Alumni Profile: Karin Muraszko’81

Karin Muraszko with one of her patients. Photos courtesy of Karin Muraszko.

Karin Muraszko’81 learned to read at  age 5, during the 13 months she spent in a full-body cast. The supine kindergartner could not play with the other kids in her New Jersey neighborhood, so books were her escape.

“I remember vividly the day I understood about how letters got together and made a word, and if you looked at the words, it was a sentence, and suddenly you can read. It opened up a world,” she says.

Dr. Muraszko, a 2020 electee to the National Academy of Medicine in pediatric neurosurgery and the first woman in the United States to lead an academic neurosurgery department, was born with closed spina bifida. Latin for “split spine,” the congenital anomaly restricted her spinal movement and caused her right leg to be shorter than her left. The cast, which covered young Karin’s torso and right leg after a spinal fusion performed at Columbia, was progressively tilted and re-plastered to straighten her vertebrae. (Today, doctors insert a growing rod, eliminating the cast.) 

“At the time I was born, spina bifida wasn’t quite a death sentence, but pretty close to it,” she says. Medical staff suggested putting her in an institution. Instead, her Catholic parents chose to have no more children and focused solely on Karin, who defied all predictions.

When she returned to Columbia at age 6 to have the cast removed, she remembers a subway-tiled bathroom where her mother helped her into a leg brace. The child stood, looked in the mirror, and was shocked to see herself taller, older, with long hair.

“The person I was looking at, I had never seen before,” she says.

That person would score in the top 1% percent in the country on her ACT and attend Yale University, where she studied history and biology. She attended medical school at Columbia and in 1981 became the first woman admitted to the neurosurgery residency at Columbia’s New York Neurological Institute, followed by training there in pediatric neurosurgery. She worked for two years at the National Institute of Neurological Disorders and Stroke at the NIH before moving to the University of Michigan in 1990. She headed the pediatric neurosurgery section, rising to the rank of professor in 2003. In 2005 she became chair, the first woman in the United States to serve in that role.

“One, I had the abilities, and I was not as disabled as people thought I would be. And two, I am innately driven and innately an optimist,” Dr. Muraszko says of beating the expectations. “I view a roadblock as nothing more than an alternative journey.”

A senior physician told Dr. Muraszko (a 4-foot 10-inch woman with a “handicap”) that her acceptance into Columbia’s neurosurgery residency was unlikely. She would need to prove herself with a list ranging from grades to board scores, research, publications, an away-rotation, and networking.

“He lit my fire because he was challenging me to do this,” she says. “And I came back a year later having checked off all the boxes on the list. I said, ‘So now why can’t I be a neurosurgeon?’”

With a heap of tenacity and a healthy sprinkling of levity—as is her way—Karin Muraszko got into the grueling seven-year residency of 
her dreams. 

“All learning takes some pain,” she adds.

Today, she is one of the world’s leading surgeons for tethered spinal cords and pediatric brain tumors.

CNN Chief Medical Correspondent Sanjay Gupta describes Dr. Muraszko as the second most powerful woman in his life after his mother. During the seven years he trained under her at the University of Michigan, she not only drilled down on his technique and judgment, but also compassionately watched for the subtle signs that his blood sugar might be dropping during long operations. Then, she would ask that nurses unwrap an apple Jolly Rancher candy, which she knew was his favorite, and place it behind his mask.

“She had no patience for whining, but she did take the time to remind me what my purpose was—as a surgeon, but also as a human,” he wrote in a CNN special report. “We all need someone like Karin in our lives—someone who tells you what you need to hear, not just what you want to hear, and with a smile.” 

At Home in the Unknown

Speaking with Dr. Muraszko today, even at the distance of Zoom chat, is to receive the glow of a woman who, despite her reserve of knowledge, still radiates wonder. She recalls the neurosurgery she observed as a third-year medical student that made her “gaga” for the field: “I was absolutely awestruck. I had never seen anything as beautiful, anything as spectacular. It was breathtaking.”

As if beholding the kaleidoscopic vaults of a cathedral, Dr. Muraszko describes the cervical-medullary junction, the region at the base of the skull where the brainstem becomes the spinal cord. It is packed with formidable under-and-overlapping anatomy: ligaments, muscles, nerves, and an artery whose disruption is incompatible with life. 

Dr. Muraszko at her 1981 graduation.

This particular junction belonged to a 45-year-old man who was weak in one hand and had difficulty swallowing. The area was enlarged, but imaging at the time was unable to show why. Over eight hours, she stole glances through the residents’ secondary microscope, monitoring the precise incision into the spine and how the surgeon maneuvered microinstruments to dissect the spinal cord. She marveled at the small patties that were intricately placed to prevent bleeding, at the instruments that were delicate and manipulated precisely.

“It wasn’t a bloody mess. They were very careful about what they did. It was a lot of almost being persnickety, and so the operative field itself was pristine,” Dr. Muraszko recalls. They removed the tumor with ultrasonic pulses of an aspirator, and the patient made an excellent recovery.

“We have just been in the middle of the most precious area of this man’s body, and he 
looks like he is ready to walk home tomorrow,” she remembers. 

Not all cases, or outcomes, are as clean as the first she witnessed. Dr. Muraszko soon learned that neurosurgeons spend as much time figuring out how to get to something in the brain as they do actually being there. It’s intensely gratifying when things go well and intensely saddening when they don’t. Neurosurgeons work some of the longest hours.

“I like that it occupied so much of my soul. Neurosurgeons are some of the smartest, hard-working people I’ve ever met in the hospital. And that didn’t scare me. That attracted me,” she says.

Dr. Muraszko chose neurosurgery because of all that was unknown at the time. And in a field with so many unknowns, pediatrics was at the edge of the edge. Case numbers were slim, and doctors often translated standard adult procedures to kids. She saw more to be done for children and that pediatric neurosurgeons were actively tackling what others hadn’t or didn’t want to.

“I loved the fact that they viewed themselves as pioneers. They were doing something good, but also something for which, if they got enough knowledge, they were going to move the needle forward,” she says.

The arc of knowledge in neurosurgery continues to be mapped at a rapid pace, fueled by the speed of technology. In the 1980s, the average survival rate for a child with medulloblastoma, a cancerous brain tumor, hovered above 30%. Today it is highly survivable, within the 80th and 90th percentiles. Endoscopes can be used in the middle of the brain these days. And spinal cord conditions such as Dr. Muraszko’s can, in some cases, be treated in utero. While awake brain surgery was only performed on adults during her training, she has recently performed awake craniotomies in kids as young as 9.

Dr. Muraszko’s research has focused on the treatment of brain tumors and hereditary neurological anomalies. She pioneered a localized injection therapy for cancer cells that float in the fluid around the brain, killing them before they permeate the nervous system. She began a prospective study to monitor how surgeries at the skull’s posterior base can cause a syndrome affecting coordination, speech, and emotions. She also has studied how cerebellar tissue herniates into the spinal canal while the skull and brain are growing, which happens during a rare congenital anomaly called Chiari 1 malformation.

For these contributions and more, Dr. Muraszko was elected in 2020 to the National Academy of Medicine, which is considered one of the highest honors in the fields of health and medicine.

It’s easy to assume that Dr. Muraszko pursued pediatric neurosurgery because she has spina bifida. Still, the tidiness of that conclusion obviates the reality: She is at home intellectually in the middle of the action, where some of the most challenging questions in medicine are being asked and answered, and where the stakes are high. 

“I don’t want to become a poster child for spina bifida or neurosurgery because I have spina bifida. I actually get upset when someone tries to ascribe it to that. I wish I could tell you that I knew all along what I was going to do, what I was going to be, but I didn’t. What I tried to do was be honest with myself about what my strengths and weaknesses were, and work from there,” she says.

The Fabric of People

While neurosurgery places Dr. Muraszko at the operating suite’s center, she wasn’t always so comfortable in the spotlight. She walked with a full leg brace and built-up shoe until 2014, when an imperfect back surgery left her in a wheelchair. The teenaged Karin would desperately gravitate toward the walls at gatherings to avoid stares. Her father would lovingly tease her that she was blending into the drapes.

“When you are growing up as a child with a disability, you sometimes feel not worthy because you are different. Everyone is making judgments instantaneously the moment you move,” she says. As the kid who often found herself observing others rather than participating, she became hyperperceptive.

“I can tell a conversation, what’s going on with it, just watching from a distance,” she says.

Her experiences also bring her closer to her young patients, and their parents trust that Dr. Muraszko knows the lives they are living. Children also bring resiliency, happiness, and honesty to the exam room, which is a pleasure. “To walk into a room and have a family hand over to me the thing they love and consider most precious in their lives, a child, that’s a pretty awesome responsibility,” she says.

Dr. Muraszko in the OR with Sanjay Gupta during the filming of a CNN profile.

Dr. Muraszko reminds her residents that it is a gift to train on such exciting cases without the full duty falling on their shoulders. The enjoyment of watching both her patients and residents grow in skills and confidence over the years is immense. The same goes for her children, 17-year-old twins who were babies when she and her husband adopted them. Dr. Muraszko met Scott Van Sweringen in 1994 on a blind date arranged by an OR nurse. Speaking first on the phone, they soon realized that they had grown up five minutes from one another in Union County, New Jersey, and attended the same theaters, concerts, and restaurants.

“We had lived most of our lives either seeing or facing each other continuously. He understood my upbringing in life, and I understood his absolutely,” she recalls. Scott was also resilient enough to handle being married to a neurosurgeon who is often called away. “There has to be an understanding that you orbit together because you choose to, not because one is absolutely in need of the other.” 

The couple collaborate on an annual volunteer mission called “Project Shunt,” which Dr. Muraszko has led at the University of Michigan since 1998. She leads a team of surgeons, residents, and nurses to Guatemala City, where it’s not unusual to encounter children on pallets with wheels—known to doctors as patients with untreated myelomeningocele—or with enlarged heads from untreated hydrocephalus. Scott, an architect, creates the itinerant operating suites in barebones settings to treat the indigenous Mayans for various congenital malformations.

As opposed to Guatemala, the United States is a “sterile society,” Dr. Muraszko says. American commercials will often include a well-dressed kid in a wheelchair as if that were a display of diversity. “The wheelchair is kind of ‘neat.’ Why don’t you show me someone who is working really hard with a walker or has cerebral palsy and is using crutches? Use a little bit more effort,” she suggests, adding that the effort should extend to people with different cognitive abilities, such as autism, schizophrenia, or manic depression.

“We are all part of the fabric of people. There is no normal. There is only what we perceive as normal because all of us fall out of it, in some place,” she says.

Dr. Muraszko thinks a lot about where she fits in that tapestry of life and what she hopes to leave behind: a husband who feels loved and respected, children who have grown to be good and kind, parents who know she hasn’t squandered their enormous energy, and mentors who see she has done something with their efforts. 

“We may not be remembered 100 years from now, but hopefully some little ripple of what we did is recognized as part of the world,” she says.

From Silence, Memories

Although she has lived in Michigan for decades, Dr. Muraszko defines herself as a New Yorker. Watching the world go by in the Big Apple “with a good cup of coffee in a window seat in a coffee shop or a restaurant—to me, there is no better place in the world,” she says. 

"Neurosurgeons are some of the smartest, hardworking people I’ve ever met in the hospital. And that didn’t scare me. That attracted me."

This is partly because the formative years of her life and medical training took place in New York, specifically at what was then known as Babies Hospital.

One night during her residency, Dr. Muraszko was rounding on the children’s ward. Her path took her down a ramp between a four-bed and eight-bed room, and because the usual cacophony of the hospital had slipped into quiet, she was able to recall this same space in another time.

“Oh my God, this is the ramp I raced on when I was a kid in the hospital here.”

Another child had once wheeled the young Karin, who was lying flat on a stretcher after her spinal fusion, gleefully down the hill near rooms of four and eight. She remembered being rolled by nurses through the same tunnels under the hospital, which she now traversed as a doctor, to the Neurological Institute.

She remembered the very first time, as a child, that she saw how serif letters carved in stone above the hospital’s entrance became words, and those words became a verse: “FOR OF THE MOST HIGH COMETH HEALING.”