podcast
Chasing Life
All over the world, there are people who are living extraordinary lives, full of happiness and health – and with hardly any heart disease, cancer or diabetes. Dr. Sanjay Gupta has been on a decades-long mission to understand how they do it, and how we can all learn from them. Scientists now believe we can even reverse the symptoms of Alzheimer’s dementia, and in fact grow sharper and more resilient as we age. Sanjay is a dad – of three teenage daughters, he is a doctor - who operates on the brain, and he is a reporter with more than two decades of experience - who travels the earth to uncover and bring you the secrets of the happiest and healthiest people on the planet – so that you too, can Chase Life.
The Secret Lives of Neurosurgeons
Chasing Life
Oct 4, 2024
The brain is one of the most complex and mysterious organs in our body, and neurosurgeons are at the forefront of unraveling its secrets. But what’s it really like behind the scenes in the operating room, and how do neurosurgeons view the brain’s deepest mysteries? Sanjay sits down with Dr. Theodore Schwartz, a leading neurosurgeon and author of Gray Matters, to delve into the personal experiences that have shaped their careers, explore the impact of AI on brain surgery, and how their work pushes the boundaries of what we know about the human mind.
Episode Transcript
Dr. Sanjay Gupta
00:00:00
You know, many of you know me as a journalist and a podcast host. But I wanted to tell you, the way that I see myself primarily is as a husband and a father to three teenage girls.
Dr. Sanjay Gupta
00:00:12
That's my primary role in life, but also as a doctor, a brain surgeon.
Dr. Sanjay Gupta
00:00:17
Brain surgery was my first and truest professional love. And it's something that I think about all the time. I love being a brain surgeon. I love being a neurosurgeon. I love taking care of patients. A lot of times patients I take care of are people who are going from having a perfectly normal, wonderful day to suddenly the worst day of their lives. And it's something that I'm very mindful of.
Dr. Sanjay Gupta
00:00:41
I take care of patients who come in with chronic pain, who've dealt with pain for decades, hoping for some sort of relief. People who have been given a new diagnosis of a brain tumor and are grappling with how much that means to them practically and existentially. It has made me appreciate life in ways that I don't think I otherwise could have. I operate in hospitals here in the United States on battlefields across the world. It is a tremendous privilege.
Dr. Sanjay Gupta
00:01:10
And I also never take for granted the complexity and beauty of the human brain. Three and a half pounds of tissue. That is the most enigmatic tissue anywhere in the known universe. It controls everything. All of our loves, our joys, our hopes, our dreams. Our emotions, our memories. I never take it for granted.
Dr. Sanjay Gupta
00:01:33
Nor do I take for granted the remarkable colleagues that I have in this field, some of whom are my best friends. Nothing bonds you together like going through a residency training program, seven years of incredibly hard work, 100 hour plus workweeks just to try and keep pushing the boundaries of what is possible.
Dr. Sanjay Gupta
00:01:56
One of my colleagues that I really deeply admire is someone you're going to get to hear from today, Dr. Theodore Schwartz. He's a fellow neurosurgeon. He is regarded as one of the foremost skull based surgeons in the country, people who operate at the base of the skull. That area of the brain. He is a professor at Weill Cornell Medical School. He is also a father. And I think that's probably his most defining role as you're about to hear. And he's become a really good friend.
Dr. Sanjay Gupta
00:02:23
I think what makes Ted unique beyond his surgical skill is his desire to communicate the most profound aspects of our work. And as I read his book, Gray Matters, I realize that many people don't know a lot about what neurosurgeons do, what our lives are like, what motivates us. Suffice it to say that it takes a lot of dedication to become a neurosurgeon. And sometimes the path to get there, that's going to surprise you a little bit.
Dr. Theodore Schwartz
00:02:53
I would try to eat Chinese food with chopsticks in my left hand for literally a year. I was like, I'm only going to eat with my left hand to try to make my left hand as good as my right hand.
Dr. Sanjay Gupta
00:03:03
During an interview, I was once asked to tie knots inside of a matchbox holder. The guy was asking me questions. I was trying to do this very technically demanding skill. It was part of them trying to determine whether or not we had what it takes to be a brain surgeon.
Dr. Sanjay Gupta
00:03:18
Ted and I share this in common, and knowing him, I think has made me reflect a bit more on my own journey as a neurosurgeon, certainly as a doctor, and just even as a human being. So today we have something special for you. I'm going to share a conversation I recently had with Dr. Schwartz about what it takes to really do what we do, but also how he sees the world.
Dr. Sanjay Gupta
00:03:40
What continues to fuel his passion for surgery, as well as his deeper understanding of the brain. And I got to say, it was refreshing to get a little vulnerable as well with someone who does the exact same sort of work that you do. It gave me a chance to open up a bit about my own journey.
Dr. Sanjay Gupta
00:03:57
I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Chasing Life.
Dr. Sanjay Gupta
00:04:07
The conversation you're about to hear between Dr. Schwartz and I took place at the 92nd Street Y in New York, and we had a live audience, a wonderful audience. We talked about his new book called Gray Matters: A Biography of a Brain Surgeon.
Dr. Sanjay Gupta
00:04:25
Good evening, everybody.
Dr. Theodore Schwartz
00:04:26
Thank you for being here.
Dr. Sanjay Gupta
00:04:27
What a delight to neurosurgeons on stage. What could go wrong?
Dr. Theodore Schwartz
00:04:31
Exactly. All we need is an anesthesiologist to put everybody to sleep.
Dr. Sanjay Gupta
00:04:37
I want to set the stage a little bit because we're going to talk a lot about neurosurgery, but a few things that maybe you don't know. There's about 4000 neurosurgeons in the country and they staff about 6000 hospitals. It's a seven year training program in neurosurgery. So that's after medical school. So most people don't really start their professional career until they're some some point in their 30s. So they have this sort of prolonged adolescence of sorts, albeit a pretty intense one. The sacrifices are considerable, but as you're about to hear, the rewards are pretty significant as well. They're enormous. And that's a lot of what you write about in the book. Why don't we start there? What why did you decide to write this?
Dr. Theodore Schwartz
00:05:19
You know, I felt that the public really didn't know a lot about what brain surgeons do. You know, there's a lot of myths about brain surgery that it's really hard.
Dr. Sanjay Gupta
00:05:29
And is that a myth?
Dr. Theodore Schwartz
00:05:31
Well, there's part of it that's myth. And I wanted to really understand where that came from. Like, where does the myth come from that brain surgery is supposed to be so hard. But I wanted there were so many stories that are in our field that we know very well about famous neurosurgeons that have been influential on us, famous people who've had brain surgery, what it's like to really do what we do, you know, and to make those decisions in the operating room where someone's future is really in your hands and you're responsible for their future day in and day out over a course of an entire career where you really get no break. And to put that in a way that the general public could really absorb and not be intimidated by the subject. It was really a passion project and was just so much fun because I was not only telling stories that I've always wanted to tell and put down in words, I mean talking about myself a little bit, but also researching things that I really didn't know that much about that I wanted to learn more about.
Dr. Sanjay Gupta
00:06:25
Why did you decide to become a neurosurgeon? And let me preface it with this sort of bouncing on something you just said that John F Kennedy once said, We do these things not because they're easy, but because they are hard. And I think what he was saying is that some of the joy is in the challenge. The challenges, the joy. Was that the case for you?
Dr. Theodore Schwartz
00:06:47
Yeah. I was a kid who played instruments. For example, I was a musician and I loved to try to take a piece of music that was thought to be very challenging and focus on trying to learn how to do it. And I'm not saying I could play it perfectly at that period of time, but I love to sit in my room by myself and just go over it again and again and again. And there's that sort of focus that's required. I was also very interested in astronomy and I wanted to be an astronaut and I thought, How cool. I love studying, you know, the universe and space time. And I thought it'd be amazing to be an astronaut, to use computers and technology to travel to a place and see things that no one gets to see. And the first time I saw a brain surgeon operating under a microscope, I actually had a camera taking a picture of it. I was a resident at the time, and I saw this person who was sitting in the cockpit of a chair with their arm being suspended to reduce their tremor, looking into a microscope. And they were traveling into this realm that nobody gets to go to. And I was in awe of that and really astonished by that. And I thought, this can fulfill my childhood dream of being an astronaut. And I can also help people, which is a whole other aspect to it. So that's what drove me to it.
Dr. Sanjay Gupta
00:07:55
So you're either going to be a rocket scientist or a brain surgeon?
Dr. Theodore Schwartz
00:07:58
It was one or the other. It was one or the other. Yeah, I was the black sheep of the family. My brother is out here as well. Ralph, he'll tell you.
Dr. Sanjay Gupta
00:08:04
By the way, you're mentioning this, this chair that you're sitting in and you have a chair that is actually designed to reduce tremor. Most people probably never have been inside the operating room. Can you just describe this a little bit, including the chair and just how you situate yourself?
Dr. Theodore Schwartz
00:08:20
Yeah. I mean, because we deal with the world around us on the order of, you know, inches and centimeters. You know, we grab things there, sort of this big, this big. And when you're working in the world of neurosurgery, you're really living in the realm of you know, millimeters, and sometimes even less than millimeters. That's not a area that we're comfortable existing in.
Dr. Theodore Schwartz
00:08:39
And so you have to use these microscopes that magnify everything or endoscopes where you can literally put the lens, you know, very, very close to where you're operating. And everybody has a little bit of a tremor. I remember when I first decided I thought maybe I'd be a neurosurgeon. I remember I was like sort of reading a newspaper. And I looked at the corner of the newspaper and I could see it wiggling a little bit. And I was like, oh my, I have a tremor. Like, how am I going to do this job? Like, what am I going to do to learn how to reduce my tremor? And you learn how to do that.
Dr. Theodore Schwartz
00:09:06
It's a skill and we have different techniques that we do. So when I'm under the microscope and I'm, you know, making very delicate moves just before I'm about to do them, I'll actually hold my breath and I realize that I'm doing it. And then you learn how to brace your pinky or your hand or even the instrument.
Dr. Theodore Schwartz
00:09:21
I'll try to actually, the scissors that I'm about to cut with, I'll try to brace the scissors on the edge of the skull to make sure that it is absolutely not moving because we all have a physiologic tremor, so everybody has it. And you have to find ways to reduce it during the operation. And what's terrifying is when something goes wrong in a surgery like you're operating on an aneurysm and the aneurysm ruptures and you realize that you have to get control over this. And what happens is your heart rate will suddenly go from 60 beats a minute to 160 beats per minute. And that will exacerbate your tremor, because if your heart rate goes up, you start to tremble and you realize if you're trembling, you can no longer do what you need to do. You physically can't do it. And so you have to calm yourself at that moment and try to focus yourself to get back into the moment in order to perform that task. And I think I was very taken by that aspect of neurosurgery, the physicality of it, the microscopic nature of it, the voyaging into a place that people don't get to go to. The technical aspect really appealed to me.
Dr. Sanjay Gupta
00:10:21
I got to say, it's really interesting talking to you, Ted, because, you know, we're both neurosurgeons and even a conversation like this is often a conversation that is not had. You know, we go through our training and there's it's very didactic. It's very procedural. But, you know, just even this little newspaper story you're talking about and your own sort of insecurities around that, we don't actually have those conversations a lot.
Dr. Theodore Schwartz
00:10:43
So I remember I would try to eat Chinese food with chopsticks in my left hand for literally a year. I was like, I'm only going to eat with my left hand to try to make my left hand as good as my right hand.
Dr. Sanjay Gupta
00:10:53
I would stay up late and go to the lab because, you know, it's funny, I was worried that I wasn't technically good enough. I thought I was okay, but I knew that I would watch some people in the operating room and they were virtuosos. They just know no movement was wasted. And for me, I needed to practice a lot. So I'd go to the lab and I'd so skin grafts under rats and things like that and just make do with my left hand and my right hand and do all that.
Dr. Theodore Schwartz
00:11:20
There are some surgeons who literally in their office, even a full attendings who have been practicing, I've gone to their offices and they will have suture kits with a microscope where they literally just come back to their office and continue to practice microscopic and asked the most of these because it's such a critical skill to learn how to do. And it's not intuitive, but anyone can learn how to do it, you know...
Dr. Sanjay Gupta
00:11:40
At what point did you know? That you were good enough for this.
Dr. Theodore Schwartz
00:11:45
I'll let you know. I mean. I, look, I...
Dr. Sanjay Gupta
00:11:49
You are regarded not not because you're a humble guy, but you are regarded as one of the foremost skull base surgeons in the country. And these are challenging operations.
Dr. Theodore Schwartz
00:11:57
I'll tell you, I do not feel that way a single day that I wake up. I always feel that I'm still trying to get better. I still feel like I'm not good enough. I still come home, you know, trying to figure out how to make operations better and sort of kicking myself if things don't go perfectly.
Dr. Theodore Schwartz
00:12:17
So and I actually wrote a paper recently where I looked at my results over a thousand of a particular operation that I did. And I looked at the last 150 idea with the first hundred, and I was getting better at every stage. Like, even after I'd done 750 of this particular operation, the next 250 were a little better than the prior hundred and 50. And I think we do continue to get better and better and better because it's not just the technical, it's also the judgment, right? We're making so many decisions during our operations, and each one of those decisions is so critical. How hard do I pull? What can I get away with? You know, can this vein come off? Can this nerve come off? Where do I need to make the cut with the scissors to save the nerve and not damage it? And all of those decisions you make, unfortunately, because sometimes you don't do it right, you know, previously, and then you do it better the next time. Right. And in neurosurgery is a very humbling profession because and that's one of the things I try to write about a little bit, is that on the one hand, you do have to have a certain amount of arrogance, right?
Dr. Theodore Schwartz
00:13:13
Like you have to convince your patient that you're the best person to do this particular operation. And you know, you're going to do a good job and you know you're going to give your all for it. But you also have to have an enormous amount of humility at the same time, because you know that at any given moment, something could go sideways. And you have to know to never lose your vigilance, right. You have to always be completely focused because you have to deal with the burden of that when things don't go well, which is, you know, horrible and such a weight on us.
Dr. Sanjay Gupta
00:13:41
People come to you, I'm sure, like they do to me. Would you advise or recommend your own children go into medicine or even neurosurgery? Medicines changed a lot since you first went to medical school. What would you say?
Dr. Theodore Schwartz
00:13:53
If you're passionate about being a doctor? And really what it comes down to is caring for other people. I mean, at its at its very basics, even though brain surgery is very technical and there's the whole technical aspect of it, you're still a caregiver, right? You still have to really want to give your time to help another human being in need that has to charge you up. You know, you have to love doing that. If you're that person and you love doing that and you love taking care of people you know more than other things, like, you know, your free time or maybe your salary, then absolutely, you should do it. It's an incredible profession. I mean, I think it's a I love what I do. And you still do it, by the way. You don't have to operate. Right. But you do. So why do you still go into the operating room?
Dr. Sanjay Gupta
00:14:31
No, I yeah, I think it's I think it's the same the same reason I get a lot of satisfaction out of caring for patients. And I think that there's no other relationship in society like the physician patient relationship. I mean, it's interesting. I think some of the most intense relationships in my life outside of my family are probably with my patients because, you know, you're forced to have this this intensity to the relationship, you know?
Dr. Theodore Schwartz
00:14:55
'I write about it in the prologue and it happens so commonly where you sort of walk into the family waiting room at the end of the operation and you're meeting a family that, you know, you maybe you've met the spouse, the husband, the wife, the kids, maybe they came to the pre-op visit, maybe they did. And maybe you just met them before the surgery. You barely know them. And you can see the anticipation when you're walking out because they don't know if you're coming out and saying, I'm sorry, things didn't go well or things went great. And when you come out and say everything went great, we got the whole tumor out. And your husband, your wife, they're going to be fine. You just see the relief in their bodies and it's palpable. And then so commonly, they will literally just say, can I give you a hug? Or they'll just reach out and give you a hug at that moment. And it's just person you don't even know. And I'm like, yes, like, I love that hug. You know, when that happens, like, to me, that's the payoff of neurosurgery. And I'll often have students with me, you know, over the summer and I'll have them come with me into the waiting room. And often they'll be there for that moment and they'll see it. And I'll be like, Did you see that? Like, that's what it's all about.
Dr. Sanjay Gupta
00:15:58
Have you have you had a most, call it harrowing operation? I mean, an operation that has never left you?
Dr. Theodore Schwartz
00:16:07
There are many... Just to sort of rewind, when I trained in neurosurgery, if you were operating deep into the brain in areas we call like the third ventricle and taking out transferring geometry to these tumors that are just sort of ensconced deep in the brain. The way to take it out was to make a big incision like this and to take down all the bone to the side of the face.
Dr. Sanjay Gupta
00:16:25
And as you're describing this, because, again, most people have never seen this before. Yeah. So as much as you can and I'm happy to help out, but just like in the operating room, so patient is on the table, obviously asleep. Right. To mobilize the head.
Dr. Theodore Schwartz
00:16:38
We're fixing, we literally pin the head with these. They're literally incredibly sharp pins. Right. There's two on one side, one on the other. So the head is turned and we're pinning them because. Because the head cannot move during the...
Dr. Sanjay Gupta
00:16:49
It sits in the the pins and then that frame....
Dr. Theodore Schwartz
00:16:51
And by the way, you put like 60 to 80 pounds of pressure.
Dr. Sanjay Gupta
00:16:54
Right.
Dr. Theodore Schwartz
00:16:55
And you're literally like ratcheting it.
Dr. Sanjay Gupta
00:16:56
And the patient's asleep by the way.
Dr. Theodore Schwartz
00:16:57
They're asleep. You don't feel anything. We have to get into the skull. And, you know, we talk about the microsurgery, but getting in and out of the skull is like carpentry. Like the skull is very, very thick. The scalp is very, very bloody. So we have to take a shave, a bit of the hair, and we have to take a knife and open up the scalp. And then we have to literally pull the scalp down to expose the skull. And then we drill holes in the skull to remove a piece. Sorry for grossing anybody out. I apologize. But the point is, once you get to that point, you get to the dura, which is the covering of the brain, and you carefully open that up and then you're looking at the brain, which, by the way, is incredible. Every time I expose the brain, there's like a gasp of, my goodness, this is.
Dr. Sanjay Gupta
00:17:34
After 30 years.
Dr. Theodore Schwartz
00:17:35
After 30 years.
Dr. Sanjay Gupta
00:17:36
And I learned, you see this, this brain. And it is it's pulsating.
Dr. Theodore Schwartz
00:17:40
It's pulsating.
Dr. Sanjay Gupta
00:17:40
It's incredible. It's alive and you know it's alive. But to see the brain and to realize that every thought, every joy, every love, every memory, everything... is there.
Dr. Theodore Schwartz
00:17:54
The ultimate responsibility, it's like someone is handing you their their most prized possession, basically, and saying, will you take care of this? This is the most valuable thing that I own. I'm giving it to you for four hours.
Dr. Sanjay Gupta
00:18:04
And you still, as I do, I'm sure, think about this every time you do it.
Dr. Theodore Schwartz
00:18:09
Every time. Every time. So this sort of dismantling of the head and then you have to essentially move the brain out of the way. And by retracting it, which you want to do very, very gently, because you have to displace it to get underneath the brain. And it can take you an hour and a half just to even see the tumor, you know, in the beginning. And so very early in my career, I started to be one of the early adopters and first people to start doing a surgery where we would just go up through the nostrils that endoscope, which is a long, thin telescope so we wouldn't make any incisions.
Dr. Theodore Schwartz
00:18:38
There was one person in particular who had a very big tumor deep in her brain. She was a very well known designer whose vision was very important. She was losing her vision. She had the means to seek second, third and fourth opinions. And she sought many opinions and got many different opinions from different, you know, chairmen of departments. One said, you need to open up this side of your head. One said, we're going to put a needle in there and we're going to put radioactive material into it because it's too dangerous to even take this tumor out. Another one said, Open up the head. And I said, you know what? I can take this out just by going through your nostrils without making any incisions whatsoever. We're going to put a scope up your nose and I can take it out.
Dr. Theodore Schwartz
00:19:15
And at that moment in time, this was the biggest tumor I'd ever taken out. I wasn't 100% sure what would happen, but I had taken out tumors that were close to it and about that big. And it made sense for for me to take it out this way. And she went to see another surgeon and said, Well, Dr. Schwartz says, you can take it out through my nose. Like, why are you opening up the side of my head? And he looked here and he said, Whatever you do, do not let Dr. Schwartz take that tumor out through your nose.
Dr. Sanjay Gupta
00:19:40
Wow.
Dr. Theodore Schwartz
00:19:40
I was like four years into my career.
Dr. Sanjay Gupta
00:19:44
So the chairman of another department presumably is saying absolutely not. Yeah. You're four years out of your training and you're saying, I can do this.
Dr. Theodore Schwartz
00:19:52
I can do it.
Dr. Sanjay Gupta
00:19:53
So we'll get to this part. But that that's the confidence slash arrogance with the humility that the audience is getting to see with you.
Dr. Theodore Schwartz
00:20:03
Yeah. And by the way, that chairman has since called me up and said you were right.
Dr. Sanjay Gupta
00:20:09
That's unusual.
Dr. Theodore Schwartz
00:20:09
This is the way this is a better way to do it. You taught me how to do this operation.
Dr. Sanjay Gupta
00:20:13
Wow.
Dr. Theodore Schwartz
00:20:13
And just see this as you know, this is the way all tumors are done now nowadays. Right. But back then, nobody was doing it. Right. And it took that sort of vision and foresight and, you know, cojones excuse me for it to say like, I can do this, I can get it done. I know I can do it safely. It makes sense. It made logical sense. It just made so much more sense than coming in from the side to take a straight shot into the middle of the tumor. But I was terrified. And I was up all night the night before, and I was thinking about it.
Dr. Theodore Schwartz
00:20:41
And what you do when you prepare for one of these surgeries, as you know, is you sort of imagine what you're going to see on the way in and you run through every step like, first I'm going to do this and then I'm going to just and I expect to see this and I'm gonna expect to see that. And then when you get in there, you hope that's what you see, but sometimes it's not right. Right. So sometimes you get in there and what you see is like, like this isn't what I expected. So then you have to change your plan on the spot and you have to say, All right, I can't go this way. I'm going to try to go this way or I'm going to try to go this way. And we got the whole tumor out. It has never come back.
Dr. Theodore Schwartz
00:21:13
She's now retired. She's doing great. And I've since taken out another 150 craniopharyngiomas, which is a big number for a very rare tumor and done 2000 of those operations. And as you know, that's the way everybody in the world takes out pituitary tumors and craniopharyngiomas. And it was it was great, like within a lifetime to feel like the needle moved, like you were involved. And I was not the first one to do it. But, you know, I was involved in moving the needle, which was great, and publishing papers on it and teaching courses on it and writing books about it. And so that was very fulfilling.
Dr. Sanjay Gupta
00:21:44
That's pretty cool, dude. Here, bring it in.
Dr. Theodore Schwartz
00:21:46
Thanks, man.
Dr. Sanjay Gupta
00:21:47
That's it. That's amazing. No, really? I mean, yeah, please.
Dr. Sanjay Gupta
00:21:52
You probably didn't know what to expect listening to two brain surgeons just opening up on stage. So next, Dr. Schwartz and I are going to dive into the role of A.I. in neurosurgery. This is a fascinating topic. We're also going to take audience questions live. We'll be right back.
Dr. Sanjay Gupta
00:22:14
For this audience. I'm wondering, you know, hope or hype. How do you think about AI in medicine and specifically neurosurgery?
Dr. Theodore Schwartz
00:22:21
So I think it's a little bit of hope and a little bit of hype. I think the hope part is that we will be working alongside of AI and there's some things that AIs do incredibly well. If you have to sift through a lot of information and make a decision based on that information, it could be, you know, a list of symptoms and tests to make a diagnosis. And the same thing for looking at pathology slides, where you're looking at the slides and you teach them how to do it.
Dr. Theodore Schwartz
00:22:45
That is different than performing brain surgery, because when you perform brain surgery, it's a physical task where you have to interact with the outside world in a very physical way. And I really feel that human beings have evolved to learn how to interact with the outside world. You know, we evolved to find food and to build shelter and to learn how to cook food and run away from predators and then, you know, kill predators. And so we have a physical intuition about the world around us. We know that, you know, how much this weighs and what's going to happen when I drop it. And if I look away, it's still going to be there.
Dr. Theodore Schwartz
00:23:20
Robots and AIs didn't evolve that way. They didn't evolve on the planet Earth in order to survive. They evolved basically in a box on somebody's desk. They're not, you know, evolving on their own at the moment in the physical world. And so I think at the moment, human beings are just much better at performing intricate physical tasks where you have to make thousands and thousands of decisions and each decision you make is going to alter the outside world in a particular way and you have to react to that. So I think there's some things that guys are going to do incredibly well. Now, if you have to we I use a robot in the operating room to place electrodes in the brain where I need to put an electrode at a certain trajectory through the brain. And I'll go on a computer and I'll be able to see exactly where I want it to go and how to get it there. And I can use a robotic arm to put me right in that place. So there are some tasks that don't involve a thousand decisions right into one decision where AIS and robots and computers can be incredibly helpful. So I think we'll work alongside them. But I think there's some things that we're always going to do better for a long time, and they're things that they're going to do better.
Dr. Sanjay Gupta
00:24:19
'Do you think that with AI, it's always going to be a trust but verify sort of model? I mean, we at our at our institution, every every image, whether it be a chest X-ray or a CT scan of the brain, is read now by an AI platform first, and then a radiologist will look at it as well. And what has struck me, Ted, is that sometimes they do a great job, the platforms, but sometimes they get a wildly, wildly wrong answer. Not seeing an obvious lung cancer or something like that.
Dr. Theodore Schwartz
00:24:50
RIght.
Dr. Sanjay Gupta
00:24:51
And it's bizarre to me, to be honest.
Dr. Theodore Schwartz
00:24:53
But I think what will eventually happen is we're going to figure out what the error rate of that is. Right? It's going to have a certain error rate, but human beings are going to have a certain error rate to. Right. And so at some point, the error rate is going to be much whether it's better or lower... It's going to be much better than the human. And at that point it's going to be trust the AI more so than the human. But until...
Dr. Sanjay Gupta
00:25:13
And how long would you think before we're at that point?
Dr. Theodore Schwartz
00:25:15
I think it could happen in 2 or 3 years. I mean, I don't think that's going to take that long for certain tasks.
Dr. Sanjay Gupta
00:25:20
So reading images, maybe doing dermatological exams, looking at slides for pathology.
Dr. Theodore Schwartz
00:25:26
Yeah. I mean, but we have to have the experience of having both results next to each other and saying, who's making more mistakes, right? We figure it out.
Dr. Sanjay Gupta
00:25:34
And it'll be far more efficient if we get to that point. People can get lab results and tumor results, all that sort of stuff much more quickly.
Dr. Sanjay Gupta
00:25:43
Not the end of our discussion at 92nd Street Y, we couldn't let Dr. Schwartz go before taking some questions from the audience.
Dr. Sanjay Gupta
00:25:51
What makes a good brain surgeon? This is from Richard Sloan.
Dr. Theodore Schwartz
00:25:57
Well, I think there's no one thing. And obviously human beings are very different and they're many different types of people who can be good brain surgeons. But the ability to sacrifice, be willing to sacrifice, the ability to focus for long periods of time. I write a little bit about the book, this great moment, where I talked to a professor who is a transplant surgeon. When I was a med student, I was really scared about giving up my life to become a neurosurgeon, all my other interests. And he said, You know what, Ted? If you want people to depend on you, you have to be dependable. So I think being dependable, right? So being a person who you're always there when someone when they need you. Because if you're not there, when they call, whether it's referring doctor or a friend, they're going to call someone else. And then you're no longer the go to guy. So if you want to be the go to guy, you have to be willing to be the go to guy, which takes that or woman excuse me, which takes some sacrifice. So there's a lot of different qualities, but focus, sacrifice, being dependable, caring about another other human beings, like deeply caring about other human beings is important.
Dr. Sanjay Gupta
00:26:57
And I think constantly keeping your skills up. constantly immersing yourself in the field as you do. Here's another question... What is an exciting development for the future of neurosurgery? This is from Sabrina.
Dr. Theodore Schwartz
00:27:08
So brain computer interfaces so I want to talk just for a minute about that. And we hear a lot of it. About it because of Elon Musk's Neuralink company. But we now have the ability to implant electrodes in the brain and take information out of the brain and put it into a computer and translate from the brain's code to computer code. So if you have a patient who's quadriplegic and they're in a wheelchair and can't move their arms or their legs, we have the ability to have them just think about moving a computer cursor or tapping on a screen, or they can move a robotic arm or a robotic leg, or you can even take language out of the brain by having electrodes on the part of the brain that control how the mouth moves and the tongue moves.
Dr. Theodore Schwartz
00:27:52
So they have to imagine themselves moving their mouth and tongue and speaking, and that information can be put into a computer and you can literally have a virtual face talking while a person who can't speak in a wheelchair is thinking about talking. And all that information can be taken out of their brain. So the concept of telepathy or telekinesis or getting ideas out of our brain or moving objects at a distance, just by thinking all of those things we can do. And we've been able to do it for decades in research institutions. And Elon Musk has now developed the device that wirelessly does it that gets implanted in the skull and the electrodes that get implanted in the brain to take information out of the brain and put it into a computer. And there are some other examples of other devices. There are other companies that are now starting to compete with Elon's company because it's technology that exists. We already have the ability to do it. And it's really a remarkable future for us because at some point when the surgery becomes safe enough, you could imagine taking a normal human being like you or me and putting something in our brain so that we can literally just think about controlling computers and you think about anything that a computer can do, basically, which is essentially everything.
Dr. Sanjay Gupta
00:28:58
So everything I think could actually.
Dr. Theodore Schwartz
00:29:01
It's not thinking at the moment. You have to be doing it. So it's not about thinking about a word. It's about thinking about saying the word, which I love, by the way. So there's a difference.
Dr. Sanjay Gupta
00:29:11
That kind of regulates you a little bit...
Dr. Theodore Schwartz
00:29:12
Regulates because you worry about privacy issues, right? You don't want a device that can read your mind and the device can't read your mind. So I can have all the private thoughts that I want, but I have to think about moving my lips to say that thing in order to get the information out. We don't know how thoughts are created in the brain. So the brain computer interfaces don't take your thoughts. You have to, for example, think about writing something and then the written word will come out. But you can't just think about the idea.
Dr. Sanjay Gupta
00:29:38
Last question... Do you believe we have free will?
Dr. Theodore Schwartz
00:29:43
I do not.
Dr. Sanjay Gupta
00:29:44
Really.
Dr. Theodore Schwartz
00:29:45
I don't. I mean.
Dr. Sanjay Gupta
00:29:46
I guess I'd expect that as a as a brain surgeon.
Dr. Theodore Schwartz
00:29:49
Well, there are experiments that you can do on the human brain that brain surgeons have done, that neurosurgeons have done, because we have incredible access to the machinery of the mind. Right. The brain is the machinery of the mind. And if you've done it long enough and you've read the papers and you've studied the experiments that have been done, you realize that the brain is essentially making decisions for us. And you can put electrodes in the brain that will record what you're about to do before you even know that you want to do it. And so those neurons will start to fire to move your hand, not because you've decided to move your hand, but they start to fire before you even made the decision to move your hand. And we know this because of the experiments that have been done. It's not just a fantasy, it's true. And we also know that we can implant information into the brain and the brain can control your movement or control your feelings in ways that you're not aware of.
Dr. Theodore Schwartz
00:30:42
And then when you behave that way, if someone asks you why did you why did you just do that? You make up a story and you say, I did that because I was curious what was over there? So you can put an electrode in the brain that moves the head to the left. Every time you push a button, the head to the left. So this experiment was actually done. They pushed the button, the head turned to the left. They said, Well, why did you just turn your head to the left? And they said, I was looking for my slippers or...
Dr. Sanjay Gupta
00:31:04
Interesting.
Dr. Theodore Schwartz
00:31:05
So the thought is that maybe everything that we do, the brain is making the decision for us and we're doing it. And then another part of your brain is just making up a story afterwards to make sense of why you did that thing and convincing you that you did it. And there's a incredible amount of evidence and you can read the book if you want to learn more about it. The little plug to show why that is the case.
Dr. Sanjay Gupta
00:31:26
That's terrifying.
Dr. Theodore Schwartz
00:31:28
It's terrifying.
Dr. Sanjay Gupta
00:31:30
And we're going to have to leave it there. So, hey, how about a really warm round of applause. You gotta read the book. I read the book. I loved it.
Dr. Theodore Schwartz
00:31:40
Thank you.
Dr. Sanjay Gupta
00:31:45
We don't get to have conversations like this very often.
Dr. Sanjay Gupta
00:31:47
And I think speaking to Dr. Schwartz in the way that we just did in many ways reminded me of why I chose this profession in the first place. It reminded me that the brain is such a mysterious and fascinating organ, and it's worth diving into those mysteries and to continue to be awed by them. It's also nice to step away for a second and remember why we do this job and to be able to share some of that with all of you. As I mentioned at the top of the podcast, there's only about 4000 neurosurgeons in the country. We staff around 6000 hospitals. Most of us know each other, at least know of each other.
Dr. Sanjay Gupta
00:32:25
And as you just heard, many of us have become really good friends along the way. So thank you, Ted, for sharing and letting me dive into this conversation with you. And thank you for listening to this episode of the podcast. The book Gray Matters is out now. I highly recommend you check it out. I think you're going to really enjoy it.
Dr. Sanjay Gupta
00:32:46
Alright. Up next, our segment Paging Dr. Gupta. I get to answer one of your questions. We'll be right back.
Dr. Sanjay Gupta
00:32:57
Now it's time to reach into the mailbag to answer your questions for our new segment on Call. And this week, a listener from Reno, Nevada, named Anne sent in this question. Does Covid really affect your memory? Well, we're learning more and more about Covid and its effects on the brain. And while there are still many mysteries, let me tell you what we do know. For starters, we know that people who experience Long Covid, and that means people who still have symptoms three months after the initial infection, do commonly complain of neurocognitive issues or brain fog. And that can include symptoms like forgetfulness, trouble concentrating, focusing.
Dr. Sanjay Gupta
00:33:36
But here's the thing. Even people who don't go on to develop Long Covid can experience memory problems. There was one study made up of thousands of participants from the U.K. which found that people had had Covid performed worse on a working memory test than people who had not had Covid. Now, working memory is what allows us to remember a small amount of information while we perform another task. It's involved in activities such as problem solving, reasoning and engaging in a conversation. These findings were true for adults 25 years and above, but interestingly, not for those who were in the youngest age category 18 to 24.
Dr. Sanjay Gupta
00:34:16
'The good news is the study authors found that memory scores eventually did improve over time, except for those who developed long Covid. Now, even at this point, researchers are not entirely sure why the virus that causes Covid can cause cognitive problems like memory issues. But at the same time, it would not be the first infection to do so. Plenty of infections, even the flu. The common cold can cause cognitive impairment, especially in older adults. So Anne, I hope that helps. Thanks so much for the question. And if you have a question for me, I want to know record a voice memo. Email it to Ask Sanjay at CNN dot com. Or give us a call. (470) 396-0832 and leave a message.
Dr. Sanjay Gupta
00:35:05
That's all for this week. Thanks for listening. And of course, keep chasing life. We'll see you next Friday. Chasing Life is a production of CNN Audio. Our podcast is produced by Eryn Mathewson, Jennifer Lai, Grace Walker and Jesse Remedios. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Sealy is our showrunner. Dan Dzula is our technical director and the executive producer of CNN Audio is Steve Lickteig. With support from Jamus Andrest, John Dianora, Haley Thomas, Alex Manasseri, Robert Mathers, Leni Steinhardt, Nichole Pesaru, and Lisa Namerow. Special thanks to Ben Tinker and Nadia Kounang of CNN Health and Katie Hinman.
