L. Dade Lunsford:
Reflections on 45 years
Author: L. Dade Lunsford, MD
I am providing diversity by still being in the game as a Senior Neurosurgeon. Like many current applicants for training, I made a decision to go into neurosurgery while doing two years of research in my last two years of UVa. I was doing callosotomies on rats to study subcortical learning using spreading depression to temporarily put one rat hemisphere to sleep. It’s now called neuroscience. My class was the last class at UVA without women. As I look at the book of freshmen recently sent me in advance of my 50th year anniversary, I see a lot of white, male faces, and a lot of prep schools. I was public high guy.
I entered medical school working for a neurologist at Columbia who was concerned that phenytoin might increase the risk of lymphoma. This was a hazardous hypothesis as phenytoin had been tested as a magic drug at Columbia and Parke Davis had funded a lot of people.
The ruling neurosurgery Mafia at Columbia decided I was not worthy of a residency slot, so after four years I decamped to do my internship back at UVA. 80 hours? Who are you kidding! All the other interns heard I wanted to go into neurosurgery, so they dumped their rotation on me. At that time, John Jane wanted every drunk college kid with a head bump admitted overnight. There were a lot of drunk college kids.
I left for Pittsburgh after the senior neurosurgery resident decided I should do the 850 discharge summaries that he had failed to do. Not sure John Jane ever forgave me. In that era the residency slot was determined during internship. It was the era of “great thanks” followed by “I changed my mind and am going to …”. It was a stealthy game. Peter Jannetta was the winner? Residency hours at Pittsburgh made me think internship was not so bad after all. In the final months as chief, I was awarded the Van Wagenen Fellowship. After that PJ offered me a job and helped to underwrite the meager stipend ($10,000 for a year in Stockholm even then was close to poverty). But that was the best year of my life- new concepts, new procedures, new lifestyle, new lifelong friends. Like doing a sabbatical before you take your first academic job. I never took another one.
My plan was to develop a dedicated and functional stereotactic OR, and we put in a dedicated CT scanner in 1982—the third CT in Pittsburgh “as a dedicated surgical tool.” I was glad to hear UCSF did the same a year or so ago. Next came a 6-year plan to install the first US 201 source Gamma knife, the fifth one constructed. Over the next 32 years I advanced up the academic ladder, eventually succeeding PJ as the department chair. Ten years later, a coup d'etat led to a new chair (he lasted two years, so at least I beat that record). I determined to concentrate on patient care, outcomes research, minimally invasive alternatives, and guiding residency training. In 2020, 34 years later, I am passing the torch as Residency Director. We recently published a 50-year look back of residents at UPMC/ Pitt in Journal of Neurosurgery. To be brief, the quality remains tremendous, the incidence of behavioral glitches by decade was statistically unchanged, but there are lingering concerns about the intensity of focus of some more current residents. Seems like we old guys and gals managed to focus on our patient care, writing, leadership, and research activities without as much lip service to wellness. Not everyone has the same balance in life. My mentor Joe Maroon has been working on it for more than 50 years and keeps trying to instruct me. I am a slow learner.
Neurosurgery is blessed by attracting the brightest and best every year. Our goal should be (in my view) to train competent surgeons who want to take in the entire life of each patient and reflect on what we do and its impact on every patient. I am seeing patients I operated on almost 40 years ago. How else will we know that what we did makes sense? Did we help them? Some of our trainees will be future quadruple threats—writers, researchers, leaders. I hope they will be first of all competent, thoughtful, caring physicians and surgeons. To teach them these skills remains our role as educators, whether we are newly minted or old curmudgeons. The diversity of applicants is amazing. We must be sure they are totally in the game. So, more than 20,000 procedures later, I remain in the game. As my wife of 48 years reminds me “I love you but not for lunch”.