Transcripts For CSPAN2 Dr. 20240704

A little bit about you, dr. Jay wellons holds the cal turner, chair of pediatric neurosurgery and chief of the division of pediatric neurosurgery, Vanderbilt University Medical Center here in nashville and the Monroe Carroll Jr at Childrens Hospital at vanderbilt is a professor in the departments of neurological surgery, pediatrics, Plastic Surgery and, radiology, and hes also the vice chair at the department of neurosurgery. He has served on the Editorial Board journal of neurosurgery pediatrics. He was chair of the House Committee for the aa and s cns section on pediatric neurosurgery three annual meeting in nashville in 2018, currently on the executive committee of the American Society of pediatric neurosurgeon ns in the capacity of president elect and in addition to his scientific, he has been a contributor to the New York Times sunday review. Time garden and gun magazine, fresh air in pr and over daily tor. Com his science nonscientific focuses specifically on his specialty. A pediatric neurosurgery surgery, but also the broader field of medicine and the profound Lessons Learned from. The children and parents that he has cared for for over the last 30 years, which hes going to tell us all about. So were very, very much looking forward to that. Thank you. Well, first, lets go ahead and dive in. For those who havent yet read all, that moves us. Tell us about it briefly. Whats it about . Who do we need . Well, we a lot of different patients, a lot of children that ive cared for. We meet sophia, a little girl who came in in the midst of the pandemic with a ruptured avm in her brain. We meet delilah, just a darling, six year old child that presented blond with a brain tumor that we took out acutely. And her vision came back. And then we had to navigate the fact it was malignant and we meet luke, whos a boy who was involved in a terrible motorcycle accident. Meet alissa, who, unfortunately involved with a selfinflicted gunshot wound because of social media. We meet so many children who have gone through just really challenging times, who have come out on the other end most of the time, just with this phenomenal resilience. And it was difficult for me to not see the grace within that shared moments of joy and sorrow. So for me its the book really is about the children. But there is some about my father who was important figure in my life who passed away from lou gehrigs disease when i was a young medical our young resident. I was young at some point, younger and and then its a little bit about my mentors who had an impact on me. And its a little bit about the mentees, the residents that i work with who still an impact on me. And its a little bit about my mother, members of my family, too. So i think it started out to be really a series of stories about patients. What happens is as you kind of unzip and and kind of pour yourself out on the pages you, you cant help but, you know, but find a lot of commonalities between them in you. Lets talk about a bit more about that. Lets go behind the story and. Talk about your purpose. What was your purpose in writing this book . Where did the idea come from and how long did it take to write . So in. 17, i was kind of going five, you know, i was a program director, which means i was in charge of the residency program. I had a couple of other leadership positions at vanderbilt. You know, i filled my day up, you know, 26 hours a day with things to do. And all of a sudden, ive myself, as opposed to sitting with a family. You know, we used to be looking at x rays, but now its looking on a computer screen. And oftentimes i will say, like, you know, here is the tumor. And what we need to do. My chairman thompson, ive and ive taken this from but i still give him credit for it. He has this great thing. He talks about being theres peace with the plan. And one of the things that you can give people when there is chaos, when they have this unusual diagnosis of a neurosurgical issue like a brain tumor or blood vessel malformation or some kind of congenital issue, is that, you know, this is what it is. This is what were going to do and this is when were going to do it. And a little bit, what were talking about before, just trying to give that of peace like, yes, there are risks. Yes, this is hard territory, but this is how were going to move through this. So instead of me saying words, it was me hearing those words and it was another doctor showing me a tumor in my pelvis. And that just hit like a ton of bricks. And i had surgery to have it taken out. I had a repeat surgery. And basically i was on bed rest two and a half months. So not to be the star trek geek, but i was, you know, went from working on to, you know, impulse power, maybe like i was just stuck and theres only so much netflix that you can watch, i promise. And it was my sister, sarah, whos the ultimate enabler. In a good way. I mean, you know, who said, why dont you write down some of these stories you can tell on us . You know, after dinner, you know, or during which i would not tell many stories during dinner. But the point is that it was a good idea. So i wrote a up that was funny and sent it to the New York Times and it was printed and. My it turns out that my editor there, peter catapano, was Margaret Reynolds editor. And it turns out his shtick is to take new writers and help them write more into themselves and write more. Doesnt matter if youre. 5051 at the time or if youre 22. And so he said, you know, this is a funny piece. Youre a pediatric neurosurgeon. Know you have a serious piece. I want you write me a serious. And so i did i wrote a piece about a girl who was basically saved by a blackhawk helicopter that flew out through a storm and got her to our hospital. When i was in birmingham. And at the end of the piece, know she many years later recovered. We did surgery. You know, i would get letters from her parents. Then one day i get a letter from her and her telling me that shes getting married and invited to her wedding. And shes telling me how grateful that she was for those blackhawk pile outs and for the e. R. Doctor at the outside of hospital. And for me and all i can think of is how grateful i was her, because it was in my first year of practice when youre just learning how hard to push, how much to expect of people. And so piece went out and with the first piece i had emails, friends and saying, hey, you know, thats really funny piece. Youre a funny writer. But the second piece i had literally like almost 1000 emails from people around the world about how much hope that it gave them and. What i realized is that the pandemic was starting to raise its head. You know, it was just from wuhan to italy and was a lot of anxiety in society. And i realized that know, maybe theres a place for all the things that these have taught me about grace and resilience, about and joy and how they go together in your hands. You know, theres, you know, Kahlil Gibran has written about this christian mystics have written about this, buddhists have written about this concept of how joy, sorrow, hold in your hand, you know, Kahlil Gibrans poem on joy and sorrow. Its phenomenal. You know, like if youre standing with joy, dont forget, sorrow is laying on your bed and waiting for you. So, you know, for me, it was really just the to say, i think that im going to i have so many experiences with these children that are about joy and sorrow. I want to put them together in a book. Did you ever think you would write . Well, i was an english major at the university of mississippi, and i decided after kind of doing both the premed track and the english major that i was going to go to medical and i was going to be a Family Medicine doctor, and i was going to write and get paid by patients and tomatoes and chickens and live in south mississippi. Thats really what i thought. I was going to do. And then i remember you know, every part of medical school is is the anatomy lab. I went to university of mississippi Medical Center, which is a great medical im very proud of my time there because we we really learned the anatomy. We really learned the physiology and when it was time to take care of patients, we were the we were the ones taking care of patients. So by the time i got to duke as a resident, i had done more procedures and been involved with the direct patient care than many other people. So i just say all that to say that that anatomy lab i just remember dissecting out the brachial plexus, which is this beautiful, beautiful white macrame like series of nerves in the neck that out of the spinal cord. And that was it just laid down and just laid that thought about being a Family Medicine at the altar of neurosurgery and and all of a sudden, i was in the spinal cord. I was in the brain, and that was it. Yeah. Just took me 25 years to write it. Yeah. Lets back up a bit. And now pediatric neurosurgery is that is quite a specialty in its own right. How does one become a pediatric neurosurgeon . How did you become a pediatric nurse . Neurosurgeon . Well, i think a lot of my life is about the people that im exposed to. I mean, when i on the pediatric rotation as a student fed the babies i and my chief resident at the time said, aha, if feed the babies, youre going to become a pediatric surgeon and and, and i can still remember this one baby and i wrote about this baby and in the prolog, but you know, a lot of others other children had parents come see them, but this one didnt. This was born with addiction to crack. Wed gotten through it, but i just didnt feel like that child had any love in their life. And i remember coming in early, like 330 in the morning before we were around. And i would feed that baby and ill hold that baby my lap. And i could look down and i could see the little sutures. There were the bones come together and just that little ridge. And i just remember feeling i had so much love, my own life that i just wanted to share some of it with that baby. So i think i was all already somehow drawn to children. But i tried to myself out of neurosurgery. I, i cant even tell you, you know, hundreds of times like i loved cardiology. I vascular surgery. Id i had a hard time. Like finally admitting to myself that i wanted to be a neurosurgeon. But every time i would walk by o. R. Six, which was the o. R. , where neurosurgery did their work and where we were in medical school, you know, i would look up through the port to see what they were doing just not once, not twice, but like every single, solitary. And so finally, i accepted a position at duke, went there and and had a great residency. A lot of it is a blur. I wish i had taken more notes because that was a time of this metronomic like existence where you go between between joy and grief so quickly. But i met a mentor there named tim george. And and basically i just he was this the second africanamerican pediatric neurosurgeon in our community and our community. And i just wanted to be like him. He was a good person. He was a great surgeon. And and i just remember saying to myself, i can live a life like that where i help people, then i can be like, i think that would make me happy. As a pediatric neurosurgeon, you approach life and death scenarios on a regular. How do you cope with lives . Patients lives are in your hands. Well, i think, you know. Id like to say that, you know, we follow sir william holzers equanimity, you know, which is you keep this mask. Between yourself and the patient, this kind of calm mask sounds. But. But i can just tell you that, you know, i remember vividly, you know, our daughter fair being six years old and me getting called in to operate on a on a six Year Old Girl that had a brain tumor. And im sitting with that family and were looking at the films and im talking about the surgery. Im going to do to impart that piece with a plan. And it is impossible for to connect with that person. It is impossible for me not to connect that person. And somehow it changed his from, you know, the and insufferable neurosurgeon looming over the patient and telling them that, you know, child has a brain tumor and it has to be taken out somehow. It just changed for me to one person sitting across from another person and just talking about what we were going to do and and just sharing that moment and helping them understand that we were going to do the very best that we could do to help their child and that affect me early enough on that that, that i think ive tried as much as i can, you know, to to repeat that over and over again, that peace and garden and gun was about a child, an eight year old child that had a brain tumor that similar where i just had to sit down the family and talk to them about, you know, at the end of an eight hour operation. You know, im not back there in my suit at oclock at night. You know, my tie on telling them that there was no bleeding and everything went fine. You know, its its your your youre just too human. Youre three human beings. Just sharing a moment. Youre just doing your best for other group of people. And think weve all been in situations before, have been frightening and stressful and being in a few myself and then also my time in health care, i know that we take our cues from from the doctor in the room. Yeah. And talked about that just a bit before. The session you were telling me about how you introduce yourselves to your young patients and tell us about that. Yeah, well i am. I like go in and reduce myself to the Children First as long as theyre old enough, you know, its i dont do that, you know, an infant. Hello, little infant. Oh you know. But but i do that to any over the age of five, right. I kind of feel like five is the is the age where they can communicate and understand that youre being kind of a sly little jokester. Right. And just say, well, you know, hey, james, do you go by james . You go by j, what do you want . What do you want, james . All right, great. All right. Well, im dr. J. Nice to meet you. Who you got here with you . Whos this lady . Is she . Just come in with you or what . You know, and. Well, thats my mom, of course, you know. Oh, your mom. Okay. All right. Nice to meet you guys. And then inevitably, that will turn to looking what you know, the child has and im giving you clinic. Im giving you once like in clinic, right where its calm because that scenario then if the child something that is be operated on its typically and it is about that child being comfortable what youre going to do its about that family comfortable with what you need to do. And its kind of a slower peace with the plan. Its very different when in the emergency room trying to pick you. You know, in those scenarios, theres not only is there some, but there is angst with, a lot of grief. And so you know, you have to recognize that that what youre about to do is, first of all, this is this persons worst time in their life that they most likely ever had their whole life. Is it going to be and youre going to meet them and youre going to be the person, the last person that ever wanted to meet. Right. And so over the years, i have definitely evolved to feeling that that is a really important time to instill grace into the conversation i just cant impart that enough. And i think that comes from from more than just you. I that comes from a higher power wherever. Your higher power exists whatever your theological construct is. I just feel like that that is the time where where grace is absolute need it. I think its a great time to step into the story a bit more now would you read a passage or two thats particularly meaningful to you . Yeah, sure. Ill start on page one and go to page 362. Let me see what do i want to read . I i once 74 this is this is a story about a boy who was in a very awful motorcycle accident. He was racing motorcycle. And so ill just read a bit from this. Its called lukes jump. I had a lot of opportunities to speak to the family members about the what happened at the setting itself. Because one of the things about when youre doing narrative nonfiction and its its really important to not write about times. So im getting into the wackiness of it, but to write about times that you werent there right because you can become like you start writing fiction if you do that. And so its really important if youre writing about a place that you werent there when it first happened, that you a firsthand account of what it was like. Right. So its called lukes jump. On the third jump of the race, things went hell, the dusty cloud of tumbling riders and dirt bikes finally came to a stop right in front of the trackside bleachers packed with eager and suddenly horrified parents, giant floodlights dotted by swarming insects. And the fall and the warm fall evening turned the late dusk and spotlighting the chaotic in front of them. Slowly one by one, the riders up rubbed their heads and waved to the crowd. Parents pulled midrun down to the gate that, opened onto the track, relieved, tentative laughter spread across the crowd. A few early claps. One boy, however, did not rise. Still on the track, his crumpled form unmoving, a spreading pool of blood to form under his head. Silence back in. Whose boy is there . That luke. That boy in the was indeed luke. Luke one and he would not sit up again for quite some time with his father watching from the trackside. Luke, then 12, had accelerated up the dirt after gaining speed on a quick straightaway during his first and only time around the track, just as the riders around him were doing. Then somehow someones wheel caught another and the chaos began on the first bounce back to earth, was thrown off the bike and his strapped on helmet somehow flew off his head with the second bounce, the handlebar of one of the tumbling motorcycles pierced his skull and out a one inch deep rough and the skull and brain along the left side his dominant hemisphere, where areas of the brain that regulate language and speech are represented. More often than not, this is a non survivable injury. The patient dies at the scene, lukes father rushing to his sons side and pushing to the gathering crowd reflexively lifted. The boy off the dirt track, swept him into someones vehicle for a fast ride at a local hospital. Astonishingly, he had no sponsor, no spot injury. The most common reason for on scene a mobilization after a quick head wrap by the Emergency Personnel at the hospital done to hold pressure and stanch the bleeding. The boy been a marginally to us via ambulance the page went out early in the evening notifying. Relevant teams of his impending arrival. We were there as the ambulance emptied him into the trauma bay. His father out of the ambulance and walked briskly alongside it the gurney. I had come down the eddy despite my residents presence because i had just finished an afternoon case lasting well into the evening and had yet to retrieve my backpack for my bike ride home. Still in my first year of practice, i was eager be involved from the very beginning. Perhaps some of my residents were staying me then melissa, my wife was a junior medical resident and destined be chief medicine resident some years later. Her call was equally busy managing nonsurgical issues and. She was often in the hospital overnight. There was no cozy dinner or, interesting conversation, beckoning me from home, i felt the familiar rush of adrenaline setting in as i walked through the eddy after i peeked under the hastily applied but lifesaving head wrap, i quickly that i would not be heading home for the next several hours and shifted gears. Once i glanced over the ct scan of the boys head, showing immense damage to the skull and underlying brain. I brought the father into the emergency consultation room to discuss the impending surgery. I also needed to obtain consent. The absence of consent to do the surgery. When there is a parent present could be construed as battery as odd as that sounds. So consent is therefore critical to proceed. Back in the days my residency before this, this conversation was way more about the consent than the connection. And that would change for me forever on this night as well. I was standing for the conversation and as was the father, our eyes at the same height he wore a goatee, his beard mostly unshaven around his thin blue jean jacket, was and his baseball hat dusty hair underneath, matted with sweat his eyes were red. His face creased, concern in the effects of sustained intensity began to set in. We ourselves alone in the room, the lightbox held select films on it, showing the devastation to the boys the bluish light casting across as both i myself by name as the pediatric neurosurgeon on call as i did his dropped to his chest. His hand came up to cover his eyes. It was early in my career i want to say that i reached out and put a hand on his shoulder to comfort him even quickly with the need to get to the o. R. Paramount, thats what i would do now. Its what, 95 of the pediatric neurosurgeons i know would do. Now, strike the balance, compassion and focus then on to the work. But i was yet to experience the hundreds of moments like this to come. I didnt have those lessons yet. Get the consent. I told myself just get to the o. R. Ill leave it at. Very personal stories that clearly have made a Lasting Impact on you. And we talked before about them, the weight of the responsibility, how you go into these situations with life and death in some cases. Lets talk a bit more that, you know, that a doctor has to be at his best, really, in all circumstances. I mean, the next patient that you operated on may not know that there was a very difficult circumstance like that, that how do you how do you deal with that . I mean, how do you go from one room and then into the next and just ready to to do what you need to do and to be at your best . Well, there is definitely a reset that occurs. But i mean, there something, you know, i think its important i want read this short little piece about how as a neurosurgery resident it means youre doing a seven Year Training Program youre not just learning how to operate your dodge, just learning how to make about taking care of patients. But youre also learning to handle that metronomic like existence that we were talking about. And i do want to read this part in a single hour of being on call as a neurosurgical resident, you can sit with an elderly woman in the Emergency Department to tell her that the brain hemorrhage her husband 50 years just suffered while shaving is not survivable and surgery will change that. Then just afterward you be called to the pediatric icu to place a life saving drain in the brain of four Year Old Girl dying from elevated intracranial pressure. And watch as the child her eyes. A few minutes later, squeezing her parents hands. One hour in the span of one single hour, those things happen over and over. Over in the weeks, then months, seven years of formal training that job training at the part that deals in the intense and important human truths for aged at the unspoken places navigate is never ending. So you know for i think i have. I have this this green field that exists outside of my vision to the left of my kind of sensorium. And in that green field, a place where i take very difficult memories, you know delilah wrote about in this book is that, you know, little girl who passed away from a glioblastoma multiforme, me, the one that came in blond, but ultimately died because of the type of tumor. And we still cant treat that because of chemotherapy, but not good enough or a set of congenital that we attempted to to separate emergency one many many years ago because one was dying and killing the other and both died in the operating room and those are important parts of who i am but i cant i cant let blind me to where i need to go. And so the way i deal with it is i take that memory and i walk off into this green field and i walked past a lot of places where there are bumps in the earth. And i go to a new place. And i and i take the grass off the top of it and put the grass over this the sod over to the side. And then i dig a hole and then i take that memory and put it in a box and close the box and i lock the box and i wrap chain around the box like that and then i put that in the hole and i put the dirt back on it and then i put the grass back on it and i tamp it back down. And then i stand for a moment with that memory so that its always with me. And then ill walk back in to normal life so i can access it when i need to, when i need to. Remember the Lessons Learned or that particular individual. But i need it to be done in a way that doesnt paralyze me in times where we have to make Big Decisions in the operating room, to get things done, to save a life to pull somebody back from over the edge or to do what it was that we were intended to do. It was a french in a french surgeon who said every every surgeon has a graveyard that they visit from time to time. And and that was said, my goodness, you know, 100 and some years, 150 years ago. So i think this probably something similar to that. Theres just this man. You also practice yoga. I do i do . Yes, i do. And i have some of my yoga friends here. Thank you all for coming. But but theres a great story about being on book tour that i wanted to tell and that is that i was very so we had this great book tour and we decided to take a break and and go to where was it, melissa ash asheville, north carolina. And and and patchett, whos has a wonderful writing sensei. And let me just say, you know, its not lost on me that, you know, i was programed director for the residents. We have and residents that that that i have an opportunity to teach. Ive always been in academics thats a part of who am and its not lost on me that in the age of 50, you know, i peter catapano, whose job is help people write more i have ann patchett and margaret wrinkle and marie la philippot. These amazing nashville writers who all just descended upon me and helped me in major ways. This whole book, i mean, its just phenomenal to feel that circle, flap and back and and my editor had in my book, he said, do you realize that you write about residents, you write about seven of honor women . Is that important to you . And it is important to me that women get trained in media, neurosurgery and pediatric neurosurgeon in pediatric surgery is almost percent women now. And for all of a sudden to have this this team of women now coming their wisdom on me, i just felt so grateful and so full circle, so and sad. Any time that you go to a town, you should find out if it has an independent bookstore and you should just go and sign their books. Thats a nice thing to do. They love that i can just tell you. And so i done it once before and it was fine, you know, and and so we were in asheville. My son jack is a terrific ultimate frisbee, very proud of him. He just got asked to to try out for the under 20 United States ultimate frisbee team. So i get to say that because im a proud but at the time we had little break we rafted the French Broad River we had this was in between you know book tour issues and i decided to go by malaprop, which is the bookstore there, and asked. So i went to the front and i was like, huh, i dont see the out in the window. Well, thats all right. Thats all right. Maybe theyre inside on the hot nonfiction table, right . So i went inside and i looked at the hot nonfiction table and was like, well, i dont i dont see my anywhere. And so they must be sold, obviously. So obviously i went to the window and i said and want to just happened was the book had i very high in that literally high but i was very high because Jerome Groopman had just given a positive, really positive review. The new yorker. Right. So i was like i am jay wellons. Ive written a book on the movies. They got a good review in the new yorker, and i just was going to come here and sign it. My buddy and pagets, that was a good idea but i dont see the books and i figured you must have sold out of them or something and so i just maybe have some in the back in a box. Im happy to weigh whatever you guys want me to do. I got pen. You know, i read a sign and the lady in the lady behind counter and they still had the plexiglass there. She was like, whats it cause . And all the moves us cause, all that moves us all that moves us. Shes okay. I know where that is . And she walked me to back of the store and there in the yoga section was my book all the moves that i. So there we go so so that is from my yoga my yoga comrades but they that was the time that i that id kind of established my confidence intervals. You know i texted my partners i said one minute youre in the new yorker and the next minute youre in the yoga section. What does that mean in life . And my partner, who also does yoga he takes it back. He said, no, i must stay you know, i cant make this. Yeah. So were getting to the end of our conversation. And if anyone has a question if you could go ahead and be lining up here at this microphone. I know you have questions that you want to ask so be making your way up. One thing i wanted to ask before we end our conversation, we talked before about this beautiful cover, if cant see it, if youve not held the book in your hand theres a teddy bear. Its got a bandage on its head its its its clearly undergone a medical procedure. It looks like its got an ivy and lets talk about that. Well so, you know, youre a first author with with Penguin Random house. You know, and you realize that theyre actually going to pay you to a book, which i didnt realize, you know. I was like, oh, my gosh, you know, but you get a whole team of people. You get a you know, you get an editor that you work with and man mark warren amazing you get a publicist and she was amazing. You get a social media publicist you get you know, the of nonfiction. And then you also get creative team. And so for for the hardback everybody loved the the picture of the surgeon looking down. And a lot of people think that thats me and thats actually not me but my friend asha whos the chairman of cardiac surgery here, hes indianamerican he looked at the cover i was shown. I said, what you think about this . And he goes, hey, is that atul gawande . And i was like, oh, my gosh, it is. Its a tool gawande day. Theyve a picture of a tool gawande day for the of the book and i freaked out and i called my editor and i called the head of nonfiction and he said is this a stock photo is this atul gawande are you because the four heads exactly the same i the wrinkles theres like three wrinkles if you look at his other books, theres three polls in his book like we cant do this. They were like, its not. Atul gawande. They and they found, you know, its like its a surgeon. Like from pakistan. So i guess the top of my head looks like a surgeon from general surgeon from pakistan. But what was really neat when it came time for the for the paperback, they said, what do you want to do . And we work with terrific people and a Childrens Hospital, whether its the lucile whos here, whos the scheduler in our clinic. Lucille, where are you . There you are. So, lucille schedules the operations in our clinic. Were very lucky. The room team is amazing. We have a fantastic neuro pediatric neuro team. And i said, you know, they do this really cool thing and. So i just want to read this one piece because its just like a one and a half pager that describes it. Surgery is scary at any age, but particularly for children. They dont want to be separated from mom and dad. They want to be with total strangers down a hall on a gurney into bright room, marked sterile on the door. And they sure dont want to be alone on a bed in the center of that bright room with unfamiliar people milling about them going back and forth to computer screens or instrument trays. Oh, everyone them kindly when they arrive particularly the o. R. , nurses a special group of people with a smile that can be seen around the edges of their mask and their kind eyes gleaming. Our anesthesia colleagues do their best to distract and comfort to the kids. Get to choose what flavor they can smell, and the inhaled anesthetic mask. Strawberry is popular. Banana is not small. Talk about superheroes, their favorite toys or sports teams mixes with the quiet chatter of the o. R. Circulating nurse and scrub tech as they begin to carefully prepare the back tables by laying out sterile blue drapes. Ive watched all play out thousands of times from the side, the room where we as the Surgical Team and await the word from the anesthesia ologist that we may move ahead with and prepping and the surgical itself. But it is what the nurses do after the child goes to sleep is my absolute favorite. And where the new cover for this book comes in. Nearly without fail, the younger kids will be clutching a beloved stuffed animal as they make the journey into the operating room. Teddy smiling foxes, purple elephants, toothy dinosaurs. Ive seen all sorts of stuffed animals on that gurney over the years. I remember a plush scorpion named justin next to a little boy as he fell off to sleep as. We prepared to take out a sizable brain tumor that was giving him headaches. After the all the instruments are laid and verified and the checklist completed, its finally time to start the actual. And thats when the o. R. Nurses get to work on the stuffed animals, stealing precious minutes during a break to carefully wrap the childs stuffed animal in its own surgical dressing to match the dressing that the child will find themselves wrapped in when they wake up. And yes, the scorpion fitted with a nifty head wrap when its owner woke up and opened his eyes and became aware of his surroundings. The pediatric icu there was his best buddy, justin. Look in the same way the child, the stuffed animal then heal together in the days after surgery, when its time for the head wrap to come off. Off comes the head wrap on the stuffed animal as well. Better be careful of that stinger dr. Big removal term. Same for the animal. Its a command and simple way to help a child understand what theyre going through and that they are not alone. And isnt that really what helps most of all . Love, kindness and healing together . Like i said, it takes a special person to be a nurse in the pediatric o. R. I love that story and what it tells me when i told you before was that the choice in this cover, it tells so much about not only the book and what you wanted people to understand from the book as soon as they saw it, but also how you approach medicine and how your Team Approaches it. And i think that is something thats just so incredibly important to setting that tone right from the beginning, when you meet your patients, when you ask them to trust you. Yeah, you well, i think now its your turn. Who . A question. If youll just come right up to the microphone. And dont miss your chance to to ask some things of doctor whelans and just hear him talk a bit more about his work and his book and surely be glad to answer any questions you might have. I think we have someone making her way up. All right, here we go. This is my favorite part. Hi, doctor. Well, how are you . Good. Ive heard your name since i was. A little girl. My moms a seal . Yes, ive heard your name since youre sure . Yes, im sure. Hows the car . Is it fixed . Well, we got rid of the crv. Ive got a new one now. Okay, good. So im in my third year of college. Im a classics major. And you mentioned that you had a background in english. Yes. And wanted to know if you felt like that background in the humanities helped you in becoming a doctor. Yeah, absolutely. You know, i think that you know, learning the science medicine is very Building Block based. So for example, you learn biology so that you can learn organic. You know, you learn chemistry. So you can learn organic chemistry and you learn organic chemistry. So you can understand pharmacology. You understand pharmacology so that you can understand how to write prescriptions for patients and how it fits with the pathology that they have right. And of course, important to have the background classes. But to me, theres so much knowledge and you know, just standing in the middle, a bookstore and looking around or in a library, theres so much knowledge about humanity imparted, whether its about love or loss or, you know, happy times, unanswered prayers or miracles. Its just, you. I know, being an english major, you know, the residents make fun of me because occasionally ill quote shakespeare in the operating room. But its a lot its a lot more than that. You know, its its understanding getting a glimpse of the human condition through eyes over the ages. And i just to me would not do i would not go back and do it differently at all. Like im very im very proud of the fact that i was an english major and are very proud of the fact that i at university of mississippi and had some terrific, you know, creative writers. I worked with barry hanna. I worked with alan douglas. You know these are really terrific southern writers and i wouldnt change that for the world. So i do think theres a big role for the humanities. And i think medical schools have learned that because we need to be able to communicate with our patients definitely we need people to be smart enough to come up with vaccines, you know, and definitely we need people to be smart enough to do things where communicate. Its not the most important, but a lot of roles. Now youre you come out way with the patients and frankly, youre expected to be better communicator and to me, being able to draw from massive bank of knowledge that has come from writers from james joyce to william to, you know, hemingway, all points in between is just invaluable for me. Thats exactly what i hope you would say. So yeah, great question. You have another. So im excited to read your book. I havent read it yet. I really loved what you had to say about holding joyce sorrow in grief all at once. And i was wondering if you could give all of us, because thats kind of the human, human condition. We all deal with these extreme moments of joy, mix of sorrow, mix of grief. What would be like a takeaway that you would give of how we can all maybe hold all of those great and difficult things all at once yes. Well, you know, i think an example of that is that scenario were sitting with the family. So ill give you an example and ill give you an answer. So your child has a brain tumor, grief. Your child woke up from surgery neurologically intact, moving everything, saying their names asking for mom and dad joy, the mri scan done the next day it looks clean. Theres evidence of tumor joy. The path came back on postop. Day five, benign joy. The path came back on postop. Day five, malignant grief. So its just its just in every thing that approach in medicine and particularly in neurosurgery. You know i think all of medicine you know you know if im insufferable neurosurgeon about anything think its because i do think we deal i mean i love my Orthopedic Surgeon colleagues. I love them. They have helped me have had, you know, hip arthroscopy my son has broken his finger and, you know, he thought this, you know, his ultimate frisbee is over, you know. But ive love orthopedic i mean but but but neurosurgery we we pull people back over the edge. Thats what we do. And so theres a lot of joy and grief in. And so, you know, me reading back with the mystics, you know, finding the poem on joy and sorrow by gibran, i mean, you know, somebody handed me a when i was out, you know, yesterday i got in between the two buildings and i got home last. Open it up and whats in there. But joy sorrow. So i think theres something a theres something than us that its this understanding that life not going to be without sorrow. You know, theres this concept that, you know, to you the sorrow is what hollows out flute. But then the joy is the music that comes once its hollowed. So i think i for me personally, you know, and i dont want to wax too long, but but you know, this last year that ive had has been one of great joy, the opportunity to go and and speak to other people about these children and about this concept of joy and grief and about how to telling stories is important because it makes gives people commonality. And in commonality creates community. And once we create, then we can solve the big problems. But you know ive also had some medical issues come and thats also been grief. And thats just the way the world the world works. And you just hope that have people around you that you work with or people in the clinic or the owner or your partners or their people at the yoga studio. You go to, or people that your friends that you rely on, you know, that you go to to have a beer and decompress or whatever. Its okay to say on cspan. But, you know, the i just like life is about community. And thats how we handle all this together. Thank you. That was beautiful. I think we have time for one last question, joe, step right up. Oh, this going to be big and can we cut the mic off, please . About 2 minutes and then we have a hard stop. Hi, doctor. Thank you. When you when you were talking about taking some of harder memories and putting them underneath the grass and digging the hole and wrapping up that box that sounded like sort of next level, compartmentalizing, you know, way beyond what the average person can do with those things. So i wondering if, one, if you are trained to do Something Like that in your practice to compartmentalize and then to this might seem silly but because youre a neurosurgeon, do you sort of better understand the ability to compartmentalize with your brain . I think and i think that we do that we. We model that for our residents. You know, we really do actively the ability to compartmentalize us. I think thats really important. Theres, you know, this one thing i know we have a hard stop and you know i should i like public in the south and but i will tell you that like this this one paragraph about a kid about a child. Ryan, who had an aneurysm that ruptured that i inherited from my senior partner when i came in on call the next day and he was already the ngo suite and the way that i knew how to treat that was with an aneurysm but the person that was doing it was going to put some glue inside of it which nowadays 20 years later is is no way to do. But back then it was a clear and ultimately that happened and he rewrapped and he died and i know i that i could have put a clip on that and ryan would be 25 years hed be the same age as my son, you know, hed be 18, 19 or 20. And, you know, so i wrote this to this day, i have no idea if he have returned with a rupture. Had i taken him the o. R. That same day as the initial angiogram clipped it . Even now, as i write this the very idea that the same thing would have happened regardless of my actions sounds, like a feeble attempt to assuage my guilt if i had performed the surgery and had re ruptured later, im certain that id have written an essay similar to this one instead of remorse that i did act. It had been remorse because i did. People can die. Kids can die. You can do or not do. You can pray or not pray. You work past the edge of exhaustion, but they still die. Death a part of your daily rhythm. One may become inured to it, but yet to find a way to rid myself of it completely, i desperately want to go on and. Yet for some odd reason, i desperately want it to never let it go without it, theres no final line to hold, without it to struggle against. We become less of who we think we are. So i think we do learn how to compartmentalize. And i do. And i think that we model that our residents and we hope that they it better than us. And then the residents they have do it better than. Thanks. Thank you so much for coming. Oh, thank you. Its been a pleasure. Yeah. Thanks, everybody. Thank you. Thanks, guys. Good evening. Im matthew spalding. Im Vice President of hillsdale co