"Providing good quality patient care with good communication is the best part of my job."
Miss Helen Fernandes is a consultant neurosurgeon at Addenbrooke’s Hospital in Cambridge, part of Cambridge University Hospitals NHS Foundation Trust
I decided I wanted to be a doctor at the age of six. My mother was a nurse and my father a surgeon, although both did their best to put me off a medical career! I had a natural bent for the sciences and went to medical school in Newcastle after my A levels.
I thoroughly enjoyed the eight-week surgical placements that were part of my medical degree – in orthopaedic, general and vascular surgery. The theatre environment really appealed to me and I decided to pursue a career in surgery.
I’ve been a consultant for 15 years and I trained before the foundation programme was introduced. After my medical degree I completed a six month rotation in medicine and a further six months in surgery. I spent the next year as an anatomy demonstrator for a medical school, which provided great experience for my future surgical career.
The next stage of my training involved working for two years as a senior house officer. (This has now been replaced by the second year of foundation training). I did four six-month placements that included vascular surgery, general surgery, neurosurgery and A&E. I loved the neurosurgery, as it offered the opportunity to work with very sick people and to provide life-changing surgery. I found the operations totally fascinating.
However, I didn’t apply for a training post in neurosurgery at this stage, instead choosing ENT, as the work life balance looked better. After nine months in this specialty, I decided that neurosurgery was what I really wanted to do after all.
With the full support of my ENT consultants I decided to change direction and successfully applied for a two year registrar’s job in neurosurgery. This provided varied experience in the specialty. I learnt how to be a good junior doctor and therefore useful to my consultant, learning the essential skills of clinical assessment and examination alongside practical surgical skills.
During this job I also learnt more about the importance of good communication – both when dealing with patients and also when talking to consultants. A consultant needs the junior doctor to communicate effectively and reliably, and this is even more important for those on-call conversations that may take place in the middle of the night.
At the end of this training I worked for two years as a research registrar in neurosurgery, which took me out of the clinical setting entirely. Under the expert leadership of Professor Mendelow I contributed to a research project of international significance on intracerebral haemorrhages and obtained my MD. I also had my second child at this point, which was helped by the more regular working hours in research.
My training took another four years to complete before I was awarded my CCT.
My working week can vary, but I generally spend one or two half days in the outpatient clinic and one or two full days in the operating theatre.
Half my time is spent working with paediatric cases and the remaining half with adult patients. I work closely with a large MDT that includes paediatricians, ophthalmologists, occupational therapists, physiotherapists and speech and language therapists.
The operations I conduct for children can vary widely in their levels of complexity. Typical operations can include removal of a brain tumour and ependymona, surgery to remove a tumour arising from the ependyma, where malignant (cancer) cells form in the tissues of the brain or spinal cord.
Surgery to remove a tumour from the brain stem is another challenging operation that I perform on children. Although these operations can be risky, an important part of my job is reassuring children and their parents and offering them hope.
My work with adults is different in that the focus is patients of all ages with spinal conditions, such as lumbar disc prolapse and lower back pain. These operations are much lower risk. I also operate on patients who have suffered head and spinal trauma, perhaps after a car or horse-riding accident.
Outpatients work is very interesting and is often about helping patients come to term with changes in their life after brain or spinal injury.
The rest of my week is spent teaching and training medical students and junior doctors and attending several MDT meetings. There’s lots of admin work but I rely on my fantastic secretary.
I’m also chair of my local negotiating committee and look after the interests of doctors and consultants in our trust, in areas such as pay and working conditions. I don’t conduct research, but was awarded the prestigious Huntarian Professorship in 2002 and the Greg Wilkins-Barrett Visiting Professorship in 2014 by the American Association of Neurosurgeons for my contribution to women in neurosurgery.
Providing good quality patient care with good communication is the best part of my job. The work is also very varied. In one week I could be operating on a 110 kg adult and a pre-term baby weighting only 750 grams!
Neurosurgery is a very demanding specialty and you sometimes have to break bad news to patients and their families. Some of the operations I perform are high-risk and if things don’t go well it is horrible for everyone. With experience I’ve gained a sense of peace, helped by the knowledge that I’ve always done my best. There are occasions when patients do not recover in the way that everyone would like, but this is beyond my control. It’s important to be robust and keep a sense of perspective at these times.
I have three children aged 15, 19 and 21. I made the decision to have my children during my training, rather than waiting until I was a consultant, and have always worked full-time. I used the hospital nursery when the children were small, and also relied on the help of family and friends and employed a nanny once my children started school.
As a working mother in neurosurgery you must be extremely well-organised. Support from colleagues, friends and family is also vital.
My working day starts at around 7.30 am and I usually finish work at 6.30-7 pm. I’m on-call one night a week during the week and once in about every 10-12 weekends. During the week I can often handle the on-call queries over the phone.
It’s important to leave time for a life outside work as surgery can be all-consuming. As well as spending time with my family, I like playing tennis, and am preparing to run a marathon in the near future. I also enjoy cooking.
I’m delighted to have been recently elected onto the council of the Royal College of Surgeons. I’m hoping to get involved in areas like less than full time training for surgeons and issues surrounding work life balance.
- if you’re interested in neurosurgery it’s important to get organised early on, either during your medical degree or the first year of foundation training
- ensure you get the right exposure and experience – this includes getting involved in research or audit and ensuring you see a project through to completion. It doesn’t have to be high-brow or of international significance – a local audit could be just as beneficial
- try to find a consultant neurosurgeon who is willing to be your mentor – this is about making the right contacts and showing enthusiasm