The ThinkND Podcast
The ThinkND Podcast
Virtues & Vocations, Part 25: Medicine: A Vocation of Head and Heart
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Episode Topic: Medicine: A Vocation of Head and Heart
Brain and Heart: The Triumphs and Struggles of a Pediatric Neurosurgeon is a medical memoir that explores the thoughts and emotions that accompany the responsibility of making complex choices with life-changing consequences. Listen in to a conversation with Dr. David Sandberg on courage, love, compassion, hope and the other virtues that shape his vocation as a pediatric neurosurgeon.
Featured Speakers:
-David I. Sandberg, MD, FACS, FAAP, The University of Texas Health Science Center at Houston (UTHealth)
Read this episode's recap over on the University of Notre Dame's open online learning community platform, ThinkND: https://go.nd.edu/0b72e7
This podcast is a part of the ThinkND Series titled Virtues & Vocations.
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Introduction to Virtues and Vocations
1Hi everyone. Welcome to our webinar Virtues and Vocations, conversations on Character and the Common Good. In this series, we share conversations about how education and work can promote human flourishing. This series is part of Virtues and Vocations, a national forum housed at the Institute for Social Concerns at the University of Notre Dame, and supported by the Kern Family Foundation. I am Suzanne Shehan, and I direct the Institute for Social Concerns and I'm host of this series. Virtues in Vocations is an effort seeking to foster a community of practice amongst scholars and practitioners across disciplines who are all keen to understand how best to cultivate character and moral purpose in higher education and the professions. This webinar is one way we facilitate these conversations today. We are thrilled to welcome Dr. David Sandberg. Dr. Sandberg is a recently retired pediatric neurosurgeon until July, 2025. Dr. Sandberg served as director of pediatric neurosurgery at McGovern Medical School, children's Memorial Hermann Hospital and the University of Texas md. Anderson Cancer Center in Houston. He received his undergraduate degree from Harvard University and his medical degree from the university or Johns Hopkins University School of Medicine. He completed neurosurgery residency training at the Weill Cornell Medical College at Cornell University, New York Presbyterian Hospital. After residency, he completed fellowship training in pediatric neurosurgery at the Children's Hospital Los Los Angeles. His major research interest involves novel delivery methods to treat malignant brain tumors in children. Dr. Sandberg has been principal investigator of several clinical trials, testing direct infusion of chemotherapy into the brain to treat recurrent malignant brain tumors in children. He also has a longstanding interest in neuro surgery in low and middle income countries. In 2019, he received the humanitarian award from the American Association of Neurological Surgeons, one of the very highest honors bestowed by his organization. Today we will have a conversation about him, uh, with him about his recently released book, reign and Heart, the Triumphs and Struggles of a pediatric neurosurgeon, a medical memoir that explores the thoughts and emotions that accompany the responsibility of making complex medical choices with life changing consequences. We look forward to a conversation with Dr. Sandberg on courage, love, compassion, hope, and the other virtues that shape his vocation as a pediatric neurosurgeon. Welcome, David.
Speaker 2Thank you so much, Suzanne. It's so, I'm such a, it's such a big honor to be here with you.
1Well, thank you for joining us on this lovely day. Let's jump right in, uh, with a bit of a discussion about, uh, how you came to this wonderfully thoughtful and moving book. In the introduction, you describe why you wrote it and for whom. I'm hoping you can share a bit about that with us here.
Dr. Sandberg's Journey to Medicine
Speaker 2Yeah, there are many reasons in different audiences, and the first is, you know, as I went through my career year after year and more than two decades now, we accumulate great stories. And I often thought to myself, these stories need to be shared. Stories about compassion, stories about great triumphs, stories about huge failures and complications. There are many books that. Discuss medicine from the patient's point of view. And there are a few books that truly let you into the mind of your child's doctor or your doctor. And one of the things that I think is unique about this book is I really let. Others who are reading the book know what I'm thinking. So I thought that would be useful to patients and families who've been through tragedies, who've had their children diagnosed with brain tumors, things like that. The other is for students, you know, high school students, college students thinking is a career for medicine. You know, is career in medicine, is that for me, medical students who are deciding what specialty to enter within the field of medicine to see what a field like neurosurgery is actually like from the inside with honest views of what we go through in our training, what we go through in our daily lives. You know, are they capable of having the hard conversations, things like that. And then, you know, just for the general public, anyone interested in interesting medical stories?
1Great. Thank you. one of the things I was really taken by is how you described your journey, uh, to becoming a pediatric neurosurgeon and in particular your earlier days as an undergraduate. Uh, Notre Dame, like many elite private schools, has probably more than 40% of our students coming in, aspiring, aspiring to work in some field of medicine. Um. So I found it very interesting that you first described, uh, kind of an experience with the unhoused and, and working with homeless populations. Can you talk a little bit about, how that work? Got you Thinking about a future vocation.
Speaker 2So my father was a physician. He's recently retired. He's an ophthalmologist, and he really inspired me to go into medicine. I wanted to be like him. He was my hero. He took me on some medical missions to Dominican, Dominican Republic, Jamaica, and Antigua that were really impactful to me. I approached medicine from the service standpoint. There are some who approach it more from the science standpoint. I was a history major in college. Um, I grew up in a sheltered environment in North Miami Beach, Florida. I never knew what winter was like. And when I went to Boston for college, I was shocked that I was still cold despite the huge big blue winter coat that my parents had bought me. And I was. Shocked further, you know, and very naive of course, that there were people sleeping on the streets in the dead of winter. And it was so cold and I was rushing to get back to my dorm or to get to classes, and I wondered why this was their best option. I began to volunteer at a student run homeless shelter, and, wound up becoming, you know, a director of that shelter. Look, looking at ways to transition the unhoused from the streets to jobs and permanent housing. I thought I was gonna wind up doing something in medicine related to indigent patients primary care, perhaps internationally, perhaps domestically. But once I got to medical school, I encountered neurosurgery and fell in love with that specialty, and I knew that's what I had to do.
1So can you talk a little bit about, that transition to finding neurosurgery and what about that specialty just drew you in and did that have anything to do with how you describe your, your interest in medicine emerging from, from service, not from, from the scientific research dimensions of it.
Speaker 2You know there, there are some individuals who know they wanna be a neurosurgeon from the time they come outta the womb. I was clearly not one of those individuals. In medical school you do different rotations and one of the important rotations for me was emergency medicine.'cause you see who comes in the emergency room and you see where they get triaged. And I found myself intrigued by the surgical patients. They came in with acute problems. it wasn't just the surgeries. When I did my surgery rotation. It was the conversations actually between surgeon and patient where a patient comes scared outta their mind and a surgeon says. Here's your problem. Here's what I can do to fix it. Goes over risks and benefits or says I can't fix it and nobody else can either, and explains, you know, how, how terrible that feels. I thought that that work seemed very, very compelling. And then neurosurgery specifically, you know, I wanted to try different surgical subspecialist subspecialties because I was intrigued by surgery. I spent a month on the neurosurgery service. I've never worked harder as a medical student, but I wasn't tired. I was up all night, night after night. But I was amazed at first of all the passion of the individuals doing the work, how much they cared, how much they loved the work they treated me. So well. It was really a team environment. and I caught the bug.
1So, um, you described this, it's sort of moment of falling in love with neurosurgery and. I think when the average person thinks of a neurosurgeon, they don't think of them at least many people. In terms of compassion and humility and the way you describe the esprit core, the energizing environment, the care, the compassion, the kindness, was this something that you found? Almost universally amongst surgeons and neurosurgeons in particular, or was this an unusual environment that you then hoped to cultivate where you went after that experience?
Handling Difficult Conversations with Families
Speaker 2You know, surgeons have a reputation of being a little bit rough around the edges. What I've encountered in my career are surgeons who are incredibly passionate about what they do and really care deeply about patients and their families, and for the most part are very good people. Neurosurgery, you know, you think of neurosurgeons as you know. They may be pompous, they may think they're very smart. in, in truth, neurosurgery is quite a humbling specialty. The brain is very unpredictable and, you know, sometimes you do your very, very best and the patient is worse neurologically than they were before the surgery. And when that's a child that hurts really badly and it breeds humility, not, you know, hubris, in terms of, you know, kindness or compassion. I love children. I've always had great sympathy, which has been heightened since I had my own kids. And you see what goes into raising a child and how much I love my own children. And you imagine getting the news that I deliver, being on the receiving end of that news, I have compassion for those families and those parents and those children and, you know, amazement at the bravery that they show. I'm inspired by them and then figuring out whether it's for me. Somebody has to have these really hard conversations in which you tell a parent their child has died or their child has a brain tumor. I think how those conversations go is so important and makes a huge difference, perhaps for the rest of that family's life. Those are conversations that will be remembered forever and I thought that somebody has to do it and it should be me.
1That's, uh, yeah, I, I find that incredibly moving and poignant. in the first chapter of the book, you tell the story of Garrett, uh, who had suffered a traumatic brain injury, and you describe this in one of these conversations with his parents, and you note that you tried to do so with kindness and compassion, but also brutal honesty. That's a really hard combination to bring to a table. can you talk a little bit about the story of Garrett and that conversation with his parents for the audience?
Speaker 2Yeah, the, the story of Garrett was meant to show the uncertainty. You know, when you think of neurosurgery, you think of a field that's very technical, and we can do amazing things with amazing technology. We can target deep brain tumors with devices like frameless, stereo taxi, and robots, and you know, it's precise and all that, but there are so much. In precision, there is so much that is not defined by existing medical literature. So Garrett's case is a case of, of relatively straightforward problem In neurosurgery, a severe head trauma, there's a big blood clot. It's shifting over the brain. Typically, you would take that patient to the operating room emergently and remove that blood clot and hopefully save that patient's life. The problem is by the time Garrett got to our hospital, his neurological examination was so poor that I wasn't sure if he had progressed to brain death initially. He had no reaction when I shined a light in his eyes when I pinched him as hard as he could. He didn't move. He wasn't breathing above the ventilator. His pupils were large and non-reactive, which is a terrible sign. and so there was no definite signs of. Brain function. I pinched him as hard as I could, you know, three, four times. And then finally I pinched him one more time and he did this, his arms extended, that's called extensor posturing, which is not a good thing. You know, it indicates typically severe and permanent damage to the brainstem and. I had not seen children with that degree of impairment, who had good outcomes in general. Most of'em had terrible outcomes. So I had a brutally honest conversation with his father and then his mother when his mother arrived, in which I said, you know, we could take him to the operat room and take out this blood clot, but I think there's a very good chance he's gonna progress to brain death regardless. And I think even if he survives, he's unlikely to be the child. You know, and you've raised, you know, and I children who are fed by, who are bedridden, who are nonverbal, nonambulatory, blind, and. I wound up taking Garrett to the operating room and he made an absolutely miraculous recovery today. It's as if he never had surgery. He played on the golf team in high school. He, you know, works at a nuclear power plant. You know, he's a joy. He's an amazing, amazing kid. and to, you know, to his parents, I'm the hero. I saved their child's life. but what I talk about in the book is how his case haunts me because I truly advise them, you know, if this were my child, I would not take him to surgery. Thinking of the hundreds of kids who I have taken to surgery who have bad outcomes in similar CRC circumstances. so that story was meant to show the imprecision of what we do, which should be terrifying to the general public.
1So it's, it's also an an extraordinary story of humility in that it is something that haunts you about this, and you have this opportunity and this responsibility with parents to provide them the best information you can, but. It's also, you have extraordinary, I don't know if it's control or an ability to shape family decisions in these moments. how is it that you're able to kind of navigate that, the kind of weight of that responsibility in a conversation with a parent, where you're. Trying to give them all the information they need, but also allow them to make a decision that they're going to feel okay with.
Speaker 2Yeah. So there are some decisions that that are or should be black and white, right? If Garrett came in with that blood clot and. He had a better neurological examination, it would be a no-brainer. You go immediately to the operating room. You don't even have the discussion with the parents very for very long.'cause you gotta get that kid to the operating room and save his life if he was definitively brain dead. You don't have that discussion. The hard thing are the gray discussions and I think, you know. Brutal honesty, not sugarcoating things. I've seen a lot of doctors sugarcoating bad news. It never serves the patient well. It never serves the family well, and it never serves the relationship well between doctor and patient and family, which has to be built on a sacred trust and then compassion, you know, putting that. Family, you know, putting yourself in their shoes. God forbid I have given horrible news, hundreds and hundreds and thousands of times, but you never know how you're gonna react when you're on the receiving end of that news, even if you've given it hundreds of times. So just having compassion, saying words that you would want to hear if you were in their shoes and having to make these impossible decisions.
Training and Mentorship in Neurosurgery
1So, um, I appreciate that. In your conversation about these hard conversations, you talk about the brutal honesty, the listening and the compassion as this sort of, three part way that you proceed. How did you learn to do that? Are you just a na naturally frank and compassionate person, or was this something others modeled for you in your training as a, as a neurosurgeon?
Speaker 2You know, it's funny, it, it may be better at some medical schools these days, but I received a lot of training on how to do brain surgery. I received zero training on how to have difficult conversations. None in my entire career, but I watched as when I was a, when I was a medical student, when I was a resident, especially, I watched my mentors have some of these difficult conversations. Sometimes I cringed because it was awful what they said. Just not mixed in with the appropriate level of love and compassion. And sometimes I was like, wow, that was really well phrased. And so what, what I do now as a, as a, as a teacher, as a faculty member is whenever I'm gonna have one of these horrible conversations, I look around and I hope that there's a resident or a medical student or somebody younger than I'm around that I can take with me. And as I'm walking quickly to have that conversation, I tell them what I'm gonna say and how it's gonna go and. Afterwards, I check in with them and make sure they're okay emotionally. And then I tell them, you should take what you liked from that conversation and employ it when you have to be the bearer of bad news one day. and what you don't like, don't use and, you know, watch a lot of people do this and pick the best from each of them. So I didn't really learn from any instructor or anything. It's just by watching other people and picking the best and the worst and, and making a plan.
1So, um, I find that really interesting that you didn't, you weren't trained on how to do this, and yet, uh, you approach it with extraordinary integrity and it seems a consistency. So the honesty, the compassion, the listening. are these things when you're, training new neurosurgeons that you talk about those virtues of compassion or honesty as. As something you think others ought to cultivate, or is your approach more to say There are different ways to do this and they have to be authentic to who you are as a person to match the kind of way you wanna be in the world?
Speaker 2I think you have to be authentic and you have to be true to yourself. But I do feel that there's a right way and a wrong way to, for example, tell a family that a child has died, you know? There are things that would be horrible, like doing it standing up, like not, you know, saying how sorry you are, that your heart goes out to that family. Mm-hmm. Um, you know, it would be wrong not to include expressions of compassion of love. It would be wrong not to wait patiently and listen to what the family says, how they react, and try to comfort them and try to answer their questions. Honestly, it would be wrong to be wishy-washy. Right. You know? It would be wrong to give false hope. so I, I do have strong opinions about how it should be done.
1So I, I sometimes wonder when, in general, when people are going to have a challenging conversation that sometimes we're, that people are wishy-washy, out of lack of confidence that they're not confident. How a conversation is going to unfold or confident that it can be kind and compassionate and at the same time be straightforward and analytic and honest about something. do you ever struggle in those conversations with confidence in, in your ability to do this well? Or is it at this point you feel like I'm kind of good at these, this sort of. Something extraordinary. I can bring in difficult times.
Speaker 2I don't struggle with these conversations. They come naturally to me. maybe after years of doing them. and I often feel like I'm undoing bad conversations that have preceded me. Mm-hmm. I'll give you an example. You know, there are certain brain tumors. There's a brain tumor called diffuse intrinsic pontin glioma. It's the worst cancer diagnosis in medicine. It happens to children typically in the second half of the first decade of life. So you got a five or six or 7-year-old kid. they present with various neurological problems. You make the diagnosis. Surgery is not an option. Radiation therapy helps temporarily like for a few months, and there's no chemotherapy agent alone or in combination that has ever helped. And the children die universally within a year, and they have a horrible death. Right? So can you imagine anything worse? Right. So I've heard others come in and talk to families and say, well, we can try chemotherapy, we'll give radiation. It should, you know. Help with symptoms. And I think to myself, these parents deserve to know the truth. And so I sit down with them sometimes after a conversation like that and I will say, listen, there's no easy way to say this. You know, I have children. I'm upset when my child has a cold. I know how much you love your child, and I say the name of the child, of course. but I need to be honest with you. I need to tell you the truth. And this is a horrible, horrible situation. And I explain that there are different options for brain tumors. That none of the options are possible and that this is gonna have an unhappy ending no matter what. We try and that frees them to grieve. And it frees them to make decisions that are rational, right? If somebody says, well, you can try chemotherapy without saying, no chemotherapeutic agent has ever worked ever in for this diagnosis, you're likely gonna choose chemotherapy. You might wanna choose instead to go to Disney World and create a special memory while your kid is neurologically able to do so. That's a choice whether to enter a clinical trial or things like that. So in any case, that's an example of the importance of having a brutally honest conversation, not sugarcoating the truth.
1Do you think that that way of being is something you carry into the non-medical dimensions of your life? that. And compassion's simultaneously combined with brutal honesty. Is that how you're with your kids or your friends? Is this sort of David's way of being in the world?
Speaker 2I'm a little different at work than at home. You know, I think the bridge is gratitude. I'm so grateful for my own health or the health of my. Family, my children especially, you know, I come home after these conversations and you know, I definitely hug my kids a little harder and don't tell'em why I don't discuss work with them very much. My wife a little more so. But even my wife, I keep some things to myself, and I'm kind of joking and playful and, you know, regular guy at home, so I don't think I apply. Gratitude. I don't think I, at my home it's.
Balancing Work and Family Life
1One of the things that you describe in the book is sort of how you've come to this sort of work life, uh, balance. And you talk about, uh, how you can in fact, be, a pediatric neurosurgeon, uh, devoutly committed to your work, working long, long hours and at the same time, right, have a flourishing family life. Talk a little bit about that because I do think it is, sort of a misnomer or a way of thinking that lots of people have, either you're a doctor or you're all the, all the other dimensions of what it is to be a human.
Speaker 2Yeah, it's a little, little easier now in terms of the training because there's restriction of work hours, and that's a whole discussion I have in the book about whether that's a good or a bad thing. Yeah. Back when I trained, the hours were beyond brutal, and so I was making my decisions in that era. My dad. You know who had my best interest at heart. He thought I was crazy going into neurosurgery because he was a family man. He was an ophthalmologist and he got home at a reasonable hour. He worked hard, but he was there for family dinners and you know, he knew how important, you know, family was. And I knew how important family would be to me. The problem is you've gotta do something. And this is what I tell young people. You have to do something you're passionate about, you know? I found a passion for neurosurgery and then I decided I'm gonna make it work with all the other things. And I've never missed an important family occasion or a birthday. I've missed plenty of like my son's soccer games. I've missed, you know, a few things here or there, but not the major things. As you become a faculty member, you have control of your life of when you're on call, when you schedule surgeries and things like that. I think quality time is super important. I'm proud. I'm, I think, one of very few neurosurgery surgeons who are male, who changed half the diapers. My wife is a busy physician herself. I changed as many diapers as she did. I was, was, and remain equally involved in the life of the family. and I guess the proof of success is my kids are fabulous, you know, and I have a warm and loving relationship with them and a happy marriage. And so it is doable. It is hard, but it is doable.
1Yeah. can you share that statistic that you cited about divorce amongst surgeons that you cite in the book? Because I find it fascinating.
Speaker 2I don't remember the exact statistic in the book. I do, I do remember that there was one residency program that was famous for having higher than a hundred percent divorce rate because, you know, there are some who got married and divorced twice during their residency program. That's not a badge of honor.
1You described being trained at a time where hours were limitless, and um, now there's much more, sort of regulation or constraint around that as, as you look at medical education now, you're in charge, can do anything you want. What are the kinds of things you would change about current medical education?
Speaker 2So if I could change one thing, and I hope this comes out in the book, what I would change is I think medical students, somehow, they're not exactly taught this, but maybe they're taught by example, that there should be a certain. Professionalism, there should be a certain distance between themselves and the patient in order to maintain that professionalism. And what I've found in my career is that the opposite is true. The opposite breeds connection. That it's okay to show your emotions. And I give an example in the book of a patient named Jocelyn. I use her name with her family's permission of course. And this was a little girl who was the cutest little girl you've ever seen who had a little bit of a crooked smile.'cause she had some weakness of her facial nerve. She had a recurrent malignant brain tumor. They came back despite multiple surgeries, radiation and chemotherapy. And she came to Houston for one of my clinical trials where we were infusing drugs. into the fourth ventricle, a certain space in the brain to try to blast that area with, with drugs to get high drug levels and cure their cure cancer. I talk about my interactions with her and with her family. Every time she would walk from me, I would ask her to walk, she would skip doing more than I asked. And I have this image of this little girl skipping down the hall. After many infusions of drugs into her brain, the moment of truth arrived where we got an MRI scan and I was sitting at my desk. I described feeling so anxious about this MRI scan because there was nothing left to offer. If it worked, there was hope, and if it didn't work, then she was gonna die. No other treatments were gonna be offered, and I couldn't focus. Usually. I'm very efficient. I'm doing a hundred things at once. I couldn't focus. I kept hitting refresh, refresh, refresh on the screen. When her images came up, it was devastating because her tumor had doubled in size laughing at the treatment that I tried to give her, so then I had to go. And have the conversation with the family and tell them this news. And normally I walk quickly from place to place'cause I'm in a rush. But I found myself walking very, very slowly, I guess, reflecting my reluctance to have this conversation. But there was nowhere to run or hide. And I had to have this conversation. And I sat down with this family, with these parents, these wonderful parents, um, Nicole and Michael. And as I started. Showing the images and explaining where we were. I just started to cry, you know, and, and not a little, not, you know, I've had tears in my eyes here and there in front of families, but I started bawling and I was thinking to myself, this is totally inappropriate. Like, who am I to show my emotions? Um, my grief is one, 1000th of what the parents' grief is, and I, I felt a little embarrassed by it. Years later, a few years later, I'm in touch with the family. They're dear friends. You know, I, I said to Nicole and Michael, I said, you, you remember that conversation? Of course. And you remember my emotions. How did that make you feel? I felt like that was unprofessional at the moment and things like that. And they were like, no, no, no. They said, we felt like you were in it with us. And it meant the world. And so if I could convey that to medical students, that would be the one thing I would convey. It's okay to put your arms around a patient. It's okay to put your arms around a patient emotionally and make yourself vulnerable. It breeds connection and it breeds care and connections.
Virtues of a Surgeon
1That's great. if you. Summarize that way of being or other ways of being in terms of virtues that you would aspire every, uh, medical student graduates with, what would they be? You talk a lot about honesty, humility, compassion, but if you had to name 1, 2, 3 things, what would you say are the most important, virtues to orient the life of a physician or a surgeon?
Speaker 2Yeah, I mean, a surgeon specifically, I think a focus on a hundred percent honesty is, along with compassion, is really cr crucial. I, I specifically think of that in the context of surgical complications. Mm-hmm. All of us have complications, right? No matter how well trained we are, no matter how experienced we are, there's not a surgeon that doesn't have complications. The question is. When you have complication, and as I talk about in the book, there are different extremes. You know, if I have. As I said, brain surgery is humbling. I can operate on a brain tumor in a child and everything's perfect, and they wake up perfectly and the tumor's out, and the MRI looks clean and they're cured, and I'm the hero and the next day I can operate on. A very similar appearing brain tumor in a similar location of the brain in a similar aged child. And the child wakes up and I do the same exact thing as I did the day before, and the child wakes up with new weakness of the left hand or new speech disorder, or new visual impairment or something horrible that they're gonna have to cope with the rest of their lives. Right? So what should I do with that information, right? On the one hand, I could say, you know what? I'm an experienced surgeon. I've been doing this for over two decades. I trained at the best places in our country. I have loads of experience with this exact problem. People come to me from various places For me to do these operations, it's not my fault and kind of wash my hands of it. Right? And I think if you have that attitude, you probably don't deserve the privilege of being a physician or surgeon. On the other extreme, I could say, oh my God. This wouldn't have happened if name your favorite neurosurgeon did, did that operation. and you can become so devastated by a complication that you don't wanna go on and treat the next patient, and you shy away from difficult cases passing on them. Or when you're in the middle of a difficult case, you leave half a tumor behind because you're afraid, right? That doesn't serve anybody well either. So I think there's a happy medium between those two. Bad extremes in the happy medium, you deeply, deeply reflect. And honestly, what could I have done better? Right? It may be nothing, but usually there's something. What could I have done better in the communication with the family before surgery about risks and benefits? What could I have done during the surgery differently to prevent the complication? What could I have done better in the postoperative period? And then, you know, we present these cases in morbidity and mortality conference, which is like. Showing your worst day in front of, you know, 50 to a hundred people with pictures and video to boot. those discussions are so important and we learn from honest discussion. So I think being honest with yourself and being honest with others about your complications is one thing I would wanna impart.
1Do you, throughout the book, both your journey to becoming a, a pediatric neurosurgeon, but also through your work, I, I wonder if you ever had a moment of profound doubt that this was the right path for you? Was that ever a moment that you said, I have made a mistake, and I need to rethink my vocation?
Retirement Due to Parkinson's
Speaker 2I never had that moment. Um, I've had some lows, you know, with complications where I've made kids worse, um, than they were before surgery. I've had horrible outcomes where a child dies despite my best efforts to save their lives. The research has been particularly humbling'cause I was dealing with a patient population that had a very, very poor prognosis. I had so many moments of joy and the joy far exceeded the pain. and I never for a moment doubted I was only grateful for having the opportunity to be a pediatric nurse.
1That's extraordinary. would you mind sharing a little bit about your decision to retire? You're still quite young. how did this come about?
Speaker 2Yeah. So, you know, unfortunately at the height of my career, I was 53 years old. I'm now 54. I turned 54 in August. I started developing a slight tremor of my right hand, and after seeing three neurologists, it was very subtle and it's still pretty subtle. I'm not even on any medications. I was diagnosed with early onset Parkinson's disease. You know, actually I was doing surgeries. My surgeries were going great, and I was advised that I could continue doing surgeries for a few years. The, the tremor was, is a resting tremor. So when my hands are in motion, like under an operating microscope, it actually goes away. But you know, I never wanted to be one of those individuals. You know, you think of athletes, professional athletes who are amazing in their prime years, and then they stick around a few years too long and. And you wish you didn't see those years? I never wanted to do that as a surgeon. There are some surgeons who retire too late, so I thought I would retire at 65, maybe 70 at the latest. There are some who stay on until their late seventies, even eighties, and continue operating. I never thought I'd retire at 53, but once this diagnosis was rendered and I know the natural history of the disease, I know that I'm gonna get worse. Slowly over time, I decided that I need to go out. Absolutely on top. And so, you know, in January of this year of 2025, I shocked the world and basically first told my family and then, you know, my patients, my colleagues, and stopped doing surgery cold Turkey and and retired in.
1So what is that experience like having, been in those challenging conversations as a physician to be on the other side of that and now being a patient?
Speaker 2It's really hard. It's, it's much better being on the. On the patient side, so I have even more sympathy for the patients who have been on the receiving end of the news that I've given. and I've had some, definitely some hard moments over the past year. Super hard to tell my children about the diagnosis. Hard to tell my parents. My sisters hard to tell my patients and their families. I've developed amazing relationships with a lot of families, and we had a shared vision that I was gonna take care of their kids forever. Or at least for a number of years and throughout their childhood. So that's been really hard. Um. On the other hand, you know, once I kind of shared the news with everyone and got everything off my chest, I felt a certain freedom and I felt my happiness returned to its baseline. And I feel immensely grateful for so many things. You know, I'm grateful that this happened in my fifties instead of my thirties and forties. I'm grateful that I've had the opportunity to save really thousands of kids' lives. and, um. I'm grateful that I'm not given, I've not received worse news. I've given worse news than I've received. I'm not dying. I have hopefully a normal life expectancy and hopefully many more productive things, and I'm gonna do great things.
1I think that's an extraordinary perspective that. I think speaks the joy and alacrity you have brought to your entire career to be able to have that sense of profound gratitude at this moment, it's, it's wildly impressive.
Speaker 2Thank you.
1Yeah, just wildly impressive. I wanna turn a little to some of the questions that have been popping up for the audience. So, um. First one. So how do you cope, uh, with parents who are unable to handle the bad news that you sometimes share with them?
Speaker 2Yeah, so there are so many different reactions to bad news as I describe in the book. there are some parents who sit there silently and don't say a word and stare right ahead and don't cry. There are others who are crying and bawling. I've had patients literally throw themselves on the floor. There are some that scream so loud that it creates a scene that people are looking from every direction. Um, there are some who ask a million questions and there are some who ask none. There are some who are very sophisticated and others who are less sophisticated in the questions that they ask. There are some who just can't accept the news and they say, please do something. Do something different. Save my child, this is my baby. Um. What I teach others, you know, students and others, is that every one of these reactions is absolutely normal and you just need to accommodate your approach to the information you're receiving and the, the, the emotions that you're witnessing in that patient and their family. that's the best I can answer that question.
1Okay, this is from a current medical student. Yeah. Um, who is sharing one of their main concerns is about, in choosing a specialty is about burnout. Uh, have you encountered burnout? Is this emotional compa? Is there an emotional, compassionate burnout, surgery? Burnout? have you encountered it? Do you see it in others?
Speaker 2I mean, there's a lot of discussion about burnout these days. most of my colleagues in pediatric neurosurgery, specifically when I've discussed this topic with them, say that they're not burned out. And I think it's because they love their job so much. I had no moments where I was burned out. Yeah. I had moments when I was tired or wished I didn't get woken up six times, and then a night when I was on call. but I never personally experienced burnout. To me, I think that comes from having made a wise choice of what's good for me in my career. You know, I remember as a medical student going through the different specialties and there were some days where I would. You know, they weren't so long. I would get to the hospital at eight or nine and I'd be home by five or six, and some of those days seemed so long and you know, and then there were other days where I would get to work at four in the morning and come home at midnight and the day passed by so quickly and I didn't feel as exhausted at the end of the day. It sounds crazy, but it's true. so burnout's a real thing. You have to know yourself and what your needs are regarding. Sleep and you know, outside activities. There's not a lot of room when you're a pediatric neurosurgeon in the height of your career for hobbies, you know, basically work, family, and exercise when I could. And other hobbies kind of went by the wayside'cause there just wasn't time. Um,
Advice for Aspiring Medical Professionals
1I think it's somewhat paradoxical that, such an intense. Specialty would be accompanied by, such an ethos of energizing and joy, and I just find that really interesting. okay. Next one. Do you have advice, for aspiring medical students? I'm a college student currently studying for the mcat.
Speaker 2Yeah, I mean, here's, here's the advice. I would say I've never. Been, it's very hard to get into medical school these days, and then it's hard to get into competitive specialties like neurosurgery. It's harder than it was when I was going through the process. what I would say is it's worth it. It's worth the effort and the work, and it takes work. I've never been the smartest person In almost any room that I've been in, I have often been the hardest working. And the sacrifices that I made were real. I remember, and I talk about this in the book one night where I missed a bachelor party of one of my best friends because I was on call in the hospital. I couldn't find somebody to switch call. And I remember running around the hospital at three in the morning and I was having so much fun, you know, I was saving people's lives and doing surgical procedures and putting out fires, and I was thinking to myself, I'm having more fun than those guys at bachelor party. Number one, I had chosen my career wisely, and two, that I'm a little bit crazy, but what I would say is it's worthwhile. You have to miss a party, miss the party, get a good grade on that test. I mean, there you have to have balance. So, you know, I'm not saying lock yourself in a, in a, in a library for, for the rest of your life, but the sacrifice are worth it.
1That's great. how do you remain compassionate early in your training during residency when you're pulled in so many directions to publish, learn, teach, lead, mentor, et cetera, all while working long hours?
Future of Neurosurgery
Speaker 2I mean, if you've sacrificed the compassion for any of those reasons, then you need to recalibrate yourself because, you know. It is such an amazing privilege to be a physician, to have the opportunity to take care of patients, to do the surgeries. The surgeries are so much fun. It's really fun to walk into a room and open up a skull and see the pulsating brain, and then remove a portion of that brain that's causing a problem or a tumor that's pressing on that brain or within the brain. And then. See that patient wake up. I mean, it is such a privilege to, to do what we do, and you're dealing with real human beings who are going through the worst moment of their lives. If you can't preserve that compassion, then you should try to do something else with your life.
1That's great. what new technologies and procedures do you see ahead, for neurosurgery and what moral and ethical challenges will they or will they not present to practitioners and patients?
Speaker 2Ooh, that's a great question. I don't know how good I am at predicting the future. What I would say is neurosurgery has become less and less invasive and will continue to do so. There are many surgeries that used to require a big incision in the scalp, taking off a big piece of the skull that we can now do through tiny incisions that you can't even see with little holes in the skull. Little bur holes and needles or electrodes and things like that. I think the future is both incredible and also somewhat scary. I think. There is gonna be more and more restoration of function. You know, when you think of like Elon Musk's company, Neuralink, there's a potential that we're gonna be implanting electrodes or devices of some sort in the brain that are, you know, working with artificial intelligence that are gonna work on the brain mind interface and be able to make humans, you know. Have better language function, if their language is impaired, have better motor function, if their motor function has been impaired, restore vision. I think those are amazing and clearly not controversial. I think what would be controversial would be if we find ways which I think is possible to enhance normal people, right? I don't know what the ethical questions are that are gonna be raised, but.
1Here's one from a parent. My daughter will be a freshman in college next fall and is planning on pursuing pediatric nursing. I am personally concerned for her mental health because she's so empathetic, especially towards children. What's the biggest piece of advice you would pass along to her as she makes her way down this career path? And do you have any advice for me as her mom to help her keep the course down this path?
Speaker 2I have. More advice for you than I do for her. My advice for you is to lean into her career decision. Nursing is the most wonderful field. Nurses are at the bedside, hour after hour, helping alleviate pain and helping provide comfort to families. They're on the absolute front lines, and if your daughter is a compassionate person, lean into that compassion because she's gonna have a meaningful life and a meaningful career. I worry about. Kids who choose careers that don't provide them with that meaning. Right? And many of them I think, wind up struggling later in life saying, you know, what have I done with my life? Your daughter's not gonna have that problem. She's, and this is no judgment on any career whatsoever. People should do what they're passionate about. But your daughter, I think knows her heart and she's gonna be able to do it, and she's gonna get through it emotionally and you're gonna be there for her.
1That's great. Um. One other question here. Can you say more about humility and confidence? You said something about the surgeon responding with humility, not hubris, and I'd love to know more about this.
Hopeful Future Post-Retirement
Speaker 2Yeah, it's a great question. So I think you want your doctor, and particularly your surgeon to be confident, Like neurosurgeries or neurosurgical procedures are very challenging. Some of them are very technically challenging, some are quite easy, but others are very tech. Tech technically challenging. You want your neurosurgeon to go in thinking that he or she is the right person for the job, right? With confidence based on their experience. You also don't want them. To be cocky, to take undue risks, you want them to understand their limitations. you know, what I tell residents when I'm teaching residents how to do surgeries is before surgery, we talk about risks and benefits, and we recommend surgery if the risks are outweighed by the benefits. Where some neurosurgeons make a mistake is they don't recalibrate that risk benefit ratio during the surgery. So based upon unexpected things. In other words, you go in to remove a brain tumor and unexpectedly the brain starts swelling, right? So then you have to decide, do the risks of doing this surgery, are they still outweighed by the benefits or is it safer? You know, to bite your tongue and come back another day and just close up and go back and have the hard conversation with the family. The surgery wasn't safe today and I couldn't do it today, so we're gonna have to let the brain settle down and come back in a few weeks. Right? That's a hard conversation to have, but you have to have both the confidence that you're doing the right thing and the humility to not push ahead, in those circumstances. It's a hard balance.
1Great. Thank you for that. as we wrap up, I wonder what you're most hopeful about right now in your retirement. what is animating you after having this extraordinary career as a neurosurgeon?
Speaker 2Yeah, so. I have had extraordinary opportunities to help children in my life, and there are many ways to help children, not just by doing operations. So because I have a tremor in my hand, I've stopped doing surgeries, but that doesn't mean I can't help children. I'm in the process of finalizing a job position, hopefully, where I'm gonna be working to help homeless youth. Um. Transition from being unhoused to, to getting good jobs, working with companies, trying to get them to offer better jobs to kids. I'll spare the details'cause it's not finalized. my wife said something. That I think about all the time, which has been really helpful to me. you know, you start, as you get older, and particularly as you retire, you start thinking about what your legacy is. And what my wife told me, Amy, is that there are different stories that could be said about me when I'm gone. You know, one is that I was a pediatric neurosurgeon. I saved a bunch of lives. I had meaningful relationship with families and that would be good enough. That would be great, right? But perhaps an even more powerful example for my children, for our children is I did that and then life threw me a very difficult curve ball. and I showed resilience and I went on to do something else that was meaningful. So I have great optimism that, I've got a lot of bright days ahead.
Conclusion and Farewell
1I love how it's a return to your time as an undergraduate to a certain extent. and that compassion and commitment to the unhoused has remained steadfast. So I find that just extraordinary. Thank you. And with that, we're gonna call it, I'd like to thank you everyone for joining us today. Uh, please do check out the book. Um. It is just a beautiful, beautiful story of an extraordinary human being. Thank you.
Speaker 2Thank you so much. What an honor it was to be on with you today.
1Yes. This is just really, really moving, um, and important, so thank you. please join us next time on November 3rd for our conversation with New York Times book critic, critic, Jennifer Alia, uh, on whether empathy is a threat. So thank you again, David.