03/20/2025
It was an Autumn morning towards the beginning of my sixth and final year of neurosurgery residency. Today’s patient had a large right frontal meningioma, a brain tumor causing her to have not only headaches, but weakness on her left side. I had spoken with the patient and her family in the preoperative holding area, waited patiently by the patient’s side as the anesthesiologist put her to sleep, carefully positioned her delicate body on the table so that her tumor would be facing up towards the ceiling, marked and draped the incision, numbed it up with 10cc of Lidocaine with epinephrine, and began the exposure with a fifteen blade scalpel.
“Dr. Bidiwala has started the operation, sir”, I heard the circulating nurse say peppily on the phone to Dr. Young, my attending for that case, and my mentor for the past five years. As the tan blush of the tumor was beginning to show itself through the thin bone above it, Dr. Young entered the room, got gowned and gloved, and approached the operative field that I had dutifully demarcated with four clean blue surgical towels with their creases perfectly positioned towards the soon to be exposed tumor.
“Nice job, Shaad.” I beamed under my mask because I knew that Dr. Young was not one to compliment anyone often, much less me.
Dr. Young held his right hand out to the scrub nurse. “Bipolar electrocautery.”
“Sh*t.” I thought to myself. I had forgotten to test the instruments. “Sh*t!” My silent hysteria was interrupted by the lonely clanking of the bipolar pedal without the familiar tone that the electrocautery unit emitted when it was in fact up and running.
Dr. Young shot a searing glance at me and let out an intentionally audible sigh. I was one thousand percent certain of what was going to happen next. Here it went. “Now Shaad, if you were an airline pilot, and you didn’t test the electrocautery…” His words were momentarily drowned out in my mind as I wondered why Dr. Young liked airplanes and checklists so much, and if there was still time to cut my losses and join the circus. “.. the plane would’ve crashed, right?”
It had taken me five and a half years of hearing this analogy to figure out that the answer to this particular question was always “Yes sir.” It didn’t matter if my hypothetical crew was a lot of lazy imbeciles, the air traffic controller was a drunken Russian spy, or if the plane’s wings were made of wicker and fell off through no fault of my own. Hell, it didn’t even matter that there wasn’t an electrocautery on any airplane, as a resident once pointed out before being summarily remanded to ICU pencil-sharpening duty for a week. The answer was always “Yes sir.”
“Yes sir.” I responded. Satisfied, Dr. Young smiled back from behind his mask before reaching for a now-functioning electrocautery.
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Alfred Byron Young MD was the Founding Chairman of the Department of Neurosurgery at the University of Kentucky Medical Center, and one of the most profound influences on not just my career, but my life, and well as those of the numerous neurosurgeons that received their wings before and after me. Looking back on my neurosurgical training that began almost thirty years ago, I can say that Dr. Young taught me much more than how to remove a brain tumor, implant a functioning brain machine interface, clip an aneurysm, or take the pressure off of a horribly compressed nerve in the spine. He taught me about life. Not just about my life, but about the lives of the numerous other people that I would affect in what would, to date, be my two-plus decade long career as a neurosurgeon.
Aside from the immense value of always checking the surgical instruments before making an incision – a lesson that my scrub nurses rue to this very day - Dr Young taught me that being a doctor, and, especially a neurosurgeon, meant putting your patients’ lives – and their families’ lives - above your own. He believed to his core, as I do now, that there was simply no better way to be an excellent physician or surgeon without putting your own needs aside in the service of someone who was in more immediate or critical need. This meant always pushing yourself to the limit to be better, and with less. Less food, less sleep, and less attention to the way you felt – angry, sad, tired, hungry - it didn’t matter when you had made a decision to serve the greater good. Young residents – present company included – initially found Dr. Young’s expectations to be daunting, intimidating, even paralyzingly impossible. But as we surprised ourselves by meeting those expectations, and making the impossible possible more and more often, a strange thing happened. We became the competent surgeons that Dr. Young intended us to become – and at the same time we learned a compassion and humility that was uncommon for neurosurgeons at the time, and still is.
If a patient that we had operated on ever had an adverse outcome, no matter how minor, Dr. Young would delight in making an invitation that we residents dreaded: “Why don’t you give us a talk about that on Saturday morning?” Dr. Young’s infamous several hour-long Saturday morning conferences were held every week, and would involve a handful of us presenting the week’s haul of the good and the bad, but mostly the ugly. We would describe the complication that we had experienced and then propose ways in which we could have averted it. But without any excuses whatsoever. If one of us dared to blame the patient’s diabetes for their complication, we would quickly find ourselves being “invited” to present a detailed review of the medical management of diabetes the next Saturday. If we complained that an instrument had malfunctioned, we would be giving a talk about the circuitry of that instrument and how it could be repaired the very next week. Until I came to accept and embrace that blame and excuses were not refuges that were available to neurosurgeons, I would routinely find myself booked for speaking arrangements at several Saturday conferences in a row.
This taught me that the patients and families that called upon us in their time of desperation didn’t care about excuses, nor was it their function or job to do so. It was our calling – and we had all accepted it – to do the very best we could, and to not stop until every possible option had been exhausted, and without excuses. It was our calling to care for the sick – who were, many times, weaker or less able to comprehend their situation than we were – and to treat them with the kindness and dignity that all human beings deserved. It was our duty to do everything we could to make the impossible possible. And if we failed, it was our job to explain what had happened to the best of our ability and without blame, and to accept that that family may harbor anger and resentment towards us in perpetuity, even if we had nothing to do with the failure.
I realized the value of this lesson the first, and thankfully the last, time I was sued for medical malpractice two years after I had graduated residency. A young lady had jumped from a balcony, and my team and I had unfortunately been unable to save her. As the plaintiff’s attorney hammered away at me for almost eight hours during my turn on the stand, I offered every intervention that we tried, why we tried it, what the outcome was, and what we did next. But not once did I take the bait of blaming the patient, the other doctors, or even myself. The deceased patient’s mom and her attorney didn’t care, and I did not expect them to. I couldn’t expect them to because they were both dealing with the fresh loss of a young soul. Even though they were suing me, I did my best to explain everything I could to them and the jury, without acrimony but with compassion, because that’s what this young lady’s family needed whether they realized it or not. The jury decided in my favor 12-0 in just eleven minutes of deliberation after a nearly two-week trial. All of the times Dr. Young had hammered away at me at Saturday morning conference suddenly made sense after that two weeks in court.
When I told him that at his retirement party years later, he turned to me with an all-knowing smile on his face and nodded without a single gloating word. Instead, he looked at me with a kindness in his eyes and said “I think you did the right thing, don’t you?” That’s the kind of man and teacher Dr Young was, and the kind of man and teacher I aspire to be.
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Dr. Young passed away peacefully in his sleep on January 31st 2025. I think I can speak for all of the residents that Dr. Young taught when I acknowledge that, while Dr. Young was teaching us, he was also away from his family. During the thousands of hours I spent with Dr. Young, he spoke with immense and infectious fondness about Mrs. Young, their two sons and their families. I would like to thank them for sharing Dr. Young with us. His skill, compassion, and acumen have left an indelible mark on the lives of so many surgeons, and perhaps more importantly, the patients whom we have cared for while remembering his wisdom. His legacy will always be cemented in the center of the University of Kentucky Neurosurgery family, and something that I will always be proud to have been a part of.
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It had been a long day at work, especially for post pandemic. A brain tumor, a lumbar fusion, a fractured neck, then a mad dash to the airport to meet my family for a wedding. I flew through security, boarded the plane, and made my way to my requisite window seat, where I dozed off with my face uncomfortably against the cold inner shell of the plane’s cabin. I awoke as the lights flickered and the pilot’s upbeat but apologetic voice came in abruptly on the PA. We would be returning to the terminal. Something about a door not closing.
For a brief second, my sleep-deprived mind wandered into a fantasy. I pictured myself getting out of my seat and making my way up to the cockpit. When I got to the cockpit’s open folding doors, I would read the pilot’s name badge, channel the great Dr. Young, and say in his precisely metered words: “Now, Rick, if you were a neurosurgeon, and you didn’t check the cabin door, the patient would’ve died, right?” My heart raced as I pictured the young pilot looking back at me quizzically from his instrument panel, with one eyebrow raised, motioning to the flight attendants behind me, one on each side, as they prepared to grab my arms.
Now fully awake and thankful that I was still in my seat, I chuckled to myself. “Absolutely sir, he would have,” I imagined the pilot saying.
“Absolutely. Yes sir, Dr. Young.” I let my face fall back against the cold off white plastic and fell fast asleep.
Alfred Byron Young, MD, FACS, former chair of the UK departments of surgery and neurosurgery, died peacefully in his sleep at his home in Westerville, Ohio on January 31st, 2025.
