September 23, 2024 • 38 mins
On this episode of Our American Stories, Dr. Theodore Schwartz is an attending neurological surgeon and professor of neurological surgery at Weill Cornell Medicine in NYC, one of the busiest and highest ranked neurosurgery centers in the world. His book, "Gray Matters: A Biography of Brain Surgery" is part memoir and part medical history and tells a compelling story of the life of a neurosurgeon, alongside a compelling history of brain surgery itself.
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Episode Transcript
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Speaker 1 (00:13):
This is Lee Habib, and this is our American stories,
the show where America is the star and the American
people up next. Doctor Theodore Schwartz his book Gray Matters,
a biography a brain surgery. You wrote these words in
your book about your parents. From my father, I realized
(00:35):
there was a lot going on in the brain about
which we were unaware. My mother's war experiences lent an
air of gravity to my childhood, a sense that no
matter how well things were going, tragedy lurked around every corner.
Sounds to me like your mother and father had a
lot to do with who you were talk about that.
Speaker 2 (00:57):
I was born on the Upper West Side of Manhattan
in New York City. My father was a Freudian psychoanalyst,
so I grew up in a very intellectual household. He
used to spend his weekends listening to classical music all
day long and rereading the works of Freud and Shakespeare,
and was just a very thoughtful, curious man. My mother
(01:19):
was a Holocaust survivor, where I grew up in the
Jewish faith, and she was born in Vienna and lost
her sister at a very young age to meningitis, and
then at age twelve, when Hitler marched into Vienna, she
was kicked out. Her father's store was closed, and she
spent the next five or six years running away from
(01:42):
the Germans and ended up hiding in a convent in Belgium,
changing her name to Simon Marbier from Marris Schwartz, speaking
French from her original German, until she eventually came to America.
She met an American soldier and moved to Kalamazoo Mission again,
lived as a Christian in America for a little while
(02:03):
and realized that wasn't really who she was. I think
she was trying to forget her past, and then eventually
moved to New York and met my dad, who was
a psychiatrist at Albert Einstein College of Medicine in the Bronx.
I think we're all influenced by our environment, and so
writing a little bit about my parents and how they
may have influenced me, it's hard for us to know
(02:24):
what those impacts will be, right. My brother grew up
in the same household that I grew up in and
grew up into a very different human being than I am.
He's a lovely human being, but very different.
Speaker 1 (02:36):
We talk a lot about turning points in people's lives
on this show, and you had a serious one in
high school. Talk about the woman trapped into her car
by snowplows, and how did that experience affect you, talk
about its impact.
Speaker 2 (02:51):
So I was walking to school one morning in high school,
probably you know, a junior, maybe I was fifteen, sixteen
years old. And in Manhattan, when it snows, the snowplows
come by to plow the roads and the streets, and
all the cars are parked on the side of the streets.
And so when the snow clouds do that, they basically
box in all the cars. Who now have you know,
(03:13):
a foot two feet, three feet, sometimes four feet of
snow boxing their car in, And it can be very
challenging to get your car onto the road in the morning.
And so I was walking to work and there was
a woman who was stuck, and you know, her wheels
were spitting, and the snow was flying everywhere, and it
was just slush at this point, and she could not
(03:33):
get her car out onto the road. And I saw
that she was in need, and I dropped my knapsack
on the ground and I ran over and started pushing
her car to help her. Free herself, and she got
out and she waved to me and said thanks, and
drove on with her day. And I'll never forget that
moment because I just felt so good about myself that
(03:56):
I had helped somebody in need who didn't know who
I was, and I didn't know who they were, and
I wasn't getting anything but a thank you from them,
but it meant so much to me. And I left
that experience thinking, Wow, I really want to do a
job where I get to help people every day and
they'll say thank you.
Speaker 1 (04:13):
Before we talk about what it's like to be a
brain surgeon, let's talk for a moment about what it
takes to become one who chooses this line of work.
You separate them into a few categories, talk about the
character traits, talk about the types of people who choose
your line of work.
Speaker 2 (04:29):
I try to think back on the different personalities that
I know neurosurgeons that I know, and I kind of
created categories that are sort of like the lunch room
tables in a high school, where you have the nerds
and the jocks and the musicians, and those are in
fact people who go into neurosurgery for different reasons. So
Some are nerds they're interested in neuroscience that work in labs.
(04:50):
Some are athletes who like to be the center of attention.
Neurosurgery is a very physical activity and you need a
lot of stamina, you need a lot of focus. It's
a manual task where you're affecting the world around you.
So there are a lot of athletes that go into neurosurgery.
And then there are also musicians who love to practice
(05:11):
their instruments. You know, there's a lot of manual dexterity
and surgery, which is the same as many instruments that
people play. And the ability to sit and practice their
instruments for hours on end translates very well into neurosurgery.
And every surgery we do is like a performance, you know,
we have to perform. And then there are also people
touched by neurosurgery. And there are quite a few neurosurgeons
(05:31):
who had a parent who died of a brain tumor
or an aneurysm, or who maybe their parent was a
neurosurgeon and they didn't see them that much or they
shadowed them around the hospital. But those are the trends
that I've seen, and as for myself, I was definitely
a little bit of a nerd. You know. I was
reading astronomy books when I was in high school and
(05:51):
wanted to be an astronaut. But I was also an athlete.
I played on the football team, and I was a musician.
I played bass in the jazz band. So I definitely
had a little bit of each one of those elements.
And my dad was a psychoanalyst, so he got me
interested in the brain and memory and how the brain works.
Speaker 1 (06:10):
And you've been listening to doctor Theodore Schwartz. He's the
author of Gray Matters, a biography of brain surgery. He's
also an attending neurological surgeon and professor of neurological surgery
at wild Cornell Medicine, one of the busiest and highest
ranked neurosurgery centers in the world, located in New York City.
(06:31):
And the story about his mom alone could have been
a movie.
Speaker 2 (06:34):
Now.
Speaker 1 (06:34):
The fact that she escaped Nazis for years, wound up
in Holland, learning how to speak French to disguise her accent,
disguise her German and Jewish background, ultimately marrying someone Christian
and moving to the Midwest, only to discover who she
really was discovering her identity and ending up married and
(06:55):
in New York to a second husband, and my goodness.
We learn also about the turning point in doctor Schwartz's life,
and it's that woman caught and trapped by the snowplows
in New York City and how he felt afterwards. I
didn't know who they were, they probably didn't know who
I was. But that feeling he got, that's what well
(07:16):
propelled him into the life he chose in the end,
the feeling he must get to help a stranger. When
we come back more of the life of doctor Theodore
Schwartz here on Our American Stories. Lia Bibe here host
of Our American Stories, where you'll hear stories about everything
from the arts to sports, from business to history, and
(07:38):
we're proud our show can now be heard on Virginia
Beach's Talk Radio ninety six point five and eight fifty
WTAAR week days ten pm to one am. Our American
Stories with me Leah Bibe now on weekdays on talk
radio ninety six five and eight fifty WTAR in Virginia Beach, Virginia,
(08:09):
and we return to our American Stories and Doctor Theodore Schwartz,
author of Gray Matters, a biography of brain surgery. Go
to Amazon and the usual suspects to get it. You
won't put it down, you won't be sorry. Let's pick
up where we last left off. We talk about failure
(08:29):
a lot on this show, and you write about it
in your book. Talk about how neurosurgeons learn and what
role failure plays in your learning curve.
Speaker 2 (08:38):
Well, you know, in neurosurgery, you know, it's a seven
year training program for a reason, right, and when you
start out you don't get to do that much. You're
basically an assistant. But the truth is the public wants
their neurosurgeons to When you emerge from a neurosurgery training program,
you can basically hang your single and you are credentialed
(08:59):
to brain surgery on your own. So the question is
how do you teach someone to perform brain surgery on
your own? And at the same time, when you're a patient,
you do not want anyone practicing on you, and so
you have to somehow give these trainees graded responsibility in
a safe way, letting them do slightly more in each operation,
making sure that anything that they do, you're there watching
(09:22):
them do it. Unless you're one hundred percent sure they
can do it essentially as well as you can do it.
And then I never let the residents do certain things
that I cannot reverse and that I cannot fix, because
I would have to live with myself if there were
a failure. But there's very strong mentorship and guidance. It's
like a driving test where the driver is sitting right
next to you, you know, holding the steering wheel, and
if God forbid, something goes wrong, you know you can
(09:44):
take over. Learning from failure as a surgeon is a
whole other different conversation, and I do write about this.
You know, there's a conflict between confidence and humility and
arrogance and humility, and you sort of have to be
both at the same time. I think most great surgeons
are are simultaneously arrogant and humble, because you have to
believe in your heart that you're the best person to
(10:06):
do this operation, and you have to become the best
person you can be to do that operation. And with
that training and experience comes a certain amount of arrogance.
You have to convince the patient I can do this,
I can take care of you, I'm the right person
for the job. At the same time, no matter how
good you are, every neurosurgeon who does complex neurosurgery will
have complications and failures. It's inevitable. And we say, if
(10:27):
you haven't had a complications because you're not doing complicated operations.
And that creates a lot of humility because you can't
become arrogant, you can't lose your focus, you can't assume
that things are going to go well. I'm always assuming
that something's going to go wrong in every operation, and
I'm always thinking what can I do to prevent this
from going wrong. That's just my attitude with everything I do,
and it makes you very, very humble, and by being humble,
(10:49):
that's how you get better. I am better, you know,
thirty years out than I was, twenty five years out
than I was twenty years out than fifteen.
Speaker 1 (10:56):
Let's talk about head trauma, because, as you put it,
it's the bread and butter of your profession, in the
same way that skateboards and trampolines of the bread and
butter of your orthopedic surgeon colleagues talk about head trauma,
What is it? And how many people are your die
from head trauma? And while we're at it, tell the
(11:17):
story of the Swiss Army knife.
Speaker 2 (11:19):
So we separate head trauma into blunt head trauma and
penetrating head trauma and blunt heead trauma is you know,
let's say you're in a car accident and your head
hits the steering wheel where you're playing football in your
helmeted head to hit someone else's head, or a baseball
hits your head, it's blunt penetrating, of course, is a
gunshot wound, an arrow wound, or a knife wound or
something like that, And they're very different, and they affect
(11:41):
the brain and the skull very very differently. And as
you can imagine, a lot of neurosurgeons in the early
part of the twentieth century and surgeons before that, would
attend to soldiers on the battlefield and there were a
lot of injuries, and so a lot of what we
learned was learned on the battlefield, and our field developed
taking care of head injuries. And we've been very involved
(12:04):
also in designing football helmets and motorcycle helmets and the
baseball helmet. All of these things at one time or
another were designed by brain surgeons to protect the brain,
because that's our job. We have to fix the brain.
But we also have to prevent head injuries from occurring
in the first place. And there was one case who
had a Swiss Army knife, which is not a big knife.
(12:25):
You don't think of a Swiss Army knife as a
leathfal knife. But it turns out there's a part of
the skull right under the temple. There's muscle here, but
the bone is about a millimeter thick right behind the eye,
and if you were to jam a knife in right
there hard enough, you can penetrate the skull fairly easily.
And this gentleman came into the emergency room literally with
a Swiss Army knife sticking out of his head, and
(12:48):
it turns out the tip of the knife is very
close to a critical artery called the internal carotid artery,
So we had to do a full crannyotomy because we
can just pull it out because if you pull it out,
and you might have sheared the artery and actually have
someone pull it out while I was staring at the
ordery after opening up his head. And we did manage
to save his life, but he was essentially handcuffed to
his gurney with a police officer at his side because
(13:11):
he was involved in some nefarious activities, so I never
really figured out what happened or why it happened to him.
Speaker 1 (13:17):
I want to talk next about those initial office visits
by the patient. You describe them so beautifully in the book.
I want you to do a reading from a passage,
and if you could set the passage up.
Speaker 2 (13:30):
The initial office visit, in fact, 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. They're also 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.
(13:52):
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. 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 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
(14:13):
the world planning his retirement and next lavish vacation, who
will soon be closing his fund. 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 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
(14:35):
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 and shepherd these victims of nature's callous
and indifferent design. I believe in revealing the truth to
my patient's prognosis at a slow and deliberate pace. But
(14:57):
I also never ever take a 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 Groupman in his book The Anatomy of Hope.
How people prevail in the face of illness, true hope
sounds more like this. They're a small group of long
term survivors, and I'm going to do everything in my
(15:19):
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.
Speaker 1 (15:28):
Let's talk about the surgery itself. You're right about the
fact that sometimes the patient needs to stay awake during
brain surgery. Does the patient feel pain? Why do they
stay awake?
Speaker 2 (15:39):
Yeah, If you watch your feeds on Facebook or Instagram,
every once in a while, I go see like a
patient having brain surgery is playing the violin, or they're
playing the guitar, or they're reciting Shakespeare, and people are
excited by that. We have to do surgery awake sometimes,
and I'll talk about how, But first is why if
a tumor is very close to a part of the
(16:00):
brain's important for a speech and language. The neurons that
allow you to speak are in a different location in
every human being. We know roughly where they are, but
we don't know exactly where they are, and so there's
some tumors that sit in the areas that can be
very very close to parts of the brain that are
critical for speech. And the only way to know it
in this day and age with confidence is to have
your pasion awaken the operating room, having them doing a
(16:22):
language tasks, so they're reading, they're naming objects, they're talking,
and you stimulate their brain with an electrode, and stimulating
the brain in that way basically knocks out a small
area of brain. It stops that brain bit from being
able to function. So you move the electrode around and
you map out where their speech areas are, and when
you hit an area that's important for speech, the patient
(16:43):
will be able to talk. So if you show them
a picture of a car or a pen, they'll say
this is a and they'll stutter and they'll have trouble
getting the word out. And then you lift the electrode
up and they'll go a pen. And it's crazy to
think that you can cause that in someone else's brain
just by simulating a particular area. So that allows us
to do our surgeries more safely. How we do it
(17:06):
is that we give people ivy anesthesia, so we make
them sleepy when we're doing the opening, because when you
open the skull and the scalp. You know, it's more
like carquentry. The microsurgery we do later on is more
like Swiss watchmaking, but getting in and out of the
skull is really blue collar labor to some extent. During
that period of time, they're asleep and we numb the
scalp with a lot of local anesthesia. Surprisingly, when you
(17:27):
open up the brain, the brain has no sensory or
pain fibers, So if someone is touching your brain, you
won't feel anything. There's no pain, there's no sense of
someone touching you. Only your skin has these touch fibers
that you feel when you touch the skin, but your
brain does not have them. So we can operate on
the brain and the patient feels absolutely nothing.
Speaker 1 (17:51):
The story a biography a brain surgery continues here on
our American story, and we continue with our American stories
and with doctor Theodore Schwartz. He's the author of Gray Matters,
(18:14):
a Biography of Brain Surgery. It's part memoir and it's
part history, and that is the history of brain surgery
and in some ways our understanding of the brain. Let's
pick up where we last left off. You note in
the book by the way that the human brain feels
a lot like a sponge. That's for anyone wondering what
(18:34):
the brain actually feels like. What I also learned is
that you've removed nearly ten thousand brain tumors, but not
all of those surgeries end with good news. Talk about
breaking the bad news to a patient. In fact, if
you wouldn't mind reading from a passage you wrote about,
it was so poignant, it was so moving.
Speaker 2 (18:54):
So I take my cues from them. 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 and we got out as much tumor
(19:14):
as could safely be removed. Although it's a tough tour
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 and treating glioblastomas, and
that we will find them the most experienced neurooncologists to
help coordinate the next stage of this process. While our
neuroncologists at Cornell are some of the best in the world,
(19:37):
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,
didn't explore all the options, or left a stone unturned.
(19:58):
I've witnessed only a handful of medical miss 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 reminder that my degree and years of experience go
(20:20):
only so far. What makes these long term survivors so special?
What did 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
my patients will place blame on environmental exposures, such as
smoking power lines or toxic chemicals released by a local factory.
(20:44):
They also worry that their brain tombor might have been
inherited and will be passed to future generations. Both fears
are somewhat legitimate. Most brain canswers are triggered by some
random and little understood series of events that either alters
their DNA within the nucleus of brain cells or misilignes
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
(21:06):
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 (21:18):
I want to go next to the choices you have
to make as the surgeon while the patient is under
You write about this beautifully because in the end it
boils down to your choice. The patient depends on your talents,
your inexperience, and your knowledge. Talk about the burdens of
that responsibility and also the exhilaration of that responsibility.
Speaker 2 (21:41):
Well, there's a moment that comes a couple hours into
an operation, when you're getting tired. You've been there for
a while, You've debulked a lot of the tumor, and
maybe at that point there's a little bit that's left.
There may be part you can't see it very well.
It could be obscured by an artery or vein, some
normal anatomy that's in the way. It could be very
stuck to an artery or a vein, And you have
to figure out how aggressive do you want to be.
(22:01):
Do I want to try to get every last bit
of this tumor out, which potentially could cure the patient,
or if I leave some behind, it could grow back
and they might need another surgery. But if I'm too
aggressive trying to get that last bit of tumor off
and I damage a nerve or an artery or vein,
it could be catastrophic for the patient. And so I
have to make that decision at that moment in time,
and I sort of question, who am I to make
(22:23):
that decision?
Speaker 1 (22:24):
Right?
Speaker 2 (22:24):
It's not my body? You know, why do I have
this responsibility? Is it fair? Is it right? But the
truth is, if it's not me, you know who is
it going to be? Who's going to make the decision
at that moment in time. I'm the best qualified person
to do it because I'm physically there. I've dissected down
to the tumor. I've done it hundreds of times before
and trained to do this. So I need to make
(22:45):
this decision. And ultimately I say to myself, well, if
this were me on the table, what would I want done?
And that's what I do.
Speaker 1 (22:54):
There are a lot of famous names and patients in
your book, doctor Schwartz, and I want you to talk
about one. I want you to talk about Rosemary Kennedy,
and I want you to talk about lobotomies.
Speaker 2 (23:05):
I knew nothing about lobotomies when I trained in neurosurgery.
We didn't hear anything about the surgery, didn't know anything
about the history why I was done, who it was done,
on how many were done. I saw it as sort
of a skeleton in our closet that neurosurgeons really didn't
talk about. There were sixty thousand in frontal lobotomies done
in America in the nineteen fifties and nineteen sixties, which
(23:25):
is a remarkably high number. You have to understand the context.
At the time. There was no treatment for psychiatric illness,
so people who had severe schizophrenia depression would just sit
in the hallways of mental institutions that were filling with
these patients with no way to treat them. And some
of the treatments were also barbaric. They would, you know,
submerge them in ice cold water, or shock them, or
give them insulin and lower their glucose, so they're essentially
(23:47):
torturing these patients. The surgery itself was developed mostly by
neurologists and psychiatrists. I found out it really was not
a surgery developed by neurosurgeons. A guy named Burkhardt did
the first one years ago, and then Mones was a neurologist,
won the Nobel Prize believe it or not, for the
front of the botomy that was based on very little
(24:08):
scientific basis. And then there was a gentleman named Walter
Freeman who was also a neurologist, and he started doing
the Bottomi's in America. He started out working with a
neurosurgeon and where they would drill burholes at the top
of the head and put essentially a butter knife down
into the brain and sweep it back and forth on
each side to disconnect the frontal part of the brain
from the back of the brain. He didn't like relying
(24:28):
on a neurosurgeon. He wanted to be able to do
it on his own. He didn't want to have to
rely on anesthesiologists. He was a neurologist. He had no
credentials to perform surgery. So he ran about an Italian
neurosurgeon who did a procedure basically taking an ice pick
and lifting the upper lid of the eye and taking
the ice pick, putting it under the eyelid and cracking
through the skull into the frontal lobe and sweeping it
(24:48):
back and forth. And he could do one of these
procedures in about ten minutes. He would charge twenty five
dollars for it. He would do six or seven in
a day. He would do it with no antiseptic anesthesia.
He would actually give a lecture shock therapy to the
patients to put them under, and then he would do
this procedure and he would have people around him, and
he publicized it, and he traveled all around the country
(25:09):
doing I think he personally did about four thousand lobotomies,
this guy, Walter Freeman. And the truth is, there were
some people who got better, and there were a few
neurosurgeons who studied the lobotomy who sort of scientifically said,
all right, we're going to do this right, We're going
to do it cleanly. And at least a third of
the patients really got better from the lobotomies, but two
thirds of them didn't, and some patients were really damaged,
severely damaged. And Rosemary Kennedy was one of those. So
(25:32):
Walter Freeman did her lobotomy. Many people didn't know she
had a lobotomy. Her brothers and sisters didn't really know.
Joe Kennedy basically just took her to have this done.
They were hiding her mental illness at the time. It
was very shameful that she had mental illness at the time,
and when she emerged from the lobotomy, you know, she
was essentially a vegetable. She had regressed dramatically. She was
like a little child, and she was institutionalized after that.
(25:54):
But what the lobotomy did dude for neurosurgery was it
promoted the development of a lot of new techniques. So
a lot of the things we do now, the focal
delivery of radiation called stereotactic radio surgery, the implantation of
deep brain electrodes which we use to treat Parkinson's disease
and obsessive compulsive disorder and epilepsy, and the stereotactic radiation
(26:15):
which we can use to treat tumors and facial pain.
All of those things those were developed by surgeons trying
to improve on the frontal lobotomy because they realized it
was a sort of grotesque, imprecise operation and they wanted
to figure out a better way to do it. So
they developed all these new techniques and then realized they
could use all these techniques to treat other neurologic diseases,
and we still use those techniques today. So the frontal abiody,
(26:35):
that was a horrific moment in time where we rashly
adopted a surgery before it was well vetted, but it
propelled the feel forward fairly dramatically into a lot of
what modern neurosurgery is about today.
Speaker 1 (26:48):
That is so true about so much we learn in
the field of medicine, the bad and the good, and
my goodness, I just remember first hearing about a lobotomy
when I was an English major in college Tennessee. Williams
had to in the end give the go ahead to
give his sister Rose a full frontal lobotomy. He never
recovered from it.
Speaker 2 (27:07):
And when we come.
Speaker 1 (27:07):
Back more of the biography of brain surgery, the author
of the book Gray Matters is doctor Theodore Schwartz. More
with doctor Schwartz after these messages, and we continue with
(27:38):
our American stories, and with doctor Theodore Schwartz, the author
of Gray Matters, a Biography of Brain Surgery. Let's pick
up where we last left off. Chapter fourteen is especially compelling.
The title alone is compelling. What's it like to be
a brain? But you dive into the human experience, the
human tragedy of the end of life. We've all had
(28:02):
grandparents and parents who suffered from loss of memory, dementia,
and worse talk about that.
Speaker 2 (28:08):
So philosophically, we talk about the brain, and we talk
about the mind as a separate entity, and we like
to imagine and common sense tells us and our intuition
tells us that we can make decisions, our mind can
make decisions that will have an impact on the physical
world around us, and that we control our behaviors. But
(28:32):
there is no such thing as mind. There's no mysterious
substance that we have yet to identify by science that
is mind. All we know of is brain in neurons
and neurons firing that somehow creates our experience of what
it is like to be ourselves, and our identity is
very much a part of that. We feel like we
have an identity, we have a past, we have a future,
(28:53):
But the truth is the self and who we are,
and the decisions that we make are all based in
the mind. And the mind is a physical organ. It's
controlled by the laws of physics, and the laws of
physics do not allow for there to be a mind,
a substance that has a cause and effect, because the
only thing that can have a cause is another physical substance.
So there are a number of neurosurgical operations that have
(29:16):
been done and experiments done during brain surgery that lead
us to believe that our concept of the self is
not what we think it is. For example, if the
brain creates the mind and the self, and we can
do an operation where we take the two halves of
our brain and basically split them in half and cut
the connection, so you have two independent brains that can
(29:38):
think independently in your head. You would think that someone
would feel like there's two selves, but they don't. They
actually still feel like they only have one self. So
how is it possible to have two brains and only
one self. You can remove an entire hemisphere of the
brain in someone and they will wake up and feel
like their whole. They don't feel like they're half the
person that they were before. So there's clearly a disconnect
(30:00):
between this physical thing brain and this construct we have
of the self. And the truth is that who we
are is changing constantly based on our experiences, and we lose,
you know, thousands of neurons every day, we make new connections,
and so that creates our identity. And it is possible
to change someone's identity either because they have a stroke
and they forget who people are, Like the man who
(30:21):
mistook his wife for a hat doesn't recognize his wife anymore.
You can put electrodes in someone's brain, and this has
been well described and change the way they feel, change
their moods, make them happier, make them sadder, give them
brain fog. One pasion had an electro putting their brain
and they turned it on and suddenly they started enjoying
the music of Johnny Cash. And they turned it off
and they didn't like Johnny Cash anymore. And so if
you can trigger things that we think of as our identity, right,
(30:44):
I think of myself as someone who likes certain things
and dislikes some certain things, that's who I am. If
I can change those things just by stimulating your brain
or triggering your brain, what does that mean about who
you are and who you think you are. The other
fascinating thing that I'll just briefly talk about is there's
a lot of data showing that there are neurons firing
in your brain that precede every behavior that you do.
(31:06):
Right you imagine, sure, if I want to move my finger,
there's a neuron that's going to move that makes my
fingermoove and when I decide to move my finger, there's
some neurons that are saying, oh, I'm deciding to move
my finger. But it turns out that there are neurons
that are firing in your brain before you make the
decision to move your finger, about a second before you
make the decision, and the second before you make the
(31:28):
decision to say certain words, there are neurons firing in
your brain to make those words come out. So many
people think what happens is that the brain has independent
modules that are functioning and working all the time, and
they're taking in information processing it sitting out things to do,
and we behave based on what our brain wants us
to do. And then afterwards we experience that and we
(31:48):
create a story as to why we did what we did.
We move it back in time and our brain messes
with the time to pretend that we had agency and
that we create we wanted to do that in the
first place, but really our brain wanted to do it,
and that's why it happened.
Speaker 1 (32:03):
In your chapter Unlocking the Brain, you focus on two
stories that of Jean Dominique, Bobie and Stephen Hawking. Why
those two stories so.
Speaker 2 (32:14):
Jean Dominique Boubie was an editor of the French Ell
magazine who had a stroke that left him locked in.
So what locked in means is there are some places
you can have a stroke where essentially your entire body
is paralyzed, so you imagine you're in a wheelchair. Your
facial musculature is also paralyzed, so you cannot talk. All
some of these people can do is blink their eyes,
(32:36):
that's it. But their brains, in terms of their mentation,
are fully intact. So you're fully aware, fully conscious, but
you're a prisoner in your own body and all you
can do is blink your eyes. So it's really a
horrible way to live. And John Dominique Boube he would
blink his eyes and someone would point at different letters
(32:57):
on a screen to allow him to communicate. And he
wrote a book, The Butterfly and the Bell Jar using
that technique. So the question is how do you get
information out of a brain when the body can't allow
that information to escape. And Stephen Hawking had also had
the same problem. He could move a cheek muscle, and
so he used his cheek muscle to control a computer
(33:19):
that would go across to different levels and he would
stop it when he was trying to sell a certain letter.
So this leads us to the technology called brain computer interfaces.
A lot of people have read about with Elon Musk's
device of the neuralink device, which is basically a chip
implanted in the brain wires that read the firing of neurons,
and the neural code can be put into a computer
(33:41):
and the computer can interpret that neural code, and so
someone can use the power of their brain alone to
think and move a cursor on a screen, or type
letters on a screen, or move a robotic arm, or
move robotic legs or a full robotic body, or even
have their thoughts come out by speakings. So if you
imagine articulating the words you want to say and putting
(34:03):
electrodes in the part of the brain that move your
mouth and your tongue, the same neurons will fire every
time you say the vowel the letter A, and the
same neuron. Different neurons will fire when you say the
letter B, or you say this word or that word,
And so you can learn what those patterns of neuronal
firing is and correlate it with those different words, so
that every time you try to say something, the computer
(34:25):
will learn what you're trying to say, and suddenly someone
who can't talk can communicate, which is really remarkable. So
brain computer interfaces will allow human beings. The power of
telepathy and telekinesis getting ideas out of our head merely
by thinking about doing different things. It's no longer science
fiction and science fact. It's already going on at several
(34:48):
major institutions, academic institutions, and has been going on for decades.
It's just that Elon Musk has developed a commercially available
device that he's trying to sell and and improve upon
to move that technology forward. But it already exists, and
it's a fascinating future of the human race, and someday
we may all have implants in our brains that allow
(35:10):
us to interact with computers.
Speaker 1 (35:12):
Talk for a bit about work life balance, doctor Schwortz.
Because your job isn't one you can phone in. You
can't do it remotely, and it's certainly not a part
time gig. Talk about work and life, Talk about work
and family. How do you deal with balancing those things?
It must be a constant struggle.
Speaker 2 (35:31):
There's no question that I was not present for all
the things that a lot of other parents are present for.
I rarely ever walked my kids to school. My wife
always did that. If my kids had a game after
school at three point thirty, I never went to it.
But if they had a hockey game and both my
boys played hockey at seven o'clock PM, I was at
(35:52):
every single one and I brought them to practice on
the weekends. So you can't go to everything, and you
can't do everything, but you just have to be present enough.
You have to be there enough, and when you can
carve the time out, you have to carve the timeout.
So you have to be able to create that balance
when when your kids need you to. My wife often
would go to parties without me, and she learned how
(36:14):
to dance by herself on the dance floor. But I also,
you know, spent a lot of time with her when
I could, and when I was with her, I was
very present. So the key is to be very present
when you're there so that when you know you're not there,
they know that you were there. The other thing that
I did was I took all my kids into the
operating room so that they could watch me operate and
be a part of that experience, So they knew what
(36:34):
I was doing, and they knew how important it was.
And it wasn't some mysterious thing that took Dad away,
but it was something that we did together and that
we could talk about. And so they embraced that ultimately
and felt a part of it, and so they loved it,
you know when I got called, because they knew that
I was doing something important, and I think they respected
(36:54):
and appreciated that, and that helped me do it because
I had their acceptance and I had my wife's acceptance,
no resentment at any time. So I was blessed to
have a very loving, supportive family.
Speaker 1 (37:04):
I want to close things out, doctor Schwartz, with one
final reading from your book again about the life of
a neurosurgeon. Like a priest or anun we swear an
oath to dedicate ourselves to a higher purpose, far greater
than ourselves, the health of our patients.
Speaker 2 (37:21):
Soldiers.
Speaker 1 (37:22):
Creeds hold true for neurosurgery as well. I will always
place the mission first. I will never accept defeat. I
will never quit. And that's something your kids and wife
can hold close as they think about their father, the
man they love. And you've been listening to doctor Theodore Schwartz.
(37:44):
He's the author of Brain Matters, a biography of brain surgery.
He's also am attending neurological surgeon and professor of neurological
surgery that Wild Cornell Medicine in New York City, and
we heard so much, absolutely riveting and fascinating about his
day to day life. We love to do that here
on this show, the story of doctor Theodore Schwartz and
(38:05):
a Biography of brain surgery. Here on our American Stories
This is Lee Habib, and this is our American stories,
the show where America is the star and the American
people up next. Doctor Theodore Schwartz his book Gray Matters,
a biography a brain surgery. You wrote these words in
your book about your parents. From my father, I realized
(00:35):
there was a lot going on in the brain about
which we were unaware. My mother's war experiences lent an
air of gravity to my childhood, a sense that no
matter how well things were going, tragedy lurked around every corner.
Sounds to me like your mother and father had a
lot to do with who you were talk about that.
Speaker 2 (00:57):
I was born on the Upper West Side of Manhattan
in New York City. My father was a Freudian psychoanalyst,
so I grew up in a very intellectual household. He
used to spend his weekends listening to classical music all
day long and rereading the works of Freud and Shakespeare,
and was just a very thoughtful, curious man. My mother
(01:19):
was a Holocaust survivor, where I grew up in the
Jewish faith, and she was born in Vienna and lost
her sister at a very young age to meningitis, and
then at age twelve, when Hitler marched into Vienna, she
was kicked out. Her father's store was closed, and she
spent the next five or six years running away from
(01:42):
the Germans and ended up hiding in a convent in Belgium,
changing her name to Simon Marbier from Marris Schwartz, speaking
French from her original German, until she eventually came to America.
She met an American soldier and moved to Kalamazoo Mission again,
lived as a Christian in America for a little while
(02:03):
and realized that wasn't really who she was. I think
she was trying to forget her past, and then eventually
moved to New York and met my dad, who was
a psychiatrist at Albert Einstein College of Medicine in the Bronx.
I think we're all influenced by our environment, and so
writing a little bit about my parents and how they
may have influenced me, it's hard for us to know
(02:24):
what those impacts will be, right. My brother grew up
in the same household that I grew up in and
grew up into a very different human being than I am.
He's a lovely human being, but very different.
Speaker 1 (02:36):
We talk a lot about turning points in people's lives
on this show, and you had a serious one in
high school. Talk about the woman trapped into her car
by snowplows, and how did that experience affect you, talk
about its impact.
Speaker 2 (02:51):
So I was walking to school one morning in high school,
probably you know, a junior, maybe I was fifteen, sixteen
years old. And in Manhattan, when it snows, the snowplows
come by to plow the roads and the streets, and
all the cars are parked on the side of the streets.
And so when the snow clouds do that, they basically
box in all the cars. Who now have you know,
(03:13):
a foot two feet, three feet, sometimes four feet of
snow boxing their car in, And it can be very
challenging to get your car onto the road in the morning.
And so I was walking to work and there was
a woman who was stuck, and you know, her wheels
were spitting, and the snow was flying everywhere, and it
was just slush at this point, and she could not
(03:33):
get her car out onto the road. And I saw
that she was in need, and I dropped my knapsack
on the ground and I ran over and started pushing
her car to help her. Free herself, and she got
out and she waved to me and said thanks, and
drove on with her day. And I'll never forget that
moment because I just felt so good about myself that
(03:56):
I had helped somebody in need who didn't know who
I was, and I didn't know who they were, and
I wasn't getting anything but a thank you from them,
but it meant so much to me. And I left
that experience thinking, Wow, I really want to do a
job where I get to help people every day and
they'll say thank you.
Speaker 1 (04:13):
Before we talk about what it's like to be a
brain surgeon, let's talk for a moment about what it
takes to become one who chooses this line of work.
You separate them into a few categories, talk about the
character traits, talk about the types of people who choose
your line of work.
Speaker 2 (04:29):
I try to think back on the different personalities that
I know neurosurgeons that I know, and I kind of
created categories that are sort of like the lunch room
tables in a high school, where you have the nerds
and the jocks and the musicians, and those are in
fact people who go into neurosurgery for different reasons. So
Some are nerds they're interested in neuroscience that work in labs.
(04:50):
Some are athletes who like to be the center of attention.
Neurosurgery is a very physical activity and you need a
lot of stamina, you need a lot of focus. It's
a manual task where you're affecting the world around you.
So there are a lot of athletes that go into neurosurgery.
And then there are also musicians who love to practice
(05:11):
their instruments. You know, there's a lot of manual dexterity
and surgery, which is the same as many instruments that
people play. And the ability to sit and practice their
instruments for hours on end translates very well into neurosurgery.
And every surgery we do is like a performance, you know,
we have to perform. And then there are also people
touched by neurosurgery. And there are quite a few neurosurgeons
(05:31):
who had a parent who died of a brain tumor
or an aneurysm, or who maybe their parent was a
neurosurgeon and they didn't see them that much or they
shadowed them around the hospital. But those are the trends
that I've seen, and as for myself, I was definitely
a little bit of a nerd. You know. I was
reading astronomy books when I was in high school and
(05:51):
wanted to be an astronaut. But I was also an athlete.
I played on the football team, and I was a musician.
I played bass in the jazz band. So I definitely
had a little bit of each one of those elements.
And my dad was a psychoanalyst, so he got me
interested in the brain and memory and how the brain works.
Speaker 1 (06:10):
And you've been listening to doctor Theodore Schwartz. He's the
author of Gray Matters, a biography of brain surgery. He's
also an attending neurological surgeon and professor of neurological surgery
at wild Cornell Medicine, one of the busiest and highest
ranked neurosurgery centers in the world, located in New York City.
(06:31):
And the story about his mom alone could have been
a movie.
Speaker 2 (06:34):
Now.
Speaker 1 (06:34):
The fact that she escaped Nazis for years, wound up
in Holland, learning how to speak French to disguise her accent,
disguise her German and Jewish background, ultimately marrying someone Christian
and moving to the Midwest, only to discover who she
really was discovering her identity and ending up married and
(06:55):
in New York to a second husband, and my goodness.
We learn also about the turning point in doctor Schwartz's life,
and it's that woman caught and trapped by the snowplows
in New York City and how he felt afterwards. I
didn't know who they were, they probably didn't know who
I was. But that feeling he got, that's what well
(07:16):
propelled him into the life he chose in the end,
the feeling he must get to help a stranger. When
we come back more of the life of doctor Theodore
Schwartz here on Our American Stories. Lia Bibe here host
of Our American Stories, where you'll hear stories about everything
from the arts to sports, from business to history, and
(07:38):
we're proud our show can now be heard on Virginia
Beach's Talk Radio ninety six point five and eight fifty
WTAAR week days ten pm to one am. Our American
Stories with me Leah Bibe now on weekdays on talk
radio ninety six five and eight fifty WTAR in Virginia Beach, Virginia,
(08:09):
and we return to our American Stories and Doctor Theodore Schwartz,
author of Gray Matters, a biography of brain surgery. Go
to Amazon and the usual suspects to get it. You
won't put it down, you won't be sorry. Let's pick
up where we last left off. We talk about failure
(08:29):
a lot on this show, and you write about it
in your book. Talk about how neurosurgeons learn and what
role failure plays in your learning curve.
Speaker 2 (08:38):
Well, you know, in neurosurgery, you know, it's a seven
year training program for a reason, right, and when you
start out you don't get to do that much. You're
basically an assistant. But the truth is the public wants
their neurosurgeons to When you emerge from a neurosurgery training program,
you can basically hang your single and you are credentialed
(08:59):
to brain surgery on your own. So the question is
how do you teach someone to perform brain surgery on
your own? And at the same time, when you're a patient,
you do not want anyone practicing on you, and so
you have to somehow give these trainees graded responsibility in
a safe way, letting them do slightly more in each operation,
making sure that anything that they do, you're there watching
(09:22):
them do it. Unless you're one hundred percent sure they
can do it essentially as well as you can do it.
And then I never let the residents do certain things
that I cannot reverse and that I cannot fix, because
I would have to live with myself if there were
a failure. But there's very strong mentorship and guidance. It's
like a driving test where the driver is sitting right
next to you, you know, holding the steering wheel, and
if God forbid, something goes wrong, you know you can
(09:44):
take over. Learning from failure as a surgeon is a
whole other different conversation, and I do write about this.
You know, there's a conflict between confidence and humility and
arrogance and humility, and you sort of have to be
both at the same time. I think most great surgeons
are are simultaneously arrogant and humble, because you have to
believe in your heart that you're the best person to
(10:06):
do this operation, and you have to become the best
person you can be to do that operation. And with
that training and experience comes a certain amount of arrogance.
You have to convince the patient I can do this,
I can take care of you, I'm the right person
for the job. At the same time, no matter how
good you are, every neurosurgeon who does complex neurosurgery will
have complications and failures. It's inevitable. And we say, if
(10:27):
you haven't had a complications because you're not doing complicated operations.
And that creates a lot of humility because you can't
become arrogant, you can't lose your focus, you can't assume
that things are going to go well. I'm always assuming
that something's going to go wrong in every operation, and
I'm always thinking what can I do to prevent this
from going wrong. That's just my attitude with everything I do,
and it makes you very, very humble, and by being humble,
(10:49):
that's how you get better. I am better, you know,
thirty years out than I was, twenty five years out
than I was twenty years out than fifteen.
Speaker 1 (10:56):
Let's talk about head trauma, because, as you put it,
it's the bread and butter of your profession, in the
same way that skateboards and trampolines of the bread and
butter of your orthopedic surgeon colleagues talk about head trauma,
What is it? And how many people are your die
from head trauma? And while we're at it, tell the
(11:17):
story of the Swiss Army knife.
Speaker 2 (11:19):
So we separate head trauma into blunt head trauma and
penetrating head trauma and blunt heead trauma is you know,
let's say you're in a car accident and your head
hits the steering wheel where you're playing football in your
helmeted head to hit someone else's head, or a baseball
hits your head, it's blunt penetrating, of course, is a
gunshot wound, an arrow wound, or a knife wound or
something like that, And they're very different, and they affect
(11:41):
the brain and the skull very very differently. And as
you can imagine, a lot of neurosurgeons in the early
part of the twentieth century and surgeons before that, would
attend to soldiers on the battlefield and there were a
lot of injuries, and so a lot of what we
learned was learned on the battlefield, and our field developed
taking care of head injuries. And we've been very involved
(12:04):
also in designing football helmets and motorcycle helmets and the
baseball helmet. All of these things at one time or
another were designed by brain surgeons to protect the brain,
because that's our job. We have to fix the brain.
But we also have to prevent head injuries from occurring
in the first place. And there was one case who
had a Swiss Army knife, which is not a big knife.
(12:25):
You don't think of a Swiss Army knife as a
leathfal knife. But it turns out there's a part of
the skull right under the temple. There's muscle here, but
the bone is about a millimeter thick right behind the eye,
and if you were to jam a knife in right
there hard enough, you can penetrate the skull fairly easily.
And this gentleman came into the emergency room literally with
a Swiss Army knife sticking out of his head, and
(12:48):
it turns out the tip of the knife is very
close to a critical artery called the internal carotid artery,
So we had to do a full crannyotomy because we
can just pull it out because if you pull it out,
and you might have sheared the artery and actually have
someone pull it out while I was staring at the
ordery after opening up his head. And we did manage
to save his life, but he was essentially handcuffed to
his gurney with a police officer at his side because
(13:11):
he was involved in some nefarious activities, so I never
really figured out what happened or why it happened to him.
Speaker 1 (13:17):
I want to talk next about those initial office visits
by the patient. You describe them so beautifully in the book.
I want you to do a reading from a passage,
and if you could set the passage up.
Speaker 2 (13:30):
The initial office visit, in fact, 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. They're also 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.
(13:52):
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. 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 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
(14:13):
the world planning his retirement and next lavish vacation, who
will soon be closing his fund. 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 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
(14:35):
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 and shepherd these victims of nature's callous
and indifferent design. I believe in revealing the truth to
my patient's prognosis at a slow and deliberate pace. But
(14:57):
I also never ever take a 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 Groupman in his book The Anatomy of Hope.
How people prevail in the face of illness, true hope
sounds more like this. They're a small group of long
term survivors, and I'm going to do everything in my
(15:19):
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.
Speaker 1 (15:28):
Let's talk about the surgery itself. You're right about the
fact that sometimes the patient needs to stay awake during
brain surgery. Does the patient feel pain? Why do they
stay awake?
Speaker 2 (15:39):
Yeah, If you watch your feeds on Facebook or Instagram,
every once in a while, I go see like a
patient having brain surgery is playing the violin, or they're
playing the guitar, or they're reciting Shakespeare, and people are
excited by that. We have to do surgery awake sometimes,
and I'll talk about how, But first is why if
a tumor is very close to a part of the
(16:00):
brain's important for a speech and language. The neurons that
allow you to speak are in a different location in
every human being. We know roughly where they are, but
we don't know exactly where they are, and so there's
some tumors that sit in the areas that can be
very very close to parts of the brain that are
critical for speech. And the only way to know it
in this day and age with confidence is to have
your pasion awaken the operating room, having them doing a
(16:22):
language tasks, so they're reading, they're naming objects, they're talking,
and you stimulate their brain with an electrode, and stimulating
the brain in that way basically knocks out a small
area of brain. It stops that brain bit from being
able to function. So you move the electrode around and
you map out where their speech areas are, and when
you hit an area that's important for speech, the patient
(16:43):
will be able to talk. So if you show them
a picture of a car or a pen, they'll say
this is a and they'll stutter and they'll have trouble
getting the word out. And then you lift the electrode
up and they'll go a pen. And it's crazy to
think that you can cause that in someone else's brain
just by simulating a particular area. So that allows us
to do our surgeries more safely. How we do it
(17:06):
is that we give people ivy anesthesia, so we make
them sleepy when we're doing the opening, because when you
open the skull and the scalp. You know, it's more
like carquentry. The microsurgery we do later on is more
like Swiss watchmaking, but getting in and out of the
skull is really blue collar labor to some extent. During
that period of time, they're asleep and we numb the
scalp with a lot of local anesthesia. Surprisingly, when you
(17:27):
open up the brain, the brain has no sensory or
pain fibers, So if someone is touching your brain, you
won't feel anything. There's no pain, there's no sense of
someone touching you. Only your skin has these touch fibers
that you feel when you touch the skin, but your
brain does not have them. So we can operate on
the brain and the patient feels absolutely nothing.
Speaker 1 (17:51):
The story a biography a brain surgery continues here on
our American story, and we continue with our American stories
and with doctor Theodore Schwartz. He's the author of Gray Matters,
(18:14):
a Biography of Brain Surgery. It's part memoir and it's
part history, and that is the history of brain surgery
and in some ways our understanding of the brain. Let's
pick up where we last left off. You note in
the book by the way that the human brain feels
a lot like a sponge. That's for anyone wondering what
(18:34):
the brain actually feels like. What I also learned is
that you've removed nearly ten thousand brain tumors, but not
all of those surgeries end with good news. Talk about
breaking the bad news to a patient. In fact, if
you wouldn't mind reading from a passage you wrote about,
it was so poignant, it was so moving.
Speaker 2 (18:54):
So I take my cues from them. 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 and we got out as much tumor
(19:14):
as could safely be removed. Although it's a tough tour
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 and treating glioblastomas, and
that we will find them the most experienced neurooncologists to
help coordinate the next stage of this process. While our
neuroncologists at Cornell are some of the best in the world,
(19:37):
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,
didn't explore all the options, or left a stone unturned.
(19:58):
I've witnessed only a handful of medical miss 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 reminder that my degree and years of experience go
(20:20):
only so far. What makes these long term survivors so special?
What did 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
my patients will place blame on environmental exposures, such as
smoking power lines or toxic chemicals released by a local factory.
(20:44):
They also worry that their brain tombor might have been
inherited and will be passed to future generations. Both fears
are somewhat legitimate. Most brain canswers are triggered by some
random and little understood series of events that either alters
their DNA within the nucleus of brain cells or misilignes
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
(21:06):
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 (21:18):
I want to go next to the choices you have
to make as the surgeon while the patient is under
You write about this beautifully because in the end it
boils down to your choice. The patient depends on your talents,
your inexperience, and your knowledge. Talk about the burdens of
that responsibility and also the exhilaration of that responsibility.
Speaker 2 (21:41):
Well, there's a moment that comes a couple hours into
an operation, when you're getting tired. You've been there for
a while, You've debulked a lot of the tumor, and
maybe at that point there's a little bit that's left.
There may be part you can't see it very well.
It could be obscured by an artery or vein, some
normal anatomy that's in the way. It could be very
stuck to an artery or a vein, And you have
to figure out how aggressive do you want to be.
(22:01):
Do I want to try to get every last bit
of this tumor out, which potentially could cure the patient,
or if I leave some behind, it could grow back
and they might need another surgery. But if I'm too
aggressive trying to get that last bit of tumor off
and I damage a nerve or an artery or vein,
it could be catastrophic for the patient. And so I
have to make that decision at that moment in time,
and I sort of question, who am I to make
(22:23):
that decision?
Speaker 1 (22:24):
Right?
Speaker 2 (22:24):
It's not my body? You know, why do I have
this responsibility? Is it fair? Is it right? But the
truth is, if it's not me, you know who is
it going to be? Who's going to make the decision
at that moment in time. I'm the best qualified person
to do it because I'm physically there. I've dissected down
to the tumor. I've done it hundreds of times before
and trained to do this. So I need to make
(22:45):
this decision. And ultimately I say to myself, well, if
this were me on the table, what would I want done?
And that's what I do.
Speaker 1 (22:54):
There are a lot of famous names and patients in
your book, doctor Schwartz, and I want you to talk
about one. I want you to talk about Rosemary Kennedy,
and I want you to talk about lobotomies.
Speaker 2 (23:05):
I knew nothing about lobotomies when I trained in neurosurgery.
We didn't hear anything about the surgery, didn't know anything
about the history why I was done, who it was done,
on how many were done. I saw it as sort
of a skeleton in our closet that neurosurgeons really didn't
talk about. There were sixty thousand in frontal lobotomies done
in America in the nineteen fifties and nineteen sixties, which
(23:25):
is a remarkably high number. You have to understand the context.
At the time. There was no treatment for psychiatric illness,
so people who had severe schizophrenia depression would just sit
in the hallways of mental institutions that were filling with
these patients with no way to treat them. And some
of the treatments were also barbaric. They would, you know,
submerge them in ice cold water, or shock them, or
give them insulin and lower their glucose, so they're essentially
(23:47):
torturing these patients. The surgery itself was developed mostly by
neurologists and psychiatrists. I found out it really was not
a surgery developed by neurosurgeons. A guy named Burkhardt did
the first one years ago, and then Mones was a neurologist,
won the Nobel Prize believe it or not, for the
front of the botomy that was based on very little
(24:08):
scientific basis. And then there was a gentleman named Walter
Freeman who was also a neurologist, and he started doing
the Bottomi's in America. He started out working with a
neurosurgeon and where they would drill burholes at the top
of the head and put essentially a butter knife down
into the brain and sweep it back and forth on
each side to disconnect the frontal part of the brain
from the back of the brain. He didn't like relying
(24:28):
on a neurosurgeon. He wanted to be able to do
it on his own. He didn't want to have to
rely on anesthesiologists. He was a neurologist. He had no
credentials to perform surgery. So he ran about an Italian
neurosurgeon who did a procedure basically taking an ice pick
and lifting the upper lid of the eye and taking
the ice pick, putting it under the eyelid and cracking
through the skull into the frontal lobe and sweeping it
(24:48):
back and forth. And he could do one of these
procedures in about ten minutes. He would charge twenty five
dollars for it. He would do six or seven in
a day. He would do it with no antiseptic anesthesia.
He would actually give a lecture shock therapy to the
patients to put them under, and then he would do
this procedure and he would have people around him, and
he publicized it, and he traveled all around the country
(25:09):
doing I think he personally did about four thousand lobotomies,
this guy, Walter Freeman. And the truth is, there were
some people who got better, and there were a few
neurosurgeons who studied the lobotomy who sort of scientifically said,
all right, we're going to do this right, We're going
to do it cleanly. And at least a third of
the patients really got better from the lobotomies, but two
thirds of them didn't, and some patients were really damaged,
severely damaged. And Rosemary Kennedy was one of those. So
(25:32):
Walter Freeman did her lobotomy. Many people didn't know she
had a lobotomy. Her brothers and sisters didn't really know.
Joe Kennedy basically just took her to have this done.
They were hiding her mental illness at the time. It
was very shameful that she had mental illness at the time,
and when she emerged from the lobotomy, you know, she
was essentially a vegetable. She had regressed dramatically. She was
like a little child, and she was institutionalized after that.
(25:54):
But what the lobotomy did dude for neurosurgery was it
promoted the development of a lot of new techniques. So
a lot of the things we do now, the focal
delivery of radiation called stereotactic radio surgery, the implantation of
deep brain electrodes which we use to treat Parkinson's disease
and obsessive compulsive disorder and epilepsy, and the stereotactic radiation
(26:15):
which we can use to treat tumors and facial pain.
All of those things those were developed by surgeons trying
to improve on the frontal lobotomy because they realized it
was a sort of grotesque, imprecise operation and they wanted
to figure out a better way to do it. So
they developed all these new techniques and then realized they
could use all these techniques to treat other neurologic diseases,
and we still use those techniques today. So the frontal abiody,
(26:35):
that was a horrific moment in time where we rashly
adopted a surgery before it was well vetted, but it
propelled the feel forward fairly dramatically into a lot of
what modern neurosurgery is about today.
Speaker 1 (26:48):
That is so true about so much we learn in
the field of medicine, the bad and the good, and
my goodness, I just remember first hearing about a lobotomy
when I was an English major in college Tennessee. Williams
had to in the end give the go ahead to
give his sister Rose a full frontal lobotomy. He never
recovered from it.
Speaker 2 (27:07):
And when we come.
Speaker 1 (27:07):
Back more of the biography of brain surgery, the author
of the book Gray Matters is doctor Theodore Schwartz. More
with doctor Schwartz after these messages, and we continue with
(27:38):
our American stories, and with doctor Theodore Schwartz, the author
of Gray Matters, a Biography of Brain Surgery. Let's pick
up where we last left off. Chapter fourteen is especially compelling.
The title alone is compelling. What's it like to be
a brain? But you dive into the human experience, the
human tragedy of the end of life. We've all had
(28:02):
grandparents and parents who suffered from loss of memory, dementia,
and worse talk about that.
Speaker 2 (28:08):
So philosophically, we talk about the brain, and we talk
about the mind as a separate entity, and we like
to imagine and common sense tells us and our intuition
tells us that we can make decisions, our mind can
make decisions that will have an impact on the physical
world around us, and that we control our behaviors. But
(28:32):
there is no such thing as mind. There's no mysterious
substance that we have yet to identify by science that
is mind. All we know of is brain in neurons
and neurons firing that somehow creates our experience of what
it is like to be ourselves, and our identity is
very much a part of that. We feel like we
have an identity, we have a past, we have a future,
(28:53):
But the truth is the self and who we are,
and the decisions that we make are all based in
the mind. And the mind is a physical organ. It's
controlled by the laws of physics, and the laws of
physics do not allow for there to be a mind,
a substance that has a cause and effect, because the
only thing that can have a cause is another physical substance.
So there are a number of neurosurgical operations that have
(29:16):
been done and experiments done during brain surgery that lead
us to believe that our concept of the self is
not what we think it is. For example, if the
brain creates the mind and the self, and we can
do an operation where we take the two halves of
our brain and basically split them in half and cut
the connection, so you have two independent brains that can
(29:38):
think independently in your head. You would think that someone
would feel like there's two selves, but they don't. They
actually still feel like they only have one self. So
how is it possible to have two brains and only
one self. You can remove an entire hemisphere of the
brain in someone and they will wake up and feel
like their whole. They don't feel like they're half the
person that they were before. So there's clearly a disconnect
(30:00):
between this physical thing brain and this construct we have
of the self. And the truth is that who we
are is changing constantly based on our experiences, and we lose,
you know, thousands of neurons every day, we make new connections,
and so that creates our identity. And it is possible
to change someone's identity either because they have a stroke
and they forget who people are, Like the man who
(30:21):
mistook his wife for a hat doesn't recognize his wife anymore.
You can put electrodes in someone's brain, and this has
been well described and change the way they feel, change
their moods, make them happier, make them sadder, give them
brain fog. One pasion had an electro putting their brain
and they turned it on and suddenly they started enjoying
the music of Johnny Cash. And they turned it off
and they didn't like Johnny Cash anymore. And so if
you can trigger things that we think of as our identity, right,
(30:44):
I think of myself as someone who likes certain things
and dislikes some certain things, that's who I am. If
I can change those things just by stimulating your brain
or triggering your brain, what does that mean about who
you are and who you think you are. The other
fascinating thing that I'll just briefly talk about is there's
a lot of data showing that there are neurons firing
in your brain that precede every behavior that you do.
(31:06):
Right you imagine, sure, if I want to move my finger,
there's a neuron that's going to move that makes my
fingermoove and when I decide to move my finger, there's
some neurons that are saying, oh, I'm deciding to move
my finger. But it turns out that there are neurons
that are firing in your brain before you make the
decision to move your finger, about a second before you
make the decision, and the second before you make the
(31:28):
decision to say certain words, there are neurons firing in
your brain to make those words come out. So many
people think what happens is that the brain has independent
modules that are functioning and working all the time, and
they're taking in information processing it sitting out things to do,
and we behave based on what our brain wants us
to do. And then afterwards we experience that and we
(31:48):
create a story as to why we did what we did.
We move it back in time and our brain messes
with the time to pretend that we had agency and
that we create we wanted to do that in the
first place, but really our brain wanted to do it,
and that's why it happened.
Speaker 1 (32:03):
In your chapter Unlocking the Brain, you focus on two
stories that of Jean Dominique, Bobie and Stephen Hawking. Why
those two stories so.
Speaker 2 (32:14):
Jean Dominique Boubie was an editor of the French Ell
magazine who had a stroke that left him locked in.
So what locked in means is there are some places
you can have a stroke where essentially your entire body
is paralyzed, so you imagine you're in a wheelchair. Your
facial musculature is also paralyzed, so you cannot talk. All
some of these people can do is blink their eyes,
(32:36):
that's it. But their brains, in terms of their mentation,
are fully intact. So you're fully aware, fully conscious, but
you're a prisoner in your own body and all you
can do is blink your eyes. So it's really a
horrible way to live. And John Dominique Boube he would
blink his eyes and someone would point at different letters
(32:57):
on a screen to allow him to communicate. And he
wrote a book, The Butterfly and the Bell Jar using
that technique. So the question is how do you get
information out of a brain when the body can't allow
that information to escape. And Stephen Hawking had also had
the same problem. He could move a cheek muscle, and
so he used his cheek muscle to control a computer
(33:19):
that would go across to different levels and he would
stop it when he was trying to sell a certain letter.
So this leads us to the technology called brain computer interfaces.
A lot of people have read about with Elon Musk's
device of the neuralink device, which is basically a chip
implanted in the brain wires that read the firing of neurons,
and the neural code can be put into a computer
(33:41):
and the computer can interpret that neural code, and so
someone can use the power of their brain alone to
think and move a cursor on a screen, or type
letters on a screen, or move a robotic arm, or
move robotic legs or a full robotic body, or even
have their thoughts come out by speakings. So if you
imagine articulating the words you want to say and putting
(34:03):
electrodes in the part of the brain that move your
mouth and your tongue, the same neurons will fire every
time you say the vowel the letter A, and the
same neuron. Different neurons will fire when you say the
letter B, or you say this word or that word,
And so you can learn what those patterns of neuronal
firing is and correlate it with those different words, so
that every time you try to say something, the computer
(34:25):
will learn what you're trying to say, and suddenly someone
who can't talk can communicate, which is really remarkable. So
brain computer interfaces will allow human beings. The power of
telepathy and telekinesis getting ideas out of our head merely
by thinking about doing different things. It's no longer science
fiction and science fact. It's already going on at several
(34:48):
major institutions, academic institutions, and has been going on for decades.
It's just that Elon Musk has developed a commercially available
device that he's trying to sell and and improve upon
to move that technology forward. But it already exists, and
it's a fascinating future of the human race, and someday
we may all have implants in our brains that allow
(35:10):
us to interact with computers.
Speaker 1 (35:12):
Talk for a bit about work life balance, doctor Schwortz.
Because your job isn't one you can phone in. You
can't do it remotely, and it's certainly not a part
time gig. Talk about work and life, Talk about work
and family. How do you deal with balancing those things?
It must be a constant struggle.
Speaker 2 (35:31):
There's no question that I was not present for all
the things that a lot of other parents are present for.
I rarely ever walked my kids to school. My wife
always did that. If my kids had a game after
school at three point thirty, I never went to it.
But if they had a hockey game and both my
boys played hockey at seven o'clock PM, I was at
(35:52):
every single one and I brought them to practice on
the weekends. So you can't go to everything, and you
can't do everything, but you just have to be present enough.
You have to be there enough, and when you can
carve the time out, you have to carve the timeout.
So you have to be able to create that balance
when when your kids need you to. My wife often
would go to parties without me, and she learned how
(36:14):
to dance by herself on the dance floor. But I also,
you know, spent a lot of time with her when
I could, and when I was with her, I was
very present. So the key is to be very present
when you're there so that when you know you're not there,
they know that you were there. The other thing that
I did was I took all my kids into the
operating room so that they could watch me operate and
be a part of that experience, So they knew what
(36:34):
I was doing, and they knew how important it was.
And it wasn't some mysterious thing that took Dad away,
but it was something that we did together and that
we could talk about. And so they embraced that ultimately
and felt a part of it, and so they loved it,
you know when I got called, because they knew that
I was doing something important, and I think they respected
(36:54):
and appreciated that, and that helped me do it because
I had their acceptance and I had my wife's acceptance,
no resentment at any time. So I was blessed to
have a very loving, supportive family.
Speaker 1 (37:04):
I want to close things out, doctor Schwartz, with one
final reading from your book again about the life of
a neurosurgeon. Like a priest or anun we swear an
oath to dedicate ourselves to a higher purpose, far greater
than ourselves, the health of our patients.
Speaker 2 (37:21):
Soldiers.
Speaker 1 (37:22):
Creeds hold true for neurosurgery as well. I will always
place the mission first. I will never accept defeat. I
will never quit. And that's something your kids and wife
can hold close as they think about their father, the
man they love. And you've been listening to doctor Theodore Schwartz.
(37:44):
He's the author of Brain Matters, a biography of brain surgery.
He's also am attending neurological surgeon and professor of neurological
surgery that Wild Cornell Medicine in New York City, and
we heard so much, absolutely riveting and fascinating about his
day to day life. We love to do that here
on this show, the story of doctor Theodore Schwartz and
(38:05):
a Biography of brain surgery. Here on our American Stories
Host
Lee Habeeb
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