Well, good a team. Welcome to another episode of the You Project. It's Fatty Harps. It's Craig Anthony Harper's Sunday morning in the thriving Metropolis. It's thirteen minutes past nine and one of my friends. We're friends now. We used to be acquaintances. We knew each other a little bit. Now we've hung out a bit, We've we've dined together, We've spent time together, We've shared kaffeene together and stories together. He helps me and I help him periodically. Doctor Alex,
welcome back to the show, my friend. How are you?
I'm great, It's really great to see you. It's great to talk again.
It's good to see you, mate. What's going on? Is there anything before we dive in? I want to talk to you about. I actually want to have a proper grown up podcast today about neurosurgery, the profession and the practice and the science and the development of it and all that, because I think it's obviously it's interesting fast. It's day to day for you, but it's interesting fast. But other than that, what's going on? How's marriage? How's married life? Be? Still married? By the way, because I
went to your wedding, I haven't checked in. Still good, there's still good there. Yes, I don't know. No one would have seen the photos. But you turned up for the first time I've seen in a suit and a tie, and I didn't recognize you to start off with. In fact, you look like the biggest, baddest bouncer I've ever had at any wedding or ever seen at any wedding. There's a good look for you.
You look at what the agents out of the matrix. Yeah.
Well, I do get asked for directions or people ask me questions when I turn up at things in a suit because they one think I'm on staff in some capacity. So that shows you how much you're loved, because I'm not putting on a suit for fucking anyone generally, especially not for under ten thousand dollars. But I did it for you, and you know, so that's a sign of my devotion and love.
It was greatly appreciated. Hups. It was a good day. Great and Carlie's great. She's at work at the moment at the kids hospital. That's the way it is. That we had a wedding yesterday to go to and I was there on my own because Carli had a shift, and so there's a bit of ships in the night sort of vibe with everything. But it's also great having somebody else who's in the surgical fraternity because the nuances of stuff that happens, you don't need to describe the background.
You can just dive into it and unload and the other person will immediately get it. But then again, also there's no sympathy. So if Carli's got something on her mind and I've been through it like ten times, then she gets no sympathy. I'm just like, yeah, that's the way it is, get over it.
Yeah, and that's going to happen and keep happening. Yep, move on.
And then I get no sympathy because she's tired or she's been through it ten times. But it's great. It's a really interesting dynamic. Obviously, female and pursuing a career is it's quite a it's a difficult topic because it's a you know, when it comes to family and children,
females have a different experience than the guy. They've got a certain time frame and there's always that pressure, that biological pressure about family, and then certainly in recent times there's this huge pressure for career as well, I feel it really feels like that, and and it's great because a career is very stimulating, very fulfilling, engaging, and it
goes beyond. You know, a kid can leave at the age of beteen from home and then what he left with, but a career stays with you until the day you retire. So's that's an interesting balancing act. We've had a couple of conversations about it, and we haven't resolved it. And I have lots of conversations with patients and other and other colleagues in the specialty about this. I was talking to people at the wedding last night about this because
it's quite a it's an unresolved and unresolved issue. We haven't we haven't worked out but both loving the career highly stimulating.
What is the issue, like, is the issue we're gonna have kids? Or are we? Or when are we? Or it's because it's kind of not fair that the women have to do that, right, Like, there's no other option, is there? No?
They get that that's a much bigger deal. I mean, obviously it has a huge effect on their body and their time. You know, they've got to have maternity leave and go through all of that, and then that's a big chunk out of training like that. You know, take three or six months off from a training program to do that.
And when you say you mean medical training, you don't mean the gym, right, or do you mean the gym?
Yeah, like surgical training training to become a surgeon, which is you know, six or seven years, so you've got to take time off during that. And then you know, it's a really tough gig being a mum. How do you know, then be a mom to a young child and push extremely hard career wise, that that's a really difficult. A lot of people have nannies and family around to help with that, and I don't know if if you can do both perfectly. I actually don't know how somebody balances.
I know some surgeons you've got several kids and they have two or three nannies and that's almost the only way that it works, someone there during the day to look after the kids. Anyway, haven't We haven't cracked this code yet.
So just tell people what because obviously I don't think you tell us specifically what Kylie's doing. So she's a doctor, of course, and she's doing her training to become a surgeon. Is that it.
Yeah, she's finished med school, so she's a doctor. She's done her required years in the hospital general training you have to do before you can apply to get on the surgical training program. You have to do the general the surgical training program to be a qualified consultant, right, And so she's going to apply for that next year. So she's at the start of the of the process of the actual official training program, which will be six years.
So and that's in pediatric surgery, which he loves and really enjoys a job and is really good at it. But there's lots of decisions coming up. Will stand by, will stand by, But lots of people were listening, would would have you know something similar like if it doesn't have to be medicinal surgery. They're having family and all sorts of careers in facing the same issues, and it's incredibly difficult. But it's an ongoing conversation.
Is there a particular personality or type that is more likely to become a surgeon or is it not at all unrelated?
There's definitely a good aptitude for surgery. You can just look at someone and say they've just got a good aptitude for it. They get the anatomy, they get the physicality of surgery. They're efficient, they're a decision maker. That's really important. They can make a decision. And there's also
the attitude of dealing with people. I didn't realize this how important that was, but in a hospital you may not know it, but there are a whole spread of personalities from toxic personality to you know, to someone who's quite pleasant, and that's very, very difficult to deal I mean, you can have an okay day at work and just your day is ruined by toxic personality, a clash with another consultant or someone in ICU or in theater. That was a problem to deal with personality wise. I don't know.
I just I always just wanted to do surgery. There was just no there was no plan B. So it was very driven. I guess Klie is very driven, and I don't know. Perhaps why do you do what you do? Do you think you've got a specific personality for talking to people? I don't know. This is a really important issue because selecting surgeons, you have to do. The interview is a big part of the process. You've got a c you've got referees, and then you have to sit down at an interview and for me, there were six
spots out of all of Australia. How do you pick six people to get on the training program? And you ask a series of questions and trying to get to know these people, and then you just base it off those responses. So it's actually really tricky to pick the right person. And there's ongoing research and what are the right questions, what's the right way to sort out these people and find who has got the right aptitude or surgery And then often they said that fails and then
the surgical training program becomes the screening. So they go through the training and then they are that they will thrive all they'll struggle, and if they're struggling, then that becomes a sign that tough conversations need to be had because.
It's I think it's from the outside looking in, it's like, obviously you need you know, you need to be intelligent, you need a great understanding of an anime in physiology and all that, all the skills and all the science or the knowledge. Then you need to be able to have I would think extreme an extreme ability to focus and concentrate and be present and not distracted. Then you need goods social skills to be able to lead a team and communicate and not piss people off and not
get pissed off. And then you need to be able to self regulate in the middle of fucking chaos so you're not losing your shit. And then you need to be physically, mentally and emotionally healthy yourself so you know. And then you need to have good leadership skills. And then you need to be a high level problem solver, because surgery in some ways is problem solving in real time, and it's like this fucking collision of a million different variables that all matter.
And it's not like sport, where you are great when you're young and you've identified yourself as good at sport, and then you go down this pathway and you just get better and better at what you've already demonstrated you're good at this. You kind of don't really know that you're good at it until you've gone through the whole process and you start, and even not until you're halfway through the process do you realize if you're any good at it.
It's so true about how many people study mate and then like even the people that I did one hundred years ago when I did my first degree. People who studied physic or human movement or whatever we want to call it, exercise science, and they go through the whole thing and then at the end of it they go, oh,
I want to do this at all. And they never spend one day writing one exercise program or prescribing anything for anyone, but they do the whole thing, and or they go and do a bit of work experience, or they start to work in the industry or with a sporting club. And then the amount of people I've seen that I went to UNI with who are still working in the space of exercise science, it's probably less than five percent twenty years after they did their degree, Like very minimal.
It doesn't surprise me. I'll see that in surgery people get halfway through and they decide to go down at a completely different route. They go and do radiology or general practice, or go into business or admin. And that's tough, isn't You did that whole You go through meta school and half of a training program and then decide this is not for you.
Do you think that I think for some people that it's just the emotional and psychological cost where you just you get to a point where and I think it's okay. I don't think it's weakness or bad. I don't think it's a flaw. I think it's just a realization. Like, if I'm being honest, there's been twenty six times in my PhD where I've said to myself and that's only a PhD, that's not all the shit that you've done, right,
I'm like, is this worth it? Like this is so hard and so much and I go, you know, where you weigh it up? And there's been a bunch of times where I thought I didn't need to do this, you know, and for whatever reason, I keep doing it.
But I can understand, like the amount of people who start a PhD and drop out is something like eighty percent, Like it's very high number the people who don't complete their PhD. And I'm thinking, with what you do it, that's you know, my experience, yours would be time was twenty five in terms of how difficult it is to get where you got. I just think that people just weigh it up and go, could I get through? Probably? Maybe?
But is it worth it? No? Because I'm fucking miserable, I'm anxious, I don't sleep, I'm stressed, my health suffering, So I think that you know that probably eliminates people naturally anyway, that way, it's.
One hundred percent through. The drive is really important. You've got to have that inner drive to do surgery because that's what gets you through. You will get you over the hurdles that you inevitably will face. If you're doing it for any other reason than you want to do it, You're going to struggle and probably go in a different direction given enough hurdles. And that certainly was my drive
since year ten. That was all I wanted to do, and I had plenty of hurdles, but each hurdle was just an excuse to hit harder and jump higher type thing. And if you didn't have that, you would certainly give up. It's probably a weird question, but could you? And I know there's no typical day, but one of the things I say to my clients or back in the day, especially when someone would come to me, I'd say, walk me through a typical day of you, and by that
I mean sleep, food, exercise. You know, are you sitting for four hours a day? So can you walk us through a typical day of being and we don't need your breakfast and your dinner. But the neurosurgery stuff, like what's a typical day, And I know it varies broadly, but of neurosurgery, like on the days that you're working, do you do you do one up a day, four ops a day. I know it varies wildly, but can
you give us a snapshot into the day of a neurosurgeon. Yeah, I get up at three thirty, go to the gym, I come home and I meditates and then I read my natomy text.
Though you're a fucking idiot. We know that's not true.
Mark Woolberg sort of schedule, which I think is day of rubbish. A typical day like Friday is one of my operating days. He's a classic day. So the theaterist starts at eight, and I'm there at ten to eight, and I'm in theater by eight and I've got my walk in there and you can tell it's going to be a great day. The anesiis that I love is there. The scrub nurse that I love is there, the assistant that is my favorite. You've got the whole team there.
He's got a good vibe straight away. And then the patients in the anesthetic bay, I go and have a chat with them, they sign their consent form and then we're off. And the first case on Friday was a spinal tumor, and so I sit down and look at the scan and just rehearse what I'm going to do. And I'm looking at the scan in terms of the anatomy, so landmarks that I'll be looking for and what I'm going to try and what I want to recognize when I get in there to guide me where I'm going.
And then also looking at the scan for things that are going to trip me or potentially that can cause a complication and how I'm going to avoid that. So that's review that for a good twenty minutes or so, and then a typical day could be anywhere between four and I've done up to seven cases in a day, depending on the anisthetus and the team and hospital beds. And it's I love the efficiency of surgery. And I watched my guy down in Hobart operate and that's where
I got that from. Incredibly efficient in terms of all of his movements and starting doing the operation, closing up, wrapping up, and then my aniesthetus is very efficient as well. So the turnover can be quick because don't forget. If you do five cases, that's about you know, that's four turnover times. And so if the anesthas is fast, that's half an hour per turnover time, so that's two hours
extra added to the operating time. Or if they're not as quick and it's an hour, that's an extra four hours of the day added just sitting around waiting for the anesthetus to do their things. So there's that element. I think I've got five cases. They will take me forty minutes each, will be done by two o'clock, and then you've got to add in the anesthetic time, which is four hours, so actually we'll be done at eight o'clock. Wow. Yeah. But the theater days, it's the best part of it.
I do a lot of consulting, sitting at the desk and talking to patients and that's becoming a more rewarding process as well. And that would typically start at nine o'clock and finish around about round four seeing new patients going and I love the education side of things. I'm talking to them about their problem, trying to identify what their problem is. That's really really key often it's not straight up obvious what it is that they want to
talk about. And so finding that getting expectations sorted out that's really really key. Expectations. They need to need to be on the same page otherwise that causes real problem. So finding that I love the education side of things, showing them the scan, showing them what's wrong. People love to see that there is something wrong. It's very common that they say, oh, you know what, I actually thought I was going crazy. There's actually something wrong with me. Yes,
very And I take video of surgery. I've got this video app that I've called Surgery TV, which I've developed over the last two years with a colleague, and in fact, we just we just got awarded a government grant for this video app. It was about eighty six thousand dollars, which is just great in terms of us being able
to push it further. But essentially, what it does is allow me to record the video of every operation I do, which it always do, but it takes about you can take you about forty minutes to download a video of each operation onto a USB and then you've got to do something with it. With this app that we've designed, it goes from the microscope straight to my iPhone ready
to go. So it's an automated process. So now I have a video of everyone's surgery for everyone that I do, and I give it to them to the patient the following morning, and again I've told them about an operation, they've consented for an operation, they've had the operation, and then the following morning, after their operation, I showed them the video of the problem and me fixing the problem. And they still say, oh, that was so good to see.
There's actually something wrong with me. I wasn't going crazy. Yes you must have. I mean you're still possibly there was something you thought you were crazy.
You know what I love about that? That shows that you have absolute confidence in what you do to be able to record, to record that and then say here's the video. A lot of surgeons would not do that, is my guess.
Well, that is a very good point that you raise. Patients say a couple of things about the video, and one of them is exactly that, Well, if you're confident enough to record the operation, then I'm confident in you doing the operation. But I look at it like this, if you don't have a video of surgery, the surgeon stuffed up if you do have a video of surgery, it was a difficult case, just say there's a complication. Surgeons say I don't want a complication recorded on video. Well,
surgeons are rarely negligent. In fact, they're almost never negligent. It's just bad luck or the case was just very very difficult, And you can't say that. You can't say the case was difficult, or it was bad luck, or there was this you know, this anatomical variation. You can write it at an opropose, but it's just very difficult to communicate that because you're you're contrasting that to an outcome that's not ideal, and that's blank and white. So
it's sort of good evidence. So I say, well, you know, without a video, basically people just think that you stuffed up. With a video, people will see that it was just it was bad luck or it was a difficult case. So the video is actually protective.
Amazing. How often do you get in there? And I would imagine the answer is not much. But so you've got all the stuff that you need to see and analyze beforehand, do you ever get in there and you're surprised, like, oh, I didn't think this would be here, or I expect.
That, not surprised about the location of something. I know to a millimeter where something is going to be because you can tell on the scan. The MRI scan is high resolution imaging, so I know exactly where something is going to be. What can be a surprise is what that thing is made of, or how stuck it is, or how adherent it is to different structures. That's the only real surprise. Like the spinal timber, for example, I knew to a millimeter where the top of the bottom
of that, where the lateral the medial margin was. What I was unsure about is what it was actually going to look and feel like. Was it going to be soft and gelatinous and come out easy. Was it going to be tough and fibrous where it's going to be a bit more difficult to take out. So it's difficult to judge what something is going to be. Consistency of the stuff is going to be like, which is makes a huge impact on how you deal with it. If
something soft and gelatinous, that's quite easy to remove. If it's fibrous and densely adherent to stuff, and that's a lot more difficult to remove. So that's the unknown.
I never thought of that. So when you're cutting out something that's soft and gooey versus something that's tougher and more fibrous and dense, do you use the exact same tool, the exact same scalpel or whatever, or is it? There are a bunch of you go no, this is like removing an old bit of leather boots.
So we use something different. There's something different. This tumor on Friday was soft into latinous. So the tumor has a capsule which has possibly got nerve fibers running through the capsule, so you have to preserve the capsule. So I make a linear cut through the capsule, which is like half a millimeter thick, and it springs open and reveals the sort of soft latinous tumor underneath.
Sin.
As I see that, I know this is going to go well. And there's a curet that's a bit spoon shaped, and I essentially slide it between the tumor and the capsule, and it's like scooping out a pee out of a pod, almost, and I just gently separate it and gently separated and gently free it up. There's a couple of places where it's densely adherent, and there's a micro scissor. It's beautiful micro scissor and that's used to divide where it's densely adherent and then it comes out comes out quite nicely.
If it's more fibrous. We've got this beautiful machine called a CUSA CUSA which stands for Cavetron Ultrasonic aspirator. It's brilliant. It's this fine tip and it uses I think it's an ultrasonic wave to fracture the tissue at the tip and then it asperates the fractured tissue, so in effect, it's like having a pencil and at the tip of the pencil the tumor just dissolves and goes up the sucker. So it can be quite fibrous and dense and it will just literally dissolve it and suck it. And the
beautiful instrument for tumors are a lot more dense. We joke that the CUSA actually c USA stands for can't use straight up because it takes about forty minutes to set the thing up.
That's hilarious. Is there any I don't know if I want to ask this question, but I know you'll answer it honestly in general terms, like I think people a lot of people have been essentially led to believe that if you're going to have surgery, make sure you get the surgeon. Make sure you get your surgery in the morning, because that's when the surgeon's at his or her best, and surgeons are human. I would imagine that that might be true, or is that not true, or it depends.
I see a patient in the anesthetic bay, and it doesn't matter where they are on the list. If they're first, I say, you're first up, everyone's fresh. You're in the best position. If they're fourth on the list, I walk in there, I say, we've done three already. Everybody's warmed up and got their eye, and you're in the best position. It doesn't matter. They all have a laugh and it relaxes them. It doesn't matter because every operation, the experience
is the same, which is a laser focus. Sitting around and waiting is different. You've got a bit more energy waiting in the morning and the evening, the waiting is you know, a bit more painful. But as soon as the microscope gets wheeled into place, the brain just switches on and it becomes a laser focus and it's like nothing has changed. It's like the first case. Wow.
You spoke before about how the idea that you walk and it's going to be a good day because you've got the team that you love, You've got your dream team. Who organizes that, Like do you go, I want to work with these people or do you just show up on the day? And it depends who's rostered on.
The nursing staff are rosted, the anesthetic staff. I have relationships with those guys and have essentially elected to work with them, and that's the dynamics. Over time, you sort of start to get the team that you want to have with the nursing staff and the scrub team they're rosted that you start to get more and more time with the people that you like.
Do you think over time like racking up all the surgeries that you've done and are doing, and of course everyone who's doing a job, over time, you know, develop skill and competence and all of those things. Do you think that you've become calmer? Not that you were probably ever chaotic, but like I think most of us doing obviously most of us wouldn't do what you do, but something where the potential consequences are so big, you know, one way or the other. I mean, that's for us
mere mortals. That's a recipe for fucking overthinking, self doubt, rumination, anxiety. But obviously those things don't work being in any of those states don't work. When you need so much fine motor skill, so much calmness, and so much presence, how do you stay calm but also at the same time fully alert and switched.
On watching a mental watching and learning during the training years. Again, my guide out in Hobart still the most naturally gifted guy I've seen around Australia, and I've been around Australia. It was observing him under pressure and how he reacted to it. I still remember a pediatric brain tumor case. It went for ten hours or something like that, and he just stood there with his shoulders down, his elbows by his side, risk just moving slowly, slowly for that
whole time. And at the time I was like, why is he taking so long? I'm tired, I want to go home, let's wrap this up. Until I had a case of a pediatric brain tumor that I was doing on my own. I've told this story before. I think it was. It started at eight or nine and went through to eleven o'clock that night. Difficult pediatric tumor, and it was stuck to the brain stem. It was bleeding profusely.
Progress was super slow. At times, it was hard to make out what was tumor and what was normal brain stem. And the brain stem is highest priced real estate you can get in the brain. I touched that and there are huge consequences. So that was extremely incredibly stressful operation. And I thought, this is probably what my mentor was feeling. This is the emotions he was feeling during that ten hour case. He was looking at that structure, going is that tumor?
Or?
Is that is that I need? I don't know. I imagine that that's what was going through his head. And I only worked that out when I was doing the case. But at the time he was just composed and just went millimeter by millimeter. I just remember that, and during this pediatric tumor case of mine, I just replicated that. I just kipped my head, kept my car and knew that it was okay just to proceed slowly. I learned
a huge amount just watching this guy. The other thing, Do I stay calm I think I get I am definitely calm and get calmer with time, but I get not agitated. But I don't think grumpy is the right word either. But it's essentially I get shorter and clearer and maybe a little bit blunter with instructions in theater because I know more now the value of nipping any variable in the bud, any new variable that's introduced during theater. If you allow too many new variables to accumulate, that's
when you start getting complications. So my instructions are crystal clear, and I'm actually quite blunt, and if there is a minor variation to that, I stop, corrected and then move forward. And it can be the simplest thing. The screen needs to be facing this particular way, the drape needs to be on a certain way, The instrument needs to always be the same. Told the story of the hammer they handed me during a spine operation, a hammer that I
was not expecting. It was a slightly smaller one. They had a laugh, and I was quite short and blunt back at them, Not because I'm just a toxic, a difficult personality, but I was nipping a variable in the bud. They don't understand that variable, but if you have enough of them, it just disorientates you. And then once you start getting disorientated, that's where complications occur. Every time, almost invariably, if there's a complication, you can trace it back to
a root pause. It's when this step wasn't normal, but you accepted it and thought, oh, that's okay. We'll just get on with the case and move forward. And so again, my guy down in Hobart, he had white line fever. If anything change in theater, he would just he would just get so angry. And I couldn't understand it at the time, and I don't condone that sort of behavior, but I understand the concept of of what he was, what his philosophy was, don't give me a new variable.
It's the same time every time, because if I do that, then I'm least likely to have a complication and I'm going to do my best work.
And I think, also, that's amazing, thank you for that. Like dealing with people like every every day, you're dealing literally with life and death, like literally like and so you don't really.
Happen in hups. It's worse than that. It's not life and death, it's it's life and life with a morbidity. The worst thing is for someone to I mean, obviously death is bad, but that really happens. The bad thing if someone goes in and they're normal and they come out with a neurological deficit, they have to live the rest of their life with that neurological deficit. Right, That's
that's the worst outcome. You go in there and you're able to speak, and you come out and you can't speak, Or you go in there and your foot is working and you come out with a foot drop. It's a huge burden on your quality of life. That's that's really that. Yes, death is bad, but it really happens. It's causing a irreversible problem that they then have to live with for the rest of their life. That's the thing we really fear.
Yeah, I had not thought of that. That is fucking terrifying. And I guess also when you're under that pressure and you're making decisions and doing the thing that you don't you don't really in that moment have the bandwidth to be able to want to or have to cater to people's individual emotions and to keep everyone you know happy in because you're just doing your thing. So it's not your job to take or to be responsible for how everyone's feeling in the middle of that surgical reality.
I don't even think about it. Teamwork is really important. And when a scrub nurse hands me something that is perfect, which means I'm looking down the microscope, I hand out my hand and they put the instrument in my hand in such a way. I just got to close my hand and put it back in. And if they do that, I say, perfect, that was perfect, thank you. And if I hold my hand out and then they give it to me as if what's easy for them, Like they grab the instrument in their hand and they hand it
to me, so it's pointing the wrong way. I've got to move my hand then to grasp that. I don't even do that anyway. I say give it to me properly. I actually give it back to them. Say give it to me properly. And because it's teamwork, you know, they get the best out of me when I get the best out of them. So I reinforce great behavior and
I ask for it in return. We have something called the Mayo table, which is a It sounds fancy, but essentially it's just a tray that sits on top of the bed, but it's got some legs onto the floor. It's called basically sit instruments on this on this mayo table. And when that mayo table, it's got a lot of instruments that the scrub nurse is using. It's the stuff that I'm using is going on and off, back and forwards. When that mayo is organized, all the instruments are lined up, dunk.
I say that the mayo is a is a glimpse into the scrub nurse's mind. The mayo is a reflection of the mind. When that mayo is organized, I feel organized. I feel they are organized, and I'm confident in them. And I say that, I actually say that. I said that your mayo is very clean and tidy. Clearly, your mind is very clear clear at the moment, I appreciate that.
Yeah, how quickly or slowly does neurosurgery evolve? I feel it's probably not linear. It's probably on an incline at the moment. With tech or what the fuck do I know?
Give usked a fascinating question, And I've written an article on this. There is some technology at the moment, like a robot or the endoscope for spine surgery quite a bit of tech at the moment where it's a huge expenditure to develop that tech, massive expenditure and the price to purchase this equipment is phenomenal, the million dollars for a piece of equipment, and the benefit to the patient is extremely marginal. And the reason I say that you just wind back the clock not far at all. CT
scan which revolutionize medicine. I mean Planet Earth probably stopped spinning for about two seconds when the CT scan arrived at address Planet Earth. That was developed on a shoe string budget by a guy from the Second World War who is working with radar, and over three years persevered and against expectations, came up with the CT scanner. Minimal expenditure, exponential effect on medicine and patient outcomes. The same with MRI scan and in eurosurgery. There's some beings, some texts.
The big one for us is stereotactic. That is using a computer to be able to decide where something is inside the brain or the spine that's mainly inside the brain, and so we use it all the time. If there's a tumor that's three centimeters blow the surface of the brain, this computer can tell us on the skin where that projection is, so we can get the cut on the
scalp in the perfect position. Stereotactic surgery revolutionize the game, and now it feels like industry brings out technology for the purposes of maintaining earnings for the quarter, and in a way, without being cynical, in a way, a lot of tech at the moment gives whoever's got that tech a commercial advantage. If this hospital has got a robot and this hospital does not have a robot, then obviously this hospital is better and that's where people should go.
And that's a big part of a landscape at the moment. So hospitals are forced to buy this equipment because another hospital has got it without it at a disadvantage in terms of their quality of care. But really the quality of care is almost unchanged. And it's a really dangerous landscape that we're entering where there's becoming more and more of a push by industry to adopt this technology for
their shareholders and less so for actual patient outcomes. Huge expenditure for very very marginal outcome, but it's a really easy sell to the patient. I use a robot. How could you resist that I use an endoscope for spine surgery. It's truly keyhole surgery. How do you say no to that?
Yes?
Yes, the reality behind the scenes is slightly different, and it's much harder to sell the fact that perhaps that robot doesn't actually change very much at all, and there's a different reason that hospital has a robot. That's a hard sell. But just to say we have a robot is a very easy cell.
Yeah. Yeah, What about I don't even know if this is a good question, So if it's dumb, I'll take it out. What about current or future surgical treatments for neurological diseases like Alzheimer's, Parkinson's and so on? Is there do you ever do? Is that a thing?
Alzheimer's No, Parkinson's, Yes, Parkinson's disease. The surgical treatment for that is phenomenal. The fuck has three parts of the rigidity, the hand tremor, and then they walk really stiff and slow, and it can be completely debilitating. There are drugs for it. But there's an operation called deep brain stimulation. The target is a few millimeters wide, deep in the center of
the brain, and the target was discovered by accident. A number of years ago, but now we've got the target and we can put a probe into that target and stimulate or cause a lesion in that target. The effect is phenomenal. A patient can be completely immobilized and incapacitated by their Parkinson's symptoms and then post surgery getting towards barely recognizable, almost back to normal. There's another condition called
a central tremor, which again is a type of neurodegenerative condition. Essentially, when their hand is at rest, it's fine, but when they go out to reach something, the hand starts shaking violently. You may have seen it. They reach out to grab a glass of water, and the closer you get to the glass of water, the hand just starts just shaking uncontrollably. It's obviously they can't use their hand for anything because as soon as they go to do something, it's called
an action tremor. As soon as they use the hand for anything, the hand just completely starts flailing around. And then after deep brain stimulation the hand works completely normally like it's a phenomenal before and after video. So that's been around for a while. The accuracy is what's improved exactly where that probe goes in what location and ensuring the accuracy. That is certainly improved. The instruments we have to do the surgery have improved, making it easier to
manipulate tissues and do things safely. But for lo the philosophy is the same. Surgery is a game of physicality. It's removing something that shouldn't be there, or putting something back in its normal place, or fixing something that's physically broken. That's essentially the name of the game. If it comes to brain tumors, the outcomes for a lot of them haven't changed in fifty years. Surgery hasn't changed. The only thing that's really going to change that is drugs.
So a friend of mine's got an essential tremor. I did not know what you just told me, So I'm going to ring him after this. How long?
How long does that procedure take? Give or take not long at all? The planning takes a while going to do a scan of the brain and identify that target and his minuscule harps. It's a tiny target deep in the brain. Planning is a big part of that. Doing the operation, they'll do it in under an hour.
Wow, And what's the chances of a good outcome.
In someone who's experience, who knows how to do the planning and to minimize risk, and has experience in minimizing the risk and the one of the big challenges is that the brain moves, so it moves with each heartbeat, so you kind of have a moving target. You have a moving target when you put it in, but also when it's actually in the brain's still moving, so it's
still like a moving target for the stationary tip. People have experienced doing that and know how to work around that, their chances of success are high.
What's the bit of the brain called where you said, we accidentally found this out and it's like a bit of the brain that's a few millimeters what's it called.
One of them is called the VIM which I think is the ventral intermediary something. I'll have to look that up. I can't remember. V im is is the acronym. There's a couple of targets. There's a subthallomic target. I'm not an expert in this, but there's a subfalloming target. There's a couple of other targets. It was absolutely discovered that the story goes. I think it was. I think it
was last century. A guy was doing a blood vessel operation like in ancient times, and he clipped the wrong blood vessel as he would do because he didn't have microscopes and modern instruments. He clipped the wrong blood vessel and the patient woke up and their tremor was gone. He hadn't fixed the original blood vessel problem that he'd set out to fix, but he couldn't help but notice the patient's tremor had completely disappeared. And I think that
they did. They didn't even have a scan of that time. I think they did a post mortem and worked out where that stroke was in the brain and then started putting two and two together.
So they had to kind of reverse engineer it to figure out how that fucking fixed it correct.
That is, that is the one I wound up understanding the human brain. The only way that we have gathered any valuable information about the function of human brain is to observe the broken and work backwards.
It wasn't that the way that they discovered viagra as well. Wasn't that meant to be like some kind of vasil vaso dilator or something for blood pressure and it ended up giving blokes hard cocks?
Yep. It was for pulmary hypertension and this side effect.
And then they're like, hey, we invented this, We've we've solved one of the biggest problems for men of all time. You're welcome. And then nobody solved it at all. They just fucking stumbled across it.
Yeah, that's a phenomenal story is at Viagra and with the tie. It's a great name, it's a great product that that will be if if that was your project that fires or whoever made that, that's that's a legacy that is that's a game changer.
One hundred percent. Yeah. Yeah. Have you ever have you ever encountered a case of been involved in a case that fundamentally changed how you viewed the brain or consciousness or the way that you just looked at it in general, or perhaps you heard of a case or you reviewed a case or something, or there's been no real surprises, but.
There was one central case that changed the way I looked at the human brain. Awake Cranny oto me patients awake during surgery. And I've done it many times before. This was the first time I was doing it as a consultant, so fully qualified. And the thing that rattled me. The thing that I realized for the first time in my career was essentially the mystery of the physical and the non physical, that gap between the physical and non physical.
So what I mean is I could see the human brain, and I'd seen it a thousand times before, and because the patients awake under the drape, I could see them having a conscious experience, and I understood for the first time what people were talking about between that gap between the physical brain and this non physical thing that is experience, you know, feelings, seeing, hearing, all that sort of stuff. And it was it was, it was. It was a game changer for me to see that played out in
theater and there was what was really was. I don't know why I only thought about it at that particular time. I remember the day that it happened and I just sort of started thinking deeply about it. I just never thought about it, and all of a sudden it did a deep dive in theater in that moment exploring the topic. During the operation, there was no clue on the surface of the brain of how that physical brain was connecting with the non physical world. There was just no clue.
It was just pulsating with a heartbeat, but it wasn't glowing green, and there was no sparkles and no distortion in the atmosphere, which there should have been, because it's still the greatest mystery known to man how the human brain does that. It's a complete void, how that physical brain creates the non physical phenomena of experience. There should be some supernatural evidence of how it's doing that, and it's and there just isn't. It's just a white brain pulsating.
It's as physical as your arm or your delt muscle or you know, your heart. It's as physical as everything else, yet it's got this magical quality of creating consciousness. And looking at the brain, I realize what everybody was talking about. There's just no evidence about how it's doing that. I couldn't hear any voices from heaven. I couldn't. There was
just nothing. And it was a unique situation because the patient was actually awake, having a conscious experience, where usually there are sleeps of general anisex bond them out, but they're having the actual non physical experience and I can see the physicals, I can see the physical, and I can see the evidence of the non physical in the same person. And no link between the two of them. And I thought, that is that is a cool mystery.
Like I get what people are talking about when they say that's the thing they really want to understand before they die. I mean, that is that's a that's a brain breaker. That is I remember that day. I was like, I get it. That is that actually is very cool. That is that is the greatest mystery known to man playing out right in front of me. It's like a front row seat, no answers, but you know, I kind
of like the mystery. I like it hasn't been solved, but as a found moment to see it actually played out in front of you, it'd be like, are you're visiting a black hole? Like that's just imagine if Eli Must said I can fly you to a black hole. Not only can you stand on the edge of the black hole, I'll let you go in for five seconds just to see what it's like. You'd be like, oh, yeah.
Well, I mean it's funny because my job kind of is the mind and your job is the brain, and we know they're related, but we kind of don't really know how you know, and that the truth is, we don't really have evidence of a mind only evidence of a brain, you know, and we know that there's consciousness, and we know that there's a brain, but we don't know how one arises from the other. And neuroscience is having a big crack at it. But I don't know
that we're going to understand that anytime soon. And maybe it's good that we don't. Maybe that is that spiritual part, maybe there is, maybe there's you know, well, there's definitely stuff that we you know. I think that when we can't understand or explain something in science, we're very uncomfortable to go, well, it exists, but we don't get it.
And I think sometimes we've just got to say, you know, on our current level of with our current level of knowledge science, you know, ability to examine whatever we don't know, and it's okay that we don't know, you know. And even some of the things we think we do know, we find out in ten years, oh, we didn't know that at all. We only thought we knew.
Yeah, there's two things I want to say about that. It's interesting. Number One, I feel like technology will be the antsick because it has been the answer up till date. If you'd said to Caesar Julius Caesar, DNA, Show me DNA, tell me about it, what does it look like, how does it work? He would just lock you up in
an asylum. You think you're crazy. He's got no chance of understanding an atom or what it looks like, or what DNA is, And just that's completely ethereal concept, not even a concept, and technology, through X ray technology and mathematics was able to uncover that. So I feel like consciousness today is much of a bizarre concept as DNA would have been to Julius Caesar, solved by technology, and so there's a lot who feel that probably will be
the answer for this as well. But there is an interesting, interesting catch with the mind, as you know, it's called the other minds problem, meaning I can never examine I can never experience someone else's mind. I can only experience my own mind. I can only examine my own mind. I could never I mean I can do it through some surrogate Marcus, asking some questions and things like that, that I can never enter your mind to experiment on it and try and study it.
Yeah, well that there's a whole area of research in psych called theory of mind, which is that which is trying to understand the mind of somebody else, and then you know, but again, it's it's really just high level guessing, or in some instances low level guessing, trying to understand somebody else's version. And you and I have spoken about this between ourselves. But you know, when we go, all right, well, let's say ten thousand people listen to this chat, nobody's
going to have an identical experience. There might be some very similar experiences, but that's it's it's likely now that some people have already tuned out and gone, fuck this, this is bullshit, And there's it's likely also that some people are going, this is ace. I hope it keeps going for as long as possible. Some people are this is in enlightening some people. This is boring some people, this is confusing. And you know, so there's the stimulus
and then there's the individual's reaction cognitive, emotional, psychological reaction. Yeah, and trying to have an insight into like me, trying to have an insight into in real time, into how you think or how you're feeling, or how this is going for you as a conversation, but also simultaneously me having a greater than me awareness of the listening experience
for thousands of people. And so when I ask a question, I'm like, what's the best question that I can ask, which hopefully will be broadly interesting to the biggest percentage of people that I can, you know, rather than I want to know things that I'm fascinated in as well. But if I think I'm the only one fascinated by this question, I'm not asking it, not in this context anyway.
Does it frustrate you?
No, I'm fascinated by I mean, ergo my PhD. Right, But I'm fascinated with how others think and how others see. You know, And then you think about, like, where does your version of right, where does your personal experience come from? Well, part of it comes from part of it is genetic, and part of it comes from the brain and the biochemistry of the brain. Correct me if I fuck anything up from your end. But part of it is about
your interpretation of what's going on. You know, some people are interpreting this as interesting, and therefore they're in the moment experience is that they are interested, that they are fascinated. Somebody else's interpretation of the exact same stimulus could be this is boring, and their literal experience is boredom. But either way, those experience are self created. They're stimulated by you, and I bet they're created by the interpreter of the data or the stimuli.
It's interesting what you say, and it fascinates me how little control we actually have, how easily an external stimulus can change the way we feel, think, or what we say. And it's almost like we don't have any real control. I'm a product of my genetics, shore and my biochemistry, but it doesn't take much for me to change the way I view the world on a particular day. So who am I really? I feel like I'm just a complicated stimulus response machine.
You in some ways you are in some ways we all are. And you made a good point, and that is that nine am Alex might be quite different to seven pm alex, depending on you know, whether or not you've eaten, how tired you are, whether or not you had a blue with Karli, you know, whether not it's raining, whether or not one of the dogs did away in the house, you know, like that in the moment version
of you. Sometimes I said this to Melissa yesterday. I said, I don't want to jinx it, but I'm not even sure why, but lately I feel fucking amazing, and I've been trying to figure out what I'm doing that makes me feel I'm not saying I am amazing, but I feel amazing, you know, like mentally, emotionally, cognitively, I feel sharp, I feel physically strong. I'm strong in the gym. I'm
fucking solving problems like a motherfucker. I'm like everything is just and I'm trying to I'm trying to reverse engineer what am I doing that is making this this state that I'm in because it's not psychological, because it's been a.
Surprise I was about to finish their PhD to me.
Maybe that's it. Maybe I can just see the light at the end of the academic tunnel. Maybe this all right. Let's wind up with one or two questions. Right, this is not really your field or your area of expertise, but it's in your area of kind of and I can chime in on this, but we're not interested in me. What advice do you have for people who want to look after their brain? And I know that you're not really the lifestyle guy or the you know, but I mean,
you work with brains. And therefore you must have advice for people on you know how to best look after their brain so that in terms of their choices and behaviors, they can keep it working whatever optimally is for them.
Great question, it's quite simple. Don't stuff it up because you've only got one. Basically there reason I say that quickly. Story eighteen year old guy drunk got into a fight. This was in Perth when I was training, got into a fight, got king hit. During the fight. King hit for those who don't know, that's being punched in the back of the head, so you don't see the assailant coming, so you haven't got any of your defenses up, so your arm's down by your side. You don't see it coming.
And when you get punched in the back of the head, it knocks you out cold. So you hit the deck, which means because you're out cold again, none of your defenses are mobilized, your hands don't reach out to break your fall or anything like that. So the skull hits the concrete flush and it causes a catastrophic brain injury. And this guy had several operations permanent brain damage. Basically a vegetable and there was one day that really struck
me and rattled me. I remember the day clearly, walking into his room. We're talking three or four months down the track, and he's in a hospital bed. He's on a ventilator, he's rigid, he's staring into space. Lights are on, there's no one home. It's a severe brain injury. His parents are there. He's got sweat on him, he's got a fan on, his brain, stems misfiring, he can't regulate.
It's just a.
Total disaster physiologically and everything. And the thing that got me with the photos up on the wall, and there was the eighteen year old kid with his dad and holding a fish for memory, and then there was another photo of his eighteen year old kid smiling with his girlfriend at I presume end of view, end of school formal smiling pull a potential, a perfectly firing brain, eighteen year old kid's brain, all the potential in the world, can think clearly, can do anything. It's his number one
asset is his brain. And then there's another photo with him and his mates doing something up on the wall as well. And then I look at him lung in the bed and he's lost all of that. And the message is very clear. It's you know, people say, what can I do to look after my brain? Well, quite literally that just look after it. It's the best asset you ever have. And it doesn't matter what knock to the head you have, what insults your brain has, you
will pay the price for that. You may lose one or two IQ points, or you may lose your entire future. Just don't stuff it up. Is quite literally as simple as that. You don't get a second chance with the brain. Sometimes the effects are not immediately obvious, but the effects are certainly there, and it doesn't repair itself. You've got one look after it, use it. Just don't stuff it up. Beer yep.
So I'm guessing the UFC is not high on your list of career options for now.
What's UFC? Absolutely enthralled by it and then I cringe out at the same time. It's like this dichotomy of experiences when watching it. I love the I mean, it's just it's visceral to see combat. I'm sure that's why the Romans loved it. Build a Coliseum, because there's something natural about seeing a blood sport and two people in combat. It just it just gets you in a way that you can't really explain. But then I see the slow mods of the punch to the head, and I know
what that means in terms of brain function. I know what that will look like on a CT scan. But the context is different, isn't harps. They're getting paid to take damage. Basically, that is their career. That's what they've signed up for. I guess so, and.
They know, and you know what. So yeah, I'm it's funny you say that. I've said essentially what you said. It's for me. It's a dichotomy because on the one hand, I'm an excise scientist. I love I love athleticism and power and speed and skill and those guys and girls in the UFC and more broadly, you know, mixed martial arts across the spectrum. You know, there's so many great things. There's that unavoidable thing, which is you are going to at the very least damage your brain a bit, if
not completely fuck it up. Like nobody gets out of full contact sport. Nobody, zero people with zero damage. Nobody has no damage. But I don't know, if you're across this, this is going to make you shudder. So Dana White, who who is the boss of the UFC who you know, you know who he is?
Right? Yeah?
So also, I mean people hate him. I fucking I find him hilarious. I don't agree with everything he says, but here's what I do love about Dana White. You will never not know what he thinks.
I was going to say. He has a very clear mind.
He has no filter, and he gives no fucks if people agree or disagree, and he's not doing it to be controversial or for attention. And he's built this fucking incredible brand from nothing to this multi billion dollar thing. And he's just a knock about bloke who's a visionary. And yeah, he's got all these flaws and all these chinks in his art and all that shit, but he's just take he saw I think it was two years ago. There's this thing there's face slapping competition, right, which happens
in lots of countries around the world. But he took this idea and he turned it into power slap. So these I think it's I don't know if women are involved. Maybe women are, fuck but all the ones I've seen the men where they literally stand with their hands behind their back. It's almost like they're leaning over a bench. Which is for arm wrestling. But they just they just stand there and this bloke on the other side just winds up and smacks them with an open hand across
the face with like ridiculous force. So they're just getting struck in the head. And this has gone from nothing to now being it's it's like I heard him talking about it the other day, where it's it's becoming this big spectator sport. Clearly not for everyone. I don't I don't watch it. I've just seen some reels. I can't watch it. I can't get on board. I can get on board the UFC, but I can't get board this.
But I'll send you. I'll send you a clip and you as a you as a neurosurgeon, mate, you're just gonna fucking shake your head.
I've seen his clips from India, the slap competitions from India. These Begindian guys. It's it's bizarre. I've got like this, this respect of each other and this courtesy and then they wind up and fucking so bang.
That's not good. All right, mate, I love chatting with you. This has been one of my favorite chats. I feel like there was a lot of great information and a lot of great insight in there. We'll chat off here. Is there anything you don't want to got nothing to sell? I always say to my guests, where do you want to send our listeners? We are There is some news coming from Alex next year. There's going to be some big shit. I'm going to be involved in a little bit.
I'm the one percent, he's the ninety nine. But I'm gonna I'm going to have my toe in the in the Alex door next year to help him do a couple of things. But we'll let you know more about that in the future. But for the moment, mate, love talking to you, Appreciate you and thanks for being on the new project yet again.
Thanks Harts, really enjoyed it. Great to see you.