The Obstacle Is the Way; The Struggle Is What Defines Us.

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Montana. Taking six grandkids to 9,500 feet over eight miles. The struggle is the reward.

“It is not the critic who counts; not the man who points out how the strong man stumbled, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs and comes short again and again; who know the great enthusiasms, the great devotions; who spends himself in a worthy cause; who, at the best knows in the end the triumph of high achievement, and who, at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those timid souls who know neither victory or defeat.” – Theodore Roosevelt

The request was simple: write about the hardships all of us face during our neurosurgical careers, notably the impact and interaction of family, marriage, health, with our chosen vocation. Whew…

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As Joe Maroon taught me in 1986, “Mistakes are avoided by wisdom… Wisdom is gained by making mistakes.”

I am a very wise man…

Personally, my greatest struggle is attempting to maintain some type of balance, as so eloquently stated in Dr. Maroon’s CNS Presidential Address in 1986, Aequanimitas.

It also happens to be the name of one of Sir William Osler’s most famous essays, delivered to the new doctors in 1889 as his farewell address at the Pennsylvania School of Medicine, prior to transferring to Johns Hopkins.

It always comes full circle: we once again return to Philadelphia, site of the 2022 AANS Annual Meeting, and location of Osler’s address. As Ecclesiastes, 1:9 tells us: “What has been will be again, and what has been done will be done again; there is nothing new under the sun.”

The same issues that Osler struggled with, we struggle with today.

This past year as AANS President has afforded me the honor to be Visiting Professor at numerous academic programs. I tend to give a lecture about “Ambiguity and Balance,” discussing the role of holding at least two competing ideas in our head simultaneously, which F. Scott Fitzgerald stated is the measure of a person’s intellect.

Thoughts are given about “Spinal Balance vs Alignment,” and the BALANCE of the different aspects of our lives: social, professional, spiritual and physical.

Numerous books and articles are written about “work-life balance.”

In truth, there is no absolute balance, as balance is dynamic, with constant motion, constant juggling, perpetual tension and friction.

Maybe, the word is HARMONY…

I have lectured about obtaining a “harmonious” alignment and curvature of the spine. Not angular, bent at acute angles, but smooth, fluid continuous. During one of my most recent visitations, another neurosurgeon (and I am embarrassed that I forget who), suggested we translate that same goal of HARMONY into our lives.

We never fully achieve “balance” in our lives… but we can work at HARMONY. The simultaneous existence of more than one competing aspect of our lives.

Maybe the title of my talk should be “Ambiguity and Harmony,”… having the ability to hold all of these competing goals and needs and blend them into some type of fluid interface that promotes a healthy life.

Alas, if only this lesson was learned earlier in my life and career. At times, my harmony has been off tune.

All of us have struggles: health, marriage, children, financial, parents, siblings and partners… nobody escapes unscathed.

As Marcus Aurelius, the stoic comments in Meditations, his personal diary:
“Our actions may be impeded… but there can be no impeding our intentions or dispositions. Because we can accommodate and adapt. The mind adapts and converts to its own purpose the obstacle to our acting… the impediment to action advances action. What stands in the way becomes the way.”

Thus, the obstacle is the way; the struggle is what defines us.

Like most of us, my life has had several significant setbacks: lost friends, failed relationships, sub-optimization of parenting opportunities, periods of less than perfect physical fitness…

This is the fabric of life… Not even Neurosurgeons can escape the inevitable. However, we must find a way to turn the obstacles upside down, to grow stronger, wiser from the struggles, and learn from our mistakes, both personal and professional. We must be willing to “take off our armor,” and allow our neurosurgical comrades to support us. We need to support each other, as a community.

I urge you to take some time to sit and think… Slow down, take a hike, leave the phone at home… reflect on the honor and privilege of our profession. Talk to your colleagues, about your success and failures. We have a hard job… really, really hard. Learn from our past mistakes and move on…

In the words of Father Mulcahy, in the show MASH… the secret to life, in times of stress… “Just keep moving.”

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