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  1. Michael Chen
  1. Correspondence to Michael Chen, MD, Department of Neurological Surgery, Rush University Medical Center, 1725 West Harrison Street, Suite 855, Chicago, IL 60612, USA; michael_chen{at}

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Dear Malia,

Soon you'll graduate from high school and leave home. Of course you will care about your grades and test scores. The people you meet and work with will be from different backgrounds and have their own interests and personalities, some of whom may be a big influence. There are so many different paths you can take and you'll be making many of these decisions on your own. I sometimes worry myself sick over all the possibilities. I'm sure most parents know this feeling.

How do I reconcile my imminently reduced role in your daily life and my inversely proportional concern for the important decisions you will soon be making? Perhaps I can share with you some of the challenges in decision-making I face now as a physician. I think by the time you read this you will be old enough to understand. From these stories, and maybe from my actions, I hope you can see why I am making such a fuss over this.

As you know, I take care of patients with brain blood vessel problems. Patients are often afraid that they might die from these. In many cases we don't know for sure if the lesions will eventually cause a problem.1 I have been trained to do procedures that allow us to diagnose and treat some of the problems. These procedures involve placing devices within the head and, with a lot of patience, thoughtfulness and experience, can help patients profoundly. Even though it happens often enough, it always catches me off guard when a patient thanks me for ‘saving their life’. On rare occasions though, these procedures can hurt patients unintentionally.2 Fortunately, for most of the patients who come to see me, the risks of the lesion are low and we don't necessarily have …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.