Ireland’s first female consultant neurosurgeon, Catherine Moran, says that to work in neurosurgery “you’ve got to put in those hours and years of practice and gradually train on the job”.
But being a brain surgeon requires a certain state of mind too. “You’ve also got to be able to be aggressive with yourself, push yourself out of your comfort zone and stay on the edge a little when carrying out complex brain surgery,” she explains.
We are sitting in the modest office she has shared with two other neurosurgeons at Beaumont Hospital in Dublin since her appointment in October 2020.
With both of us wearing medical masks, it’s impossible to see the full expression on her face but she laughs easily and speaks lightly about the years of training she has put in to finally join a profession which has long been dominated by men in Ireland.
“I grew up in Glasson, Co Westmeath, with an identical twin, Rosalyn, who is a neuroscientist in Kings College, London. We went to an all-girls’ convent school. I loved science at school and got into medicine at University College Dublin,” she explains.
They ask, 'Are you doing the surgery?' I think sometimes they expect to see a man come out of the cupboard behind me
With a good gender balance at college, she says she didn’t experience gender bias during her academic years or even at later specialist trainings, but that patients are often taken by surprise by her gender. “It’s not uncommon when I introduce myself as their neurosurgeon and my name is on their chart that they ask, ‘Are you doing the surgery?’ I think sometimes they expect to see a man come out of the cupboard behind me,” she says. “It doesn’t upset or shock me when this happens and sometimes it takes a little bit longer to get patients’ trust, but I presume that will change over time,” she says.
Moran reflects that her interest in becoming a brain surgeon goes right back to her college days. “I spent days, nights and weekends reading books on the brain in UCD’s Earlsfort Terrace library, listening to musicians practicing in the National Concert Hall beside me. I found the brain to be by far the most fascinating organ. My lecturers, some of whom I now work with, were really interesting,” she says.
Her passion for surgery itself began when she was first scrubbed up for a gynaecological operation during her internship at St Vincent’s hospital. “I spent four hours holding a retractor [the surgical instrument used to hold an incision open] but I knew it was where I wanted to be all the time,” she says.
She puts her attraction to surgery down to the physicality of the job. “It’s so different from prescribing a drug. It’s about fixing something and finishing it off. It is stressful in a way but it’s the most relaxing part of my job. Ask any surgeon and they’ll tell you they are at their happiest when in theatre. You don’t notice the time go by.”
As part of her two years general surgery training, Moran spent time in Beaumont, the national centre for neurosurgery. After that she did six years training as a specialist registrar and three years of fellowship training in Ireland, England and the United States which resulted in her choosing complex spinal neurosurgery and functional neurosurgery as her sub-specialty.
Moran understands why patients are often more daunted about having neurosurgery than surgery on any other part of the body, even though a hip replacement can sometimes be more complex than a simple neurosurgical operation. “It’s high-stakes surgery. If complications arise, it’s dire and serious and the patient can end up in a coma or with a disability or brain injury,” she explains.
She describes the difference between simple and complex neurosurgery citing a chronic subdural haematoma [when blood has gathered between the brain and its hard outer lining] as a relatively simple procedure. “You have to make two burr holes in the skull to release blood which has collected as a result of a minor fall,” she explains.
Even the night before, it's on your mind. You're planning it in your head
But, operating on a person where a tumour has extended into the cerebellum [the brain’s centre for balance, co-ordination and speech] is more complex. “Called a posterior fossa craniectomy, this requires making an opening in the back of the head to gain access to the brain and can take up to five hours.”
Before a day in surgery, she will get a good night’s sleep to be fresh and ready. “Even the night before, it’s on your mind. You’re planning it in your head,” she explains.
Moran’s sub-specialisation in functional neurosurgery means that she will become the first Ireland-based neurosurgeon to carry out deep brain stimulation. This involves implanting electrodes in the deep nucleus of the brain which send a current to disturb the abnormal motor circuits so that the patient’s normal movement is restored.
“This is a life-changing operation for people. It’s suitable for between 10 and 15 per cent of patients with Parkinson’s disease who suffer from unpredictable bouts of lack of movement which can happen after years on medication to control their tremors,” she explains. Deep brain stimulation is also used for some epileptic conditions and dystonia, a muscle disorder.
Deep brain stimulation surgeries are due to begin in 2021 with a team from the neurology department at the Mater hospital; the Neurosurgery Centre at Beaumont is already putting plans in place. “The neurologists at the Mater will do tests to see if it’s suitable for certain patients and we’ve already purchased the robot that will guide me accurately to the correct place in the brain to carry out the surgery,” she explains.
The procedure, which will be suitable for about 50-60 patients with Parkinson's disease each year, will be welcomed for patients who previously would have had to travel to England or Belfast for the surgery. It is almost 15 years since patients and doctors began calling for the introduction of deep brain stimulation to Ireland. (Beaumont Hospital Foundation is fundraising to support the cost of establishing the DBS service - anyone wishing to make a donation can do so at beaumontfundraising.ie or by calling (01) 809 2161).
Moran says that as a neurosurgeon, you can’t ever consider working a strict 40-hour week. “It just doesn’t work because of the mix of doing surgery and seeing patients. You have to know your patients. And you will want to do a ward round on the patient you have operated on. And, even then, it’s hard to switch off. Sometimes, I’ll phone in to check up on how patients are doing when I get home.”
She says that the pandemic has reduced the capacity in theatre, mainly because theatre staff have been redeployed to Covid intensive care units. For her patients, it has meant that a family member can’t accompany them to appointments. “It’s hard for patients because I have to talk through, for example, a complex spinal tumour and it’s difficult to take it all in [that information] on their own, especially when we are all wearing masks.”
She says that while she is currently the only female neurosurgeon on the small team at Beaumont, she hopes Taffy Mandiwanza will join her when she returns from her training in paediatric neurosurgery at Great Ormond Street Hospital in London. “I have had good female role models, in particular Alexandra Golby, professor of neurosurgery at Harvard Medical School who was a warm, friendly person I could talk to. So, I have a role to encourage other women into this specialty. I’d love it if we had more women in neurosurgery.”