Speaker 1: Well, good a team. Welcome to another episode of the
Speaker 1: You Project. It's Fatty Harps. It's Craig Anthony Harper's Sunday
Speaker 1: morning in the thriving Metropolis. It's thirteen minutes past nine
Speaker 1: and one of my friends. We're friends now. We used
Speaker 1: to be acquaintances. We knew each other a little bit.
Speaker 1: Now we've hung out a bit, We've we've dined together,
Speaker 1: We've spent time together, We've shared kaffeene together and stories together.
Speaker 1: He helps me and I help him periodically. Doctor Alex,
Speaker 1: welcome back to the show, my friend. How are you?
Speaker 2: I'm great, It's really great to see you. It's great
Speaker 2: to talk again.
Speaker 1: It's good to see you, mate. What's going on? Is
Speaker 1: there anything before we dive in? I want to talk
Speaker 1: to you about. I actually want to have a proper
Speaker 1: grown up podcast today about neurosurgery, the profession and the
Speaker 1: practice and the science and the development of it and
Speaker 1: all that, because I think it's obviously it's interesting fast.
Speaker 1: It's day to day for you, but it's interesting fast.
Speaker 1: But other than that, what's going on? How's marriage? How's
Speaker 1: married life? Be? Still married? By the way, because I
Speaker 1: went to your wedding, I haven't checked in. Still good,
Speaker 1: there's still good there. Yes, I don't know. No one
Speaker 1: would have seen the photos. But you turned up for
Speaker 1: the first time I've seen in a suit and a tie,
Speaker 1: and I didn't recognize you to start off with. In fact,
Speaker 1: you look like the biggest, baddest bouncer I've ever had
Speaker 1: at any wedding or ever seen at any wedding. There's
Speaker 1: a good look for you.
Speaker 2: You look at what the agents out of the matrix. Yeah.
Speaker 1: Well, I do get asked for directions or people ask
Speaker 1: me questions when I turn up at things in a
Speaker 1: suit because they one think I'm on staff in some capacity.
Speaker 1: So that shows you how much you're loved, because I'm
Speaker 1: not putting on a suit for fucking anyone generally, especially
Speaker 1: not for under ten thousand dollars. But I did it
Speaker 1: for you, and you know, so that's a sign of
Speaker 1: my devotion and love.
Speaker 2: It was greatly appreciated. Hups. It was a good day.
Speaker 2: Great and Carlie's great. She's at work at the moment
Speaker 2: at the kids hospital. That's the way it is. That
Speaker 2: we had a wedding yesterday to go to and I
Speaker 2: was there on my own because Carli had a shift,
Speaker 2: and so there's a bit of ships in the night
Speaker 2: sort of vibe with everything. But it's also great having
Speaker 2: somebody else who's in the surgical fraternity because the nuances
Speaker 2: of stuff that happens, you don't need to describe the background.
Speaker 2: You can just dive into it and unload and the
Speaker 2: other person will immediately get it. But then again, also
Speaker 2: there's no sympathy. So if Carli's got something on her
Speaker 2: mind and I've been through it like ten times, then
Speaker 2: she gets no sympathy. I'm just like, yeah, that's the
Speaker 2: way it is, get over it.
Speaker 1: Yeah, and that's going to happen and keep happening. Yep,
Speaker 1: move on.
Speaker 2: And then I get no sympathy because she's tired or
Speaker 2: she's been through it ten times. But it's great. It's
Speaker 2: a really interesting dynamic. Obviously, female and pursuing a career
Speaker 2: is it's quite a it's a difficult topic because it's
Speaker 2: a you know, when it comes to family and children,
Speaker 2: females have a different experience than the guy. They've got
Speaker 2: a certain time frame and there's always that pressure, that
Speaker 2: biological pressure about family, and then certainly in recent times
Speaker 2: there's this huge pressure for career as well, I feel
Speaker 2: it really feels like that, and and it's great because
Speaker 2: a career is very stimulating, very fulfilling, engaging, and it
Speaker 2: goes beyond. You know, a kid can leave at the
Speaker 2: age of beteen from home and then what he left with,
Speaker 2: but a career stays with you until the day you retire.
Speaker 2: So's that's an interesting balancing act. We've had a couple
Speaker 2: of conversations about it, and we haven't resolved it. And
Speaker 2: I have lots of conversations with patients and other and
Speaker 2: other colleagues in the specialty about this. I was talking
Speaker 2: to people at the wedding last night about this because
Speaker 2: it's quite a it's an unresolved and unresolved issue. We
Speaker 2: haven't we haven't worked out but both loving the career
Speaker 2: highly stimulating.
Speaker 1: What is the issue, like, is the issue we're gonna
Speaker 1: have kids? Or are we? Or when are we? Or
Speaker 1: it's because it's kind of not fair that the women
Speaker 1: have to do that, right, Like, there's no other option,
Speaker 1: is there? No?
Speaker 2: They get that that's a much bigger deal. I mean,
Speaker 2: obviously it has a huge effect on their body and
Speaker 2: their time. You know, they've got to have maternity leave
Speaker 2: and go through all of that, and then that's a
Speaker 2: big chunk out of training like that. You know, take
Speaker 2: three or six months off from a training program to
Speaker 2: do that.
Speaker 1: And when you say you mean medical training, you don't
Speaker 1: mean the gym, right, or do you mean the gym?
Speaker 2: Yeah, like surgical training training to become a surgeon, which
Speaker 2: is you know, six or seven years, so you've got
Speaker 2: to take time off during that. And then you know,
Speaker 2: it's a really tough gig being a mum. How do
Speaker 2: you know, then be a mom to a young child
Speaker 2: and push extremely hard career wise, that that's a really difficult.
Speaker 2: A lot of people have nannies and family around to
Speaker 2: help with that, and I don't know if if you
Speaker 2: can do both perfectly. I actually don't know how somebody balances.
Speaker 2: I know some surgeons you've got several kids and they
Speaker 2: have two or three nannies and that's almost the only
Speaker 2: way that it works, someone there during the day to
Speaker 2: look after the kids. Anyway, haven't We haven't cracked this
Speaker 2: code yet.
Speaker 1: So just tell people what because obviously I don't think
Speaker 1: you tell us specifically what Kylie's doing. So she's a doctor,
Speaker 1: of course, and she's doing her training to become a surgeon.
Speaker 1: Is that it.
Speaker 2: Yeah, she's finished med school, so she's a doctor. She's
Speaker 2: done her required years in the hospital general training you
Speaker 2: have to do before you can apply to get on
Speaker 2: the surgical training program. You have to do the general
Speaker 2: the surgical training program to be a qualified consultant, right,
Speaker 2: And so she's going to apply for that next year.
Speaker 2: So she's at the start of the of the process
Speaker 2: of the actual official training program, which will be six years.
Speaker 2: So and that's in pediatric surgery, which he loves and
Speaker 2: really enjoys a job and is really good at it.
Speaker 2: But there's lots of decisions coming up. Will stand by,
Speaker 2: will stand by, But lots of people were listening, would
Speaker 2: would have you know something similar like if it doesn't
Speaker 2: have to be medicinal surgery. They're having family and all
Speaker 2: sorts of careers in facing the same issues, and it's
Speaker 2: incredibly difficult. But it's an ongoing conversation.
Speaker 1: Is there a particular personality or type that is more
Speaker 1: likely to become a surgeon or is it not at
Speaker 1: all unrelated?
Speaker 2: There's definitely a good aptitude for surgery. You can just
Speaker 2: look at someone and say they've just got a good
Speaker 2: aptitude for it. They get the anatomy, they get the
Speaker 2: physicality of surgery. They're efficient, they're a decision maker. That's
Speaker 2: really important. They can make a decision. And there's also
Speaker 2: the attitude of dealing with people. I didn't realize this
Speaker 2: how important that was, but in a hospital you may
Speaker 2: not know it, but there are a whole spread of
Speaker 2: personalities from toxic personality to you know, to someone who's
Speaker 2: quite pleasant, and that's very, very difficult to deal I mean,
Speaker 2: you can have an okay day at work and just
Speaker 2: your day is ruined by toxic personality, a clash with
Speaker 2: another consultant or someone in ICU or in theater. That
Speaker 2: was a problem to deal with personality wise. I don't know.
Speaker 2: I just I always just wanted to do surgery. There
Speaker 2: was just no there was no plan B. So it
Speaker 2: was very driven. I guess Klie is very driven, and
Speaker 2: I don't know. Perhaps why do you do what you do?
Speaker 2: Do you think you've got a specific personality for talking
Speaker 2: to people? I don't know. This is a really important
Speaker 2: issue because selecting surgeons, you have to do. The interview
Speaker 2: is a big part of the process. You've got a
Speaker 2: c you've got referees, and then you have to sit
Speaker 2: down at an interview and for me, there were six
Speaker 2: spots out of all of Australia. How do you pick
Speaker 2: six people to get on the training program? And you
Speaker 2: ask a series of questions and trying to get to
Speaker 2: know these people, and then you just base it off
Speaker 2: those responses. So it's actually really tricky to pick the
Speaker 2: right person. And there's ongoing research and what are the
Speaker 2: right questions, what's the right way to sort out these
Speaker 2: people and find who has got the right aptitude or
Speaker 2: surgery And then often they said that fails and then
Speaker 2: the surgical training program becomes the screening. So they go
Speaker 2: through the training and then they are that they will
Speaker 2: thrive all they'll struggle, and if they're struggling, then that
Speaker 2: becomes a sign that tough conversations need to be had because.
Speaker 1: It's I think it's from the outside looking in, it's like,
Speaker 1: obviously you need you know, you need to be intelligent,
Speaker 1: you need a great understanding of an anime in physiology
Speaker 1: and all that, all the skills and all the science
Speaker 1: or the knowledge. Then you need to be able to
Speaker 1: have I would think extreme an extreme ability to focus
Speaker 1: and concentrate and be present and not distracted. Then you
Speaker 1: need goods social skills to be able to lead a
Speaker 1: team and communicate and not piss people off and not
Speaker 1: get pissed off. And then you need to be able
Speaker 1: to self regulate in the middle of fucking chaos so
Speaker 1: you're not losing your shit. And then you need to
Speaker 1: be physically, mentally and emotionally healthy yourself so you know.
Speaker 1: And then you need to have good leadership skills. And
Speaker 1: then you need to be a high level problem solver,
Speaker 1: because surgery in some ways is problem solving in real time,
Speaker 1: and it's like this fucking collision of a million different
Speaker 1: variables that all matter.
Speaker 2: And it's not like sport, where you are great when
Speaker 2: you're young and you've identified yourself as good at sport,
Speaker 2: and then you go down this pathway and you just
Speaker 2: get better and better at what you've already demonstrated you're
Speaker 2: good at this. You kind of don't really know that
Speaker 2: you're good at it until you've gone through the whole
Speaker 2: process and you start, and even not until you're halfway
Speaker 2: through the process do you realize if you're any good
Speaker 2: at it.
Speaker 1: It's so true about how many people study mate and
Speaker 1: then like even the people that I did one hundred
Speaker 1: years ago when I did my first degree. People who
Speaker 1: studied physic or human movement or whatever we want to
Speaker 1: call it, exercise science, and they go through the whole
Speaker 1: thing and then at the end of it they go, oh,
Speaker 1: I want to do this at all. And they never
Speaker 1: spend one day writing one exercise program or prescribing anything
Speaker 1: for anyone, but they do the whole thing, and or
Speaker 1: they go and do a bit of work experience, or
Speaker 1: they start to work in the industry or with a
Speaker 1: sporting club. And then the amount of people I've seen
Speaker 1: that I went to UNI with who are still working
Speaker 1: in the space of exercise science, it's probably less than
Speaker 1: five percent twenty years after they did their degree, Like
Speaker 1: very minimal.
Speaker 2: It doesn't surprise me. I'll see that in surgery people
Speaker 2: get halfway through and they decide to go down at
Speaker 2: a completely different route. They go and do radiology or
Speaker 2: general practice, or go into business or admin. And that's tough,
Speaker 2: isn't You did that whole You go through meta school
Speaker 2: and half of a training program and then decide this
Speaker 2: is not for you.
Speaker 1: Do you think that I think for some people that
Speaker 1: it's just the emotional and psychological cost where you just
Speaker 1: you get to a point where and I think it's okay.
Speaker 1: I don't think it's weakness or bad. I don't think
Speaker 1: it's a flaw. I think it's just a realization. Like,
Speaker 1: if I'm being honest, there's been twenty six times in
Speaker 1: my PhD where I've said to myself and that's only
Speaker 1: a PhD, that's not all the shit that you've done, right,
Speaker 1: I'm like, is this worth it? Like this is so
Speaker 1: hard and so much and I go, you know, where
Speaker 1: you weigh it up? And there's been a bunch of
Speaker 1: times where I thought I didn't need to do this,
Speaker 1: you know, and for whatever reason, I keep doing it.
Speaker 1: But I can understand, like the amount of people who
Speaker 1: start a PhD and drop out is something like eighty percent,
Speaker 1: Like it's very high number the people who don't complete
Speaker 1: their PhD. And I'm thinking, with what you do it,
Speaker 1: that's you know, my experience, yours would be time was
Speaker 1: twenty five in terms of how difficult it is to
Speaker 1: get where you got. I just think that people just
Speaker 1: weigh it up and go, could I get through? Probably? Maybe?
Speaker 1: But is it worth it? No? Because I'm fucking miserable,
Speaker 1: I'm anxious, I don't sleep, I'm stressed, my health suffering,
Speaker 1: So I think that you know that probably eliminates people
Speaker 1: naturally anyway, that way, it's.
Speaker 2: One hundred percent through. The drive is really important. You've
Speaker 2: got to have that inner drive to do surgery because
Speaker 2: that's what gets you through. You will get you over
Speaker 2: the hurdles that you inevitably will face. If you're doing
Speaker 2: it for any other reason than you want to do it,
Speaker 2: You're going to struggle and probably go in a different
Speaker 2: direction given enough hurdles. And that certainly was my drive
Speaker 2: since year ten. That was all I wanted to do,
Speaker 2: and I had plenty of hurdles, but each hurdle was
Speaker 2: just an excuse to hit harder and jump higher type thing.
Speaker 2: And if you didn't have that, you would certainly give up.
Speaker 2: It's probably a weird question, but could you? And I
Speaker 2: know there's no typical day, but one of the things
Speaker 2: I say to my clients or back in the day,
Speaker 2: especially when someone would come to me, I'd say, walk
Speaker 2: me through a typical day of you, and by that
Speaker 2: I mean sleep, food, exercise. You know, are you sitting
Speaker 2: for four hours a day? So can you walk us
Speaker 2: through a typical day of being and we don't need
Speaker 2: your breakfast and your dinner. But the neurosurgery stuff, like
Speaker 2: what's a typical day, And I know it varies broadly,
Speaker 2: but of neurosurgery, like on the days that you're working,
Speaker 2: do you do you do one up a day, four
Speaker 2: ops a day. I know it varies wildly, but can
Speaker 2: you give us a snapshot into the day of a neurosurgeon. Yeah,
Speaker 2: I get up at three thirty, go to the gym,
Speaker 2: I come home and I meditates and then I read
Speaker 2: my natomy text.
Speaker 1: Though you're a fucking idiot. We know that's not true.
Speaker 2: Mark Woolberg sort of schedule, which I think is day
Speaker 2: of rubbish. A typical day like Friday is one of
Speaker 2: my operating days. He's a classic day. So the theaterist
Speaker 2: starts at eight, and I'm there at ten to eight,
Speaker 2: and I'm in theater by eight and I've got my
Speaker 2: walk in there and you can tell it's going to
Speaker 2: be a great day. The anesiis that I love is there.
Speaker 2: The scrub nurse that I love is there, the assistant
Speaker 2: that is my favorite. You've got the whole team there.
Speaker 2: He's got a good vibe straight away. And then the
Speaker 2: patients in the anesthetic bay, I go and have a
Speaker 2: chat with them, they sign their consent form and then
Speaker 2: we're off. And the first case on Friday was a
Speaker 2: spinal tumor, and so I sit down and look at
Speaker 2: the scan and just rehearse what I'm going to do.
Speaker 2: And I'm looking at the scan in terms of the anatomy,
Speaker 2: so landmarks that I'll be looking for and what I'm
Speaker 2: going to try and what I want to recognize when
Speaker 2: I get in there to guide me where I'm going.
Speaker 2: And then also looking at the scan for things that
Speaker 2: are going to trip me or potentially that can cause
Speaker 2: a complication and how I'm going to avoid that. So
Speaker 2: that's review that for a good twenty minutes or so,
Speaker 2: and then a typical day could be anywhere between four
Speaker 2: and I've done up to seven cases in a day,
Speaker 2: depending on the anisthetus and the team and hospital beds.
Speaker 2: And it's I love the efficiency of surgery. And I
Speaker 2: watched my guy down in Hobart operate and that's where
Speaker 2: I got that from. Incredibly efficient in terms of all
Speaker 2: of his movements and starting doing the operation, closing up,
Speaker 2: wrapping up, and then my aniesthetus is very efficient as well.
Speaker 2: So the turnover can be quick because don't forget. If
Speaker 2: you do five cases, that's about you know, that's four
Speaker 2: turnover times. And so if the anesthas is fast, that's
Speaker 2: half an hour per turnover time, so that's two hours
Speaker 2: extra added to the operating time. Or if they're not
Speaker 2: as quick and it's an hour, that's an extra four
Speaker 2: hours of the day added just sitting around waiting for
Speaker 2: the anesthetus to do their things. So there's that element.
Speaker 2: I think I've got five cases. They will take me
Speaker 2: forty minutes each, will be done by two o'clock, and
Speaker 2: then you've got to add in the anesthetic time, which
Speaker 2: is four hours, so actually we'll be done at eight o'clock. Wow. Yeah.
Speaker 2: But the theater days, it's the best part of it.
Speaker 2: I do a lot of consulting, sitting at the desk
Speaker 2: and talking to patients and that's becoming a more rewarding
Speaker 2: process as well. And that would typically start at nine
Speaker 2: o'clock and finish around about round four seeing new patients
Speaker 2: going and I love the education side of things. I'm
Speaker 2: talking to them about their problem, trying to identify what
Speaker 2: their problem is. That's really really key often it's not
Speaker 2: straight up obvious what it is that they want to
Speaker 2: talk about. And so finding that getting expectations sorted out
Speaker 2: that's really really key. Expectations. They need to need to
Speaker 2: be on the same page otherwise that causes real problem.
Speaker 2: So finding that I love the education side of things,
Speaker 2: showing them the scan, showing them what's wrong. People love
Speaker 2: to see that there is something wrong. It's very common
Speaker 2: that they say, oh, you know what, I actually thought
Speaker 2: I was going crazy. There's actually something wrong with me. Yes,
Speaker 2: very And I take video of surgery. I've got this
Speaker 2: video app that I've called Surgery TV, which I've developed
Speaker 2: over the last two years with a colleague, and in fact,
Speaker 2: we just we just got awarded a government grant for
Speaker 2: this video app. It was about eighty six thousand dollars,
Speaker 2: which is just great in terms of us being able
Speaker 2: to push it further. But essentially, what it does is
Speaker 2: allow me to record the video of every operation I do,
Speaker 2: which it always do, but it takes about you can
Speaker 2: take you about forty minutes to download a video of
Speaker 2: each operation onto a USB and then you've got to
Speaker 2: do something with it. With this app that we've designed,
Speaker 2: it goes from the microscope straight to my iPhone ready
Speaker 2: to go. So it's an automated process. So now I
Speaker 2: have a video of everyone's surgery for everyone that I do,
Speaker 2: and I give it to them to the patient the
Speaker 2: following morning, and again I've told them about an operation,
Speaker 2: they've consented for an operation, they've had the operation, and
Speaker 2: then the following morning, after their operation, I showed them
Speaker 2: the video of the problem and me fixing the problem.
Speaker 2: And they still say, oh, that was so good to see.
Speaker 2: There's actually something wrong with me. I wasn't going crazy.
Speaker 2: Yes you must have. I mean you're still possibly there
Speaker 2: was something you thought you were crazy.
Speaker 1: You know what I love about that? That shows that
Speaker 1: you have absolute confidence in what you do to be
Speaker 1: able to record, to record that and then say here's
Speaker 1: the video. A lot of surgeons would not do that,
Speaker 1: is my guess.
Speaker 2: Well, that is a very good point that you raise.
Speaker 2: Patients say a couple of things about the video, and
Speaker 2: one of them is exactly that, Well, if you're confident
Speaker 2: enough to record the operation, then I'm confident in you
Speaker 2: doing the operation. But I look at it like this,
Speaker 2: if you don't have a video of surgery, the surgeon
Speaker 2: stuffed up if you do have a video of surgery,
Speaker 2: it was a difficult case, just say there's a complication.
Speaker 2: Surgeons say I don't want a complication recorded on video. Well,
Speaker 2: surgeons are rarely negligent. In fact, they're almost never negligent.
Speaker 2: It's just bad luck or the case was just very
Speaker 2: very difficult, And you can't say that. You can't say
Speaker 2: the case was difficult, or it was bad luck, or
Speaker 2: there was this you know, this anatomical variation. You can
Speaker 2: write it at an opropose, but it's just very difficult
Speaker 2: to communicate that because you're you're contrasting that to an
Speaker 2: outcome that's not ideal, and that's blank and white. So
Speaker 2: it's sort of good evidence. So I say, well, you know,
Speaker 2: without a video, basically people just think that you stuffed up.
Speaker 2: With a video, people will see that it was just
Speaker 2: it was bad luck or it was a difficult case.
Speaker 2: So the video is actually protective.
Speaker 1: Amazing. How often do you get in there? And I
Speaker 1: would imagine the answer is not much. But so you've
Speaker 1: got all the stuff that you need to see and
Speaker 1: analyze beforehand, do you ever get in there and you're surprised, like, oh,
Speaker 1: I didn't think this would be here, or I expect.
Speaker 2: That, not surprised about the location of something. I know
Speaker 2: to a millimeter where something is going to be because
Speaker 2: you can tell on the scan. The MRI scan is
Speaker 2: high resolution imaging, so I know exactly where something is
Speaker 2: going to be. What can be a surprise is what
Speaker 2: that thing is made of, or how stuck it is,
Speaker 2: or how adherent it is to different structures. That's the
Speaker 2: only real surprise. Like the spinal timber, for example, I
Speaker 2: knew to a millimeter where the top of the bottom
Speaker 2: of that, where the lateral the medial margin was. What
Speaker 2: I was unsure about is what it was actually going
Speaker 2: to look and feel like. Was it going to be
Speaker 2: soft and gelatinous and come out easy. Was it going
Speaker 2: to be tough and fibrous where it's going to be
Speaker 2: a bit more difficult to take out. So it's difficult
Speaker 2: to judge what something is going to be. Consistency of
Speaker 2: the stuff is going to be like, which is makes
Speaker 2: a huge impact on how you deal with it. If
Speaker 2: something soft and gelatinous, that's quite easy to remove. If
Speaker 2: it's fibrous and densely adherent to stuff, and that's a
Speaker 2: lot more difficult to remove. So that's the unknown.
Speaker 1: I never thought of that. So when you're cutting out
Speaker 1: something that's soft and gooey versus something that's tougher and
Speaker 1: more fibrous and dense, do you use the exact same tool,
Speaker 1: the exact same scalpel or whatever, or is it? There
Speaker 1: are a bunch of you go no, this is like
Speaker 1: removing an old bit of leather boots.
Speaker 2: So we use something different. There's something different. This tumor
Speaker 2: on Friday was soft into latinous. So the tumor has
Speaker 2: a capsule which has possibly got nerve fibers running through
Speaker 2: the capsule, so you have to preserve the capsule. So
Speaker 2: I make a linear cut through the capsule, which is
Speaker 2: like half a millimeter thick, and it springs open and
Speaker 2: reveals the sort of soft latinous tumor underneath.
Speaker 1: Sin.
Speaker 2: As I see that, I know this is going to
Speaker 2: go well. And there's a curet that's a bit spoon shaped,
Speaker 2: and I essentially slide it between the tumor and the capsule,
Speaker 2: and it's like scooping out a pee out of a pod, almost,
Speaker 2: and I just gently separate it and gently separated and
Speaker 2: gently free it up. There's a couple of places where
Speaker 2: it's densely adherent, and there's a micro scissor. It's beautiful
Speaker 2: micro scissor and that's used to divide where it's densely
Speaker 2: adherent and then it comes out comes out quite nicely.
Speaker 2: If it's more fibrous. We've got this beautiful machine called
Speaker 2: a CUSA CUSA which stands for Cavetron Ultrasonic aspirator. It's brilliant.
Speaker 2: It's this fine tip and it uses I think it's
Speaker 2: an ultrasonic wave to fracture the tissue at the tip
Speaker 2: and then it asperates the fractured tissue, so in effect,
Speaker 2: it's like having a pencil and at the tip of
Speaker 2: the pencil the tumor just dissolves and goes up the sucker.
Speaker 2: So it can be quite fibrous and dense and it
Speaker 2: will just literally dissolve it and suck it. And the
Speaker 2: beautiful instrument for tumors are a lot more dense. We
Speaker 2: joke that the CUSA actually c USA stands for can't
Speaker 2: use straight up because it takes about forty minutes to
Speaker 2: set the thing up.
Speaker 1: That's hilarious. Is there any I don't know if I
Speaker 1: want to ask this question, but I know you'll answer
Speaker 1: it honestly in general terms, like I think people a
Speaker 1: lot of people have been essentially led to believe that
Speaker 1: if you're going to have surgery, make sure you get
Speaker 1: the surgeon. Make sure you get your surgery in the morning,
Speaker 1: because that's when the surgeon's at his or her best,
Speaker 1: and surgeons are human. I would imagine that that might
Speaker 1: be true, or is that not true, or it depends.
Speaker 2: I see a patient in the anesthetic bay, and it
Speaker 2: doesn't matter where they are on the list. If they're first,
Speaker 2: I say, you're first up, everyone's fresh. You're in the
Speaker 2: best position. If they're fourth on the list, I walk
Speaker 2: in there, I say, we've done three already. Everybody's warmed
Speaker 2: up and got their eye, and you're in the best position.
Speaker 2: It doesn't matter. They all have a laugh and it
Speaker 2: relaxes them. It doesn't matter because every operation, the experience
Speaker 2: is the same, which is a laser focus. Sitting around
Speaker 2: and waiting is different. You've got a bit more energy
Speaker 2: waiting in the morning and the evening, the waiting is
Speaker 2: you know, a bit more painful. But as soon as
Speaker 2: the microscope gets wheeled into place, the brain just switches
Speaker 2: on and it becomes a laser focus and it's like
Speaker 2: nothing has changed. It's like the first case. Wow.
Speaker 1: You spoke before about how the idea that you walk
Speaker 1: and it's going to be a good day because you've
Speaker 1: got the team that you love, You've got your dream team.
Speaker 1: Who organizes that, Like do you go, I want to
Speaker 1: work with these people or do you just show up
Speaker 1: on the day? And it depends who's rostered on.
Speaker 2: The nursing staff are rosted, the anesthetic staff. I have
Speaker 2: relationships with those guys and have essentially elected to work
Speaker 2: with them, and that's the dynamics. Over time, you sort
Speaker 2: of start to get the team that you want to
Speaker 2: have with the nursing staff and the scrub team they're
Speaker 2: rosted that you start to get more and more time
Speaker 2: with the people that you like.
Speaker 1: Do you think over time like racking up all the
Speaker 1: surgeries that you've done and are doing, and of course
Speaker 1: everyone who's doing a job, over time, you know, develop
Speaker 1: skill and competence and all of those things. Do you
Speaker 1: think that you've become calmer? Not that you were probably
Speaker 1: ever chaotic, but like I think most of us doing
Speaker 1: obviously most of us wouldn't do what you do, but
Speaker 1: something where the potential consequences are so big, you know,
Speaker 1: one way or the other. I mean, that's for us
Speaker 1: mere mortals. That's a recipe for fucking overthinking, self doubt, rumination, anxiety.
Speaker 1: But obviously those things don't work being in any of
Speaker 1: those states don't work. When you need so much fine
Speaker 1: motor skill, so much calmness, and so much presence, how
Speaker 1: do you stay calm but also at the same time
Speaker 1: fully alert and switched.
Speaker 2: On watching a mental watching and learning during the training years. Again,
Speaker 2: my guide out in Hobart still the most naturally gifted
Speaker 2: guy I've seen around Australia, and I've been around Australia.
Speaker 2: It was observing him under pressure and how he reacted
Speaker 2: to it. I still remember a pediatric brain tumor case.
Speaker 2: It went for ten hours or something like that, and
Speaker 2: he just stood there with his shoulders down, his elbows
Speaker 2: by his side, risk just moving slowly, slowly for that
Speaker 2: whole time. And at the time I was like, why
Speaker 2: is he taking so long? I'm tired, I want to
Speaker 2: go home, let's wrap this up. Until I had a
Speaker 2: case of a pediatric brain tumor that I was doing
Speaker 2: on my own. I've told this story before. I think
Speaker 2: it was. It started at eight or nine and went
Speaker 2: through to eleven o'clock that night. Difficult pediatric tumor, and
Speaker 2: it was stuck to the brain stem. It was bleeding profusely.
Speaker 2: Progress was super slow. At times, it was hard to
Speaker 2: make out what was tumor and what was normal brain stem.
Speaker 2: And the brain stem is highest priced real estate you
Speaker 2: can get in the brain. I touched that and there
Speaker 2: are huge consequences. So that was extremely incredibly stressful operation.
Speaker 2: And I thought, this is probably what my mentor was feeling.
Speaker 2: This is the emotions he was feeling during that ten
Speaker 2: hour case. He was looking at that structure, going is
Speaker 2: that tumor?
Speaker 1: Or?
Speaker 2: Is that is that I need? I don't know. I
Speaker 2: imagine that that's what was going through his head. And
Speaker 2: I only worked that out when I was doing the case.
Speaker 2: But at the time he was just composed and just
Speaker 2: went millimeter by millimeter. I just remember that, and during
Speaker 2: this pediatric tumor case of mine, I just replicated that.
Speaker 2: I just kipped my head, kept my car and knew
Speaker 2: that it was okay just to proceed slowly. I learned
Speaker 2: a huge amount just watching this guy. The other thing,
Speaker 2: Do I stay calm I think I get I am
Speaker 2: definitely calm and get calmer with time, but I get
Speaker 2: not agitated. But I don't think grumpy is the right
Speaker 2: word either. But it's essentially I get shorter and clearer
Speaker 2: and maybe a little bit blunter with instructions in theater
Speaker 2: because I know more now the value of nipping any
Speaker 2: variable in the bud, any new variable that's introduced during theater.
Speaker 2: If you allow too many new variables to accumulate, that's
Speaker 2: when you start getting complications. So my instructions are crystal clear,
Speaker 2: and I'm actually quite blunt, and if there is a
Speaker 2: minor variation to that, I stop, corrected and then move forward.
Speaker 2: And it can be the simplest thing. The screen needs
Speaker 2: to be facing this particular way, the drape needs to
Speaker 2: be on a certain way, The instrument needs to always
Speaker 2: be the same. Told the story of the hammer they
Speaker 2: handed me during a spine operation, a hammer that I
Speaker 2: was not expecting. It was a slightly smaller one. They
Speaker 2: had a laugh, and I was quite short and blunt
Speaker 2: back at them, Not because I'm just a toxic, a
Speaker 2: difficult personality, but I was nipping a variable in the bud.
Speaker 2: They don't understand that variable, but if you have enough
Speaker 2: of them, it just disorientates you. And then once you
Speaker 2: start getting disorientated, that's where complications occur. Every time, almost invariably,
Speaker 2: if there's a complication, you can trace it back to
Speaker 2: a root pause. It's when this step wasn't normal, but
Speaker 2: you accepted it and thought, oh, that's okay. We'll just
Speaker 2: get on with the case and move forward. And so again,
Speaker 2: my guy down in Hobart, he had white line fever.
Speaker 2: If anything change in theater, he would just he would
Speaker 2: just get so angry. And I couldn't understand it at
Speaker 2: the time, and I don't condone that sort of behavior,
Speaker 2: but I understand the concept of of what he was,
Speaker 2: what his philosophy was, don't give me a new variable.
Speaker 2: It's the same time every time, because if I do that,
Speaker 2: then I'm least likely to have a complication and I'm
Speaker 2: going to do my best work.
Speaker 1: And I think, also, that's amazing, thank you for that.
Speaker 1: Like dealing with people like every every day, you're dealing
Speaker 1: literally with life and death, like literally like and so
Speaker 1: you don't really.
Speaker 2: Happen in hups. It's worse than that. It's not life
Speaker 2: and death, it's it's life and life with a morbidity.
Speaker 2: The worst thing is for someone to I mean, obviously
Speaker 2: death is bad, but that really happens. The bad thing
Speaker 2: if someone goes in and they're normal and they come
Speaker 2: out with a neurological deficit, they have to live the
Speaker 2: rest of their life with that neurological deficit. Right, That's
Speaker 2: that's the worst outcome. You go in there and you're
Speaker 2: able to speak, and you come out and you can't speak,
Speaker 2: Or you go in there and your foot is working
Speaker 2: and you come out with a foot drop. It's a
Speaker 2: huge burden on your quality of life. That's that's really that. Yes,
Speaker 2: death is bad, but it really happens. It's causing a
Speaker 2: irreversible problem that they then have to live with for
Speaker 2: the rest of their life. That's the thing we really fear.
Speaker 1: Yeah, I had not thought of that. That is fucking terrifying.
Speaker 1: And I guess also when you're under that pressure and
Speaker 1: you're making decisions and doing the thing that you don't
Speaker 1: you don't really in that moment have the bandwidth to
Speaker 1: be able to want to or have to cater to
Speaker 1: people's individual emotions and to keep everyone you know happy
Speaker 1: in because you're just doing your thing. So it's not
Speaker 1: your job to take or to be responsible for how
Speaker 1: everyone's feeling in the middle of that surgical reality.
Speaker 2: I don't even think about it. Teamwork is really important.
Speaker 2: And when a scrub nurse hands me something that is perfect,
Speaker 2: which means I'm looking down the microscope, I hand out
Speaker 2: my hand and they put the instrument in my hand
Speaker 2: in such a way. I just got to close my
Speaker 2: hand and put it back in. And if they do that,
Speaker 2: I say, perfect, that was perfect, thank you. And if
Speaker 2: I hold my hand out and then they give it
Speaker 2: to me as if what's easy for them, Like they
Speaker 2: grab the instrument in their hand and they hand it
Speaker 2: to me, so it's pointing the wrong way. I've got
Speaker 2: to move my hand then to grasp that. I don't
Speaker 2: even do that anyway. I say give it to me properly.
Speaker 2: I actually give it back to them. Say give it
Speaker 2: to me properly. And because it's teamwork, you know, they
Speaker 2: get the best out of me when I get the
Speaker 2: best out of them. So I reinforce great behavior and
Speaker 2: I ask for it in return. We have something called
Speaker 2: the Mayo table, which is a It sounds fancy, but
Speaker 2: essentially it's just a tray that sits on top of
Speaker 2: the bed, but it's got some legs onto the floor.
Speaker 2: It's called basically sit instruments on this on this mayo table.
Speaker 2: And when that mayo table, it's got a lot of
Speaker 2: instruments that the scrub nurse is using. It's the stuff
Speaker 2: that I'm using is going on and off, back and forwards.
Speaker 2: When that mayo is organized, all the instruments are lined up, dunk.
Speaker 2: I say that the mayo is a is a glimpse
Speaker 2: into the scrub nurse's mind. The mayo is a reflection
Speaker 2: of the mind. When that mayo is organized, I feel organized.
Speaker 2: I feel they are organized, and I'm confident in them.
Speaker 2: And I say that, I actually say that. I said
Speaker 2: that your mayo is very clean and tidy. Clearly, your
Speaker 2: mind is very clear clear at the moment, I appreciate that.
Speaker 1: Yeah, how quickly or slowly does neurosurgery evolve? I feel
Speaker 1: it's probably not linear. It's probably on an incline at
Speaker 1: the moment. With tech or what the fuck do I know?
Speaker 2: Give usked a fascinating question, And I've written an article
Speaker 2: on this. There is some technology at the moment, like
Speaker 2: a robot or the endoscope for spine surgery quite a
Speaker 2: bit of tech at the moment where it's a huge
Speaker 2: expenditure to develop that tech, massive expenditure and the price
Speaker 2: to purchase this equipment is phenomenal, the million dollars for
Speaker 2: a piece of equipment, and the benefit to the patient
Speaker 2: is extremely marginal. And the reason I say that you
Speaker 2: just wind back the clock not far at all. CT
Speaker 2: scan which revolutionize medicine. I mean Planet Earth probably stopped
Speaker 2: spinning for about two seconds when the CT scan arrived
Speaker 2: at address Planet Earth. That was developed on a shoe
Speaker 2: string budget by a guy from the Second World War
Speaker 2: who is working with radar, and over three years persevered
Speaker 2: and against expectations, came up with the CT scanner. Minimal expenditure,
Speaker 2: exponential effect on medicine and patient outcomes. The same with
Speaker 2: MRI scan and in eurosurgery. There's some beings, some texts.
Speaker 2: The big one for us is stereotactic. That is using
Speaker 2: a computer to be able to decide where something is
Speaker 2: inside the brain or the spine that's mainly inside the brain,
Speaker 2: and so we use it all the time. If there's
Speaker 2: a tumor that's three centimeters blow the surface of the brain,
Speaker 2: this computer can tell us on the skin where that
Speaker 2: projection is, so we can get the cut on the
Speaker 2: scalp in the perfect position. Stereotactic surgery revolutionize the game,
Speaker 2: and now it feels like industry brings out technology for
Speaker 2: the purposes of maintaining earnings for the quarter, and in
Speaker 2: a way, without being cynical, in a way, a lot
Speaker 2: of tech at the moment gives whoever's got that tech
Speaker 2: a commercial advantage. If this hospital has got a robot
Speaker 2: and this hospital does not have a robot, then obviously
Speaker 2: this hospital is better and that's where people should go.
Speaker 2: And that's a big part of a landscape at the moment.
Speaker 2: So hospitals are forced to buy this equipment because another
Speaker 2: hospital has got it without it at a disadvantage in
Speaker 2: terms of their quality of care. But really the quality
Speaker 2: of care is almost unchanged. And it's a really dangerous
Speaker 2: landscape that we're entering where there's becoming more and more
Speaker 2: of a push by industry to adopt this technology for
Speaker 2: their shareholders and less so for actual patient outcomes. Huge
Speaker 2: expenditure for very very marginal outcome, but it's a really
Speaker 2: easy sell to the patient. I use a robot. How
Speaker 2: could you resist that I use an endoscope for spine surgery.
Speaker 2: It's truly keyhole surgery. How do you say no to that?
Speaker 1: Yes?
Speaker 2: Yes, the reality behind the scenes is slightly different, and
Speaker 2: it's much harder to sell the fact that perhaps that
Speaker 2: robot doesn't actually change very much at all, and there's
Speaker 2: a different reason that hospital has a robot. That's a
Speaker 2: hard sell. But just to say we have a robot
Speaker 2: is a very easy cell.
Speaker 1: Yeah. Yeah, What about I don't even know if this
Speaker 1: is a good question, So if it's dumb, I'll take
Speaker 1: it out. What about current or future surgical treatments for
Speaker 1: neurological diseases like Alzheimer's, Parkinson's and so on? Is there
Speaker 1: do you ever do? Is that a thing?
Speaker 2: Alzheimer's No, Parkinson's, Yes, Parkinson's disease. The surgical treatment for
Speaker 2: that is phenomenal. The fuck has three parts of the rigidity,
Speaker 2: the hand tremor, and then they walk really stiff and slow,
Speaker 2: and it can be completely debilitating. There are drugs for it.
Speaker 2: But there's an operation called deep brain stimulation. The target
Speaker 2: is a few millimeters wide, deep in the center of
Speaker 2: the brain, and the target was discovered by accident. A
Speaker 2: number of years ago, but now we've got the target
Speaker 2: and we can put a probe into that target and
Speaker 2: stimulate or cause a lesion in that target. The effect
Speaker 2: is phenomenal. A patient can be completely immobilized and incapacitated
Speaker 2: by their Parkinson's symptoms and then post surgery getting towards
Speaker 2: barely recognizable, almost back to normal. There's another condition called
Speaker 2: a central tremor, which again is a type of neurodegenerative condition. Essentially,
Speaker 2: when their hand is at rest, it's fine, but when
Speaker 2: they go out to reach something, the hand starts shaking violently.
Speaker 2: You may have seen it. They reach out to grab
Speaker 2: a glass of water, and the closer you get to
Speaker 2: the glass of water, the hand just starts just shaking uncontrollably.
Speaker 2: It's obviously they can't use their hand for anything because
Speaker 2: as soon as they go to do something, it's called
Speaker 2: an action tremor. As soon as they use the hand
Speaker 2: for anything, the hand just completely starts flailing around. And
Speaker 2: then after deep brain stimulation the hand works completely normally
Speaker 2: like it's a phenomenal before and after video. So that's
Speaker 2: been around for a while. The accuracy is what's improved
Speaker 2: exactly where that probe goes in what location and ensuring
Speaker 2: the accuracy. That is certainly improved. The instruments we have
Speaker 2: to do the surgery have improved, making it easier to
Speaker 2: manipulate tissues and do things safely. But for lo the
Speaker 2: philosophy is the same. Surgery is a game of physicality.
Speaker 2: It's removing something that shouldn't be there, or putting something
Speaker 2: back in its normal place, or fixing something that's physically broken.
Speaker 2: That's essentially the name of the game. If it comes
Speaker 2: to brain tumors, the outcomes for a lot of them
Speaker 2: haven't changed in fifty years. Surgery hasn't changed. The only
Speaker 2: thing that's really going to change that is drugs.
Speaker 1: So a friend of mine's got an essential tremor. I
Speaker 1: did not know what you just told me, So I'm
Speaker 1: going to ring him after this. How long?
Speaker 2: How long does that procedure take? Give or take not
Speaker 2: long at all? The planning takes a while going to
Speaker 2: do a scan of the brain and identify that target
Speaker 2: and his minuscule harps. It's a tiny target deep in
Speaker 2: the brain. Planning is a big part of that. Doing
Speaker 2: the operation, they'll do it in under an hour.
Speaker 1: Wow, And what's the chances of a good outcome.
Speaker 2: In someone who's experience, who knows how to do the
Speaker 2: planning and to minimize risk, and has experience in minimizing
Speaker 2: the risk and the one of the big challenges is
Speaker 2: that the brain moves, so it moves with each heartbeat,
Speaker 2: so you kind of have a moving target. You have
Speaker 2: a moving target when you put it in, but also
Speaker 2: when it's actually in the brain's still moving, so it's
Speaker 2: still like a moving target for the stationary tip. People
Speaker 2: have experienced doing that and know how to work around that,
Speaker 2: their chances of success are high.
Speaker 1: What's the bit of the brain called where you said,
Speaker 1: we accidentally found this out and it's like a bit
Speaker 1: of the brain that's a few millimeters what's it called.
Speaker 2: One of them is called the VIM which I think
Speaker 2: is the ventral intermediary something. I'll have to look that up.
Speaker 2: I can't remember. V im is is the acronym. There's
Speaker 2: a couple of targets. There's a subthallomic target. I'm not
Speaker 2: an expert in this, but there's a subfalloming target. There's
Speaker 2: a couple of other targets. It was absolutely discovered that
Speaker 2: the story goes. I think it was. I think it
Speaker 2: was last century. A guy was doing a blood vessel
Speaker 2: operation like in ancient times, and he clipped the wrong
Speaker 2: blood vessel as he would do because he didn't have
Speaker 2: microscopes and modern instruments. He clipped the wrong blood vessel
Speaker 2: and the patient woke up and their tremor was gone.
Speaker 2: He hadn't fixed the original blood vessel problem that he'd
Speaker 2: set out to fix, but he couldn't help but notice
Speaker 2: the patient's tremor had completely disappeared. And I think that
Speaker 2: they did. They didn't even have a scan of that time.
Speaker 2: I think they did a post mortem and worked out
Speaker 2: where that stroke was in the brain and then started
Speaker 2: putting two and two together.
Speaker 1: So they had to kind of reverse engineer it to
Speaker 1: figure out how that fucking fixed it correct.
Speaker 2: That is, that is the one I wound up understanding
Speaker 2: the human brain. The only way that we have gathered
Speaker 2: any valuable information about the function of human brain is
Speaker 2: to observe the broken and work backwards.
Speaker 1: It wasn't that the way that they discovered viagra as well.
Speaker 1: Wasn't that meant to be like some kind of vasil
Speaker 1: vaso dilator or something for blood pressure and it ended
Speaker 1: up giving blokes hard cocks?
Speaker 2: Yep. It was for pulmary hypertension and this side effect.
Speaker 1: And then they're like, hey, we invented this, We've we've
Speaker 1: solved one of the biggest problems for men of all time.
Speaker 1: You're welcome. And then nobody solved it at all. They
Speaker 1: just fucking stumbled across it.
Speaker 2: Yeah, that's a phenomenal story is at Viagra and with
Speaker 2: the tie. It's a great name, it's a great product
Speaker 2: that that will be if if that was your project
Speaker 2: that fires or whoever made that, that's that's a legacy
Speaker 2: that is that's a game changer.
Speaker 1: One hundred percent. Yeah. Yeah. Have you ever have you
Speaker 1: ever encountered a case of been involved in a case
Speaker 1: that fundamentally changed how you viewed the brain or consciousness
Speaker 1: or the way that you just looked at it in general,
Speaker 1: or perhaps you heard of a case or you reviewed
Speaker 1: a case or something, or there's been no real surprises, but.
Speaker 2: There was one central case that changed the way I
Speaker 2: looked at the human brain. Awake Cranny oto me patients
Speaker 2: awake during surgery. And I've done it many times before.
Speaker 2: This was the first time I was doing it as
Speaker 2: a consultant, so fully qualified. And the thing that rattled me.
Speaker 2: The thing that I realized for the first time in
Speaker 2: my career was essentially the mystery of the physical and
Speaker 2: the non physical, that gap between the physical and non physical.
Speaker 2: So what I mean is I could see the human brain,
Speaker 2: and I'd seen it a thousand times before, and because
Speaker 2: the patients awake under the drape, I could see them
Speaker 2: having a conscious experience, and I understood for the first
Speaker 2: time what people were talking about between that gap between
Speaker 2: the physical brain and this non physical thing that is experience,
Speaker 2: you know, feelings, seeing, hearing, all that sort of stuff.
Speaker 2: And it was it was, it was. It was a
Speaker 2: game changer for me to see that played out in
Speaker 2: theater and there was what was really was. I don't
Speaker 2: know why I only thought about it at that particular time.
Speaker 2: I remember the day that it happened and I just sort
Speaker 2: of started thinking deeply about it. I just never thought
Speaker 2: about it, and all of a sudden it did a
Speaker 2: deep dive in theater in that moment exploring the topic.
Speaker 2: During the operation, there was no clue on the surface
Speaker 2: of the brain of how that physical brain was connecting
Speaker 2: with the non physical world. There was just no clue.
Speaker 2: It was just pulsating with a heartbeat, but it wasn't
Speaker 2: glowing green, and there was no sparkles and no distortion
Speaker 2: in the atmosphere, which there should have been, because it's
Speaker 2: still the greatest mystery known to man how the human
Speaker 2: brain does that. It's a complete void, how that physical
Speaker 2: brain creates the non physical phenomena of experience. There should
Speaker 2: be some supernatural evidence of how it's doing that, and
Speaker 2: it's and there just isn't. It's just a white brain pulsating.
Speaker 2: It's as physical as your arm or your delt muscle
Speaker 2: or you know, your heart. It's as physical as everything else,
Speaker 2: yet it's got this magical quality of creating consciousness. And
Speaker 2: looking at the brain, I realize what everybody was talking about.
Speaker 2: There's just no evidence about how it's doing that. I
Speaker 2: couldn't hear any voices from heaven. I couldn't. There was
Speaker 2: just nothing. And it was a unique situation because the
Speaker 2: patient was actually awake, having a conscious experience, where usually
Speaker 2: there are sleeps of general anisex bond them out, but
Speaker 2: they're having the actual non physical experience and I can
Speaker 2: see the physicals, I can see the physical, and I
Speaker 2: can see the evidence of the non physical in the
Speaker 2: same person. And no link between the two of them.
Speaker 2: And I thought, that is that is a cool mystery.
Speaker 2: Like I get what people are talking about when they
Speaker 2: say that's the thing they really want to understand before
Speaker 2: they die. I mean, that is that's a that's a
Speaker 2: brain breaker. That is I remember that day. I was like,
Speaker 2: I get it. That is that actually is very cool.
Speaker 2: That is that is the greatest mystery known to man
Speaker 2: playing out right in front of me. It's like a
Speaker 2: front row seat, no answers, but you know, I kind
Speaker 2: of like the mystery. I like it hasn't been solved,
Speaker 2: but as a found moment to see it actually played
Speaker 2: out in front of you, it'd be like, are you're
Speaker 2: visiting a black hole? Like that's just imagine if Eli
Speaker 2: Must said I can fly you to a black hole.
Speaker 2: Not only can you stand on the edge of the
Speaker 2: black hole, I'll let you go in for five seconds
Speaker 2: just to see what it's like. You'd be like, oh, yeah.
Speaker 1: Well, I mean it's funny because my job kind of
Speaker 1: is the mind and your job is the brain, and
Speaker 1: we know they're related, but we kind of don't really
Speaker 1: know how you know, and that the truth is, we
Speaker 1: don't really have evidence of a mind only evidence of
Speaker 1: a brain, you know, and we know that there's consciousness,
Speaker 1: and we know that there's a brain, but we don't
Speaker 1: know how one arises from the other. And neuroscience is
Speaker 1: having a big crack at it. But I don't know
Speaker 1: that we're going to understand that anytime soon. And maybe
Speaker 1: it's good that we don't. Maybe that is that spiritual part,
Speaker 1: maybe there is, maybe there's you know, well, there's definitely
Speaker 1: stuff that we you know. I think that when we
Speaker 1: can't understand or explain something in science, we're very uncomfortable
Speaker 1: to go, well, it exists, but we don't get it.
Speaker 1: And I think sometimes we've just got to say, you know,
Speaker 1: on our current level of with our current level of
Speaker 1: knowledge science, you know, ability to examine whatever we don't know,
Speaker 1: and it's okay that we don't know, you know. And
Speaker 1: even some of the things we think we do know,
Speaker 1: we find out in ten years, oh, we didn't know
Speaker 1: that at all. We only thought we knew.
Speaker 2: Yeah, there's two things I want to say about that.
Speaker 2: It's interesting. Number One, I feel like technology will be
Speaker 2: the antsick because it has been the answer up till date.
Speaker 2: If you'd said to Caesar Julius Caesar, DNA, Show me DNA,
Speaker 2: tell me about it, what does it look like, how
Speaker 2: does it work? He would just lock you up in
Speaker 2: an asylum. You think you're crazy. He's got no chance
Speaker 2: of understanding an atom or what it looks like, or
Speaker 2: what DNA is, And just that's completely ethereal concept, not
Speaker 2: even a concept, and technology, through X ray technology and
Speaker 2: mathematics was able to uncover that. So I feel like
Speaker 2: consciousness today is much of a bizarre concept as DNA
Speaker 2: would have been to Julius Caesar, solved by technology, and
Speaker 2: so there's a lot who feel that probably will be
Speaker 2: the answer for this as well. But there is an interesting,
Speaker 2: interesting catch with the mind, as you know, it's called
Speaker 2: the other minds problem, meaning I can never examine I
Speaker 2: can never experience someone else's mind. I can only experience
Speaker 2: my own mind. I can only examine my own mind.
Speaker 2: I could never I mean I can do it through
Speaker 2: some surrogate Marcus, asking some questions and things like that,
Speaker 2: that I can never enter your mind to experiment on
Speaker 2: it and try and study it.
Speaker 1: Yeah, well that there's a whole area of research in
Speaker 1: psych called theory of mind, which is that which is
Speaker 1: trying to understand the mind of somebody else, and then
Speaker 1: you know, but again, it's it's really just high level guessing,
Speaker 1: or in some instances low level guessing, trying to understand
Speaker 1: somebody else's version. And you and I have spoken about
Speaker 1: this between ourselves. But you know, when we go, all right, well,
Speaker 1: let's say ten thousand people listen to this chat, nobody's
Speaker 1: going to have an identical experience. There might be some
Speaker 1: very similar experiences, but that's it's it's likely now that
Speaker 1: some people have already tuned out and gone, fuck this,
Speaker 1: this is bullshit, And there's it's likely also that some
Speaker 1: people are going, this is ace. I hope it keeps
Speaker 1: going for as long as possible. Some people are this
Speaker 1: is in enlightening some people. This is boring some people,
Speaker 1: this is confusing. And you know, so there's the stimulus
Speaker 1: and then there's the individual's reaction cognitive, emotional, psychological reaction. Yeah,
Speaker 1: and trying to have an insight into like me, trying
Speaker 1: to have an insight into in real time, into how
Speaker 1: you think or how you're feeling, or how this is
Speaker 1: going for you as a conversation, but also simultaneously me
Speaker 1: having a greater than me awareness of the listening experience
Speaker 1: for thousands of people. And so when I ask a question,
Speaker 1: I'm like, what's the best question that I can ask,
Speaker 1: which hopefully will be broadly interesting to the biggest percentage
Speaker 1: of people that I can, you know, rather than I
Speaker 1: want to know things that I'm fascinated in as well.
Speaker 1: But if I think I'm the only one fascinated by
Speaker 1: this question, I'm not asking it, not in this context anyway.
Speaker 2: Does it frustrate you?
Speaker 1: No, I'm fascinated by I mean, ergo my PhD. Right,
Speaker 1: But I'm fascinated with how others think and how others see.
Speaker 1: You know, And then you think about, like, where does
Speaker 1: your version of right, where does your personal experience come from? Well,
Speaker 1: part of it comes from part of it is genetic,
Speaker 1: and part of it comes from the brain and the
Speaker 1: biochemistry of the brain. Correct me if I fuck anything
Speaker 1: up from your end. But part of it is about
Speaker 1: your interpretation of what's going on. You know, some people
Speaker 1: are interpreting this as interesting, and therefore they're in the
Speaker 1: moment experience is that they are interested, that they are fascinated.
Speaker 1: Somebody else's interpretation of the exact same stimulus could be
Speaker 1: this is boring, and their literal experience is boredom. But
Speaker 1: either way, those experience are self created. They're stimulated by you,
Speaker 1: and I bet they're created by the interpreter of the
Speaker 1: data or the stimuli.
Speaker 2: It's interesting what you say, and it fascinates me how
Speaker 2: little control we actually have, how easily an external stimulus
Speaker 2: can change the way we feel, think, or what we say.
Speaker 2: And it's almost like we don't have any real control.
Speaker 2: I'm a product of my genetics, shore and my biochemistry,
Speaker 2: but it doesn't take much for me to change the
Speaker 2: way I view the world on a particular day. So
Speaker 2: who am I really? I feel like I'm just a
Speaker 2: complicated stimulus response machine.
Speaker 1: You in some ways you are in some ways we
Speaker 1: all are. And you made a good point, and that
Speaker 1: is that nine am Alex might be quite different to
Speaker 1: seven pm alex, depending on you know, whether or not
Speaker 1: you've eaten, how tired you are, whether or not you
Speaker 1: had a blue with Karli, you know, whether not it's raining,
Speaker 1: whether or not one of the dogs did away in
Speaker 1: the house, you know, like that in the moment version
Speaker 1: of you. Sometimes I said this to Melissa yesterday. I said,
Speaker 1: I don't want to jinx it, but I'm not even
Speaker 1: sure why, but lately I feel fucking amazing, and I've
Speaker 1: been trying to figure out what I'm doing that makes
Speaker 1: me feel I'm not saying I am amazing, but I
Speaker 1: feel amazing, you know, like mentally, emotionally, cognitively, I feel sharp,
Speaker 1: I feel physically strong. I'm strong in the gym. I'm
Speaker 1: fucking solving problems like a motherfucker. I'm like everything is
Speaker 1: just and I'm trying to I'm trying to reverse engineer
Speaker 1: what am I doing that is making this this state
Speaker 1: that I'm in because it's not psychological, because it's been a.
Speaker 2: Surprise I was about to finish their PhD to me.
Speaker 1: Maybe that's it. Maybe I can just see the light
Speaker 1: at the end of the academic tunnel. Maybe this all right.
Speaker 1: Let's wind up with one or two questions. Right, this
Speaker 1: is not really your field or your area of expertise,
Speaker 1: but it's in your area of kind of and I
Speaker 1: can chime in on this, but we're not interested in me.
Speaker 1: What advice do you have for people who want to
Speaker 1: look after their brain? And I know that you're not
Speaker 1: really the lifestyle guy or the you know, but I mean,
Speaker 1: you work with brains. And therefore you must have advice
Speaker 1: for people on you know how to best look after
Speaker 1: their brain so that in terms of their choices and behaviors,
Speaker 1: they can keep it working whatever optimally is for them.
Speaker 2: Great question, it's quite simple. Don't stuff it up because
Speaker 2: you've only got one. Basically there reason I say that quickly.
Speaker 2: Story eighteen year old guy drunk got into a fight.
Speaker 2: This was in Perth when I was training, got into
Speaker 2: a fight, got king hit. During the fight. King hit
Speaker 2: for those who don't know, that's being punched in the
Speaker 2: back of the head, so you don't see the assailant coming,
Speaker 2: so you haven't got any of your defenses up, so
Speaker 2: your arm's down by your side. You don't see it coming.
Speaker 2: And when you get punched in the back of the head,
Speaker 2: it knocks you out cold. So you hit the deck,
Speaker 2: which means because you're out cold again, none of your
Speaker 2: defenses are mobilized, your hands don't reach out to break
Speaker 2: your fall or anything like that. So the skull hits
Speaker 2: the concrete flush and it causes a catastrophic brain injury.
Speaker 2: And this guy had several operations permanent brain damage. Basically
Speaker 2: a vegetable and there was one day that really struck
Speaker 2: me and rattled me. I remember the day clearly, walking
Speaker 2: into his room. We're talking three or four months down
Speaker 2: the track, and he's in a hospital bed. He's on
Speaker 2: a ventilator, he's rigid, he's staring into space. Lights are on,
Speaker 2: there's no one home. It's a severe brain injury. His
Speaker 2: parents are there. He's got sweat on him, he's got
Speaker 2: a fan on, his brain, stems misfiring, he can't regulate.
Speaker 1: It's just a.
Speaker 2: Total disaster physiologically and everything. And the thing that got
Speaker 2: me with the photos up on the wall, and there
Speaker 2: was the eighteen year old kid with his dad and
Speaker 2: holding a fish for memory, and then there was another
Speaker 2: photo of his eighteen year old kid smiling with his
Speaker 2: girlfriend at I presume end of view, end of school
Speaker 2: formal smiling pull a potential, a perfectly firing brain, eighteen
Speaker 2: year old kid's brain, all the potential in the world,
Speaker 2: can think clearly, can do anything. It's his number one
Speaker 2: asset is his brain. And then there's another photo with
Speaker 2: him and his mates doing something up on the wall
Speaker 2: as well. And then I look at him lung in
Speaker 2: the bed and he's lost all of that. And the
Speaker 2: message is very clear. It's you know, people say, what
Speaker 2: can I do to look after my brain? Well, quite
Speaker 2: literally that just look after it. It's the best asset
Speaker 2: you ever have. And it doesn't matter what knock to
Speaker 2: the head you have, what insults your brain has, you
Speaker 2: will pay the price for that. You may lose one
Speaker 2: or two IQ points, or you may lose your entire future.
Speaker 2: Just don't stuff it up. Is quite literally as simple
Speaker 2: as that. You don't get a second chance with the brain.
Speaker 2: Sometimes the effects are not immediately obvious, but the effects
Speaker 2: are certainly there, and it doesn't repair itself. You've got
Speaker 2: one look after it, use it. Just don't stuff it up.
Speaker 2: Beer yep.
Speaker 1: So I'm guessing the UFC is not high on your
Speaker 1: list of career options for now.
Speaker 2: What's UFC? Absolutely enthralled by it and then I cringe
Speaker 2: out at the same time. It's like this dichotomy of
Speaker 2: experiences when watching it. I love the I mean, it's
Speaker 2: just it's visceral to see combat. I'm sure that's why
Speaker 2: the Romans loved it. Build a Coliseum, because there's something
Speaker 2: natural about seeing a blood sport and two people in combat.
Speaker 2: It just it just gets you in a way that
Speaker 2: you can't really explain. But then I see the slow
Speaker 2: mods of the punch to the head, and I know
Speaker 2: what that means in terms of brain function. I know
Speaker 2: what that will look like on a CT scan. But
Speaker 2: the context is different, isn't harps. They're getting paid to
Speaker 2: take damage. Basically, that is their career. That's what they've
Speaker 2: signed up for. I guess so, and.
Speaker 1: They know, and you know what. So yeah, I'm it's
Speaker 1: funny you say that. I've said essentially what you said.
Speaker 1: It's for me. It's a dichotomy because on the one hand,
Speaker 1: I'm an excise scientist. I love I love athleticism and
Speaker 1: power and speed and skill and those guys and girls
Speaker 1: in the UFC and more broadly, you know, mixed martial
Speaker 1: arts across the spectrum. You know, there's so many great things.
Speaker 1: There's that unavoidable thing, which is you are going to
Speaker 1: at the very least damage your brain a bit, if
Speaker 1: not completely fuck it up. Like nobody gets out of
Speaker 1: full contact sport. Nobody, zero people with zero damage. Nobody
Speaker 1: has no damage. But I don't know, if you're across this,
Speaker 1: this is going to make you shudder. So Dana White,
Speaker 1: who who is the boss of the UFC who you know,
Speaker 1: you know who he is?
Speaker 2: Right? Yeah?
Speaker 1: So also, I mean people hate him. I fucking I
Speaker 1: find him hilarious. I don't agree with everything he says,
Speaker 1: but here's what I do love about Dana White. You
Speaker 1: will never not know what he thinks.
Speaker 2: I was going to say. He has a very clear mind.
Speaker 1: He has no filter, and he gives no fucks if
Speaker 1: people agree or disagree, and he's not doing it to
Speaker 1: be controversial or for attention. And he's built this fucking
Speaker 1: incredible brand from nothing to this multi billion dollar thing.
Speaker 1: And he's just a knock about bloke who's a visionary.
Speaker 1: And yeah, he's got all these flaws and all these
Speaker 1: chinks in his art and all that shit, but he's
Speaker 1: just take he saw I think it was two years ago.
Speaker 1: There's this thing there's face slapping competition, right, which happens
Speaker 1: in lots of countries around the world. But he took
Speaker 1: this idea and he turned it into power slap. So
Speaker 1: these I think it's I don't know if women are involved.
Speaker 1: Maybe women are, fuck but all the ones I've seen
Speaker 1: the men where they literally stand with their hands behind
Speaker 1: their back. It's almost like they're leaning over a bench.
Speaker 1: Which is for arm wrestling. But they just they just
Speaker 1: stand there and this bloke on the other side just
Speaker 1: winds up and smacks them with an open hand across
Speaker 1: the face with like ridiculous force. So they're just getting
Speaker 1: struck in the head. And this has gone from nothing
Speaker 1: to now being it's it's like I heard him talking
Speaker 1: about it the other day, where it's it's becoming this
Speaker 1: big spectator sport. Clearly not for everyone. I don't I
Speaker 1: don't watch it. I've just seen some reels. I can't
Speaker 1: watch it. I can't get on board. I can get
Speaker 1: on board the UFC, but I can't get board this.
Speaker 1: But I'll send you. I'll send you a clip and
Speaker 1: you as a you as a neurosurgeon, mate, you're just
Speaker 1: gonna fucking shake your head.
Speaker 2: I've seen his clips from India, the slap competitions from India.
Speaker 2: These Begindian guys. It's it's bizarre. I've got like this,
Speaker 2: this respect of each other and this courtesy and then
Speaker 2: they wind up and fucking so bang.
Speaker 1: That's not good. All right, mate, I love chatting with you.
Speaker 1: This has been one of my favorite chats. I feel
Speaker 1: like there was a lot of great information and a
Speaker 1: lot of great insight in there. We'll chat off here.
Speaker 1: Is there anything you don't want to got nothing to sell?
Speaker 1: I always say to my guests, where do you want
Speaker 1: to send our listeners? We are There is some news
Speaker 1: coming from Alex next year. There's going to be some
Speaker 1: big shit. I'm going to be involved in a little bit.
Speaker 1: I'm the one percent, he's the ninety nine. But I'm
Speaker 1: gonna I'm going to have my toe in the in
Speaker 1: the Alex door next year to help him do a
Speaker 1: couple of things. But we'll let you know more about
Speaker 1: that in the future. But for the moment, mate, love
Speaker 1: talking to you, Appreciate you and thanks for being on
Speaker 1: the new project yet again.
Speaker 2: Thanks Harts, really enjoyed it. Great to see you.