May 1, 2025 • 7 mins
On this episode of Our American Stories, Dr. Theodore Schwartz, a neurosurgeon at Weill Cornell Medicine and best-selling author of Gray Matters: A Biography of Brain Surgery, shares how he approaches the difficult task of delivering bad news to patients with terminal and late-stage brain cancer.
Support the show (https://www.ouramericanstories.com/donate)
See omnystudio.com/listener for privacy information.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:10):
This is Lee Habib and this is Our American Stories,
the show where America is the star and the American people.
Up next, the story from a brain surgeon, one of
the best in the country, about how he breaks bad
news to patients. His name is doctor Theodore Schwartz. His
book Gray Matters, a biography of brain surgery, is an
(00:34):
amazing read. He's a real life brain surgeon at wild
Cornell Medicine in New York City, one of the busiest
and highest rank neurosurgery centers in the world. He's also
a heck of a storyteller. We did a longer version
of the whole story of brain surgery, and you can
go to our American Stories dot com and search for
(00:56):
doctor Theodore Schwartz. Here now is doctor Schwartz talking about
how he breaks bad news to patients.
Speaker 2 (01:05):
The initial office visit in facts can be surreal. At
this early stage. The patient is often minimally symptomatic. They're
obviously aware that something is growing in their brain. They
sought out medical care, after all, and they know it
needs to be removed. Maybe they've done a little research,
or they've had a family member with a brain tumor,
which may or may not have been similar. They're also
(01:25):
often scared and unsure of what lies ahead or what
it all means. Commonly, they're frequently somewhat oblivious to the
gravity of the situation. This is all new to them.
But as I listen to their questions, I see things
they are not yet capable of seeing, let alone processing.
I see the mother of three young children who will
not make it to their high school graduation. I see
the father and sole provider for a family of teenagers
(01:48):
with college payments looming, who will not be walking his
daughter down the aisle. I see the hedge fund manager
who is sitting on top of the world, planning his
retirement and next lavish vacation, who will soon be closing
his fond He's about to lose not only his long
anticipated opportunity to spend his money, but his ability to
bathe and feed himself. And yes, thinking of others' deaths
(02:09):
can be debilitating. It's even the most hardened of US
surgeons giving bad news. Seeing families crumple from the oncoming
train bearing down on them. As I stare into the
void imagining their future, I want to stand up and
scream at the top of my lungs or collapse on
the ground in a flood of tears. I do none
of this, of course. My job at this moment is
to fight this battle with every fiber in my body
(02:31):
and shepherd these victims of nature's callous and indifferent design.
I believe in revealing the truth of my patient's prognosis
at a slow and deliberate pace, but I also never
ever take away their most powerful weapon. Hope. We're not
talking about false hope, as in, we're going to beat
this thing, but rather true hope, a concept introduced by
Jerome Grubman in his book The Anatomy of Hope, How
(02:53):
people prevail in the face of illness. True hope sounds
more like this. They're a small group of long term
survivor and I'm going to do everything in my power
to give you the best chance of being one of them,
or even your remaining days with your family can be beautiful,
maybe even more beautiful than all the days that have
come before. So how does a doctor walk this tightrope
(03:14):
between truth and hope. I usually start the conversation with
a clear presentation of the facts. I may say that
the preliminary diagnosis showed what we feared that the tumor
is in fact malignant. I prefer to use the words
we and us. I also emphasize whatever positives I can.
The good news is that the surgery went extremely well
(03:34):
and we got out as much tumor as could safely
be removed. Although it's a tough tumor to be the
surgery puts US in the best place going forward to
attack the microscopic disease invariably left behind. I then tell
them that they will likely need radiation and chemotherapy, the
standard of care in treating glioblastomas, and that we will
find them the most experienced neuraloncologists to help coordinate the
next stage of this process. While our neural oncologists at
(03:56):
Cornell are some of the best in the world. Patients
often want second opinions, so I let them know we
will help them get their records together to send wherever
they'd like. Patients often express a fear of telling you
they want a second opinion, as if they're cheating on
their spouse or insulting a relative. You never want anyone
looking back as the end approaches, feeling that they didn't
do everything in their power to find the right treatment,
(04:16):
didn't explore all the options or left a stone unturned.
Speaker 1 (04:21):
It's unimaginable what it must be like to share that
kind of news, the kind of job some people have.
What doctor Schwartz said bears repeating. As I stare into
the void imagining their future, I want to stand up
and scream at the top of my lungs, or collapse
on the ground in a flood of tears. I do
(04:41):
none of this, of course. My job is to fight
this battle with every fiber in my body and shepherd.
Speaker 3 (04:49):
These victims through nature's callous and indifferent design. What words
and then that hope and how to give patients hope?
And what a talent that is? And then doctor Schwartz well,
he started to talk about how he breaks the bad
news to patients. Here's doctor Schwartz.
Speaker 2 (05:12):
I've witnessed only a handful of medical miracles in my career.
Tumors that miraculously shrank without any treatment, long term survivors
of fatal diseases. What's the explanation. We just don't know.
But these cases do provide some room for hope. The
patients I've treated who are still alive five, ten, or
even fifteen years after a GBM diagnosis are a rare
(05:32):
reminder that my degree and years of experience go only
so far. What makes these long term survivors so special?
What do they do to beat the odds? Another frequent
question my malignant tumor patients ask is why me? Was
it anything I did? It's human nature to attempt to
find cause for suffering, to create order out of chaos,
to shake our fist at the randomness of fate. Often
(05:52):
my patients will place blame on environmental exposures, such as
smoking power lines or toxic chemicals released by a local factory.
They also worry that their brain tomor might have been
inherited or will be passed to future generations. Both fears
are somewhat legitimate. Most brain cancers are triggered by some
random and little understood series of events that either alters
their DNA within the nucleus of brain cells or misaligns
(06:13):
the careful balance of proteins that promote and suppress cell growth.
I therefore try to emphasize to my patients that they
did nothing to bring this upon themselves. There is no
one to blame or resent, and there's no reason to
feel guilty that their children might be at a higher
risk of the same fate. As scientifically unsatisfying as the
answer may be, the cause for most brain tumors is
just plain old bad luck.
Speaker 1 (06:34):
And you've been listening to doctor Theodore Schwartz. He's the
author of Gray Matters, a biography of brain surgery. He's
a neurological surgeon at while Cornell Medicine in New York City,
one of the busiest and highest ranked neurosurgery centers in
the world. Schwartz has removed nearly ten thousand brain tumors.
And that question, that recurring question he gets from patients
(06:57):
is why me? Was it anything I did? He described
how it was human nature to attempt to find causes
for suffering and to create order out of chaos, but
in the end he always just settled them in with
the idea that there was no one to blame, no
one to resent.
Speaker 3 (07:14):
It was just a case of plain old bad luck.
Speaker 1 (07:17):
The story of our brain surgeon breaks the bad news
to his patience. Hear on our American stories. Here are
to our American stories. We bring you inspiring stories of history, sports, business, faith,
and love. Stories from a great and beautiful country that
(07:39):
need to be told. But we can't do it without you.
Our stories are free to listen to, but they're not
free to make. If you love our stories in America
like we do, please go to our American stories dot
com and click the donate button. Give a little, give
a lot, help us keep the great American stories coming.
That's our American Stories dot com.
This is Lee Habib and this is Our American Stories,
the show where America is the star and the American people.
Up next, the story from a brain surgeon, one of
the best in the country, about how he breaks bad
news to patients. His name is doctor Theodore Schwartz. His
book Gray Matters, a biography of brain surgery, is an
(00:34):
amazing read. He's a real life brain surgeon at wild
Cornell Medicine in New York City, one of the busiest
and highest rank neurosurgery centers in the world. He's also
a heck of a storyteller. We did a longer version
of the whole story of brain surgery, and you can
go to our American Stories dot com and search for
(00:56):
doctor Theodore Schwartz. Here now is doctor Schwartz talking about
how he breaks bad news to patients.
Speaker 2 (01:05):
The initial office visit in facts can be surreal. At
this early stage. The patient is often minimally symptomatic. They're
obviously aware that something is growing in their brain. They
sought out medical care, after all, and they know it
needs to be removed. Maybe they've done a little research,
or they've had a family member with a brain tumor,
which may or may not have been similar. They're also
(01:25):
often scared and unsure of what lies ahead or what
it all means. Commonly, they're frequently somewhat oblivious to the
gravity of the situation. This is all new to them.
But as I listen to their questions, I see things
they are not yet capable of seeing, let alone processing.
I see the mother of three young children who will
not make it to their high school graduation. I see
the father and sole provider for a family of teenagers
(01:48):
with college payments looming, who will not be walking his
daughter down the aisle. I see the hedge fund manager
who is sitting on top of the world, planning his
retirement and next lavish vacation, who will soon be closing
his fond He's about to lose not only his long
anticipated opportunity to spend his money, but his ability to
bathe and feed himself. And yes, thinking of others' deaths
(02:09):
can be debilitating. It's even the most hardened of US
surgeons giving bad news. Seeing families crumple from the oncoming
train bearing down on them. As I stare into the
void imagining their future, I want to stand up and
scream at the top of my lungs or collapse on
the ground in a flood of tears. I do none
of this, of course. My job at this moment is
to fight this battle with every fiber in my body
(02:31):
and shepherd these victims of nature's callous and indifferent design.
I believe in revealing the truth of my patient's prognosis
at a slow and deliberate pace, but I also never
ever take away their most powerful weapon. Hope. We're not
talking about false hope, as in, we're going to beat
this thing, but rather true hope, a concept introduced by
Jerome Grubman in his book The Anatomy of Hope, How
(02:53):
people prevail in the face of illness. True hope sounds
more like this. They're a small group of long term
survivor and I'm going to do everything in my power
to give you the best chance of being one of them,
or even your remaining days with your family can be beautiful,
maybe even more beautiful than all the days that have
come before. So how does a doctor walk this tightrope
(03:14):
between truth and hope. I usually start the conversation with
a clear presentation of the facts. I may say that
the preliminary diagnosis showed what we feared that the tumor
is in fact malignant. I prefer to use the words
we and us. I also emphasize whatever positives I can.
The good news is that the surgery went extremely well
(03:34):
and we got out as much tumor as could safely
be removed. Although it's a tough tumor to be the
surgery puts US in the best place going forward to
attack the microscopic disease invariably left behind. I then tell
them that they will likely need radiation and chemotherapy, the
standard of care in treating glioblastomas, and that we will
find them the most experienced neuraloncologists to help coordinate the
next stage of this process. While our neural oncologists at
(03:56):
Cornell are some of the best in the world. Patients
often want second opinions, so I let them know we
will help them get their records together to send wherever
they'd like. Patients often express a fear of telling you
they want a second opinion, as if they're cheating on
their spouse or insulting a relative. You never want anyone
looking back as the end approaches, feeling that they didn't
do everything in their power to find the right treatment,
(04:16):
didn't explore all the options or left a stone unturned.
Speaker 1 (04:21):
It's unimaginable what it must be like to share that
kind of news, the kind of job some people have.
What doctor Schwartz said bears repeating. As I stare into
the void imagining their future, I want to stand up
and scream at the top of my lungs, or collapse
on the ground in a flood of tears. I do
(04:41):
none of this, of course. My job is to fight
this battle with every fiber in my body and shepherd.
Speaker 3 (04:49):
These victims through nature's callous and indifferent design. What words
and then that hope and how to give patients hope?
And what a talent that is? And then doctor Schwartz well,
he started to talk about how he breaks the bad
news to patients. Here's doctor Schwartz.
Speaker 2 (05:12):
I've witnessed only a handful of medical miracles in my career.
Tumors that miraculously shrank without any treatment, long term survivors
of fatal diseases. What's the explanation. We just don't know.
But these cases do provide some room for hope. The
patients I've treated who are still alive five, ten, or
even fifteen years after a GBM diagnosis are a rare
(05:32):
reminder that my degree and years of experience go only
so far. What makes these long term survivors so special?
What do they do to beat the odds? Another frequent
question my malignant tumor patients ask is why me? Was
it anything I did? It's human nature to attempt to
find cause for suffering, to create order out of chaos,
to shake our fist at the randomness of fate. Often
(05:52):
my patients will place blame on environmental exposures, such as
smoking power lines or toxic chemicals released by a local factory.
They also worry that their brain tomor might have been
inherited or will be passed to future generations. Both fears
are somewhat legitimate. Most brain cancers are triggered by some
random and little understood series of events that either alters
their DNA within the nucleus of brain cells or misaligns
(06:13):
the careful balance of proteins that promote and suppress cell growth.
I therefore try to emphasize to my patients that they
did nothing to bring this upon themselves. There is no
one to blame or resent, and there's no reason to
feel guilty that their children might be at a higher
risk of the same fate. As scientifically unsatisfying as the
answer may be, the cause for most brain tumors is
just plain old bad luck.
Speaker 1 (06:34):
And you've been listening to doctor Theodore Schwartz. He's the
author of Gray Matters, a biography of brain surgery. He's
a neurological surgeon at while Cornell Medicine in New York City,
one of the busiest and highest ranked neurosurgery centers in
the world. Schwartz has removed nearly ten thousand brain tumors.
And that question, that recurring question he gets from patients
(06:57):
is why me? Was it anything I did? He described
how it was human nature to attempt to find causes
for suffering and to create order out of chaos, but
in the end he always just settled them in with
the idea that there was no one to blame, no
one to resent.
Speaker 3 (07:14):
It was just a case of plain old bad luck.
Speaker 1 (07:17):
The story of our brain surgeon breaks the bad news
to his patience. Hear on our American stories. Here are
to our American stories. We bring you inspiring stories of history, sports, business, faith,
and love. Stories from a great and beautiful country that
(07:39):
need to be told. But we can't do it without you.
Our stories are free to listen to, but they're not
free to make. If you love our stories in America
like we do, please go to our American stories dot
com and click the donate button. Give a little, give
a lot, help us keep the great American stories coming.
That's our American Stories dot com.
Host
Lee Habeeb
Popular Podcasts
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com