Your local brain surgeon, driving to work at 5:15 in the morning, is probably not listening to a special CD in his collection, "Perspectives in Central Nervous System Malignancies."

"It's too painful," said Michael Horgan, a 40-year-old neurosurgeon at Fletcher Allen Health Care and assistant professor at the University of Vermont College of Medicine. "You can only take so much!"

If it's Friday, your local brain surgeon is not driving from Charlotte for a pre-dawn arrival at the hospital. That's the day he carves time from his action-packed schedule to take his oldest sons to school and his dog, Daisy, to the groomer. Your local brain surgeon is already talking to his secretary about child No. 4, trying to loosen up his schedule for the early spring birth of the baby.

Horgan has undergone more training than Lance Armstrong. He prefers, when the medical condition allows, to operate on brains by drilling bone and moving it out of the way -- a specialty called skull-base surgery.

"It's anatomical approaches to the brain and brain stem through the bones of the skull and face," Horgan said, "to get underneath the brain instead of through the brain."

Horgan loves the one-third-inch or so of space that opens up en route to the brain if you just move the eye orbit out of the way. Sometimes, he'll remove the orbital rims of the eye, push down on the eyeballs to get them out of the way, and voila! -- he's got the access he needs.

"The general public is very unaware what neurosurgeons actually do during their day," Horgan says. "It always kind of makes me laugh: It's not as complicated as people perceive it to be. Once you live with a brain surgeon, you realize that."

Just ask his wife, Kelly Horgan, a candidate for a doctorate in education. She says that apart from a wonderful, down-to-earth, hands-on-father the minute he walks in the door, she needs a "second husband" to do everything else around the house.

This has become more clear since the family moved from Burlington to Charlotte, and has to deal with equipment such as wells. "It's been really comical because sometimes the well breaks, and he looks at it and scratches his head," Kelly Horgan said. "I'm like, 'Clearly this takes more than a brain surgeon.'"

This brain surgeon doesn't know how much it costs for him to perform bypass surgery on occluded vertebral arteries that extend from the back of your neck to your brain, plugging in arteries harvested from the arm and attaching them to tiny blood vessels in the brain.

But Horgan does know that this technically demanding, daylong surgery on Halloween, though it cut into trick-or-treating with his kids, was "an extremely rare opportunity and one of the coolest things I've done."

An angiogram done after the surgery shows everything looking good, Horgan says. About a week after the surgery, he remained very excited by the challenge and the accomplishment.

The anatomical intricacies and variations, the stamina and patience required for a 10-hour case, are thrilling. "Sickly," he said, "I enjoy that."

Horgan, a theater major at Tufts, has been at Fletcher Allen for five years. He attended medical school at University of Medicine and Dentistry-New Jersey, completed a residency program in surgery (one year) and neurosurgery (six years) at Oregon Health Sciences University and a fellowship in cerebrovascular and skull base surgery in Phoenix.

He decided he wanted to be a neurosurgeon his first year at medical school, after taking an anatomy class. Horgan contacted a neurosurgeon at the hospital, and "he grabbed me in right away." Next thing Horgan knew, he was researching the neurological manifestations of AIDS. The more he learned, the more "hooked" he became on neurosurgery.

Wearing blue scrubs and soft leather clogs, Horgan was talking full-throttle about his work the other day in his office atop the hospital. As he spoke, he was getting beeper updates from the OR about a surgery with a partner, a neck fusion, that he was to join. When the call came alerting Horgan that he was up, he walked casually toward the OR, chatting in the hallway.

He had to backtrack for a moment to pick up a bring-your-own item he had left in his office: his loupes, or surgical telescopes. After the neck fusion, he was scheduled to remove a malignant brain tumor.

Your local brain surgeon is less local than you might think. He is deeply committed to establishing a professional relationship with a hospital in the Dominican Republic and will travel there Tuesday with the department chairman, Bruce Tranmer, to further his efforts to bring adequate neurosurgery care to patients in the Dominican Republic.

This collaboration began serendipitously, when he received a call a few years ago from an upstate New York doctor requesting Horgan's help. He had learned of Horgan's expertise in skull-base surgery and asked if he would operate on a relative in the Dominican Republic who had a benign brain tumor called a meningioma.

"I'll do whatever it takes," Horgan said. He has since performed a similar operation on a patient who traveled to Burlington from the Dominican Republic.

His goal is to establish a foundation that will work with physicians from the Dominican Republic to provide a certain level of care to patients there. He plans to train doctors in relatively basic procedures -- "things we consider our bread and butter" -- and to help provide the necessary, very expensive equipment.

He wants a component of the foundation to fund patients who need to travel to Fletcher Allen for more complicated cases, including those requiring skull-base surgery.

Kelly Horgan said she plans to work with her husband on the foundation. "He's really committed to the DR and trying to help serve underprivileged people," she said. "He's been touched when he's been down there ... and he's committed to dedicating time to that."

"This is what I know how to do," Horgan said. "If I didn't do this, I wouldn't know what to do. I'm not good at anything but this, and playing with my kids."

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