Speaker 1: This is Lee Habib, and this is our American stories,
Speaker 1: the show where America is the star and the American
Speaker 1: people up next. Doctor Theodore Schwartz his book Gray Matters,
Speaker 1: a biography a brain surgery. You wrote these words in
Speaker 1: your book about your parents. From my father, I realized
Speaker 1: there was a lot going on in the brain about
Speaker 1: which we were unaware. My mother's war experiences lent an
Speaker 1: air of gravity to my childhood, a sense that no
Speaker 1: matter how well things were going, tragedy lurked around every corner.
Speaker 1: Sounds to me like your mother and father had a
Speaker 1: lot to do with who you were talk about that.
Speaker 2: I was born on the Upper West Side of Manhattan
Speaker 2: in New York City. My father was a Freudian psychoanalyst,
Speaker 2: so I grew up in a very intellectual household.
Speaker 3: He used to spend his weekends.
Speaker 2: Listening to classical music all day long and rereading the
Speaker 2: works of Freud and Shakespeare, and was just a very thoughtful,
Speaker 2: curious man. My mother was a Holocaust survivor, where I
Speaker 2: grew up in the Jewish faith, and she was born
Speaker 2: in Vienna and lost her sister at a very young
Speaker 2: age to meningitis, and then at age twelve, when Hitler
Speaker 2: marched into Vienna, she was kicked out.
Speaker 3: Her father's store was closed.
Speaker 2: And she spent the next five or six years running
Speaker 2: away from the Germans and ended up hiding in a
Speaker 2: convent in Belgium, changing her name to Simon Mabier from
Speaker 2: Mars Schwartz, speaking French from her original German, until she
Speaker 2: eventually came to America. She met an American soldier and
Speaker 2: moved to Kalamazoo. Michig again lived as a Christian in
Speaker 2: America for a little while and realized that wasn't really.
Speaker 3: Who she was.
Speaker 2: I think she was trying to forget her past, and
Speaker 2: then eventually moved to New York and met my dad,
Speaker 2: who was a psychiatrist at Albert Einstein College of Medicine
Speaker 2: in the Bronx. I think we're all influenced by our environment,
Speaker 2: and so writing a little bit about my parents and
Speaker 2: how they may have influenced me, it's hard for us
Speaker 2: to know what those impacts will be, right. My brother
Speaker 2: grew up in the same household that I grew up
Speaker 2: in and grew up into a very different human being
Speaker 2: than I am.
Speaker 3: He's a lovely human being, but very different.
Speaker 1: We talk a lot about turning points in people's lives
Speaker 1: on this show, and you had a serious one in
Speaker 1: high school. Talk about the woman trapped into her car
Speaker 1: by snowplows, and how did that experience affect you, talk
Speaker 1: about its impact.
Speaker 2: So I was walking to school one morning in high school,
Speaker 2: probably you know, a junior, maybe I was fifteen, sixteen
Speaker 2: years old. And in Manhattan, when it snows, the snowclouds
Speaker 2: come by to plow the roads and the streets, and
Speaker 2: all the cars are parked on the side of the streets.
Speaker 2: And so when the snow clouds do that, they basically
Speaker 2: box in all the cars. Who now have you know,
Speaker 2: a foot two feet, three feet, sometimes four feet of
Speaker 2: snow boxing their car in, And it can be very
Speaker 2: challenging to get your car onto the road in the morning.
Speaker 3: And so I was walking to work and there was
Speaker 3: a woman who was.
Speaker 2: Stuck, and you know, her wheels were spitting, and the
Speaker 2: snow was flying everywhere, and it was just slush at
Speaker 2: this point, and she could not get her car out
Speaker 2: onto the road. And I saw that she was in need,
Speaker 2: and I dropped my knapsack on the ground and I
Speaker 2: ran over and started pushing her car to help her
Speaker 2: free herself. And she got out and she waved to
Speaker 2: me and said thanks, and drove on with her day.
Speaker 2: And I'll never forget that moment because I just felt
Speaker 2: so good about myself that I had helped somebody in
Speaker 2: need who didn't know who I was, and I didn't
Speaker 2: know who they were, and I wasn't getting anything but
Speaker 2: a thank you from them, but it meant so much
Speaker 2: to me. And I left that experience thinking, Wow, I
Speaker 2: really want to do a job where I get to
Speaker 2: help people every day and they'll say thank you.
Speaker 1: Before we talk about what it's like to be a
Speaker 1: brain surgeon, let's talk for a moment about what it
Speaker 1: takes to become one who chooses this line of work.
Speaker 1: You separate them into a few categories, talk about the
Speaker 1: character traits, talk about the types of people who choose
Speaker 1: your line of work.
Speaker 2: I tried to think back on the different personalities that
Speaker 2: I know neurosurgeons that I know, and I kind of
Speaker 2: created categories that are sort of like the lunch room
Speaker 2: tables in a high school, where you have the nerds
Speaker 2: and the jocks and the musicians, and those are, in
Speaker 2: fact people who go into neurosurgery for different reasons. So
Speaker 2: some are nerds they're interested in neuroscience that work in labs.
Speaker 2: Some are athletes who like to be the center of attention.
Speaker 2: Neurosurgery is a very physical activity and you need a
Speaker 2: lot of stamina, you need a lot of focus. It's
Speaker 2: a manual task where you're affecting the world around you.
Speaker 2: So there are a lot of athletes that go into neurosurgery.
Speaker 2: And then there are also musicians who love to practice
Speaker 2: their instruments.
Speaker 3: You know, there's a lot of manual.
Speaker 2: Dexterity and surgery which is the same as many instruments
Speaker 2: that people play.
Speaker 3: And the ability to sit and practice your.
Speaker 2: Instruments for hours on end translates very well into neurosurgery.
Speaker 2: And every surgery we do is like a performance, you know,
Speaker 2: we have to perform. And then there are also people
Speaker 2: touched by neurosurgery. And there are quite a few neurosurgeons
Speaker 2: who had a parent who died of a brain tumor
Speaker 2: or an aneurysm, or who maybe their parent was a
Speaker 2: neurosurgeon and they didn't see them.
Speaker 3: That much or they shadowed them around the hospital. But
Speaker 3: those are the.
Speaker 2: Trends that I've seen. And as for myself. I was
Speaker 2: definitely a little bit of a nerd, you know. I
Speaker 2: was reading astronomy books when I was in high school
Speaker 2: and wanted to be an astronaut. But I was also
Speaker 2: an athlete. I played on the football team, and I
Speaker 2: was a musician. I played bass in the jazz band.
Speaker 2: So I definitely had a little bit of each one
Speaker 2: of those elements. And my dad was a psychoanalyst, so
Speaker 2: he got me interested in the brain and memory and
Speaker 2: how the brain works.
Speaker 1: And you've been listening to doctor Theodore Schwartz. He's the
Speaker 1: author of Gray Matters, a biography of brain surgery. He's
Speaker 1: also an attending neurological surgeon and professor of neurological surgery
Speaker 1: at wild Cornell Medicine, one of the busiest and highest
Speaker 1: ranked neurosurgery centers in the world, located in New York City.
Speaker 1: And the story about his mom alone could have been
Speaker 1: a movie now. The fact that she escaped Nazis for years,
Speaker 1: wound up in Holland, learning how to speak French to
Speaker 1: disguise her accent, disguise her German and Jewish background, ultimately
Speaker 1: marrying someone Christian and moving to the Midwest, only to
Speaker 1: discover who she really was, discovering her identity and ending
Speaker 1: up married and in New York to a second husband,
Speaker 1: and my goodness. We learn also about the turn point
Speaker 1: in doctor Schwartz's life, and it's that woman caught and
Speaker 1: trapped by the snowplows in New York City and how
Speaker 1: he felt afterwards. I didn't know who they were, they
Speaker 1: probably didn't know who I was. But that feeling he got,
Speaker 1: that's what well propelled him into the life he chose
Speaker 1: in the end, the feeling he must get to help
Speaker 1: a stranger when we come back more of the life
Speaker 1: of doctor Theodore Schwartz here on our.
Speaker 3: American Stories.
Speaker 1: Lieh Habib here, and I'd like to encourage you to
Speaker 1: subscribe to Our American Stories on Apple podcasts, the iHeartRadio app,
Speaker 1: or wherever you get our podcasts, and a story you
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Speaker 1: daily again, Please subscribe to the Our American Stories podcast
Speaker 1: anywhere you get your podcasts. It helps us keep these
Speaker 1: great American stories coming. And we return to our American
Speaker 1: Stories and doctor Theodore Schwartz, author of Great Matters, a
Speaker 1: biography of brain surgery. Go to Amazon and the usual
Speaker 1: suspects to get it. You won't put it down, you
Speaker 1: won't be sorry. Let's pick up where we last left off.
Speaker 1: We talk about failure a lot on this show, and
Speaker 1: you write about it in your book. Talk about how
Speaker 1: neurosurgeons learn and what role failure plays in your learning curve.
Speaker 2: Well, you know, in neurosurgery, you know it's a seven
Speaker 2: year training program for a reason, right, and when you
Speaker 2: start out you don't get to do that much. You're
Speaker 2: basically an assistant. But the truth is the public wants
Speaker 2: their neurosurgeons to When you emerge from a neurosurgery training program,
Speaker 2: you can basically hang your shingle and you are credentialed
Speaker 2: to perform brain surgery on your own. So the question
Speaker 2: is how do you teach someone to perform brain surgery
Speaker 2: on your own? And at the same time, when you're
Speaker 2: a patient, you do not want anyone practicing on you,
Speaker 2: and so you have to somehow give these trainees graded
Speaker 2: responsibility in a safe way, letting them do slightly more
Speaker 2: in each operation, making sure that anything that they do,
Speaker 2: you're there watching them do it unless you're one hundred
Speaker 2: percent sure they can do it. Essentially as well as
Speaker 2: you can do it, and then I never let the
Speaker 2: residents do certain things that I cannot reverse and that
Speaker 2: I cannot fix, because I would have to live with
Speaker 2: myself if there were a failure.
Speaker 3: But there's very strong mentorship and guidance.
Speaker 2: It's like a driving test where the driver is sitting
Speaker 2: right next to you, you know, holding the steering wheel,
Speaker 2: and if God forbid, something goes wrong, you know you
Speaker 2: can take over. Learning from failure as a surgeon is
Speaker 2: a whole other different conversation, and I do write about this.
Speaker 2: You know, there's a conflict between confidence in humility and
Speaker 2: arrogance and humility, and.
Speaker 3: You sort of have to be both at the same time.
Speaker 2: I think most great surgeons are are simultaneously arrogant and humble,
Speaker 2: because you have to believe in your heart that you're
Speaker 2: the best person to do this operation, and you have
Speaker 2: to become the best person you can be to do
Speaker 2: that operation. And with that training and experience comes a
Speaker 2: certain amount of arrogance. You have to convince the patient
Speaker 2: I can do this, I can take care of you.
Speaker 2: I'm the right person for the job. At the same time,
Speaker 2: no matter how good you are, every neurosurgeon who does
Speaker 2: complex neurosurgery will have complications and failures.
Speaker 3: It's inevitable.
Speaker 2: And we say, if you haven't had a complications because
Speaker 2: you're not doing complicated operations. And that creates a lot
Speaker 2: of humility because you can't become arrogant, you can't lose
Speaker 2: your focus, you can't assume that things are going to
Speaker 2: go well. I'm always assuming that something's going to go
Speaker 2: wrong in every operation, and I'm always thinking what can
Speaker 2: I do to prevent this from going wrong. That's just
Speaker 2: my attitude with everything I do. And it makes you very,
Speaker 2: very humble, And by being humble, that's how you get better.
Speaker 2: I am better, you know, thirty years out than I was,
Speaker 2: twenty five years out than I was twenty years out
Speaker 2: than fifteen.
Speaker 1: Let's talk about head trauma, because, as you put it,
Speaker 1: it's the bread and butter of your profession, in the
Speaker 1: same way that skateboards and trampolines of the bread and
Speaker 1: butter of your orthopedic surgeon colleagues talk about head trauma,
Speaker 1: what is it? And how many people are your die
Speaker 1: from head trauma? And while we're at it, tell the
Speaker 1: story of the Swiss Army knife.
Speaker 2: So we separate head trauma into blunt head trauma and
Speaker 2: penetrating head trauma and blunt heead trauma is you know,
Speaker 2: let's say you're in a car accident and your head
Speaker 2: hits the steering wheel where you're playing football in your
Speaker 2: helmeted head to hit someone else's head, or a baseball
Speaker 2: hits your head, it's blunt penetrating of course, is a
Speaker 2: gunshot wound, an arrow wound, or a knife wound or
Speaker 2: something like that. And they're very different, and they affect
Speaker 2: the brain and the skull very very differently. And as
Speaker 2: you can imagine, a lot of neurosurgeons in the early
Speaker 2: part of the twentieth century and surgeons before that, would
Speaker 2: attend to soldiers on the battlefield and there were a
Speaker 2: lot of injuries, and so a lot of what we
Speaker 2: learned was learned on the battlefield, and our field developed
Speaker 2: taking care of head injuries. And we've been very involved
Speaker 2: also in designing football helmets and motorcycle helmets and the
Speaker 2: baseball helmet. All of these things, at one time or
Speaker 2: another were designed by brain surgeons to protect the brain,
Speaker 2: because that's our job. We have to fix the brain,
Speaker 2: but we also have to prevent head injuries from occurring.
Speaker 2: In the first place, and there was one case who
Speaker 2: had a Swiss Army knife, which is not a big knife.
Speaker 2: You don't think of a Swiss Army knife as a
Speaker 2: lethal knife. But it turns out there's a part of
Speaker 2: the skull right under the temple. There's muscle here, but
Speaker 2: the bone is about a millimeter thick right behind the eye,
Speaker 2: and if you were to jam a knife in right
Speaker 2: there hard enough, you can penetrate the skull fairly easily.
Speaker 2: And this gentleman came into the emergency room literally with
Speaker 2: a Swiss Army knife sticking out of his head, and
Speaker 2: it turns out the tip of the knife is very
Speaker 2: close to a critical artery called the internal carotid artery,
Speaker 2: so we had to do a full crannyotomy because we
Speaker 2: can just pull it out because if you pull it out,
Speaker 2: you might have sheared the artery and actually have someone
Speaker 2: pull it out while I was staring at the ordery
Speaker 2: after opening up his head. And we did manage to
Speaker 2: save his life, but he was essentially handcuffed to his
Speaker 2: gurney with a police officer at his side because he
Speaker 2: was involved in some nefarious activities. So I never really
Speaker 2: figured out what happened or why it happened to him.
Speaker 1: I want to talk next about those initial office visits
Speaker 1: by the patient. You describe them so beautifully in the book.
Speaker 1: I want you to do a reading from a passage,
Speaker 1: and if you could set the passage up.
Speaker 2: The initial office visit, in fact, can be surreal. At
Speaker 2: this early stage. The patient is often minimally symptomatic. They're
Speaker 2: obviously aware that something is growing in their brain. They
Speaker 2: sought out medical care, after all, and they know it
Speaker 2: needs to be removed. They're also often scared and unsure
Speaker 2: of what lies ahead or what it all means. Commonly,
Speaker 2: they're frequently somewhat oblivious to the gravity of the situation.
Speaker 3: This is all new to them.
Speaker 2: But as I listened to their questions, I see things
Speaker 2: they are not yet capable of seeing, let alone processing.
Speaker 2: See the mother of three young children who will not
Speaker 2: make it to their high school graduation. I see the
Speaker 2: father and sole provider for a family of teenagers with
Speaker 2: college payments looming, who will not be walking his daughter
Speaker 2: down the aisle.
Speaker 3: I see the.
Speaker 2: Hedge fund manager who is sitting on top of the
Speaker 2: world planning his retirement and next lavish vacation, who will
Speaker 2: soon be closing his fund. He's about to lose not
Speaker 2: only his long anticipated opportunity to spend his money, but
Speaker 2: his ability to bathe and feed himself. And yes, thinking
Speaker 2: of others' deaths can be debilitating. It's even the most
Speaker 2: hardened of us surgeons giving bad news. Seeing families crumple
Speaker 2: from the oncoming train bearing down on them. As I
Speaker 2: stare into the void imagining their future, I want to
Speaker 2: stand up and scream at the top of my lungs,
Speaker 2: or collapse on the ground in a flood of tears.
Speaker 3: I do none of this, of course.
Speaker 2: My job at this moment is to fight this battle
Speaker 2: with every fiber in my body and shepherd these victims
Speaker 2: of nature's callous and indifferent design. I believe in revealing
Speaker 2: the truth to my patient's prognosis at a slow and
Speaker 2: deliberate pace, but I also never ever take away their
Speaker 2: most powerful weapon.
Speaker 3: Hope.
Speaker 2: We're not talking about false hope, as in, we're going
Speaker 2: to beat this thing, but rather true hope, a concept
Speaker 2: introduced by Jerome Groupman in his book The Anatomy of Hope,
Speaker 2: how people prevail in the face of illness.
Speaker 3: True hope sounds more like this.
Speaker 2: They're a small group of long term survivors, and I'm
Speaker 2: going to do everything in my power to give you
Speaker 2: the best chance of being one of them, or even
Speaker 2: your remaining days with your family can be beautiful, maybe
Speaker 2: even more beautiful than all the days that have come before.
Speaker 1: Let's talk about the surgery itself. You're right about the
Speaker 1: fact that sometimes the patient needs to stay awake during
Speaker 1: brain surgery.
Speaker 3: Does the patient feel pain?
Speaker 1: Why do they stay awake?
Speaker 2: Yeah, If you watch your feeds on Facebook or Instagram,
Speaker 2: every once in a while, you go see like a
Speaker 2: patient having brain surgery is playing the violin, or they're
Speaker 2: playing the guitar, or they're reciting Shakespeare, and people are
Speaker 2: excited by that. We have to do surgery awake sometimes,
Speaker 2: and I'll talk about how, But first is why if
Speaker 2: a tumor is very close to part of the brain
Speaker 2: is important for a speech and language. The neurons that
Speaker 2: allow you to speak are in a different location in
Speaker 2: every human being. We know roughly where they are, but
Speaker 2: we don't know exactly where they are, and so there's
Speaker 2: some tumors that sit in the areas that can be
Speaker 2: very very close to parts of the brain that are
Speaker 2: critical for speech and the only way to know it
Speaker 2: in this day and age with confidence is to have
Speaker 2: your patient awaken the operating room, having them doing a
Speaker 2: language tasks, so they're reading, they're naming objects, they're talking,
Speaker 2: and you stimulate their brain with an electrode. And stimulating
Speaker 2: the brain in that way basically knocks out a small
Speaker 2: area of brain. It stops that brain bit from being
Speaker 2: able to function. So you move the electrode around and
Speaker 2: you map out where their speech areas are, and when
Speaker 2: you hit an area that's important for speech, the patient
Speaker 2: will be able to talk. So if you show them
Speaker 2: a picture of a car or a pen, they'll say
Speaker 2: this is a and they'll stutter and they'll have trouble
Speaker 2: getting the word out. And then you lift the electrode
Speaker 2: up and they'll go a pen. And it's crazy to
Speaker 2: think that you can cause that in someone else's brain
Speaker 2: just by a stick mulating a particular area. So that
Speaker 2: allows us to do our surgeries more safely. How we
Speaker 2: do it is that we give people ivy anesthesia, so
Speaker 2: we make them sleepy when we're doing the opening, because
Speaker 2: when you open the skull and the scalp, you know,
Speaker 2: it's more like carpentry.
Speaker 3: The microsurgery.
Speaker 2: We do later on is more like Swiss watchmaking, but
Speaker 2: getting in and out of the skull is really blue
Speaker 2: collar labor to some extent. During that period of time,
Speaker 2: they're asleep and we num the scalp with a lot
Speaker 2: of local anesthesia. Surprisingly, when you open up the brain,
Speaker 2: the brain has no sensory or pain fibers, so if
Speaker 2: someone is touching.
Speaker 3: Your brain, you won't feel anything. There's no pain, there's
Speaker 3: no sense of someone touching you.
Speaker 2: Only your skin has these touch fibers that you feel
Speaker 2: when you touch the skin, but.
Speaker 3: Your brain does not have them.
Speaker 2: So we can operate on the brain and the patient
Speaker 2: feels absolutely nothing.
Speaker 1: The story of biography, and we continue with our American
Speaker 1: stories and with doctor Theodore Schwartz. He's the author of
Speaker 1: Gray Matters, a biography of brain surgery. It's part memoir
Speaker 1: and it's part history, and that is the history of
Speaker 1: brain surgery and in some ways our understanding of the brain.
Speaker 1: Let's pick up where we last left off. You note
Speaker 1: in the book, by the way, that the human brain
Speaker 1: feels a lot like a sponge. That's for anyone wondering
Speaker 1: what the brain actually feels like. What I also learned
Speaker 1: is that you've removed nearly ten thousand brain tumors, but
Speaker 1: not all of those surgeries, and with good news, talk
Speaker 1: about breaking the bad news to a patient. In fact,
Speaker 1: if you wouldn't mind reading from a passage you wrote about,
Speaker 1: it was so poignant, it was so moving.
Speaker 3: So I take my cues from them.
Speaker 2: I usually start the conversation with a clear presentation of
Speaker 2: the facts. I may say that the preliminary diagnosis showed
Speaker 2: what we feared, that the tumor is in fact malignant.
Speaker 2: I prefer to use the words we and us. I
Speaker 2: also emphasize whatever positives I can. The good news is
Speaker 2: that the surgery went extremely well and we got out
Speaker 2: as much tumor as could safely be removed.
Speaker 3: Although it's a.
Speaker 2: Tough tour to be the surgery puts US in the
Speaker 2: best place going forward to attack the microscopic disease invariably
Speaker 2: left behind. I then tell them that they will likely
Speaker 2: need radiation and chemotherapy, the standard of care and treating glioblastomas,
Speaker 2: and that we will find them the most experienced neurooncologists
Speaker 2: to help coordinate the next stage of this process. While
Speaker 2: our neuraloncologists at Cornell are some of the best in
Speaker 2: the world. Patients often want second opinions, so I let
Speaker 2: them know we will help them get their records together
Speaker 2: to send wherever they'd like. Patients often express a fear
Speaker 2: of telling you they want a second opinion, as if
Speaker 2: they're cheating on their spouse or insulting a relative.
Speaker 3: You never want.
Speaker 2: Anyone looking back as the end approaches, feeling that they
Speaker 2: didn't do everything in their power to find the right treatment,
Speaker 2: didn't explore all the options, or left a stone unturned.
Speaker 2: I've witnessed only a handful of medical mirror in my career.
Speaker 2: Tumors that miraculously shrank without any treatment, long term survivors
Speaker 2: of fatal diseases. What's the explanation? We just don't know,
Speaker 2: But these cases do provide some room for hope. The
Speaker 2: patients I've treated who are still alive five, ten, or
Speaker 2: even fifteen years after a GBM diagnosis are a rare
Speaker 2: reminder that my degree and years of experience go only
Speaker 2: so far. What makes these long term survivors so special?
Speaker 2: What did they do to beat the odds? Another frequent
Speaker 2: question my malignant tumor patients ask is why me?
Speaker 3: Was it anything I did? It's human nature?
Speaker 2: To attempt to find cause for suffering, to create order
Speaker 2: out of chaos, to shake our fist at the randomness
Speaker 2: of fate. Often my patients will place blame on environmental exposures,
Speaker 2: such as smoking power lines or toxic chemicals released by
Speaker 2: a local factory. They also worry that their brain termor
Speaker 2: might have been inherited and will be passed to future generations.
Speaker 2: Both fears are somewhat legitimate. Most brain canswers are triggered
Speaker 2: by some random and little understood series of events that
Speaker 2: either alters their DNA within the nucleus of brain cells
Speaker 2: or misilignes the careful balance of proteins that promote and
Speaker 2: suppressed cell growth. I therefore try to emphasize to my
Speaker 2: patients that they did nothing to bring this upon themselves.
Speaker 3: There is no one to blame or resent, and there's no.
Speaker 2: Reason to feel guilty that their children might be at
Speaker 2: a higher risk of the same fate. As scientifically unsatisfying
Speaker 2: as the answer may be, the cause for most brain
Speaker 2: tumors is just plain old bad luck.
Speaker 1: I want to go next to the choices you have
Speaker 1: to make as the surgeon while the patient is under
Speaker 1: You write about this beautifully because in the end it
Speaker 1: boils down to your choice. The patient depends on your talents,
Speaker 1: your experience, and your knowledge. Talk about the burdens of
Speaker 1: that responsibility and also the exhilaration of that responsibility.
Speaker 2: Well, there's a moment that comes a couple hours into
Speaker 2: an operation, when you're getting tired. You've been there for
Speaker 2: a while, You've debulked a lot of the tumor, and
Speaker 2: maybe at that point there's a little bit that's left.
Speaker 2: There may be pardon you can't see it very well.
Speaker 2: It could be obscured by an artery or vein, some
Speaker 2: normal anatomy that's in the way. It could be very
Speaker 2: stuck to an artery or vein, And you have to
Speaker 2: figure out how aggressive do you want to be. Do
Speaker 2: I want to try to get every last bit of
Speaker 2: this tumor out, which potentially could cure the patient, or
Speaker 2: if I leave.
Speaker 3: Some behind, it could grow back and they might need
Speaker 3: another surgery.
Speaker 2: But if I'm too aggressive trying to get that last
Speaker 2: bit of tumor off and I damage a nerve or
Speaker 2: an artery or vein, it could be catastrophic for the patient.
Speaker 3: And so I have to make that decision at that moment.
Speaker 2: In time, and I sort of question, who am I
Speaker 2: to make that decision?
Speaker 3: Right?
Speaker 2: It's not my body? You know, why do I have
Speaker 2: this responsibility?
Speaker 3: Is it fair? Is it right?
Speaker 2: But the truth is, if it's not me, you know,
Speaker 2: who is it going to be? Who's going to make
Speaker 2: the decision at that moment in time. I'm the best
Speaker 2: qualified person to do it because I'm physically there.
Speaker 3: I've dissected down to the tumor.
Speaker 2: I've done it hundreds of times before and trained to
Speaker 2: do this.
Speaker 3: So I need to make this decision.
Speaker 2: And ultimately I say to myself, well, if this were
Speaker 2: me on the table, what would I want done? And
Speaker 2: that's what I do.
Speaker 1: There are a lot of famous names and patients in
Speaker 1: your book, doctor Schwartz, and I want you to talk
Speaker 1: about one, to talk about Rosemary Kennedy, and I want
Speaker 1: you to talk about lobotomies.
Speaker 2: I knew nothing about lobotomies when I trained in neurosurgery.
Speaker 2: We didn't hear anything about the surgery, didn't know anything
Speaker 2: about the history, why I was done, who it was
Speaker 2: done on, how many were done. I saw it as
Speaker 2: sort of a skeleton in our closet that neurosurgeons really
Speaker 2: didn't talk about. There were sixty thousand in frontal lobotomies
Speaker 2: done in America in the nineteen fifties and nineteen sixties,
Speaker 2: which is a remarkably high number.
Speaker 3: You have to understand the context. At the time.
Speaker 2: There was no treatment for psychiatric illness, so people who
Speaker 2: had severe schizophrenia depression would just sit in the hallways
Speaker 2: of mental institutions that were filling with these patients with
Speaker 2: no way to treat them. And some of the treatments
Speaker 2: were also barbaric. They would, you know, submerge them in
Speaker 2: ice cold water, or shock them, or give them insulin
Speaker 2: and lower their glucose, so they're essentially torturing these patients.
Speaker 2: The surgery itself was developed mostly by neurologists and psychiatrists.
Speaker 2: I found out it really was not a surgery developed
Speaker 2: by neurosurgeons. A guy named Burkhardt did the first years ago,
Speaker 2: and then Mones was a neurologist, won the Nobel Prize
Speaker 2: believe it or not, for the front of the botomy
Speaker 2: that was based on very little scientific basis. And then
Speaker 2: there was a gentle named Walter Freeman who was also
Speaker 2: a neurologist, and he started doing the Bottomi's in America.
Speaker 3: He started out working with a neurosurgeon and.
Speaker 2: Where they would drill burholes at the top of the
Speaker 2: head and put essentially a butter knife down into the
Speaker 2: brain and sweep it back and forth on each side
Speaker 2: to disconnect the frontal part of the brain from the
Speaker 2: back of the brain. He didn't like relying on a neurosurgeon.
Speaker 2: He wanted to be able to do it on his own.
Speaker 2: He didn't want to have to rely on anesthesiologists. He
Speaker 2: was a neurologist. He had no credentials to perform surgery.
Speaker 2: So he ran about an Italian neurosurgeon who did a
Speaker 2: procedure basically taking an ice pick and lifting the upper
Speaker 2: lid of the eye and taking the ice pick, putting
Speaker 2: it under the eyelid and cracking through the skull into
Speaker 2: the frontal lobe and sweeping it back and forth. And
Speaker 2: he could do one of these procedures in about ten minutes.
Speaker 2: He would charge twenty five dollars for it. He would
Speaker 2: do six or seven in a day. He would do
Speaker 2: it with no antiseptic theesia. He would actually give a
Speaker 2: lecture shock therapy to the patients to put them under
Speaker 2: and then he would do this procedure and he would
Speaker 2: have people around him, and he publicized it, and he
Speaker 2: traveled all around the country doing I think he personally
Speaker 2: did about four thousand lobotomies, this guy, Walter Freeman. And
Speaker 2: the truth is, there were some people who got better,
Speaker 2: and there were a few neurosurgeons who studied the lobotomy
Speaker 2: who sort of scientifically said, all right, we're going to
Speaker 2: do this right, We're going to do it cleanly. And
Speaker 2: at least a third of the patients really got better
Speaker 2: from the lobotomies, but two thirds of them didn't, and
Speaker 2: some patients were really damaged, severely damaged. Me and Rosemary
Speaker 2: Kennedy was one of those. So Walter Freeman did her lobotomy.
Speaker 2: Many people didn't know she had a lobotomy. Her brothers
Speaker 2: and sisters didn't really know. Joe Kennedy basically just took
Speaker 2: her to have this done. They were hiding her mental
Speaker 2: illness at the time. It was very shameful that she
Speaker 2: had mental illness at the time. And when she emerged
Speaker 2: from the lobotomy, you know, she was essentially a vegetable.
Speaker 2: She had regressed dramatically. She was like a little child
Speaker 2: and she was institutionalized after that. But what the lobotomy
Speaker 2: did dude for neurosurgery was it promoted the development of
Speaker 2: a lot of new technique. So a lot of the
Speaker 2: things we do now, the focal delivery of radiation called
Speaker 2: stereotactic radio surgery, the implantation of deep brain electrodes which
Speaker 2: we use to treat Parkinson's disease and obsessive compulsive disorder
Speaker 2: and epilepsy, and the stereotactic.
Speaker 3: Radiation which we can use to treat tumors.
Speaker 2: And facial pain. All of those things those were developed
Speaker 2: by surgeons trying to improve on the frontal lobotomy because
Speaker 2: they realized it was a sort of grotesque, imprecise.
Speaker 3: Operation and they wanted to figure out a better way
Speaker 3: to do it.
Speaker 2: So they developed all these new techniques and then realized
Speaker 2: they could use all these techniques to treat other neurologic diseases,
Speaker 2: and we still use those techniques today. So the frontal
Speaker 2: a body that was a horrific moment in time where
Speaker 2: we rashly adopted a surgery before it was well vetted,
Speaker 2: but it propelled the feel forward fairly dramatically into a
Speaker 2: lot of what modern neurosurgery is about today.
Speaker 1: That is so true, about so much we learn in
Speaker 1: the field of medicine, the bad and the good, and
Speaker 1: my goodness, I just remember first hearing about a lobotomy
Speaker 1: when I was an English major in college Tennessee. Williams
Speaker 1: had to in the end give the go ahead to
Speaker 1: give his sister Rose a full frontal lobotomy. He never
Speaker 1: recovered from it.
Speaker 3: And when we come.
Speaker 1: Back more of the biography of brain surgery, the author
Speaker 1: of the book Gray Matters is doctor Theodore Schwartz. More
Speaker 1: with doctor Schwartz after these messages, and we continue with
Speaker 1: our American stories and with doctor Theodore Schwartz, the author
Speaker 1: of Gray Matters, a Biography of Brain Surgery. Let's pick
Speaker 1: up where we last left off. Chapter fourteen is especially compelling.
Speaker 1: The title alone is compelling. What's it like to be
Speaker 1: a brain? But you dive into the human experience, the
Speaker 1: human tragedy of the end of life. We've all had
Speaker 1: grandparents and parents who suffered from loss of memory, dementia,
Speaker 1: and worse. Talk about that.
Speaker 2: So philosophically, we talk about the brain, and we talk
Speaker 2: about the mind as a separate entity, and we like
Speaker 2: to imagine and common sense tells us and our intuition
Speaker 2: tells us that we can make decisions, our mind can
Speaker 2: make decisions that will have an impact on the physical
Speaker 2: world around us, and that.
Speaker 3: We control our behaviors. But there is no such thing
Speaker 3: as mind.
Speaker 2: There's no mysterious substance that we have yet to identify
Speaker 2: by science that is mind. All we know of is
Speaker 2: brain in neurons and neurons firing that somehow creates our
Speaker 2: experience of what it is like to be ourselves, and
Speaker 2: our identity is very much a part of that. We
Speaker 2: feel like we have an identity, we have a past,
Speaker 2: we have a future, But the truth is the self
Speaker 2: and who we are, and the decisions that we make
Speaker 2: are all based in the mind.
Speaker 3: And the mind is a physical organ that controlled by
Speaker 3: the laws of.
Speaker 2: Physics, and the laws of physics do not allow for
Speaker 2: there to be a mind, a substance that has a
Speaker 2: cause and effect, because the only thing that can have
Speaker 2: a cause is another physical substance. So there are a
Speaker 2: number of neurosurgical operations that have been done and experiments
Speaker 2: done during brain surgery that lead us to believe that
Speaker 2: our concept of the self is not what we think
Speaker 2: it is. For example, if the brain creates the mind
Speaker 2: and the self, and we can do an operation where
Speaker 2: we take the two halves of our brain and basically
Speaker 2: split them in half and cut the connections, so you
Speaker 2: have two independent brains that can think independently in your head.
Speaker 2: You would think that someone would feel like there's two selves,
Speaker 2: but they don't. They actually still feel like they only
Speaker 2: have one self. So how is it possible to have
Speaker 2: two brains and only one self? You can remove an
Speaker 2: entire hemisphere of the brain in someone and they will
Speaker 2: wake up and feel like their whole.
Speaker 3: They don't feel like.
Speaker 2: They're half the person that they were before. So there's
Speaker 2: clearly a dis connect between this physical thing brain and
Speaker 2: this construct we have of the self. And the truth
Speaker 2: is that who we are is changing constantly based on
Speaker 2: our experiences, and we lose thousands of neurons every day
Speaker 2: we make new connections, and so that creates our identity.
Speaker 2: And it is possible to change someone's identity either because
Speaker 2: they have a stroke and they forget who people are,
Speaker 2: like the man who mistook his wife for a hat
Speaker 2: doesn't recognize his wife anymore. You can put electrodes in
Speaker 2: someone's brain, and this has been well described, and change
Speaker 2: the way they feel, change their moods, make them happier,
Speaker 2: make them sadder, give them brain fog. One pasion had
Speaker 2: an electro putting their brain and they turned it on
Speaker 2: and suddenly they started enjoying the music of Johnny Cash.
Speaker 2: And they turned it off and they didn't like Johnny
Speaker 2: Cash anymore. And so if you can trigger things that
Speaker 2: we think of as our identity, right, I think of
Speaker 2: myself as someone who likes certain things and dislikes some
Speaker 2: certain things, that's who I am. If I can change
Speaker 2: those things just by stimulating your brain or triggering your brain,
Speaker 2: what does that mean about who you are and who
Speaker 2: you think you are. The other fascinating thing that I'll
Speaker 2: just briefly talk about is there's a lot of data
Speaker 2: showing that there are neurons firing in your.
Speaker 3: Brain that precede every behavior that you do.
Speaker 2: Right you imagine, sure, if I want to move my finger,
Speaker 2: there's a neuron that's going to move that makes my
Speaker 2: finger mooove. And when I decide to move my finger,
Speaker 2: there's some neurons that are saying, oh, I'm deciding to
Speaker 2: move my finger. But it turns out that there are
Speaker 2: neurons that are firing in your brain before you make
Speaker 2: the decision to move your finger, about a second before
Speaker 2: you make the decision, and the second before you make
Speaker 2: the decision to say certain words, there are neurons firing
Speaker 2: in your brain to make those words come out. So
Speaker 2: many people think what happens is that the brain has
Speaker 2: independent modules that are functioning and working all the time,
Speaker 2: and they're taking in information processing it spitting out things
Speaker 2: to do, and we behave based on what our brain
Speaker 2: wants us to do. And then afterwards we experience that
Speaker 2: and we create a story as to why we did
Speaker 2: what we did. We move it back in time and
Speaker 2: our brain messes with the time to pretend that we
Speaker 2: had agency and that we create we wanted to do
Speaker 2: that in the first place, but really our brain wanted
Speaker 2: to do it, and that's why it happened.
Speaker 1: In your chapter Unlocking the Brain, you focus on two
Speaker 1: stories that of Jean Dominique Bobie and Stephen Hawking. Why
Speaker 1: those two stories?
Speaker 2: So, Jean Dominique Boubie was an editor of the French
Speaker 2: Ell magazine who had a stroke that left him locked in.
Speaker 2: So what locked in means is there are some places
Speaker 2: you can have a stroke where essentially your entire body
Speaker 2: is paralyzed, so you imagine you're in a wheelchair. Your
Speaker 2: facial musculature is also paralyzed, so you cannot talk. All
Speaker 2: some of these people can do is blink their eyes,
Speaker 2: that's it. But their brains, in terms of their mentation,
Speaker 2: are fully intact. So you're fully aware, fully conscious, but
Speaker 2: you're a prisoner in your own body, and all you
Speaker 2: can do is blink your eyes. So it's really a
Speaker 2: horrible way to live. And John Dominique Boube, he would
Speaker 2: blink his eyes and someone would point at different letters
Speaker 2: on a screen to allow him to communicate, and he
Speaker 2: wrote a book, The Butterfly and the Bell Jar using
Speaker 2: that technique. So the question is how do you get
Speaker 2: information out of a brain when the body can't allow
Speaker 2: that information to escape. And Stephen Hawking had also had
Speaker 2: the same problem. He could move a cheek muscle, and
Speaker 2: so he used his cheek muscle to control a computer
Speaker 2: that would go across too different levels and he would
Speaker 2: stop it when he was trying to sell a certain letter.
Speaker 2: So this leads us to the technology called brain computer interfaces.
Speaker 2: A lot of people have read about with Elon Musk's
Speaker 2: device of the neuralink device, which is basically a chip
Speaker 2: implanted in the brain wires that read the firing of neurons,
Speaker 2: and the neural code can be put into a computer
Speaker 2: and the computer can interpret that neural code, and so
Speaker 2: someone can use the power of their brain alone to
Speaker 2: think and move a cursor on a screen, or type
Speaker 2: letters on a screen, or move a robotic arm, or
Speaker 2: move robotic legs or a full robotic body, or even
Speaker 2: have their thoughts come out by speaking. So if you
Speaker 2: imagine articulating the words you want to say and putting
Speaker 2: electrodes in the part of the brain that move your
Speaker 2: mouth and your tongue, the same neurons will fire every
Speaker 2: time you say the vowel the letter A, and the
Speaker 2: same neuron.
Speaker 3: Different neurons will fire when you say.
Speaker 2: The letter B, or you say this word or that word,
Speaker 2: And so you can learn what those patterns of neuronal
Speaker 2: firing is and correlate it with those different words, so
Speaker 2: that every time you try to say something, the computer
Speaker 2: will learn what you're trying to say, and suddenly someone
Speaker 2: who can't talk can communicate, which is really remarkable.
Speaker 3: So brain computer interfaces will allow human beings.
Speaker 2: The power of telepathy and telekinesis getting ideas out of
Speaker 2: our head merely by thinking about doing different things.
Speaker 3: It's no longer science fiction and science fact.
Speaker 2: It's already going on at several major institutions academic institutions,
Speaker 2: and has been going on for decades. It's just that
Speaker 2: Elon Musk has developed a commercially available device that he's
Speaker 2: trying to sell and improve upon to move that technology forward.
Speaker 2: But it already exists, and it's a fascinating future of
Speaker 2: the human race, and someday we may all have implants
Speaker 2: in our brains that allow us to interact with computers.
Speaker 1: Talk for a bit about work life balance, doctor Schwortz.
Speaker 1: Because your job isn't one you can phone in. You
Speaker 1: can't do it remotely, and it's certainly not a part
Speaker 1: time gig. Talk about work in life, talk about work
Speaker 1: and family. How do you deal with balancing those things?
Speaker 1: It must be a constant struggle.
Speaker 2: There's no question that I was not present for all
Speaker 2: the things that a lot of other parents are present for.
Speaker 2: I rarely ever walked my kids to school. My wife
Speaker 2: always did that. If my kids had a game after school.
Speaker 2: At three point thirty I never went to it, but
Speaker 2: if they had a hockey game, and both my boys
Speaker 2: played hockey at seven o'clock PM, I was at every
Speaker 2: single one and I brought them to practice on the weekends.
Speaker 2: So you can't go to everything, and you can't do everything,
Speaker 2: but you just have to be present enough. You have
Speaker 2: to be there enough, and when you can carve the
Speaker 2: time out, you have to carve the timeout. So you
Speaker 2: have to be able to create that balance when when
Speaker 2: your kids need you to. My wife often would go
Speaker 2: to parties without me, and she learned how to dance
Speaker 2: by herself on the dance floor. But I also, you know,
Speaker 2: spend a lot of time with her when I could,
Speaker 2: and when I was with her, I was very present.
Speaker 2: So the key is to be very present when you're
Speaker 2: there so that when you know you're not there, they
Speaker 2: know that you were there. The other thing that I
Speaker 2: did was I took all my kids into the operating
Speaker 2: room so that they could watch me operate and be
Speaker 2: a part of that experience. So they knew what I
Speaker 2: was doing and they knew how important it was. And
Speaker 2: it wasn't some mysterious thing that took Dad away, but
Speaker 2: it was something that we did together and that we
Speaker 2: could talk about and so they embraced that ultimately and
Speaker 2: felt a part of it, and so they loved it,
Speaker 2: you know when I got called, because they knew that
Speaker 2: I was doing something important, and I think they respected
Speaker 2: and appreciated that, and that helped me do it because
Speaker 2: I had their acceptance, and I had my wife's acceptance
Speaker 2: and no resentment at any time.
Speaker 3: So I was blessed to have a very loving, supportive family.
Speaker 1: I want to close things out, doctor Schwartz, with one
Speaker 1: final reading from your book again about the life of
Speaker 1: a neurosurgeon. Like a priest or Anon, we swear an
Speaker 1: oath to dedicate ourselves to a higher purpose, far greater
Speaker 1: than ourselves, the health of our patients.
Speaker 3: Soldiers.
Speaker 1: Creeds hold true for neurosurgery as well. I will always
Speaker 1: place the mission first. I will never accept defeat. I
Speaker 1: will never quit. And that's something your kids and wife
Speaker 1: can hold close as they think about their father, the
Speaker 1: man they love. And you've been listening to doctor Theodore Schwartz.
Speaker 1: He's the author of Brain Matters, a biography of brain surgery.
Speaker 1: He's also am attending neurological surgeon and professor of neurological
Speaker 1: surgery that Wild Cornell Medicine in New York City, and
Speaker 1: we heard so much, absolutely riveting and fascinating about his
Speaker 1: day to day life. We love to do that. Here
Speaker 1: on this show, the Story of doctor Theodore Schwartz and
Speaker 1: a biography of brain surgery. Here on our American Stories.