The operator lifts the upper eyelid, inserts the lobotom into the conjunctival sac.

There were 60,000 frontal lobotomies done in America in the 1950s and 1960s, which is a remarkably high number.

You have to understand the context.

At the time, there was no treatment for psychiatric illness.

So people who had severe schizophrenia and depression would just sit in the hallways of mental institutions that were filling with these patients with no way to treat them.

And some of the treatments were also barbaric.

They would, you know, submerge them in ice cold water or shock them or, you know, raise their, give them insulin and lower their glucose.

Spurred on by Freeman, the number of lobotomies performed annually soared from a hundred and fifty in nineteen forty-five to over five thousand in nineteen forty-nine.

I want you to talk about Rosemary Kennedy, and I want you to talk about lobotomies.

I, I knew nothing about lobotomies.

When, when I trained in neurosurgery, we didn't hear anything about the surgery, didn't know anything about the history, why it was done, who it was done on, how many were done.

I saw it as sort of a skeleton in our closet that neurosurgeons really didn't talk about.

There were 60,000 frontal lobotomies done in America in the 1950s and 1960s, which is a remarkably high number.

You have to understand the context.

At the time, there was no treatment for psychiatric illness, so people who had severe schizophrenia and depression would just sit in the hallways of mental institutions that were filling with these patients with no way to treat them, and some of the treatments were also barbaric.

Talk about that.

Yeah

...

they tend to be, uh, for ne- negative, uh, reasons.

And I tried to trace the origins of those two myths historically, and the myth of the brilliant neurosurgeon really goes back to Harvey Cushing, right, who is the founder of neurosurgery, and it-- he really, you know...

I- it's rare to have a field where it all goes back to one individual.

Um, but in neurosurgery, there really is this one individual, and yes, there were neurosurgeons before him who sort of did certain things that were, uh, certainly led to him being able to do what he does, but he took the field from a mortality rate of 50% when he started to a mortality rate of 8%, you know, and he made it from something that was just so risky that, that very few people dared to do it to something that became something that was reasonable to do, where patients left the OR in better shape than they were when they came into the OR.

Um, and every neurosurgeon on the planet is sort of a disciple of, of Harvey Cushing and can trace their li- lineage to him.

Any advice for young people entering the field of neurosurgery?

I've just come out of it and you're telling me that I've got a GBM and you've gotten through the permanent.

Yeah.

So- This is a situation where, you know, the first interaction is, it wouldn't be with you, right? It would be with whoever came with you to the hospital and is waiting in the waiting room, because I've already seen you and your significant other or your family member beforehand, and we've had a conversation.

And at that first conversation, and it's one of the things I try to get to in the book, is that the patient, when they first get diagnosed with a brain tumor, knows there's something in their head that shouldn't be there.

They've been referred to a neurosurgeon, but they very often don't know what it is.

And the first question is like, what is this? Is it a malignant tumor? Is it a benign tumor? And when you've been doing it for a long time, And I'm sorry to back up the conversation because you sort of have to set the context, right? When you've been doing it for a long time, I can look at the image, the MRI scan, and I know exactly what it is, right? Because I've taken out 500 of this type and 500 of that type and 500 of the other type.

And if it is a malignant brain tumor, what you're describing, there's this moment where you sort of see that person's future playing out in a way that they have no idea what's coming, right? So you have this crystal ball.

Because the doctor kind of disappeared because

Why do so many neurosurgeons get divorced?

divorced?I think it's the same thing.

You know, uh, when you have a career where not only are you out of the house for a long time and you get called out of the house at awkward times, so that could be on Valentine's Day, right? That could be at 2:00 in the morning.

But even when you're there, even when you're at home, there's part of you that's always absent.

You know, one thing that I realized is no matter where I am, there's always part of me that's thinking about the patients that are in the hospital that I operated on last week and how they're doing, and maybe one of them is, you know, struggling a little bit, and I have to be aware of that.

And I'm thinking about the patients I'm gonna operate on next week and the challenging cases coming up and how those are gonna go, and I'm visualizing them in advance constantly.

So the past and the future of what you do is weighing on you all the time, so that even when you're present at home, you're not fully present at home.

What do you think of Neuralink as a company, their products, what they do?