Graduating residents look back over the time they spent with the Neurosurgery Department

Seven years is a long time … unless you are a neurosurgery resident at the University of Minnesota. Chief residents Molly Hubbard, MD, and Joshua (Josh) Lim, MD, can attest to that. Both acknowledged that the time they spent learning how to become proficient neurosurgeons flew by, culminating in their graduation today, June 21, 2019. This seminal event in their lives will be celebrated by colleagues, family and friends starting at 6:15 pm in the Indoor Club Room at TCF Bank Stadium in Minneapolis.

They are both moving on to fellowships – Hubbard to study pediatric neurosurgery at Oregon Health and Science University in Portland. “There is something really satisfying about working with kids who have been dealt a bad hand,” she said. “The pathology in children is much different than in adults and I think it’s an interesting area.” Lim’s fellowship will focus on spinal procedures at Johns Hopkins in Baltimore, MD.

Well prepared
They feel well prepared for their next steps. “A lot of it was the gradual independence that staff and senior residents gave us at the U,” noted Hubbard. “I always found there was an appropriate amount of supervision – enough to make you feel that you were living on the edge of your comfort zone so you’re pushing yourself to get better without getting complacent.” Lim said that, “Every bit of teaching in every moment helped a lot.”

Becoming a neurosurgeon isn’t easy. There are many challenges that a resident must overcome. Hubbard looked at the challenges she faced from an internal standpoint. “A lot of it is trying to be confident in your decision making,” she said. “It goes back to the independence we were given; I felt I could come up with my own plan and if it was reasonable, staff and senior residents would allow it to go forward. If it wasn’t, they would help me understand why and how it could be made better. I had to learn to command my ownership of decisions. That confidence took time for me to build.”

Unforgettable
There will be things that neither resident will forget, based on the time they spent at the University of Minnesota. For Hubbard, it was all about her patients. “Dr. [Daniel] Guillaume [from Pediatric Neurosurgery] was my assigned mentor when I started,” said Hubbard. “He taught me the importance of being kind but straightforward with your patients and about the importance of the trust you build with them. Rarely do people question our credentials, which I find very impressive. We learned how to best foster that respect in our relationship with patients while staying humble.”

There were both good and bad patient experiences for each of the graduating residents. One of the more unforgettable experiences happened during Lim’s intern year. “I was locked in a room by a psychotic patient who was homicidal, suicidal and hallucinating,” he said. “He came in with a broken neck and was tied down by security, but somehow he broke the restraints and was running around the hospital. He came into the room where I was working and locked the door behind him. He was screaming … I thought I was in a hostage situation.”

"Thank you for saving my life"
A young woman who was struck by a car while riding her bike made a lasting impression on Hubbard. “When she came in, she was almost dead,” she said. “We performed surgery and the next morning when I was on rounds in the ICU, she was awake, her breathing tube was gone and she said, ‘Thank you for saving my life.’ I thought, ‘Oh wow, this is real.’ That experience showed me how big an effect we can have.”

Patient outcomes weren’t always what the residents hoped they would be. “I had several patients with severe injuries at Hennepin Healthcare who had to have care withdrawn and passed away,” Hubbard said. “I had to learn to be the person to have those conversations with the family. Even though I struggled to find the right words, I’m glad I had that experience. It’s part of the job. I was lucky enough to work with the palliative care team at Hennepin to develop this skill that will serve me in the future.”

Good things coming
Speaking of the future, Hubbard and Lim see good things happening for the U’s Neurosurgery Department. “I’m hoping that with the number of faculty coming, the program will be able to expand, adding another resident,” Hubbard said. “We’re really starting to increase the subspecialties in the department. It’s just going to continue to get bigger and better.”

Lim believes the program will change in another way. “There will be additions to the faculty,” he said. “It will eventually stabilize and introduce a new culture and environment.”

As they look back over the past seven years, the newly minted neurosurgeons have some advice for incoming residents. “Exercise,” Hubbard suggested. “It will keep you sane, even if it’s just running up and down the stairs on a call shift. Do something to get your heart rate up. It really helps a lot.”

Lim took a broader approach to the advice he would give. “Time flies, work hard, focus on your life and yourself,” he said.

Congratulations to both Hubbard and Lim as they begin the next step on their journey toward becoming practicing neurosurgeons.