#1 Brain Surgeon: The Secrets to Saving a Child’s Life — What Every Parent Needs to Know Today

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1:14What I would say is to embrace the humanity side of medicine. We're taught even without words, just by watching examples of other doctors, that you should maintain a certain distance between yourself and the patient and family, a sort of professionalism, one would say. What I would say is to drop that and to show the families love and compassion and make yourself vulnerable. I've shed tears in front of families and, you know, wondering at times whether I was crossing a boundary of being unprofessional, but learning later that actually the families feel that you're in it with them, that you're suffering with them.

1:49And I think that's important. Welcome to Open Book. I am your host, Anthony Scaramucci. Joining us today is Dr. David Sandberg. He's a pediatric neurosurgeon who is the director of pediatric neurosurgery at McGovern Medical School. And he's an author of an incredible book, Brain and Heart, The Triumphs and Struggles of a Pediatric Neurosurgeon. And what a heart-rendering book this is, Dr. David. And I will just also tell you that I've been involved with the Brain Tumor Foundation, which I think you know, in New York the last couple of decades. My dad had a brain tumor, which was successfully operated on by Dr.

2:27Kelly. I think you may remember Pat Kelly. If you're a neurosurgeon, you remember Pat Kelly, a former head of Mayo Clinic, and then went on to NYU, the chief of neurosurgery there. He operated on my father. So I know a lot about this, probably more than the average person, but welcome to Open Book. You've had this extraordinary life, and you wrote this very moving book. But before we get there, I want to know a little bit about your journey, sir, into pediatric neurosurgery. Okay, you could have gone into dermatology, a little bit simpler of a business, right? But you went into pediatric neurosurgery.

3:04Why did you do that? And then we'll go talk about the memoir in a second. So first of all, thank you for having me on your show. And thank you for all you've done for the Brain Tumor Foundation. It's something that a lot of people don't know about you, that you've been involved in helping families navigate very difficult situations when they get the diagnosis of a brain tumor. It's not easy. So thank you for that. As far as my journey to pediatric neurosurgery, my father was a physician. He is a retired physician. He's an ophthalmologist. I went to medical school following his footsteps. He took me on some medical mission trips when I was in high school and college that were very meaningful to me.

3:42We went to Jamaica, Antigua, and the Dominican Republic, and I was attracted to medicine from the standpoint of service. I never thought I would become a neurosurgeon. One of the ways you figure out what you want to do is your emergency medicine rotation in medical school. And in that rotation, I found myself gravitating towards the surgical patients. It was just exciting. It was interesting. I liked the surgical approach to diseases. And then once I saw brain surgery and interacted with neurosurgeons, I was hooked. It's a tough job though. You're dealing, and first of all, you have a wonderful bedside manner.

4:16I mean, we don't know each other, but reading the book, I know that you're an empathic person and you're somebody that really cares about your patients and obviously the parents of your patients. And you've had some, you know, you've had some really tough cases, which you described. So why write the memoir and write, why write it now? So a number of reasons, you know, I think first of all, as I went through my career, you know, over two decades of being a pediatric neurosurgeon, I accumulated great stories. And every once in a while, I would think to myself, somebody's got to hear about this. And I would write myself down a few notes, just to remember in case I would write it up in some form at some point.

4:57There are a lot of books that focus on the patient experience going through terrible diagnoses. There are a few books that really let you into the mind, the honest truth of what your doctor is thinking when he or she does the hard things, has the difficult conversations, tells a parent that your child has died, God forbid, or tells a parent that your child has a brain tumor, to know what's going through my mind when I have a surgical complication, all sorts of situations. And also, I thought I'd accumulated some wisdom over the years that might be helpful for students, high school, college students, deciding, is being a doctor for me?

5:38Or for medical students, is being a neurosurgeon or a similar challenging specialty is that for me? So those are the reasons I wrote the book. It captures the intensity of the situation and it captures the emotional weight of performing brain surgery on children. What is it like to revisit some of these cases in such a personal way? Reading the book, I was feeling the weight of what's before you. And reading the book, I mean, you've got a tough job, sir. You're talking to people before the surgery, you're dealing with a young child, unfortunately, that is relying on his parents and relying on you and other responsible adults for their health and safety.

6:23And now you've got to talk to the parents. I mean, it's just a super tough job, sir. So take us through. I mean, I'm reading the book. It gave me heart palpitations. You reliving it, did it give you heart palpitations? Well, it's been my life. So it doesn't give me palpitations. You know, it's a career that has tremendous highs and tremendous lows. It's hard to put into words the beauty of saving a child's life. And I've saved many, you know, dramatic situations, and there's nothing more rewarding. The cases I remember most are the ones that we failed, are the ones where we tried to save a life and were unable to.

7:06And worse still, or when there's a surgical complication despite our best efforts. I'm gonna say it differently. You see, I wanna approach it differently. I feel like I'm getting from your book, your internal thoughts. I feel like you've taken us through the mind of Dr. David Sandberg when he's going through this process. And so take us through, if you don't mind, in your own words, some of the things you're thinking about in the operating room, talking to a parent, Getting yourself prepared to talk about a success, which is obviously probably a little easier and more joyous, but also a failure.

7:44And I don't mean a failure, just something that happens which we can't, that are outside of our control. Yeah, I mean, so many different scenarios and so many different emotions. For a success, let's take a trauma, for example. A patient, God forbid your kid is riding a bicycle, gets hit by a car. Please, all parents who are listening to this, have your kids wear helmets every single time they ride a bicycle. And they hit their head and all of a sudden they're unconscious and they're in an emergency room. They get a CT scan. There's a big blood clot shifting over the brain. You rush to the operating room.

8:17So there's an adrenaline, you know, kind of like, you know, it's the fourth quarter of the Super Bowl and you're the quarterback. And you're directing a team of people with a single purpose is to save the life of a child. and you do it, you've done it so many times, but there's still that rush, that adrenaline. There's anxiety. You know, what's going to happen when I open this kid's skull? Is the brain going to swell out? Am I going to be able to save this child's life? When it goes well and the blood clot is out and the brain looks relaxed and you know the child is likely going to wake up and do okay, there's such an exhilaration that you feel.

8:53And, you know, I can't wait to go out and have that conversation with the parents in which I tell them, you know, I have good news. You know, your son or your daughter, I think he or she's going to be okay. We were able to remove this blood clot, the brain looks good, and then you hope and pray with them that that patient wakes up as you expect them to. On the other extreme are patients who you're giving the worst news a parent has ever heard. So let's take, for example, I did a lot of research in my career and I focused on recurrent malignant brain tumors in children, Children who had failed everything.

9:28Your dad, thank God, had a benign tumor, a meningioma. I deal with benign tumors and also aggressive tumors, cancers. And those cancers are treated with surgery, radiation, chemotherapy, and novel therapies. And when you failed surgery multiple times and you failed every chemotherapy regimen that's been tried and you failed radiation, the odds are heavily stacked against you. And some of those patients came to me for clinical trials. We had a few dramatic successes, but we had many failures. And those conversations, I talk about one of those in the book, those conversations are incredibly difficult.

10:03You know, obviously for the parents, it's the worst moment of their life. And for me, you know, it takes its toll. My father's situation, you know, slow-growing tumor left him disoriented. He got dizzy. He fell, hit his head. And, you know, a slow-growing tumor undetected, however, it would have put a lot of pressure on his brain and could have led to his death without us really knowing what happened. And so one of the things we tried to do with the Brain Tumor Foundation, sir, was to raise awareness and to create a pathway of early detection. We offered low-cost brain scans and education because you and I both know catching something early, particularly as it relates to a brain issue, you have a higher rate of survivability.

10:47And so this is just a public service message from Dr. David Sandberg and Anthony Scaramucci in the middle of this podcast. But I want to go to your parenthood because something struck me about the book is that you are a doctor, you're a pediatric neurosurgeon, but you're also a dad. And tell us a little bit about how parenthood has shaped your approach to your job, dealing with patients and their families. So before I had children, I think I was a compassionate neurosurgeon. But once I had my own kids, I kind of got it a little bit more. You know, when you raise a child, you see how much you love that kid.

11:36and how much effort, energy, joy, and love goes into raising that child. And, you know, you get upset when your kid has a cold or a fever and doesn't feel well. Imagine if your child has a brain tumor. And I've never experienced that from a parental standpoint, but I've told, you know, so many patients, parents, that that's what's going on with their child. I think being a parent made me more empathetic to their situation. You've gone to some underserved countries. You've dropped yourself into places that usually the doctors, the hospital system doesn't have your level of expertise or your skill set.

12:21Tell us a little bit about that and what experience in that genre did it teach you about medicine, resilience, but also inequity, doctor? Yeah, I mean, my children are so lucky and I'm so lucky that if any of us in our family have a medical problem, we will get the best care in the world. You know, we will get it within the city where we live or we'll travel to another city because we have the means to do so. There are children all over the world in low and middle income countries who are dying every day of diseases that in the United States would be easily cured with a surgery or with a medicine or who knows what.

12:57and it's tragic. And I don't think those kids are any less worthy than my own children of receiving medical care that they deserve. So I've always been interested in neurosurgery in low and middle income countries. I've been on 20 trips or so, 10 of which have been to Haiti, which is the poorest country in our hemisphere, which has poverty, which rivals the worst poverty in the world and in sub-Saharan Africa. And it's a 90 minute flight from Miami and you get down there and it's a completely different world. I mean, it's completely unsafe. I mean, now I couldn't even go. It's not safe to be there.

13:32But even when it was safer, it wasn't really particularly safe. The diseases are so advanced. It's tragic. It certainly makes me appreciate what I have, what my children have. It makes me appreciate the tools and toys I have in the operating room because they certainly don't have them down there. It's incredible, right? You know, and it's a, I don't know how to describe it. I'm always grateful for different things, but your book made me so aware how lucky we are to live in this country and to have this availability of this type of healthcare because the comparison and contrast that you write about is tragic.

14:12What do you hope for other doctors, medical students, even parents that, what do you hope they take away from brain and heart? Well, as far as other physicians and particularly young physicians, one thing I would say, you know, surgeons have a stereotype about them that they're a little rough around the edges. You know, they can be a little bit tough. What I would say is to embrace the humanity side of medicine. And particularly, I think we're taught, even without words, just by watching examples of other doctors, that you should maintain a certain distance between yourself and the patient and family, a sort of professionalism, one would say.

14:56What I would say is to drop that and to show the family's love and compassion and make yourself vulnerable. I've shed tears in front of families. I talk about it in the book. and wondering at times whether I was crossing a boundary of being unprofessional, but learning later that actually the families feel that you're in it with them, that you're suffering with them. And I think that's important. I want you to step back and I want you to give some advice to people about their brain. And almost like they do on Instagram, they say, okay, I'm a neurosurgeon. And if I were giving me some advice about your brain, I would do the following.

15:37Okay. So give me a couple of things I should do. Wear a helmet when you're riding a bicycle or motorsport, right? Yeah. I'm focused on children, right? And so - Tell me about how I should protect my children. Right. So bicycle helmets I mentioned, I'm going to mention it again because it's so important. I've been practicing for over 20 years. I've never seen a devastating head injury from a child riding a bicycle who's wearing a helmet. But I've seen many kids who are dead or devastated who are not riding helmets. And that includes on scooters, ATVs, et cetera. Guns, right? We can talk about the Second Amendment and gun laws.

16:19I don't want to get into that. What I do want to get into is I think every single family can agree that if you own a gun, and there are plenty of them here where I am in Texas, and that's fine, that they should be locked up. They should be stored safely. Kids shouldn't find guns. I've had four-year-olds find a gun on the counter and shoot themselves or their sibling. It's absolutely crazy. Those are two things that I'm really focused on, gun safety and helmets. I mean, it's nice to hear it. I wanted you to share that with us if you didn't mind. What about, have you ever been in a situation, sir, where your emotions have gotten the best of you because of the case?

17:04And if so, describe that to us. So one of the cases I describe in the book is this little girl, Jocelyn. She was the most adorable little girl who, when I would ask her to walk, she would exceed my asking and she would skipped down the hall. She was the cutest little thing. She had one of these recurrent malignant brain tumors that failed everything. And I remember distinctly, you know, usually I'm in a rush. I'm moving from place to place. I've got a lot to do. And I remember the morning of her MRI scan after we had given her chemotherapy infusions into her brain in an experimental fashion. I was so anxious.

17:42I was so hopeful because she looked great. I was hopeful that the treatment was working and I couldn't focus on anything else. And then her images came up on the screen and her tumor had dramatically increased in size, laughing at my best attempts to do something. And then I had to go talk to the family. And usually I moved quickly, as I said, but I walked very slowly because I was so reluctant. And when I sat down and went over the imaging studies with the family, I just kind of burst out crying and not like a few little tears running down my cheeks, you know, kind of choking on my words. And it was almost as if I was kind of letting out all the emotions from so many children who I've given bad news about.

18:24But, you know, as I said, you know, I think the parents, I asked them about it later. I asked them, was that unprofessional? You know, because that's my self-perception. And they said, no, no, no. You know, we love you. We feel you're in it with us. And, you know, that means the world. God bless you, sir, for this type of work. I have a friend of mine that I, and one of the ways we're meeting is I have a friend of mine who has a child who has a brain cancer. They've used some chemotherapy on it. It's not an angioma, and I'm forgetful of what the exact diagnosis is, but they're working with her, and she's developed some neurological deficits and some coordination deficits as a result of the tumor.

19:06and the parents are being stoic and the parents are doing whatever they can to keep the child living a normal life. And the reason I'm bringing this up is that I'm on the outside, sir, and I'm feeling it. You're on the inside way closer to the emotional sun of that. And I'm just wondering about the mental exercises that you have to do to do the job because it's, you know, you're a human being and you're a dad. So, you know, tell us about that. I mean, the hardest part is the conversations with the parents. You know, I think it's so important to be brutally honest. So many doctors are not completely honest because they're afraid of giving bad news.

19:52It's hard to do, but, you know, and it's something that medical students don't learn very well in medical school. I had zero minutes in my whole medical education on talking to families. Nothing, no training whatsoever. I encourage students when I'm going and giving bad news, especially to come and sit with me with the family and listen to how I do it and then take the best of what I do. And if they don't like some things, ignore that and watch other people do it because these interactions are so important. They're interactions that parents will remember for the rest of their lives. As far as its toll on me, it takes its toll.

20:29You know, I mean, I'm kind of quiet about it at home. I separate my life. I come home, you know, I might hug my kids a little harder. I usually don't tell them why. And I kind of keep it bottled up inside. And sometimes I share things with my wife. But many times I keep everything just bottled up inside. Who is the, who is your mentor? I know your dad, he's a physician. but there had to be somebody that you met in medical school or a neurosurgeon or something guided you into this. So was there anybody that comes to mind? I mean, there are so many. I've been so fortunate to have amazing mentors in neurosurgery.

21:08So it's not just one person, but the single biggest influence on my career was Mark Swadan, who is the director of pediatric neurosurgery at Weill Cornell Medical Center in New York. I was a resident in that program, and when I watched him, when he operates, it's absolutely beautiful. It's like poetry. And when I watched him operate and the interactions he had with families, how much he cared about children, how much he cared about educating me, I said to myself, I want to be like that guy when I grow up. And I have modeled my career after his decade after decade. So he's my inspiration. We took five words out of your book.

21:51So if you've listened to our podcast before, my producer and I pick five words and we want our authors to give us a reaction to things that they've written. And you can give me a sentence, two, paragraph. If I say the word medicine to you, what comes to mind? Honor. It's an honor to practice medicine. It's a privilege. I've been so fortunate. My life has been so meaningful by having the opportunity to wake up every day and be your child, if you're the parent, your child's doctor. It's been a great privilege. When I hear the word medicine, I think service. You know, I mean, other people think profession and there's a great dignity to medicine and even in some ways a great status to medicine, but you're in the service of other people in a way that's incredibly intense.

22:47If I say the word patience, and I don't mean patience like us waiting for our wives to get ready before we go to dinner. I'm talking about your patience and your clients and your profession. Yeah. What do you think of? precious children. Every child is worthy of love. Every child is worthy of health. The kids that I take care of are an inspiration to me because they are so brave. They are going through things that their peers and siblings are not going through. Their parents are terrified. They're terrified if they're old enough to understand what's going on. And yet they amaze me with their humor, with their resilience.

23:31So I'm in awe of my patients. What about the word brain? I say the word brain. Well, in the spirit of the book, what I would say is unpredictable, right? So when we think of, and that's why the title is Brain and Heart, when we think of the brain, we think of a precise organ that does amazing things. It helps you see and feel and use your hands and have complex thoughts and emotions and memories, so many things. Everything goes through the brain. And you think that neurosurgeons have it all figured out and we can target precise small areas in the brain for biopsies, for surgery, using modern technology.

24:10But there's so much of what we do that actually is not based upon good published data in the medical literature. It's based on our gut or our heart. So neurosurgery is not as precise as you would think it is. and there's a lot we don't know about the brain. Okay. So the next obvious word is going to be heart. So when I say heart. In the context of the book, heart signifies a number of different things. Number one, the fact that you have to have a heart in order to do this work. You have to have a big heart or else you shouldn't be in the field. The other is heartbreak. I've seen a lot of heartbreak.

24:52And those are the main applications of the word for the book. There's something else that struck me, and I want to just get your reaction to it. When you say brain and heart and I read your book, I feel, I'm not a physician, I don't have any experience in the medical world, but I feel that the average person sort of feels that these are parts like in a car, like the heart and the lungs and the brain and the leg. But yet when you really think about the whole thing, it's so wildly interconnected. Everything is almost like one unit. And we have a tendency as non-professionals, non-medical professionals to see it mechanically as opposed to holistically.

25:36Am I right about that, sir? Or how would you describe the human body? It's just a perception thing. When neurosurgeons joke around with our other colleagues, I'll tell my cardiac surgery friends that the only purpose of the heart is to pump blood to the brain and that if the heart doesn't work, no big deal. You just transplant it, but you can't transplant the brain, at least not yet. You probably never will be able to. Right. Right. But I guess the point, I'm making the point that the brain is getting signals from the body, responding to the signals to the body and vice versa. It's just way more of a holistic unit.

26:13You're right. You replace a kidney or a lung or a heart. I'm being facetious when I say that. No, these interactions are incredibly complex. I mean, it's amazing that you can think in your mind, I want to pick up a pencil. And in lightning speed, you pick up the pencil, just right when you have that thought. But what has to happen is you have to have that thought cause an action in a certain area of the brain, the motor cortex involving your hand that shoots a signal from your brain down your spinal cord and you pick up that pencil. And that's not even a complex function, right? It's amazing. The other thing is like your brain is, you know, if you're overthinking something or you're dealing with high stress or high anxiety or you're running from a bear in the woods, your brain is flooding the body, right?

27:09It's sending signals to the body to flood it with adrenaline and cortisone and your heart. You know, so to me, you know, I don't know. I mean, I spent a lot of time trying to think about how I can calm my brain down and control my brain quickly in my job, right? you got to be doing that in the same as you. So my last words, that was four of the words. I just wanted to ask that question. Four of the words. Fifth word, three words, and I'll give you the last word, sir. When I say Dr. David Sandberg, what do you think? What do you think of? Oh boy. I mean, luck. I've been so lucky to be Dr. David Sandberg.