, when you're in a brain. Things happen that you didn’t expect. And you kind of have to adjust.

A: Yes. you always have the—prepared for the smooth case, and then you're always prepared for the unexpected, you know. You can't go in without kind of multiple plans of how the case is going to go.

Q: You may have to switch course—

A: --Right, exactly.

Q: --at a moment’s notice.

Q: You know, we were just talking about there aren’t very many women in the field. So when you walk into a room with a patient, you might not be the person they're expecting to walk in, particularly a person who’s early in their career. How do you approach the patient? And how do you establish the credibility that, you know, “I'm going to operate on your brain, and I'm going to do a really good job”?

A: So one, I've been pretty lucky. And I do get asked a lot about how many times I've done things, or you know, how old I am. [laughter]

Q: Have you done this before?

A: Yeah. But I haven't had anyone say, “Okay, well you know, no thanks.” Because I just go in with confidence, and I go in with, you know, the—the intention of trying to build a relationship, and let the patient know that—that I am there for them. That I'm ready to do the best job that I can do for them, that I sit down with them. I show them the images. You know, I talk to them and examine them. You know, I just—I don’t dive in and just say, “This is what we’re doing. Nice to meet you.” So it's a conversation. And it can happen over a few minutes, you know. And then sometimes, it’s a longer process. But you know, you go in with the white coat on, and answer all their questions. The fact that they question me is, a lot of times they’ll apologize. But I don’t mind, you know. I would ask the same things if I were them. And just getting to ask it, I think, is what they want. They just want to be able to ask it. “Well, how many of these have you done?”

Q: Yeah, so it’s kind of putting on the uniform, having the confidence, and knowing your stuff.

A: Yeah, you got to—

Q: -- And being able to back it up.

Q: Great. Before we get out of here, I have final five questions for you.

A: Okay.

Q: These are kind of quick hit questions. So the first question, what is the best piece of advice you’ve gotten?

A: I think the best piece of advice I've gotten is to put your—keep your blinders on, you know. Just you just got to stay focused on the task at hand, the goal in the future, you know. So keep your blinders on during surgery. You're there to do the surgery. Keep your blinders on your premed, and you want to go to med school, you just got to—you just got to focus. Oh, and you know, once you’ve decided to be a neurosurgeon, like residency is the time for training. And then, once you're a neurosurgeon, okay, what's that problem that you want to figure out, and want to help improve the field, so they can say, “Hey, that’s the person that helped Cushing’s disease in this way or, you know, helped brain tumor therapy for this treatment, or for this patient.” So it’s just, you know, don’t get distracted by getting down on yourself.

Q: Blinders on. So the name of this podcast is “Charged.” In the context of your work, what does that mean to you?

A: I think “Charged” means having the energy to push the field forward. So waking up each day, knowing that, okay, today I'm going to do this. If it’s for a patient, or if it’s to go, you know, work on a paper that’s going to report some new findings. Staying energized for the future of—of improved neurosurgical care. I think it’s charged for the future of women in neurosurgery, and saying, you know, I think we’re at a—the tipping point. And let’s go. Let’s, you know, work on my. Let’s go do some work so I can, you know, work on a promotion, and then encourage more women to say, “Oh, I can—I can do that.”

Q: Neurosurgery is hard work. How do you recharge?

A: I recharge by getting physical exercise. So I think it’s so important for mental health, just to move. So going for a run around the Charles, or you know, going to a dance class. I think moving is like the best way to clear your head.

Q: When and where are you happiest?

A: Happiest, probably with my family, like on holiday, yeah, definitely. So—because that usually involves, like, food, and dancing, and just having fun. But I am pretty happy in the OR too, you know. Most days go well, and you just leave, it’s a way to just leave the day feeling actually more energized than—than it started, even.

Q: And the last question, do you have any rituals that help you have a successful day?

A: Well, I always have a cup of coffee in the morning. But—And I don’t always really drink it, but it’s more of the ritual of like getting that warm cup of coffee. And most days it’s putting pearls on. So my—my patients will get really—Like it’s become to a point where—because all the nurses know me, for a long time now. And so I’ll go to see a patient, like a patient’s admitted. And they're told, “Oh, have you met the neurosurgeon yet?” You know, because I might have been in the OR, and I'm going to come up later that day. And they're told, “Oh, well just wait. She has—She’ll have pearls on.” [laughter]

Q2: Oh my God.

A: And so that, you know, if I don’t, then it’s like, this big letdown. And, you know—or they don’t believe. But no, it’s—Yeah. So putting on those pearls and getting out there. [laughter]

Q: All right. Well, thank you so much for being here. It’s been really great to talk to you, to—you know, just find out what it’s like to be a neurosurgeon. And thank you, Aswita, for joining.

A: Thanks. Thank you.

Q2: Yeah, thank you. Thank you for sharing your background and your history and experience.

A: Thanks.