The minimalism of maximality

I was recently invited to give a TEDx Talk, an extremely prestigious occasion. TEDx is a non-profit organization devoted to spreading ideas, usually in the form of short powerful talks. It began as a conference in 1984 where technology, entertainment, and design converged, hence the name. A TEDx Talk is a showcase for speakers presenting great, well-formed ideas in under 18 minutes. Imagine a day filled with nine brilliant speakers, thought-provoking videos, and mind-blowing notions. This TEDx event, the third edition organised by the students of Somaiya Vidhyavihar, created a unique gathering in which to unleash new ideas, inspire, and inform, and I was happy to be part of it.

The day was brimming with insights from an educational futurist, a visual artist, an architect, a culture editor, a data scientist, a psychological illusionist, and the founders and curators of social cases such as Dharavi Reloaded and Earth5R. Then, of course, there was yours truly, a humble neurosurgeon, who is happy to share some excerpts from his talk.

 

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What’s the difference between God and a neurosurgeon? God doesn’t think he’s a neurosurgeon.

 

A neurosurgeon is someone who operates on the human brain and spine, and that’s why we like to believe, albeit erroneously, that we are on the top of the totem pole of all medical specialists. We have the reputation of being arrogant and occasionally even obnoxious. We are the only progeny of surgical specialties who have access to the insides of the human brain on a daily basis, and even so, we haven’t yet figured out how most of it works. Researchers tell us that humans use only about 10% of the brain, but I’m sure most of us have had personal encounters with those who use much less.

 

Over 100 years ago, there were no specialist brain surgeons. Brain tumours were removed by general surgeons or even obstetricians and gynaecologists, for that matter, pretty much in the same way they delivered babies. The mortality rate for operating on the brain was 100%. A general surgeon renowned for performing super speedy amputations managed to beat that statistic: While amputating his patient’s leg at the hip, he accidentally sliced through the fingers of one of his assistants resulting in uncontrollable bleeding that killed both patient and assistant. Another doctor observing the operation collapsed watching the blood bath and died of a heart attack. The general surgeon in question, therefore, had performed a surgery with a 300% mortality rate.

 

However, for brain surgery, much has evolved since then. In the early 1900s, if someone went home alive after surgery, even if in a vegetative state, it was considered successful. Then came a time when people got out of the hospital pretty much the same way they came into it, and that was considered success. Over the years, we have started seeing improvements in neurological functions and deficits at discharge. Today, a patient can even go home the same day or the next after brain tumour or spine surgery, with a justifiable expectation of full functional recovery, alleviation of pain, and an improved quality of life.

 

What has made this possible? Our understanding of anatomy and physiology has evolved, and like in every other field, technology has chipped in. The MRI shows us fibre tracts that can delineate eloquent areas of the brain. We can study metabolic activity, look inside arteries and veins, and now, with virtual reality, we can tip-toe into someone’s head, looking around the corners of brain tumours and vascular aneurysms.

 

Today, we are also able to remove a brain tumour in someone who is fully awake. Patients can move their hands and legs as we perform brain surgery; this helps us safely push the limits and achieve maximal tumour excision while preserving neurological function. While all of this goes on, the patient can view his brain tumour being removed in real time on a monitor in front of him. The brain itself physically feels no pain, and yet, all the pain-generating centres are smack within it. That’s what makes this organ the last and grandest biological frontier, the most complex thing we have discovered in the universe yet.

 

The way we visualize the brain has also changed. From operating with bare eyes and magnifying loupes, the introduction of the microscope made operating on the brain an ethereal experience. We can use fluorescence to get tumours to light up, which then helps delineate the ugly monster from within the pristine brain. Today, we are able to remove brains tumours by entering the skull through the nose. Using small tubular pipes or endoscopes, we can get a panoramic view of the brain that takes one on a journey of breath-taking views, stunning beauty, and miraculous outcomes, curing a patient’s woes with a simple operation.

 

Let me tell you, however, that no surgery is simple – only a surgeon who makes it seems so. Simple is actually really hard. It takes about 5-6 years of medical school and another 6-7 years of residency to graduate as a neurosurgeon. Most of the latter time is spent working 20-24 hours a day in sub-optimal living conditions, sacrificing family, friends, and another four-letter word that starts with F. Food! It takes 15 years to learn how to operate but another 15 to learn when not to.

 

As a result of all that training, we can now enter the brain through the eye, nose, and ear; please don’t attempt to imagine any other orifice. But yes, as unimaginable as it may sound, we can also get into the brain through the groin. We can guide microcatheters into vessels of the brain and remove blood clots and coil aneurysms, things that we needed to open up the head for just a few decades ago.

 

Functional neurosurgery has started gaining momentum. We can insert electrodes into the brain and cure tremors caused by Parkinson’s and other movement disorders. Imagine curing a professional violinist or guitarist whose hand goes into spasm only while playing a certain note. You can get them into the operating room with their musical paraphernalia and make them play. With their brain lying open in front of you, you stimulate the targeted area responsible for that particular action, and voila! He’s cured. We are now beginning to try this for depression, anxiety, obsessive-compulsive disorder, bipolar disorder, obesity, and maybe even erectile dysfunction; who knows where this may stop.

 

Can we use this power of tweaking the brain to achieve immortality? If you think that’s pushing it, how about inserting an electrode in the prefrontal cortex of a rapist, and when he walks out of the operating room, he’s transformed instead into a messiah for promoting women’s rights and protecting them. Can we use transcranial magnetic stimulation to soften hardened criminals? Can neurosurgery transform society and make us nicer, ,kinder and more humane? Of course, one can argue that the Art of Living Foundation can do that as well, but there are some among us who would prefer if all it took was a few hours rather than having to meditate for 30 minutes each day for the rest of one’s life. From attempting to cure diseases, could the next frontier be enhancing one’s quality of life?

 

On the other hand, can we regulate certain centres in our brain to become more intelligent, enhance our IQ, augment our memory? If Roger Federer wants to improve his backhand, and no amount of practice or coaching is doing it for him, can he undergo neuromodulation and win a few more grand slams? Can those on the death penalty be given one last chance to turn their lives around?

 

How many senses do you believe humans have? Most of us think it’s 5: we can list sight, hearing, taste, touch, and smell. Recent data suggests, however, that we may have anywhere between 22-23 senses: a sense of balance, a sense of movement, a sense of knowing which parts of your body are where without looking at them, how we sense the passing of time, how we feel pain, how we experience temperature… I’m not sure if a sense of humour makes it to this scientific list of other senses, but there are some senses that animals have and we don’t: the ability to feel electrical fields around us, the ability to sense the Earth’s magnetic field or even polarised light and use it to navigate, for example. What if we could externally enhance these senses to perform better, to increase awareness, become more mindful, or even simply to stay protected?

 

Is exploring the hidden potential of our brains by means of assisted devices ethical and acceptable in society or is this just some sort of audacious optimism? Who decides who can avail of it, if it is possible at all? Are we really trying to play God? I only have the questions; the answers are yet to be given to us.

 

Today, the world is turning towards spirituality. We are surrounded by people who have a higher understanding of the self and the subtle body. With the right guidance and a little bit of practice, we can tap into the power of the subconscious mind to rid us of negativity and stress, reshaping our health and destiny to live a miraculous life. In my opinion, paradigms will truly shift when we are able to combine medicine with superior technologies and spiritual nourishment to bring about a holistic form of healing and health to one and all. You see, it’s not just a neurosurgeon who’s been given the license to create miracles. Miracles lie in compassionate gestures, a few kind words, a loving touch. Miracles lie in extraordinary ordinariness. And that’s what brings you closer to God.

 

Dr. Mazda K. Turel is a minimally invasive brain and spine surgeon. He is a consultant at Wockhardt Hospital, Mumbai Central, and also an Honorary at Sir JJ Hospital. He can be reached on mazdaturel@gmail.com or +91 993.017.4567. To know more about him you can visit www.mazdaturel.com.

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