Heather McCrea graduated from Brown University in 2002 with an ScB in Biochemistry. She is the Director of Pediatric Neurosurgery at Holtz Children's Hospital/Jackson Health System and Assistant Professor of Neurosurgery at the University of Miami.
Carney Institute (CI): Tell us about yourself. Was neurosurgery a career path that interested you early on?
Heather McCrea (HM): I grew up loving animals and was on the equestrian team at Brown, so I initially thought I wanted to be a veterinarian. Partway through undergrad, I started having doubts of whether veterinary medicine was the right field for me. I had gained some exposure to basic science labs and then started shadowing in the hospital. I was fortunate to have two mentors that I knew through horseback riding who encouraged me to think about M.D.-Ph.D. programs. Neurosurgery wasn’t on my radar as an undergrad, but I did take a neuroscience course second semester of senior year which I found fascinating. In med school, I had the good fortune of finding a mentor who was a pediatric neurologist (and Brown alum) and then began shadowing her husband, a pediatric neurosurgeon, as well.
CI: What was the driver to pursue an M.D.-Ph.D. versus a single course of study?
HM: I knew I loved basic science research, but I also really enjoyed working with patients. In order to pursue both, I was encouraged to look at M.D.-Ph.D. programs. These programs are typically federally funded and allow you to complete both your M.D. and Ph.D. in an integrated program. At Yale, we had two and a half years of med school, followed by our Ph.D.,. followed by a return to clinical rotations. This allowed me clinical exposure before my Ph.D. years, so that during my Ph.D. I was able to go to clinic and the operating room, helping confirm I wanted to pursue pediatric neurosurgery.
CI: How does pediatric neurosurgery differ from neurosurgery?
HM: As a pediatric neurosurgeon, we work on young patients from premature infants to teenagers. With these different ages, there are differences in the ability of the brain to recover from an injury as well as differences in the consistency of the brain, how the skull is fused or not fused, and how it responds to the impact of a trauma or a bleed, so we have to be mindful both of the underlying pathology and the age of the patient in order to appropriately intervene. We also have to explain what we are doing both to the parents and the child in an age appropriate manner.
CI: The consequences of making an error in the OR can be profound and have lifelong impact on your patients. How do you remain resilient?
HM: You go through a long training before you become a pediatric neurosurgeon. Part of that is to learn how to operate and make appropriate clinical decisions and part of it is preparing you for the responsibility of making these hard decisions. We have amazing weeks and great saves, but we can have tough cases that are beyond our help as well.
For example, there’s one particular type of brain tumor that we can't surgically remove. We know that whatever we do, that tumor will win. And that’s very hard for me and my clinical team because everyone gets to know the patient. If the patient has a low-grade tumor in a good location, I can go in, take it out completely, and that child is going to live a long, healthy life. Those are my favorite kinds of cases — the ones that we can truly fix. The ones we can’t fix are devastating, so I try to focus on research, including a clinical trial for these deadly tumors, in the hope that someday we will have better treatments.
CI: Of late, the conversation about traumatic brain injury in professional sports has become an especially pressing issue. As someone who has come from an athletic background and who's now a pediatric neurosurgeon, what are your thoughts about things like contact sports for young people?
HM: I love playing and watching sports, and I'm incredibly grateful for having been on the varsity equestrian team at Brown. Being an athlete teaches you leadership skills and resilience which are particularly important in my field. In the operating room, we’re essentially functioning as a team with me, as the captain, working with neurosurgery trainees, my circulating and scrub nurse who hands instruments, and the anesthesiologist and their team.
But I recognize the trauma that can occur on the field, particularly when performed at a high level. There's some evidence emerging that if you delay contact until children are older, that's probably safer, but we're never going to fully be able to take risk out of something like football. I think the important thing is making sure people can make informed choices for their family. Following concussion protocols helps to allow the brain to heal after injury before taking a second hit.
CI: Training to be a neurosurgeon is among the longest and most specialized in medicine. What advice would you give to someone who is considering neurosurgery?
HM: It is long – after Brown I did 15 years of training before becoming an attending neurosurgeon - seven years of M.D./Ph.D., followed by seven years of neurosurgery residency in NYC at Cornell and Memorial Sloan Kettering, and one year of pediatric neurosurgery fellowship at Boston Children’s Hospital. I always encourage trainees to focus not just on the long term but on the next steps. You may want to be a neurosurgeon, but the first priority is to do well in your college classes to get into medical school. Then, you need to do well in medical school to get into residency. It's also important for people to seek out opportunities by shadowing people in the hospital. The more I shadowed people in different disciplines, the more I figured out what I wanted to do. Prior to COVID, I always had medical students and undergraduate students, regularly in my clinic. Our hospital even had a program for high school students, and they would occasionally come to the clinic and the OR.
It’s also important to keep an open mind because what someone thinks neurosurgery may entail may not be a good representation of the actual field. That's one of the great things about the third year of medical school: you rotate through everything, and you really get a sense of what fits you and your personality as well as which types of patients you most enjoy caring for.
CI: When you think back to your time at Brown, what sticks with you?
HM: The faculty at Brown were phenomenal, well above and beyond what people I know that went to comparable schools experienced. I remember one chemistry professor, for example, who gave my small group of friends five-hour review sessions for our chemistry exams. Our professors still knew all of our names and kept in contact with many of us well after graduation. My time on the equestrian team also sticks with me – my teammates were some of the smartest people I knew at Brown and remain some of my closest friends. Being a student athlete shaped who I am today and my ability to succeed as a neurosurgeon.