Surgical Heroism

Dr. Arthur L. Jenkins III left a Mount Sinai faculty position and opened his own practice five blocks away the next day. In this conversation, he talks about the brutal training era that made him and what academic medicine protects. He also explains why health systems reward volume over outcomes and why “wrogma,” wrong dogma, hurts patients.We cover his Bertolotti syndrome classification, patients told their pain isn’t real, defining success beyond the MRI, and the day he had to tell a patient he couldn’t help. He also describes the inventions he’s building, from a radiation shield for the spinal cord to a neck collar that freezes on impact.About the guestDr. Arthur L. Jenkins III, MD, FACS, is a neurosurgeon and spine surgeon. He holds nine issued US patents, has published the largest patient series on Bertolotti syndrome, and developed the classification system that bears his name. He founded Quantum Leap Medical Technologies.Website: https://jenkinsneurospine.com/about/meet-dr-jenkins/About Neurosurgery TalesNeurosurgery Tales is a podcast of candid conversations with surgeons about the parts of medicine rarely said out loud. It is hosted by neurosurgeon Dr. Aureliana Toma.

Dr. Martínez Santos grew up in the Dominican Republic and became the first Dominican international medical graduate to match into neurosurgery in the United States. He completed his residency at the Medical University of South Carolina and his fellowship in complex cranial and cerebrovascular surgery at the University of Wisconsin under Dr. Mustafa Başkaya, and is now assistant professor of neurosurgery at MUSC in Charleston. He performs aneurysm clipping, cerebral bypass, AVM surgery, and skull base tumor surgery, and runs a microsurgical anatomy lab for students and residents.In this episode of Neurosurgery Tales, we talk about:• The IMG pathway to US neurosurgery: J-1 and O-1 visas, the Canadian route he almost took, and the prejudice international doctors still face• Why he calls himself an anatomist before a surgeon, and why neurosurgery leans too hard on technology• Open vs. endovascular aneurysm treatment, flow diverters, AVM cure rates, and what “minimally invasive” really means• Whether the open cerebrovascular surgeon is a specialist, a relic, or a last resort• Training under Dr. Başkaya, his “tormentor”• Microsurgical simulation, and why surgeons should operate with caution, not fear• Teaching and leadership in residency: Extreme Ownership and decentralized command• Why RVUs and hospital incentives push trainees away from complex surgery• Why “shortcut” and “neurosurgery” don’t belong in the same sentence“I prefer the term maximally safe and minimally disruptive surgery.”SOCIAL: 🔗 TikTok: @neurosurgery.tale🔗 Instagram: / neurosurgery_tales 🔗 Patreon: https://www.patreon.com/cw/neurosurgerytalesBooks mentioned• Extreme Ownership and The Dichotomy of Leadership, by Jocko Willink and Leif Babin• Better, by Atul Gawande• Mastery, by Robert Greene

dnan H. Siddiqui is a dual-trained cerebrovascular and endovascular neurosurgeon, clinician-scientist, and technology leader working at the intersection of surgery, stroke care, and innovation. He is Professor and Vice Chair of Neurosurgery at the University at Buffalo, leads one of the busiest comprehensive stroke services in the United States, and directs large NIH-funded research programs focused on aneurysms, stroke, imaging, and hemodynamics. He has led major international clinical trials, and plays a central role in shaping training standards, device development, and evidence-based practice in neuroendovascular surgery through national and regulatory bodies. He is also CEO of the Jacobs Institute, where he works to translate surgical ideas into real-world technologies that reach patients.This conversation goes beyond technique. It examines judgment, training, failure, and the systems that produce true surgical excellence.In this episode, we discuss:00:45 – Why Dr. Adnan Siddiqui Chose Neurosurgery02:00 – Personal Loss and the “Dark Ages” of Neurosurgery03:15 – What Cerebrovascular Neurosurgery Overestimates Today04:40 – How to Stay Curious Without Losing Focus05:55 – When Robotic Microsurgery Became Inevitable06:50 – First Experiences With Surgical Robotics (Da Vinci & Beyond)08:45 – What Robots Do Better Than Human Hands in Microsurgery09:50 – Patient Selection for Robotic Intracranial Surgery10:45 – Why Adult Moyamoya Was the Right First Robotic Case12:05 – Indirect vs Direct Bypass in Adult Moyamoya Disease13:00 – Training Surgical Judgment When Technology Removes Friction14:20 – Why Some Neurosurgery Programs Create Leaders, Not Technicians15:35 – How the Jacobs Institute Built Real Interdisciplinary Innovation17:50 – Designing Surgical Environments That Improve Collaboration18:30 – Does Innovation Create a Two-Tier System in Medicine?20:15 – Why Perfection Still Matters in Neurosurgery21:00 – Early Career Mistakes and Learning Through Failure

Fourth-year neurosurgery resident Dr. Subhashree Hari (P.D. Hinduja Hospital, Mumbai) joins Neurosurgery Tales to talk about what residency really looks like inside one of India’s busiest centers: high-volume clinics, learning under national leaders, the first mistake you never forget, and why communication can matter as much as the knife. Subtle cultural contrasts emerge naturally as we discuss training realities, resources, and mindset.In this episodeThe long path into Indian neurosurgery residencyMentorship under top surgeons: inspiration vs. expectation80–100 patient clinics: speed, stamina, and what actually sticksThe hardest non-surgical skill: clear, right-sized communicationThe “first mistake” and how to prioritize under pressureCase presentations and turning data into a story that landsWhat her program does well, and how residents fill the gapsBuild up or break down first? A realistic view of resilienceFailure, “mediocrity,” and keeping the patient firstThe 10-year vision: subspecialty, family, access, and teachingGuestDr. Subhashree Hari • 4th-Year Neurosurgery ResidentP.D. Hinduja National Hospital & MRC, Mumbai, IndiaChapters00:00 Intro01:00 When residency first felt real04:20 Training under India’s leading neurosurgeons06:00 High-volume clinics: sharper or just tired?08:00 The hardest non-surgical skill: communication14:15 The first mistake you never forget20:25 How to turn medical data into a compelling narrative24:45 What Indian programs do well (and where residents self-correct)29:30 Build up vs. break down33:45 Failure, mediocrity, and keeping outcomes first39:30 A 10-year vision: subspecialty, family, access, teaching45:15 ClosingAbout the showNeurosurgery Tales shares modern, honest conversations with neurosurgeons and residents worldwide. Contact / CollabsPress, academic, and sponsorship: [email protected]

About Dr. Fernandez-MirandaProfessor of Neurosurgery at Stanford University; Surgical Director, Brain Tumor, Skull Base, and Pituitary Centers; internationally recognized for endoscopic skull base surgery, pituitary and cavernous sinus surgery, and white-matter–respecting approaches.In this episode, Professor Juan C. Fernandez-Miranda, MD (Stanford Neurosurgery) unpacks the decision to leave Spain for Albert Rhoton’s lab, what “complete resection” means when function is at risk, why restraint can be braver than reach, and the reconstruction choices that truly reduce CSF leaks. We also dig into training realities: endoscopic endonasal technique, cavernous sinus work, simulation that includes stress and chaos, and how to prepare teams for the complications that matter.Topics:• Spain → Rhoton: the leap that changed his career• The line he refuses to cross, even when he could “get it done”• Functional risk and defining “complete resection”• CSF-leak reduction: grafts, flaps, lumbar drains, and when to go free flap• Overused approaches in 2025 and where they still belong• Simulation that’s actually useful: bleeding, pressure, and team choreography• Habits outside medicine that sharpen intraoperative judgment• What to audit when technical perfection doesn’t help the patient• Training the next generation without shortcuts.Chapters00:00 Intro00:30 Spain → Rhoton: strategy vs leap of faith05:10 The surgical line he won’t cross07:20 What “complete resection” means when function is on the line10:50 Reconstruction to reduce CSF leaks (high-flow vs low-flow; flap strategy)15:05 Overused approaches and narrow indications (endonasal, transorbital)17:50 Simulation and realistic visualization (VR + cadaveric, carotid-injury drills)23:10 Concentration, meditation, and pre-op mental rehearsal26:15 When technical success ≠ patient benefit: indication, timing, expectations28:05 Teaching: wide base before tall tower; what he hopes fellows surpass him in29:35 What changed him most across a career — and what stayed the samePODCAST INFO: YouTube: https://www.youtube.com/@NeurosurgeryTalesPodcastSOCIAL: - TikTok: @neurosurgery.tale- Instagram: https://www.instagram.com/neurosurgery_tales/- Patreon: https://patreon.com/AurelianaToma

Dr. Daniele Bongetta is Head of Neurosurgery at Fatebenefratelli in Milan, a researcher and educator. Trained at the University of Pavia, he has performed thousands of neurosurgical procedures with expertise spanning brain tumors, spinal and vascular surgery, and traumatic injuries. He co-founded the Neurosurgical Basics course to give residents essential skills often overlooked in traditional training, and he has published extensively on topics ranging from fluorescence-guided tumor surgery to impostor syndrome in young surgeons. Dr. Bongetta is also the Co-Director of the first-ever NeuroOlympics, an international event debuting in Rome that blends surgical training, competition, and the spirit of sport to reimagine how neurosurgeons learn and connect. In this episode:• Leadership as burden vs. opportunity• Why he co-founded Neurosurgical Basics to fill gaps in resident training• Impostor syndrome in neurosurgery and the mentors who change everything• Fluorescence-guided tumor surgery and low-cost innovation in the OR• Athlete or artist? The mindset surgeons carry into operating room• Designing the “perfect” operating room of the future• Mistake on the Lake: why we must talk openly about surgical complications• The defining challenge for the next generation of neurosurgeons• The first NeuroOlympics in Rome — mixing skill, sport, and community• Choosing neurosurgery again

Who owns your brain?Brain tech is here.Headbands track your focus. Stick-on “e-tattoos” read stress in real time. Neuralink implants are already in people.But the law is only now catching up.Chile has written neurorights into its Constitution. Colorado and California have declared brain-wave data “sensitive.” The EU bans emotion recognition in workplaces and schools.Still—outside the clinic, your brain data is often treated like shopping history, not sacred self. And that raises a bigger, more urgent question: If your thoughts can be recorded, who owns the master? You… or the system?In this episode of Deeply Unqualified, I explore:• The rise of consumer neurotech—headbands, tattoos, and headphones that read the mind• Why brain scans aren’t as anonymous as you think• How laws in Chile, the U.S., and Europe are drawing the first battle lines• What “neurorights” really mean for the future of privacy and identityAnd maybe the new rule we need is simple: My brain. My rules.PODCAST INFO: YouTube: https://www.youtube.com/@NeurosurgeryTalesPodcastSOCIAL: - TikTok: @neurosurgery.tale- Instagram: https://www.instagram.com/neurosurgery_tales/- Patreon: https://patreon.com/AurelianaToma

A conversation with Dr. Andrew Brunswick, neurosurgeon at Kaiser Permanente, Columbia and NYU trained, as we explore the intersections of finance, surgery, and mindset.In this episode:• From Wall Street to neurosurgery – how his early detour shaped ambition and risk-taking• Why simulation training is essential for rare, high-stakes moments in the OR• The balance between data, protocol, and intuition in neurosurgery• Coping with complications and the hidden emotional toll of surgery• Parenting, identity, and building resilience outside the OR• Rethinking burnout and what needs to change in neurosurgical training• The future culture of neurosurgery and why balance matters for the next generationDr. Brunswick also shares how meditation, equanimity, and mindset training can transform the way surgeons practice, both technically and emotionally.PODCAST INFO: YouTube A conversation with Dr. Andrew Brunswick, neurosurgeon at Kaiser Permanente, Columbia and NYU trained, as we explore the intersections of finance, surgery, and mindset.In this episode:• From Wall Street to neurosurgery – how his early detour shaped ambition and risk-taking• Why simulation training is essential for rare, high-stakes moments in the OR• The balance between data, protocol, and intuition in neurosurgery• Coping with complications and the hidden emotional toll of surgery• Parenting, identity, and building resilience outside the OR• Rethinking burnout and what needs to change in neurosurgical training• The future culture of neurosurgery and why balance matters for the next generationDr. Brunswick also shares how meditation, equanimity, and mindset training can transform the way surgeons practice, both technically and emotionally.PODCAST INFO: YouTube https://www.youtube.com/@NeurosurgeryTalesPodcast SOCIAL: - TikTok: @neurosurgery.tale- Instagram: https://www.instagram.com/neurosurgery_tales/- Patreon: https://patreon.com/AurelianaToma

A conversation with Prof. Peter Vajkoczy, Chairman of Neurosurgery at Charité Berlin, as we explore leadership, empathy, surgical philosophy, and life at the edge of medicine.In this episode:• Why arrogance is a risk in neurosurgery — and how humility must be protected• Writing Kopfarbeit: why he chose to share surgical failures as well as triumphs• Why empathy — and even suffering — are essential for growth in neurosurgery• Building one of the world’s top neurosurgery programs at Charité• His vision of mentorship and what young neurosurgeons most need to hear• Redefining success in life-extending but not life-curing surgeries• How daily work between life and death has shaped his view of mortality• Why perfection is impossible — and why constant improvement matters more. Connect with Prof. Peter Vajkoczy:Instagram: @pvajkoczyX (Twitter): @vajkoczyPODCAST INFO: SOCIAL: - TikTok: @neurosurgery.tale- Instagram:@neurosurgery_tales- Patreon: https://patreon.com/AurelianaToma

What happens when doing “everything” becomes too much? In this episode of Deeply Unqualified, I confront the myth of surgical heroism—and the devastation it can leave behind.In this episode:• The cultural obsession with heroic surgery• Data from DECRA, RESCUEicp & JAMA Surgery• Ethical dilemmas: Can survival be a failure?• A personal reckoning with ego, courage, and the limits of medicineThis isn’t about blaming surgeons. It’s about asking better questions.What does it mean to be a good doctor when doing less might be the most humane act?