Feel Better, Live More with Dr Rangan Chatterjee - #185 Life Lessons from a Brain Surgeon with Dr Rahul Jandial

Episode Date: May 25, 2021

Today I'm delighted to welcome one of the world's leading neurosurgeons, Dr Rahul Jandial back onto the podcast. I first spoke to Rahul back on episode 76 about the simple things that we can all do to improve and optimise our brain health. I decided to invite Rahul back onto the show after taking a look at his latest book, Life on a Knife's Edge: A Brain Surgeon’s Reflections on Life, Loss and Survival, which is a beautifully written account of the resilience, courage and belief he has witnessed in his patients, and the lessons about human nature he has learned from them. At this point in his career, Rahul has operated on several thousand skulls and brains. He is the last hope for patients with extreme forms of cancer. And in treating them, he's observed humanity at its most raw, but also at its most robust. He has journeyed to unimaginable extremes with his patients, guiding them through the darkest moments of their lives and in today's conversation, he shares some of the powerful lessons that he's learned that are applicable to us all. In our conversation, we cover a wide range of different topics such as Rahul’s own practices and rituals to get him ready for high pressure surgery. We also talk about what specific breathing technique he uses when stressful situations come up whilst he is in the middle of an operation. We discuss what Rahul has learned about the brain, our minds and our sense of self and what cancer patients at the ends of their lives have taught him about living. He explains the importance of balancing times of stress with time for rest, the importance of connection and compassion and we chat about resilience. This really was a fabulous conversation that I myself got a lot out of. I really hope you enjoyed listening. Thanks to our sponsors: http://blublox.com/livemore http://www.vivobarefoot.com/uk/livemore http://www.athleticgreens.com/livemore Show notes available at https://drchatterjee.com/185 Follow me on instagram.com/drchatterjee/ Follow me on facebook.com/DrChatterjee/ Follow me on twitter.com/drchatterjeeuk DISCLAIMER: The content in the podcast and on this webpage is not intended to constitute or be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have heard on the podcast or on my website.

So I've met over 10,000 people. I've opened thousands of human bodies. And what's interesting is not the anatomy. It's their journeys before and after the surgery that matter. I've met them all in their crises. I've met them all in their most difficult times in their lives. And they've let me come aboard and partner with them and journey with them for a little bit. And they have shown me that difficult times, they hold a reservoir

for growth. Hi, my name is Rangan Chatterjee. Welcome to Feel Better, Live More. Hello, how are you wherever you are in the world right now listening to this podcast? I hope you are having a good week. Today on the show, I'm delighted to welcome one of the world's leading neurosurgeons, Dr. Rahul Jandil back onto the podcast. Now, long-time listeners of the show may recall that I first spoke to Rahul way back on episode 76 about the simple things that we can all be doing to improve and optimize our brain health. If you've not yet heard that conversation, it's well worth going back and having a listen at some point. Now, I decided to invite Rahul back onto the show after taking a look at his latest book, Life on a Knife's Edge, which is a beautifully written account of the resilience, courage, and belief that he has witnessed in his patients

and the lessons about human nature that he has learned from them. At this point in his career, Rahul has literally operated on several thousand skulls and brains. He is the last hope for patients with extreme forms of cancer. And in treating them, he's observed humanity at its most raw, but also at its most robust. He has journeyed to unimaginable extremes with his patients, guiding them through the darkest moments of their lives. And in today's conversation, he shares some of the powerful lessons that he's learned that are absolutely applicable to us all. In our conversation, we cover a wide range of different topics, such as Rahul's own practices and rituals to get him ready for high-pressure surgery. We also talk about what specific

breathing technique he uses when stressful situations come up whilst he is in the middle of an operation. We talk about resilience, what he has learned about the brain, our minds, and our sense of self, what cancer patients at the ends of their lives have taught him about living, the importance of balancing times of stress with time for rest, as well as the importance of connection and compassion. This really was a fabulous conversation that I myself got a lot out of. I really hope you enjoy listening.

And now, my conversation with the inspirational Dr. Rahul Jandil. You are a world-class brain surgeon. You deal with incredibly complex patients. You do high pressure operating where the stakes really could not be higher. What do you do the night before and the morning of one of these big operation days? That's a great question to open up with. I think, first of all, just to give context, most surgeons don't do dangerous operations. So I chose to be a cancer surgeon. I chose to take on the big cases. That's what drives me. That's what is a meditative state for me when I have to focus that much. So I have a lot of gratitude for my patients for trusting me. That said, I always want to bring my A game to the case, to the operation. So the night before, there is a ritual and it involves a little bit of physical exercise because often not realized by people is that a long operation is a physical endeavor. I mean, you're hunched over, I'm wearing a headlight, I've got loops on my eyes, you're moving, you're in awkward positions.

So I will do some light weight training the night before, nothing that wears out my hands and forearms, but just postural stuff. And what that does is it's sort of like a pre-game prep so i bring a physical preparation to that and then mental or psychological uh the ritual is the last 10 minutes before i fall asleep i'm running through the shape of the cancer and the dangerous anatomy that it's ensconced in so you have to dissect out a cancer from not normal anatomy, right? When the cancer grows, it distorts the blood vessel. So it doesn't look like an anatomy book. So you have to imagine around this corner, you might bump into this around this way. If I hit this vessel, what's my next maneuver. So I do a pre falling asleep, uh, run through of the shape, the process.

And then I let, I sort of let my dreams and my you know put my mind to work at night and that's the way i focus for the case the next day hearing you describe your you know your pre-game ritual is it's quite reminiscent of sports people, you know, who may have a certain ritual to allow peak performance the following day. I've heard this from golfers before, from all kinds of athletes, but you don't tend to hear it as much from people in non-sporting professions. Yeah. And I would imagine all of us on some level could benefit from looking at our day-to-day work with the same kind of microscopic precision that you do. Yes, the stakes are high for the job that you've chosen, but I guess it's all relative because in

our own lives, we all want peak performance in whatever we're doing. Yeah, that stress you're feeling the next day, whether it's trying to navigate a fight with a lover or trying to navigate a conversation with a boss or get to work on time, stress and pain, these things are personal dimensions. So the approach to a challenge, the lessons apply to all of us, whatever our individual challenges are. And it is like sport. I think that's often

not understood that surgery is a physical task. That's why it was called an operating theater. It's a performance. Some of us are better at it. It's not always the same 100 steps. Some people are slicker and have softer touch and can get the work down in 60 steps. So I love that technical aspect of it. But whatever the challenge I have found, I have found a little bit of physical activity mixed with a little bit of thought, not total step-by-step preparation for, you know, not engineering or sort of micro planning the next day, but something about being physically active the day before improves my sleep. Something about running through what the next day will bring gives me sort of a

background preparation because what I do, you can't always anticipate what's going to happen, but that's life for most people. And so I think the pre-falling asleep window is a unique portal to some of the subconscious things we do in our dreams and our sleep. And as a sort of digression, creativity, a lot of people have used the falling asleep period and the waking up period as a way to sort of introduce fresh approaches and new thinking to a problem that they've been struggling with. which is a new thinking to a problem that they've been struggling with. So whether it's Einstein or the guy that designed the Louvre, the inception of the movie was based on that. So I try to take real science, biology, electrophysiology to guide my process. Now, people may have other ways of doing it, but I like it to be anchored in something scientific.

of doing it, but I like it to be anchored in something scientific. The way you describe it, it sounds very much to me as though you have experimented with different techniques over the years before sort of falling upon this one that currently gets you into peak performance. So I guess I'm interested, is it quite unique what each individual needs to do? And then can that approach change and evolve over time as we change and evolve over time? Yeah. I mean, I think you have to stay adaptive, but we're talking about a certain thing here where I have an anticipated challenge. But what this last year has shown us is what do we do when we've had no preparation, no anticipation? And I think that takes a different set of skills. So there's crisis management in something you're going in prepared for.

And then there's crisis management for a crisis you've never anticipated. And I think those require two different skill sets. One, you can have some rituals that become a portal to your peak performance or your optimum technical ability or optimum stress management for yourself, whether that's through breathing techniques or a ritual before you go to sleep. But what happens when there's a crisis you don't anticipate? That's harder. That's harder to be prepared for. But what you can draw on is sort of the it's often a overused word. So I just want to add some nuance to it. But resilience, there's two types and peak performance, resilience, emotional regulation, all these things tie in together. But I really liked taking apart the term resilience in this book. And so there's the physics and engineering definition where you take, you know, there's a, you know, you get deformed and you return to original state, but the psychological definition and going back to crisis management for things you haven't seen before,

the psychological definition is fascinating to me. So there's two types of resilience, processive resilience and systemic. Let's start with systemic. Systemic resilience means you got it in you. It's what you bring to the fight. Systemic resilience is what I bring to the operating room on Wednesdays. Systemic resilience is what we had in us before 2020 rocked the world.

But that's not your final story because there's also processive resilience. And that's what the fight brings out in you. So I think that's very powerful for me because it leaves us thinking no matter where you are in your life, whether you're getting rocked and whether you're struggling because of something difficult going on, or whether you're feeling triumphant, that tomorrow is always possible because of processive resilience, what the fight, what the struggle will bring out in you that you may not even recognize in yourself. And I bring that to crisis management. When I go to the OR, it's planned, I've seen it, I'm planned for the uncertainty. But relationships, raising children, life, that requires a resilience that you have yet to demonstrate based on the struggle in front of you.

When I think of it that way, I feel very optimistic, regardless of the place I might find myself in today. Yes, a beautiful way of looking at the two kinds of uncertainty that we face in life, that predictable uncertainty and the unpredictable. And I guess I wonder when I hear that, does your diligent practice of attention to ritual attention to your performance for that predictable uncertainty in the operating room does that transfer over to help you be more resilient to that unpredictable uncertainty you know are there is there a unified skill set there? Is some of that skill transferable across? And therefore, does that mean all of us should, in some ways, try and do certain practices

on a daily, weekly, monthly basis to prepare for when those uncertain events happen as they always do? It's an excellent question. A difficult one, but I think one where I can just offer you my understanding. So the crises, crisis management, whether in the operating room or outside of the operating room, or outside of the operating room, there is a physiologic response that happens in our skulls,

you know, chemicals, hormones, electricity, blood flow. It's not just wiring. It's an ecosystem, and there's a response that happens. And what I've learned from the operating room is when i get into a tricky situation the first thing i do is just prevent myself from hyperventilating i think everybody thinks oh you're born with nerves of steel and no you train yourself to be calmer to allow that calmness to release the ability to come up with good solutions and behavior that you, that's not reactive, that's not freaked out. So what the operating room has taught me is the cadence of breathing. And I think a lot of people are thrown off. They're like, this brain surgeon talking about breathing, you know, it's like, but that's, there's, again, there's physiology about that. And if i may um when we freak out for whatever

reason we breathe faster and in the past it was probably a saber-toothed tiger we'd appropriately freak out and it was usually accompanied by running or movement and as you know when our muscles churn we make carbon dioxide which is the stuff we blow out and the things that you know plants absorb but so we hyperventilate to to get rid of that that metabolic waste from the muscles churning but if we hyperventilate or freak out and we're not running we're just in the operating room or we're sitting in our car or we see something on our phone. Well, now you're, you're blowing off or, you know, evacuating carbon dioxide that you haven't built up from churning muscles and that kind of hyperventilation, which actually lowers the levels of carbon dioxide in your blood. Okay. That's, that leads to twitchiness, frenetic thoughts, irritability.

It's physiologic. Hyperventilating without also accompanied physical activity makes us nervous, gets in the way of our thinking. And so when we know that that's the biology and the physiology, I mean, you can measure it um then the first step in crisis management in the operating room is just slow it down and get it through my nose just just two three seconds in two three seconds out my mind is racing my mind is all over the place but what i'm doing is not exacerbating my inner panic through hyperventilation so the first thing i do my inner panic through hyperventilation. So the first thing I do, just slow it down my breathing and then just keep thinking, keep, keep, keep thinking. And I didn't always do that. I'd fog up my glasses when I was operating. And now people after the pandemic know what it is to have

mask and glass and imagine operating through that, right? You're, you're, you're nervous, you're panicking, you're learning how to operate your, and you're, you're getting in the way by hyperventilating. Not only are you making yourself twitchy, you're fogging up the glasses you're looking through as you operate. So I had to really get my breathing under check. And that's a thought process. Now, I don't have to worry about fogging up my glasses because of my breathing, but that is my go-to move for crisis management in the operating room. Now, back to your question, unanticipated challenges and crises, you can't prepare for them the night before, right? That we can't do. But wherever you are in your moment and you

feel that fear or panic or anxiety grip you, the weapon you have against that, it's not going to be equally effective in everybody, but the biology and the physiology that you can control with thought is to get that breathing under control, get that breathing under check. Whatever you do through that, you may still make a bad decision. I'm not trying to get to people having outcomes, but you'll be in the best position for you as that individual to think clearly and to have the most emotional regulation you can. Yeah. I mean, there's so much there to unpack. I think the key point that I'd love to just, whether you just emphasize for everyone listening or watching, is that you are a leading neurosurgeon. When the stakes are high, when the pressure starts to mount up, you start to focus on your breathing.

Through your nose, three seconds in, three seconds out. That is what gets you through and able to perform, or one of the things I should say. the things I should say. And for people who are skeptical of breathwork and the power of controlling your breath like that, I think the example you just demonstrated should shatter any skepticism remaining in someone to go, look, if Rahul Janneal is doing it when he's operating, well, maybe you might want to think about it when you're having a row with your partner, or when the kids are starting to wind you up and you're starting to react or whatever it is. That's what I think is so one of the powerful things about what you just said. Thank you, brother. And it's free. You know, that's just, that's the thing is I just struggle so much. You know,

I live in Los Angeles and I. The wellness capital of the world, man. And I think I saw you on tv down here at the local tv station that i do stuff at one time and they asked me about you i said yeah he set me up with a wonderful opportunity and interview and interaction in london so they were they were glad to have you and um kcl i think that was yeah yeah yeah i've been doing that for 12 years that's where i got my start and it bounced off and ricocheted into different things. But, you know, Los Angeles is fascinating because I'm going to come back to this breathing. You know, it's not just Hollywood. Actually, if you look at it, it's such a huge place.

Only the Hollywood Hills and small pockets are what most people have in mind when they think of los angeles but they're also major major university centers ucla usc jpl caltech city of hope uh even cedars then you go south you get to er i mean there's just a lot of powerhouse uh academics going on and and i think that's where I saw that breath and breathing, both edges. I saw it being sold at niche meditation yoga clubs. They charged people for it. And I thought, you know, that's too much because this is a power that we're endowed with. And I felt, you know, that's too much because this is a power that we're endowed with. And then on the other side, I saw it being applied to teaching patients how to calm down before they get their cancer diagnosis or in their MRI machine every three months waiting to see how the cancer spreads. So you see like the spectrum of how breath and breathing control is presented.

how breath and breathing control is presented. But absolutely, I mean, if I don't get my breathing right, I'm not at my best. And I don't mean just like, oh, my fingers are, you know, people are like, I'm not talking, my fingers don't shake. That's not the point. My thinking, my focus, the balance between my thought and emotion. You don't want all thought when you're operating. You have to have guts. But if it's all emotion, it's not tactical. So that fine thermostat, for all of us, right, that balance between thought and emotion, the way to find that balance, to turn those knobs, to control those knobs, is to get breathing under control. I mean, I can show you and draw out the physiology with fancy little molecules and we can put little tubes, you know, a mask and show you breathing and measure it. This is not,

this is not something I'm talking about figuratively. I'm talking about literally if you hyperventilate and you're not physically active, you're just going to freak yourself out even more. In the moment of stress, you apply a certain technique to help you. Is that something you practice outside the operating room? Do you have a daily practice to get better at it so that when you need it, you can apply it better? Or is this just something you've picked up over time? That was one point. The other point, which is from your new book, which I'm definitely going to get into shortly because it's

absolutely brilliant what I've read of it so far. There's this section where you talk about surgeons and how they often use a bit of tape at the side to prevent the fogging up. But you don't use that tape because the message I was getting is that you use it as a, almost like an alarm sign. If you're starting to fog up, it's telling you, hey, I need to control my breathing. So I found that I found those two aspects really, really interesting. I think, you know what, I think that's essentially the concept of when you hear the word neurofeedback, you know, when you do something right, you get a positive response. Yeah, so this is a real world situation. This isn't just, you know, me talking about ideas and concepts. me talking about ideas and concepts. When I started training, the mask, we put tape over the mask. And that way, if we hyperventilated during the difficult part of the case,

the hot air wouldn't go up to our glasses that have the magnifying loops on them. loops on them and now at this age i'm 48 and at this you know uh level of practice that i have i actually don't use the tape much um or at all now because i rely on that um when my glasses fog up it actually tells me you're breathing too fast. So it's become my own little neurofeedback technique that, hey, you're breathing too fast, your glasses are fogging up, slow it down. So I'm having this internal dialogue with myself as I'm navigating the people in the operating room, as well as when I'm operating. And I think that's the other lesson is that by not hyperventilating, you allow your thoughts to turn inwards. And so you can have that inner dialogue about navigating the emotions, the thoughts, the breathing at that moment.

And I think that behavior control is really powerful. It's something that has to be trained. So the operating room taught me that. Now, I don't do it as a ritual daily, but in moments where I feel anxious or strained or stressed, and it's whether it's appropriate or inappropriate, I will, I notice myself only breathing through my nose and you know people say well it's through your nose or mouth what the what's important is that you inhale slowly and you don't dump you don't just exhale quickly there's a deliberate nature and cadence to the breathing and i find that in and out through the nose helps me set that just right and i use it it not on schedule, but as needed outside of the operating room. Yeah. I've had quite a few guests now, Brian McKenzie, Patrick McKeown, James Nesta on the show. We've spoken at length about breathing, some of the physiological benefits

of nasal breathing. And it's interesting what you've landed upon yourself that you know helps you. I'd love to turn my attention to your new book, Life on a Knife's Edge, which wasn't what I was expecting after your last book. And I've got to say it was a really pleasant surprise. It's so personal. The storytelling is incredible. And I thought some of the concepts in it are well worth exploring in our conversation today. So as a primer, I've been thinking a lot about you over the last few days in preparation for this and your job as a neuroscientist and as a neurosurgeon. And I wonder, what has your job given you with respect to an insight on this incredible organ? Not only have you studied the organ, you are literally looking at that organ in an operating theatre several times a week.

What sort of insight does that give you about how powerful this organ is that the rest of us who don't have the opportunity possibly fail to grasp? I would take that in a slightly different direction. I'll show you how I get there. I would take that in a slightly different direction. I'll show you how I get there. When I first started, I mean, just seeing somebody's forehead removed and seeing the glistening white frontal lobes with those beautiful arteries so fine and tortuous, it was mesmerizing. I almost thought thought is that even possible um so the first now you know the first part of my career i was fascinated by the actual craft the work the anatomy the the structure itself but along the way there's been an evolution in my um focus if you will, or purpose even, that I saw it as really a window to study humanity. Now, I've operated on thousands. Imagine opening thousands of skulls.

And as you know, that means I've met a lot more people. You don't operate on everybody that comes to see you, and you don't operate every day of the week. So I've met over 10,000 people operating on more than several thousand skulls and brains and things like that. You could look at it that way, or you could see it as, think about all the different people I've met and I've met them all in their crises. I've met them all in their most difficult times in their lives. And they've let me come aboard and partner with them and journey with them for a little bit. And so I started to see the ways in which they coped. I started to the human story of these people who see growth in their own lives based on their description.

When we would perceive it as calamity, a cancer diagnosis, a scan where the cancer has spread. And they have shown me that not always, but that difficult times, you know, they hold a reservoir for growth. Nobody wishes they go through difficult times like these, but those are the lessons I've seen. And that's sort of what I get into with the stories in the book is the optimism and the heroism and the, and just sort of the transcendence of the things that usually encumber us, the little thoughts, the little steps, the little frustrations. So in some ways they're set free. It's not, it's not something they choose for themselves, but when that finish line comes into view, because I take care of advanced cancer patients, they live differently and they often wonder

why did not we have these focuses, focus on these kinds of things, quality of life before the cancer diagnosis. So I've gone from a surgeon to a neuroscientist to somebody who now really appreciates the human story through my patients. surgeon to a neuroscientist to somebody who now really appreciates the human story through my patients it's fascinating that your job you know you say that it enables you to study humanity and i wonder given that you see incredibly sick patients and challenging patients and people who really

might be at the end of the road, and actually this is the last gasp hope when they come to see you, does that give you a skewed view of humanity? Yeah, no, it's definitely a skewed view. I've taken care of thousands of patients and I've helped hundreds of people pass away. End of life. It's definitely a skewed view. But what I would say is it offers us insight and perspective to a fate that one that we will all face, you know, that, that the finish line and death and mortality is unavoidable. And the lessons I have learned from people who are facing it, some young, some old, but there is clarity in those moments that I want to share with people who have yet to face that, that final moment or those final struggles.

And so it is definitely a skewed perspective, but a rare one. I think that can shed light on how to live fully and how to live your life, realizing that it does end one day. And I think those insights are positive and optimistic and triumphant. They're not negative. They're not pessimistic. And so they inspire me, they enlighten me with their descriptions of what they wish they would have done differently now that the end is within sight. What are some of the insights that you've learned that have changed you and changed the way that you live your life.

Because it's that frustrating thing about the human experience that we often need to confront our own mortality before we start truly living. Yet, I wonder, because you have seen that so many times, has that infused into your brain and you thought, you know what, I don't want to wait till I'm confronting my own mortality. I want to start living now. Just taking a quick break to give a shout out to AG1, one of the sponsors of today's show. Now, if you're looking for something at this time of year to kickstart your health, I'd highly recommend that you consider AG1. AG1 has been in my own life for over five years now. It's a science-driven daily health drink with over 70 essential nutrients to support your overall health.

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There is no shortcut. Just because I take care of cancer patients doesn't mean I think of death all the time. In fact, only recently have I started to put it together and have a synthesis of what I've been seeing and experiencing. And I'm 48 years old. of a synthesis of what I've been seeing and experiencing and I'm 48 years old. But what it means for me is not just to live well or live fully, because that's sort of a personal dimension, but what are the lessons we can take from the approach cancer patients implement when they're facing those crises? So I can't bring people to, hey, life's going to end one day, make the most of it. That's not my intention.

And people have had struggles in many different ways. I used to be, I do pediatric neurosurgery. I've seen parents lose children. I've done trauma surgery. I mean, there are insights from all of those patients, but the techniques, the approaches that I see cancer patients employ, utilize, to me, that's fascinating. So let's take one example. After the cancer diagnosis, you have to get scans all the time. I mean, it's every three months for life.

And I always think, how scary must that be? To be in that scanner, what are they going to find? Has it come back? Has it grown? Is it the same? It's a lot of uncertainty to face that, not just having a trauma that you survive and say, that's in the rear view.

Remember five years ago, we got in a car accident. It was a very difficult experience. Their trauma unfolds every three months. And so what I saw was they started to do sort of a compartmentalization of the three months. And I started guiding my patients about that too. Like, listen, three months, when you see that invitation for the MRI from Rahul Jandial, it's going to be disruptive. Of course it is. You can't be mindful when you see the MRI request come in. You can't be centered. It's going to rock you a little bit. So what we do is we try to limit that disruption so it doesn't eat into the 11 weeks in between. So we come up with this plan. You're going to get a request. That week is going to

suck. You have to come in, wait in long lines, just be miserable. Let it be disruptive. Put yourself first. We'll get in the scanner. You'll see me afterwards or I'll call you. And let's just brace for that week. But what we do is we protect the time before and after that. So there's a structure in which they say, okay, it's going to be a rough week because I have a scan and I've had something called scansiety and that's a difficult time. So we compartmentalize because you can't just say, don't stress out. That's not fair, especially with their situation. because you can't just say don't stress out that's not fair especially with their situation yeah so they have little release valves and time points when they allow themselves to stress out

um that hey i've got a i've got a brain scan this week it's gonna be a rough week for me and that's okay but after and before let's protect that time to live fully so that's like one technique i learned from cancer patients that I try to apply to my life as well. There's a certain intentionality, isn't there, living like that? And as you describe that, I'm struck by how many of us just live on autopilot. We don't really think about what we're doing day to day. We're just existing before we know it. It's the end of the month before we know it, the season has changed. But what I'm hearing from these patients is that because of the three monthly scan, they have to, I guess, like an athlete in some ways, live with intention. That's the stressful part. That could be,

for an athlete, the performance that that's when you're having your race but whilst you're training you're going to have some build weeks you're going to have some rest weeks you know i'm super conscious i'm i'm not trying to say being an athlete and suffering from cancer it's the same thing at all just to be super clear but there's something about that rhythm that they they have a certain rhythm to life because of these fixed points. Brother, you captured it well. The word season. So I'm just going to go on a random riff here.

I hope you don't mind. That's what this show is all about. You go for it. Look, Matt, the problem is thinking in terms of something being linear or wires. And what I have learned from patients and what is true neurobiology, I mean, take a piece of brain, you put it under a microscope. The neurons branch towards each other. We call it arborization. The ones you don't engage, the brain trims them. We call it pruning. So seasons and gardens and ecosystems is the right way to think of your brain. And that's something cancer patients do. There will be a season of growth, but there will

also be a winner. That doesn't mean the winner puts you back. It's not two steps forward and one step back. You're pulsing through your life. There are moments of triumph, but that's not forever. Maybe that's springtime. And there are moments of tragedy or difficulty, and that's not forever either. So if we really start to see our brains, and I just wish I could show people, it's like 100 billion electric jellyfish crammed into a skull that's floating in clear liquid, spraying chemicals and electricity like it's Aurora Borealis. and electricity like it's Aurora Borealis. If we knew we are like that in our skulls, I think we would see our mind and reactions and behavior differently. And I think your word season is spot on. There are seasons of growth and there are seasons of, you know, sort of winter and loss. And there are also sort of seasons within the brain where things are dormant. There are brain cells that are dormant until you have a certain stress. And that's the cue for them

to activate. If the stress is too high, they stay dormant. If there isn't any stress, they stay dormant. So if we start to think of our brains as gardens, it fits more with the patterns of life that cancer patients have. A very difficult diagnosis. What do you do next? Just suffer for the three years ahead or the 13 years ahead? So they bring in this concept of the seasons of their year. Difficult moments, surgery, moments surgery chemotherapy radiation that was a difficult season after that they have some vitality and a good window to see family and

travel that springtime in their life i think if we do it that way our stumbles and our difficulties don't feel like setbacks they just feel like something that we we push through we brace through we manage through that crisis for this next springtime in our life that will arrive that that approach in their minds serves them well what about the patients who are not going to be coming back for the three-month scan for those who it literally is the end of the roads what can what have you learned from their outlook and therefore you know what can we learn um from hearing their stories well that's harder you know um because last year there was nobody at their bedside and You know, because last year there was nobody at their bedside and hospitals in America. You couldn't have you come in for cancer surgery or even end of life.

Things were happening on FaceTime and stuff like that. So I. You know, it's hard to say. I mean, I've I've I've helped over 100 people at the end of life journey. I've helped over 100 people at their end of life journey. And most of them have left their intentions written. And most of them have family or friends that guide those final decisions. But I would rewind maybe three months before that moment where they come to the place in their mind where they realize they don't want more treatment.

They're not surrendering. They're not giving up. But they're realizing that the hospital, as far as treatments, and there's still pain control and hospice, but that the hospital cannot serve them anymore in their journey. And that's actually a pretty intense moment because then they have to say, okay, now there is no partner for these final moments. You can have loved ones, those sort of things. And in their eyes at those discussions I have in clinic or in those conversations, it's interesting that most often I see them sort of running through a film tape of their life and how quickly it has gone by, you know, where they were born, the key places they lived, their family, friends, achievements, failures.

And that's an intense interaction to see that, that at some point you have to say medicine and surgery. I don't choose that anymore. And that time with them has been very illuminating for me personally, that that time will come for me as well. And I don't live in fear or darkness. Actually, it creates an optimism. Like this morning I got up and I was like, man, I'm thankful to be here today. And what am I going to do with this today? I take my days less for granted after seeing patients look up as my father did. And you can sort of like, almost like a windshield, you can see

like the journey of their life. And when I see that in patients, I think there's no time to waste. And that's very important for me that there's no time to waste. Yeah. It must be very humbling. You know, you're someone who has achieved a lot in the conventional Western medical model. And therefore to hear what was it like when you heard patients for the first time saying to you, yeah, you know, I'm kind of, I'm done with surgery and medicine. This is not the path for me. Was there a struggle on some level? Because that's what you had been trained to do, your medical school, residency, your exams, your peers. Tell me about that, because that sounds like a super interesting moment in one's

career, where you maybe start to look at your training or certainly what you're here to do through a different lens that's a great question that is the evolution of a surgeon um in the beginning i thought my skill had more potential to help than it does and so so I would, I would guide patients towards surgery, surgery that they can get at other places. But I always believe that surgery could do something helpful. And then when you take care of enough patients, you also see that surgery has risks and complications too and that is the the nuance that's taken 15 20 years to learn is that for each patient um what do i offer how do i explain and whereas you can always cut things out you know that's it's the person that's left after i'm done with surgery that matters to me and i always did but especially now so for example i take care of women who have breast cancer that spreads to the brain

now when they have like a 12 or 13 year old because they get breast cancer some you know in their 40s and they're they're at a different point in their life they're individuals and that's where you have to study humanity to be a cancer surgeon because your tool should not be offered or applied to everybody but when they say to me he's my son is 14 i mean i just, you know, I'd love to see him graduate high school. So now that menu for them, I say, okay, I just want you to know there are a lot of treatment options and there are some surgical options that will help and keep you going and these sort of things. So we lean a bit different in my toolkit in our momentarium. On the other hand, if I had somebody who's 78, 84, I do talk to them about that. Some of my patients after choosing surgery have had issues

and never left the hospital, not because the surgery didn't go well in surgery. It's just that medical complications after surgery in people in their 70s and 80s that's what uh keeps them from getting out of the hospital and yeah and so from within that range i would say there's another whole spectrum of considerations and i actually feel good about look man i first thing is you can choose nothing at all. That's what I say to my cancer patients. You are driving. And here are the different ways, different approaches.

But you really have to become an expert in people and their stories and what they want and what they're fighting for to be the best surgeon for them. More than just something technical. be the best surgeon for them more than just something technical you know as a fellow medical doctor i'm not a surgeon but i i share a very similar view to you that is also my experience you know you need to understand humanity you need to understand people you need to be respectful you need to treat people with kindness with compassion with real respect that's what medicine for me actually is all about and it's it's really fantastic for me to hear that um you know coming from a neurosurgeon and someone who i respect a lot it's really it's really wonderful that was one of the wonderful things about about reading your new book actually is the humility that's there. And I've got to say, humility is not something

typically people associate with surgeons. And that is a prejudicial thing to say, just to be super clear. Yeah, I get that. But within the medical profession and also out with the medical profession, there is a certain stereotype of surgeons, particularly high-powered surgeons like brain surgeons. But what's interesting for me as I reflect on that is one of my best friends, a guy called Steve, is a spinal surgeon on the south coast of England. And the compassion and empathy that he shows his patients is second to none. And he's a very, very well-respected, competent, highly technical surgeon. But those people skills, I think, elevate him, and certainly in my eyes and his patients' eyes.

And with you as well, there's this real compassion. There's this real understanding that empathy with your patients is important, that you have to treat the person, that individual, rather than necessarily the scan. And it's striking to me that there is that generalization out there. It's striking to me that there is that generalization out there. Yet my good buddy, Steve, who I know well, and now you, you guys are showing real humility and compassion. And yeah, why do you think that might be?

That's, you know, surgeons are known to be more interested in the procedure than the patient. And when I was learning, there's just so much to learn that it can appear that way. And I think for me, I think for me, I never thought I'd become a physician. I mean, I didn't. I think we talked about it last time. You know, I dropped out of university for a little while, fumbled my way back in, went to medical school, became a surgeon, became a neurosurgeon, became a neuroscientist. It's just been haphazard going forward. I'm extremely grateful for the tremendous career and life that I have now. I have a big life. I don't know if it's a good life or a bad

life, but it's a big life. I'm talking to you in London. I do things in Eastern Europe and South America and Asia. I think what makes me connect with my cancer patients is that I bring a lot of my own life to my interaction with them. It's okay for them to see that their surgeon has also struggled or having difficult times or had a parent pass away, or I connect with them about that. And people say, well, how do you do that? It's not storytelling. It's not here, read these five questions to get a high patient satisfaction. They read your energy. They read your eyes. They read your, they just, they just get it. And I think as a cancer surgeon, it's also sometimes in the beginning, I felt depleted sometimes because you can't just walk into a room and talk to a patient who has cancer in

some formulaic way. Hey, nice to meet you. How are you doing? That's not the guy I am. That's not what they deserve. But at first I used to, I felt like maybe I was losing some of the empathy. And then the more I tried to just bring, not my problems, but my complexities and share them also with them about my family, about the way I'm thinking, my journey. It became a strange sort of reciprocal therapy session. They're going through a lot. I was like, look, I'm going through a lot. And I would just share what was going on in my life, good and bad. And that was the thing is to be a cancer surgeon. I mean, what greater connection you meet me, you meet somebody, you say, nice, you know, go ahead and open my skull take me through the last

few years of my life that to me is an incredible uh privilege just but from the curious side an opportunity how do you connect in 20 minutes do you hold their hand before they go back to surgery how do you how do you make them feel uh so i've learned to say things because, oh my gosh, with these masks and things going on, can you imagine? They were like, who are these people around me? And I would always say to them, you know, the minute before you roll back to surgery, after having seen a lot of different people, you'll see me there. I'll hold your hand and I'll look in your eyes and I'll do the whole operation myself. You know, I'm there with you. eyes and I'll do the whole operation myself. You know, I'm there with you. And that was something that they, you know, so you start to see that they have concerns like who's my surgeon, who's, who's going to be in there. So I would, I would try to address that. I would give their family a call before and after certain, you know, certain rituals that surgery doesn't start for like an hour and a half later. And for many of them that were praying, they're praying at 730. But the surgery, by the time I get started is, you know, 845, because you have to set things up. So I would let them know that I'll be beginning around eight, they just feel connected

that this person is attentive. And the other thing I learned to show them, share with them is, I am with you. And I don't know where your journey goes because they're cancer patients you know it's not a knee replacement where I can tell you you're gonna be walking you're gonna be fine I don't know where your journey goes but you I always tell them you'll never feel stranded and I've even learned to use like physical cues after watching like the sound of metal and different people with sign language like there's a lot to yeah there's a lot to capturing a patient then and so there's the body language i i you'll never be stranded i do this you know and there's a certain way i hold their hand and just just there's a certain firmness just for a moment and there's a there's a there's a way i've developed

to connect with them yeah and um i thank them for teaching me that, you know? I thank them for teaching me that, that that's what works. There's always flexibility in how I do it, but it's a difficult position they're in. And I feel so grateful that they let me into those moments in their lives. I mean, it's wonderful to hear what you do. I can only imagine how comforting that is for a scared

patient about to go into theatre and you sort of beforehand you're looking them in the eye you're telling them I'm going to be here with you I'm the one doing your operation you know that the comforts you know that sort of connection I think it's the missing link in medicine. It's not what we get taught. It's not what tends to be valued. But you're a few years older than me, but in my 20 years experience of seeing patients, the number one thing that I can do for a patient is to connect with them. Because everything I can offer them comes on the other side of connection. Now, I appreciate you are hands-on. You are sometimes removing tumors from the brain. There's a technical skill that is involved there.

But how important do you think in your role that that connection is, not only to how a patient feels, but also to the outcome of what happens? That's a fascinating question that so there are people are looking at pre-operative which means before surgery uh meditation faith all these things have been shown before and after surgery um to lower the need for narcotics so clearly they feel less pain taking it a little deeper into the biological level that when you go into it doesn't matter if you're going to be getting the sleeping medicine and all of that or the the anesthetic that if you go in with your stress response activated that um that maybe the medicine doesn't work as well. And there's even some small paper suggesting that maybe cancer cells swim a little better

when the body is under stress in that moment beforehand. Now, that's not completely proven, but we are looking in that way. And so bringing them in calmly is essential. And I'll give you a more specific example. Sometimes we do awake brain surgery. So that takes a lot of coaching before when you see them in clinic, look, you're going to wake up. It's going to be a bit weird. Your skull will be open and I'll be talking to you as I'm operating. That's a lot to walk into. Just even when I still try to describe it, or I'm not laughing out of any, any, like something disrespectful. I'm just thinking if I was on the other side, I'd be like, what, what are you talking

about? You know, but to operate in the language region on the left temporal lobe, that is required. You're risking their humanity, but if you don't do an awake brain surgery. But coming back to connecting, that's a lot to walk people through. And then you wake them up when they're in the operating room. The scalp is numbed up. The skull is off. And they're talking to you. And you're tickling the brain.

It doesn't feel on its own. So you can tickle it. It only feels through the nerves. You can touch the surface of the brain and the person doesn't notice it and you walk them through counting and reading words and different things and you have to have a connection to take them through that and so it doesn't have to be only an awake brain surgery i try to bring that to all of my patients. But that connection also, you know, I don't know if you can just teach empathy in a class. I used to always say, make these medical students do other things before, you know, we're going to coffee shop,

live and work a little bit because you have to bring your own life experience. I mean, I was 35 consenting 75 year olds for brain surgery. Well, I mean, you got to bring something from your own life that isn't just college and university and medical school. And that's important. I wonder if that's why your approach seems to be so different because you had that unconventional path to neurosurgery. You know, most people who end up being, who end up, who end up performing well, certainly in medicine and in surgery, often they went to the right schools. They knew from a young age, maybe their family did the same job and they go to the right college, the right university. They're on this sort of path and they often end up getting there. And of course, not everyone, but that is certainly, that happens.

But you didn't do that. You worked in different jobs. You were a security guard while your school buddies were off at college, right? So that is not conventional. So I just wonder how much of that plays into what you bring to your research. The security guard thing is funny that not only were they off in college i was a security guard at the cafeteria in their college so one day and they were like hey i was like hey i mean one day you're in class and the next day i've got my like uniform on and

i was like this is bizarre but i you know i'd never you know what other people think of me is none of my business is one of my you know and at that moment i was trying to hold on to that but i saw it as an adventure you know everybody keeps talking about like adjustment but i saw this life and i still see this life as an adventure. And that unconventional path, I mean, and then, you know, then I, I took the long road and it's been unconventional, but during those times I was seeking unique interactions. I mean, I worked at an, I mean, volunteered in an Alzheimer's clinic. I worked at Marie Callender's as a busboy in Los Angeles, worked at GNC in the mall. And it wasn't, I mean, it was, I was seeking those opportunities out. I mean, I think I've been a student of human nature since I was young.

And then I went into the career thing. And now I'm back to being a student of human nature. And I realized I've been, you know, the master class has been my career as a cancer surgeon. So that's fascinating to me that I fell forward into these things. I feel very, again, fortunate for my life. to, you know, the system selects for people who are spending all day, all night in the library. The marks required to become a physician and surgeon is so high that you actually can't have fun. Most people are not going to have fun and pull off the mark. So it's kind of a weird thing that you're almost selecting for bookworms in some sense. And then you're saying, here's the hospital where you'll find everything from addicts to CEOs, CEOs that are addicts, addicts that are coming in and out of, you know, it's just such a wide range of humanity. And then you're putting bookworms in there.

I think that there's a flaw in that. And maybe they just need to say, hey, listen, six months, you're going to have to do some odd job. You got to get out there a little bit before we throw you in the hospital. I don't have a solution, but I see where there might be an issue of connection between physicians and patients. Yeah. I mean, I've shared this on the show before, but I went to medical school, like maybe two weeks after I turned 18. And you can come out five years later. So I know you were on Julia Samuel's podcast recently. Julia's a good friend. And I remember chatting to her about this when she was on the show. I said, listen, I was seeing patients when I was like 23 years old. I didn't have any life experience to offer to bring to the table.

Like, they were telling me about personal stuff. They were a lot older than me. Things were going on. And look, I certainly did the best that I could, but I genuinely think I was too young. They're teaching you. Well, you know what? They've always taught me. I've said this in all of my books, that my patients have taught me a hell of a lot more than I taught them. And that is something that

I've noticed with your language throughout this conversation. You have said on multiple occasions what I learned from them, what I learned from them. It's something that comes up through your book as well. And I love that sort of humility and that sort of idea that actually we are learning just as much, if not more from our patients than they are from us. Before we get back to this week's episode, I just wanted to let you know that I am doing my very first national UK theatre tour. I am planning a really special evening where I share how you can break free from the habits that are holding you back and make meaningful changes in your life that truly last. It is called the Thrive Tour. Be the architect of your health and happiness. So many people tell me that health feels really

complicated, but it really doesn't need to be. In my live event, I'm going to simplify health and together we're going to learn the skill of happiness, the secrets to optimal health, how to break free from the habits that are holding you back in your life, and I'm going to teach you how to make changes that actually last. Sound good? you how to make changes that actually last. Sound good? All you have to do is go to drchatterjee.com forward slash tour and I can't wait to see you there. This episode is also brought to you by the Three Question Journal, the journal that I designed and created in partnership with Intelligent Change. Now journaling is something that I've been recommending to my patients for years.

It can help improve sleep, lead to better decision-making, and reduce symptoms of anxiety and depression. It's also been shown to decrease emotional stress, make it easier to turn new behaviours into long-term habits, and improve our relationships. There are, of course, many different ways to journal, and as with most things, it's important that you find the method that works best for you. One method that you may want to consider is the one that I outline in the three-question journal.

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three-question journal completely free on episode 413 of this podcast. But if you are keen to check it out, all you have to do is go to drchatterjee.com forward slash journal, or click on the link in your podcast app. Look, I think towards the end, I have something about it's almost, you know, because I'm evolving, I'm changing. I mean, it's been an intense couple of years. I've had some, everybody's going through difficult times. I guess that's one of the things I've also learned from them. There may not be a time in your life when things aren't difficult, but you can't stop living and enjoying. It's sort of both.

For me, the seasonal concept works well. There are times of growth, and then there's times where winter, and there's times of fall. That helps me understand the almost cyclical nature of things in our lives. But they say, hey, yeah, I mean, I'm living with cancer. What am I supposed to do? In fact, because time is limited, I've got to party, rock out, travel, see people. I'm living with cancer. I mean, gosh, that is such an interesting phrase.

So why can I not live when I don't have cancer? You know, I just so such insightful stuff you get from them. And back to thanking them in the last. Now I'm like, cancer, you know, I just, so, such insightful stuff you get from them and back to thanking them. And the last now I'm like, why are you thanking me? Yeah. I should thank you for letting me come into this moment in your life for a few months or a few years. And I'm, you know, there's this concept of vicarious trauma traumatization where people see trauma or, you know, nearby and they're affected by it. But I feel the opposite. I feel like I've had vicarious fortification. I have learned through my patient struggles without actually having to

bear the real weight of the diagnosis and the treatments, right? I'm there with them. I'm learning with them. I'm partnering with them. I'm getting wiser from them so i thank them i thank them for allowing me to learn from their lives i mean and think about the sheer number of patients oh my gosh i was i was writing this book i was like thousands yeah 48 and i've at least shook hands people are like what you know the different way to think about it i've met over 10 000 people for at least 15 minutes i mean that's a lot of volume of human interaction right maybe skewed but not all of them there's other before i was a cancer surgeon we see people for routine things and then i've opened thousands of human bodies and what's interesting is not the anatomy,

is that the interactions with them before and after. Don't get me wrong. I had to think about the anatomy and the procedure and the craft and getting talented at it. But along the way, it's their journeys before and after the surgery that matter. after the surgery that matter in some ways you know you we we get the we get the the best deal out of it right we go along with their journey we we we get to share we get to learn but we don't have to deal with the quite severe consequences sometimes do you know what i mean it's it's 100 so you know i was just talking to my buddy about that uh the other day i said i mean for so 100 so first um when that first started i wonder where

this you know the the complexity and the um of the current things that i'm thinking about with my patients in my life you know i think I think it comes from, from trying to put meaning to the sheer number of people I have cared for and how many of them have passed away. And I haven't. And so the way I explained it to a buddy who's not, we're just, we're just talking. I said, you know, I just, for a while, you know, all I do is, all I do is parachute into crash, you know, crashing airplanes, pull up the nose for a little while. Then I bail out and the airplane crashes. You know, I extend life. I don't cure. And for a while I started eating at me, you know, just the sheer number of invitations to funerals. And thank you for caring for my mom. And she's in heaven, you know, just after a while, the drawer fills up with those cards and you start to feel guilty that they're

not there, they're, they're gone, but you aren't. And so I think those internal struggles about what do I, what do I do with that? That's what this book is. It's you know, it's an excavation of my emotions and thoughts, but not separate from what they're going through. Sort of interconnected are the lessons and the insights. Yeah, what's so wonderful about it is the specificity of the stories is what I think will speak to everyone. It gives it that general broad appeal because it's in each of those stories, even if you've never had cancer or you've never

had one of the sort of severe operations that some of these patients have undergone, you tend to see one part of yourself somewhere along the journey. And it's, you know, I was going to say, I'm a fan of storytelling. We're all fans of storytelling. That's what we're wired to, you know, learn from and connect with. And, you know, it really is a brilliant read, which I think will cause anyone to reflect a bit differently about themselves and their life. And just put things in perspective. You know, one of the favorite guests on the podcast so far, James Ness, I can see looking at your book that he gave you a wonderful quote for the cover,

wondrous and wild, I loved this book. You know, that's a great compliment from someone like James, who's possibly written one of the best books on breath, certainly in the last five or 10 years or so. I've read that, yeah. Yeah, it's great. Look, I want to shift gears a little bit. Early on in the conversation, you mentioned balance between thoughts and emotions. I think that's a really interesting concept to unpack a little bit.

I've heard in a previous conversation that you've had that you said that depression, anxiety, OCD, and overeating all come from a similar part of the brain. And that, again, with these conditions, there can be a problem with this balance. So I wonder if you could explain some of that, please. Yeah. So, I mean, this is going to take a little while for me to set up. But if, you know. Hey, we got time. Okay. But it's very important to me that we've lost the nuance in our understanding.

So let's just take a few simple examples. Inflammation is bad. Is it? I don't know. I mean, certain types of inflammation are bad. Yes. If you are constantly stressed out and that's also generating an inflammatory response, that's horrible for you. Certain types of inflammation are necessary. But now let's get deeper with emotions and feelings and anxiety and these sort of things, right? There's a certain amount of anxiety that is appropriate. You should have situational anxiety. That's by design. That's protective.

But when there isn't a threat and you're too vigilant and too anxious, not only is that unnecessary and wasting precious calories if you're in the savannah or thousands of years ago, it actually is unhealthy for your brain and mind. You're not living well because you're anxious, but there isn't a cue for that. If you're anxious on the day of the scan, hey, that's normal. That's what you want. Otherwise, I get worried that you're not really understanding the gravity of the situation. So the thermostat or the dial or the balance is very important to understand that there is no, let's take another one, addiction. That balance is off. But those same pathways, the same chemicals,

the branching in the gardens of our mind that lead to addiction are also the ones that get you after your friend's spinal surgery to get up and try to walk also the ones that get you to try to go to the cancer center despite the odds right so that reward is a double-edged sword yeah anxiety and vigilance is a double-edged swordance is a double-edged sword. Inflammation is a double-edged sword. That's the efficiency of the design. It's not on-off, it's tone. It can be modulated. That way, everything inside us can help or hurt. With that comes responsibility. With that comes responsibility. So now that we, if we think about, let's get back to, you know, OCD, anxiety, let's think about these things. These are the simplest way I can prove to you that they are a product or an outcome, or they come from

the ether of our emotional brains. And it's a simple term, but I'll get into that. Is that when we manipulate them with little electrodes called deep brain stimulation, we don't tickle the surface right under the skull. We don't tickle the frontal lobes where cognition, executive function, thought, creativity even is we we tickle deeper to the emotional brain limbic system structures words you've heard before amygdala hippocampus these kind of things structures that animals have also yeah so though that tells us that that the the emotional brain is not in balance with the thinking brain in some of these situations. And so let's get deeper into that.

So when the reptilian brain, which is through your mouth, through your mouth and like in this direction, it didn't morph into the emotional brain. The emotional brain is sort of like a babushka doll or a mushroom. It was on top of it. You can see three structures. If you took a side picture of an MRI, there's like the cortical canopy. We call it the cortical canopy. What a beautiful word. And it's like an accordion because it's just so big, it had to be wrinkled to pack into the skull. Cortical canopy, underneath it is the emotional brain behind is the reptilian brain reptilian brain is triggering breath when you're unconscious some basic functions emotional brain is should i jump when i'm at the edge of a cliff should i pull back when i see a snake on the ground you don't think about that you react to that and then the cortical canopy, the prefrontal lobes, they give the emotional brain context.

Now, stay with me here. How is it that we don't keep jumping at a rubber snake? It's the first time, right? And then we say, wait a second. That's the interplay between cognition, the frontal lobes, and the emotional brain. There are actual pictures of branching of neurons between these regions. And that is that growing that garden, tending to that garden, however you do it.

I don't have a simple answer for that. But if you know there's a physical interface between your thinking brain and your emotional brain trying to find that dance, then what you see is you feel empowered. You feel empowered that maybe I can have a new perspective on fear. Maybe I can have a new perspective on PTSD through therapy and through other things we can talk about. Maybe this anxiety is something by controlling my breathing, I can tamp down. So that's, that's powerful that you can, you can dance with your emotional brain. You don't have to get rid of it because life without emotion is not lush, but you don't have to have the emotional brain take over your behavior and

decisions and get you into trouble. The last thing I want to say about that is the last example for people to know that this is possible. If you go to a movie and you get scared, it's the same amygdala, which is simplified. The amygdala is not the fear center. It's a vigilance center. It just pays attention to uncertainty. But the same emotional brain uncertainty but the same emotional brain goes off whether you're being actually chased by an axe murderer in the street or watching one in a movie theater but when you watch in a movie theater and that adrenaline pulses through and your emotional brain you actually like you get scared but you don't run away because that's your frontal lobe branches coming down to your emotional brain saying, don't run away. It'll be embarrassing. This is actually just a movie. That's context. So the weather, how we stop jumping at the plastic snake on the second

time, how we know the difference between a real attack and a fake attack on a movie, there is thought and emotion. Those two examples, beautifully working with each other. The emotion protection in the beginning, where thought would be too much of a delay, but then thought also says, you know what, maybe these emotions are not, haven't earned their place in our lives. So that is emotional regulation. And that being off is anxiety, OCD, those sort of things. That's my understanding of it. I mean, firstly, I just love the awe and wonder with which you speak about the brain. It's just incredible because you've obviously studied it, but you've seen it. You've seen

all these parts. I love hearing you describe the anatomy and you're sort of pointing through your math. This is not like stuff you just read in a book. You literally know where it is and it's wonderful to hear actually. It certainly gives it a certain something. When the balance is off between those two parts of the brain, and you said there's no simple answer, we can have all kinds of issues like depression, anxiety, OCD, eating too much, all these kind of things where maybe the cortical canopy isn't sort of tapping it down and understanding the context here. Just because the emotional brain is feeling this, we don't need to act on that. What are some of the things that we might want to do in our lives to help us potentially sort of recalibrate that balance and make us better at regulating our emotions? And I think the things that I can answer with go back to the original part of our conversation, that turning your thought inward on whether these emotions

are justified is step one. And controlling your breathing, especially for anxiety, is the go-to move there. Now, can you just think down OCD, depression? Not really. Because now you're in an altered balance that becomes a feed forward. The inward directed thoughts about your life, time to reflect daily, the breathing to control the anxiety, those are prevention and maintenance things coming up. If you find yourself in a depression, that's hard to do because now the balance is,

is turned so far off that it's spiraling and gaining momentum. And that's where you need to have, uh, you know, you need to think about medicine, therapy, um, physical activity. So it really matters what we're talking about. Is it a daily maintenance of mental health, which we all need, right? I mean, we know so much about the heart and our skin, but from a young age, daily maintenance and tending to our mental health is important. But if you come in and you have significant mental health issues, there's a different approach for that. Let me give you some biology about significant mental health issues, there's a different approach for that. Let me give you some biology about significant mental health issues. Let's say you have anxiety and somebody prescribes you Valium. Valium is a benzodiazepine. It's an anxiolytic, okay? It can also make you stop

breathing. It's dangerous. But I want to go back to that interface between thought and emotion. Inside our skulls, with a microscope, it would look like two trees with branches going into each other. I mean, you can see it. It's not something you imagine. Well, when those neurons branch and connect to each other, they don't touch. When two neurons come to each other other they pause and they spray chemicals chemicals you might have heard about dopamine serotonin these sort of things so when you take valium for anxiety or seizures what it's doing is it's manipulating gaba the chemical

that chills things down so you've you've exorbitantly put in a medicine that goes to those branching interconnections and quiets the electricity. So, cause it's, it's, it's glitching out and you feel calm. And I think when people start to see that, okay, that's how this medicine, where it goes, how it works, it's powerful because the other thing that turns down that glitchy electricity is meditative breathing. And I need people to know when I, when I talk about breathing, I can explain it down to the chemicals being sprayed by those branches. Breathing or volume do the same, at the molecular level in your brain. And he said, how do you, how do you know? Well, the first book showed that when we do some

surgeries, we put electrodes in and look for seizures. I mean, we have hardcore surgical and biological data for that. Now let's take another example. So you take an antidepressant. Well, what is that? I mean, what is, well well just like we were talking about reward getting you to get up in the morning to go and get your treatments or leading to addiction mood can make you feel good or bad okay that makes sense but when people are depressed there's a paucity or lack you know serotonin isn't just right so when you take if somebody takes prozac we're back at those branches of brain cells and what they're spraying at each other between one neuron there's a hundred billion and they have 10 to 10 000 connections each what ssri is selective

serotonin reuptake inhibitor pros at whatever it is is when serotonin is sprayed from one neuron to another the vacuum to evacuate it is turned off by that medicine so you have more ambient serotonin and your mood gets better and it takes time for that to happen globally that's why antidepressants take you know a couple of months so i'm not asking people to go on antidepressants take, you know, a couple of months. So I'm not asking people to go on antidepressants or not, but just to start to think of your brain as an electrical and chemical garden. And so when you breathe, you affect the electricity and chemistry of your brain. When you take Valium or Prozac, you affect the chemistry of your brain. And when people wear those helmets and those things on their head, they're trying to learn about the electricity of the brain. And when people wear those helmets and those things on their head,

they're trying to learn about the electricity of the brain. So everything, if we have an understanding of anatomy, chemistry, the chemicals are being sprayed and then electrical currents are being generated like jellyfish, but the pattern is more like Aurora Borealis, you can start to think about when I do this or I take this, how does it fit within the garden of my mind and the garden of my brain? I think it's important when people know how it works, they're more likely to implement that measure. Yeah, for sure. I certainly hope that everyone listening and watching will understand the importance of being able to manipulate and control your breath to help them in their day-to-day lives. Well, if we think about this second book, certainly second book here in the UK,

I know you've had other publications in America. It's a very different book. It's a very reflective book. And I like the way you've structured the chapters around different topics, you know, loss, grief, performance, you know, it's a beautiful way of getting these ideas out there. The chapter that I sort of got stuck on and kept reading was the one on self i think chapter seven and i want to talk about the self because i thought you had an interesting way of talking about it describing it seeing it through different operations and how people saw themselves after some pretty brutal operations, actually. So there's a couple of things there. You have said in the book that it is a combination of body, mind, and autobiographical narrative. You said our sense of self rarely changes through

life. So what is our sense of self? What is different. So, you know, what is our sense of self? What is different about it from the mind? What is different about that from the brain? And what have these various procedures and operations taught you about it? Yeah, that's a big question. And what I would say is there is no right or final answer that this was my best effort to shed new light on a topic that has been relevant and inquired about since antiquity. surprise neurophilosophy they put neuro in front of everything now like neuroeconomics but neurophilosophy caught me by uh and it was actually in san diego where i did my phd what is neurophilosophy so the concept of identity and self people have written about that for a long time but in a certain operation where the brain is like a walnut, there's a bridge in the middle, there's hemispheres. We do something called disconnection surgery. And that's to keep electricity from one side from going to the other side if it's,

you know, if it's related to epilepsy. So epilepsy is aberrant electricity. It's too much. If we can't cool it off with volume and things that cool down the electricity, then at least we prevent it from going to the other side of the brain where a person will be, you know, knocked out and lose consciousness. But when you do those disconnection surgeries, sometimes people don't recognize they work. Normally they don't recognize halves of their body and different types of injuries have done this too and oliver sacks has written about this a little bit so what happens um when you take a small sort of band of neurons that connect the two hemispheres of your brain and you dissect through that and the person can no longer recognize a part of their own body right not

phantom limb not this kind of stuff but they have uh uh they just can't recognize their own part of their body and they had somebody had written like well maybe this corpus callosum this structure can be argued as the seat of self and identity you disrupt it and people don't recognize halves of their body. And I thought, OK, that's interesting. But my patients have shown me something else. And so I try in this chapter to add to that. That's that's established. You can read about that.

And so what I've seen is there is sort of the body's relevance to a sense of self. There's the mind's relevance to the sense of self. And I'll take you through three examples. And then there's also sort of having a sense of self of your own life and journey, your autobiographical memory, that you are on this journey and somehow you don't remember the details of 20 years ago, but you're still that person moving through all those life events. The first one that really rocked me was a very challenging operation where the cancer was taking over the pelvis and half the body was removed. It's called the hemicorpectomy. And when you read about those operations and how those patients do afterwards, there's a lot of suicidal ideation. It's in a

pursuit for a cure. Sometimes they are, sometimes they aren't. But this one patient taught me that the connection between body and mind is not just something figurative, that it's literal. And the connection of his lower half of his body to his mind, when he lost that bottom half, when he chose to have that bottom half of his body surgically removed, it altered his sense of self, not just a limb, not just an amputation, not an appendage, but the bottom half of his body. And what I learned from him was that everybody's got a unique sense of self when it comes to their body. And it shed a lot of light about people who, they do self-harm, they do tattoos, they do piercing. There's a lot of ways that how we feel about ourselves is connected to the ways we manipulate our bodies or feel connected to our bodies.

And for him, not all patients, but many, losing the pelvis and below was just too much. It was something he regretted and something I regretted. He signed consent for the surgery and there was a whole team involved and it's in the book. But after that, he went into a depression that just couldn't be fixed and medicines didn't work nothing worked and that gave me an interesting insight on wait the body and the mind at some point that is important other people are paralyzed they haven't had this issue so something about

they can't move their body and it's connected. They feel whole. But this guy, he could move his arms. He just lost belly button below. But that dismembering of half of his body left him in a psychological state that he could not reconcile with his former self. Whereas I've seen a lot of patients who are paralyzed, they don't have that same experience. So that was one example that shed light. And just briefly, the other example was operating on the insula. The brain actually can be opened up without being entered and there's a little island of cortical canopy in there. And operating in that area, people wake up not only not recognizing other parts of their body, usually the other side, but denying its existence, like throwing their own arm out of the

bed. And then you start to think about a sense of self as that's interoception, the cohesion with which we experience our body, as well as the extent we'll go to even throwing part of our body out of the bed to keep our our our perception of reality intact and so if you manipulate the insula and this gets thanks for letting me go a little deeper into this when you manipulate the insula there's the the brain looks fine the mind has decided this arm is in mind it's not like the part of the brain that controls that arm is is damaged the insula in wanting to feel whole will actually um disregard the physical inputs coming from the whole half of the body and that's called confabulation that can happen with your type of drinking and stuff like that. People will create lies to keep a perception, a psychological perception of being whole and intact. So those are the two main examples that I can give you that I think shed light on body and mind.

I mean, that last example, what you said there is just incredible because you're saying structurally... Beautiful. Beautiful, intact, no problem. You know, we know everything required to do this particular function. It is all there. It's looking pristine. Yet another part of the brain or the mind, I guess, is sort of... Mind. The mind is bringing a bit of nuance and context and going,

hey, hey, stretch is okay. That's cool. But you know what? I'm not happy. I need to make some changes to how I'm experiencing my life and my body. For whatever reason, it is incredibly... It it's a bit scary it's inspiring it's i guess it all speaks to the incredible magical it's yeah but the incredible power of our mind has and also then speaks to potentially the untapped potential we all have for our minds, right?

Yeah, I love that. The examples are just to expand the way we see ourselves. With intact flesh, what the flesh creates, the white flesh of the brain creates the mind. The mind will actually come back at it and say i'm i'm not going to accept certain signals and that's fascinating to me that that flesh creates thought and certain thoughts can go backwards and change the flesh that i mean if you if you think about like emotional regulation breathing, you're choosing to do these things that in turn

change the structure from where these thoughts arose. So that the brain mind, even more than mind body, the brain mind relationship is a reciprocal one. If you, you know, the common example is you drive a London cab or, you know, that part of that tuft of your brain gets thicker. So certain behaviors and activities and rituals and things you do to improve your life, come back and fortify at the physical level of what's going on in your brain. And that's the, that's the power I want people to feel is that working on emotional regulation, working on meditative breathing, working on taking 15 minutes a day to reflect will structurally modify those branches and connections between thought and emotion, making it easier to deal with stuff in the future because you're building up that part of your brain. So that reciprocal brain, mind, mind, brain is the reason why we should try. brain, mind, mind, brain is the reason why we should try. We should try to be better because it changes us at the physiologic and at the molecular, at the cellular level. It's incredibly

powerful if you think about your efforts at improving your life will actually change the nature of your brain. And people say, come on, that doesn't make sense. Well, well, look at children. They don't walk and then they walk. So, right. I mean, there's a lot going on there. Well, why stop at that? Look at adolescents. They're not mature and they become mature, but why stop at 25? What if, what if the same potential for improvement and self, you know, self-improvement and actually changing the physical structure at the microscopic level of your brain was possible throughout your life. With these efforts at self-improvement, at coping, at connecting, I think that's incredibly powerful. And again, my patients, patients have seen that in them. And I can show you the slides of what the brain looks like under a microscope where these things visibly happen. This isn't

something like a gas in the sky. Yeah. I mean, it's incredible. And that's one thing that science is really showing us over the last few years that we don't necessarily have to accept inevitable decline as we age. There's plenty of things that we can do that will certainly stop or slow down the decline and potentially even reverse it in some cases, right? So what are some of these things that all of us, no matter who we are, no matter where we are in our life, no matter where we live, what are some of the things that we can start doing and what kind of difference will that make? So if my children were to ask me this question or a patient or a loved one or a friend or even a foe, it doesn't matter. The answers from what we know are clear. So I'll tell you what and then why, and please allow me to explain why. I feel that when

people understand why they're more likely to follow through with the change. Otherwise it's, you know, it's sort of like fad psychology or do these three steps and life will be better. And when it isn't, there's this frustration that things that work for others aren't working for me. So with that caveat, with that disclaimer that your life is individual and your inner life and your inner experiences are yours. And I don't know where you are at this day,

this station in your life, triumphant, struggling, somewhere in between, whatever season. That said, the brain is flesh. Okay, so to keep flesh healthy in the body, it needs to be irrigated. Blood is delivered by blood vessels. If those blood vessels are clogged, the flesh that it irrigates, much like a sprinkler to a part of the lawn, will wither and die off. So poor, it's not heart health. I just want to be very clear. Poor vascular health. If your blood vessels going into your brain are clogged and not delivering all the blood flow they can, parts of your brain will start to die.

Little swaths of it will start to die. I see it on MRIs and people as they get older. Micro strokes, white matter changes, these sort of like technical things. So the first thing is, if we're talking about brain health and mental health, you gotta keep the flesh irrigated, okay? How do you do that?

A lot of other people can tell you that. Some people take cholesterol medicine you exercise you keep your blood vessels healthy same thing for heart blood vessels same thing applies for brain blood vessels now let's zoom in so okay so we're just going to take this from you know just like the solar system but i'm going to go i want to go flesh to molecules. So keep the white flesh healthy. I think that people understand. Then let's zoom in. What neurons look like? Okay. So we've gone from like the beautiful garden from a distance to now we're actually looking at one plant, one neuron. Neurons send chemicals and electricity all around. The speed with which that electricity travels is improved by having the tentacles of those

jellyfish, if you will, wrapped in a certain fat. Insulation, just like your wires or cables that you're looking at are wrapped in something, not just to protect you, but sometimes also to improve the conduction, the speed. That's where fatty fish or mega threes come in. The myelin sheath, that's what it's called, wrapping those tentacles or those neurons, the hundred billion, requires a fatty substance. And you don't have, you can be vegan and get this so fatty fish twice a week like salmon or chia seeds and other things will provide the nutrients okay first you got the irrigation to the garden that's blood vessels vascular health now you've got the nutrients that fertilize and keep keep the not fertilized actually i want to say that that that

help build the branches of those plants in your garden those neurons in your garden so that's a certain dietary thing you want to do mostly vegetarian with with fatty fish or if you're vegan with something that supplements omega-3s that's That's the second thing you want to do. Now, the third thing you want to do is you want to fertilize that garden, that ecosystem in your skull. And the best fertilizer is exercise. So exercise, not like something comes up from your muscles and lands in your brain. Your brain has its own pharmacy. When you exercise, it starts spraying all the brain, the neurons with things like growth factors like BDNF. And so now you're globally tending to the garden. And then the fourth thing you want to do is the most important thing is think and challenge yourself. If you get into habits and ruts and don't keep expanding

the corners of your life and thought, what happens is parts of that garden become dormant. You don't need them. You can get home on the tube or on the freeway with just using a small part of the garden. Why would you engage at all? It's very inefficient. So you actually have to consciously, thought has to say, I want to try new things, learn new things. You don't have to get good at it, but the process of learning, of challenging yourself changes the concentration and patterns of the chemicals that are being sprayed between those neurons. And to me, that's the most powerful thing, that thought is the ultimate, ultimate tender cultivator of the human brain and the mind. elevator of of the human brain and the mind and i can't tell you how your journey will go whether you'll reflect or you know take time to reflect turn your attention inward you know deep meditative

breathing i don't know how you'll put it all together but i just want people to know that's how that's how it is and those are the skull contents if you will and i'll conclude with to me the understanding is the gift um the possibility is the gift and now if everybody has that in their mind when they deploy it when they rely upon it is up to them and that's what I've learned from my patients and from the science I've been working on in my own life journey. Yeah, I mean, it reminds me a little bit of a conversation I had yesterday evening, actually, with my mum, right? So my mum lives about five minutes away. She's, she lives by herself. She's certainly not as mobile as she used to be. And I feel that there's been a decline recently because I think there's been a lot of help.

I go around and give her breakfast most days. And the last few days I've noticed, mum's not going to get things herself. She's waiting for people to come. And I made sure I was in a good state of mind yesterday in the evening, but I thought, let me have a calm conversation. I tried to explain. I said, hey, mum, listen, look, I know it's easier if I get you this or my brother gets you this, but at your age and the way your health is, I actually think you'd go a few

days of us getting stuff for you and your brain's just gonna go i don't need to do that anymore i really just yeah and i said mom and i saw a difference this morning actually i went around and she actually said no i'm gonna get it and i was it was really nice but i guess you would sort of you would say that that was the right thing you would sort of you know you definitely subscribe to that use it or lose it yeah unless you're trying to hide from your mom and you're using this as an excuse but i don't think you are i think the the most important thing is that with uh with moms and loved ones you know if we said you know we know with kids we don't want to baby them otherwise

they won't develop or cultivate you know mature i think with older folks isolation is a big issue so if you know spending time is great for them the connection is great for them but doting on them in the way where you're doing their activities of daily living for them i think that gets in the way and that's exactly what you're hitting on a great, you know, ground level life example. Like they got to go to the patients. Like, look, you got to go to the bathroom on your own. I know it's easier to have a commode next to your bedside. No, you got to walk to the kitchen. You got to walk to the bathroom. Don't sit on that, that part. You have to keep them where they are, if not more yet with older folks, loneliness and isolation can weigh in so let let her do her

stuff and then just hang out with her yeah for sure good stuff man well rahul look i've i really enjoyed our conversation um i i really big fan of both of the books here in the uk i really hope people rush out to get your new one life Life on a Knife's Edge. This podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of life. You've beautifully gone through some practical things that people can actually do in their day-to-day lives. But I thought a really nice way to close off this conversation is your sort of final higher level thoughts and wisdom. Because what I really get from the new book and our conversation today is, yeah, the

things we do day to day, yes, they are important, of course. But the way we think about our life, the way we prioritize our life, the way we can learn from people who feel that they may be at the end of their life. I feel there's some real powerful wisdom there. So I wonder if you could just share some of your closing thoughts on that for my audience. Thank you. First of all, I'm honored just to be asked that question. Again, I would like to share that that life at its depths also reveals its heights, meaning that people who are struggling can also demonstrate tremendous powers and strength and growth

that they didn't know they had in them. And to witness that has been powerful. And the second thing I would say is that no triumph or tragedy is forever. And I have seen that in families going through very difficult stuff. And so if we see our lives and the moments in our lives as seasons, enjoy where you're at. And if you find yourself in a difficult place, you know, that too shall pass and there will be a new season after that.

Those are the lessons I've learned. Rahul, thanks for making time for the conversation today. And I hope I get a chance to speak to you in person at some point in the future. Thank you. Really hope you enjoyed that conversation. As always, please do have a think about one thing that you can take away from this episode and apply into your own life.

And do, of course, check out Rahul's latest book, Life on a Knife's Edge. Before we finish, I really want to let you know about Friday Five. It's my weekly newsletter that contains five short doses of positivity to get you ready for the weekend. I try and vary it up each week, but usually there's a practical tip for your health. I'll often write about a book that I've been reading or an article or video that I found inspiring. I sometimes share a recipe that I've been making or a quote that's caused me to stop and reflect.

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