Challenge. Thats why we are working around the clock to keep you connected. Were doing our part so its easier for you to do yours. Spark light supports cspan 2 as a public service. Munro carol jr. Hospital at vanderbilt. Pediatrics, Plastic Surgery and radiology. The vice chair of the department of neurosurgery. He has served on the editorial board, journal of pediatrics. Chair of the Host Committee of the cns section on pediatric neurosurgery in 2018. Serves on the executive committee of the American Society of pediatric nurse surgeons. In addition to scientific writing he has been a contributor to the New York Times sunday review. Garden and gone magazine. His scientific writing focuses on pediatric neurosurgery. Also the broader field of medicine and profound Lessons Learned of children and parents he cared for over the last 30 years. He will tell us all about it. Were looking forward to that. First, lets dive in. For those who have not read it, tell us about it. We meet a lot of children that i have cared for. Sophia. Little girl who came in the midst of the pandemic with a rupture in her brain. We met delilah, a sixyearold child with a brain tumor. We took out acutely and her vision came back and we had to navigate the fact that it was malignant. We met luke who was involved with a terrible motorcycle accident. Alyssa was involved in a self inflicted gunshot wound because of social media. We met so many children who have gone through challenging times. Who have, on the other and most of the time. With the phenomenal resilience and it was difficult for me to not see the grace within that. The shared moments of joy and cheryl. For me, the book really is about the children. There is something about my father who was a important figure in my life who passed away when i was a young resident. It is a little bit about my mentors who had impact on me and a little bit about the mentee residents who i worked with who still have an impact on me. Its a little bit about my other members of family, too. It started out to be a series of stories about patients. You unzip yourself and pour yourself out on the pages. You cant help it. You find a lot of commonalities between them and you. Lets talk more about that. Lets go behind the story and talk about your purpose. What was your purpose writing this book . Where did the idea come from and how long did it take to write . Two in 2017, i was going mach 5. I was a Program Director. I was in charge of the residency program. I had a couple other leadership positions at vanderbilt. I filled my day up 26 hours a day with things to do. All of a sudden, i found myself as opposed to sitting with the family, i used to look at xrays , now im working on a computer screen. Often times i would say that i could see the tumor and heres what to do. My chairman, thompson, i have taken this from him, but i still give him credit for, he has this study talks about being a piece of the plan. One of the things that you give people when there is chaos, when there is a issue like a brain tumor or a congenital issue, this is what it is. This is what we are going to do. This is when we are going to do it. A little bit of what we were talking about before, trying to get the sense of use. There are risks. This is how we will move through this. Instead of me saying those words, it was me hearing those words. It was another doctor showing me a tumor in my pelvis. That just hit me like a ton of bricks. I had surgery to have it taken out. I had a repeat surgery. I was basically on bed rest for 2 1 2 months. Not to be a star trek geek, i went to impulse power, maybe . I was stuck. There is only so much netflix that you can watch, i promise. My sister, sarah, is the ultimate enabler, in a good way. She said, why dont you write down some of the stories you tell us after and during dinner . I would not tell that many stories during dinner but it was a good idea. I wrote a story that was funny. I sent it to the New York Times and it was printed. It turns out that my editor there, peter, his stick is to take new writers and help them write more into themselves and write more. It does not matter if you are 50 or 22. He said this is a funny piece. Your pediatric neurosurgeon, why dont you write a serious piece . I did. I wrote a piece about a girl who was basically saved by a blackhawk helicopter who got her to the hospital in birmingham. At the end, many years later, she has recovered. We did surgery. I will get letters from her parents. One day i get a letter from her and they tell me that shes getting married and i was invited to her wedding. She told me how grateful she was for the blackhawk pilots and for the er doctor at that hospital. For me, all i could think of was how grateful i was to her. It was my first year of practice. That piece went out. The first piece i had emails from friends who said that was funny. That i was a funny writer. The second piece i literally had almost 1000 emails from people around the world about how much hope it gave them. When i realized, the pandemic was starting to raise its head. It was moving from wuhan to italy. There was a lot of anxiety in society. I realize that maybe there was a place for all of the things that these children have taught me about grace and resilience, grief, joy, how they go together in your hands. There is Khalil Gibran who wrote about this. Christian wrote about this. Buddhist, they have wrote about this. Phenomenal. If you are standing with joy, do not forget sorrow is laying on your bed waiting for you. For me, it was really the opportunity to say that i think i am going 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 . I was a english major at the university of mississippi. I decided after doing both the premed track and english major track, i would go to medical school and be a Family Medicine dr. And i would write and get paid by patients about tomatoes and chicken. Thats really what i thought i would do. I remembered that every part of medical school is a anatomy lab. I went to the university of mississippi medical center. It really is a great medical center. I am proud of my time there. We really learned the anatomy. We really learned the physiology. When it was time to take care of patients, we were the ones taking care of patients. The time i got to duke, i had done more procedures and been involved with direct patient care than many other people. I say all of that to say that the anatomy lab, i remember dissecting this beautiful macrami series of nerves that come out of the spinal cord. That was it. I laid down the thought about being a family medical doctor and all the sudden i was in the brain and that was it. It took me 25 years to write it. Lets back up a bit. Pediatric neurosurgery is quite a specialty. How does one become one . How did you . A lot of my life is about the people i am exposed to. When i was on the pediatric rotation as a student, i fed the babies. My chief resident at the time said, no, if you feed the babies you will become a pediatrician. I can still remember this one baby and i wrote about this baby in the prologue. A lot of the other children had parents come see them but this one did not. This one was born addicted to crack. Had gotten through it but i did not feel like that child had any love in their life. I remember coming in early and i would feed the baby and hold the baby and i could look down and see the little sutures of where the bones come together. The little ridge. I remember feeling like i had so much love in my own life, i wanted to share some with that baby. I was already drawn to children. I tried to talk myself out of neurosurgery. I cannot tell you, hundreds of times. I love cardiology. I love vascular surgery. I had a hard time admitting to myself that i wanted to be a neurosurgeon. Every time i would walk by or 16, thats where neurosurgery did their work, i would look up through the window and see what they were doing. Not once, not twice, every single time. Finally i accepted a position at duke and went there. I had a great residency. A lot of it is a blur, i wish i took more notes, because that was a time that the metronomic existence were you go between joy and grief so quickly i meant toward, the second africanamerican neurosurgeon in our community, i wanted to be like him. He was a good person. A great surgeon. I remember saying to myself, if i could live a life like that where i help people, that would make me happy. As a pediatric neurosurgeon you approach lifeanddeath on a regular basis. How do you cope knowing that the patients lives are in your hands . I would like to say that we follow sir William Michael bevan asked. You keep the mass between yourself and the patients. This calm mask. I can tell you that i remember vividly my daughter being six years old, me being called in to operate on a sixyearold girl that had a brain tumor. Im sitting with that family and we are looking at the films. Were talking about the surgery i will do and trying to come up with the plan, its impossible for me not to connect with that person. Its impossible. Somehow it changes from the insufferable neurosurgeon looming over the patient and telling them that their child has a brain tumor and has to be taken out. Somehow it changed for me to one person sitting across from another person. To just talk about what we would do and sharing that moment and helping them understand that we would do the best we could do to help their child. That affected me early enough on, i think that i tried as much as i can to repeat that over and over again. The piece in garden and gun, was about it an eightyearold child who had a brain tumor that was similar to where i had to sit down with the family to talk to them about the end of an eight hour operation, im not back there with a tie on and telling them there was no bleeding and everything went fine. You are just three human beings sharing a moment where you are doing your best for the other group of people. We have all been in situations i have been frightening and stressful. Being in a few myself and from my time in healthcare, we take our cues from the doctor in the room. We talked about that a bit before this session. You are tell me about how you introduce yourselves to your young patients. Tell us about that . I like to introduce myself to the children first. As long as they are old enough. I do not do that to an infant. Hello, little infant. How are you . But, i do do that to any child over the age of five. I feel like five is the age they can communicate and understand that you are being a jokester. Do you go by, james . I am dr. Jay. Nice to meet you. Who do you have here with you . Who is this lady . Did she come with you . That is my mom, of course. Oh, your mom. Nice to meet you. Inevitably, that will turn to looking at what the child has. I am giving you clinic. It is calm. In that scenario, if the child has to be operated on it is typically elective. Its about that child being comfortable with what you will do. Its about the family being comfortable. It is a slower piece of the plan. Is very different when you are in the emergency room. In those scenarios, not only is there angst, but there is angst with a lot of grief. You have to recognize that what you are about to do, it is this persons worst time in their life. You will meet them and be the person, the last person they ever wanted to meet. Over the years i have definitely evolved to feeling like it is a really important time to instill grace into the conversation. That comes from more than just you. That comes from a higher power. Wherever that exists. If you like that is the time where grace is absolutely needed. It is a great time to step into the story a bit more now. Would you read a passage or two that is meaningful to you . I will start on page 1 and go to page 362. Let me see what do i want to read . 174. This is a story about a boy who within a very awful motorcycle accident, he was racing motorcycles i will read from this. Its called, lukes john. I had a lot of opportunities to speak to the family members about what happened at the setting. One of the things when you do a narrative nonfiction, its important to not write about to write about times that you were not there. You could become to start writing fiction if you do that. It is really important if you are writing about a place that you were not there when it first happened, but you get a firsthand account of what it was like. It is called, lukes john. On the third jump of the race, things went to. The dusty cloud, dirt bikes, finally came to a stop in front of the bleachers packed with eager and horrified parents. Giant floodlights dotted by swarming insects in the fall evening. It turned the desk into day. The spotlight chaotic scene in front of them. Slowly, one by one, they set up and waved to the crowd. Parents ran down relieved. Tentative laughter spread across the crowd. One boy, however, did not rise. Still on the truck, he is crumpled form unmoving. A pool of blood began to form under his head. Whose boy is that . Is that luke . The boy in the dust was indeed. He would not sit up again for quite some time. With the father watching from the bleachers, luke, 12, accelerated up the hill after gaining speed during his first and only time around the track. Just as the writers around him are doing. Someones will call another and the chaos began. The first bounce to earth, luke was thrown off the bike and his helmet flew off his head. The second bounce the handle bars pierced his skull and gouged out one inch of his brain on the left side. His dominant hemisphere were the areas of the brain for language and speech. More often than not, this is a nonsurvivable injury. The patient died at the scene. Lukes father rushing to his son side and pushing through the crowd, reflectively lifts the boy off the track and goes into the vehicle for a ride to the hospital. Essentially he had no spine injury, the most common reason for immobilization. After a quick head wrap, they stanched the bleeding. He emergently was sent to the ambulance for the page one out early notifying the teams of his arrival. We were there as the ambulance got him at the trauma bay. His father stepped out of the ambulance and walked briskly. I came down to the ed despite the presence there because i just finished well into the evening. Still in my first year of practice, i was eager to be involved from the beginning. Perhaps some of my residence will stay with me. My wife was a junior medical resident and destined to be chief resident some year later. She was often in the hospital overnight. There was no cozy dinner or interesting conversation beckoning me at home. I felt the familiar rush of adrenaline setting in as i walked to the ed. After i peaked under the hud rep, i quickly realized i would not be going home for the next several hours. I shifted gears. Once i glanced over the scan of the boys had showing the damage to his skull, i brought the father into the emergency consultation room to discuss the impending surgery. I also needed to get consent. The absence of consent to do the surgery when there is a parent present can be construed at battery, as odd as that sounds. It is critical to proceed. Back in the days of my residency, this conversation was way more about the consent of the connection and that would change for me forever on this night. I was standing for the conversation, as was the father. Our eyes the same height. He wore a goatee. His thin blue jean jacket was faded and his baseball hat, with dark hair underneath was matted with sweat. His eyes were red, face creased, concerned intensity began to set in. We found ourselves alone in the room. The lightbox held films showing the devastation to the boys school. I introduced myself by name as the pediatric neurosurgeon on call. As i did, his chin dropped to his chest. His hands covered 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. Thats what i would do now. Its what 95 of pediatric neurosurgeons would do now. Strike the balance. Compassionate focus. On to the work. I was yet to experience the lessons. Get the consent, get to the or. Very personal stories. Clearly made a Lasting Impact on you. We talked before about the responsibility going into these situations. They are life and death in some cases. Lets talk more about that. A doctor has to be at his best in all circumstances. The next patient that you operate on may not know that there was a difficult circumstance like that. How do you deal with that . How do you go from one room and into the next, ready to do what you need to do . There is definitely a reset at first. There is something important. I want to read this short piece. Its about as a neurosurgery resident, youre doing a seven year training program, youre not just learning to operate. Your learning to make decisions about taking care of patients. Youre also learning how to handle that existence that we were talking about. I want to read this part. In a single hour of being on call as a neurosurgical resident, you can set with another leak woman to tell her that the rain hemorrhage her husband of 50 years just suffered while shaving is not survivable. No surgery will change that. Just afterward, you could be called to the pediatric icu to give a drain to a fouryearold girl and watches as the child opens her eyes and squeezes her parents hands. In the span of one single hour those things can happen over and over again. In weeks, months, seven years, formal training, that job training, the part that deals with the important human truths forged at the unspoken places we navigate. It is never ending. For me, i have this greenfield that exists outside of my vision to the left. In the greenfield, it is a place i take difficult memories. We wrote about the glorious little girl who passed away, the one who came in behind that ultimately died with the type of tumor that chemotherapy is not good enough for her. Or a set of congenital twins that we separate emergently. One was dying and killing the other. They both died in the operating room. Those are important parts of who i am. I cannot let that blind me to where i need to go. The way i deal with that, i take that memory and i walk off into the green field. I walk past a lot of places where there are bumps in the earth and i go to a new place. I take the grass off the top and put the grass over the side and dig a hole. I take that memory and they put it in a box. I closed the box and i locked the box. I wrap a chain around the box. I locked that and put that in a whole. What did her on it in the grass back on and i put it back down. I stand for a moment with that memory so it is always with me. Then i will walk back in to normal life. I can access it when i need to. When i need to remember the Lessons Learned for that particular individual. I need it to be done in a way that does not paralyze me at times when we have to make decisions in the operating room to get things done to save a life. It was a french surgeon who sai