🩺 Board Certified Neurosurgeon Interview

📧 🎙 With Dr. Upadhyaya
Date : July 22th 2025 @ 7:00 am

INTRODUCTION SECTION

• Q: What’s your name, title, and what department do you work for, and what hospital, clinic, or organization are you currently employed at?
  
  Dr. Sunil Upadhyaya, Consultant Neurosurgeon

Current hospital/clinic/organization:
Jerudong Park Medical Center and Brunei Neuroscience Stroke and Rehabilitation Center
(Practicing neurosurgery for over 20 years; 9.5 years at current institution)

BACKGROUND

1. What inspired you to pursue medicine or healthcare?
Right, so it’s always challenging when we talk about our days. Those days, there was no internet. Any information you wanted, you had to go to the library or ask people around you. If someone in your family was a doctor, they’d guide you toward medicine.
In my family, there was no doctor. I’m the first doctor in three generations. There was no driving force—just the challenge of entering a new field. My father and mother were in completely different fields.
One important reason I can say that ignited my interest was that my mother was asthmatic. When I was ten, I used to take her to a cardiologist. I’d sit outside the clinic and watch him work—wearing a tie, treating patients, talking kindly. Everyone recognized and greeted him. That left a mark on me.
That was my first encounter with medicine. Of course, I had no idea that it meant at least 12 years of study before practicing. To practice medical science, any specialty, you have to be mentally prepared to give 12–14 years after high school.
In the U.S., you do basic sciences, then MD (or MBBS), internship, specialization, then fellowship. It’s long, but it’s structured. In our time, we joined out of fascination. We entered first-year medical college, started reading, and only then did we decide whether we liked it.
But I think in the U.S., you have a good option—you can decide after your basic sciences whether you want to go into medicine. That’s definitely good.

2. What was your path like—undergrad major, med school, residency, fellowship, any detours?
In India, training is completely different. We have a national exam called NEET. There are around 70,000 medical seats in India, and over 2.3 million students appear each year. That’s less than a 2% acceptance rate.
There’s no admissions process based on A-levels, GPA, or extracurriculars. Everything depends on your exam rank. Once you get a rank, you choose a college accordingly.
But if you're passionate about becoming a doctor, nothing can stop you. Passion and hard work take you a long way. You need that drive. Once you commit, you have to give 200%—you can’t back out after 3–4 years.
During my undergrad years in 1997, industrialization and the IT boom hadn’t taken off yet. Medicine, law, and engineering were the major career options. Today, students have many more paths—AI, YouTube, finance, business. But if you’re truly passionate, you should go for medicine.

THE JOB ITSELF

3. What does a typical day look like for you?
Before joining neurosurgery, I was a general surgeon. I did appendectomies, breast surgeries, thyroid surgeries. Then I decided I wanted to do something different and entered neurosurgery.
In India, neurosurgery requires three years of general surgery, then two to three years as a registrar or assistant professor, then 6–12 months in a neurosurgery department. After that, you sit for another entrance exam, then do a 3-year neurosurgery degree. That’s 9 years post-MD.
During training, my days started at 6:30 AM and ended around 7 PM. Three to four days a week, I had 24-hour hospital calls—essentially 36-hour shifts. After training, you start as an assistant professor, then move up.
Now, I operate four days a week, starting around 8 AM. I finish surgeries by 2:30 to 5:30 PM, do ward rounds, and go home. My phone never stops ringing—even on weekends. Outside the OR, I give lectures, teach undergraduates, publish, and manage patients.
Physical fitness is essential. I play badminton, hydrate, sleep well, and maintain good nutrition. All my colleagues—whether in Singapore, Australia, or Japan—play sports or go to the gym. Even after 20 years, I still love the adrenaline of brain surgery.

4. What’s the hardest or most surprising part of your job?
The job doesn't get easier just because you’re done training. Being a consultant means you're responsible for patient outcomes. Surgery isn't done when the operation ends—it’s done when the patient walks out of the hospital safely. That’s always the goal.

REFLECTIONS

5. Favorite surgery or most memorable patient experience?
I love brain surgeries. I’ve done hundreds of tumors—frontal, posterior, lateral. 

Last week, I operated on a 62-year-old retired policewoman with a tumor near the brainstem, originating from the 7th cranial nerve. It was a critical 4–5 cm tumor. I started at 8 AM and finished by 5 PM. The next morning, she was smiling and walking. No stroke, no complications. I discharged her after four days. That’s what makes it all worth it.
She’s smiling to me. The post-operative scan was clear—no bleed, no stroke. She is saying thank you to me. She is running. I discharged her after keeping her in the hospital for four to five days.
This is what I’m talking about. There are many cases, not just one. From small babies where you operate on tumors or spinal dysraphism surgeries, to spine cases like today. Today, I did a spine surgery on a young man. I put four screws in his back. It was about a two-and-a-half-hour surgery. I started around 8:39, finished by 12:30, did my rounds, and after rounds, I finished my work by 3:30 and went home.
That’s why I picked this day to talk to you. Every case is good. Every case is fantastic. The interesting part is that whatever you operate on, the next morning you do rounds with your team, and the patient smiles at you, holds your hand, and says you saved their life—you are like a god to them.
Those words and those smiles from patients and their family members are amazing. When you think about this world, you feel attracted only to human-to-human connection, right? You cannot love machines—you love humans.

When you get praised by your patients almost every day, that’s a real kick. I think that is what everybody wants—some recognition. So when this recognition comes from your own patients and their families, who love you, like you, wait for you in your clinics, send you greeting cards, and beautiful messages, that’s something really special.

6. How do you mentally prepare for a high-risk surgery?
As for mental preparation before high-risk surgeries like neurosurgery or brain tumor removals: experience matters a lot. Most surgeries I perform as an independent surgeon are ones I am well-trained in. Every job is important and requires preparation—just like astronauts or fighter pilots need extensive training and focus.
High-risk surgeries are not a one-day story; they require many years of practice. If I know I have a high-risk surgery that will last many hours, I sleep early, read the case thoroughly, and review the scans like MRI and CT in detail with my team the day before. I say: “This is the brain, this is your tumor, this is your problem here, and this is how we’re going to do the surgery. This is the surgery to be performed. This is how the scan looks. We are going from here.” Then I draw and tell them, “We are going from here, we’re going from there, we’ll reach there, and we’ll take it out. We can take it out 100%, or we’ll take it out 70%.” If I think it is stuck to some critical structures, I will leave a small portion of the tumor and give radiotherapy.
So, we explain everything. And I think you read about the case. Obviously, after two months of much discussion with family members, discussing the scans and MRI, you're mentally prepared. You're already mentally prepared that you want to do that. So, the day before, yes, you sleep well because you're going to do a major surgery tomorrow, and hydrate well, eat well. I mean, don’t go empty stomach into the theatres. Keep your family issues and personal health in mind.
You have to take care of it. You have to be fit, right? If you're going for a 5-hour surgery or a 10-hour surgery in the operating theatre, you have to be physically fit. You cannot afford to have a viral fever. See, in any other profession, you can still get away with some elements. If you have a running nose, sneezing, a cough, or mild body ache, in any other profession with a desk or table job, you can still do that.
But when the human body is involved, and you're going to do major surgery the next day, you can’t afford to have an unfit body. You have to be literally fit. Your body should not be aching, you should not be having cramps. You should not have mental issues. Anybody can have depression or side issues, not good things happening at home, children having problems.
All these things have to be in line when you operate on one patient. Your physical health, your mental health, your knowledge, and your experience. When all these things come together, then the patients do well. The second is teamwork. You have a team, other doctors with you. They will help you in surgery. You have an anesthetist team. You have ICU doctors to look after everybody.
It’s teamwork. Two consultant neurosurgeons will be there. If I’m tired, I can say I’m tired and want to take a coffee. Great. Another surgeon can start doing the surgery, then I’ll go rest for half an hour and come back to start again. It’s teamwork, it’s good work.
Preparing a case the night before or a few days before is very important, very important. In every case, not just in surgery but any surgery where a human life is involved, you have to give very high weight to it. You cannot just casually walk in. The night before is critical. But after so many years of practice and operating thousands of cases, it’s pretty much normal now.

Years of experience count.

ADVICE SECTION

7. What advice would you give to high schoolers or college students interested in medicine?
I always tell young medical students to first decide if they are interested in the medical field. That is the most important thing. Then you go into medical school and don’t worry about studying for 12 or 14 years or when you will start earning—that will come naturally. You need to stay motivated and passionate. You need to be very active and motivated. You need passion. Join medical school with that passion. After medical school and internship rotations, you choose whether you are a medical person or a surgical person. If you want to do this, that passion will carry you through.
After joining medical school, finish your medical training and internship rotations. Then decide whether you want to be a medical person or a surgical person. There are two main paths. If you think surgery is not for you and you prefer medical branches, then you can choose to be a gynecologist, pediatrician, dermatologist, pathologist, radiologist, endocrinologist, rheumatologist—there are many beautiful specialties. Choose whichever field you like.
In my MBBS batch, we had 125 students. Currently, about 28 are consultants working in the U.S., around 16 in the U.K., two in Germany, four in Australia, two in the U.A.E., and 29 are practicing in India. So people are practicing worldwide. Out of 125 students, only two of us became neurosurgeons. Others went into cardiology, dermatology, gynecology, radiology, and so on.
Some students even switched careers entirely. For example, one girl from Australia finished MBBS but then switched to business administration and started her own medical-related business. So, choose wisely. If you are interested in medicine, think about the other things later. Don’t start thinking you have to do surgery if you don’t want to. That should be your goal, your passion.

PERSONAL

8. What’s a case that has changed the way that you think about medicine or life in general? Like a case that has shifted your perspective.
I can’t remember one case.
Whether it’s a pediatric child, I have one. Bye-bye. One patient, who’s a girl around when I operated first, she was ten years old. And I operated one brain tumor called craniopharyngioma, right? It’s a tumor in the center portion of the brain, and I operated it from the head, opened the skull, and went inside.

She was ten years old. The problem with this type of tumors is craniopharyngioma. They always have a very high incidence of recurrence, right? They recur. The tumors grow again. Then I operated her at ten years. Then she went to school. She was operating very well. She was doing really great. Going to school, then she went to college. Then she developed the same craniopharyngioma in another portion of the brain. So, I operated her at ten years of age. Then I operated her again when she was eighteen years of age. That tumor was very critical, stuck to the brain stem. So, I can’t take out a hundred percent because otherwise, she would develop stroke. She would die on table. So, I had to take out ninety percent of the tumor. I left ten percent of the tumor. I gave radiotherapy after that. Radiotherapy usually sometimes works. Sometimes it doesn’t work for craniopharyngiomas. She lived happily for three to four years after that. Then I think she died when she was twenty-two, in spite of multiple brain surgeries. This is one I always think about. I had one more girl, she was twenty-one years old. She came to emergency almost dead. She was going to die. She had a huge bleed in the brain. That day and night, that’s why I say how life is very challenging. She came around seven or eight o’clock in the evening. I operated on her at night, ten o’clock, in spite of my whole day being busy. I was very tired. I went to the hospital around ten o’clock at night, finished surgery around two o’clock. I opened the skull, took out that clot. She recovered — almost that comatose patient became perfectly normal.
But the cause of the bleed was still there. So I did certain tests and found she developed some kind of AVM. We call it arteriovenous malformations. They are connections between arteries and veins in the brain.
I did the tests and found out. She was talking. She was smiling.
Her memory was good. She had no weakness in the limbs. Then I did her surgery six weeks later — a proper surgery where I excised the culprit for the bleed and put her bone back.
Now I’m seeing her in my clinic again after six years. She’s coming for my follow-up. She’s married, has kids, finished her master’s, and is doing great.

One girl, 22 years old, who came to my clinic because her menstrual cycles had stopped for the last six months. She wasn’t having normal cycles. So, my endocrinologist ordered an MRI, and we found that she had a pituitary tumor in the brain. Because of the pituitary tumor, her prolactin levels were very high, which caused her menstrual cycles to stop.
She was married but unable to have children because her cycles were irregular. I performed an endoscopic surgery by inserting a camera through the nose and excised the tumor completely.
One month after the surgery, her menstrual cycle started again. Now she already has a nearly three-year-old baby and is planning for a second pregnancy.
This is one fascinating case. I also had a young man, 32 years old, who came with a brain tumor—possibly his third tumor. He had a ventricular tumor that caused hydrocephalus, which is fluid buildup in the brain, exactly in the center portion.
I made a hole and inserted a camera into the brain ventricle, opened the spaces, and removed the tumor. It turned out to be a germinoma, and he received radiotherapy.
This gentleman was partially comatose when he arrived, but now he’s married, has a child, and his brain is tumor-free. He comes to my clinic regularly, and every time I see him, his whole family thanks me repeatedly. 

There are not just one or two cases like this—there are hundreds. This field is something which you can literally, you can give something, you can give something to the society back.

9. What underrated non-medical skill has surprisingly helped you the most in your career?

One non-medical thing that has helped me a lot is keeping your physical fitness at most. You have to be fit. Especially as a surgeon. If you’re a physician, even if you have a fever, backache, hand pain, or are on dialysis, you can still sit in a clinic and see patients. But once you decide to be a surgeon, you have to be very fit.

So, one non-medical thing that helps me a lot is keeping yourself active. You can read books, not medical books, other types like novels. If you like watching movies on Netflix, please watch Netflix. If you like to spend time with family and friends two days a week, that’s really good to keep yourself calm, focused, and energized for work.

If you think of good food, yes, why not? Go to restaurants, beaches, travel, spend time with family. Anything, AI learning, finance, stocks, anything that gives you energy.

For me, I always play sports. I never miss my sports activities. Obviously, if I’m stuck in the theater till seven o’clock, I can’t go, but two days a week I play active sports. Plus or minus one more day, so two or three days a week.

I go for high-intensity badminton two days a week. I go to the gym doing cardio and simple weightlifting, not to become a bodybuilder, just to tone up the body.

Sleep well at night. On holidays, go for a long drive. If you like alcohol, why not? It’s your choice. There’s nothing against anything. You have to decide what you want to do.

10. If you could change one thing about the healthcare system, what would it be and why?

If I could change one thing about the healthcare system, I think I would like the U.S. system because they have something called a basic graduation program before joining MD, which is really good.

The one thing I would change is especially for students coming from backgrounds where there is no doctor in the family. I’m from such a background — I’m the first doctor in my family. For us, it’s really difficult to know about the field — what kind of pressure you have to deal with, what kind of life you will have mentally and financially, and whether you will be a good doctor.

All these questions, they say, “What you are doing is a wonderful job,” but at the student level, before joining, you are talking to someone for half an hour, and you hear stories. But I took almost 20 years to understand all this about surgery.

So I think this kind of awareness should start at the school level. Students should be asked if they want to pursue medicine early on. They should have opportunities to visit hospitals or have interactive sessions with doctors and medical professionals so their passion can keep growing.

This awareness helps students make the right decision — whether this field is meant for them or not. If they are not fit for it, they should come out early. I think awareness is the most important thing.

I also think there should be more use of technology. This is a technology-driven world. I go for small trainings and learn new technologies and start using them. You have to be tech-savvy and keep up with the world.

Medical science is all about gadgets now. AI is coming up fast.

Think about the future. If you join medical school in 2027 or 2029, you will start a basic graduation program in 2037 or so, then undergrad MD program in 2030 or 2031. Ten or fifteen years later, by 2045, the world will be completely different. It will be dominated by artificial intelligence and robotics.

If you are a physician, that’s fine, but if you are going into surgery, you have to be tech-savvy. The surgical practice you do now will not be the same in 2045. It will be completely different.

But it’s nothing to stress about. This is just a new way of learning. We always learn from scratch and adapt. It’s good to start learning anytime.

Keep yourself motivated. Do a lot of research about medicine, especially if you don’t have medical personnel in your family. Think carefully before joining — make sure this is your field and you know you can do it.

Don’t worry about the number of years or finances. People say you can start earning after 4 or 5 years in engineering, but in medicine, it takes 10 or 12 years. Don’t think about that.

Finance is important, but this field is something else. Don’t count the years — be positive, focused, and passionate.

If you have all these things, you will make a difference — 100%, you will impact many lives.

I myself, in my neurosurgery practice, have operated on around 5,000 cases to date. Think about how many lives you have affected.

Helping others is a big thing for me. I don’t want to do a job where I don’t feel fulfilled or like I’m not making a difference for other people.