How Does a Neurosurgeon Work?

At the Johns Hopkins Hospital, pediatric resident Dr. Harry Mushlin operates on a subtle and complex organ.

Jacob Brogan

Dr. Harry Mushlin

Jacob Brogan

This season on Working, we took a trip to Baltimore to chat with some of the city’s residents about how they make a living there. We’re hoping to learn a little about the ways Baltimore shapes their work—and the ways they’re shaping Baltimore by working.

Listen to this episode of Working with special guest Harry Mushlin:

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Under ordinary circumstances, the brain is a hard organ to reach. Sheathed in thick, hard bone and other protective layers, it’s not just “the most complex structure we know of in the universe,” as the Norwegian writer Karl Ove Knausgaard puts it, it’s also one of the most heavily defended.

When things go wrong within—and they do—surgeons like Dr. Harry Mushlin have to break through those biological barriers. “When you get there, it’s excitement, because you’re somewhere very special. It’s the hub of who we are, and what makes you you,” Mushlin, a pediatric neurosurgery resident at the Johns Hopkins Hospital in Baltimore, tells us in this episode of Working, which you can listen to via the player above. “I remember that first time. They took off the bone in the head and … there was the cortex with all the little vessels and the grooves. It’s very pristine. It’s very clean. It shines.”

Crisp as that environment can be, the effort of getting into it can be “pretty barbaric,” in Mushlin’s telling. He describes a process that involves cutting into bone with power tools. Of course, there’s also a great deal of precision work involved, from planning where the incision should go to carefully clamping off vascular tissue (lest a patient bleed out from the scalp). That means that surgeons like Mushlin spend a portion of their days in meetings carefully mapping out the operations ahead. But he’s also in the operating room almost every day.

In this episode, Mushlin, who studied neuroscience in college and eventually dove into deeper study of the brain in medical school, goes into detail about some of the procedures he and his fellow surgeons perform once they’ve opened up a patient’s skull. Sometimes, for example, he and his fellow surgeons have to drain fluid from the brains of their young patients. “You have a little tube that goes from inside the brain where the caves inside the brain hold this fluid. Then there’s a little valve on the skin that goes under the scalp. Then you have a tube that goes all the way down to [the patient’s] abdomen,” he explains.

Though such operations require meticulous planning, sometimes Mushlin and his associates have to conduct them with little notice. “Neurosurgery in particular has a lot of emergencies,” he says, but he also responds to medical crises of other kinds, especially during his occasional shifts at Baltimore’s Shock Trauma Center, which he describes as “an extreme ER.” There, Mushlin often comes face-to-face with the Baltimore you’re most likely to hear about on the news. “You’ll see some crazy stuff. During the summer, it’s a lot of gunshot wounds, especially last summer, when it was particularly violent,” he says.

Sometimes, that element of his work requires 24-hour shifts, mostly over the weekend, though he has to take fewer of those than he did earlier in his training and career. When he works a long shift, he says, the main difference is that he ends up eating a lot more cafeteria food than usual, watching television, or studying during his downtime—and sleeping whenever he can grab a brief rest. We chatted in one of Johns Hopkins’ call rooms, which look something like an ultra-efficiency hotel room, designed for just this purpose. Though it was pleasant enough, it didn’t appear to be designed to encourage deep rest. “I’ll admit … I can get a little grumpy. I don’t know who doesn’t,” Mushlin explains, adding that he tends to wake himself up if he’s been dozing uninterrupted for too long, worried that he’s somehow slept though an emergency.

Whatever he’s doing, capturing and communicating the complexities of the brain can be difficult, especially when you’re speaking to parents who are worried about their children’s well-being. “If you break a bone, it heals,” Mushlin says. But brains—especially the brains of young children—can respond unpredictably to surgical intervention. That’s all the more important because, as he puts it, the brain is central to what makes us ourselves: “If you damage that tissue, there’s not some secret you hiding out in the soul somewhere waiting to come out. … That concept of what created you is now altered forever.”

That said, he doesn’t currently spend as much time interacting with parents as he does with children. While the hospital can’t function without residents like Mushlin, he acknowledges that the parents of his young patients mostly interact with his attending physician, at least initially. However involved those doctors may be in the surgical process, “We are not the stars of the show before surgery,” he says.

After a procedure is complete, though, he and his colleagues have more direct interaction with patients when they’re checking up on them and monitoring their progress. Sometimes, he claims, they manage to build relationships with patients along the way: “Part of the process of being a physician is having that connection.”

Though he still fondly recalls the magic of seeing a brain for the first time, some elements of the experience have grown routine over the years. At some point, all brains start to look the same—so much so that he laughs off a pop-science factoid I had heard somewhere about the folds of individual brains being as unique as fingerprints. For all their subtle mysteries, Mushlin tells us, brains are just brains.

You can listen to our full conversation with Mushlin via the player above. Then, in a Slate Plus extra, Mushlin tells us what it’s like to operate in the shadow of Baltimore’s most famous neurosurgeon, Dr. Ben Carson. If you’re a member, enjoy bonus segments and interview transcripts from Working, plus other great podcast exclusives. Start your two-week free trial at