the world's best on the world's stage

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Karl Schaller, M.D.

Professor & Chairman, Department of NeurosurgeryUniversity of Geneva Medical Center

he World’s Best on the World’s Stage

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hatever follows further along the lines of the so-calledpeaceful competition of international football teams,the essentials may be condensed as follows: In an ideal

orld all of this would be about friendship, performance, teampirit, and long summer evenings, along with the creation of child-ood memories. As we are far from living in an ideal world, however,allow myself to elaborate on the parallels between world neurosur-ery and the football World Cup in a more personal and dialecticanner.

ENIUS LOCI

eing asked what impressions, apart from the sound of the vuvu-elas, I will keep in mind from the Fédération Internationale deootball Association World Cup that had just ended, I would answerpontaneously and in a freely interchangeable order: the facial ex-ression of the Ghanaian Asamoah Gyan, who, after having hadirtually all of the hope and the pressure of the African continent onis mind and on the tip of his foot, misplayed the penalty againstruguay. He then seemed to collapse in an immense inner sadness

s he knew that one more time the African football nations had failedn making it to the final rounds of a world championship. But, theres a second impression that will not fade away easily. Despite alleuilletonistic preoccupations and anticipations of becoming wit-esses of South Africa’s failure to get organized for these games in aroper fashion and to provide the necessary safety for the visitors

rom all over the world, we have to admit in all humility that theouth Africans demonstrated to us in an extremely sympathetic andonvincing fashion that they can do it indeed: create an enthusiasticnd happy platform for such a global event, and be excellent hostsntil the very end, even without an African team participating in thenal rounds. I share the hopes of many that this spirit may sustain,

ey wordsCompetitionGroup buildingProfessional pressureSocial responsibility

From the Department of Neurosurgery, University of Geneva Medical Center,

ORLD NEUROSURGERY 74 [2/3]: 239-241, AUGUST/SEPTEMBER

nd translate into a balanced increase in living standard and a socialoherence of the South African nation as a whole, especially in viewf the fact that considerable amounts of money may have beenrained from public welfare and other budgets for the developmentf the World Cup infrastructure.

IFFERENT WORLDS?

he principal difference between neurosurgeons and footballlayers on their respective world stages relates to the fact that weeurosurgeons do not have a public forum where we would have

o compete in teams for the highest merits by direct comparisonf performance. The H-index alone does not apply here. Second,e do not have a clearly defined forum for performance witheneralized standards being set by international referees. If wepeak about competition, this concerns a very privileged regionalr possibly a national level usually, as we all happen to function inore or less constrained environments. For example, in largeodern and opinion-leading medical centers in the Westernorld and in Asia, the challenges and the particular structuralroblems are quite different from the problems of our colleagues

n poorer or developing countries. This discrepancy may lead to aompetition about the best young trainees, however, who areeing attracted by the best academic and clinical training pro-rams, just as the best young football players are trying to getired by the best clubs worldwide.

What will always remain common to neurosurgeons is the facthat we must mobilize our physical and mental strengths undernormous constraints of time and under socially demanding orressured situations as well. We will not ever have to do so in front ofmultimillion-member audience all over the world, of course. Bute have to withstand pressure during delicate interventions, and

ach of us may find herself or himself in utterly demanding and

o whom correspondence should be addressed: Karl Schaller, M.D.E-mail: karl.schaller@hcuge.ch]

itation: World Neurosurg. (2010) 74, 2/3:239-241.OI: 10.1016/j.wneu.2010.07.035

ournal homepage: www.WORLDNEUROSURGERY.org

vailable online: www.sciencedirect.com

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2010 www.WORLDNEUROSURGERY.org 239

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KARL SCHALLER WORLD’S BEST ON THE WORLD’S STAGE

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nexpectedly difficult situations. If something goes wrong, we feelad enough. In the worst-case scenario, there might be a medicole-al consequence. But there will hardly be a dissection of our veryersonal performance in the public and in the press. Of course, the

nterdependency between the public and the media world creates aesire for the flashy and for the shiny, and the temptation to comply

s all too strong, but we all know very well who in our neurosurgicalommunity are performers and who are not, whereas large andpenly accessible sports events, such as the Fédération Internation-le de Football Association World Cup, create very large numbers ofeal and of self-declared experts, which in turn may then influenceublic opinion.

ROUP SPIRIT AND TEAM BUILDING

hat became very evident to me while watching the World Cupames was the fact that single stars may become decisive withineconds, but a unidirectional monolithic way of playing, centeredround that particular star only, did not work as it did in the past.ere, I see clear functional and even chronological parallels to

ur specialty, the development of which was driven by highlypirited visionary and hard-working individuals. They have ad-anced neurosurgery from its marginal role in the medical fieldnto an intellectually rewarding and technologically stimulatingpecialty that is now to be located at the dynamic crossroadsetween basic and clinical neurosciences, computer sciences,athematics, and engineering—and public service. The timehen gray-haired, strong-minded gentlemen would sit or stand

n front of small holes in someone’s head, hardly approachable,trictly authoritarian, and executing discrete movements withelicate instruments without making it evident to the surround-

ng juniors, is over in my opinion.This parallel is illustrated by the final games of the World Cup,

hich were played among teams who functioned as a whole, teamshat were organized as if functioning like a collective intelligence,nd in which one player would stand in for the other(s) withoutesitating for a moment. This translates perfectly in the world ofeurosurgery, in which during our process of maturation we must

earn to make all problems of a given department our own, andhereby to develop our own confidence, competence, and judgment,nd gradually make our peers develop the same degree of confidencen us and in our judgment. The capability to prioritize where it takesapid yet substantiated decision-making cannot develop in an ambi-nce of fear and awe. Young neurosurgeons should be entrustedith certain objectives in a benevolent manner, and then one must

et them grow and go. I must admit, I am still learning in the sameay myself.The professional admiration for the performance of others be-

ame evident during the very last games, in which the subdued teamsad acknowledged without anger the superiority of the concepts of

he winners. The world champion of the 2010 World Cup, the Span-sh team, is a wonderful example for the functioning of a group ofxtremely talented football players who showed the world that foot-all is about more than physical fitness alone: they did not score thatften, nor did they play as physically intensely as other teams, but

hey played technically high-end modern football, which did not

40 www.SCIENCEDIRECT.com WO

ecisive moments they scored one (dry) goal. Thereafter theymartly shut down the room for the other teams, who then hardlyound their way back into play again. When watching two sucheams playing, this sport unfolds its full beauty and intensity—it isike watching a beautiful couple dancing in perfect harmony to

usic and rhythm.Most successful football teams who participated in the 2010orld Cup reflected the cultural variety of their own societies. Suc-

essful neurosurgical teams all around the world reflect this multi-ultural aspect as well: there are chairmen with an Asian or Europeanackground in North America. There are significant inner-Euro-ean movements from one country to the other, and to an extent thatould not have been thinkable in the past, prior to legislative facili-

ation of such movements on a large scale, which translates now intohe compositions of the respective teams. And what unifies them alloncerns the ambition to further develop our specialty, as modernootball is developed by a smart combination of sportive and socialnterplay. If one looks at the author lists, even on the same article, inny issue of any of our leading neurosurgical journals, we find anstonishing and refreshing diversity of names reflecting variousultural backgrounds.

One concern relates to the drainage of gifted young peoplerom their less-developed countries to the highly developedlaces in a unidirectional fashion. Neurosurgical care at its high-st quality, including high-end intraoperative imaging and otheradgets, is available to less than 10% of the world’s population,nd it is our obligation not to leave our colleagues behind whoappen to be under less privileged circumstances. One may be

empted to think that it might be more objective and fair toompare sports teams from different countries. This, however,oes not hold true in view of the necessary social efforts, whichre all behind the development of specific training models, sportsedicine, football arenas, and even the transportation infra-

tructure. This requires enormous coordination of efforts, in-estment, and dedication. And it is here where we may observeimilar disparities between the nations.

HE VERY DECISIVE (LAST) SECONDS

gain, whoever saw the close-up of the face of the unfortunatehanaian Asamoah Gyan, who misplayed the potentially decisiveenalty in the game Ghana vs. Uruguay in the very last seconds, and

hereby initiated a cascade of events that finally led to the eliminationf Ghana from further World Cup final rounds, was probably movedy the aspects of tragedy that had become so overt. These few sec-nds, in which with ultimate concentration someone must performnder maximum pressure, reminded me of situations, both self-xperienced and observed, in which during the last moments ofurgery, e.g., after removal of an acoustic neuroma, the surgeonappened to touch the facial nerve, which had been preserved withll prudence over hours, with a microdissector or with whatever else,nd this was followed by a postoperative VIIth nerve palsy. You thinkou had scored and all it takes is to get through the very last minutes,nd suddenly all collapses— but we should not collapse with it our-

RLD NEUROSURGERY, DOI:10.1016/j.wneu.2010.07.035

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KARL SCHALLER WORLD’S BEST ON THE WORLD’S STAGE

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OMO HOMINI DEUS ET HOMO HOMINI LUPUS

ith it all comes an impudent image of obscenity as well, unfortu-ately. The capacity of a game to evoke the worst of man instead of

he best during such a supposed-to-be festival of some of the bestportsmen in the world. If you watch how talented young men, idolso many of our youth, and a great proportion of whom have nothinglse than football with which to make a living, and thus nothing elseut their physical condition, and their feet in particular, are destroy-

ng exactly these qualities in their competing counterparts, then youealize that instead of pulling out the best performance and the bestraits of character in these young people, the sad opposite mayccur. One may witness on close-up high-definition TV how, duringsplit-second when some player feels unobserved, he tries to phys-

cally damage his counterpart from the other team. They may kickheir opponents with their shoes until ligaments tear, or until bonesreak. And all you can feel when you observe that are sadness andincere disgust. The same happens to occur when you see young andhysically extremely well-trained guys falling down without foreign

nterference, just to try to make their counterparts look guilty ofomething, or to make those receiving a yellow or a red card, or toag a penalty. And when you see them lying on the ground, theiraces red from nonexistent tears of pain, although they had fallenown without having been brought down by someone else, then at

east you should start asking yourself how far this game within aarger game has gone. How far goes coherence in a certain peerroup? What are existential fear or strong ambition doing with us?ave we ever blamed someone else for our own mistakes, or have we

een someone else doing it? And how would this comply with theole of the so-called best of their profession as role models forociety?

UR OBJECTIVES ON OUR WORLD STAGE—HUMANITY ANDEVELOPMENT AS A ROLE MODEL

ow much such a major sports event affects social life and how itriggers worldwide coherence may be illustrated by the fact that

ost of us who were born in football-loving nations remember whate were and where we were during particular games of the pastorld Cups. For example, you may easily run into a British colleagueho will share the same childhood memories with you relating toarticular games of England vs. Germany, and you may then see howuch memories unfold themselves in front of your hidden eyes,hereby returning the profound feelings of those long summer eve-

ORLD NEUROSURGERY 74 [2/3]: 239-241, AUGUST/SEPTEMBER

nd that later on relate to the recall of ephemeral encounters andhose of profound friendship.

This year, I could personally recall such impressions while sittingn the lakeside in Geneva, when Argentinians were passing glassesf wine to bystanders after their team had just won against Mexico,r when I saw Spanish students jumping into public fountains inadova, Italy, on the night of the final game—and local Italianspplauding that. While being stuck in an airplane at the Munichirport and being cut off from all screens, the captain regularlynnounced the sequence of events during one of the half-finalames, and you could see how this was appreciated by the passen-ers in their own ways, and how a certain group dynamic unfolded in

he body of this plane. During these four weeks of increasing inten-ity, there was some light-headed feeling of continuing adolescencebout it all that made many of us look forward to the next game, andhat we desired to carry us on to the next World Cup in Brazil and tohe next after that and so forth—and the question of how many suchvents we might still be able to share with our closest ones, and withhose we do not even know as of yet. Is it not a privilege that weeurosurgeons have created an international forum already? A fo-um, consisting of journals, society associations, internet, and—

ost importantly—personal networks, which allows us to exchangeur concepts and ideas continuously; to take on responsibility be-ond our local obligations, e.g., by training fellows from other coun-ries or by sending our students to our colleagues around the world;nd to help our colleagues who happen to work in less protected andrivileged environments than us to close the gap between theirtandards of care and ours which may not be imposing at first sight,ut which allows us to exchange our concepts and our ideas in aontinuous fashion; to take on responsibility beyond our local obli-ations, e.g., by training fellows from other countries or by sendingur students to our colleagues around the world; and to help ourolleagues who happen to work in less protected environments thans to close the gap between their standards and ours? It is as if there

s a ball on the ground in the midst of us, and as if we just have to taket on, to kick it, and go get playing.

onflict of interest statement: The author declares that this article was composed in thebsence of any commercial or financial relationships that could be construed as a potentialonflict of interest.

itation: World Neurosurg. (2010) 74, 2/3:239-241.OI: 10.1016/j.wneu.2010.07.035

ournal homepage: www.WORLDNEUROSURGERY.org

vailable online: www.sciencedirect.com

878-8750/$ - see front matter © 2010 Elsevier Inc. All rights reserved.

2010 www.WORLDNEUROSURGERY.org 241