Erin Kreszl interviews The Chief of Neurosurgery for Main Line Health, Michelle J. Smith, MD, FAANS
The Bee Foundation is thrilled to be working with the Neurology team at Mainline Health in the effort to raise brain aneurysm awareness. Recently, The Bee Foundation’s Executive Director, Erin Kreszl, spoke with Dr. Michelle Smith, Chief of Neurosurgery for Mainline Health and Co-Medical Director of its Neuro-Science Service Line. Dr. Smith is also an Associate Professor of Neurosurgery at Jefferson.
TBF: So, tell us a little about led you to this field and your passion for neuroscience.
MS: Well, I didn’t start out thinking that I would end up as a neurosurgeon. After I graduated from Cornell, I actually taught middle school for a while, and I have to say, that was one of the toughest things I ever did! I did realize pretty quickly that that was not my path! But even though, as a child, I was always fascinated by the structure and function of the brain, it wasn’t until I was at medical school at UPenn and was exposed to the field of neurology that I really became enthralled with that area.
TBF: That must have been difficult. Current statistics show that less than 14% of neurosurgeons are women. At that time, the field probably had even fewer women neurosurgeons than it does now.
MS: There were virtually no women in neurosurgery. I was the only woman resident in my program. I remember walking up to the attending physician after viewing an operation and asking “Are women allowed to do this?” They sort of shared a laugh and said, “the RIGHT women are! So come to us if you’re interested!” And of course, I was.
TBF: And after that?
MS: I took a year off medical school to do research with that neurosurgery department team. Then I did 7 years of training at Cornell’s medical center in Manhattan, then 7 years of residency and two years of interventional neurosurgery. I was an attending physician at Penn for 5 years, then moved to Mainline Health.
TBF: Tell us a little bit about your specific area of expertise.
MS: Primarily, I specialize in open vascular micro neurosurgery and minimally invasive neurosurgery.
TBF: Put simply?
MS: Essentially, conditions of the brain that involve blood vessels. The overarching condition is really stroke which most people interpret as a clogged blood vessel. But there are two forms of stroke. The clogged blood vessels result in an ischemic stroke. But the other form is hemorrhagic, which is what results when an aneurysm ruptures. Many times this results in in emergency situations, but if caught in advance by a brain scan (MRA or MRI) they can be treated by other methods.
TBF: And it’s those new methods that are really producing some encouraging results.
MS: Yes. If it is a brain aneurysm, for instance, we can treat it either with open surgery or with one of the more minimally invasive approaches that are having much more success. First we put in a specialized IV (a kind of catheter) to access a blood vessel in the groin or armpit. Then we basically follow a roadmap that leads up into the brain. We push these very fine, delicate coils into the aneurysm so blood cannot possibly get into it, preventing the aneurysm from ever bursting. It’s essentially brain surgery from the inside out. And one of the best things about this approach is that, when you wake up, you likely won’t experience some of the physical after-effects of typical brain surgery. You might not even have a huge headache.
TBF: Obviously those are incredible developments. Of course, we know that patients still can experience a lot of the after-effects that can be discouraging, if not debilitating.
MS: That’s true, and it’s a hard thing for patients to deal with. I’ve been in practice now for 12 years and I follow all of my patients. Many of them have what is essentially PTSD. It’s not an easy recovery. After surgery, my first words to my patients are “Congratulations!” and my second are “Give yourself time.” Even for patients who breeze through surgery, it usually takes around 90 days to start feeling normal. I really focus on building relationships with my patients and I tell them at about the 4 week mark, that it may take months until they feel the cloud lifting and their memory and energy come back. This is hard work. You will get back to a normal life and your normal activities, but you need to give your body time to heal.
TBF: Looking back, what do you think are the most remarkable things about your career?
MS: It’s been quite a trip! I guess one of the things that probably influenced me was that my sister and I were the first of any of our family to go to college, and no one in our extended family is a doctor,. But in a sort of counter-intuitive way, the fact that there were no expectations freed me up. I had no limits on following my dream.
TBF: What would you say to your younger self now about contemplating a career in neurosurgery?
MS: Look for mentors. That wasn’t too easy for me at the beginning, with so few women in the field and not seeing another female face around you can make you doubt yourself. But almost every year now, we add another woman to the faculty, so those barriers are disappearing. And I did have great mentors. Some of them were men, but many were women, and they weren’t always “medical” mentors – some helped me so much in the areas of leadership, relationships, bedside manner, even motherhood.
Be realistic in your expectations of yourself. You know, women are often told “You can do anything a man can do! You can do anything you want!” That’s true, but you may not be able to do it all at once. I have a two daughters and it’s wonderful to be able to have both of these great experiences in my life. But there may be times when you have to focus on being a mom vs. being a career professional, and vice versa. Choose what’s important at that time.
And you don’t necessarily need to think of yourself as a woman in a particular profession. My personal mantra is “I want to be an exceptional neurosurgeon” and not “I want to be an exceptional female neurosurgeon.”
TBF: What’s your advice for people who suspect they may have an aneurysm, either because of family history or symptoms they are experiencing?
MS: If you are having symptoms – I think we can fairly describe this as “The worst headache of your life”, something that virtually brings you to your knees, sometimes accompanied by vomiting or even blackouts – get help. Call 911. Get to an emergency room. Time matters, and expertise matters. There are many things we can do emergently to save lives and stabilize conditions. And it’s wonderful to be able to do this work in community hospitals like Mainline Health.
TBF: Thank you Michelle. We’re so honored to be able to work with you, Mainline Health and Jefferson. I’ve heard you say that we would win the battle if we never had another ruptured aneurysm” and along with our amazing Scientific Advisory Board doctors who demonstrate so much devotion and dedication to your patients, we’re confident we can get there.
