It’s the most wonderful time of the year, to quote a popular Christmas song. Celebrations are not universally practiced in December, but gift giving (and receiving) is a large part of many winter solstice/holiday season traditions.

In our business, however, every day has the potential to feel a bit like a holiday (or birthday). Cakes, cookies, chocolates, cards … I get those almost every day that I am in the office.

We had some neighbors over for a drink last weekend. When I asked my neighbor what he would like, he said Scotch. I have a few bottles, all gifts from patients. I found an “aged 18 years” bottle. It may not be the best one that I have, but I guessed from the fancy box that it came in, it is pretty good.  Eighteen years is a long time. My friend liked it.

I once had a patient who had a bad stroke. I found out that he had also had an impressive wine collection … when his daughter started to bring 3 or 4 bottles of wine, all very good ones, each time he came for a follow up visit. He could not enjoy them anymore, so why not me, was her thinking. She was so generous that I eventually had to put a stop to it. I think that there is a line that you can cross. I do not want patients thinking that I require the extra goodies.

I have several wonderful quilts and blankets at home, hand made by patients from all walks of life. I still remember who gave them to me. The cakes and cookies and chocolates have provided more fleeting remembrances, as they disappear so rapidly. Same thing with notes and cards, though I have kept a small number of the particularly touching ones. We all get these.

What I have noticed, however, is that the best gifts come from the patients that I never operated on.

I used to think that many patients and their families are really scarred of “surgery,” especially neurosurgery. They are relieved when the neurosurgeon determines that conservative measures may do. Is it the fact that they have avoided the pain of surgery, did not end up with a large scar, or large bill, that made them happy? I have been under the knife myself … it is not that bad. But then again, I am a surgeon and understand the business.

I wonder sometimes, are they scarred of the surgery, or me?

Excuse my stream of consciousness, but my mind jumps to a recent event in the OR, that involved a junior colleague. She was perplexed that a young, newly-minted anesthesiologist, also a woman, seemed cowed or intimidated by her. The issue was that the anesthesiologist only mentioned that there was a problem with a potentially retained wire in the forearm, from an art line insertion at the start of the case, when the patient was already in the recovery room. X-rays and, eventually, a CT angiogram of the arm, had to be ordered, and there was some stress generated by a situation that could probably have been more expeditiously worked up and fixed in the OR before the patient had left there.

 Perplexed, my colleague asked me flat out. “Am I mean? Am I scarry? Am I intimidating?” She has smooth skin, few (if any) gray hairs and a sweet, sunny countenance. Married, with a husband and three small children, she does not act or look any of those things to me. Quite the opposite. But that is my opinion, and I am a neurosurgeon, and I am seldom intimidated by another doctor.

We often forget that we neurosurgeons are at or near the top of the medical food chain, at least that is the perception of others. We may see ourselves as a nice people, doing a difficult job, just trying to get through the day without messing up. But to not mess up, we must be hard on ourselves, and sometimes others. And that probably comes across as arrogance and perfectionism. Our colleagues do not see us as we see us.

Neither of course do the patients. But do they find us mean, scarry, intimidating? What vibes do we give off?

Perhaps it is that the non-operative patients, most of whom were seriously ill, are grateful for my clinical expertise that allowed them to recover without an operation. But I think not.

On many levels, I fear, patients see me as the boogie man … someone to be avoided at all costs. Only when they have dodged the bullet of surgery can they see the person behind the persona. They learn that not only have they avoided surgery, but that underneath it all I am a nice guy, and are extra-grateful. Of course, if they have surgery, and it turns out OK, they usually come to the same conclusion. But I have hurt them along the way, so they are not quite as happy.

Christmas may be the most wonderful time of year for some people. But I can give many people the gift of prolonged health and life all year long, and am privileged to receive thanks and gifts in return. It is a wonderful life.