Inside the Mind of a Brain Surgeon

This is an iHeart podcast. Guaranteed human. Saturday, August 22nd in Tampa, witnessing MMA Legends final fight. Chris Cyborg, one of the greatest in history. She's an absolute pioneer in the sport.

Defends her PFL world title. One last time. Unforgettable and got you, Margaret. To an unforgettable career. Saturday, August 22nd, live from Benchmark International Arena.

For tickets, visit pfl.info/slash tampa. Spending time outdoors, then let's talk about skin cancer. Non-melanoma skin cancers, or NMSCs, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common cancers in the U.S. and can become harder to treat if left undetected. That's why sun protection and timely detection matter.

Our sponsor, Regeneron, is raising awareness about advanced NMSCs. Learn more and take the pledge to see a dermatologist annually at let's get real about skincancer.com. My name is Jessa. One of the things I love the most about working for United Healthcare is that everybody matters. Every moment matters.

There's a person behind every problem. I care because it's what I was put on this earth to do. I'm Ben and I work at United Healthcare. I am just one piece of a larger puzzle, but every piece matters. It's more than just work.

We want to make the healthcare system better for everyone. I care because I want to make a difference. That's what committed to care means to me. This is how eBay Live usually goes. You tune into a stream just to browse.

Then something rare pops up for a total seal, like a vintage handbag or a rookie baseball card. The bids start flying, and browsing quickly turns into, I have to have this. And guess what? You win. And it's a rush because everyone else wanted it too, but you got it.

On eBay Live, you don't just watch the action, you're in it. Download the eBay app to watch live and shop live. eBay Live, things people love. This is Lee Habib, and this is Our American Stories, the show where America is the star. and the American people.

Up next, Dr. 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 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. It sounds to me like your mother and father had a lot to do. With who you were. Talk about that. 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 was a Holocaust survivor, where I grew up in the Jewish faith. Um and she was born in Vienna.

And lost her sister at a very young age to meningitis. And then, at age 12, when Hitler marched into Vienna, She was kicked out. Uh her father's store was closed. And she spent the next five or six years running away from the Germans. and ended up hiding in a convent in Belgium.

changing her name to Simone Mabier from Mara Schwartz, Speaking French from her original German until she eventually came to America. She met an American soldier and moved to Kalamazoo, Michigan. Lived as a Christian in America for a little while 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 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. that I am is a lovely human being, but very different.

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 in her car. by snowplows. And how did that experience affect you?

Talk about its impact.

So I was walking to school one morning in high school, probably a junior, maybe I was 15, 16 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 sides of the streets. And so, when the snow clouds do that, they basically box in all the cars who now have 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 her wheels were spitting and the snow was flying everywhere and it was just slush at this point and she could not 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 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. 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. I tried 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 lunchroom 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, they work in labs.

Some are athletes who like to be the center of attention. Neurosurgery is a very physical activity. 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 their instruments. You know, there's a lot of manual dexterity in surgery, which is the same as many instruments that people play. And the ability to sit and practice your 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. And then there are also people touched by neurosurgery. And there are quite a few neurosurgeons. 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 shouted 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. I was reading astronomy. books when I was in high school. and 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. And you've been listening to Dr. 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 Weill Cornell Medicine. one of the busiest and highest ranked neurosurgery centers in the world. located in New York City. And the story about his mom alone could have been a movie. 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 in New York to a second husband. And my goodness, we learn also about the turning point in Dr. 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, 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 Dr. Theodore Schwartz. Here on Our American Stories. Mm-hmm.

Lee Habib here, and I'd like to encourage you to subscribe to Our American Stories on Apple Podcasts, the iHeartRadio app, or wherever you get our podcasts. Any story you missed or want to hear again can be found there daily. Again, please subscribe to the Our American Stories podcast anywhere you get your podcasts. It helps us keep these great American stories coming. Saturday, August 22nd in Tampa, witnessing MMA Legends final fight for a cyborg.

One of the greatest in history. She's an absolute pioneer in the sport. Defends her PFL world title one last time. Unforgettable and got you! To unforgettable Korea.

Saturday, August 22nd, live from Benchmark International Arena. For tickets, visit pfl.info/slash tampa. Spending time outdoors, then let's talk about skin cancer. Non-melanoma skin cancers, or NMSCs, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common cancers in the U.S. and can become harder to treat if left undetected.

That's why sun protection and timely detection matter. Our sponsor, Regeneron, is raising awareness about advanced NMSCs. Learn more and take the pledge to see a dermatologist annually at let's get real about skincancer.com. Hi, I'm Steph, and I work at United Healthcare. When I think about United Healthcare's members, I think of my own family.

My niece was diagnosed with an ultra-rare genetic disorder. I know how hard it is for our families at United Healthcare. We can make it easier. I'm Brian. I care because I know what it's like to not speak the language.

It's not easy. Health insurance is complicated. I would say our job is to make everything easy for our UXC members. I work for United Healthcare. I'm committed to care.

IceCube's big three season has come down to this. The big three championship is coming to Charlotte, who will be crowned the Big Three Season 9 Champion. Plus the Big Three All-Star Game, the biggest names in the game, all on one court one more time. Two games of the most physical, competitive, and non-stop three-on-three action. The game played the way you love.

Watch live Saturday on CBS at 1 p.m. Eastern, 10 a.m. Pacific, and catch replays Monday on BET. Presented by iHeart. A Jay Jay?

And we return to Our American Stories and Dr. 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 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.

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 shingle. and you are credentialed to perform brain surgery on your own.

So the question is, how do you teach someone to perform brain surgery on your own when 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 them do it unless you're 100% 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 take over. Learning from failure as a surgeon is a whole other different conversation. And I do write about this. 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 simultaneously arrogant and humble. Because You have to believe in your heart that you're the best person to 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 you haven't had a complication, it's 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, that's how you get better. I am better, you know, 30 years out than I was 25 years out than I was 20 years out, than 15. 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 are the bread and butter of your orthopedic surgeon colleagues.

Talk about head trauma. What is it? And how many people a year die from head trauma? And while we're at it, Tell this story. Of the Swiss Army knife.

So we separate head trauma into blunt head trauma and penetrating head trauma. And blunt head trauma is: you know, let's say you're in a car accident and your head hits the steering wheel, or you're playing football and your helmeted head hits someone else's head, or 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 the brain and the skull very, very differently. And as you can imagine, a lot of neurosurgeons in the early part of the 20th 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 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. You don't think of a Swiss Army knife as a lethal 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 it turns out the tip of the knife was very close to a critical artery called the internal carotid artery.

So we had to do a full craniotomy because we couldn't just pull it out. Because if you pull it out, you might have sheared the artery and actually have someone pull it out while I was staring at the artery after opening up his head. We did manage to save his life. But he was essentially handcuffed to his gurney with a police officer at his side because he was involved in some. uh nefarious activities, so I never really figured out what happened or why it why it happened to him.

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. 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.

This was 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 with college payments looming. 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 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 to 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 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 gonna beat this thing, but rather true hope. A concept introduced by Jerome Grubman 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 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. Let's talk about the surgery itself. You write about the fact that sometimes the patient needs to stay awake during brain surgery. Does the patient feel pain?

Why do they stay awake? Yeah, you know, if you watch your feeds on Facebook or Instagram, every once in a while you'll 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 brain that's important for 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 are some tumors that sit in 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 patient awake in the operating room. Having them doing 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 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 stimulating a particular area.

So that allows us to do our surgeries more safely. How we do it is that we give people IV 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 carpentry. 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 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. The story of biography. Saturday, August 22nd in Tampa, witness an MMA Legends final fight. Chris Cyborg, one of the greatest in history. She's an absolute pioneer in the sport.

Defends her PFL world title. One last time. Unforgettable end. To an unforgettable career. Saturday, August 22nd, live from Benchmark International Arena.

For tickets, visit pfl.info/slash tampa. Spending time outdoors, then let's talk about skin cancer. Non-melanoma skin cancers, or NMSCs, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common cancers in the U.S. and can become harder to treat if left undetected. That's why sun protection and timely detection matter.

Our sponsor, Regeneron, is raising awareness about advanced NMSCs. Learn more and take the pledge to see a dermatologist annually at let's get real about skincancer.com. My name is Jessa. One of the things I love the most about working for United Healthcare is that everybody matters. Every moment matters.

There's a person behind every problem. I care because it's what I was put on a search to do. I'm Ben and I work at United Healthcare. I am just one piece of a larger puzzle, but every piece matters. It's more than just work.

We want to make the healthcare system better for everyone. I care because I want to make a difference. That's what committed to care means to me. IceQ's big three season has come down to this. The big three championship is coming to Charlotte.

Who will be crowned the big three season nine champion? Plus the big three all-star game, the biggest names in the game, all on one court one more time. Two games of the most physical, competitive, and non-stop three-on-three action. The game played the way you love. Watch live Saturday on CBS at 1 p.m.

Eastern, 10 a.m. Pacific, and catch replays Monday on BET. Presented by iHeart. And we continue with our American stories and with Dr. Theodore Schwartz.

He's the author of Gray Matters, 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 the brain actually feels like. What I also learned is that you've removed nearly 10,000 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.

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 as could safely be removed. Although it's a tough tour to beat, 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 neuro-oncologists to help coordinate the next stage of this process. While our neurooncologists at 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, didn't explore all the options, or left a stone unturned. 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 5, 10, or even 15 years after a GBM diagnosis are a rare reminder that my degree and years of experience go 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. They also worry that their brain tumor 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 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.

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 experience, and your knowledge. Talk about the burdens of that responsibility and also the exhilaration of that responsibility.

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 a 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? Do I want to try to get every last bit of this tumor out, which potentially could cure the patient? Um 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 a 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 that decision, right? 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, 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 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. There are a lot of famous names and patients in your book, Dr. Schwartz, and I want you to talk about one.

I want to talk about Rosemary Kennedy. And I want you to talk about lobotomies. 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 it 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 60,000 frontal lobotomies done in America in the 1950s and 1960s, which 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 and 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 were essentially 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 Moniz, who was a neurologist, won the Nobel Prize, believe it or not, for the frontal lobotomy that was based on very little scientific basis.

And then there was a gentleman named Walter Freeman, who was also a neurologist, and he started doing lobotomies in America. He started out working with a neurosurgeon, where they would drill burrow holes 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 part of the brain. He didn't like relying 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 read 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 back and forth. And he could do one of these procedures in about 10 minutes. He would charge $25 for it. He would do six or seven in a day.

He would do it with no antiseptic, no anesthesia. He would actually give electroshock therapy to the patients to put them under, and then he would do this procedure. And then he would have people around him, and he publicized it. And he traveled all around the country doing, I think he personally did about 4,000 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, Walter Freeman did her lobotomy. Many people didn't know she had 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 lobotomy, you know, she was essentially a vegetable. She had regressed dramatically. She was like a little child, and she was institutionalized after that. But what the lobotomy did do 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 radiosurgery, the implantation of deep brain electrodes, which we use to treat Parkinson's disease and obsessive compulsive disorder and epilepsy, and the stereotactic radiation, 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 body was a horrific moment in time where we rashly adopted a surgery before it was well vetted. But it propelled the field forward fairly dramatically into a lot of what modern neurosurgery is about today. 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.

In 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. And when we come back, more of the biography of brain surgery, the author of the book Gray Matters, is Dr. Theodore Schwartz Moore. with Dr.

Schwartz after these messages. Saturday. August 22nd in Tampa, witness an MMA Legends final fight. Chris Cyborg, one of the greatest in history. She's an absolute pioneer in the sport.

Defends her PFL world title one last time. Unforgettable and got you, Cyborg. To an unforgettable career. Saturday, August 22nd, live from Benchmark International Arena. For tickets, visit pfl.info/slash tampa.

Spending time outdoors, then let's talk about skin cancer. Non-melanoma skin cancers, or NMSCs, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common cancers in the U.S. and can become harder to treat if left undetected. That's why sun protection and timely detection matter. Our sponsor, Regeneron, is raising awareness about advanced NMSCs.

Learn more and take the pledge to see a dermatologist annually at let's get real about skincancer.com. My name is Jessa. One of the things I love the most about working for United Healthcare is that everybody matters. Every moment matters. There's a person behind every problem.

I care because it's what I was put on this earth to do. I'm Ben and I work at United Healthcare. I am just one piece of a larger puzzle, but every piece matters. It's more than just work. We want to make the healthcare system better for everyone.

I care because I want to make a difference. That's what committed to care means to me. IceCube's big three season has come down to this. The big three championship is coming to Charlotte, who will be crowned the big three season nine champion. Plus the big three all-star game, the biggest names in the game, all on one court, one more time.

Two games of the most physical, competitive, and non-stop three-on-three action. The game played the way you love. Watch live Saturday on CBS at 1 p.m. Eastern, 10 a.m. Pacific, and catch replays Monday on BET.

Presented by iHeart. And we continue with our American stories. And with Dr. Theodore Schwartz, the author of Gray Matters, a biography of brain surgery, let's pick up where we last left off. Chapter 14 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 grandparents and parents who've suffered from loss of memory, and Dementia and worse.

Talk about that. 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 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.

and 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. 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 that'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 been done and experiments done during brain surgery. That leads 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 south. 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 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 they're whole. They don't feel like they're half the person. that they were before.

So, there's clearly a disconnect 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 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 mistook his wife for a hat, doesn't recognize his wife anymore. You could 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 patient had an electrode put in 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? I think of myself as someone who likes certain things and dislikes 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 precedes every behavior that you do, right? You imagine: sure, if I want to move my finger, there's a neuron that's going to move that makes my finger move. 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 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, spitting out things to do. And we behave based on what our brain wants us to do, and then afterwards. We experience that and we 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 creat we wanted to do that in the first place.

But really our brain wanted to do it, and that's why it happened. In your chapter, Unlocking the Brain, you focus on two stories, that of Jean-Dominique Boby. and Stephen Hawking. Why those two stories?

So, Jean-Dominique Beaubie was an editor of the French L 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 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. That's it. But their brains.

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. Um And Jean-Dominique Beauby, he would blink his eyes. And someone would point at different letters on a screen to allow him to communicate. And he wrote a book. The butterfly in 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 ALS, who had the same problem. He could move a cheek muscle. And so he used his cheek muscle to control a computer that would go across to different levels, and he would stop it when he was trying to say a certain letter.

So, this leads us to the technology called brain-computer interfaces that a lot of people have read about with Elon Musk's device, the Neuralink device, which is basically a chip implanted in the brain, wires that read the firing of neurons, and the neuronal code. Can be put into a computer, 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 speaking.

So if you imagine articulating the words you want to say and putting electrodes in the part of the brain that move your mouth and your tongue. Um 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 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, it's science fact. It's already going on at several 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 um 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 us to interact with computers. Talk for a bit about work-life balance, Dr. Schwartz, 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. 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. Um if my kids had a game after school at 3.30, I never went to it. But if they had a hockey game and both my boys played hockey, at 7 o'clock p.m., I was at 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 time out.

So you have to be able to create that balance when your kids need you to. My wife often would go to parties without me. And she learned how 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'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 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 then we could talk about. Um and so they embraced that. Ultimately, and felt a part of it.

And so they loved it when I got called because they knew that I was doing something important. And I think they respected and appreciated that. And that helped me do it because I had their acceptance. I had my wife's acceptance. And no resentment.

at any time.

So I was blessed to have a very loving, supportive family. I want to close things out, Dr. Schwartz, with one final reading from your book, again, about the life. of a neurosurgeon. Like a priest or a nun, we swear an oath to dedicate ourselves to a higher purpose, far greater than ourselves.

the health of our patients.

Soldiers' 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 do. can hold close.

as they think about their father. the man they love. And you've been listening to Dr. 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 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 Dr. Theodore Schwartz and a biography of brain surgery.

here on Our American Stories. Saturday, August 22nd in Tampa. Witness an MMA Legends final fight. Chris Cyborg, one of the greatest in history. She's an absolute pioneer in the sport.

Defends her PFL world title. One last time. Unforgettable and got you! To an unforgettable career. Saturday, August 22nd, live from Benchmark International Arena.

For tickets, visit pfl.info/slash tampa. Spending time outdoors, then let's talk about skin cancer. Non-melanoma skin cancers, or NMSCs, including basal cell carcinoma and cutaneous squamous cell carcinoma, are the most common cancers in the U.S. and can become harder to treat if left undetected. That's why sun protection and timely detection matter.

Our sponsor, Regeneron, is raising awareness about advanced NMSCs. Learn more and take the pledge to see a dermatologist annually at let's getreal about skincancer.com. Ice Cube's big three season has come down to this. The big three championship is coming to Charlotte, who will be crowned the big three season nine champion. Plus the big three all-star game, the biggest names in the game, all on one court, one more time.

Two games of the most physical, competitive, and non-stop three-on-three action. The game played the way you love. Watch live Saturday on CBS at 1 p.m. Eastern, 10 a.m. Pacific, and catch replays Monday on BET.

Presented by iHeart. Keeping a working forest growing takes a massive commitment. That's why working forest professionals plant over 1 billion seedlings annually in the U.S., ensuring more trees are planted than harvested. But it takes more than planting to sustain these ecosystems. It means caring for everything in the forest, from clean water to thriving wildlife.

Because when we take care of our forests, they'll thrive for generations. Learn more at WorkingForestsInitiative.com.