Joshua: The Sculptor

Neurosurgeon Joshua Bederson, MD, has performed more than 4,000 neurosurgeries at Mount Sinai. In this audio profile, he talks about the beauty of the brain and the connection between neurosurgery and his other passion: sculpting. Dr. Bederson is  Leonard I. Malis, MD / Corinne and Joseph Graber Professor of Neurosurgery and System Chair for the Department of Neurosurgery at Mount Sinai Health System.

Links

• Dr. Bederson's official bio
• Department of Neurosurgery at the Icahn School of Medicine at Mount Sinai
• Neurosurgery Care at Mount Sinai
• Watch Dr. Bederson at work in his studio and in the operating room
• "What it takes to be a great neurosurgeon" (an essay about Dr. Bederson)

Episode Transcript

Dr. Bederson (00:02):
I guess you would call it a ritual, but it's more
than a ritual.
What I do before every case is Istop.
I say a little prayer, I guessyou'd call it, even though I'm
not a religious person.
Just"J.B., do everything you canto not hurt this person." I'm

(00:26):
not sure that's related to thecomplexity of the brain so much
as to the need to focus fully onwhat you're doing.
My name is Joshua Bederson.
I'm Professor and Chairman ofNeurosurgery at the Mount Sinai
Health System.

(00:49):
The structures in the brain arevery soft and delicate.
A cranial nerve that moves theeye, for example, can be one
millimeter in diameter or less,and it can have the consistency
of wet tissue paper.
Imagine trying to hold a piece,a string of wet tissue paper
between your two fingers, or thefingers of your two hands.

(01:11):
It wouldn't take much tension torip that tiny piece of wet
tissue paper.
And many of those cranial nervesand structures are in canals and
tunnels of bone.
Meaning that in order to getaccess, you have to use
instruments and tools capable ofdrilling bone that can be as

(01:32):
hard as cement.
And yet the structure you'retrying to save is as delicate as
wet tissue paper.
There are times even in my dailysurgeries where the distance
between success and tragedy is afraction of a millimeter.
There's something awe-inspiringabout doing that on a daily

(01:53):
basis.
How many surgeries have Iperformed?
Well, since coming to MountSinai I have performed
approximately 4,000 openneurosurgery procedures.
Of course there were manyhundreds and thousands of
procedures that went into mytraining.
So I'm getting up there in termsof numbers.

(02:19):
I love using my hands and if I'mnot using my hands in the
operating room, I'm in my studiodoing things.
Since second grade I've beengoing to art school and art
classes.
And in the subtractivesculptures that I do, like
carving stone and wood, you canenvision the hand or the face

(02:44):
inside the stone and you releaseit by removing the part of stone
and wood that is not relevant.
In neurosurgery, you removesomething that is potentially
ugly, like a tumor or ananeurysm, and you peel it away,
you carefully remove it fromwithin and from without, and the

(03:05):
reward at the end is a view ofwhat has to be the most
beautiful art on the planet,which is the interior structures
of the brain as pathways ofnerves and spinal fluid and
blood are revealed.
Those are extremely beautiful.

(03:26):
I think the real connection forme is in appreciating beauty,
creating beauty, and in findingbeauty.
If I could snap my fingers andunlock one mystery about the

(03:49):
brain, it would be— what can wedo about consciousness and
unconsciousness, when it seemsthat most of the structures that
should support consciousness arethere, but the patient doesn't
wake up?
The level of consciousness isadversely affected by some

(04:11):
combination of structural orcircuitry abnormalities.
And yet all of our studies andscans would lead us to believe
that the structures underlyingconsciousness should be
available.

(04:31):
So augmented reality and othertechnologies are already making
surgeries faster, safer, lessinvasive.
We create a virtual 3D-realityscenario about a patient.
And we use that during surgeryto see important structures and

(04:51):
avoid dangerous ones before weget to them.
That's now.
What I see happening in thefuture is that we will be able
to connect instruments directlyto that visual information.
So that now, instead of seeingthat you have to stop because
you're reaching the carotidartery, you will feel your
instruments stop.

(05:14):
If I could give myself a pieceof advice when I was younger, I
would say some combination ofvision and desire and impatience
is necessary to get a lot done.
But flexibility and patients arealso necessary, because there's

(05:35):
so many roadblocks and obstaclesalong the way.
So although I have managed toget something done, I feel like
most of what I've been doing istwo steps forward and 1.95 steps
backward.
And yet there's steady progressforward because the net result
is 0.05 steps forward with eachstep.