After 25 years attending school, Michael Prim ’09 only has about five more to go, and he wouldn’t have it any other way.
Prim, in his second year of residency at Saint Louis University Hospital, has taken on one of the more difficult surgical specialties that requires the longest residency among medical school graduates — neurosurgery.
The idiom “It’s not brain surgery” typically compares a simple task to one that is much more complex. The implication is that those who perform brain surgery are among the most skilled professionals in the world. The vast years of required education and training result in only about 0.6 percent of practicing physicians specializing in neurosurgery.
Prim began his journey to a career in health care in 2005; however, his initial interest was dentistry. “During my senior year of high school, an orthodontist came to speak to our class on Career Day,” Prim said. “I thought it sounded like a pretty good gig, so I entered SFA as a pre-dental student majoring in biology.”
Prim, who grew up in Crawford, Texas, found his way to SFA through his stepfather, Charlie Buenger ’73, a practicing attorney in Waco, Texas. “I applied to several Texas universities and was accepted to both the University of Texas and Texas Christian University. While I enjoyed what those schools had to offer, they just didn’t feel like my kind of crowd,” Prim said. “When I toured SFA, I loved everything about it.”
Prim enrolled at SFA and was on his way to becoming a dentist, or so he thought. But something got between him and his career aspiration — his biology courses.
Although Prim had been a straight-A student in high school, his grades in botany and zoology at SFA were Bs. “Those classes just didn’t hold my interest,” Prim said.
He also was taking courses in psychology, which Prim said he enjoyed and found challenging. “My psychology courses were really interesting to me,” Prim said. “So one-and-a-half semesters into my biology major, I approached my advisor, Dr. Kevin Langford, and I told him I wanted to switch majors to psych.”
Langford, SFA associate professor of biology and director of pre-professional programs, recalls the day Prim visited him about changing majors.
“Mike was active in the Lumberjack Marching Band and came in to see me one day after practice,” Langford said. “The biology classes Mike was enrolled in were more focused on plants and animals. Those courses involve a great deal of memorization. It was evident they weren’t challenging to him.”
Langford convinced Prim to stick with biology and take a much more difficult class, comparative anatomy
“Turns out, I loved that course,” Prim said. “I enjoyed the difficulty of it. I loved being in the lab and dissecting the specimens. I loved seeing how evolution crafted the different species and how biology worked via the old adage, ‘structure is function.’”
Early in the semester, Langford got a first glimpse of the skills that would ultimately lead Prim to his professional calling during the dissection of a shark.
“Sharks can be difficult to dissect,” Langford said. “Their skeleton is mainly composed of cartilage instead of bone, which heightens the difficulty level of the dissection.”
The procedure involves removing three loops of tissue embedded in the cartilage that are the diameter of a small strand of spaghetti. “In all my years of teaching, I’ve never witnessed a student remove it intact,” Langford said.
During this particular lab exercise, Langford watched Prim meticulously maneuver around the delicate tissue and come closer than any student ever has to achieving the almost-impossible task.
“I saw Mike working with his hands and thought he possessed the raw talent to make a great surgeon,” Langford said. “As the semester progressed, Mike was among the best students I’ve ever taught. He was always the last one to leave lab, full of questions, and he genuinely seemed to welcome every challenge.”
Prim said after taking a human physiology course during the summer and learning more about how the body worked and how nerves transmit information, he was hooked and knew he wanted to pursue a medical career.
After his graduation from SFA, Prim received his master’s degree in medical science and attended medical school at the University of Texas Health Science Center at Houston. His initial plan was to become a family practice physician and return to his small-town roots to open a practice. However, after he started clinical rotations, he changed his mind.
“There was a month in medical school where we viewed specialty surgeries,” Prim said. “One option was brain surgery, so I signed up for neurosurgery. I had a great time on that rotation, so when it was time to select a specialty for residency, I realized the rotation I had the most fun on was, in fact, neurosurgery.”
Prim was matched with Saint Louis University Hospital. His daily routine begins at 4:30 a.m. when he wakes. He arrives at the hospital by 5:30 and starts visiting patients. He said members of the neurosurgery team meet up and “run the list,” which he said translates to discussing each neurosurgery patient who is currently undergoing in-house treatment.
By 7:30 a.m., Prim said he’s off to the operating room or clinic, where he’ll spend several hours. About 6 p.m., the team “runs the list” again to discuss patient treatment once more and any new developments that have occurred during the day. If he’s not on call, he arrives home about 7 p.m. On-call residents remain at the hospital overnight covering two hospitals — one adult and one pediatric.
“Things can get very busy when you’re by yourself and covering two hospitals,” Prim said. “We have a chief resident whom we call throughout the night for questions or if someone needs to go to the operating room. There also is an attending physician on call whom we contact to ensure that he or she agrees with our treatment plan.”
When he’s on call, Prim’s shift runs 24-plus-four hours, which means he works 24 hours and then remains at the hospital four additional hours to complete paperwork and ensure transition of care for the next shift.
When asked where he expects his career to be in five years, Prim said he will still be in school.
“Training as a neurosurgeon takes so long because it is incremental,” Prim said. “Being in the operating room and having to be so precise with decisions and movements is invigorating. It’s really amazing. We put people to sleep, open their skulls and manipulate the brain by removing tumors, blood clots or even brain tissue. Then, we close up, and the patients wake up without any deficits. It really blows me away.”