Fresh Air - Best Of: Black Doctors Consortium Founder / The Life Of A Brain Surgeon

Episode Date: August 17, 2024

Pediatric surgeon and founder of the Black Doctors Consortium Dr. Ala Standford talks with Terry Gross about how, at the height of the pandemic, she dedicated herself to addressing health inequities in Black and Brown communities. She set up shop in parking lots and churches providing tests and vaccines to tens of thousands of people.Also, we'll talk with brain surgeon Dr. Theodore H. Schwartz, author of the new book Gray Matters. He'll talk about how brain surgery has been transformed by new technologies, new instruments, and more powerful computers. And Ken Tucker takes us back 50 years to Neil Young's On the Beach. Learn more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for this podcast and the following message come from the NPR Wine Club, which has generated over $1.75 million to support NPR programming. Whether buying a few bottles or joining the club, you can learn more at nprwineclub.org slash podcast. Must be 21 or older to purchase. From WHYY in Philadelphia, this is Fresh Air Weekend. I'm Sam Brigger. Today, pediatric surgeon and founder of the Black Doctors COVID-19 Consortium, Ayla Stanford. At the height of the pandemic, Dr. Stanford made the decision to step away from her role as a surgeon to dedicate herself to addressing health inequities in Black and Brown communities. She set up shop in parking lots and churches, providing tests and vaccines to tens of thousands of people. I know for certain I've saved more lives in a parking lot than I ever did in an operating room.

Also, we'll talk with brain surgeon Theodore Schwartz, author of the new book Gray Matters, a biography of brain surgery. And Ken Tucker takes us back 50 years to Neil Young's On the Beach. That's coming up on Fresh Air Weekend. The app for doing things in other currencies. Send, spend, or receive money internationally. And always get the real-time mid-market exchange rate with no hidden fees. Download the Wise app today or visit wise.com. T's and C's apply. Hey, it's Aisha Roscoe from NPR's Up First podcast. I'm one of thousands of NPR network voices coming to you from over 200 local newsrooms across the country. We bring all Americans closer together through free and independent journalism, music, politics,

culture, and so much more. The NPR Network, what you hear changes everything. Learn more at npr.org slash network. This is Fresh Air Weekend. I'm Sam Brigger. Our first guest today, Dr. Ayla Stanford, has done life-saving work in the operating room and on the streets of Philadelphia, where she grew up. As a pediatric surgeon, she performed thousands of operations on children, including babies born prematurely. Her hours in the operating room took a toll on her hands, and a shoulder injury from a car accident curtailed her work as a surgeon. But she found another life-saving calling as an activist, providing medical help for Black people in underserved Philadelphia neighborhoods. While hundreds of people were dying during the early

stages of the COVID epidemic, Dr. Stanford founded the Black Doctors COVID-19 Consortium, which provided COVID tests and vaccines to tens of thousands of people in Philadelphia. After COVID became less deadly, the consortium expanded its services by setting up clinics in Black communities around the city. Ayla Stanford has written a new memoir called Take Care of Them Like My Own, Faith, Fortitude, and a Surgeon's Fight for Health Justice. She spoke with Terry Gross. Dr. Ayla Stanford, welcome to Fresh Air. It's really an honor to have you on our show.

I live in Philly, so I know some of the amazing work that you've done here that really kind of created a national model. So welcome to Fresh Air. Thank you for having me. I feel honored. So do I. So while you were a practicing pediatric surgeon, you were having problems with your hands like carpal tunnel, resulting from all the surgeries you'd performed. And then you had a car accident and required shoulder surgery. And you were wondering how long you could continue as a surgeon. How much did that come into play in kind of changing course and becoming more of a medical activist, providing medical services, including vaccines and tests to underserved communities?

You know, I feel like I definitely thought about it, like if I had to pivot and do something different. And my majority of my life has been as a surgeon, as a pediatric surgeon, using my hands literally to heal. And if I didn't have my hands in my upper extremity, could I be as impactful? And I found out quickly because I know for certain I've saved more lives in a parking lot than I ever did in an operating room. And so let me just clarify the parking lot part. Yeah, that's where you set up vaccines. That's correct. And and testing in the beginning because I'm in testing.

Yeah, I'm sorry. I'm in testing because, yeah, the first COVID test my husband got was in a parking lot. Oh, look at that. And one of the things you mentioned, Terry, is about underserved communities. And I should preface by saying when people were calling me in March and saying they were being turned away, they weren't from impoverished communities. They were friends of friends who had insurance, who were educated, and who had my cell phone number. And not that I don't have any friends that are impoverished, but I don't have a ton, you know.

And the folks were calling me. What they had in common is that they were Black. And I thought, if people with means are having challenges, I'm sure the people who don't have access to call a doctor are really struggling. And that's when I started asking, are you really turning people away because their doc isn't on staff? And they said, well, if they took the bus, they've got to be in a car. And, you know, if they don't have an accurate prescription, we can't accept them. We can't be responsible for calling all those people back with the results. And there was this whole list of reasons that were barriers.

And so we ultimately created a barrier-free access program to get people tested against COVID. I love that the first time you tried to distribute tests, you had people call you, and then you went to their homes, like one by one by one. And then one day, because of all the driving in between, you did 12 homes. And you thought, this isn't really saving that many lives. So you changed course and figured out another system, which included the parking lots. Absolutely. But also churches. Yeah. I mean, so as a physician scientist, which I am, all of the data where people were having higher incidence of disease, the demographics, you could look it up in any city. Now, when you asked about it, you didn't hear about it in the media per se, but you could dig and find it. So that's what I did. Once I had those zip

codes, I put them in order of sickest to least sick. And then I said, okay, it's black people in the city of Philadelphia that are three times more likely to contract the disease and die. So where do they trust? And for me, in my experience, it's mosques, it's churches, it's community centers. And so I asked my pastor to help me identify a church or a mosque in each zip code where people lived and the disease was the highest. And that's where we targeted. We went to where the need was the greatest, and we set up shop.

It's amazing to me that you actually were able to get tests. This was during the period when you set up. It was during the period when no one had access to tests. It was so hard to get tests, and none seemed to be available. How did you get enough? So first of all, some of my friends will call me pushy. That is kind of my personality. And I kept calling.

Now, remember, Terry, I am or was a private practice pediatric surgeon, meaning I had my own business, my own malpractice, my own employees. And though I was on staff at different hospitals in the city where I operated, I worked for myself, which meant I had an account with LabCorp and Quest, and I could request tests just like a hospital could. And, of course, they told me no multiple times because I'm a surgeon and it's predominantly primary care docs that were doing COVID tests. But I kept calling saying the need is so great and you're missing sections of the country that are not having access to these tests. And finally, I got the right person at the right time that sent me 500 testing kits. And we used every single one of them in the first two days. And every time we use them, we sent in our specimens, they would send us a new box of 500. And for them, yes, they were doing the right thing to help, but it was also revenue generating for them. And because I said, you're going to bill me when they said, how are you going to pay for it?

I said, you're going to bill me. And by me, you meant you personally. Me personally. I said, listen, I have a practice and in good standing. I've been a doc with your company for years, which was true. And so I certainly got those $100,000, $200,000 bills for all of the COVID test processing that LabCorp was doing. Why were you willing to pay for it out of your own pocket? Because at the time, the people that I would say get paid to do it, city, state, federal government, were not. And it wasn't, there was so much bureaucracy and red tape to cut through to get the particularly the underserved, uninsured or uninsurable people did not have access. And some people with insurance couldn't get it. And I wanted it to be barrier free. If you had insurance, great. I didn't even accept insurance. I just said, if you have been exposed and you need a COVID test, come to us. That's it. That was the only requirement and a way that I

could reach you with your results. And when we didn't know if tomorrow was coming, you know, if we were all going to be dead, I wasn't worried about a50 or $100 test. I was worrying about saving a life. And that's where the priority was. You thought that if anybody was actually doing triage in terms of who needed tests and who really needed vaccines, that the Black community wasn't taken into consideration, that underserved communities weren't taken into consideration. Where do you think underserved communities should have fit in a triage mentality? The health department, regardless of what governmental level it is or in a health system, I believe you go to the most vulnerable. You go to who needs a safety net, who can't advocate for themselves. It's like how we take care of our babies and our seniors because they may need some extra help. So when you're

saying to everyone, shelter in place and don't go out into the public, but you can't afford to shelter in place because you have to go out into the public to support your family when you're saying buy a bunch of food for a month and keep it stored and people don't have the money to do that. It's sort of like the adage of telling a bootless man to pull himself up from his own bootstraps. It's like the adage of telling a bootless man to pull himself up from his own bootstraps. It's like the recommendations were applicable for certain socioeconomic tiers in society and not for others. And so in my mind, I hope we never have another pandemic again or a public health crisis. But those who have the greatest need are where you put the emphasis. And it's not to say that you can't take care of everybody at the same time,

but there should be more emphasis on where you will see the greatest death and disease. When it came to vaccines, one of the things you were sometimes told is, well, Black people distrust the vaccines. They're not going to get them. So we're not going to send them to you. We're not going to send vaccines to you. Which is crazy. What was your response to that?

So, again, being the physician scientist, I said, why don't we ask them? So it was October of 2020 and it was flu season. And so in addition to doing COVID tests, we were also doing flu shots. And we told folks, this flu shot is not going to protect you from COVID. But when they came in, we did a survey, a psychometric tool to use the proper language. And we asked them, if a vaccine were available today, what would make you take it? What would you be concerned about? And from that data, we used all of our messaging was what people's fears were or what their strengths were. But what I learned more than anything is that the majority of people said that they did trust the government to produce a vaccine. And yes,

they would take it. And so then it became using objective data to dispel a subjective narrative. And that became my quest. And so once I couldn't get it from the city right away, I had the young people in the consortium create a survey or doodle poll online and had people sign up to get the vaccine. And I said, I don't have it yet, but I'm starting to create a list. And in 48 hours, we had over 3,000 people sign up. And because we were collecting demographics, we could see the majority were African-American. And then I could go to the city and say, people want it. I put this out, you know, on Monday. On Wednesday, we've got thousands of people signed up.

And so I had to, rather than lament, rather than complain or cry about it, I backed it up with the data. And that's what helped support us getting it. Has it ever been awkward? I remember when you couldn't get a vaccine, it was so hard to get, that people were going to underserved communities because there were vaccines there, they were probably your vaccines. So was it ever awkward when a white middle class person showed up asking for a vaccine when you had gotten these vaccines specifically for underserved communities? It was ridiculously awkward. My gosh. What did you do?

It was so awkward. Well, I mean, you sort of heard these rumblings and conversations because what happened, Terry, is that all of our registration was initially online. And so and you would see predominantly people of color coming in. The people who didn't have access to online registration started getting pushed further and further to the end of the line. And so what ended up happening is they would just show up at five o'clock in the morning and wait in line and figure, well, if I'm here, they're not going to turn me away. And they were right. And because they didn't have access to make those online appointments. Now, let me go back to your question. And so when I started seeing, you know, Teslas and Range Rovers in the parking

lot in North Philly, I was like, what is going on here? Because most people take public transportation anyway. And these were some very expensive cars in my parking lot. And I would say it doesn't help if you come to this community and take a vaccine and go back to your place in the suburbs or wherever where you're sheltering in place in your own bubble and you're not interfacing with the public. And then the people who are interfacing with the public and they're going to work and they're more exposed and they're more likely to contract the disease don't have it. It doesn't make the pandemic end any sooner if you do that, right? It's not going to allow you to go on vacation any sooner if you take from those who are the ones who are most at risk. I tried to

explain that. Nobody wanted to hear it. We're listening to Terry's conversation with Dr. Ayla Stanford. She's the founder of the Philadelphia-based Center for Health Equity and the Black Doctors Consortium. Her new memoir is called Take Care of Them Like My Own, Faith, Fortitude, and a Surgeon's Fight for Health Justice. We'll hear more of their conversation after a break. I'm Sam Brigger, and this is Fresh Air Weekend. NPR Podcasts. Money. Power. Tacos. White Collar Crong. Green Parts. Black Reparations. More of the perspectives that make your world a more vibrant place. NPR Podcasts. More voices. All ears. Find NPR wherever you get your podcasts. in underserved communities of people of color. When you were born, your mother was 14, your father 17. You tell the story of the circumstances of your mother's labor, and I want you to describe that for us. Well, my mom was the same age as my twins right now, 14. And she was in labor and she tried to get a cab down in front of Wanamaker's and no one would stop for her. And her water broke and she had, you know, water going down

her legs and I would presume blood and did what she knew and she took the Broad Street subway and so from City Hall she took the subway up however many miles maybe six or eight to Einstein Hospital where I was born and when she got there she was in a lot of pain. And she has described to me that when she woke up, her stomach was flat, and she was in a pool of blood, and I was gone. And so that is how I came into the world. You were gone because you were with the preemies? Yeah, yeah. Or with the babies that had eventful births, so to speak. Like almost being born on the Broad Street subway. Yeah. And her mother didn't want to take her in because she warned her about getting pregnant and was very angry with her for getting pregnant.

How were your parents able to provide for you and for themselves? So we had and have an extended family that are like extra parents to me, that took my mom in, that taught me, that potty trained me, that fed us. And that was how, you know, my father's mother, my grandmother was also part and my father's mother's mother, my great grandma. So that was how, but honestly, my mom did, my mom was the one who at a young, young age was going to high school, taking care of me. I mean, people helped on the periphery, but she was, she was it. I mean, she, she did a lot. She had no childhood because she had us and decided that she was going to raise us as best she could. Us as your brother who was four or five years younger than you. Yeah, my brother, Kama'u, yes. So you lived through times of no electricity and hardly any food,

ironing sheets to stay warm at night, roaches, rats, shoplifting when you really needed something. You were even arrested once. So just talk about the shoplifting briefly and what your motivation was and what kind of things you lifted. Do you mind me asking? Because you've come so far from there that I think it's instructive to hear why you did it.

Well, the short answer is I was hungry. Right down from Germantown and Mount Pleasant, there was an Acme there. I think the Acme is still there. And I was with my brother who was five years. So if I was nine or eight, he would have been four. And I stole some tasty cakes is what I took because I was hungry. And, you know, granted, my brother was like a baby. He was four or five. And I was arrested and they put handcuffs on my wrist on the back and put me in the back of a paddy wagon. And my brother had to walk home by himself. We lived at Germantown in Johnson, which was kind of far for him to walk by himself. And it was black in there and it was cold and there were no windows. And they took me to Broad and Champlist and put me in a cell, I thought to myself, I'm like nine, eight. And I really didn't want them to call my mom because I knew how hard she was working to put food on the table. And I knew I was going to get spanked when she caught up to me. And she was so, I know she was disappointed. But again, it was, you know, at the

time, it was because I was hungry. And I guess what I would say, you know, so often, when you see kids taking something, and even though it may not be food, it could be clothes or sneakers or whichever. If they're taking 10 of them, it's not because they want to wear it. It's so they can sell it to get something else, which a lot of times is shelter and food and maybe things to make them feel like a kid, like a phone, sneakers, I don't know. So it's, I mean, it's actually hard to talk about some of this stuff, but I put it there so maybe as adults, we won't be so dismissive of

these young folks that we feel like won't amount to anything and they'll just end up in jail or in juvie and will be menaces to society. But maybe if we, you know, the time it took to, I don't know, put me in handcuffs in the back of a paddy wagon and take me down to a precinct, you know, that same amount of time learning something on a computer, reading a book, you know, having me come back to the police station once a week and, you know, show me, expose me to other things that may be an option, I think could have been pretty pivotal for my life as well. I mean, I turned out okay, but I guess I'm saying that for all the other kids out there that don't get that opportunity. Dr. Stanford, thank you so much for talking with us. And thank you so much for the work that you've done and that you continue to do.

Thank you, Terry, for having me. Dr. Ayla Stanford is the founder of the Philadelphia-based Center for Health Equity and the Black Doctors Consortium. Her new memoir is called Take Care of Them Like My Own, Faith, Fortitude, and a Surgeon's Fight for Health Justice. Rock critic Ken Tucker continues his summer series about great albums celebrating 50 years. What could be more appropriate for a summer series than the Neil Young album called On the Beach? However, all is not sunny. Young has referred to this 1974 album as, quote, one of the most depressing records I've ever made, unquote. Ken explains the context for that remark and why he thinks Young's downbeat

music is actually thrilling, even inspirational. But I can't face them day to day. Though my problems are meaningless, I don't make them go away I need a crowd of people But I can't face them day to day On the title song of On the Beach, Neil Young sings, I need a crowd of people, but I can't face them day to day. Two years before the release of this album in 1974, Young had put out Harvest, a huge hit that attracted that crowd of people. It remains his best-selling album.

But that success freaked him out. He started to write songs that were more downbeat, more guarded and prickly. His marriage to actress Carrie Snodgrass was collapsing. When his guitarist Danny Witten and one of his roadies, Bruce Berry, passed within months of each other in drug-related deaths, he told Rolling Stone that he held himself partly responsible. Young went into the studio and started talking about feeling like a blood-sucking vampire. I'm a vampire, baby Sucking blood from the earth

Well, I'm a vampire, baby Sell you 20 barrels, boy I'm a black-backed baby The recording sessions for On the Beach were gloomy affairs fueled by a lugubrious drug mixture the musicians called honey slides. In this context, Revolution Blues, Young's rumination on psycho killer Charles Manson, fit right into the overall mood. Young enlisted Levon Helm and Rick Danko, the rhythm section of the band,

to power up his memories of once trading guitar licks with Manson. The song ventures to get inside Manson's warped head with shocking, vivid details. It's one of the best songs Young has ever written and performed. I'm a barrel of laughs with my carbine on I keep on hoppin' till my ammunition's gone But I'm still not happy I feel like there's something wrong I got the revolution blues I see bloody fountains

And ten million dune buggies Coming down the mountain Well I hear that Laurel Canyon Is full of famous stars. But I hate them worse than lepers, and I'll kill them in the car. Is it any wonder Neil Young was Johnny Rotten's favorite hippie? The bleak but beautiful music Young was making during this period mixed folk and country with rough production and pinched, piercing vocals. It was Young's early, homegrown version of punk rock.

All the sailors with their seasick mamas Hear the sirens on the Shore Singing songs for Vince with Taylor Who charged ten dollars at the door You can really learn a lot that way. It will change you in the middle of the day. Though your confidence may be shattered, it doesn't matter. One thing On the Beach demonstrates is that artists can make good art no matter how hemmed in, churlish, or depressed they may be. What might emerge from such low moods can prove revelatory and relatable in the way that the best songs about feeling bad can feel so good to a listener.

With typical willfulness, the summarizing message of On the Beach can actually be found in its very first song, Walk On. Quote, sooner or later, it all gets real. I hear some people been talking me down Bring up my name, pass it around They don't mention the happy times They do their thing, I do mine. Oh, baby, that's hard to change. I can't tell them how they feel.

Some get stoned, some get strange. Sooner or later, it all gets real. Come on. The album cover depicts Neil Young alone, barefoot in the Santa Monica sand, his back to us, all but shouting, get off my beach. His songs are stormy warnings. Beware, I'm no role model. But its music also says, we're all in this together. A bummer and a downer, On the Beach takes us not to the edge of the ocean, but to the abyss.

Rock critic Ken Tucker revisited Neil Young's album On the Beach, which was released 50 years ago. Coming up, we'll talk about brain surgery with neurosurgeon Theodore Schwartz. I'm Sam Brigger, and this is Fresh Air Weekend. Truth, independence, fairness, transparency, respect, excellence. This is NPR. As a neurosurgeon, my guest's tools include special saws and drills to open a patient's skull. But he also uses very high-tech imaging as well as laser and computer technology that have transformed the field and can offer an alternative to opening the skull. Dr. Theodore Schwartz has spent nearly 30 years operating on people with neurological illnesses. A lot has changed in that time. He helped develop minimally invasive

surgical techniques. In his new book, Gray Matters, a biography of brain surgery, he writes about the past, present, and future of brain surgery. He says brain surgery has also contributed to our understanding of the human mind, the existence ofamish, this interview might not be for you. Dr. Schwartz, welcome to Fresh Air. The book is really fascinating. I just want to start by asking, you write that being a neurosurgeon is a dirty occupation, really dirty. Like a mechanic whose coveralls get covered in grease and grime, we often leave the OR covered in blood, betadine, and bits of brain. Bits of brain? What's in that brain matter? Do your scrubs have bits of your patient's memories? Are those the names of

favorite movies, memories of a first kiss, the ability to coordinate the act of walking that are on your scrubs? Well, you know, Terry, everything that we are as human beings is in our brain. So in fact, the answer to that is yes. You know, it's all there. It's all in the gray matter and the white matter that neurosurgeons operate on day in and day out. We are operating on the very essence of what makes us who we are. And that's really what makes the job so fascinating. How does it splatter on your scrubs? Well, there was a bit of dramatic license there, perhaps. But from time to

time, there are pieces of brain that can be sucked out and removed. Sometimes we'll take pieces of brain out that are diseased or abnormal or that are traumatized. And those pieces of brain can sometimes end up on the floor accidentally or on your shoes. Right. It's always amazed me that among the main tools used in brain surgery are a drill and a saw. Can you explain how they're used? Well, you know, we think of brain surgery as something that's very fine and delicate, and a lot of it is very fine and delicate, but the brain is housed in the skull, and the skull is very, very strong, and that's what protects our brains from injury. And so part of what we have to do as brain surgeons is first get through the skull,

and that work is often very physical and involves drills and saws in order to get through the bone. We obviously do it very carefully because the trick is to get through the bone and not damage the underlying contents. But we have to use power tools, and that's how we start out every operation, with saws whirring and buzzing and making noise and sort of bone smoke going in the air before we transition to the careful, delicate microsurgery that we do after that. Can you compare the original versions of the drills and saws used in brain surgery with what you use today? When I started training, we used a tool called the Hudson Brace, which was used for years in neurosurgery. And it was basically a handheld drill

where you would push on the back of it and you would rotate your other hand around in a circle in order to get the drill bit to move. And it was a bit terrifying because you would have to push pretty hard to have it engage with the skull. And there was always that fear that if you push too hard or if you drill too long, it would plunge into the brain. And you got very skilled over time figuring out when exactly to stop. But now we have power tools. They can be electrical tools. They can be air-driven. They go very, very fast and rotate at 10,000 RPM. That allow us to carefully essentially paint away the bone while we go. And that's one of the techniques that we use that makes what we do so much more quick and specific. had an operation that at the time, and maybe still, was rarely done because it was such a new technique and also very risky. It was on a patient who had a benign tumor that had to be removed from deep in the patient's brain. And right, the tumor was surrounded by critical nerves and blood

vessels. And if they were damaged either by the tumor or the surgery, it could lead to blindness or paralysis. So what was the dominant procedure that was used at the time to remove a tumor in this location? Traditional neurosurgery involves opening up the side of the skull. So you're drilling into the side of the head, you're taking down the muscle for chewing, which is in the temple, and going around the brain to get underneath the brain to the base of the brain. And I was lucky enough to start my career at a moment in time where the concept of minimally invasive brain surgery really came to fruition. And so we are now doing surgeries that go through the nostrils, for example, without making any incisions whatsoever using long endoscopes like telescopes that we put up through the nose. And we can do

surgeries now by making a small incision in the eyelid or the eyebrow and working our way around the orbit in order to get to the skull base. And that allows us to get to these very delicate parts of the brain much more quickly and without disrupting as much of the patient's anatomy so that they heal much faster. And it has really improved what we do. When was the first time you did this surgery? Well, the one through the nose, I'll never forget, was December 2003. It's funny you asked that, but I know that date exactly. And it was just because it was so much earlier than many other people did it. And I remember it because I was so nervous about doing it. You know, the first time you do an operation that you never trained to do, maybe you've watched someone else do it once or twice.

You may have tried it on a cadaver, which we do from time to time. But it's never the same as when you do it yourself. And obviously you're doing it on another human being. And you realize the gravity and the importance and the significance of the fact that this other person's life is in your hands. And you're trying something on them that you think will be better for sure, but you're not sure yourself of your own ability because you haven't done it a hundred times. And that's really terrifying. And it's something that, you know, we have to deal with as neurosurgeons, not just when we try something new, but essentially every

time we do an operation, right, we're taking on that enormous responsibility of another human being's life. And in a sense, having that arrogant feeling that, you know, I know what I'm doing. I know this is going to go great. I know I'm going to help them and hoping for the best and applying your skills to that procedure. So what was the outcome of this surgery? The surgeries I describe in the book, the first ones I did, did extremely well. And that's important, right? Because that helps me know that I'm on the right track. And as a surgeon, your confidence waxes and wanes based on your results, particularly when you're doing risky surgery like brain surgery. And while the majority

of our surgeries go extremely well, occasionally they don't. And when that happens, it weighs on you tremendously. And it affects how you think about all the subsequent cases that you're going to do that are similar, because you never forget those cases that didn't go quite the way you wanted them to go. So luckily, the cases I did that were the new minimally invasive ones went extremely well, and that allowed me to continue to do them and get better and better at doing them. really steady, steady hands while you perform the surgery, six hours or more without having to use the bathroom, without being able to use the bathroom, that sounds, that alone sounds stressful. Yeah, I remember when I first was considering becoming a brain surgeon, and I watched my first couple of operations, I would stand in the operating room when I was in medical school

and I would have horrible back pain because I wasn't used to that. I wasn't used to using those muscles. And it was very uncomfortable, and I wasn't sure if I would be successful at it. You know, I would look at my hand holding a newspaper, reading the newspaper, and I'd see a little tremor and the edge of the paper would shake, and I'd be afraid that, you know, what if this is something that's going to be a problem for me? But what you learn is that the more you do it and the more you train in doing it,

you develop certain habits and techniques and muscles and abilities to sit there and focus for hour after hour and after hour doing what you need to do. And you essentially get into a flow state where you're not even aware of the passage of time because you're so intensely focused on what you're doing. It's sort of the ultimate in mindful meditation is how I think of a lot of the long brain surgeries I do. You're very, very relaxed and very, very focused. And the external world does not exist for that period of time. And the same is true of your bladder. I mean,

your bladder doesn't exist really. And then at is true of your bladder. I mean, your bladder doesn't exist, really. And then at the end of the operation, you kind of realize, oh, my goodness, you know, I have to go to the bathroom. I'm tired. My neck hurts. My back hurts. But for that long duration of the surgery, none of that exists. So in the surgery we discussed, you avoided having to remove part of the skull by using a relatively new technique. But you've done a lot of surgeries where you did have to remove part of the skull by using a relatively new technique. But you've done a lot of surgeries where you did have to remove part of the skull.

So one of the reasons why you have to do that is just to get access to the part where the tumor is or where the problem is. But another reason is if there's a lot of pressure in the brain and you need to relieve the swelling so that the brain isn't pressing against the skull. What causes that kind of swelling? Is it a traumatic brain injury? One of the most common surgeries that neurosurgeons do is head trauma, and head traumas are very common. But these are neurosurgical emergencies. Anyone who has hit their head severely enough, they will have swelling in

their brain. And we can now save these people's lives just by opening up the skull because as the brain swells, if it has nowhere to go, that's when the pressure goes up. So neurosurgeons can go in very quickly and remove part of the skull and let that pressure out and then put the skull back maybe two, three weeks later or maybe even a few months later when the swelling has gone down. And we can save lots and lots of lives that way. I'm trying to imagine what it's like to have part of your skull absent for a couple of weeks. What do you do in place of the skull in that spot? Well, while the skull is off, the patients often have to wear a helmet because you do want to protect the brain from traumatic injury. But if you're just lying in bed, for example, you don't have to wear a helmet.

It looks a little odd to not have part of your skull. And so they often want to wear a helmet or they'll wear a hat or a scarf around their head. And then, of course, we try to put it back as soon as we can. Sometimes having an absent skull actually can affect the brain's function. So that's another reason why we do like to put it back as soon as we possibly can. Is the brain actually exposed? It's not. It's still covered with skin, right? So we still close the skin, yeah.

The dura? The dura is the covering of the brain, but I just mean the scalp. The scalp is closed over it. And even the hair can grow back even if you're missing a piece of skull. Wow. Did you have that reaction of wow when you started learning neurosurgery? You know, I did have a reaction of awe. I'll never forget when I first went into a neurosurgical operating room as a medical student. And most medical students aren't really sure what they're going to do with their careers and their lives. And that's why we do these rotations where you go from specialty to specialty to specialty and watch each of the different surgeons or medical doctors do what they do.

And I'll never forget walking into a neurosurgical operating room and seeing a surgeon who was in a chair. It's a special chair that can hold the arms up and working under a microscope. They looked like astronauts in the cockpit of a spaceship. And I was a kid who always wanted to be an astronaut or astronomer. And they were traveling into the microcosm of the brain instead of traveling into the macrocosm of another planet and going someplace

where few people go. And when I first saw that, it was nothing but awe and excitement. And the fact that they were doing it to help another human being and going into the brain and the mind. My father was a Freudian psychoanalyst. I talk about that and my interest in language and the brain and memory. And the fact that all of that was open and exposed to the neurosurgeon for that period of time, to me, was just an incredible moment. So when you remove part of the skull and you're not going to reinstate it for two or three weeks, how do you store the bones and how do you reinstate it? Do you glue them back in?

There are a few options we have. You can imagine if you are in a battle zone and you're at a forward hospital and you're removing part of the skull, which we call a hemicraniectomy, to save a wounded soldier's life. What you need to do is put that bone somewhere. And so we actually create a small pouch in the abdomen. You can make an incision in the belly and create a pouch in there, almost like a kangaroo pouch, and store the skull in the abdomen, close it up, and then the soldier would get transported to another hospital. And at some later date, they could just essentially unzip the stomach, take the skull out, and reimplant it. If you're in a hospital, we have bone banks where we can store skulls sterilely. But what's most commonly done now, believe it or not, is we will access a computer and 3D print

a skull implant, a prosthetic, if you will, and put that in that is custom designed to fit the defect in the skull. And there are companies that make that. And just by doing a CAT scan, they can reconstruct the defect. And then you just reimplant it when the time comes. And how do you, do you glue it back in? Yeah, so we put bone back in using titanium screws and plates. They're little tiny screws and little tiny metal plates that we do. And you put four or five of them around the circumference of the skull, and that holds it in place. And they're titanium, so if the patient gets an MRI scan,

there's no interference with the magnet of the MRI scan. And then eventually it fibrosis in and will really heal beautifully. It must be pretty exciting for you to be witnessing and performing so many new neurosurgical techniques. Yeah. One of the things I love is that some days or weeks I'll come in and I'll be training a fellow and we'll go through six, seven, eight operations and I'll tell them, you know, all these operations that we just did together, I didn't learn how to do any of these in my training 25 years ago. They're all completely new operations. And that's a wonderful thing about a field like brain surgery is that we're constantly

applying new technology and the field is changing. And you have to stay up to date, but it also keeps you active. It keeps you thinking. You're constantly working with engineers and people in other fields to figure out, what's the latest technology going on in oncology and orthopedics and OBGYN that we can apply to neurosurgery to try to make what we do better. And that's one of the things I try to emphasize in the book is just, you know, how far we've come. I mean, neurosurgery did not exist as a field before 1905, right? So it's only 120 years old, the whole field. And it went from a mortality rate of 50%

when Harvey Cushing started operating, who was the founding forefather of neurosurgery, to about 8% when he was done. And now it's well below 1%. We're using computers and MRI scanners, and we're implanting computer chips in the brain. And it's just come such a long way. And I really wanted to have the opportunity to tell that story because it's a remarkable story of human progress. Do you worry about your brain a lot? You know, in other words, like, if you've known anybody who had, you know, Alzheimer's or a similar form of dementia, you worry about, will that ever happen to me? What will it be like? Because it just really hurts to see somebody in that condition. And I'm sure you've seen your share of people with brain disorders. Do you worry about your brain a lot?

I don't. I really compartmentalize my professional life for my personal life. And I try to live my life every day as if I'm not going to get sick that day. I'm not worried about what's going to happen to me. I try to sort of be very free in what I do. Every once in a while, I'll have trouble accessing a word. Particularly, I call it or aphasia. When I'm in the operating room sometimes

and it's a stressful situation and I'll ask for a tool, I'll forget the name of the tool. And obviously, I know what the name is. But I'll blank it out. And sometimes I'll think, oh my goodness, why am I forgetting the name of that? Like, what's going on with my brain? But in general, it doesn't seem to be progressing in any significant way. So, you know, I think that the most important thing you can do to keep a healthy brain is to exercise as much as you can.

And I do try to exercise a lot. I try to eat a healthy diet, and I try to get a good night's sleep. And besides that, I don't know that we really know what we can do to keep our brains healthy. So that's the recommendation I would give. Dr. Schwartz, this has been a fascinating talk. Thank you so much for being with us on Fresh Air. Terry, thank you for having me. Dr. Theodore Schwartz spoke with Terry Gross. He's the author of the new book, Gray Matters, a biography of brain surgery. He's an attending neurological surgeon and a professor of neurological surgery at Weill Cornell Medicine. Fresh Air Weekend is produced by Teresa Madden. Fresh Air's executive

producer is Dandy Miller. Our technical director and engineer is Audrey Bentham. For Terry Gross and Tanya Mosley, I'm Sam Brigger. Who's claiming power this election? What's happening in battleground states? And why do we still have the Electoral College? All this month, the ThruLine podcast is asking big questions about our democracy and going back in time to answer them. Listen now to the ThruLine podcast from NPR. Hey there, this is Felix Contreras, one of the co-hosts of Alt Latino, the podcast from NPR Music where we discuss Latinx culture, music, and heritage with the artists that create it. Listen now to the Alt Latino podcast from NPR Music, where we discuss Latinx culture, music, and heritage with the artists that create it.

Listen now to the Alt Latino Podcast from NPR.