Doctor Alex Kofeman, Welcome back to the You Project, my friend.
It's great to see you again.
Look at you, mate, you look like you look very relaxed there. Tell everyone what you're wearing. It's like you've got a hoodie with no sleeves. Is that right?
Yeah, it's kind of a brisbee thing. I guess. I feel a little bit chilly in the morning, but my arms are free. I like it.
I just feel comfortable. Your arms are way too big for a neurosurgeon. I don't know that they need to be that big to hold a scalpel.
Now, I know that you're joking if you're telling me that my arms are too big coming from you, yeah, I'm not a surgeon. I like my arms. I like my arms and my legs free, like shorts, and this type of thing for me is the perfect outfit. That's why I like scrubs. They stop halfway down the arm. They're super comfortable. I wear scrubs consulting now in the room, not in theater, but just seeing patients in the room
as so comfortable. It's like wearing yoga yoga gear. I reckon and I asked the patience, what would you prefer me in a suit and a tie or scrubs, and I would say, like set ninety percent of people say scrubs, I look like who I say, I am?
Well, thank god for that. Having to put on a bloody suit all the time to have a conversation seems like an unnecessary pain that nobody needs.
No, that's so uncomfortable?
Is there much too? Like? And I know it varies wildly, but how many hours is a long surgery? Like not extreme, ridiculous, over the top rare, but what's just like a typical long ish surgery? How many hours? Now?
I would say, I reckon two hours would be long for me, rise of minor. Yeah, two hours. When I was training, the longest I did was eighteen but that was unusual. That depends on the surgeon and the case and how quick they are and how complex it is. But I have stood in theater eighteen hours during a case. I've done one myself that took I think twelve or fifteen hours, where that was just me doing it. But
they're the outliers. So for me now, in private practice, a typical spine case might take half an hour forty five minutes. A brain tumor might take about an hour to two hours. But this is for me, is the art form. For me, that's the bit I like about surgery is the is the efficiency Like for me, efficiency
is part of the process. Like that is the bit I actually really enjoy and the thing that will spark me off or make me unhappy or grumpy or whatever you might want it is when that process breaks down and then there's inefficiency or there's new variables being introduced into the theater. So I just love so I have. There's a couple of anethetists I have that are just the same. They're just super quick, the turnovers super fast. And then there's a scrub team I have that you're
just super slick and it's just beautiful. I love it when everything just moves without any fat on That for me is that's the most enjoyable part of it.
Do you reckon that and correct me if I get anything wrong. This is just my perception from the outside looking in that some surgeons can be perceived as being grumpy because there's such high stakes and you, I guess almost have to be a perfectionist of sorts, and so you want everything to be absolutely streamlined, perfect efficient, you know, as you said, no fat, and when that boat gets rocked a little bit, the emotional response might be disproportionate.
That's actually exactly it. So I worked with a guy down in Hobart who I would say had the worst case of white line fever. I have ever seen reasonably nice on the ward that he walked into theater and it was just like it was just something else. I mean, there were times when I thought that the CEE the hospital was going to come down and step in and tell him to leave. You know, it was just it
was just it was extraordinary. And I don't condone that sort of behavior, but I have started to understand where that behavior came from, and it was it's when someone threatened to introduce a new variable. So for him, surgery was all about eliminating variables, eliminating the unknown, and he
did that very well. And whenever someone came into theater and maybe gave him a different instrument or did something slightly different to him, that was a threat of the unknown, and then the unknown leads to problems and complications and issues further down the track. I had a personal example myself. It was a spine operation. There was a certain mallet that I was used to, and I put my hand out without looking, and then something landed in my hand
that I wasn't expecting. It wasn't the same weight, it wasn't the same size. It was just immediately different. I think it was smaller. And I went to go and tap, and then the reps just sort of joke, do you'll have to hit it a bit harder with that small one? And I looked up and I don't normally yell in theater. Actually I didn't yell, but I just I was very cross and made it very clear that that was not funny and not ideal, and I sort of was appreciating
what the guy in Hobut was doing. Is like they tried to introduce another variable. They don't understand the consequences of something going wrong. So yeah, the one I think that's the one thing.
The one thing I don't want my surgeon to be is grumpy or distracted or frust like. I want my surgeon to be calm as fuck. I want my surgeon to be in flow and happy and in his or her kind of little space where they just perform optimally. I don't want people handing them shit that they don't.
Want yeah, but there's an attitude, right, so you can take you can take a number of blows like it's like it's like a like a fighter. They could take a few puns and still perform at their maximum. But this is like that Swiss cheese model, like a little thing lines up with a little thing, which lines up with a little thing, and then you start to get bigger problems further down the track. So it's like nipping these small things in the bud right at the beginning.
That's what I do. The flows. But the flow start you talk about is just incredible. You know, forty five minutes can seem like five minutes. It's the most incredible feeling. Everything flows, you know, the scrub nurse just seems to know what you want to put out my hand and ask for it, you know, five seconds before I need it. And then the changeover is like an F one pit stop and everything. And starting an operation sometimes you just know that this is going to be a super sick operation.
There's something about the tissues, the way it looks under the microscope, the way people are feeling. You just know that this is going to be one of those great operations.
I did a podcast yesterday with doctor Denise Faness, who's a geneticist from Queensland and also a blow who you might have heard of from your also your home state, called Trevor Hendy and I was on I was on their show. I don't know if you've seen trev lately or no, but he's the full on He's awesome by the way, He's just like a big fucking six four love bunny. Anyway, we were talking about we're talking about
this getting in a state of flow. And I know, for me, if I've got to go and do my equivalent of an operation, which is to say, be in front of a big audience for say three to four hours where it's just me, like I'm there's no other speakers, there's no MC it's just the Craig Show for say four hours nine to one, and I've got to, you know, hopefully create this experience and this outcome. It really matters what I do before nine o'clock, Like it matters. It makes a you know, I can just rock up and
do my thing. And because I've done it so many times, I can rock up and I can just rely on skill and repetition and experience and runs on the board and I'll create a reasonably good outcome. But when I get my I don't know if this sounds like fucking mumbo jumbo to you and relating it to what you do, but I know that when I take five to fifteen minutes to get myself into a state I can't really describe, that's like almost this this sounds bullshitty, but transcendent, like
get out of my own bullshit. Just get out of my own you know, cognitive mayhem, and just get into this state of calm with really good intentions where I just want to do good things for good people and basically almost be a conduit where all this great stuff can happen through me. That sometimes, like you were talking about the flow state, sometimes at four hours is like
sixteen minutes. Do you have any ritual or preparation that you need to do mentally or emotionally or you just rock up and scrub up or something else.
That's a really good question. When I was training, I had something where I would training is like a baptism of fire. You're thrust into many sort of unfamiliar situations, which is why you're training. You're learning to do stuff. And I used to put the scrub and put my scrubs on and just stand there my eyes closed, hold my hands spread out so there was like my fingers were as far apart as possible. Relax my shoulders. That was a big thing, because the shoulder tension is a
big problem. Relax the shoulders, elbows by the sides, close my eyes and then just breathe deep and slow, and I try to get to twenty. And I really liked that because it calmed me down, but also it made me ignore the fear of somebody else walking into the theater and seeing me do this would look really, really weird. So if I just if I it just meant to ignore them, relax my shoulders, stretch out my hands and breathe deep, and do that. Just thinking about just doing that,
there was something really powerful about that. Every time I did that, I opened up my eyes and I just felt like I was a robot. I was just become I was just felt in control. I walked up those stairs. Everything was slow and deliberate, and I had a really good session in theater. Every single time. That always worked. And now it's just a matter of getting up in times. I'm not running late. So if I've tried to work. I drive up to work without it to rush. Then that puts me in a good spot.
Like one of my observations from working with elite athletes and I know that you are a pretty good athlete in your day as well, but working with elite footballers AFL teams and National Netball League teams and a bunch of Olympians, but mainly in the team space where players would be in the change room kind of talk and shit, and sometimes I would be in the change room, you know, the or the you know the wherever they are before they run out onto the court or ground or field,
and I would look at some of my athletes and think, man, there they're going to go no good today, Like they they're not their heads not in the right place, they're not focused, they're not angry enough, or they're not you know, serious or something. And then most times I was wrong because they would cross that metaphoric or literal white line
and that they would just switch on. And I saw this a lot with I work with a netball team called the Melbourne Vixens, who obviously are still in the National League, and that some of the girls were just all the women I should say were just so fucking incredible that they would be just so laid back and then step into the operating theater or their version of the operating theater and like complete tunnel vision focus. Don't fuck with me, get but it was like a switch.
It was like a switch, you know, to be able to step out of that and into something else instantly.
I have that under the microscope. Everything leading up to the microscope can be highly variable variable. There are levels of agitation depending on how efficient things are going. But as soon as the microscope is willed into place and I'm looking down at that is definitely a big switch for me. That's a happy place. It's my own world. I feel like I'm just in my own space and everything on the outside is completely gone. So that's my
white line is when microscope gets willed into place. There's something about that where I just feel in complete control, know what needs to be done, and I'm laser focused. So I think that's my version of running onto the field.
Yeah, And I guess when your eyes are pressed up against a microscope, you don't see anything at all except what you're meant to see, Like there's no peripheral anything, there's no distraction.
There's no total immersion.
Yes, yes, yeah, well, and then you go from all of those distractions to zero distractions when you press your eyes up against that thing.
Yeah. The only thing that can distract me is if your niece that is talking too much. And I've occasionally told them to be quiet.
Oh really, do you do you? I think I've asked you this before. I can't remember the answer. Do you do you ever have any music or anything going or No?
No, definitely not nor that if anyone's got any extra sounds going on, it gets killed straight away. There was a guy in Sydney I trained with incredible Cerabo Vaski, so he operated on blood vessels in the brain. He'd have Bob Dylan playing all day, old school Bob Dylan, scratchy, sort of high pitched sort of and it was loud, like you couldn't hear yourself think. And that was and he was doing all this complex, delicate blood vessel surgery. And I couldn't even just be in the theater and
watch him. I don't know how he was concentrating, but that was and without that he wasn't in his own I can't do noise.
I mean, that's the I mean that speaking of kind of you know, individual variability, and like the thing that would distract you puts him in the opposite state. Like the thing that you would find a distraction and a bother for him would be the thing that sharpens his focus and attention and perhaps puts him in that state of flow where he can perform at his best. So the same stimulus would make you worse than him better, isn't that fascinating?
Yeah? And man it was loud. I went there for a day to watch him for a couple of things, and I just got a headache just being in the theater listening to All Along the Watchtower for the third time.
The tambourine.
Man, oh god, nightmares of it.
Hey, so one of the one of the things that you started doing, which I fucking love. Hey everyone, if you don't follow Alex, and I'm guessing you don't, because he's got about seven followers, which is fucking tragic. So help a brother out, would you? So, Doctor d R Alex Kaufman, let me give you. So it's just Dr Alex A l e x ko e f m A
N Man, Doctor Alex Kaufeman. Go follow him on Instagram for God's sake, and not only because we want to pump up his rapidly depleting self esteem and give his ego a stroke, but because the shit that he's putting up is world class and he's yet to be discovered in this space, and I want people to find out about him. And so I have a watch like he's putting up these shorts, fascinating videos about mostly about the brain, but but what the brain does and consciousness, and you know,
I just love it. And I'm not saying that because I'm just sitting with him right now, but yeah, fascinating stuff. So what has that been fun for you? Because that's like, it's a creative process, but it's also I mean, there needs to be a fair bit of thought and planning and execution and a bit of editing and a bit of like what font will I use for this? Have you enjoyed doing something that is quite a departure from surgery? Surgery?
Man, I've loved it. This has been such an enjoyable process. I love everything about it. I love the idea, generating the idea. My favorite bit is probably the writing. The writing it. I would happily spend hours just trying to fit an idea into sixty seconds. I love it, that idea of distillation. Yeah, mainly because I did that when I was training in neurosurgery, taking all of neurosurgery and try to distill it down into the middle concepts. That's
how I understood and learnched neurosurgery. That whole process of distillation for me is that's that's the greatest experience for me. And so this is a similar process. I have sixty seconds which goes by in a flash to communicate an idea, and so I just love the challenge of writing those words as think, as possible, as precise, concise, that is just so it's so much fun. And then the shootings. Shooting has been learning a process, and the editing has
been a learning process. And then it's been fun just interacting with people. Was they sort of bounce stuff back at me when they after they watch it. That's kind of fun. But the writing process, by far is the most enjoyable.
I mean that, I guess one of the challenges is for you and for me with my research, like very different areas of course, well kind of intersex, like the brain, thinking, the mind, it's called in the same region kind of but like trying to take what can be very complicated information or ideas and then disseminate them in a way that's not only understandable to those of us who are not neurosurgeons or brain scientists, but also in a way that's maybe a bit funny and captivating that makes me
want to go watch another video or send the video to someone else to go watch this Like that is a that is a skill to go how do I share science in a way where it doesn't feel like I'm sharing science to the listener or to the viewer. Yeah.
I find that a challenging process because I you know this, I've tried something similar many times previously, and the biggest hurdle for me is I don't I just didn't really know what my voice was or who I was in a presentation sort of format. And I like how Jerry Sign describes it, and he says it's like a sculptor's process. You're a block of rock, and through your entire career, you're chipping away that rock to your true self. That's
his analogy. I think it's a really good analogy. And through this process of making the videos, I'm actually finding out what my voice is and what, you know, what's the sort of type of message I'm trying to communicate. Obviously, I'm not a comedian. I'm I'm you know, there's lots of things that I'm not, and it's really about just trying to work out what I am and the more
of it is that I do that. I feel like, you know, I'm I'm starting to sort of hack off chunks of rock off myself and get closer to my true voice and what actually works for me.
I reckon, you're an edutainer. That's what you are, the intersection of entertainment and education. Because it is like that. It is quite entertaining. And the fact that you so what I wanted to do is I want to I want to talk about a few and and encourage people to go and watch them. But give us a snapshot into some of the videos. I've got myself a little list here. I actually prepped. Can you believe I Craig Anthony Harper, who never preps. I prep. I did a
solid eight minutes. So you're welcome. So you and I both without knowing, watched the Tom Brady Roast if you haven't watched, well, I was going to recommend everyone watch it. You know what, if you're easily offended, definitely don't fucking watch it. But if you've got a thick skin and you're a bit you know, you're not a big politically correct kind of advocate, and you're not too presh, watch
the Tom Brady Roast. It's on Netflix. How the fuck they get away with the stuff they say is it is so far up the other end of the scale. It's hilarious and offensive. But Nicky Glasser or Glacier, who is a comedian, she did, she did, she did a spot, she did a she did about eight minutes of stand up just roasting the shit out of Tom Brady and
she was hilarious. And you did, you did a little vid talking about laugh You spoke about her, and then you said something like that laughter is a stress response. Can you explain that a little bit in a minute or two? Or is it a stress response? Maybe that's the question you were asking.
Is there is a good there's a number of people who think that laughter is a response to stress, right, And the theory being that there's lots of people have looked at the at humor and try to work it out like why do we laugh? You know? And other people try to dissect human because they want to be funny her or funny like a comedian. But there's some euroscience thinking that the laughter is just a way to relieve the pressure when you realize from that stress response
that there's no threats, there's no danger. So the classic one, and this is a classic human behavior walking along, someone jumps out at us and scares the hell out of us, and we jump back and it's a full, full stress response, and then we realize it's a joke, and the next thing we do is laugh, right, why do we do that?
And the stress response comes definitely comes from the hyperthalamous, like all the sympathetics originate from the hypothalamus, which is an incredible part of the brain, by the way, and so that that sort of does that automatic process. I remember this clearly. We were walking with Carli one day in the bush and I put my hand out and
stopped her without realizing what I was doing. It's completely subconscious, just stopped her and then I sort of see the snake about three meters in front of us going off the track. Like it's such an automated immediate protective response anyway. So when we see that there's no threat, then there's this sort of idea that's that's the way of releasing
relieving stress. But I also mentioned this brain tumor in the hypothalamus, that it's a rare one, but when people get it, their response is to control is to laugh uncontrollably, which is really bizarre. But it's in exactly the same spot on the brain, the hypothalamus. I don't know if we'll ever know exactly why we laugh, but that's probably one of the best theories.
What about I love the one that you did on You're talking about the way that our brain, our brain, which is kind of a one point or kilo or give or take three pound kind of lump that sits in our skull, and how it stays foot and how it doesn't really crash around inside our skull and we don't give ourselves CTU thirty five times a day. Explain why that happens. Explain yeah, how it's how it kind of protects it cell.
It's incredible. It's one point four kilos. It's floating in seawater, basically warm sea water. There's about one hundred and fifty mils of it. And that buoyancy reduces the effective weight from one point four kilos to about fifty grams. Like, that's incredibly powerful, and the spinal cord is the same. I can see it on a scan. Look at the scan of someone's neck or their back, and I can see the spinal cord running down and the fluid circuferentially
around the spinal cord nacts like a water cushion. So we're thrashing around, we're moving, we're falling, whatever we're doing, and it's basically like nature's air bag. So that buoyancy is just super super powerful. Like momentum of the brain, what's momentum mass times velocity, So it's effectively reduced the effective mass. That's a play. It's an incredibly powerful mechanism. And people who lose that fluid for whatever reason get
horrific headaches. That's one of the first thing, the first things they notice.
And so what is that, I mean, see salt water? What is it?
Like?
Literally like salt water, that's why. And it creates this buoyancy effect.
Yeah, it's got one hundred and fifty million miles of sody minutes. It's like almost exactly seawater just at body temperature. Wow, yeah, it's incredible. It's and then like the brain's got all these cuts and grooves and fishes and crevices in it as well. And I think that's another mechanism for protecting the brains. The brain's not just like a basketball like
one just solid lump of stuff. It's got all these crevices and grooves, which again further subdivides the brain up into smaller mass and gives it gives a water cushion to all different parts of the brain. And some really famous deep crevices in the brain that are filled with fluid. And there's all the smaller ones on the surface of
the brain that also act as a water cushion. It's just a really incredible mechanism for something so delicate, like during an operation, you only really appreciate being in the brain. Just how delicate actually is, Like with a sucker or a bipolar forcep the brain just gives way, It just
yields immediately, so soft and so delicate. Yet we do crazy stuff like you know people bungee jump or you know you see mma fighters do stuff or whatever it might be, or just even like normal day life, that brain should just be we should all be just like zombies. It should just be minced meat from moving around. But it just it's a testament to it's an incredible solution by nature. Float the brain in seawater.
You must look at like I was thinking as you were talking about the different ways that we impact our you know, like whether it's mma fighting or bungee jumping, but even in something like soccer, where you know, people literally hit this ball that's flying at a pretty rapid rate with their face, like when you're heading the ball, and you've been like kids start doing that at five, six,
seven years old. But do you do you kind of cringe when you see that or do you just think, well, that's just what happens now.
I cringe. I cringe at all head knocks in all sports. I don't know if you if you headed a soccer ball that's a hard hit.
Yeah, I have, but I'm yet not you know, probably five times in my life, which is probably five times too many. But do you think when it comes to CTE that there's a bit of genetic variability in terms of how much damage happens because it seems that some people, you know, there's no one that scaped escapes totally unscathed
when they've had kind of head trauma. But it seems like there are some people who, you know, sixty years of age and they played full contact sports from when they were eight to when they were thirty five, and cognitively they seem fine, and then there are other people who at forty you can tell there's a cognitive slide happening and maybe they didn't have the same level of trauma. So is there is a little bit about the genetics of the individual as well.
That probably is, but definitely a big factor is the type of trauma, there's no question about that. So head injury that involves a rotational component to where the head rotates rather than just sort of thick forwards and backwards, that's known to be particularly damaging, and there are a
number of reasons for that. One really interesting reason is that the white matter and the gray matter in the brain are different densities, and when the brain rotates as a rapetortional force, like being punched in the side of the face or falling in a twisting motion, the gray and the white matter accelerate and decelerate at slightly different rates, and so they get a shearing force between the gray and the white matter, but actually the white matter disconnect
and that is we call it the fusax on injury. But it's a devastating injury. So one rotational bad rotational injury can equal you know, twenty soccer balls to the head type thing, so that the mechanism is really powerful. As NFL guys, they can get sort of direct head contacts, but then you see them when they hit the ground and there's a real well hit from the side and their head is not only a whiplash, but it's got that real sharp rotational component to it. We know that's dangerous.
I saw a guy somebody sent me a clip of a guy getting wheel kicked in the head, always a great thing, will kicked in the head, and he was instantly unconscious on his feet, and then obviously when he fell to the ground, he didn't put his arms out
because he was already unconscious. And I had to look like I almost had to look through my fingers because I knew, well, one, he's already fucked right, He's just unconscious on his feet, and then he just falls to the ground, which was an even bigger impact because then he just smashed his head on the ground. I'm thinking just one of those, just that once, just one kick, one fall like that, that could be the end of someone's.
Life, right literally, So we call it a king hit, well probably most people call it a king hit, but a king hit in neurosurgery is a devastating brain Kids die from it. They come into into d fully intubated after a King hit. They have a horrific brain injury, and often they die. And there is is exactly as you said. They get so usually out like Saturday night,
everyone's drunk. Someone's drunk, someone comes up behind them. This is how it works, and so they don't see the assaultant come up hits him in the back of the head. So no defenses have been mobilized, so it's completely sort of an unarmed sort of type thing. And they're out conscious and so then gravity takes over and they hit the deck and normally you would break your fall, and you know, you'd break your wrist or something and try and break your fall, but there's there's nothing to break
the fall. They just do a pin drop to the ground and the head gets that second impact on the concrete and those brains, that brain in a young kid the injury is so severe that the brain just swells uncontrollably, and more often than not they die.
Well, you apart from being a a world class neurosurgeon, you also you were also a very good cricketer and you were looking at that as a potential career. So you would well know the David Hooks story. Of course, do you know that story? Yeah, he got king hit and that that's exactly what happened to him. You got hit by somebody from I think behind or the side, fell hit his head on the concrete and tragically, you know that was it. I mean, yeah, it happens all right.
On a brighter note, Let's go back to some of your bids. You did one which fascinated me. You were talking about all of the myriad of colors at Coachella, I think, and you see that magenta, what a so Magenta's like a purply color? I think? And you said, Magenta's not real, it's there is no color like it actually doesn't exist. We make it up. We make magenta up. And I think you said, in fact, we make did you say we make all colors up? But can you explain that.
It's super cool? So first with magenta. There's a wavelength for everything on the color spectrum that we see everything from, you know, from basically red to blue. So any color in amongst that it has a wavelength. There's a physical wavelength shooting through space and through the sky that hits the back of our eye, and the brain interprets that
Spiegel signal for that color. But between red and blue, when red and blue are simultaneously shot, there is the brain creates a color that doesn't exist on the color spectrum. If you shine white light on the prism int, it
will not show on the prism, Purple won't show. And it's an incredible, incredibly fascinating idea that the brain receives a wavelength of light that is red and a wavelength of light that is blue and creates a color that has never had a wavelength or existed in the physical universe. It's a pure invention of the human brain. It's an invention of biology. But there's nothing out there.
What about though, when I look at a dress that's magenta.
So and like they even TV's now the tricolor TVs. You know they're red, blue and green, or they are magenta, cyan and one other color now so, but again there's still just a combination. There's still just a combination of red and blue.
Wow. Wow, that's amazing it is.
And then every every color is every color is invented. I mean, this is the this is the real kicker. Like it's incredible. Really, it's these wavelengths of light hit the back of eye, it gets turned into an electrical signal. It's just an electrical spike. H and that travels along the optic nerve, the chias and the tract optic radiation. Then it gets to the visual cortex. It's all just electrical spikes. There's nothing more to it. And what's more
is that every color has the same electrical spike. It's an all or none principle. Every spike is exactly the same, and so there's train of identical electrical spikes arrive at the visual cortex, and that generates more electrical activity, and then at some point that electric activity turns into the spectrum of color that we appreciate around us. That's always been a fascination for me, that that gap between turning electricity into into into the into things we hear, see, feel, taste.
There's a there's a Nobel prize up for grabs if you can, if you can solve.
It, I'll look into it. I'll get back to you. I've got some stuff on but the weekend weekend job, Yeah, I'll do it on Sunday. I've got some time. Like when we talk about subjective experience and interpretation and personal reality and all of that, you know, it's like you and I get exposed to the same stimulus and we have a different experience. I think it's funny, you think it's offensive. Or I think this tastes amazing. You think the same thing tastes like dog shit.
You know?
Is that the same with color? Like I've got a yellow ball here can I oops? There we go like, yeah, so I've got a yellow ball that I just It's like I just squeeze it right, and I'm wondering. I'm holding it up everyone. I'm wondering if you and I see the like we both if I showed you, you'd probably say, yeah, that's yellow or maybe mustard or whatever. But I wonder if my version of yellow is exactly what you're seeing. Do you know what I mean? It's like the color that I recognize as blue or yellow
or orange. I wonder if you and there's no way of knowing, but I wonder if we're looking at the same thing in inverted commas.
Yeah, I wondered, And then extend that to the animal kingdom, like how do they see the world?
Yeah?
Yeah, like is like for a dog, for example, is the world coherent or is it just utter chaos? From how they see the world, it's just total chaos, just finding their way through.
Probably varies from breed to breed. All right, another one I wanted to talk to you about.
You were you go? That's that's a that's a that's a really great point. So what you raised there, that's the other mind's problem. That is a massive problem in euroscience. I will never be able to get inside your head and see what the world looks like from your point of view. That's one of the big barriers to try to work all this out. Everything else in research, you can access it, get inside it, look at break it down,
destruct it, reconstruct it, work out what's going on. But I will never ever be able to hack into your brain and see the world from your point of view. In fact, I don't even know if you're even conscious. I can't even prove that you can't prove it I'm conscious, but that that other mind's problem is one of the biggest hurdles for us understanding the human brain and.
Also understanding you know, what we call colloquially the mind, right is trying to like that's why psychology and this is coming from someone doing a PhD in psychology. I mean, it's such a fucking slippery slope because it is, you know, at least with the brain, you can see stuff, measure it, literally, quantify things, poke it, card it, dissect it, look at it under a microscope. You can't with the mind. And then you try, you know, it's like I go, I'm happy,
and you say you're happy. We could be talking about totally different things, you know. Or I get you to do a you know, some kind of self assessment, you know, on Monday morning at nine o'clock and we get certain data, and then you do the same I get you to do the same assessment Friday afternoon, and the same guy doing the same assessment gives us totally different data. That's why, yeah, exactly, that the whole subjective reality of the individual. It's a very slippery construct.
We can't even do with the brain though, I actually can't really measure the brain. All we do in neuroscience and neurosurgery, all we've ever done is wait for it to break, then see what part is broken, and then see what the patient looks like. That's how it's always been. So whether they've had a starts off with head injury. I was like, I's got a bullet this part of his brain. He's still awake, but he can't do this, and so then it was assumed that part of the
brain must have something to do with this. That's all it's ever been. We've never there's never been anything more advanced than essentially studying the injured brain, whether it's trauma or tumor, or some blood vessel problem or a stroke, and then working backwards.
Well, I mean, yeah, nobody's having surgery when their brain's perfect and healthy. What you also did another one that I loved about talking about the difference between being under a general anesthetic called being like I don't know what do you call that? Unconscious like and sleep and how you know, when I wake up in the morning, I feel like I've had eight hours sleep. But if I had an eight hour operation, I'd feel like I got put under one minute ago, Like, talk to us about that.
The evaporation of time.
It's a complete obliteration of time. I love it every time in the theater. He needs to just get sick of me talking about this. I'm like, do you just realize what you've just done. They're putting that patient to sleep, and like, what, You've just disconnected their brain from consciousness. That is where the magic is, that connection between the brain and conscious You have literally just disconnected them at that critical point. What have you done? How did you do that?
Well?
I don't know. It just gave them the drugs.
Wow. But I love intelligent anesthetis or shit.
I've got patients who like, I'm going to resist this anesthetic. I'm going to count and I'm going to stay awake for as long as possible. And they're great, they go, you just even go ten, nine, eight, set, sit, and then they're gone, yes, And then the magic happens somewhere. That propofile, that that white milky drug that we give them HiT's right at the target and disconnects and nothing else disconnects. I mean, obviously a whack to the head
does and things like that. But you know, such an incredible thing you have ten thousand people in the stadium. Consciousness is not there's no distortions like a Wi Fi signal or anything like that. It's it's just one hundred percent pure strong signal of that connection between the physical
brain and the non physical consciousness. The signals one hundred percent and it's always there unless you're dead or we have a journal anesthetic and there's just something very magical about that that is hitting at that gap between the physical and the non physical, and it is it's a complete obliteration of time. You sleep, like even a deep sleep, you feel like, oh, you know, that was a good sleep,
and you wake up and feel refreshed. Sure it doesn't feel like sitting around waiting for something for eight hours, but you sort of have a general sense that time has passed. And you might sort of have the general vague awareness during the sleep perhaps or maybe you dream, but with a general anti it is a complete obliteration of time. It is literally like that, go to sleep and bang your wake up. It's just gone.
It's like you're it's like you're pulling out the plug on an appliance and the appliance might not be turned on, but it's still connected to the power. And then but when you this is a terrible analogy, so correct me. But then like when you go under general anesthetic, like you're not connected to anything, there is no there's no energy in or out or no no connection.
It's just super bizarre. It's so bizarre. And I can spend two hours doing an operation and looking at the just looking at the brain. It looks exactly the same as if someone's awaken. I've done an operation with a patient awaken, I've done them under a general anesthetic, and the brain looks exactly the same, exactly the same. It's pulsing away, it looks the same color, it's got the same consistency. So what's different, Like what's actually been switched off?
Where is that switch that that propofol is actually done? I don't know who knows.
That's so amazing, and so nobody I know the answer to this. But I'm just double. So nobody ever dreams in surgery. Nobody ever wakes up and says I had a dream.
Never, There's some people like that the anesthetic doesn't work for whatever reason, so that switch doesn't get flicked, And like there's those horror stories. I was awake during my entire operation, but I couldn't move because of the paralysis drugs.
Fuck that.
And then there's some people have a theory, well, actually we're all we're all awake during anesthetic. All it does is just wipe our memory, so we just don't remember it. So whenever we have an operation, we're all skin and screaming in an agony. But then somehow it wipes our brain when we wake up, so we never remember the pain. I don't think that's a good theory.
You told you told a story in one of your reels about thirty four year old lady named Chloe who had a grain a brain tumor that grew I think, very slowly, but it ended up being a big brain tumor. But she didn't have like she had only minor headaches despite this fucking massive tumor. Why is that? Why wasn't she an excruciating pain?
Yeah, it's really interesting. We call it the cliff face. If something grows really slowly, the brain can adapt and if it goes super slowly and get really massive and push the brain right over to the other side of the head literally, And in this case, that's what happened to her, but it was okay because the tumor grew millimeters per year, and so the brain just would adapt to the pressure and adapt to the pressure and adapt
to the pressure and adapt to the pressure. And it's a hallmark of benign pathology when it gets super large and they're relatively well as opposed to cancer, which goes really fast, and so usually pick up cancer as a much smaller size because because it grows so fast, the brain just can't adapt to the rapid growth and it starts reacting straight away and really early on in the piece.
So she had this massive tumor, a benign tumor, but the cliff face and that is basically that is when the brain suddenly stops adapting it it runs out of its reserves. It's adapted. It's adapt that is adapted a bit like the straw that breaks the camel's back, right, and then it just runs out and people crash and burn really quickly. And that was the risk with her. So she was well that she was getting close to
that cliff face. You never know exactly where it's going to be, but you know it's coming and they're getting close.
How big was that like? Give us like compared to say a golf ball, one golf ball, half a golf ball, two gogars.
No, we're talking like a mango. Really yeah, and like you know a mango inside that is huge, like it took up it took I would say it took up about fifth nearly a quarter of her crani or space.
And how this is a dumb question, but how do you get that tumor out? Does it? Is it sucked out? Is it? Do you? I don't know how. I mean, I know this is a much more complicated than my very lame question, but yeah, how do you get it out?
There's this beautiful instrument, so I don't use a scalpel. I use the scalpel on the skin and then I never used the scalpel ever again during the operation, which is strange. Everyone thinks it's all scalpel. Yeah. There's something called accuser CUSA, which stands for uh cavetron ultrasonic aspirate. Essentially, it's like holding a pen and the tip of it vibrates at a very high frequency which shatters the tissue at its tip, and then after shattering the tissue, it
then suck the tissue up. So basically fragments a solid object and it's just beautiful and you can change the setting. And so basically I just hollow out the center of the tumor. It's like it's called a witch's caldron technique. Hollow out the center of the tumor using the cavetron and just get it so it's all hollowed out, and then collapse the capsule of the tumor in on itself
away from the brain. So you turn a solid lump into a witch's caldron, which is essentially an empty vessel, and the wall of the thing is now the capsule of the tumor. And then that's when I start collapsing the wall of the tumor in on itself and dissecting it away from the brain.
Oh my god, Oh my god. Your job is the fucking weirdest job, the most terrifying job. How long before again this could be a night naive question, but how long before that cavity, that space that you've just created with the removal of the tumor gets for one of a better term, reinhabited by the brain, that gets filled up again, or does it? Or is there a permanent kind of spare room in there.
I've seen her scan four years later, and I would say ninety percent of that space the brain has re expanded, like the brain almost always reexpands, but there is always some evidence that there has been something there. So there's a there's a gliotic cavity or a cavity lined by scar tissue. So it's never one hundred percent. I would say that her cavity is it would be the size of a ping pong ball something like that. That's something small.
Why do Why did benign tumors grow? What are they made of? I feel like they're made of fat or something. What are they made of?
You can get light pomer, like a liightpomer is a fat tumor in the brain, but hers was basically collagen fiber. Wow, it's like fiberglasts and lots and lots of college and so it's a really fibrous, fleshy type tumor metastasis like a lung met to the brain or breast smetastas to the brain. That's really what we call psychomatists, which is another word for saying a fleshy tumor, And that's mainly just all cells that under a microscope. It's just a whole heap of cells stacked on top of each other,
and it's really fleshy like liver. Basically, they come out really easily, but meningioma is a really fibrous, dense tumor. It takes a while to hollow those things out. This is his typathology man all pathology. As part of our exam, look at a slide and say what tumors is based on looking at the cells and the structure. It's the thing we learned last.
Do you do you ever get you know, when you're just about like is there a This is a weird question, but do you enjoy it? Like when you're getting rid of that shit and you're basically healing this person or at least opening a doorway to healing for this person. Does it give you joy in the moment or are you just too caught up in the focus and the process to enjoy it.
Not thinking about the patient at all, not once to even think of their face, remember talking to them. It's just purely a game of biological chess. So that is it's a goal to be achieved, and I absolutely love the challenge of doing that, of using a surgical technique, whatever that technique might be, to get that thing out without causing a problem. And that's just how I see it.
Now when said that, When you just said that, I'm not thinking of the patient at all. Some people are like, oh, he's a fucking sociopath. Tell us why you're not a sociopath.
Well, it'd be like you saying bolt after all that training at the one hundred meters the Olympics final, looking across and feeling sorry for or worrying about how the other guys are going, Are you okay? Are you going to be all right? You know you want me to slad whatever. He's not thinking about that, he's thinking about he's thinking about the squad is about the push off the gun, you know, the first ten meters and then getting upright, and then it's about an execution of a
skill that gives the best results. So in surgery, it's an execution of a of a of a technique or a skill that leads to the best results. So if you're thinking about the patients, it's actually it actually puts you off your game. And maybe some surgeons do, but you know I certainly don't. And all the great ones that I trained with, certainly don't. It's very much about executing plan and that's all all the focus.
Is whatever you need to do to get the best result. That's what I think. Like and I think, yeah, maybe because I'm an mpath, right, I'd be a terrible surgeon for more reasons than that. But I'd be a terrible surgeon. But I think that, which is not to say you don't care. I know you care because I know how you. I know how you liaise with your patients and meet with your patients.
Know that.
But I guess in that moment, if you were worried or you know, you were feeling certain feelings about the patient, that's taking away from your focus and therefore from the execution of what needs to be done.
I guess absolutely. But that's that's it's a very different game before the operation and after the operation. Sitting in the room, talking to them in my room, it's it's a it's a complete opposite. I'm talking to them as if they are my family.
Yeah.
Yeah, And they always asked me like if I was your dad or your mum, what would you do? Yes, So before the before and after the operation is exactly it's the exact opposite, Like I'm talking to them as if they are family, Like I look at them and go, if that was my dad or my mum, what would I want them to have done? Yes, So it's all I'm thinking about is them and their quality of life. I'm always struck. I'm always struck after just say the
simplest operation, I do a micro diskectomy. It might take me fifteen twenty minutes, no sweat, routine operation, and I ring up the family and go Dlex here, I've just reading to let you know I finished the operation. It's all gone well, and the wife or the husband or the daughter or the whatever on the phone. The relief that comes off their shoulders is completely disproportionate to what I feel like I have just done. But what I feel like I've done is it's been a walk in
the park and super easy. And for them, it's like they've just had this incredible weight on their shoulders worrying about this operation. And I really like that because it just reminds me about the human side of what's going on here. Like, yes, it is an operation, but ultimately it's about someone's life. And when you're talking about their health it's a huge thing and you don't really fully appreciate it, I suppose to until you're a patient. In fact.
Henry Marsh is a neurosurgeon in the UK who has just written his last book. He's an eminent neurosurgeon, and his last book he talks about having prostate cancer and the idea of going from being a surgeon and the apex predator in a hospital basically to being the prostate guy in bed seven and feeling what it's like to suddenly just be nothing, irrelevant and just a patient, not even by naming he's the prostate cancer guy in seven and that is just the sense of inevitability, the sense
of almost not being even human. I found that really quite an interesting insight from a surgeon who's subsequently become a patient. And I've just made it my goal never to make someone feel like that because happening to you and even like, you know, one of my parents had surgery and you just realize what it's like on the other side of the fence. You know, it's it's that's your mum. It's like that's everything you've lived with him
in your entire life. And I get that. I didn't get it at the start of my career, but I definitely get that now, so I have a good balance now before and after. It's it's all about the patient, their life and everything that they represent during the operation. It's it's you know, it's it's a game of biological chests and pure focus.
Mate. I've got another ten things on my list. I think we might have to come back next week and do another one. So doctor Alex kofeman ko e f m A n on in to go follow him, give him, give him a little bit of love and as always, enlightening, informative, great edutainment by you and we will. I'm coming to Brisbane soon, by the way, I'm coming to hang on checks whiteboard July twenty five, so you and I'll have to do dinner and we'll get together. Put it in
your diary. Probably I'll be on July twenty five. I'm up July twenty five, doing a corporate gig on on the twenty sixth, but I'm doing a public workshop on the twenty fifth, by the way, Brizzy people. That'll be announced soon, so booking only twenty people. Private workshop called Stop Wasting Your Potential. Alex might come and do a cameo. Who the fuck knows, but you and I will definitely have to do food, coffee and spooning on the couch.
Yep, you be wearing those cargo shorts, so you gotta WACKPD some jeans fore you get a effort.
I'll be wearing some spandex and yeah, no, of course I'll be in mate. I don't have any other clothes. I'm all about function, All about function. Thanks mate, Thanks Craig.
There's awesome mate thinking