Coup de blues

Some years ago, the place to be for a brain tumor surgeon was the public academic hospital. It was the meeting place

where medical doctors, students from medical schools, PhD-students from biological sciences, and scientific researchers interacted in a synergistic and fruitful dialogue.

However, we have to admit that this might not be true anymore. All around Europe, most of my colleagues involved in brain tumor surgery have chosen to join the private healthcare, be they in Munich, Madrid, Lisbon, London, Tilburg, Barcelona or Milano. And started to re-create this academic atmosphere within their private structure.

I never asked them personally the reasons of their choices, because I did not need to ask. I know there are two reasons:

- the cost of living in a big European city is not anymore compatible with the income of an academic neurosurgeon exerting in a public hospital,

- the atmosphere in the public hospital became progressively hostile, if not toxic. You have to fight daily to find an available slot in an operative room to operate your patient, to fight to get the surgical instruments in good working order, to fight to find the human resources to take care of your patients for other care than surgery itself (speech therapists, psychologists, neuropsychologists, nurses, …). This continuous fight consumes your energy and enthousiasm, makes you nervous and anxious, and one day you realize that the price to pay to follow your vocation is too high, that the past years have left you prematurely worn out. At this point, you have four options: to dig so deep into your disillusion that an unexpected source of “élan vital” emerges, giving you the strength to continue the battle, more determined than ever (by far the less frequently observed outcome), to resign (by far the most widely elected attitude) – after all, “il n’y a pas que la neurochirurgie dans la vie” -, to start excessive alcohol consumption (I do not have the stats) or to move to the private.

In the French neurosurgical community (about 300 souls), at least four full professors decided to give up with the public over the past five years, moving towards an exclusively private activity (in the cities of Nantes, Brest, Marseille and Saint-Etienne). As stated in a French expression, “Les rats quittent le navire”. And this despite the fact that the French public system has a specificity: some doctors (usually not the bad ones) are authorized, if this is their wish, to have a private practice within the public hospital. The private in the public. A little bit confusing maybe, but a smart rule: thanks to this, all patients are taken in charge within the very same level of technological equipments and medical expertise. However, it appears that this opportunity to benefit of the advantages of both worlds is no more sufficient to convince practitioners to stay in the public.

But we have experienced much more dramatic events. Over the past 5 years, four French neurosurgeons, aged 27, 34, 36, and 50, suddenly died. Two of them committed suicide (including one within the neurosurgical unit), another one died close to the operative theater, and a last one died while consulting patients. Maxime, Frederic, Laurent, Pierre, this post is dedicated to your memory.

To the best of my knowledge, no one in the neurosurgical community has had the courage to face these co-occurrences and to search for an underlying cause that would make the link between these tragic deaths, beyond the individual and unique trajectories of each personal history.

Now, the real question: why do we prefer to stay blind in front of this reality ? why not launching a collective questioning about the global meaning of all these facts ?

A topic for a future post ...

Et comme le rappelait l’auvergnat moraliste Vialatte, « Et c'est ainsi qu'Allah est grand »