• Burnout and Renewal - Changing Perspectives in Neurosurgery: What I Anticipated and What Actually Happened

    Author: Joseph C. Maroon, MD

    The Greek philosopher Plutarch said, “The mind is not a vessel to be filled but a fire to be kindled,” and I am forever grateful to my mentors for following this sage advice. Throughout my residencies at Indiana, Oxford, Georgetown, and Vermont Universities, my instructors lit a fire that continues to burn brightly.1 Indeed, I soared early in my career and accrued numerous marks of success, including publications, international presentations, and technical contributions to our field. However, in my early 40s, I began a frightening descent. Just like another ancient Greek—the mythological Icarus—I flew too high, the sun melted my waxed wings, and I plummeted into a sea of depression. Today, 57 percent of current neurosurgeons report similar “burnout” in their career,2 and we must recognize this as both a very serious issue, and a very preventable one.

    For me, it was my unidimensional commitment to become the best neurosurgeon I could be that insidiously led to complete imbalance in my life. Clinical neurosurgery and research had become all consuming, which meant I had neglected my family, my own health, and any deep sense of purpose. So, ten years after completing residency, rather than feeling elated and successful, I had really only succeeded in ruining a marriage, losing any sense of purpose in my work, and becoming physically and emotionally exhausted. I had no idea if I could ever recover, but I did know this was clearly not what I anticipated when I began my career!

    Figure 1

    British author James Barrie wrote, “Every man’s life is a diary in which he means to write one story but then writes another, and his humblest hour is when he compares the story that was written with what he intended to write.” I had reached my humblest hour, but fortunately, I was able to recognize that the adversity I faced was, in fact, a powerful mentor in another form, and I seized the opportunity to learn from my experience. I eventually recovered and returned to my neurosurgical career, and six years later, was standing in front of the Congress of Neurological Surgeons to give a presidential address. In my talk, “From Icarus to Aequanimitas,”3 I retold my personal and painful story and described how I discovered the secret to a better, more balanced life.3 My renewal required me to learn how to maintain proper focus not only on my work, but also on the other three “sides” of life: Physical health, a commitment to spirituality, and relationships.

    Taken together, these four elements make up a balanced and stable square, and represent the critical importance of the mind-body connection. The mind can sicken the body, and an unhealthy body certainly affects the mind, which supports the term psychosomatic (from the Greek psyche, “mind” and somas, “body”). But the field of psychoneuroimmunology and the latest research on exercise and depression prove that the brain and body can also work to heal each other in astounding ways.4

    In my latest book, Square One: A Simple Guide to a Balanced Life, (Figure 1),5 I recount my own story of adversity and am humbled to be able to share the stories of three other amazing human beings who represent the best of balanced living. Rajesh Durbal, the only triple amputee to complete the Kona Ironman World Championship triathlon, turned to faith to overcome indescribable adversity. Paraphrasing from the Book of Isaiah, Rajesh is now the epitome of someone who “rises up on wings like an eagle, runs without being weary, and walks without getting tired.” Fellow Pittsburgh neurosurgeon Dr. Elizabeth Tyler-Kabara’s story shows how she found ways to combine her passionate work in medicine with a healthy, balanced family life, and poet and professor emeritus Sam Hazo’s story inspires us all to recognize the limitless benefits of forming and maintaining the relationships so critical to our health and happiness.

    Square One also addresses how to control the stress of our busy careers, how balanced living can help prevent many of the chronic diseases of aging, and how creativity, humor, and purpose can affect our health span—not just our life span. My renewal led to a rediscovery of the excitement and the rewards of caring for others, the importance and fun of new research projects, and the undeniable benefits of empathy and stimulating friendships. I continue to participate in triathlons (Figure 2) and I am reaping the benefits of better lifestyle choices. With my own “wings like eagles,” I now find neurosurgery, good health, and relationships more fulfilling than ever.

    Figure 2

    I am certainly deep into the fourth quarter of my life and am cognizant that on an unknown day at an unknown time, all of what I know will come to an end; it’s the moment Stanford neurosurgical resident and author Paul Kalanithi achingly described as “breath becoming air.” Until my story actually ends, however, I live daily with gratitude for everything adversity has taught me and with the deepest respect for those who took the time during my early training to light the fire within me. Now, we must learn to turn and look toward one another to see examples of the resiliency, compassion, and humility that are needed in times of adversity—both in the O.R. and in life.


    1. My mentors include: Robert Campbell, MD (Indiana University); Joe Pennybacker, MD (the Radcliffe Infirmary, Oxford University); Alfred Luessenhop, MD (Georgetown University); and RMP Donaghy, MD (University of Vermont).
    2. McAbee JH, Ragel BT, McCartney S, Klimo, P. Factors associated with career satisfaction and burnout among US neurosurgeons: results of a nationwide survey. Jnl Neurosurg. 2015;123(1):1-13.
    3.  Maroon JC. From Aequanimitas to Icarus. Clinical Neurosurgery, Vol. 34. 1988; 3-15.
    4. Cooney GM, Dwan K, Greig CA, et al. Exercise for Depression. Cochrane Database of Systematic Reviews 9. 2012; CD004366, doi:10.1002/14651858.CD004366.pub.
    5. Maroon JC, Kennedy C. Square One—A Simple Guide to a Balanced Life. Bridgeport, Ohio: Pythia Press; 2016. www.maroonsquareone.com

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