WEBVTT - Inside the Mind of a Brain Surgeon

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<v Speaker 1>This is Lee Habib, and this is our American stories,

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<v Speaker 1>the show where America is the star and the American

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<v Speaker 1>people up next. Doctor Theodore Schwartz his book Gray Matters,

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<v Speaker 1>a biography a brain surgery. You wrote these words in

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<v Speaker 1>your book about your parents. From my father, I realized

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<v Speaker 1>there was a lot going on in the brain about

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<v Speaker 1>which we were unaware. My mother's war experiences lent an

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<v Speaker 1>air of gravity to my childhood, a sense that no

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<v Speaker 1>matter how well things were going, tragedy lurked around every corner.

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<v Speaker 1>Sounds to me like your mother and father had a

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<v Speaker 1>lot to do with who you were talk about that.

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<v Speaker 2>I was born on the Upper West Side of Manhattan

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<v Speaker 2>in New York City. My father was a Freudian psychoanalyst,

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<v Speaker 2>so I grew up in a very intellectual household.

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<v Speaker 3>He used to spend his weekends.

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<v Speaker 2>Listening to classical music all day long and rereading the

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<v Speaker 2>works of Freud and Shakespeare, and was just a very thoughtful,

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<v Speaker 2>curious man. My mother was a Holocaust survivor, where I

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<v Speaker 2>grew up in the Jewish faith, and she was born

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<v Speaker 2>in Vienna and lost her sister at a very young

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<v Speaker 2>age to meningitis, and then at age twelve, when Hitler

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<v Speaker 2>marched into Vienna, she was kicked out.

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<v Speaker 3>Her father's store was closed.

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<v Speaker 2>And she spent the next five or six years running

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<v Speaker 2>away from the Germans and ended up hiding in a

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<v Speaker 2>convent in Belgium, changing her name to Simon Mabier from

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<v Speaker 2>Mars Schwartz, speaking French from her original German, until she

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<v Speaker 2>eventually came to America. She met an American soldier and

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<v Speaker 2>moved to Kalamazoo. Michig again lived as a Christian in

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<v Speaker 2>America for a little while and realized that wasn't really.

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<v Speaker 3>Who she was.

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<v Speaker 2>I think she was trying to forget her past, and

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<v Speaker 2>then eventually moved to New York and met my dad,

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<v Speaker 2>who was a psychiatrist at Albert Einstein College of Medicine

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<v Speaker 2>in the Bronx. I think we're all influenced by our environment,

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<v Speaker 2>and so writing a little bit about my parents and

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<v Speaker 2>how they may have influenced me, it's hard for us

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<v Speaker 2>to know what those impacts will be, right. My brother

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<v Speaker 2>grew up in the same household that I grew up

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<v Speaker 2>in and grew up into a very different human being

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<v Speaker 2>than I am.

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<v Speaker 3>He's a lovely human being, but very different.

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<v Speaker 1>We talk a lot about turning points in people's lives

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<v Speaker 1>on this show, and you had a serious one in

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<v Speaker 1>high school. Talk about the woman trapped into her car

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<v Speaker 1>by snowplows, and how did that experience affect you, talk

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<v Speaker 1>about its impact.

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<v Speaker 2>So I was walking to school one morning in high school,

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<v Speaker 2>probably you know, a junior, maybe I was fifteen, sixteen

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<v Speaker 2>years old. And in Manhattan, when it snows, the snowclouds

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<v Speaker 2>come by to plow the roads and the streets, and

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<v Speaker 2>all the cars are parked on the side of the streets.

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<v Speaker 2>And so when the snow clouds do that, they basically

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<v Speaker 2>box in all the cars. Who now have you know,

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<v Speaker 2>a foot two feet, three feet, sometimes four feet of

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<v Speaker 2>snow boxing their car in, And it can be very

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<v Speaker 2>challenging to get your car onto the road in the morning.

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<v Speaker 3>And so I was walking to work and there was

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<v Speaker 3>a woman who was.

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<v Speaker 2>Stuck, and you know, her wheels were spitting, and the

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<v Speaker 2>snow was flying everywhere, and it was just slush at

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<v Speaker 2>this point, and she could not get her car out

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<v Speaker 2>onto the road. And I saw that she was in need,

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<v Speaker 2>and I dropped my knapsack on the ground and I

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<v Speaker 2>ran over and started pushing her car to help her

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<v Speaker 2>free herself. And she got out and she waved to

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<v Speaker 2>me and said thanks, and drove on with her day.

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<v Speaker 2>And I'll never forget that moment because I just felt

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<v Speaker 2>so good about myself that I had helped somebody in

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<v Speaker 2>need who didn't know who I was, and I didn't

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<v Speaker 2>know who they were, and I wasn't getting anything but

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<v Speaker 2>a thank you from them, but it meant so much

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<v Speaker 2>to me. And I left that experience thinking, Wow, I

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<v Speaker 2>really want to do a job where I get to

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<v Speaker 2>help people every day and they'll say thank you.

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<v Speaker 1>Before we talk about what it's like to be a

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<v Speaker 1>brain surgeon, let's talk for a moment about what it

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<v Speaker 1>takes to become one who chooses this line of work.

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<v Speaker 1>You separate them into a few categories, talk about the

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<v Speaker 1>character traits, talk about the types of people who choose

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<v Speaker 1>your line of work.

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<v Speaker 2>I tried to think back on the different personalities that

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<v Speaker 2>I know neurosurgeons that I know, and I kind of

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<v Speaker 2>created categories that are sort of like the lunch room

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<v Speaker 2>tables in a high school, where you have the nerds

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<v Speaker 2>and the jocks and the musicians, and those are, in

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<v Speaker 2>fact people who go into neurosurgery for different reasons. So

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<v Speaker 2>some are nerds they're interested in neuroscience that work in labs.

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<v Speaker 2>Some are athletes who like to be the center of attention.

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<v Speaker 2>Neurosurgery is a very physical activity and you need a

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<v Speaker 2>lot of stamina, you need a lot of focus. It's

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<v Speaker 2>a manual task where you're affecting the world around you.

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<v Speaker 2>So there are a lot of athletes that go into neurosurgery.

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<v Speaker 2>And then there are also musicians who love to practice

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<v Speaker 2>their instruments.

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<v Speaker 3>You know, there's a lot of manual.

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<v Speaker 2>Dexterity and surgery which is the same as many instruments

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<v Speaker 2>that people play.

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<v Speaker 3>And the ability to sit and practice your.

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<v Speaker 2>Instruments for hours on end translates very well into neurosurgery.

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<v Speaker 2>And every surgery we do is like a performance, you know,

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<v Speaker 2>we have to perform. And then there are also people

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<v Speaker 2>touched by neurosurgery. And there are quite a few neurosurgeons

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<v Speaker 2>who had a parent who died of a brain tumor

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<v Speaker 2>or an aneurysm, or who maybe their parent was a

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<v Speaker 2>neurosurgeon and they didn't see them.

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<v Speaker 3>That much or they shadowed them around the hospital. But

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<v Speaker 3>those are the.

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<v Speaker 2>Trends that I've seen. And as for myself. I was

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<v Speaker 2>definitely a little bit of a nerd, you know. I

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<v Speaker 2>was reading astronomy books when I was in high school

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<v Speaker 2>and wanted to be an astronaut. But I was also

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<v Speaker 2>an athlete. I played on the football team, and I

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<v Speaker 2>was a musician. I played bass in the jazz band.

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<v Speaker 2>So I definitely had a little bit of each one

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<v Speaker 2>of those elements. And my dad was a psychoanalyst, so

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<v Speaker 2>he got me interested in the brain and memory and

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<v Speaker 2>how the brain works.

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<v Speaker 1>And you've been listening to doctor Theodore Schwartz. He's the

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<v Speaker 1>author of Gray Matters, a biography of brain surgery. He's

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<v Speaker 1>also an attending neurological surgeon and professor of neurological surgery

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<v Speaker 1>at wild Cornell Medicine, one of the busiest and highest

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<v Speaker 1>ranked neurosurgery centers in the world, located in New York City.

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<v Speaker 1>And the story about his mom alone could have been

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<v Speaker 1>a movie now. The fact that she escaped Nazis for years,

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<v Speaker 1>wound up in Holland, learning how to speak French to

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<v Speaker 1>disguise her accent, disguise her German and Jewish background, ultimately

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<v Speaker 1>marrying someone Christian and moving to the Midwest, only to

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<v Speaker 1>discover who she really was, discovering her identity and ending

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<v Speaker 1>up married and in New York to a second husband,

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<v Speaker 1>and my goodness. We learn also about the turn point

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<v Speaker 1>in doctor Schwartz's life, and it's that woman caught and

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<v Speaker 1>trapped by the snowplows in New York City and how

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<v Speaker 1>he felt afterwards. I didn't know who they were, they

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<v Speaker 1>probably didn't know who I was. But that feeling he got,

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<v Speaker 1>that's what well propelled him into the life he chose

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<v Speaker 1>in the end, the feeling he must get to help

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<v Speaker 1>a stranger when we come back more of the life

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<v Speaker 1>of doctor Theodore Schwartz here on our.

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<v Speaker 3>American Stories.

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<v Speaker 1>Lieh Habib here, and I'd like to encourage you to

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<v Speaker 1>subscribe to Our American Stories on Apple podcasts, the iHeartRadio app,

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<v Speaker 1>daily again, Please subscribe to the Our American Stories podcast

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<v Speaker 1>anywhere you get your podcasts. It helps us keep these

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<v Speaker 1>great American stories coming. And we return to our American

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<v Speaker 1>Stories and doctor Theodore Schwartz, author of Great Matters, a

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<v Speaker 1>biography of brain surgery. Go to Amazon and the usual

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<v Speaker 1>suspects to get it. You won't put it down, you

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<v Speaker 1>won't be sorry. Let's pick up where we last left off.

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<v Speaker 1>We talk about failure a lot on this show, and

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<v Speaker 1>you write about it in your book. Talk about how

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<v Speaker 1>neurosurgeons learn and what role failure plays in your learning curve.

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<v Speaker 2>Well, you know, in neurosurgery, you know it's a seven

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<v Speaker 2>year training program for a reason, right, and when you

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<v Speaker 2>start out you don't get to do that much. You're

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<v Speaker 2>basically an assistant. But the truth is the public wants

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<v Speaker 2>their neurosurgeons to When you emerge from a neurosurgery training program,

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<v Speaker 2>you can basically hang your shingle and you are credentialed

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<v Speaker 2>to perform brain surgery on your own. So the question

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<v Speaker 2>is how do you teach someone to perform brain surgery

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<v Speaker 2>on your own? And at the same time, when you're

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<v Speaker 2>a patient, you do not want anyone practicing on you,

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<v Speaker 2>and so you have to somehow give these trainees graded

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<v Speaker 2>responsibility in a safe way, letting them do slightly more

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<v Speaker 2>in each operation, making sure that anything that they do,

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<v Speaker 2>you're there watching them do it unless you're one hundred

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<v Speaker 2>percent sure they can do it. Essentially as well as

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<v Speaker 2>you can do it, and then I never let the

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<v Speaker 2>residents do certain things that I cannot reverse and that

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<v Speaker 2>I cannot fix, because I would have to live with

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<v Speaker 2>myself if there were a failure.

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<v Speaker 3>But there's very strong mentorship and guidance.

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<v Speaker 2>It's like a driving test where the driver is sitting

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<v Speaker 2>right next to you, you know, holding the steering wheel,

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<v Speaker 2>and if God forbid, something goes wrong, you know you

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<v Speaker 2>can take over. Learning from failure as a surgeon is

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<v Speaker 2>a whole other different conversation, and I do write about this.

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<v Speaker 2>You know, there's a conflict between confidence in humility and

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<v Speaker 2>arrogance and humility, and.

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<v Speaker 3>You sort of have to be both at the same time.

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<v Speaker 2>I think most great surgeons are are simultaneously arrogant and humble,

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<v Speaker 2>because you have to believe in your heart that you're

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<v Speaker 2>the best person to do this operation, and you have

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<v Speaker 2>to become the best person you can be to do

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<v Speaker 2>that operation. And with that training and experience comes a

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<v Speaker 2>certain amount of arrogance. You have to convince the patient

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<v Speaker 2>I can do this, I can take care of you.

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<v Speaker 2>I'm the right person for the job. At the same time,

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<v Speaker 2>no matter how good you are, every neurosurgeon who does

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<v Speaker 2>complex neurosurgery will have complications and failures.

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<v Speaker 3>It's inevitable.

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<v Speaker 2>And we say, if you haven't had a complications because

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<v Speaker 2>you're not doing complicated operations. And that creates a lot

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<v Speaker 2>of humility because you can't become arrogant, you can't lose

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<v Speaker 2>your focus, you can't assume that things are going to

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<v Speaker 2>go well. I'm always assuming that something's going to go

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<v Speaker 2>wrong in every operation, and I'm always thinking what can

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<v Speaker 2>I do to prevent this from going wrong. That's just

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<v Speaker 2>my attitude with everything I do. And it makes you very,

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<v Speaker 2>very humble, And by being humble, that's how you get better.

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<v Speaker 2>I am better, you know, thirty years out than I was,

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<v Speaker 2>twenty five years out than I was twenty years out

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<v Speaker 2>than fifteen.

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<v Speaker 1>Let's talk about head trauma, because, as you put it,

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<v Speaker 1>it's the bread and butter of your profession, in the

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<v Speaker 1>same way that skateboards and trampolines of the bread and

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<v Speaker 1>butter of your orthopedic surgeon colleagues talk about head trauma,

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<v Speaker 1>what is it? And how many people are your die

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<v Speaker 1>from head trauma? And while we're at it, tell the

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<v Speaker 1>story of the Swiss Army knife.

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<v Speaker 2>So we separate head trauma into blunt head trauma and

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<v Speaker 2>penetrating head trauma and blunt heead trauma is you know,

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<v Speaker 2>let's say you're in a car accident and your head

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<v Speaker 2>hits the steering wheel where you're playing football in your

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<v Speaker 2>helmeted head to hit someone else's head, or a baseball

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<v Speaker 2>hits your head, it's blunt penetrating of course, is a

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<v Speaker 2>gunshot wound, an arrow wound, or a knife wound or

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<v Speaker 2>something like that. And they're very different, and they affect

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<v Speaker 2>the brain and the skull very very differently. And as

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<v Speaker 2>you can imagine, a lot of neurosurgeons in the early

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<v Speaker 2>part of the twentieth century and surgeons before that, would

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<v Speaker 2>attend to soldiers on the battlefield and there were a

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<v Speaker 2>lot of injuries, and so a lot of what we

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<v Speaker 2>learned was learned on the battlefield, and our field developed

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<v Speaker 2>taking care of head injuries. And we've been very involved

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<v Speaker 2>also in designing football helmets and motorcycle helmets and the

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<v Speaker 2>baseball helmet. All of these things, at one time or

0:12:10.800 --> 0:12:13.800
<v Speaker 2>another were designed by brain surgeons to protect the brain,

0:12:13.840 --> 0:12:16.360
<v Speaker 2>because that's our job. We have to fix the brain,

0:12:16.400 --> 0:12:19.120
<v Speaker 2>but we also have to prevent head injuries from occurring.

0:12:19.160 --> 0:12:22.880
<v Speaker 2>In the first place, and there was one case who

0:12:23.000 --> 0:12:25.360
<v Speaker 2>had a Swiss Army knife, which is not a big knife.

0:12:25.400 --> 0:12:27.040
<v Speaker 2>You don't think of a Swiss Army knife as a

0:12:27.320 --> 0:12:29.640
<v Speaker 2>lethal knife. But it turns out there's a part of

0:12:29.640 --> 0:12:33.080
<v Speaker 2>the skull right under the temple. There's muscle here, but

0:12:33.120 --> 0:12:35.800
<v Speaker 2>the bone is about a millimeter thick right behind the eye,

0:12:36.280 --> 0:12:38.800
<v Speaker 2>and if you were to jam a knife in right

0:12:38.840 --> 0:12:42.160
<v Speaker 2>there hard enough, you can penetrate the skull fairly easily.

0:12:42.880 --> 0:12:44.880
<v Speaker 2>And this gentleman came into the emergency room literally with

0:12:44.920 --> 0:12:48.319
<v Speaker 2>a Swiss Army knife sticking out of his head, and

0:12:48.800 --> 0:12:50.360
<v Speaker 2>it turns out the tip of the knife is very

0:12:50.360 --> 0:12:53.439
<v Speaker 2>close to a critical artery called the internal carotid artery,

0:12:53.800 --> 0:12:55.559
<v Speaker 2>so we had to do a full crannyotomy because we

0:12:55.600 --> 0:12:56.920
<v Speaker 2>can just pull it out because if you pull it out,

0:12:56.920 --> 0:12:59.400
<v Speaker 2>you might have sheared the artery and actually have someone

0:12:59.480 --> 0:13:01.559
<v Speaker 2>pull it out while I was staring at the ordery

0:13:01.600 --> 0:13:04.079
<v Speaker 2>after opening up his head. And we did manage to

0:13:04.120 --> 0:13:08.760
<v Speaker 2>save his life, but he was essentially handcuffed to his

0:13:08.760 --> 0:13:11.040
<v Speaker 2>gurney with a police officer at his side because he

0:13:11.120 --> 0:13:14.600
<v Speaker 2>was involved in some nefarious activities. So I never really

0:13:14.640 --> 0:13:16.959
<v Speaker 2>figured out what happened or why it happened to him.

0:13:17.480 --> 0:13:20.480
<v Speaker 1>I want to talk next about those initial office visits

0:13:20.520 --> 0:13:24.480
<v Speaker 1>by the patient. You describe them so beautifully in the book.

0:13:25.040 --> 0:13:27.240
<v Speaker 1>I want you to do a reading from a passage,

0:13:27.679 --> 0:13:30.000
<v Speaker 1>and if you could set the passage up.

0:13:30.440 --> 0:13:33.679
<v Speaker 2>The initial office visit, in fact, can be surreal. At

0:13:33.679 --> 0:13:37.200
<v Speaker 2>this early stage. The patient is often minimally symptomatic. They're

0:13:37.240 --> 0:13:40.040
<v Speaker 2>obviously aware that something is growing in their brain. They

0:13:40.160 --> 0:13:42.520
<v Speaker 2>sought out medical care, after all, and they know it

0:13:42.559 --> 0:13:45.920
<v Speaker 2>needs to be removed. They're also often scared and unsure

0:13:45.920 --> 0:13:48.440
<v Speaker 2>of what lies ahead or what it all means. Commonly,

0:13:48.679 --> 0:13:51.400
<v Speaker 2>they're frequently somewhat oblivious to the gravity of the situation.

0:13:52.120 --> 0:13:53.640
<v Speaker 3>This is all new to them.

0:13:53.760 --> 0:13:56.280
<v Speaker 2>But as I listened to their questions, I see things

0:13:56.320 --> 0:13:59.040
<v Speaker 2>they are not yet capable of seeing, let alone processing.

0:13:59.679 --> 0:14:01.640
<v Speaker 2>See the mother of three young children who will not

0:14:01.679 --> 0:14:04.200
<v Speaker 2>make it to their high school graduation. I see the

0:14:04.240 --> 0:14:07.080
<v Speaker 2>father and sole provider for a family of teenagers with

0:14:07.120 --> 0:14:09.880
<v Speaker 2>college payments looming, who will not be walking his daughter

0:14:09.920 --> 0:14:10.520
<v Speaker 2>down the aisle.

0:14:11.200 --> 0:14:11.600
<v Speaker 3>I see the.

0:14:11.600 --> 0:14:13.559
<v Speaker 2>Hedge fund manager who is sitting on top of the

0:14:13.640 --> 0:14:17.240
<v Speaker 2>world planning his retirement and next lavish vacation, who will

0:14:17.280 --> 0:14:19.960
<v Speaker 2>soon be closing his fund. He's about to lose not

0:14:20.000 --> 0:14:23.120
<v Speaker 2>only his long anticipated opportunity to spend his money, but

0:14:23.240 --> 0:14:26.800
<v Speaker 2>his ability to bathe and feed himself. And yes, thinking

0:14:26.880 --> 0:14:29.160
<v Speaker 2>of others' deaths can be debilitating. It's even the most

0:14:29.200 --> 0:14:32.960
<v Speaker 2>hardened of us surgeons giving bad news. Seeing families crumple

0:14:32.960 --> 0:14:35.880
<v Speaker 2>from the oncoming train bearing down on them. As I

0:14:35.920 --> 0:14:38.600
<v Speaker 2>stare into the void imagining their future, I want to

0:14:38.640 --> 0:14:40.520
<v Speaker 2>stand up and scream at the top of my lungs,

0:14:40.920 --> 0:14:42.920
<v Speaker 2>or collapse on the ground in a flood of tears.

0:14:43.280 --> 0:14:44.480
<v Speaker 3>I do none of this, of course.

0:14:44.960 --> 0:14:46.840
<v Speaker 2>My job at this moment is to fight this battle

0:14:46.840 --> 0:14:49.880
<v Speaker 2>with every fiber in my body and shepherd these victims

0:14:49.880 --> 0:14:53.440
<v Speaker 2>of nature's callous and indifferent design. I believe in revealing

0:14:53.480 --> 0:14:56.280
<v Speaker 2>the truth to my patient's prognosis at a slow and

0:14:56.360 --> 0:15:00.280
<v Speaker 2>deliberate pace, but I also never ever take away their

0:15:00.280 --> 0:15:01.240
<v Speaker 2>most powerful weapon.

0:15:01.720 --> 0:15:02.200
<v Speaker 3>Hope.

0:15:02.840 --> 0:15:05.000
<v Speaker 2>We're not talking about false hope, as in, we're going

0:15:05.080 --> 0:15:08.200
<v Speaker 2>to beat this thing, but rather true hope, a concept

0:15:08.240 --> 0:15:11.200
<v Speaker 2>introduced by Jerome Groupman in his book The Anatomy of Hope,

0:15:11.280 --> 0:15:13.320
<v Speaker 2>how people prevail in the face of illness.

0:15:13.800 --> 0:15:15.080
<v Speaker 3>True hope sounds more like this.

0:15:15.680 --> 0:15:18.000
<v Speaker 2>They're a small group of long term survivors, and I'm

0:15:18.000 --> 0:15:19.640
<v Speaker 2>going to do everything in my power to give you

0:15:19.680 --> 0:15:22.000
<v Speaker 2>the best chance of being one of them, or even

0:15:22.320 --> 0:15:24.920
<v Speaker 2>your remaining days with your family can be beautiful, maybe

0:15:24.920 --> 0:15:27.440
<v Speaker 2>even more beautiful than all the days that have come before.

0:15:28.000 --> 0:15:30.720
<v Speaker 1>Let's talk about the surgery itself. You're right about the

0:15:30.720 --> 0:15:34.160
<v Speaker 1>fact that sometimes the patient needs to stay awake during

0:15:34.200 --> 0:15:35.080
<v Speaker 1>brain surgery.

0:15:35.320 --> 0:15:36.680
<v Speaker 3>Does the patient feel pain?

0:15:37.600 --> 0:15:38.840
<v Speaker 1>Why do they stay awake?

0:15:39.120 --> 0:15:43.800
<v Speaker 2>Yeah, If you watch your feeds on Facebook or Instagram,

0:15:43.800 --> 0:15:44.920
<v Speaker 2>every once in a while, you go see like a

0:15:44.960 --> 0:15:47.280
<v Speaker 2>patient having brain surgery is playing the violin, or they're

0:15:47.280 --> 0:15:51.240
<v Speaker 2>playing the guitar, or they're reciting Shakespeare, and people are

0:15:51.280 --> 0:15:55.920
<v Speaker 2>excited by that. We have to do surgery awake sometimes,

0:15:56.000 --> 0:15:58.440
<v Speaker 2>and I'll talk about how, But first is why if

0:15:58.480 --> 0:16:00.600
<v Speaker 2>a tumor is very close to part of the brain

0:16:00.680 --> 0:16:02.960
<v Speaker 2>is important for a speech and language. The neurons that

0:16:03.240 --> 0:16:05.280
<v Speaker 2>allow you to speak are in a different location in

0:16:05.320 --> 0:16:07.400
<v Speaker 2>every human being. We know roughly where they are, but

0:16:07.440 --> 0:16:10.040
<v Speaker 2>we don't know exactly where they are, and so there's

0:16:10.080 --> 0:16:11.720
<v Speaker 2>some tumors that sit in the areas that can be

0:16:11.880 --> 0:16:13.520
<v Speaker 2>very very close to parts of the brain that are

0:16:13.520 --> 0:16:15.600
<v Speaker 2>critical for speech and the only way to know it

0:16:15.720 --> 0:16:19.000
<v Speaker 2>in this day and age with confidence is to have

0:16:19.040 --> 0:16:22.040
<v Speaker 2>your patient awaken the operating room, having them doing a

0:16:22.240 --> 0:16:26.000
<v Speaker 2>language tasks, so they're reading, they're naming objects, they're talking,

0:16:26.320 --> 0:16:29.080
<v Speaker 2>and you stimulate their brain with an electrode. And stimulating

0:16:29.080 --> 0:16:32.200
<v Speaker 2>the brain in that way basically knocks out a small

0:16:32.280 --> 0:16:35.520
<v Speaker 2>area of brain. It stops that brain bit from being

0:16:35.560 --> 0:16:37.960
<v Speaker 2>able to function. So you move the electrode around and

0:16:38.000 --> 0:16:41.120
<v Speaker 2>you map out where their speech areas are, and when

0:16:41.160 --> 0:16:43.400
<v Speaker 2>you hit an area that's important for speech, the patient

0:16:43.440 --> 0:16:44.760
<v Speaker 2>will be able to talk. So if you show them

0:16:44.800 --> 0:16:47.440
<v Speaker 2>a picture of a car or a pen, they'll say

0:16:47.440 --> 0:16:52.120
<v Speaker 2>this is a and they'll stutter and they'll have trouble

0:16:52.160 --> 0:16:54.280
<v Speaker 2>getting the word out. And then you lift the electrode

0:16:54.320 --> 0:16:57.320
<v Speaker 2>up and they'll go a pen. And it's crazy to

0:16:57.360 --> 0:16:59.360
<v Speaker 2>think that you can cause that in someone else's brain

0:16:59.480 --> 0:17:02.240
<v Speaker 2>just by a stick mulating a particular area. So that

0:17:02.320 --> 0:17:05.600
<v Speaker 2>allows us to do our surgeries more safely. How we

0:17:05.640 --> 0:17:08.560
<v Speaker 2>do it is that we give people ivy anesthesia, so

0:17:08.600 --> 0:17:10.680
<v Speaker 2>we make them sleepy when we're doing the opening, because

0:17:10.680 --> 0:17:12.679
<v Speaker 2>when you open the skull and the scalp, you know,

0:17:12.720 --> 0:17:13.800
<v Speaker 2>it's more like carpentry.

0:17:14.119 --> 0:17:14.960
<v Speaker 3>The microsurgery.

0:17:15.000 --> 0:17:17.119
<v Speaker 2>We do later on is more like Swiss watchmaking, but

0:17:17.200 --> 0:17:19.639
<v Speaker 2>getting in and out of the skull is really blue

0:17:19.640 --> 0:17:22.760
<v Speaker 2>collar labor to some extent. During that period of time,

0:17:22.800 --> 0:17:24.800
<v Speaker 2>they're asleep and we num the scalp with a lot

0:17:24.840 --> 0:17:28.200
<v Speaker 2>of local anesthesia. Surprisingly, when you open up the brain,

0:17:28.480 --> 0:17:31.840
<v Speaker 2>the brain has no sensory or pain fibers, so if

0:17:31.840 --> 0:17:32.800
<v Speaker 2>someone is touching.

0:17:32.520 --> 0:17:35.440
<v Speaker 3>Your brain, you won't feel anything. There's no pain, there's

0:17:35.440 --> 0:17:36.840
<v Speaker 3>no sense of someone touching you.

0:17:37.160 --> 0:17:39.480
<v Speaker 2>Only your skin has these touch fibers that you feel

0:17:39.480 --> 0:17:41.159
<v Speaker 2>when you touch the skin, but.

0:17:41.119 --> 0:17:42.200
<v Speaker 3>Your brain does not have them.

0:17:42.240 --> 0:17:44.040
<v Speaker 2>So we can operate on the brain and the patient

0:17:44.040 --> 0:17:45.119
<v Speaker 2>feels absolutely nothing.

0:17:51.480 --> 0:18:10.120
<v Speaker 1>The story of biography, and we continue with our American

0:18:10.160 --> 0:18:12.919
<v Speaker 1>stories and with doctor Theodore Schwartz. He's the author of

0:18:13.160 --> 0:18:17.280
<v Speaker 1>Gray Matters, a biography of brain surgery. It's part memoir

0:18:17.520 --> 0:18:20.560
<v Speaker 1>and it's part history, and that is the history of

0:18:20.600 --> 0:18:24.480
<v Speaker 1>brain surgery and in some ways our understanding of the brain.

0:18:24.840 --> 0:18:28.800
<v Speaker 1>Let's pick up where we last left off. You note

0:18:28.800 --> 0:18:31.159
<v Speaker 1>in the book, by the way, that the human brain

0:18:31.240 --> 0:18:34.439
<v Speaker 1>feels a lot like a sponge. That's for anyone wondering

0:18:34.440 --> 0:18:37.480
<v Speaker 1>what the brain actually feels like. What I also learned

0:18:37.520 --> 0:18:41.119
<v Speaker 1>is that you've removed nearly ten thousand brain tumors, but

0:18:41.280 --> 0:18:45.400
<v Speaker 1>not all of those surgeries, and with good news, talk

0:18:45.440 --> 0:18:48.800
<v Speaker 1>about breaking the bad news to a patient. In fact,

0:18:49.040 --> 0:18:52.000
<v Speaker 1>if you wouldn't mind reading from a passage you wrote about,

0:18:52.040 --> 0:18:54.600
<v Speaker 1>it was so poignant, it was so moving.

0:18:54.600 --> 0:18:56.159
<v Speaker 3>So I take my cues from them.

0:18:56.440 --> 0:18:59.280
<v Speaker 2>I usually start the conversation with a clear presentation of

0:18:59.320 --> 0:19:03.080
<v Speaker 2>the facts. I may say that the preliminary diagnosis showed

0:19:03.080 --> 0:19:05.879
<v Speaker 2>what we feared, that the tumor is in fact malignant.

0:19:06.320 --> 0:19:08.399
<v Speaker 2>I prefer to use the words we and us. I

0:19:08.440 --> 0:19:11.920
<v Speaker 2>also emphasize whatever positives I can. The good news is

0:19:11.960 --> 0:19:14.040
<v Speaker 2>that the surgery went extremely well and we got out

0:19:14.080 --> 0:19:15.960
<v Speaker 2>as much tumor as could safely be removed.

0:19:16.280 --> 0:19:16.880
<v Speaker 3>Although it's a.

0:19:16.800 --> 0:19:18.600
<v Speaker 2>Tough tour to be the surgery puts US in the

0:19:18.640 --> 0:19:22.040
<v Speaker 2>best place going forward to attack the microscopic disease invariably

0:19:22.080 --> 0:19:24.720
<v Speaker 2>left behind. I then tell them that they will likely

0:19:24.720 --> 0:19:28.400
<v Speaker 2>need radiation and chemotherapy, the standard of care and treating glioblastomas,

0:19:29.040 --> 0:19:31.600
<v Speaker 2>and that we will find them the most experienced neurooncologists

0:19:31.640 --> 0:19:34.240
<v Speaker 2>to help coordinate the next stage of this process. While

0:19:34.240 --> 0:19:36.359
<v Speaker 2>our neuraloncologists at Cornell are some of the best in

0:19:36.400 --> 0:19:39.000
<v Speaker 2>the world. Patients often want second opinions, so I let

0:19:39.040 --> 0:19:40.879
<v Speaker 2>them know we will help them get their records together

0:19:41.119 --> 0:19:44.040
<v Speaker 2>to send wherever they'd like. Patients often express a fear

0:19:44.080 --> 0:19:46.000
<v Speaker 2>of telling you they want a second opinion, as if

0:19:46.000 --> 0:19:48.280
<v Speaker 2>they're cheating on their spouse or insulting a relative.

0:19:48.520 --> 0:19:49.200
<v Speaker 3>You never want.

0:19:49.040 --> 0:19:51.520
<v Speaker 2>Anyone looking back as the end approaches, feeling that they

0:19:51.520 --> 0:19:54.160
<v Speaker 2>didn't do everything in their power to find the right treatment,

0:19:54.280 --> 0:19:57.280
<v Speaker 2>didn't explore all the options, or left a stone unturned.

0:19:58.080 --> 0:20:00.960
<v Speaker 2>I've witnessed only a handful of medical mirror in my career.

0:20:01.160 --> 0:20:05.040
<v Speaker 2>Tumors that miraculously shrank without any treatment, long term survivors

0:20:05.040 --> 0:20:08.639
<v Speaker 2>of fatal diseases. What's the explanation? We just don't know,

0:20:09.119 --> 0:20:11.919
<v Speaker 2>But these cases do provide some room for hope. The

0:20:11.960 --> 0:20:14.399
<v Speaker 2>patients I've treated who are still alive five, ten, or

0:20:14.440 --> 0:20:17.760
<v Speaker 2>even fifteen years after a GBM diagnosis are a rare

0:20:17.840 --> 0:20:20.680
<v Speaker 2>reminder that my degree and years of experience go only

0:20:20.720 --> 0:20:23.920
<v Speaker 2>so far. What makes these long term survivors so special?

0:20:24.040 --> 0:20:26.560
<v Speaker 2>What did they do to beat the odds? Another frequent

0:20:26.640 --> 0:20:28.920
<v Speaker 2>question my malignant tumor patients ask is why me?

0:20:29.240 --> 0:20:31.560
<v Speaker 3>Was it anything I did? It's human nature?

0:20:31.600 --> 0:20:34.040
<v Speaker 2>To attempt to find cause for suffering, to create order

0:20:34.080 --> 0:20:36.320
<v Speaker 2>out of chaos, to shake our fist at the randomness

0:20:36.320 --> 0:20:40.040
<v Speaker 2>of fate. Often my patients will place blame on environmental exposures,

0:20:40.040 --> 0:20:42.760
<v Speaker 2>such as smoking power lines or toxic chemicals released by

0:20:42.760 --> 0:20:45.320
<v Speaker 2>a local factory. They also worry that their brain termor

0:20:45.440 --> 0:20:47.960
<v Speaker 2>might have been inherited and will be passed to future generations.

0:20:48.560 --> 0:20:51.720
<v Speaker 2>Both fears are somewhat legitimate. Most brain canswers are triggered

0:20:51.760 --> 0:20:54.399
<v Speaker 2>by some random and little understood series of events that

0:20:54.480 --> 0:20:57.000
<v Speaker 2>either alters their DNA within the nucleus of brain cells

0:20:57.040 --> 0:21:00.040
<v Speaker 2>or misilignes the careful balance of proteins that promote and

0:21:00.040 --> 0:21:02.800
<v Speaker 2>suppressed cell growth. I therefore try to emphasize to my

0:21:02.840 --> 0:21:05.600
<v Speaker 2>patients that they did nothing to bring this upon themselves.

0:21:05.680 --> 0:21:08.200
<v Speaker 3>There is no one to blame or resent, and there's no.

0:21:08.160 --> 0:21:09.960
<v Speaker 2>Reason to feel guilty that their children might be at

0:21:09.960 --> 0:21:13.360
<v Speaker 2>a higher risk of the same fate. As scientifically unsatisfying

0:21:13.400 --> 0:21:15.680
<v Speaker 2>as the answer may be, the cause for most brain

0:21:15.720 --> 0:21:17.480
<v Speaker 2>tumors is just plain old bad luck.

0:21:17.920 --> 0:21:20.960
<v Speaker 1>I want to go next to the choices you have

0:21:21.040 --> 0:21:24.560
<v Speaker 1>to make as the surgeon while the patient is under

0:21:24.920 --> 0:21:27.399
<v Speaker 1>You write about this beautifully because in the end it

0:21:27.440 --> 0:21:31.840
<v Speaker 1>boils down to your choice. The patient depends on your talents,

0:21:32.240 --> 0:21:36.000
<v Speaker 1>your experience, and your knowledge. Talk about the burdens of

0:21:36.040 --> 0:21:40.960
<v Speaker 1>that responsibility and also the exhilaration of that responsibility.

0:21:41.040 --> 0:21:43.520
<v Speaker 2>Well, there's a moment that comes a couple hours into

0:21:43.560 --> 0:21:46.119
<v Speaker 2>an operation, when you're getting tired. You've been there for

0:21:46.119 --> 0:21:48.480
<v Speaker 2>a while, You've debulked a lot of the tumor, and

0:21:48.560 --> 0:21:50.840
<v Speaker 2>maybe at that point there's a little bit that's left.

0:21:51.400 --> 0:21:53.040
<v Speaker 2>There may be pardon you can't see it very well.

0:21:53.040 --> 0:21:55.280
<v Speaker 2>It could be obscured by an artery or vein, some

0:21:55.320 --> 0:21:57.080
<v Speaker 2>normal anatomy that's in the way. It could be very

0:21:57.080 --> 0:21:59.639
<v Speaker 2>stuck to an artery or vein, And you have to

0:21:59.760 --> 0:22:01.720
<v Speaker 2>figure out how aggressive do you want to be. Do

0:22:01.800 --> 0:22:03.480
<v Speaker 2>I want to try to get every last bit of

0:22:03.480 --> 0:22:07.080
<v Speaker 2>this tumor out, which potentially could cure the patient, or

0:22:07.520 --> 0:22:08.240
<v Speaker 2>if I leave.

0:22:08.040 --> 0:22:09.760
<v Speaker 3>Some behind, it could grow back and they might need

0:22:09.800 --> 0:22:10.560
<v Speaker 3>another surgery.

0:22:11.240 --> 0:22:13.359
<v Speaker 2>But if I'm too aggressive trying to get that last

0:22:13.359 --> 0:22:15.159
<v Speaker 2>bit of tumor off and I damage a nerve or

0:22:15.160 --> 0:22:17.399
<v Speaker 2>an artery or vein, it could be catastrophic for the patient.

0:22:18.040 --> 0:22:20.480
<v Speaker 3>And so I have to make that decision at that moment.

0:22:20.480 --> 0:22:23.240
<v Speaker 2>In time, and I sort of question, who am I

0:22:23.280 --> 0:22:24.160
<v Speaker 2>to make that decision?

0:22:24.200 --> 0:22:24.320
<v Speaker 3>Right?

0:22:24.359 --> 0:22:27.520
<v Speaker 2>It's not my body? You know, why do I have

0:22:27.600 --> 0:22:28.680
<v Speaker 2>this responsibility?

0:22:29.200 --> 0:22:30.360
<v Speaker 3>Is it fair? Is it right?

0:22:31.040 --> 0:22:33.679
<v Speaker 2>But the truth is, if it's not me, you know,

0:22:33.760 --> 0:22:35.119
<v Speaker 2>who is it going to be? Who's going to make

0:22:35.119 --> 0:22:37.440
<v Speaker 2>the decision at that moment in time. I'm the best

0:22:37.480 --> 0:22:40.160
<v Speaker 2>qualified person to do it because I'm physically there.

0:22:40.200 --> 0:22:41.679
<v Speaker 3>I've dissected down to the tumor.

0:22:42.160 --> 0:22:44.760
<v Speaker 2>I've done it hundreds of times before and trained to

0:22:44.800 --> 0:22:45.040
<v Speaker 2>do this.

0:22:45.119 --> 0:22:46.520
<v Speaker 3>So I need to make this decision.

0:22:47.320 --> 0:22:50.640
<v Speaker 2>And ultimately I say to myself, well, if this were

0:22:50.640 --> 0:22:53.280
<v Speaker 2>me on the table, what would I want done? And

0:22:53.320 --> 0:22:54.000
<v Speaker 2>that's what I do.

0:22:54.240 --> 0:22:56.399
<v Speaker 1>There are a lot of famous names and patients in

0:22:56.440 --> 0:22:58.840
<v Speaker 1>your book, doctor Schwartz, and I want you to talk

0:22:58.880 --> 0:23:02.480
<v Speaker 1>about one, to talk about Rosemary Kennedy, and I want

0:23:02.520 --> 0:23:04.040
<v Speaker 1>you to talk about lobotomies.

0:23:05.359 --> 0:23:08.920
<v Speaker 2>I knew nothing about lobotomies when I trained in neurosurgery.

0:23:09.040 --> 0:23:11.800
<v Speaker 2>We didn't hear anything about the surgery, didn't know anything

0:23:11.800 --> 0:23:13.639
<v Speaker 2>about the history, why I was done, who it was

0:23:13.680 --> 0:23:15.879
<v Speaker 2>done on, how many were done. I saw it as

0:23:15.880 --> 0:23:19.320
<v Speaker 2>sort of a skeleton in our closet that neurosurgeons really

0:23:19.400 --> 0:23:22.800
<v Speaker 2>didn't talk about. There were sixty thousand in frontal lobotomies

0:23:22.880 --> 0:23:25.199
<v Speaker 2>done in America in the nineteen fifties and nineteen sixties,

0:23:25.200 --> 0:23:26.879
<v Speaker 2>which is a remarkably high number.

0:23:27.320 --> 0:23:29.359
<v Speaker 3>You have to understand the context. At the time.

0:23:29.440 --> 0:23:31.800
<v Speaker 2>There was no treatment for psychiatric illness, so people who

0:23:31.840 --> 0:23:35.520
<v Speaker 2>had severe schizophrenia depression would just sit in the hallways

0:23:35.560 --> 0:23:37.960
<v Speaker 2>of mental institutions that were filling with these patients with

0:23:38.040 --> 0:23:40.240
<v Speaker 2>no way to treat them. And some of the treatments

0:23:40.280 --> 0:23:42.879
<v Speaker 2>were also barbaric. They would, you know, submerge them in

0:23:42.920 --> 0:23:45.959
<v Speaker 2>ice cold water, or shock them, or give them insulin

0:23:46.000 --> 0:23:48.680
<v Speaker 2>and lower their glucose, so they're essentially torturing these patients.

0:23:49.240 --> 0:23:54.080
<v Speaker 2>The surgery itself was developed mostly by neurologists and psychiatrists.

0:23:54.160 --> 0:23:56.600
<v Speaker 2>I found out it really was not a surgery developed

0:23:56.880 --> 0:24:00.760
<v Speaker 2>by neurosurgeons. A guy named Burkhardt did the first years ago,

0:24:00.920 --> 0:24:04.119
<v Speaker 2>and then Mones was a neurologist, won the Nobel Prize

0:24:04.400 --> 0:24:06.280
<v Speaker 2>believe it or not, for the front of the botomy

0:24:06.640 --> 0:24:09.439
<v Speaker 2>that was based on very little scientific basis. And then

0:24:09.480 --> 0:24:11.360
<v Speaker 2>there was a gentle named Walter Freeman who was also

0:24:11.440 --> 0:24:14.480
<v Speaker 2>a neurologist, and he started doing the Bottomi's in America.

0:24:15.400 --> 0:24:17.400
<v Speaker 3>He started out working with a neurosurgeon and.

0:24:17.359 --> 0:24:19.240
<v Speaker 2>Where they would drill burholes at the top of the

0:24:19.280 --> 0:24:21.639
<v Speaker 2>head and put essentially a butter knife down into the

0:24:21.640 --> 0:24:24.120
<v Speaker 2>brain and sweep it back and forth on each side

0:24:24.359 --> 0:24:26.600
<v Speaker 2>to disconnect the frontal part of the brain from the

0:24:26.640 --> 0:24:29.280
<v Speaker 2>back of the brain. He didn't like relying on a neurosurgeon.

0:24:29.320 --> 0:24:30.720
<v Speaker 2>He wanted to be able to do it on his own.

0:24:30.760 --> 0:24:32.840
<v Speaker 2>He didn't want to have to rely on anesthesiologists. He

0:24:32.880 --> 0:24:35.440
<v Speaker 2>was a neurologist. He had no credentials to perform surgery.

0:24:35.960 --> 0:24:38.800
<v Speaker 2>So he ran about an Italian neurosurgeon who did a

0:24:38.840 --> 0:24:42.680
<v Speaker 2>procedure basically taking an ice pick and lifting the upper

0:24:42.720 --> 0:24:44.960
<v Speaker 2>lid of the eye and taking the ice pick, putting

0:24:44.960 --> 0:24:47.640
<v Speaker 2>it under the eyelid and cracking through the skull into

0:24:47.680 --> 0:24:50.159
<v Speaker 2>the frontal lobe and sweeping it back and forth. And

0:24:50.320 --> 0:24:52.719
<v Speaker 2>he could do one of these procedures in about ten minutes.

0:24:53.040 --> 0:24:55.200
<v Speaker 2>He would charge twenty five dollars for it. He would

0:24:55.200 --> 0:24:57.399
<v Speaker 2>do six or seven in a day. He would do

0:24:57.440 --> 0:25:01.600
<v Speaker 2>it with no antiseptic theesia. He would actually give a

0:25:01.640 --> 0:25:04.120
<v Speaker 2>lecture shock therapy to the patients to put them under

0:25:04.200 --> 0:25:06.200
<v Speaker 2>and then he would do this procedure and he would

0:25:06.200 --> 0:25:08.119
<v Speaker 2>have people around him, and he publicized it, and he

0:25:08.119 --> 0:25:10.560
<v Speaker 2>traveled all around the country doing I think he personally

0:25:10.600 --> 0:25:14.359
<v Speaker 2>did about four thousand lobotomies, this guy, Walter Freeman. And

0:25:14.400 --> 0:25:16.480
<v Speaker 2>the truth is, there were some people who got better,

0:25:16.520 --> 0:25:18.600
<v Speaker 2>and there were a few neurosurgeons who studied the lobotomy

0:25:18.600 --> 0:25:20.320
<v Speaker 2>who sort of scientifically said, all right, we're going to

0:25:20.400 --> 0:25:22.560
<v Speaker 2>do this right, We're going to do it cleanly. And

0:25:22.720 --> 0:25:24.800
<v Speaker 2>at least a third of the patients really got better

0:25:24.840 --> 0:25:27.480
<v Speaker 2>from the lobotomies, but two thirds of them didn't, and

0:25:27.520 --> 0:25:30.680
<v Speaker 2>some patients were really damaged, severely damaged. Me and Rosemary

0:25:30.760 --> 0:25:33.679
<v Speaker 2>Kennedy was one of those. So Walter Freeman did her lobotomy.

0:25:34.160 --> 0:25:37.440
<v Speaker 2>Many people didn't know she had a lobotomy. Her brothers

0:25:37.440 --> 0:25:40.040
<v Speaker 2>and sisters didn't really know. Joe Kennedy basically just took

0:25:40.040 --> 0:25:42.240
<v Speaker 2>her to have this done. They were hiding her mental

0:25:42.240 --> 0:25:43.960
<v Speaker 2>illness at the time. It was very shameful that she

0:25:44.000 --> 0:25:46.359
<v Speaker 2>had mental illness at the time. And when she emerged

0:25:46.359 --> 0:25:49.000
<v Speaker 2>from the lobotomy, you know, she was essentially a vegetable.

0:25:49.040 --> 0:25:51.560
<v Speaker 2>She had regressed dramatically. She was like a little child

0:25:51.560 --> 0:25:55.440
<v Speaker 2>and she was institutionalized after that. But what the lobotomy

0:25:55.440 --> 0:25:59.159
<v Speaker 2>did dude for neurosurgery was it promoted the development of

0:25:59.200 --> 0:26:01.280
<v Speaker 2>a lot of new technique. So a lot of the

0:26:01.320 --> 0:26:04.240
<v Speaker 2>things we do now, the focal delivery of radiation called

0:26:04.240 --> 0:26:09.040
<v Speaker 2>stereotactic radio surgery, the implantation of deep brain electrodes which

0:26:09.080 --> 0:26:12.440
<v Speaker 2>we use to treat Parkinson's disease and obsessive compulsive disorder

0:26:12.480 --> 0:26:15.080
<v Speaker 2>and epilepsy, and the stereotactic.

0:26:14.600 --> 0:26:16.720
<v Speaker 3>Radiation which we can use to treat tumors.

0:26:16.600 --> 0:26:19.800
<v Speaker 2>And facial pain. All of those things those were developed

0:26:19.880 --> 0:26:22.679
<v Speaker 2>by surgeons trying to improve on the frontal lobotomy because

0:26:22.760 --> 0:26:26.000
<v Speaker 2>they realized it was a sort of grotesque, imprecise.

0:26:25.440 --> 0:26:27.160
<v Speaker 3>Operation and they wanted to figure out a better way

0:26:27.200 --> 0:26:27.560
<v Speaker 3>to do it.

0:26:27.680 --> 0:26:29.720
<v Speaker 2>So they developed all these new techniques and then realized

0:26:29.720 --> 0:26:32.200
<v Speaker 2>they could use all these techniques to treat other neurologic diseases,

0:26:32.280 --> 0:26:35.119
<v Speaker 2>and we still use those techniques today. So the frontal

0:26:35.119 --> 0:26:37.760
<v Speaker 2>a body that was a horrific moment in time where

0:26:37.760 --> 0:26:41.199
<v Speaker 2>we rashly adopted a surgery before it was well vetted,

0:26:41.800 --> 0:26:46.639
<v Speaker 2>but it propelled the feel forward fairly dramatically into a

0:26:46.640 --> 0:26:48.560
<v Speaker 2>lot of what modern neurosurgery is about today.

0:26:48.880 --> 0:26:51.639
<v Speaker 1>That is so true, about so much we learn in

0:26:51.680 --> 0:26:54.960
<v Speaker 1>the field of medicine, the bad and the good, and

0:26:55.040 --> 0:26:57.560
<v Speaker 1>my goodness, I just remember first hearing about a lobotomy

0:26:57.600 --> 0:27:00.920
<v Speaker 1>when I was an English major in college Tennessee. Williams

0:27:00.920 --> 0:27:02.800
<v Speaker 1>had to in the end give the go ahead to

0:27:02.800 --> 0:27:06.080
<v Speaker 1>give his sister Rose a full frontal lobotomy. He never

0:27:06.119 --> 0:27:06.959
<v Speaker 1>recovered from it.

0:27:07.160 --> 0:27:07.919
<v Speaker 3>And when we come.

0:27:07.800 --> 0:27:11.600
<v Speaker 1>Back more of the biography of brain surgery, the author

0:27:11.880 --> 0:27:15.200
<v Speaker 1>of the book Gray Matters is doctor Theodore Schwartz. More

0:27:15.640 --> 0:27:38.399
<v Speaker 1>with doctor Schwartz after these messages, and we continue with

0:27:38.480 --> 0:27:41.960
<v Speaker 1>our American stories and with doctor Theodore Schwartz, the author

0:27:42.000 --> 0:27:44.640
<v Speaker 1>of Gray Matters, a Biography of Brain Surgery. Let's pick

0:27:44.720 --> 0:27:50.080
<v Speaker 1>up where we last left off. Chapter fourteen is especially compelling.

0:27:50.400 --> 0:27:53.840
<v Speaker 1>The title alone is compelling. What's it like to be

0:27:53.920 --> 0:27:58.240
<v Speaker 1>a brain? But you dive into the human experience, the

0:27:58.320 --> 0:28:01.879
<v Speaker 1>human tragedy of the end of life. We've all had

0:28:01.920 --> 0:28:06.320
<v Speaker 1>grandparents and parents who suffered from loss of memory, dementia,

0:28:06.520 --> 0:28:08.120
<v Speaker 1>and worse. Talk about that.

0:28:08.840 --> 0:28:13.520
<v Speaker 2>So philosophically, we talk about the brain, and we talk

0:28:13.560 --> 0:28:17.439
<v Speaker 2>about the mind as a separate entity, and we like

0:28:17.520 --> 0:28:20.560
<v Speaker 2>to imagine and common sense tells us and our intuition

0:28:20.720 --> 0:28:25.080
<v Speaker 2>tells us that we can make decisions, our mind can

0:28:25.119 --> 0:28:28.080
<v Speaker 2>make decisions that will have an impact on the physical

0:28:28.119 --> 0:28:29.280
<v Speaker 2>world around us, and that.

0:28:29.280 --> 0:28:33.320
<v Speaker 3>We control our behaviors. But there is no such thing

0:28:33.359 --> 0:28:33.879
<v Speaker 3>as mind.

0:28:34.000 --> 0:28:37.040
<v Speaker 2>There's no mysterious substance that we have yet to identify

0:28:37.119 --> 0:28:39.080
<v Speaker 2>by science that is mind. All we know of is

0:28:39.120 --> 0:28:43.720
<v Speaker 2>brain in neurons and neurons firing that somehow creates our

0:28:44.560 --> 0:28:47.800
<v Speaker 2>experience of what it is like to be ourselves, and

0:28:47.920 --> 0:28:49.720
<v Speaker 2>our identity is very much a part of that. We

0:28:49.760 --> 0:28:51.720
<v Speaker 2>feel like we have an identity, we have a past,

0:28:51.760 --> 0:28:55.200
<v Speaker 2>we have a future, But the truth is the self

0:28:55.280 --> 0:28:57.000
<v Speaker 2>and who we are, and the decisions that we make

0:28:57.040 --> 0:28:58.120
<v Speaker 2>are all based in the mind.

0:28:58.200 --> 0:29:00.840
<v Speaker 3>And the mind is a physical organ that controlled by

0:29:00.880 --> 0:29:01.440
<v Speaker 3>the laws of.

0:29:01.400 --> 0:29:04.280
<v Speaker 2>Physics, and the laws of physics do not allow for

0:29:04.320 --> 0:29:07.560
<v Speaker 2>there to be a mind, a substance that has a

0:29:07.640 --> 0:29:09.720
<v Speaker 2>cause and effect, because the only thing that can have

0:29:09.720 --> 0:29:14.640
<v Speaker 2>a cause is another physical substance. So there are a

0:29:14.720 --> 0:29:17.840
<v Speaker 2>number of neurosurgical operations that have been done and experiments

0:29:17.880 --> 0:29:21.520
<v Speaker 2>done during brain surgery that lead us to believe that

0:29:21.560 --> 0:29:24.280
<v Speaker 2>our concept of the self is not what we think

0:29:24.280 --> 0:29:28.960
<v Speaker 2>it is. For example, if the brain creates the mind

0:29:29.640 --> 0:29:32.240
<v Speaker 2>and the self, and we can do an operation where

0:29:32.240 --> 0:29:34.080
<v Speaker 2>we take the two halves of our brain and basically

0:29:34.160 --> 0:29:36.680
<v Speaker 2>split them in half and cut the connections, so you

0:29:36.760 --> 0:29:40.960
<v Speaker 2>have two independent brains that can think independently in your head.

0:29:41.320 --> 0:29:43.640
<v Speaker 2>You would think that someone would feel like there's two selves,

0:29:43.760 --> 0:29:46.760
<v Speaker 2>but they don't. They actually still feel like they only

0:29:46.800 --> 0:29:48.520
<v Speaker 2>have one self. So how is it possible to have

0:29:48.560 --> 0:29:51.200
<v Speaker 2>two brains and only one self? You can remove an

0:29:51.360 --> 0:29:53.960
<v Speaker 2>entire hemisphere of the brain in someone and they will

0:29:53.960 --> 0:29:55.440
<v Speaker 2>wake up and feel like their whole.

0:29:55.480 --> 0:29:56.200
<v Speaker 3>They don't feel like.

0:29:56.200 --> 0:29:59.480
<v Speaker 2>They're half the person that they were before. So there's

0:29:59.480 --> 0:30:02.200
<v Speaker 2>clearly a dis connect between this physical thing brain and

0:30:02.240 --> 0:30:04.200
<v Speaker 2>this construct we have of the self. And the truth

0:30:04.280 --> 0:30:07.760
<v Speaker 2>is that who we are is changing constantly based on

0:30:07.840 --> 0:30:11.280
<v Speaker 2>our experiences, and we lose thousands of neurons every day

0:30:11.320 --> 0:30:14.480
<v Speaker 2>we make new connections, and so that creates our identity.

0:30:14.480 --> 0:30:17.800
<v Speaker 2>And it is possible to change someone's identity either because

0:30:17.840 --> 0:30:20.240
<v Speaker 2>they have a stroke and they forget who people are,

0:30:20.400 --> 0:30:21.840
<v Speaker 2>like the man who mistook his wife for a hat

0:30:21.840 --> 0:30:24.480
<v Speaker 2>doesn't recognize his wife anymore. You can put electrodes in

0:30:24.560 --> 0:30:27.040
<v Speaker 2>someone's brain, and this has been well described, and change

0:30:27.040 --> 0:30:29.240
<v Speaker 2>the way they feel, change their moods, make them happier,

0:30:29.520 --> 0:30:32.880
<v Speaker 2>make them sadder, give them brain fog. One pasion had

0:30:32.880 --> 0:30:34.600
<v Speaker 2>an electro putting their brain and they turned it on

0:30:34.640 --> 0:30:37.400
<v Speaker 2>and suddenly they started enjoying the music of Johnny Cash.

0:30:37.720 --> 0:30:39.160
<v Speaker 2>And they turned it off and they didn't like Johnny

0:30:39.160 --> 0:30:42.360
<v Speaker 2>Cash anymore. And so if you can trigger things that

0:30:42.400 --> 0:30:44.360
<v Speaker 2>we think of as our identity, right, I think of

0:30:44.480 --> 0:30:46.800
<v Speaker 2>myself as someone who likes certain things and dislikes some

0:30:47.000 --> 0:30:49.160
<v Speaker 2>certain things, that's who I am. If I can change

0:30:49.200 --> 0:30:51.880
<v Speaker 2>those things just by stimulating your brain or triggering your brain,

0:30:51.920 --> 0:30:54.480
<v Speaker 2>what does that mean about who you are and who

0:30:54.520 --> 0:30:57.520
<v Speaker 2>you think you are. The other fascinating thing that I'll

0:30:57.520 --> 0:31:00.280
<v Speaker 2>just briefly talk about is there's a lot of data

0:31:00.920 --> 0:31:03.400
<v Speaker 2>showing that there are neurons firing in your.

0:31:03.240 --> 0:31:06.720
<v Speaker 3>Brain that precede every behavior that you do.

0:31:06.800 --> 0:31:08.880
<v Speaker 2>Right you imagine, sure, if I want to move my finger,

0:31:08.920 --> 0:31:11.080
<v Speaker 2>there's a neuron that's going to move that makes my

0:31:11.120 --> 0:31:14.280
<v Speaker 2>finger mooove. And when I decide to move my finger,

0:31:14.320 --> 0:31:16.400
<v Speaker 2>there's some neurons that are saying, oh, I'm deciding to

0:31:16.440 --> 0:31:19.280
<v Speaker 2>move my finger. But it turns out that there are

0:31:19.320 --> 0:31:22.240
<v Speaker 2>neurons that are firing in your brain before you make

0:31:22.280 --> 0:31:25.360
<v Speaker 2>the decision to move your finger, about a second before

0:31:25.440 --> 0:31:27.960
<v Speaker 2>you make the decision, and the second before you make

0:31:28.000 --> 0:31:30.400
<v Speaker 2>the decision to say certain words, there are neurons firing

0:31:30.400 --> 0:31:33.120
<v Speaker 2>in your brain to make those words come out. So

0:31:33.600 --> 0:31:36.120
<v Speaker 2>many people think what happens is that the brain has

0:31:36.160 --> 0:31:38.600
<v Speaker 2>independent modules that are functioning and working all the time,

0:31:38.640 --> 0:31:41.320
<v Speaker 2>and they're taking in information processing it spitting out things

0:31:41.360 --> 0:31:44.640
<v Speaker 2>to do, and we behave based on what our brain

0:31:44.680 --> 0:31:48.200
<v Speaker 2>wants us to do. And then afterwards we experience that

0:31:48.320 --> 0:31:50.520
<v Speaker 2>and we create a story as to why we did

0:31:50.560 --> 0:31:53.480
<v Speaker 2>what we did. We move it back in time and

0:31:53.520 --> 0:31:56.440
<v Speaker 2>our brain messes with the time to pretend that we

0:31:56.480 --> 0:31:59.239
<v Speaker 2>had agency and that we create we wanted to do

0:31:59.280 --> 0:32:01.560
<v Speaker 2>that in the first place, but really our brain wanted

0:32:01.600 --> 0:32:03.320
<v Speaker 2>to do it, and that's why it happened.

0:32:03.560 --> 0:32:06.960
<v Speaker 1>In your chapter Unlocking the Brain, you focus on two

0:32:07.120 --> 0:32:12.760
<v Speaker 1>stories that of Jean Dominique Bobie and Stephen Hawking. Why

0:32:12.840 --> 0:32:14.040
<v Speaker 1>those two stories?

0:32:14.280 --> 0:32:17.120
<v Speaker 2>So, Jean Dominique Boubie was an editor of the French

0:32:17.120 --> 0:32:20.440
<v Speaker 2>Ell magazine who had a stroke that left him locked in.

0:32:20.560 --> 0:32:23.320
<v Speaker 2>So what locked in means is there are some places

0:32:23.360 --> 0:32:26.040
<v Speaker 2>you can have a stroke where essentially your entire body

0:32:26.120 --> 0:32:29.240
<v Speaker 2>is paralyzed, so you imagine you're in a wheelchair. Your

0:32:29.320 --> 0:32:34.080
<v Speaker 2>facial musculature is also paralyzed, so you cannot talk. All

0:32:34.200 --> 0:32:36.000
<v Speaker 2>some of these people can do is blink their eyes,

0:32:36.160 --> 0:32:39.240
<v Speaker 2>that's it. But their brains, in terms of their mentation,

0:32:39.400 --> 0:32:43.280
<v Speaker 2>are fully intact. So you're fully aware, fully conscious, but

0:32:43.320 --> 0:32:45.920
<v Speaker 2>you're a prisoner in your own body, and all you

0:32:45.920 --> 0:32:48.520
<v Speaker 2>can do is blink your eyes. So it's really a

0:32:48.560 --> 0:32:54.320
<v Speaker 2>horrible way to live. And John Dominique Boube, he would

0:32:54.360 --> 0:32:57.520
<v Speaker 2>blink his eyes and someone would point at different letters

0:32:57.800 --> 0:32:59.760
<v Speaker 2>on a screen to allow him to communicate, and he

0:32:59.800 --> 0:33:03.640
<v Speaker 2>wrote a book, The Butterfly and the Bell Jar using

0:33:03.680 --> 0:33:06.320
<v Speaker 2>that technique. So the question is how do you get

0:33:06.320 --> 0:33:09.800
<v Speaker 2>information out of a brain when the body can't allow

0:33:09.840 --> 0:33:13.760
<v Speaker 2>that information to escape. And Stephen Hawking had also had

0:33:13.760 --> 0:33:15.840
<v Speaker 2>the same problem. He could move a cheek muscle, and

0:33:15.880 --> 0:33:18.560
<v Speaker 2>so he used his cheek muscle to control a computer

0:33:18.960 --> 0:33:20.880
<v Speaker 2>that would go across too different levels and he would

0:33:20.880 --> 0:33:23.400
<v Speaker 2>stop it when he was trying to sell a certain letter.

0:33:23.520 --> 0:33:27.280
<v Speaker 2>So this leads us to the technology called brain computer interfaces.

0:33:27.280 --> 0:33:29.880
<v Speaker 2>A lot of people have read about with Elon Musk's

0:33:29.920 --> 0:33:33.240
<v Speaker 2>device of the neuralink device, which is basically a chip

0:33:33.280 --> 0:33:37.080
<v Speaker 2>implanted in the brain wires that read the firing of neurons,

0:33:37.440 --> 0:33:41.200
<v Speaker 2>and the neural code can be put into a computer

0:33:41.640 --> 0:33:44.680
<v Speaker 2>and the computer can interpret that neural code, and so

0:33:44.720 --> 0:33:47.480
<v Speaker 2>someone can use the power of their brain alone to

0:33:47.600 --> 0:33:50.760
<v Speaker 2>think and move a cursor on a screen, or type

0:33:50.800 --> 0:33:54.200
<v Speaker 2>letters on a screen, or move a robotic arm, or

0:33:54.240 --> 0:33:57.600
<v Speaker 2>move robotic legs or a full robotic body, or even

0:33:57.720 --> 0:34:00.280
<v Speaker 2>have their thoughts come out by speaking. So if you

0:34:00.320 --> 0:34:03.680
<v Speaker 2>imagine articulating the words you want to say and putting

0:34:03.680 --> 0:34:05.080
<v Speaker 2>electrodes in the part of the brain that move your

0:34:05.120 --> 0:34:09.560
<v Speaker 2>mouth and your tongue, the same neurons will fire every

0:34:09.560 --> 0:34:11.840
<v Speaker 2>time you say the vowel the letter A, and the

0:34:11.880 --> 0:34:12.440
<v Speaker 2>same neuron.

0:34:12.440 --> 0:34:14.160
<v Speaker 3>Different neurons will fire when you say.

0:34:14.120 --> 0:34:16.840
<v Speaker 2>The letter B, or you say this word or that word,

0:34:17.160 --> 0:34:19.800
<v Speaker 2>And so you can learn what those patterns of neuronal

0:34:19.840 --> 0:34:23.600
<v Speaker 2>firing is and correlate it with those different words, so

0:34:23.640 --> 0:34:25.560
<v Speaker 2>that every time you try to say something, the computer

0:34:25.600 --> 0:34:28.200
<v Speaker 2>will learn what you're trying to say, and suddenly someone

0:34:28.239 --> 0:34:31.319
<v Speaker 2>who can't talk can communicate, which is really remarkable.

0:34:31.800 --> 0:34:34.760
<v Speaker 3>So brain computer interfaces will allow human beings.

0:34:34.800 --> 0:34:39.239
<v Speaker 2>The power of telepathy and telekinesis getting ideas out of

0:34:39.239 --> 0:34:42.920
<v Speaker 2>our head merely by thinking about doing different things.

0:34:43.800 --> 0:34:45.839
<v Speaker 3>It's no longer science fiction and science fact.

0:34:46.160 --> 0:34:51.200
<v Speaker 2>It's already going on at several major institutions academic institutions,

0:34:51.200 --> 0:34:53.520
<v Speaker 2>and has been going on for decades. It's just that

0:34:54.040 --> 0:34:57.960
<v Speaker 2>Elon Musk has developed a commercially available device that he's

0:34:58.000 --> 0:35:03.200
<v Speaker 2>trying to sell and improve upon to move that technology forward.

0:35:03.200 --> 0:35:05.880
<v Speaker 2>But it already exists, and it's a fascinating future of

0:35:05.920 --> 0:35:09.320
<v Speaker 2>the human race, and someday we may all have implants

0:35:09.360 --> 0:35:11.719
<v Speaker 2>in our brains that allow us to interact with computers.

0:35:12.000 --> 0:35:14.760
<v Speaker 1>Talk for a bit about work life balance, doctor Schwortz.

0:35:15.080 --> 0:35:17.799
<v Speaker 1>Because your job isn't one you can phone in. You

0:35:17.840 --> 0:35:20.840
<v Speaker 1>can't do it remotely, and it's certainly not a part

0:35:20.880 --> 0:35:25.040
<v Speaker 1>time gig. Talk about work in life, talk about work

0:35:25.080 --> 0:35:28.760
<v Speaker 1>and family. How do you deal with balancing those things?

0:35:28.800 --> 0:35:31.120
<v Speaker 1>It must be a constant struggle.

0:35:31.680 --> 0:35:35.920
<v Speaker 2>There's no question that I was not present for all

0:35:35.960 --> 0:35:38.480
<v Speaker 2>the things that a lot of other parents are present for.

0:35:39.000 --> 0:35:41.560
<v Speaker 2>I rarely ever walked my kids to school. My wife

0:35:41.600 --> 0:35:45.120
<v Speaker 2>always did that. If my kids had a game after school.

0:35:45.120 --> 0:35:47.680
<v Speaker 2>At three point thirty I never went to it, but

0:35:47.840 --> 0:35:49.640
<v Speaker 2>if they had a hockey game, and both my boys

0:35:49.680 --> 0:35:52.399
<v Speaker 2>played hockey at seven o'clock PM, I was at every

0:35:52.440 --> 0:35:54.680
<v Speaker 2>single one and I brought them to practice on the weekends.

0:35:55.080 --> 0:35:58.000
<v Speaker 2>So you can't go to everything, and you can't do everything,

0:35:58.040 --> 0:36:00.400
<v Speaker 2>but you just have to be present enough. You have

0:36:00.440 --> 0:36:02.799
<v Speaker 2>to be there enough, and when you can carve the

0:36:02.840 --> 0:36:04.920
<v Speaker 2>time out, you have to carve the timeout. So you

0:36:05.000 --> 0:36:08.879
<v Speaker 2>have to be able to create that balance when when

0:36:08.880 --> 0:36:11.319
<v Speaker 2>your kids need you to. My wife often would go

0:36:11.320 --> 0:36:14.520
<v Speaker 2>to parties without me, and she learned how to dance

0:36:14.560 --> 0:36:16.840
<v Speaker 2>by herself on the dance floor. But I also, you know,

0:36:16.880 --> 0:36:18.640
<v Speaker 2>spend a lot of time with her when I could,

0:36:18.680 --> 0:36:20.360
<v Speaker 2>and when I was with her, I was very present.

0:36:20.880 --> 0:36:22.960
<v Speaker 2>So the key is to be very present when you're

0:36:23.000 --> 0:36:25.560
<v Speaker 2>there so that when you know you're not there, they

0:36:25.600 --> 0:36:27.920
<v Speaker 2>know that you were there. The other thing that I

0:36:28.040 --> 0:36:29.840
<v Speaker 2>did was I took all my kids into the operating

0:36:29.920 --> 0:36:32.440
<v Speaker 2>room so that they could watch me operate and be

0:36:32.480 --> 0:36:34.640
<v Speaker 2>a part of that experience. So they knew what I

0:36:34.680 --> 0:36:37.040
<v Speaker 2>was doing and they knew how important it was. And

0:36:37.040 --> 0:36:39.279
<v Speaker 2>it wasn't some mysterious thing that took Dad away, but

0:36:39.320 --> 0:36:41.400
<v Speaker 2>it was something that we did together and that we

0:36:41.440 --> 0:36:46.400
<v Speaker 2>could talk about and so they embraced that ultimately and

0:36:46.480 --> 0:36:48.680
<v Speaker 2>felt a part of it, and so they loved it,

0:36:48.800 --> 0:36:50.480
<v Speaker 2>you know when I got called, because they knew that

0:36:50.560 --> 0:36:54.600
<v Speaker 2>I was doing something important, and I think they respected

0:36:54.640 --> 0:36:56.720
<v Speaker 2>and appreciated that, and that helped me do it because

0:36:56.760 --> 0:36:59.160
<v Speaker 2>I had their acceptance, and I had my wife's acceptance

0:36:59.800 --> 0:37:01.719
<v Speaker 2>and no resentment at any time.

0:37:01.760 --> 0:37:04.160
<v Speaker 3>So I was blessed to have a very loving, supportive family.

0:37:04.520 --> 0:37:06.759
<v Speaker 1>I want to close things out, doctor Schwartz, with one

0:37:06.920 --> 0:37:10.000
<v Speaker 1>final reading from your book again about the life of

0:37:10.080 --> 0:37:13.879
<v Speaker 1>a neurosurgeon. Like a priest or Anon, we swear an

0:37:13.880 --> 0:37:17.640
<v Speaker 1>oath to dedicate ourselves to a higher purpose, far greater

0:37:17.719 --> 0:37:20.759
<v Speaker 1>than ourselves, the health of our patients.

0:37:21.520 --> 0:37:22.000
<v Speaker 3>Soldiers.

0:37:22.080 --> 0:37:26.000
<v Speaker 1>Creeds hold true for neurosurgery as well. I will always

0:37:26.000 --> 0:37:30.200
<v Speaker 1>place the mission first. I will never accept defeat. I

0:37:30.239 --> 0:37:33.800
<v Speaker 1>will never quit. And that's something your kids and wife

0:37:34.200 --> 0:37:38.040
<v Speaker 1>can hold close as they think about their father, the

0:37:38.080 --> 0:37:43.840
<v Speaker 1>man they love. And you've been listening to doctor Theodore Schwartz.

0:37:43.920 --> 0:37:47.280
<v Speaker 1>He's the author of Brain Matters, a biography of brain surgery.

0:37:47.680 --> 0:37:51.480
<v Speaker 1>He's also am attending neurological surgeon and professor of neurological

0:37:51.560 --> 0:37:55.440
<v Speaker 1>surgery that Wild Cornell Medicine in New York City, and

0:37:55.480 --> 0:38:00.319
<v Speaker 1>we heard so much, absolutely riveting and fascinating about his

0:38:00.440 --> 0:38:02.600
<v Speaker 1>day to day life. We love to do that. Here

0:38:02.680 --> 0:38:05.680
<v Speaker 1>on this show, the Story of doctor Theodore Schwartz and

0:38:05.840 --> 0:38:13.160
<v Speaker 1>a biography of brain surgery. Here on our American Stories.