The phrase ne plus ultra (latin, literally – no more beyond, in common usage – the epitome, the finest example, the ultimate) was first immortalized on the medieval Spanish coat of arms. The Spaniards believed that they sat at the edge of the knowable world – the Atlantic ocean was an uncrossable barrier. Accordingly, there was literally nothing more beyond Spain. Eventually, they sent an exploration to test that theory, discovered (from their perspective) a new continent, and the coat of arms promptly sacrificed the “ne” to become simply plus ultra, more beyond. Spain became the portal to the new world.
Many people have written to ask me why I chose Neurosurgery. I enjoy extremely immersive, obsessive pursuits. I feel gratified when I have very difficult, dire challenges that demand my full attention. I want to be on a team of people who felt the same way I do, who seek challenge and difficulty. Accordingly, I decided to consider surgical fields as a career.
In surgery, there are other operations which require dextrous hands, which last longer, and which are physically more challenging. But there is no operation where each action is more consequential. In our world, every time we intervene on someone’s central nervous system, our movements are forever etched upon their consciousness, on their very sense of self and their perception of reality. If we excise eloquent cortex, stretch the optic nerve too far, or occlude blood flow to the motor cortex for too long, we cannot “fix” that problem or undo it. Perhaps we get lucky, but there is no return and there are no second chances. Accordingly, I came to see neurosurgery as the ne plus ultra of surgery.
Neurosurgery is the modern medical equivalent of the medieval Spanish Empire. Much as the Spaniards sat at the edge of the old world, dipping their toes into the Atlantic ocean, we are the only humans with direct physical access to the central nervous system. We are explorers. We enable the future of neuroscience to come into being. It is exciting to be out on the frontiers of human knowledge, surrounded by opportunities for discovery. There is no other field in surgery which is similarly positioned to propel scientific progress forward.
plus ultra indeed.