Life Lessons from a Brain Surgeon Read online

  Important as emotional intelligence is, however, we all know people who have managed to succeed without it. Many creative artists and even business leaders like Steve Jobs have been famous for their abusive tempers, their demeaning treatment of associates, and their bouts of disabling depression. So what if you’re an emotional wreck? How else might you succeed?

  GRIT AND DETERMINATION.14 Psychologist Angela Duckworth, winner of a MacArthur “genius” grant, has popularized the idea that diligence and perseverance play a far bigger role in success than do just about any other qualities. The smartest person in the room, she argues, will never do as well as the one who works the hardest. The student who keeps doing her homework, the scientist who never gives up, are the ones who go the furthest. Between the lazy genius and the indefatigable wonk, Duckworth says, bet on the latter every time. One of the few studies to look for the neural basis of grit in the brain identified a tiny region in the right prefrontal cortex, which other studies have found to be involved in self-regulation, planning, goal setting, and thinking about how past failures could have been turned to successes.

  That’s all good and fine. Who can argue with the value of hard work and determination? But do you really want a talentless grind to paint a masterpiece, unravel the mysteries of outer space — or perform surgery on your brain? Isn’t there a role for innate brilliance?

  PRACTICE, PRACTICE, PRACTICE. Actually, according to psychologist K. Anders Ericsson, there is no such thing as innate brilliance. Genius, he asserts, is simply the result of years of hard work and deliberate practice.

  To support this view, Ericsson has published studies showing that a person with ordinary memory can learn to have a super-memory for numbers.15 An average college student, he proved, could learn to remember up to ninety random digits at a shot simply by practicing such feats of memory for months. But the catch, Ericsson discovered, was that the student would be no better at remembering words — or anything other than a string of random numbers — than when he or she began. The only talent that improved was the specific skill they practiced. What’s more, Ericsson claimed, practice is likewise the key for chess grandmasters and professional violinists. Beyond a certain minimal threshold, talent or general intelligence simply does not matter.

  In his book Outliers, Malcolm Gladwell popularized Ericsson’s research by putting forward the notion of a “10,000 Hour Rule.”16 According to this so-called rule, all you need to do in order to excel at something is to deliberately practice chess or guitar playing — or whatever — for 10,000 hours. Really? What if you did only 9,738 hours?

  This, of course, is nonsense. Sure, practice improves everybody’s skills, and it’s absolutely essential in some fields. But are gold medals at the Olympics handed out simply on the basis of how long the athletes practiced? Will every writer who types away for ten years be rewarded with a Pulitzer? No. There are surgeons who have done 10,000 operations, let alone hours, and they remain mediocre. Talent is an undeniable component.

  My view is simple: There are as many paths to success (and failure) as there are human beings. The smarter you are, the better your chances. The more emotionally balanced, the better. The grittier your determination to overcome obstacles and the longer you practice, the better you’ll do. And even if the frontal lobe or a kernel of the right prefrontal cortex plays essential roles in enhancing these abilities, the bottom line is that to achieve maximum results, the entire brain must work together as a harmonious, integrated whole.

  NEURO GYM: THE POWER OF SELF-TESTING

  Nobody has an instruction booklet for how to win a Nobel Prize, but it’s well established how to memorize any set of material faster and better. Doing so might not make you smarter in the long run, but it can definitely help you learn in the shortest time possible.

  Let’s say you have to learn a list of vocabulary words in a foreign language, the names of every muscle in the human body, or the lineage of ancient Egyptian pharaohs. How do you go about studying?

  If you’re like most people, you read and reread the material you are trying to learn or perhaps make a list or outline and study that. Practice makes perfect, right?

  Wrong. Studying the same material over and over again is far less effective at improving memory than self-testing, according to studies by psychologists Henry L. Roediger III and Jeffrey D. Karpicke of Washington University in St. Louis. They have shown that after a single review of material, repeated self-testing enhances learning far better than does repeated studying.17 So test yourself and find the edge of your knowledge: that’s where learning happens.

  Let’s test you right now on how many facts you remember from the section above on brain training:

  How much was Lumosity fined by the FTC?

  How many accidents did the people who did speed-of-processing training have compared to those who did not?

  What does tDCS stand for?

  How many years after speed-of-processing training was conducted did researchers see an effect on participants’ risk of developing dementia?

  After you have checked your answers, go ahead and read the next chapter. Then come back and try to answer these four questions again. I bet you do well. Self-testing is a powerful tool for helping you remember!

  3

  The Seat of Language

  It all started, Marina told me, with a simple word: pen. Six months earlier, the thirty-three-year-old English teacher had handed out a quiz to her class of high school students when one of them said that he had nothing to write with.

  “Here,” she told him, “take my —” and that was when she realized that she couldn’t produce the word for the writing implement she held in her hand.

  Over the next five months, other common words began failing her. The lapses grew more frequent, but she kept trying to dismiss them as glitches. Secretly, she was increasingly gripped by worry because her mind’s intentions weren’t finding voice.

  Marina had been born and raised in Chile until the age of twelve, when her parents immigrated to southern California. Spanish was her native language, and English was her second. And now, as English words became foreign, she had begun substituting their Spanish equivalents to keep her speech fluid. “Pen” was undiscoverable, but “pluma” slid naturally into its place. Her original tongue had resurfaced as her lexical life vest.

  After all, who hasn’t been frustrated by the occasional word or name stuck on the tip of their tongue? But at her age, to have this happen over and over again concerned her family doctor. He ordered a scan, which showed a small amorphous dark patch in the center of the left temporal lobe. The radiology report mentioned “suspicious for malignancy.”

  Had it shown up as a bright white splotch on the MRI, that would have meant it was more likely a dangerous glioblastoma. These high-grade, aggressive tumors send chemical signals to prompt the growth of new blood vessels to nourish them. As a result, they can suck up the contrast agent the nurse injects into the person’s vein, thereby making them look bright. Whereas a gray-looking mass, like Marina’s, was more likely to be slow-growing and less invasive, making it more amenable to treatment.

  I said to Marina and her husband, “I have some answers to why the words are getting stuck, but I also have some uncertainty to discuss.” I showed them the key brain images and pointed out the shadowy appearance of the tumor. Cancer? Yes, but a rare type of brain cancer that can be surgically cured if removed completely. They were blanketed with despair, but hearing the word cure allowed for a hint of hope.

  Brain surgery to remove this tumor would be no easy task, however, because Marina’s tumor was located in her left frontotemporal region: the seat of language. Cancers take on a myriad of three-dimensional shapes, and no two are alike. It’s a different enemy every time, and hers had taken refuge behind exquisitely eloquent brain tissue.

  Had it been elsewhere, I would have abundant safe zones through the brain’s surface to access deep-seated tumors. But in her, my surgical approach would have to be through th
is inscrutable “seat of language.” To get it all, I would have to find windows of safe entry in the perilous region that rests on the banks of the deep sylvian fissure, separating the left frontal lobe from the left temporal lobe, which is marbled throughout with neurons critical to language. Injure the wrong section, and you can lose the ability not only to speak but to understand signs and gestures. Marina was at risk of losing communication at its most fundamental level.

  BROCA AND WERNICKE

  Allow me to step back, for a moment, from Marina’s story to reveal a bit more about the location of language in the brain. Scientists vigorously debated the matter in the nineteenth century. Some insisted that it was nowhere and everywhere, that you could remove any section of the brain and it would not entirely wipe out the ability to speak and understand. The first piece of evidence that language has a particular home address in the brain came from a French shoemaker who, in 1840, at the age of thirty, lost the ability to speak — except for one word: tan. Louis Victor Leborgne could understand what other people said; he could reason; but until the day he died, tan remained the only word he could say or write. Asked a question, he would typically say it twice: “Tan tan.” Admitted to the Bicêtre Hospital, a psychiatric asylum just outside of Paris, he soon gained a nickname: Tan. Over the course of the next twenty-one years, he became paralyzed on his right side and developed gangrene.

  Days before his death in April 1861, Tan was visited by a physician with a special interest in speech: Pierre Paul Broca. When Tan died, Broca conducted an autopsy on his brain, finding an area of dead tissue, likely due to syphilis, at the back and lower portion of the frontal lobe, near the fissure separating it from the temporal lobe.1

  A few months later, Broca met another patient at the same hospital with nearly the same peculiar disorder. Lazare Lelong, eighty-four, could say only five words: oui (“yes”), non (“no”), trois (“three”), toujours (“always”), and Lelo (a garbled version of his own name). When Lelong died, Broca autopsied his brain, too, and found an area of dead brain tissue in almost the exact same spot as Tan’s.

  Now known as Broca’s area, this small region of the brain is recognized as critical to the production of speech. But another area, discovered soon after by the German neurologist Carl Wernicke, underlies the ability to comprehend speech. A person who suffers an injury to Wernicke’s area — near the same sylvian fissure but on the temporal side — will continue to speak fluently but in a meaningless word salad.2

  For a hundred years after Broca and Wernicke revealed their findings, scientists thought that these regions were precisely where the two doctors said they were. By the time I began my training, however, it had become clear that these were only approximations. Language, it turns out, has a fuzzy address.

  NEURO GEEK: THE NEUROSCIENCE OF BILINGUALISM

  Marina’s bilingualism was actually a gift to her brain. People who learn a second language gain significant benefits in cognitive health that last a lifetime. That shouldn’t be surprising because, as brain-mapping shows, different areas of the brain handle different languages. Busy neurons are thriving neurons; those without any assigned tasks tend to wither.

  How exactly does bilingualism pay off in brain performance?

  IMPROVED ATTENTION. British researchers at the University of Birmingham recently recruited 99 volunteers, 51 of whom spoke only English, the remainder being bilingual in English and Mandarin since childhood. The English-only speakers performed slower on two out of three tests of attention.3 Being able to switch between two languages, the researchers concluded, improves a person’s ability to maintain focus and attention.

  Dozens of other studies have demonstrated similar benefits in attention and focus for people who speak two languages. The benefits are due in part to the fact that a bilingual person’s brain must actively suppress one language when speaking another. Being able to handle that extra workload results in stronger overall control of attention. Imaging studies have shown benefits in both the prefrontal cortex and subcortical regions. The better a person speaks a second language and the earlier it is acquired, the more gray matter has been seen in the left parietal lobe cortex. More white matter has likewise been seen in both children and adults who speak two languages.

  IMPROVED LEARNING. A four-year study of children in public schools in Portland, Oregon, randomly assigned some of the kids to usual English-only classrooms and some to dual-language classrooms where they learned Spanish, Japanese, or Mandarin. By the end of middle school, the dual-language kids had gained a full year in English-reading skills on their peers.4

  In another study, English-speaking children placed in a Spanish-immersion program performed better on tests of working memory and word learning than did children who remained in an English-only program.

  PROTECTION AGAINST DEMENTIA. An extraordinary study published in 2007 by researchers in Toronto showed that people who spoke more than one language developed symptoms of dementia about four years later than people who spoke only one.5 Since then, other studies in Montreal, India, and Belgium confirmed the protective effect against dementia in bilinguals. As a recent review in the journal Current Opinion in Neurology concluded: “Lifelong bilingualism represents a powerful cognitive reserve delaying the onset of dementia.”6

  The message is clear: If you have kids and know a second language, using it around them will build their brain power and cognitive reserve.

  BRAIN MAPPING

  So if I was going to remove Marina’s tumor without destroying her ability to speak and understand language, I needed to map the surface of her unique cortical canopy, exploring for safe versus language-sensitive spots, while she was awake and able to guide me. I needed to become a cerebral cartographer in search of tiny islands of brain tissue that could be parted and serve as portals to dive deep inside her brain.

  I told Marina and her husband that I would have to remove her tumor while she was awake. She would need to tell me, by her ability to speak — or not — where it was safe for me to begin dissecting. And because she was bilingual, I would have to check each spot twice: once for English and again for Spanish.

  Three weeks after our meeting, I stood beside Marina as her eyes fluttered open. We had to put her to sleep for the beginning of the surgery, when her scalp, skull, and dura were opened. It would have been too painful for her to be awake for that portion. But because the brain itself has no nerves to feel pain, the anesthesiologist was now able to dial back the sedative in preparation for the real work.

  “Welcome back,” I said to Marina. “You okay?”

  “Groggy. Is it … open?”

  “It is. … Let me know when you’re ready,” I said.

  Days prior, we had gone over the operation and her role.

  In my left hand, I held the electric stimulator, a device the shape and size of a fountain pen. The twin tips are forked like a snake’s tongue and release a miniscule electrical current that runs from one to the other. The current works like a taser to the neurons between its prongs. It allows me to temporarily stun a tiny piece of tissue. The brain cannot feel my touch; it does not have the ability to know when it’s being touched, cut, or manipulated. But the zapped neurons are momentarily stunned, resulting in the loss of whatever function they possess.

  The neurophysiologist asked her to count to ten. Marina did. He asked her to sing the alphabet. She complied. Now he repeated both requests in Spanish, her native tongue. She performed flawlessly. We were ready.

  I lowered the stimulator onto a spot on the edge of Wernicke’s area. The neurophysiologist posed Marina a list of questions in English and Spanish, each of which she answered flawlessly. He showed her objects and asked her to identify them. All went well.

  This spot, I inferred, is safe. No harm to her language abilities would result from my inserting a scalpel there, if I must. To mark it, I placed a tiny white square of confetti-like paper directly onto the brain. The slippery surface held the dry paper with no need for adhesive.

&
nbsp; I moved to an adjoining area. The neurophysiologist had Marina singing the alphabet when I zapped the spot with the stimulator. Marina kept right on singing. Then she went through the song again in Spanish. I waited until she was halfway through to zap it. She stopped at N as if I had pressed a mute button. Her speech arrested.

  This spot was a no-go. I placed a red piece of confetti on it with a letter S for Spanish.

  An hour later, the glistening topography of the language-critical area of her left brain was covered in a mosaic of white and red confetti. Some of the reds had the letter E for English, some had S for Spanish, and some had E/S for both. White was “takeable,” meaning I could dive through the brain’s surface underneath the white pieces of paper to reach the tumor below without robbing Marina of speech.

  With the testing portion behind us, I began to perform the surgery. I removed a white-marked area and carved a one-eighth-inch corridor of tissue with my scalpel. Because the tunnel was so small, I used a surgical navigation system to see below the surface. It combined live 3-D images of Marina’s brain to show me exactly where I was going.

  Two inches deep, I reached one edge of the tumor. I switched to suction and took out as much from this angle as possible. But because the suction tube is rigid and my point of entry on the surface was surrounded by red no-go tissue, I couldn’t twist or toggle my instrument to get all of the tumor. I had to start again from another white-flagged point on the surface to come at the tumor from another angle. Carefully working the depth and incessantly attentive to the superficial portals, I got after it.