Gifted Hands: The Ben Carson Story (16 page)

The patient, already comatose, was deteriorating rapidly. Naturally I was quite concerned, feeling we had to do something, but I was still relatively inexperienced. Despite making phone call after phone call, I couldn't locate the faculty member. With each call, my anxiety increased. Finally, I realized that the man would die if I didn't do something—and something meant a lobectomy
*
—which I had never done before.

What should I do?
I started thinking of all kinds of roadblocks such as the medical/legal ramifications of taking a patient to the OR without having an attending surgeon covering. (It was illegal to perform such a surgery without an attending surgeon present.)

What happens if I get in there and run into bleeding I can't control?
I thought.
Or if I come up against another problem I don't know how to handle? If anything goes wrong I'll have other people second-guessing my actions and asking, “Why did you do it?”

Then I thought,
What is going to happen if I don't operate now?
I knew the obvious answer: the man would die.

The physician's assistant, Ed Rosenquist, who was on duty knew what I was going through. He said just three words to me
—“Go for it.”

“You're right,” I answered. Once I made the decision to go ahead, a calmness came over me. I had to do the surgery, and I would do the best job I could.

Hoping I sounded confident and competent, I said to the head nurse, “Take the patient to the operating room.”

Ed and I prepared for surgery. By the time the operation actually began I was perfectly calm. I opened up the man's head and removed the frontal and temporal lobes from his right side because they were swelling so greatly. It was serious surgery, and one may wonder how the man could live without that portion of his brain. The fact is that these portions of the brain are most expendable. We had no problems during surgery. The man woke up a few hours later and subsequently was perfectly normal neurologically, with no ongoing problems.

However, that episode evoked a great deal of anxiety in me. For a few days after I'd operated, I was haunted by the thought that there might be trouble. The patient could develop any number of complications and I could be censured for performing the operation. As it turned out, no one had anything negative to say. Everyone knew the man would have died if I hadn't rushed him into surgery.

A
highlight for me during my residency was the research I did during my fifth year. For a long time my interest had continued to grow in the areas of brain tumors and neuro-oncology. While I wanted to stay with doing this kind of research, we didn't have the right animals in which we could implant brain tumors. By working with small animals, researchers had long established that once they obtain consistent results, they could eventually transfer their findings toward finding cures, and then they could offer help to suffering human beings. This is one of the most fruitful forms of research to find cures for our diseases.

Researchers had done a lot of work using mice, monkeys, and dogs, but they encountered problems. Dog models produced inconsistent results; monkeys were prohibitively expensive; the murines (rats and mice) were cheap enough but so small that we couldn't operate on them. Neither did they image well with CT Scans
*
and MRI
†
equipment.

To accomplish the research I wanted, I faced a triple challenge: (1) to come up with a relatively inexpensive model, (2) to find one that was consistent, and (3) to find a model large enough to be imaged and operated on.

My goal was to work with one type of animal and let that be the basis (or model) for our developmental research in brain tumors. A number of oncologists and researchers who had previously established working models counseled, “Ben, if you go ahead and begin to research brain tumors, you'd better expect to spend at least two years in the lab on the project.”

When I embarked on the project I was willing to work that long or longer. But which animals should I use? While I initially started with rats, they were actually too small for our purpose. And, personally, I hate rats! Maybe they triggered too many memories of my life in Boston's tenement district. I soon realized rats did not have the qualities necessary for good research, and I began to search for a different animal.

During the next few weeks I talked to a lot of people. One fabulous thing about Johns Hopkins is that they have experts who know practically everything about their own field. I started making the rounds among the researchers asking, “What kind of animals do you use? Have you thought of any other kind?”

After a lot of questions and many observations, I hit upon the idea of using New Zealand white rabbits. They perfectly fitted my threefold criteria.

Someone at Hopkins pointed me to the research work of Dr. Jim Anderson, who was currently using New Zealand white rabbits. It was a thrill to walk into the lab there in the Blaylock Building. Inside, I saw a large open area with an X-ray machine, a surgical table off to one side, a refrigerator, an incubator, and a deep sink. Another small section housed the anesthetics. I introduced myself to Dr. Anderson and said, “I understand that you've been working with rabbits.”

“Yes, I have,” he answered and told me the results he'd already obtained by working with what he called VX2 to cause tumors in the liver and kidneys. Over a period of time, his research showed consistent results.

“Jim, I'm interested in developing a brain tumor model, and I wondered about using rabbits. Do you know any tumors that might grow in rabbits' brains?”

“Well,” he said, thinking aloud, “VX2 might grow on the brain.”

We talked a little more and then I pushed him. “Do you really think VX2 will work?”

“I don't see any reason why not. If it'll grow in other areas, there's a good chance it might grow on the brain.” He paused and added, “If you want to, try it.”

“I'm game.”

Jim Anderson aided me immensely in my research. We first tried mechanical disassociation; that is, we used little screens to grate the tumors, much like someone would grate cheese. But they didn't grow. Second, we implanted chunks of tumors into the rabbits' brains. This time they grew.

To do what we call viability testing, I approached Dr. Michael Colvin, a biochemist in the oncology lab, and he sent me to another biochemist, Dr. John Hilton.

Hilton suggested using enzymes to dissolve the connected tissue and leave the cancer cells intact. After weeks of trying different combinations of enzymes, Hilton came up with just the right combination for us. We soon had high viability—almost 100 percent of the cells survived.

From there we concentrated the cells in the quantities we wanted. By refining the experiments we also developed a way of using a needle to implant them into the brain. Soon almost 100 percent of the tumors grew. The rabbits uniformly died with a brain tumor somewhere between the twelfth and fourteenth day, almost like clockwork.

When researchers have that kind of consistency they can go on to learn how brain tumors grow. We were able to do CT scans and became excited when the tumors actually showed up. The Magnetic Resonance Imaging (MRI), developed in West Germany, was a new technology just breaking on the scene at that time, and wasn't available to us.

Jim Anderson took several of the rabbits to Germany, imaged them on the MRI, and was able to see the tumor. I would have loved to go with him and would have, except that I didn't have the money for the trip.

Then we had the use of a PET
*
scanner in 1982. Hopkins was one of the first places in the country to get one. The first scans that we did on it were the rabbits with the brain tumors. Through the medical journals we received wide publicity for our work. To this day a lot of people at Johns Hopkins and other places are working with this brain tumor model.

Ordinarily this research would have taken years to accomplish, but I had so much collaborative effort with others at Hopkins helping to iron out our problems that the model was complete within six months.

For this research work I won the Resident of the Year Award. This also meant that instead of staying in the lab for two years I came out the next year and went on to do my chief residency.

I began my year of chief residency with a quiet excitement. It had been a long, sometimes tough road. Long, long hours, time away from Candy, study, patients, medical crises, more study, more patients—I was ready to get my hands on surgical instruments and to actually learn how to perform delicate procedures in a quick, efficient way. For example, I learned how to take out brain tumors and how to clip aneurysms. Different aneurysms require different sized clips, often put on at an odd angle. I practiced until the clipping procedure became second nature, until my eyes and instinct told me in a moment the type of clip to use.

I learned to correct malformations of bone and tissue and to operate on the spine. I learned to hold an air-powered drill, weigh it in my hand, test it, then use it to cut through bone only millimeters away from nerves and brain tissue. I learned when to be aggressive and when to hold back.

I learned to do the surgery that corrects seizures. Learned how to work near the brain stem. During that intense year as chief resident, I learned the special skills that transformed the surgical instruments along with my hands, my eyes, and intuition into healing.

Then I finished the residency. Another chapter of my life was ready to open and, as often happens before life-changing events, I wasn't aware of it. The idea came across as impossible—at first.

CHAPTER 13

A Special Year

I
didn't explain the real reason to Bryant Stokes. I figured he knew it without my having to bring it out in the open. Instead I answered, “Sounds like a nice place.” Another time I said, “Who knows? Maybe one day.”

“Be a grand place for you,” he persisted.

Each time he mentioned it, I gave Stokes another excuse, but I did think about what he said. One benefit especially appealed to me. “You'd get as much experience in neurosurgery there in one year as you'd get in five years anywhere else.”

It seemed strange to me that Bryant Stokes persisted in the idea, but he did. A senior neurosurgeon in the United States from Perth, Western Australia, Bryant and I hit it off at once. Frequently Bryant would say, “You should come to Australia and be a senior registrar at our teaching hospital.”

I tried various ways of getting him off the subject. “Thanks, but I don't think it's what I want to do.” Or another time I said, “You've got to be kidding. Australia is on the other side of the world. You drill through from Baltimore and you come out in Australia.”

He laughed and said, “Or you could fly and be there in 20 hours.”

I tried evasive humor. “If you're there, who needs me or anyone else?”

A matter of deep concern for me, which I naturally didn't mention, was that people had been telling me for years that Australia was worse with apartheid than South Africa. I couldn't go there because I'm Black and they had a Whites-only policy. Didn't he realize I was Black?

I dismissed the whole idea. Aside from the racial matter, from my perspective I couldn't see that going to Australia for a year of residency would add anything in terms of my career, although it would certainly be interesting.

If Bryant hadn't been so persistent, I wouldn't have given the idea any more thought. Virtually every time we talked, he'd make a casual remark such as, “You know, you'd love Australia.”

I had other plans because Dr. Long, head of neurosurgery and my mentor, had already told me that I could stay on the faculty of Johns Hopkins after my residency. The fact that he added, “I'd be delighted to have you,” made it all that more appealing.

I couldn't think of anything more exciting than to remain at Hopkins, where so much research was going on. For me, Baltimore had become the center of the universe.

Yet, strange as it seemed, although I'd dismissed Australia, the topic dogged me. It seemed that for a while every time I went somewhere, I'd encounter someone with that particular accent saying, “Ga'day, mate, how you going?”

Turning on the television, I hit commercials saying, “Travel to Australia and visit the land of the koala.” And PBS advertised a special on the land down under.

Finally I asked Candy, “What in the world is going on? Is God trying to tell us something?”

“I don't know,” she answered, “but maybe we'd better talk a little about Australia.”

Immediately I thought of a load of problems, the main one being the Whites-only policy. I asked Candy to go to the library and check out books on Australia so we could find out about the country.

The next day Candy phoned me. “I found out something about Australia you ought to know.” Her voice held an uncommon excitement so I asked her to tell me right then.

“That Whites-only policy that's bothered you,” she said. “Australia used to have it. They abolished that law in 1968.”

I paused. What was happening here? “Maybe we ought to consider this invitation seriously,” I told her. “Maybe we just ought to go to Australia.”