Latest / The You Project / #1528 Neurosurgery For Dummies - Dr. Alex Koefman

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#1528 Neurosurgery For Dummies - Dr. Alex Koefman · The You Project

0:00
Speaker 1: Doctor Alex Kofeman, Welcome back to the You Project, my friend.
0:04
Speaker 2: It's great to see you again.
0:05
Speaker 1: Look at you, mate, you look like you look very
0:08
Speaker 1: relaxed there. Tell everyone what you're wearing. It's like you've
0:11
Speaker 1: got a hoodie with no sleeves. Is that right?
0:15
Speaker 2: Yeah, it's kind of a brisbee thing. I guess. I
0:16
Speaker 2: feel a little bit chilly in the morning, but my
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Speaker 2: arms are free. I like it.
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Speaker 1: I just feel comfortable. Your arms are way too big
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Speaker 1: for a neurosurgeon. I don't know that they need to
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Speaker 1: be that big to hold a scalpel.
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Speaker 2: Now, I know that you're joking if you're telling me
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Speaker 2: that my arms are too big coming from you, yeah,
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Speaker 2: I'm not a surgeon. I like my arms. I like
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Speaker 2: my arms and my legs free, like shorts, and this
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Speaker 2: type of thing for me is the perfect outfit. That's
0:42
Speaker 2: why I like scrubs. They stop halfway down the arm.
0:46
Speaker 2: They're super comfortable. I wear scrubs consulting now in the room,
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Speaker 2: not in theater, but just seeing patients in the room
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Speaker 2: as so comfortable. It's like wearing yoga yoga gear. I
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Speaker 2: reckon and I asked the patience, what would you prefer
0:57
Speaker 2: me in a suit and a tie or scrubs, and
1:01
Speaker 2: I would say, like set ninety percent of people say scrubs,
1:05
Speaker 2: I look like who I say, I am?
1:06
Speaker 1: Well, thank god for that. Having to put on a
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Speaker 1: bloody suit all the time to have a conversation seems
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Speaker 1: like an unnecessary pain that nobody needs.
1:15
Speaker 2: No, that's so uncomfortable?
1:17
Speaker 1: Is there much too? Like? And I know it varies wildly,
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Speaker 1: but how many hours is a long surgery? Like not extreme, ridiculous,
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Speaker 1: over the top rare, but what's just like a typical
1:32
Speaker 1: long ish surgery? How many hours? Now?
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Speaker 2: I would say, I reckon two hours would be long
1:39
Speaker 2: for me, rise of minor. Yeah, two hours. When I
1:44
Speaker 2: was training, the longest I did was eighteen but that
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Speaker 2: was unusual. That depends on the surgeon and the case
1:49
Speaker 2: and how quick they are and how complex it is.
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Speaker 2: But I have stood in theater eighteen hours during a case.
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Speaker 2: I've done one myself that took I think twelve or
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Speaker 2: fifteen hours, where that was just me doing it. But
2:02
Speaker 2: they're the outliers. So for me now, in private practice,
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Speaker 2: a typical spine case might take half an hour forty
2:11
Speaker 2: five minutes. A brain tumor might take about an hour
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Speaker 2: to two hours. But this is for me, is the
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Speaker 2: art form. For me, that's the bit I like about
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Speaker 2: surgery is the is the efficiency Like for me, efficiency
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Speaker 2: is part of the process. Like that is the bit
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Speaker 2: I actually really enjoy and the thing that will spark
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Speaker 2: me off or make me unhappy or grumpy or whatever
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Speaker 2: you might want it is when that process breaks down
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Speaker 2: and then there's inefficiency or there's new variables being introduced
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Speaker 2: into the theater. So I just love so I have.
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Speaker 2: There's a couple of anethetists I have that are just
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Speaker 2: the same. They're just super quick, the turnovers super fast.
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Speaker 2: And then there's a scrub team I have that you're
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Speaker 2: just super slick and it's just beautiful. I love it
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Speaker 2: when everything just moves without any fat on That for
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Speaker 2: me is that's the most enjoyable part of it.
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Speaker 1: Do you reckon that and correct me if I get
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Speaker 1: anything wrong. This is just my perception from the outside
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Speaker 1: looking in that some surgeons can be perceived as being
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Speaker 1: grumpy because there's such high stakes and you, I guess
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Speaker 1: almost have to be a perfectionist of sorts, and so
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Speaker 1: you want everything to be absolutely streamlined, perfect efficient, you know,
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Speaker 1: as you said, no fat, and when that boat gets
3:35
Speaker 1: rocked a little bit, the emotional response might be disproportionate.
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Speaker 2: That's actually exactly it. So I worked with a guy
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Speaker 2: down in Hobart who I would say had the worst
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Speaker 2: case of white line fever I have ever seen reasonably
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Speaker 2: nice on the ward. Then he walked into theater and
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Speaker 2: it was just like it was just something else. I mean,
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Speaker 2: there were times when I thought that the CEE the
4:00
Speaker 2: hospital was going to come down and step in and
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Speaker 2: tell him to leave. You know, it was just it
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Speaker 2: was just it was extraordinary. And I don't condone that
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Speaker 2: sort of behavior, but I have started to understand where
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Speaker 2: that behavior came from, and it was it's when someone
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Speaker 2: threatened to introduce a new variable. So for him, surgery
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Speaker 2: was all about eliminating variables, eliminating the unknown, and he
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Speaker 2: did that very well. And whenever someone came into theater
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Speaker 2: and maybe gave him a different instrument or did something
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Speaker 2: slightly different to him, that was a threat of the unknown,
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Speaker 2: and then the unknown leads to problems and complications and
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Speaker 2: issues further down the track. I had a personal example myself.
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Speaker 2: It was a spine operation. There was a certain mallet
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Speaker 2: that I was used to, and I put my hand
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Speaker 2: out without looking, and then something landed in my hand
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Speaker 2: that I wasn't expecting. It wasn't the same weight, it
4:53
Speaker 2: wasn't the same size. It was just immediately different. I
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Speaker 2: think it was smaller. And I went to go and tap,
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Speaker 2: and then the reps just sort of joke, do you'll
5:01
Speaker 2: have to hit it a bit harder with that small one?
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Speaker 2: And I looked up and I don't normally yell in theater.
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Speaker 2: Actually I didn't yell, but I just I was very
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Speaker 2: cross and made it very clear that that was not
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Speaker 2: funny and not ideal, and I sort of was appreciating
5:17
Speaker 2: what the guy in Hobut was doing. Is like they
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Speaker 2: tried to introduce another variable. They don't understand the consequences
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Speaker 2: of something going wrong. So yeah, the one I think
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Speaker 2: that's the one thing.
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Speaker 1: The one thing I don't want my surgeon to be
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Speaker 1: is grumpy or distracted or frust like. I want my
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Speaker 1: surgeon to be calm as fuck. I want my surgeon
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Speaker 1: to be in flow and happy and in his or
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Speaker 1: her kind of little space where they just perform optimally.
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Speaker 1: I don't want people handing them shit that they don't.
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Speaker 2: Want yeah, but there's an attitude, right, so you could
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Speaker 2: take you can take a number of blows like it's
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Speaker 2: like it's like a like a fighter. They could take
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Speaker 2: a few puns and still perform at their maximum. But
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Speaker 2: this is like that Swiss cheese model, like a little
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Speaker 2: thing lines up with a little thing, which lines up
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Speaker 2: with a little thing, and then you start to get
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Speaker 2: bigger problems further down the track. So it's like nipping
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Speaker 2: these small things in the bud right at the beginning.
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Speaker 2: That's what I do. The flows. But the flow start
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Speaker 2: you talk about is just incredible. You know, forty five
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Speaker 2: minutes can seem like five minutes. It's the most incredible feeling.
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Speaker 2: Everything flows, you know, the scrub nurse just seems to
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Speaker 2: know what you want to put out my hand and
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Speaker 2: ask for it, you know, five seconds before I need it.
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Speaker 2: And then the changeover is like like an F one
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Speaker 2: pit stop and everything and starting an operation. Sometimes you
6:39
Speaker 2: just know that this is going to be a super
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Speaker 2: sick operation. There's something about the tissues, the way it
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Speaker 2: looks under the microscope, the way people are feeling. You
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Speaker 2: just know that this is going to be one of
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Speaker 2: those great operations.
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Speaker 1: I did a podcast yesterday with doctor Denise Faness, who's
6:55
Speaker 1: a geneticist from Queensland and also a blow who you
7:00
Speaker 1: might have heard of from your also your home state,
7:02
Speaker 1: called Trevor Hendy and I was on I was on
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Speaker 1: their show. I don't know if you've seen trev lately
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Speaker 1: or no, but he's the full on He's awesome by
7:12
Speaker 1: the way, He's just like a big fucking six four
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Speaker 1: love bunny. Anyway, we were talking about we're talking about
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Speaker 1: this getting in a state of flow. And I know,
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Speaker 1: for me, if I've got to go and do my
7:26
Speaker 1: equivalent of an operation, which is to say, be in
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Speaker 1: front of a big audience for say three to four
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Speaker 1: hours where it's just me, like I'm there's no other speakers,
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Speaker 1: there's no MC it's just the Craig Show for say
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Speaker 1: four hours nine to one, and I've got to, you know,
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Speaker 1: hopefully create this experience and this outcome. It really matters
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Speaker 1: what I do before nine o'clock, Like it matters. It
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Speaker 1: makes a you know, I can just rock up and
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Speaker 1: do my thing. And because I've done it so many times,
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Speaker 1: I can rock up and I can just rely on
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Speaker 1: skill and repetition and experience and runs on the board
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Speaker 1: and I'll create a reasonably good outcome. But when I
8:12
Speaker 1: get my I don't know if this sounds like fucking
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Speaker 1: mumbo jumbo to you and relating it to what you do,
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Speaker 1: but I know that when I take five to fifteen
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Speaker 1: minutes to get myself into a state I can't really describe,
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Speaker 1: that's like almost this this sounds bullshitty, but transcendent, like
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Speaker 1: get out of my own bullshit. Just get out of
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Speaker 1: my own you know, cognitive mayhem, and just get into
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Speaker 1: this state of calm with really good intentions where I
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Speaker 1: just want to do good things for good people and
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Speaker 1: basically almost be a conduit where all this great stuff
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Speaker 1: can happen through me. That sometimes, like you were talking
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Speaker 1: about the flow state, sometimes at four hours is like
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Speaker 1: sixteen minutes. Do you have any ritual or preparation that
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Speaker 1: you need to do mentally or emotionally or you just
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Speaker 1: rock up and scrub up or something else.
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Speaker 2: That's a really good question. When I was training, I
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Speaker 2: had something where I would training is like a baptism
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Speaker 2: of fire. You're thrust into many sort of unfamiliar situations,
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Speaker 2: which is, you know why you're training, you're learning to
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Speaker 2: do stuff. And I used to put the scrub and
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Speaker 2: put my scrubs on and just stand there my eyes closed,
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Speaker 2: hold my hands spread out so there was like my
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Speaker 2: fingers were as far apart as possible. Relax my shoulders.
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Speaker 2: That was a big thing, because the shoulder tension is
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Speaker 2: a big problem. Relax the shoulders, elbows by the sides,
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Speaker 2: close my eyes and then just breathe deep and slow,
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Speaker 2: and I try to get to twenty. And I really
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Speaker 2: liked that because it calmed me down. But also it
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Speaker 2: made me ignore the fear of somebody else walking into
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Speaker 2: the theater and seeing me do this would look really,
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Speaker 2: really weird. So if I just if I it just
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Speaker 2: meant to ignore them, relax my shoulders, stretch out my
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Speaker 2: hands and breathe deep, and do that. Just thinking about
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Speaker 2: just doing that, there was something really powerful about that.
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Speaker 2: Every time I did that, I opened up my eyes
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Speaker 2: and I just felt like I was a robot. I
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Speaker 2: was just become I was just felt in control. I
10:17
Speaker 2: walked up those stairs. Everything was slow and deliberate, and
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Speaker 2: I had a really good session in theater. Every single time.
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Speaker 2: That always worked. And now it's just a matter of
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Speaker 2: getting up in times. I'm not running late. So if
10:28
Speaker 2: I've tried to work. I drive up to work without
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Speaker 2: it to rush. Then that puts me in a good spot.
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Speaker 1: Like one of my observations from working with elite athletes
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Speaker 1: and I know that you are a pretty good athlete
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Speaker 1: in your day as well, but working with elite footballers
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Speaker 1: AFL teams and National Netball League teams and a bunch
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Speaker 1: of Olympians, but mainly in the team space where players
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Speaker 1: would be in the change room kind of talk and shit,
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Speaker 1: and sometimes I would be in the change room, you know,
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Speaker 1: the or the you know the wherever they are before
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Speaker 1: they run out onto the court or ground or field,
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Speaker 1: and I would look at some of my athletes and think, man,
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Speaker 1: there they're going to go no good today, Like they
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Speaker 1: they're not their heads not in the right place, they're
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Speaker 1: not focused, they're not angry enough, or they're not you know,
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Speaker 1: serious or something. And then most times I was wrong
11:27
Speaker 1: because they would cross that metaphoric or literal white line
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Speaker 1: and that they would just switch on. And I saw
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Speaker 1: this a lot with I work with a netball team
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Speaker 1: called the Melbourne Vixens, who obviously are still in the
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Speaker 1: National League, and that some of the girls were just
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Speaker 1: all the women I should say, were just so fucking
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Speaker 1: incredible that they would be just so laid back and
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Speaker 1: then step into the operating theater or their version of
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Speaker 1: the operating theater and like complete tunnel vision focus. Don't
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Speaker 1: fuck with me, get but it was like a switch.
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Speaker 1: It was like a switch, you know, to be able
12:08
Speaker 1: to step out of that and into something else instantly.
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Speaker 2: I have that under the microscope. Everything leading up to
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Speaker 2: the microscope can be highly variable variable. There are levels
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Speaker 2: of agitation depending on how efficient things are going. But
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Speaker 2: as soon as the microscope is willed into place and
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Speaker 2: I'm looking down at that is definitely a big switch
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Speaker 2: for me. That's a happy place. It's my own world.
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Speaker 2: I feel like I'm just in my own space and
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Speaker 2: everything on the outside is completely gone. So that's my
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Speaker 2: white line is when microscope gets willed into place. There's
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Speaker 2: something about that where I just feel in complete control,
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Speaker 2: know what needs to be done, and I'm laser focused.
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Speaker 2: So I think that's my version of running onto the field.
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Speaker 1: Yeah, And I guess when your eyes are pressed up
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Speaker 1: against a microscope, you don't see anything at all except
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Speaker 1: what you're meant to see, Like there's no peripheral anything,
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Speaker 1: there's no distraction.
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Speaker 2: There's no total immersion.
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Speaker 1: Yes, yes, yeah, well, and then you go from all
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Speaker 1: of those distractions to zero distractions when you press your
13:17
Speaker 1: eyes up against that thing.
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Speaker 2: Yeah. The only thing that can distract me is if
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Speaker 2: your niece that is talking too much. And I've occasionally
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Speaker 2: told them to be quiet.
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Speaker 1: Oh really, do you do you? I think I've asked
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Speaker 1: you this before. I can't remember the answer. Do you
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Speaker 1: do you ever have any music or anything going or No?
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Speaker 2: No, definitely not, nor that if anyone's got any extra
13:40
Speaker 2: sounds going on, it gets killed straight away. There was
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Speaker 2: a guy in Sydney I trained with incredible Cerabo Vaski,
13:46
Speaker 2: so he operated on blood vessels in the brain. He'd
13:49
Speaker 2: have Bob Dylan playing all day, old school Bob Dylan, scratchy,
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Speaker 2: sort of high pitched sort of and it was loud,
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Speaker 2: like you couldn't hear yourself think. And that was and
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Speaker 2: he was doing all this complex, delicate blood vessel surgery.
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Speaker 2: And I couldn't even just be in the theater and
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Speaker 2: watch him. I don't know how he was concentrating, but
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Speaker 2: that was, and without that, he wasn't in his own
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Speaker 2: I can't do noise.
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Speaker 1: I mean that's the I mean that speaking of kind
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Speaker 1: of you know, individual variability, and like the thing that
14:21
Speaker 1: would distract you puts him in the opposite state. Like
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Speaker 1: the thing that you would find a distraction and a
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Speaker 1: bother for him would be the thing that sharpens his
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Speaker 1: focus and attention and perhaps puts him in that state
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Speaker 1: of flow where he can perform at his best. So
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Speaker 1: the same stimulus would make you worse than him better,
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Speaker 1: isn't that fascinating?
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Speaker 2: Yeah? And man, it was loud. I went there for
14:46
Speaker 2: a day to watch him for a couple of things,
14:48
Speaker 2: and I just got a headache just being in the
14:50
Speaker 2: theater listening to All Along the Watchtower for the third time.
14:57
Speaker 1: The tambourine.
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Speaker 2: Man, oh god, nightmares of it.
15:01
Speaker 1: Hey, so one of the one of the things that
15:04
Speaker 1: you started doing, which I fucking love. Hey, everyone, if
15:08
Speaker 1: you don't follow Alex, and I'm guessing you don't, because
15:11
Speaker 1: he's got about seven followers, which is fucking tragic. So
15:14
Speaker 1: help a brother out, would you? So? Doctor d R
15:17
Speaker 1: Alex Kaufman, let me give you. So it's just Dr
15:20
Speaker 1: Alex A l e x ko e f m A
15:24
Speaker 1: n man, Doctor Alex Kaufeman, go follow him. On Instagram
15:28
Speaker 1: for God's sake, and not only because we want to
15:31
Speaker 1: pump up his rapidly depleting self esteem and give his
15:35
Speaker 1: ego a stroke, but because the shit that he's putting
15:37
Speaker 1: up is world class and he's yet to be discovered
15:41
Speaker 1: in this space, and I want people to find out
15:42
Speaker 1: about him. And so I have a watch like he's
15:45
Speaker 1: putting up these shorts, fascinating videos about mostly about the brain,
15:53
Speaker 1: but but what the brain does and consciousness, and you know,
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Speaker 1: I just love it. And I'm not saying that because
16:01
Speaker 1: I'm just sitting with him right now, but yeah, fascinating stuff.
16:05
Speaker 1: So what has that been fun for you? Because that's like,
16:09
Speaker 1: it's a creative process, but it's also I mean, there
16:13
Speaker 1: needs to be a fair bit of thought and planning
16:16
Speaker 1: and execution and a bit of editing and a bit
16:20
Speaker 1: of like what font will I use for this? Have
16:23
Speaker 1: you enjoyed doing something that is quite a departure from surgery? Surgery?
16:29
Speaker 2: Man, I've loved it. This has been such an enjoyable process.
16:33
Speaker 2: I love everything about it. I love the idea, generating
16:37
Speaker 2: the idea. My favorite bit is probably the writing. The
16:41
Speaker 2: writing it. I would happily spend hours just trying to
16:48
Speaker 2: fit an idea into sixty seconds. I love it, that
16:51
Speaker 2: idea of distillation. Yeah, mainly because I did that when
16:55
Speaker 2: I was training in neurosurgery, taking all of neurosurgery and
16:58
Speaker 2: try to distill it down into the middle concepts. That's
17:01
Speaker 2: how I understood and learnched neurosurgery. That whole process of
17:04
Speaker 2: distillation for me is that's that's the greatest experience for me.
17:11
Speaker 2: And so this is a similar process. I have sixty
17:13
Speaker 2: seconds which goes by in a flash to communicate an idea,
17:17
Speaker 2: and so I just love the challenge of writing those
17:19
Speaker 2: words as scinc as possible, as precise, concise, that is
17:23
Speaker 2: just so it's so much fun. And then the shootings.
17:28
Speaker 2: Shooting has been learning a process, and the editing has
17:30
Speaker 2: been a learning process. And then it's been fun just
17:34
Speaker 2: interacting with people. Was they sort of bounce stuff back
17:37
Speaker 2: at me when they after they watch it. That's kind
17:39
Speaker 2: of fun. But the writing process, by far is the
17:42
Speaker 2: most enjoyable.
17:44
Speaker 1: I mean that, I guess one of the challenges is
17:47
Speaker 1: for you and for me with my research, like very
17:50
Speaker 1: different areas of course, well kind of intersex, like the brain, thinking,
17:54
Speaker 1: the mind. It's called in the same region kind of,
17:57
Speaker 1: but like trying to take what can be very complicated
18:04
Speaker 1: information or ideas and then disseminate them in a way
18:09
Speaker 1: that's not only understandable to those of us who are
18:12
Speaker 1: not neurosurgeons or brain scientists, but also in a way
18:17
Speaker 1: that's maybe a bit funny and captivating that makes me
18:20
Speaker 1: want to go watch another video or send the video
18:23
Speaker 1: to someone else to go watch this Like that is
18:27
Speaker 1: a that is a skill to go how do I
18:29
Speaker 1: share science in a way where it doesn't feel like
18:33
Speaker 1: I'm sharing science to the listener or to the viewer. Yeah.
18:39
Speaker 2: I find that a challenging process because I you know this,
18:44
Speaker 2: I've tried something similar many times previously, and the biggest
18:48
Speaker 2: hurdle for me is I don't I just didn't really
18:50
Speaker 2: know what my voice was or who I was in
18:53
Speaker 2: a presentation sort of format. And I like how Jerry
18:59
Speaker 2: Sign describes it, and he says it's like a sculptor's process.
19:02
Speaker 2: You're a block of rock, and through your entire career,
19:05
Speaker 2: you're chipping away that rock to your true self. That's
19:08
Speaker 2: his analogy. I think it's a really good analogy. And
19:11
Speaker 2: through this process of making the videos, I'm actually finding
19:15
Speaker 2: out what my voice is and what, you know, what's
19:18
Speaker 2: the sort of type of message I'm trying to communicate.
19:20
Speaker 2: Obviously I'm not a comedian. I'm I'm you know, there's
19:24
Speaker 2: lots of things that I'm not, and it's really about
19:27
Speaker 2: just trying to work out what I am and the
19:30
Speaker 2: more of it is that I do that. I feel like,
19:32
Speaker 2: you know, I'm I'm starting to sort of hack off
19:36
Speaker 2: chunks of rock off myself and get closer to my
19:39
Speaker 2: true voice and what actually works for me.
19:42
Speaker 1: I reckon, you're an edutainer. That's what you are, the
19:45
Speaker 1: intersection of entertainment and education, because it is like that.
19:50
Speaker 1: It is quite entertaining. And the fact that you so
19:53
Speaker 1: what I wanted to do is I want to I
19:56
Speaker 1: want to talk about a few and and encourage people
20:02
Speaker 1: to go and watch them, but give us a snapshot
20:05
Speaker 1: into some of the videos. I've got myself a little
20:08
Speaker 1: list here. I actually prepped. Can you believe I Craig
20:11
Speaker 1: Anthony Harper, who never preps. I prep. I did a
20:14
Speaker 1: solid eight minutes. So you're welcome. So you and I
20:17
Speaker 1: both without knowing, watched the Tom Brady Roast. If you
20:21
Speaker 1: haven't watched, well, I was going to recommend everyone watch it.
20:24
Speaker 1: You know what, if you're easily offended, definitely don't fucking
20:27
Speaker 1: watch it. But if you've got a thick skin and
20:30
Speaker 1: you're a bit you know, you're not a big politically
20:33
Speaker 1: correct kind of advocate, and you're not too presh, watch
20:38
Speaker 1: the Tom Brady Roast. It's on Netflix. How the fuck
20:42
Speaker 1: they get away with the stuff they say is it
20:44
Speaker 1: is so far up the other end of the scale.
20:48
Speaker 1: It's hilarious and offensive. But Nicky Glasser or Glacier, who
20:55
Speaker 1: is a comedian, she did, she did, she did a spot,
21:03
Speaker 1: she did a she did about eight minutes of stand
21:06
Speaker 1: up just roasting the shit out of Tom Brady. And
21:09
Speaker 1: she was hilarious. And you did, you did a little
21:12
Speaker 1: vid talking about laugh You spoke about her, and then
21:16
Speaker 1: you said something like that laughter is a stress response.
21:20
Speaker 1: Can you explain that a little bit in a minute
21:23
Speaker 1: or two? Or is it a stress response? Maybe that's
21:27
Speaker 1: the question you were asking.
21:30
Speaker 2: Is there is a good there's a number of people
21:34
Speaker 2: who think that laughter is a response to stress, right,
21:40
Speaker 2: And the theory being that there's lots of people have
21:43
Speaker 2: looked at the at humor and try to work it
21:46
Speaker 2: out like why do we laugh? You know, and other
21:49
Speaker 2: people try to dissect human because they want to be
21:51
Speaker 2: funny her or funny like a comedian. But there's some
21:56
Speaker 2: euroscience thinking that the laughter is just a way to
22:02
Speaker 2: relieve the pressure when you realize from that stress response
22:05
Speaker 2: that there's no threats, there's no danger. So the classic one,
22:08
Speaker 2: and this is a classic human behavior walking along, someone
22:11
Speaker 2: jumps out at us and scares the hell out of us,
22:13
Speaker 2: and we jump back and it's a full, full stress response,
22:17
Speaker 2: and then we realize it's a joke, and the next
22:19
Speaker 2: thing we do is laugh, right, why do we do that?
22:23
Speaker 2: And the stress response comes definitely comes from the hyperthalamous,
22:26
Speaker 2: like all the sympathetics originate from the hypothalamus, which is
22:30
Speaker 2: an incredible part of the brain, by the way, and
22:34
Speaker 2: so that that sort of does that automatic process. I
22:37
Speaker 2: remember this clearly. We were walking with Carli one day
22:40
Speaker 2: in the bush and I put my hand out and
22:42
Speaker 2: stopped her without realizing what I was doing. It's completely subconscious,
22:48
Speaker 2: just stopped her and then I sort of see the
22:50
Speaker 2: snake about three meters in front of us going off
22:53
Speaker 2: the track, Like it's such an automated, immediate protective response anyway,
22:58
Speaker 2: So when we see that there's no threat, then there's
23:03
Speaker 2: this sort of idea that's that's the way of releasing
23:05
Speaker 2: relieving stress. But I also mentioned this brain tumor in
23:08
Speaker 2: the hypothalamus, that it's a rare one. But when people
23:11
Speaker 2: get it, their response is to control is to laugh uncontrollably,
23:16
Speaker 2: which is really bizarre. But it's in exactly the same
23:18
Speaker 2: spot on the brain, the hypothalamus. I don't know if
23:22
Speaker 2: we'll ever know exactly why we laugh, but that's probably
23:24
Speaker 2: one of the best theories.
23:26
Speaker 1: What about I love the one that you did on
23:30
Speaker 1: You're talking about the way that our brain, our brain,
23:34
Speaker 1: which is kind of a one point or kilo or
23:38
Speaker 1: give or take three pound kind of lump that sits
23:41
Speaker 1: in our skull, and how it stays foot and how
23:46
Speaker 1: it doesn't really crash around inside our skull and we
23:50
Speaker 1: don't give ourselves CTU thirty five times a day. Explain
23:54
Speaker 1: why that happens. Explain yeah, how it's how it kind
23:59
Speaker 1: of protects it cell.
24:01
Speaker 2: It's incredible. It's one point four kilos. It's floating in seawater,
24:05
Speaker 2: basically warm sea water. There's about one hundred and fifty
24:08
Speaker 2: mils of it, and that buoyancy reduces the effective weight
24:13
Speaker 2: from one point four kilos to about fifty grams. Like,
24:16
Speaker 2: that's incredibly powerful. And the spinal cord is the same.
24:19
Speaker 2: I can see it on a scan. Look at the
24:21
Speaker 2: scan of someone's neck or their back, and I can
24:23
Speaker 2: see the spinal cord running down and the fluid circuferentially
24:27
Speaker 2: around the spinal cord. Nacts like a water cushion. So
24:29
Speaker 2: we're thrashing around, we're moving, we're falling, whatever we're doing,
24:33
Speaker 2: and it's basically like nature's air bag. So that buoyancy
24:37
Speaker 2: is just super super powerful. Like momentum of the brain,
24:41
Speaker 2: what's momentum mass times velocity. So it's effectively reduced the
24:45
Speaker 2: effective mass. That's a play. It's an incredibly powerful mechanism.
24:51
Speaker 2: And people who lose that fluid for whatever reason get
24:53
Speaker 2: horrific headaches. That's one of the first thing, the first
24:56
Speaker 2: things they notice.
24:58
Speaker 1: And so what is that? I mean, see salt water?
25:02
Speaker 1: What is it?
25:03
Speaker 2: Like?
25:04
Speaker 1: Literally like salt water, that's why. And it creates this
25:07
Speaker 1: buoyancy effect.
25:09
Speaker 2: Yeah, it's got one hundred and fifty million miles of
25:11
Speaker 2: sody minutes. It's like almost exactly seawater just at body temperature. Wow, yeah,
25:17
Speaker 2: it's incredible. It's and then like the brain's got all
25:22
Speaker 2: these cuts and grooves and fishes and crevices in it
25:25
Speaker 2: as well, And I think that's another mechanism for protecting
25:27
Speaker 2: the brains. The brain's not just like a basketball like one,
25:29
Speaker 2: just solid lump of stuff. It's got all these crevices
25:33
Speaker 2: and grooves, which again further subdivides the brain up into
25:36
Speaker 2: smaller mass and gives it gives a water cushion to
25:40
Speaker 2: all different parts of the brain. And some really famous
25:43
Speaker 2: deep crevices in the brain that are filled with fluid.
25:45
Speaker 2: And there's all the smaller ones on the surface of
25:47
Speaker 2: the brain that also act as a water cushion. It's
25:51
Speaker 2: just a really incredible mechanism for something so delicate, like
25:55
Speaker 2: during an operation, you only really appreciate being in the brain.
25:59
Speaker 2: Just how delicate actually is, Like with a sucker or
26:01
Speaker 2: a bipolar forcep the brain just gives way, It just
26:05
Speaker 2: yields immediately, so soft and so delicate. Yet we do
26:10
Speaker 2: crazy stuff like you know people bungee jump, or you
26:13
Speaker 2: know you see mma fighters do stuff or whatever it
26:17
Speaker 2: might be, or just even like normal day life that
26:20
Speaker 2: brain should just be we should all be just like zombies.
26:22
Speaker 2: It should just be minced meat from moving around. But
26:24
Speaker 2: it just it's a testament to it's an incredible solution
26:27
Speaker 2: by nature. Float the brain in seawater.
26:31
Speaker 1: You must look at like I was thinking as you
26:34
Speaker 1: were talking about the different ways that we impact our
26:37
Speaker 1: you know, like whether it's mma fighting or bungee jumping,
26:41
Speaker 1: but even in something like soccer, where you know, people
26:45
Speaker 1: literally hit this ball that's flying at a pretty rapid
26:49
Speaker 1: rate with their face, like when you're heading the ball,
26:53
Speaker 1: and you've been like kids start doing that at five, six,
26:56
Speaker 1: seven years old. But do you do you kind of
27:01
Speaker 1: cringe when you see that or do you just think, well,
27:04
Speaker 1: that's just what happens now.
27:07
Speaker 2: I cringe. I cringe at all head knocks in all sports.
27:13
Speaker 2: I don't know if you if you headed a soccer
27:14
Speaker 2: ball that's a hard hit.
27:16
Speaker 1: Yeah, I have, but I'm yet not you know, probably
27:19
Speaker 1: five times in my life, which is probably five times
27:21
Speaker 1: too many. But do you think when it comes to
27:24
Speaker 1: CTE that there's a bit of genetic variability in terms
27:30
Speaker 1: of how much damage happens, because it seems that some people,
27:38
Speaker 1: you know, there's no one that scaped escapes totally unscathed
27:41
Speaker 1: when they've had kind of head trauma. But it seems
27:45
Speaker 1: like there are some people who, you know, sixty years
27:48
Speaker 1: of age and they played full contact sports from when
27:51
Speaker 1: they were eight to when they were thirty five, and
27:54
Speaker 1: cognitively they seem fine, and then there are other people
27:57
Speaker 1: who at forty you can tell there's a cognitive slide
28:01
Speaker 1: happening and maybe they didn't have the same level of trauma.
28:05
Speaker 1: So is there is a little bit about the genetics
28:08
Speaker 1: of the individual as well.
28:12
Speaker 2: That probably is, but definitely a big factor is the
28:16
Speaker 2: type of trauma, there's no question about that. So head
28:22
Speaker 2: injury that involves a rotational component to where the head
28:25
Speaker 2: rotates rather than just sort of thick forwards and backwards,
28:28
Speaker 2: that's known to be particularly damaging, and there are a
28:33
Speaker 2: number of reasons for that. One really interesting reason is
28:36
Speaker 2: that the white matter and the gray matter in the
28:38
Speaker 2: brain are different densities, and when the brain rotates as
28:43
Speaker 2: a rapetortional force, like being punched in the side of
28:46
Speaker 2: the face or falling in a twisting motion, the gray
28:48
Speaker 2: and the white matter accelerate and decelerate at slightly different rates,
28:53
Speaker 2: and so they get a shearing force between the gray
28:55
Speaker 2: and the white matter, but actually the white matter disconnect
28:58
Speaker 2: and that is we call it to fusax on injury.
29:01
Speaker 2: But it's a devastating injury. So one rotational bad rotational
29:06
Speaker 2: injury can equal you know, twenty soccer balls to the
29:11
Speaker 2: head type thing, so that the mechanism is really powerful.
29:15
Speaker 2: As NFL guys, they can get sort of direct head contacts,
29:18
Speaker 2: but then you see them when they hit the ground
29:20
Speaker 2: and there's a real well hit from the side and
29:22
Speaker 2: the head is not only a whiplash, but it's got
29:24
Speaker 2: that real sharp rotational component to it. We know that's dangerous.
29:28
Speaker 1: I saw a guy somebody sent me a clip of
29:32
Speaker 1: a guy getting wheel kicked in the head, always a
29:36
Speaker 1: great thing, will kicked in the head, and he was
29:40
Speaker 1: instantly unconscious on his feet, and then obviously when he
29:43
Speaker 1: fell to the ground, he didn't put his arms out
29:45
Speaker 1: because he was already unconscious. And I had to look
29:49
Speaker 1: like I almost had to look through my fingers because
29:53
Speaker 1: I knew, well, one, he's already fucked right, He's just
29:56
Speaker 1: unconscious on his feet, and then he just falls to
29:59
Speaker 1: the ground, which was an even bigger impact because then
30:02
Speaker 1: he just smashed his head on the ground. I'm thinking
30:05
Speaker 1: just one of those, just that once, just one kick,
30:09
Speaker 1: one fall like that, that could be the end of someone's.
30:11
Speaker 2: Life, right literally, So we call it a king hit,
30:15
Speaker 2: well probably most people call it a king hit, but
30:17
Speaker 2: a king hit in neurosurgery is a devastating brain Kids
30:20
Speaker 2: die from it. They come into into d fully intubated.
30:24
Speaker 2: After a king hit. They have a horrific brain injury,
30:26
Speaker 2: and often they die. And there is is exactly as
30:29
Speaker 2: you said. They get so usually out like Saturday night,
30:33
Speaker 2: everyone's drunk. Someone's drunk, someone comes up behind them. This
30:36
Speaker 2: is how it works, and so they don't see the
30:38
Speaker 2: assaultant come up hits him in the back of the head.
30:40
Speaker 2: So no defenses have been mobilized, so it's completely sort
30:43
Speaker 2: of an unarmed sort of type thing. And they're out
30:46
Speaker 2: conscious and so then gravity takes over and they hit
30:48
Speaker 2: the deck and normally you would break your fall, and
30:51
Speaker 2: you know, you'd break your wrist or something and try
30:53
Speaker 2: and break your fall, but there's there's nothing to break
30:55
Speaker 2: the fall. They just do a pin drop to the
30:57
Speaker 2: ground and the head gets that second impact on the
31:00
Speaker 2: concrete and those brains that brain in a young kid.
31:04
Speaker 2: The injury is so severe that the brain just swells uncontrollably,
31:10
Speaker 2: and more often than not they die.
31:14
Speaker 1: Well, you apart from being a a world class neurosurgeon,
31:20
Speaker 1: you also you were also a very good cricketer and
31:23
Speaker 1: you were looking at that as a potential career. So
31:26
Speaker 1: you would well know the David Hooks story. Of course,
31:30
Speaker 1: do you know that story? Yeah, he got king hit
31:34
Speaker 1: and that that's exactly what happened to him. You got
31:36
Speaker 1: hit by somebody from I think behind or the side,
31:39
Speaker 1: fell hit his head on the concrete and tragically, you
31:44
Speaker 1: know that was it? I mean, yeah, it happens all right.
31:48
Speaker 1: On a brighter note, let's go back to some of
31:50
Speaker 1: your bids. You did one which fascinated me. You were
31:55
Speaker 1: talking about all of the myriad of colors at Coachella.
31:58
Speaker 1: I think, and you see that magenta, what a so
32:02
Speaker 1: Magenta's like a purply color? I think? And you said,
32:05
Speaker 1: Magenta's not real, it's there is no color like it
32:09
Speaker 1: actually doesn't exist. We make it up. We make magenta up.
32:15
Speaker 1: And I think you said, in fact, we make did
32:17
Speaker 1: you say we make all colors up? But can you
32:19
Speaker 1: explain that.
32:21
Speaker 2: It's super cool? So first with magenta. There's a wavelength
32:25
Speaker 2: for everything on the color spectrum that we see everything from,
32:30
Speaker 2: you know, from basically red to blue. So any color
32:35
Speaker 2: in amongst that it has a wavelength, there's a physical
32:37
Speaker 2: wavelength shooting through space and through the sky that hits
32:40
Speaker 2: the back of our eye, and the brain interprets that
32:43
Speaker 2: Spiegel signal for that color. But between red and blue,
32:48
Speaker 2: when red and blue are simultaneously shot, there is the
32:53
Speaker 2: brain creates a color that doesn't exist on the color spectrum.
32:57
Speaker 2: If you shine white light on the prism int, it
33:00
Speaker 2: will not show on the prism, Purple won't show. And
33:03
Speaker 2: it's an incredible, incredibly fascinating idea that the brain receives
33:07
Speaker 2: a wavelength of light that is red and a wavelength
33:10
Speaker 2: of light that is blue and creates a color that
33:14
Speaker 2: has never had a wavelength or existed in the physical universe.
33:17
Speaker 2: It's a pure invention of the human brain. It's an
33:19
Speaker 2: invention of biology. But there's nothing out there.
33:24
Speaker 1: What about though, when I look at a dress that's magenta.
33:28
Speaker 2: So and like they even TV's now the tricolor TVs.
33:33
Speaker 2: You know they're red, blue and green, or they are magenta,
33:36
Speaker 2: cyan and one other color now so but again there's
33:39
Speaker 2: still just a combination. There's still just a combination of
33:41
Speaker 2: red and blue.
33:43
Speaker 1: Wow. Wow, that's amazing it is.
33:46
Speaker 2: And then every every color is every color is invented.
33:49
Speaker 2: I mean, this is the this is the real kicker.
33:51
Speaker 2: Like it's incredible. Really, it's these wavelengths of light hit
33:56
Speaker 2: the back of eye, it gets turned into an electrical signal.
33:58
Speaker 2: It's just an electrical spike. H and that travels along
34:01
Speaker 2: the optic nerve, the chias and the tract optic radiation.
34:05
Speaker 2: Then it gets to the visual cortex. It's all just
34:08
Speaker 2: electrical spikes. There's nothing more to it. And what's more
34:12
Speaker 2: is that every color has the same electrical spike. It's
34:16
Speaker 2: an all or none principle. Every spike is exactly the same,
34:19
Speaker 2: and so there's train of identical electrical spikes arrive at
34:23
Speaker 2: the visual cortex, and that generates more electrical activity, and
34:28
Speaker 2: then at some point that electric activity turns into the
34:32
Speaker 2: spectrum of color that we appreciate around us. That's always
34:37
Speaker 2: been a fascination for me, that that gap between turning
34:40
Speaker 2: electricity into into into the into things we hear, see, feel, taste.
34:47
Speaker 2: There's a there's a Nobel Prize up for grabs if
34:49
Speaker 2: you can, If you can solve.
34:50
Speaker 1: It, I'll look into it. I'll get back to you.
34:52
Speaker 1: I've got some stuff on but the weekend weekend job. Yeah,
34:55
Speaker 1: I'll do it on Sunday. I've got some time. Like
35:00
Speaker 1: when we talk about subjective experience and interpretation and personal
35:04
Speaker 1: reality and all of that, you know, it's like you
35:06
Speaker 1: and I get exposed to the same stimulus and we
35:09
Speaker 1: have a different experience. I think it's funny, you think
35:12
Speaker 1: it's offensive. Or I think this tastes amazing. You think
35:15
Speaker 1: the same thing tastes like dog shit.
35:18
Speaker 2: You know?
35:20
Speaker 1: Is that the same with color? Like I've got a
35:22
Speaker 1: yellow ball here can I oops? There we go like, yeah,
35:26
Speaker 1: so I've got a yellow ball that I just It's
35:29
Speaker 1: like I just squeeze it right, and I'm wondering. I'm
35:32
Speaker 1: holding it up everyone. I'm wondering if you and I
35:34
Speaker 1: see the like we both if I showed you, you'd
35:37
Speaker 1: probably say, yeah, that's yellow or maybe mustard or whatever.
35:40
Speaker 1: But I wonder if my version of yellow is exactly
35:44
Speaker 1: what you're seeing. Do you know what I mean? It's
35:46
Speaker 1: like the color that I recognize as blue or yellow
35:49
Speaker 1: or orange, I wonder if you and there's no way
35:53
Speaker 1: of knowing, but I wonder if we're looking at the
35:56
Speaker 1: same thing in inverted commas.
35:59
Speaker 2: Yeah, I wondered, And then extend that to the animal kingdom,
36:01
Speaker 2: like how do they see the world?
36:03
Speaker 1: Yeah?
36:04
Speaker 2: Yeah, like is like for a dog, for example, is
36:07
Speaker 2: the world coherent or is it just utter chaos? From
36:12
Speaker 2: how they see the world, it's just total chaos, just
36:16
Speaker 2: finding their way through.
36:17
Speaker 1: Probably varies from breed to breed. All right, another one
36:20
Speaker 1: I wanted to talk to you about.
36:21
Speaker 2: You were you go? That's that's a that's a that's
36:25
Speaker 2: a really great point. So what you raised there, that's
36:27
Speaker 2: the other mind's problem. That is a massive problem in euroscience.
36:30
Speaker 2: I will never be able to get inside your head
36:32
Speaker 2: and see what the world looks like from your point
36:34
Speaker 2: of view. That's one of the big barriers to try
36:36
Speaker 2: to work all this out. Everything else in research, you
36:39
Speaker 2: can access it, get inside it, look at break it down,
36:43
Speaker 2: destruct it, reconstruct it, work out what's going on. But
36:46
Speaker 2: I will never ever be able to hack into your
36:50
Speaker 2: brain and see the world from your point of view.
36:52
Speaker 2: In fact, I don't even know if you're even conscious.
36:54
Speaker 2: I can't even prove that you can't prove that I'm conscious,
36:57
Speaker 2: but that that other mind's problem is one of the
37:01
Speaker 2: biggest hurdles for us understanding the human brain and.
37:04
Speaker 1: Also understanding you know, what we call colloquially the mind,
37:09
Speaker 1: right is trying to like that's why psychology and this
37:13
Speaker 1: is coming from someone doing a PhD in psychology. I mean,
37:16
Speaker 1: it's such a fucking slippery slope because it is, you know,
37:20
Speaker 1: at least with the brain, you can see stuff, measure it, literally,
37:24
Speaker 1: quantify things, poke it, card it, dissect it, look at
37:28
Speaker 1: it under a microscope. You can't with the mind. And
37:32
Speaker 1: then you try, you know, it's like I go, I'm happy,
37:35
Speaker 1: and you say you're happy. We could be talking about
37:37
Speaker 1: totally different things, you know. Or I get you to
37:41
Speaker 1: do a you know, some kind of self assessment, you know,
37:46
Speaker 1: on Monday morning at nine o'clock and we get certain data,
37:50
Speaker 1: and then you do the same I get you to
37:52
Speaker 1: do the same assessment Friday afternoon, and the same guy
37:56
Speaker 1: doing the same assessment gives us totally different data. That's why, yeah, exactly,
38:02
Speaker 1: that the whole subjective reality of the individual. It's a
38:06
Speaker 1: very slippery construct.
38:08
Speaker 2: We can't even do with the brain though I actually
38:10
Speaker 2: can't really measure the brain. All we do in neuroscience
38:14
Speaker 2: and neurosurgery, all we've ever done is wait for it
38:16
Speaker 2: to break, then see what part is broken, and then
38:20
Speaker 2: see what the patient looks like. That's how it's always been.
38:24
Speaker 2: So whether they've had a starts off with head injury.
38:26
Speaker 2: I was like, I's got a bullet this part of
38:28
Speaker 2: his brain. He's still awake, but he can't do this,
38:31
Speaker 2: and so then it was assumed that part of the
38:33
Speaker 2: brain must have something to do with this. That's all
38:36
Speaker 2: it's ever been. We've never there's never been anything more
38:42
Speaker 2: advanced than essentially studying the injured brain, whether it's trauma
38:49
Speaker 2: or tumor, or some blood vessel problem or a stroke,
38:53
Speaker 2: and then working backwards.
38:55
Speaker 1: Well, I mean, yeah, nobody's having surgery when their brain's
38:58
Speaker 1: perfect and healthy. What you also did another one that
39:02
Speaker 1: I loved about talking about the difference between being under
39:07
Speaker 1: a general anesthetic called being like I don't know what
39:11
Speaker 1: do you call that? Unconscious like and sleep and how
39:15
Speaker 1: you know, when I wake up in the morning, I
39:17
Speaker 1: feel like I've had eight hours sleep. But if I
39:20
Speaker 1: had an eight hour operation, I'd feel like I got
39:23
Speaker 1: put under one minute ago. Like, talk to us about that.
39:28
Speaker 1: The evaporation of time.
39:31
Speaker 2: It's a complete obliteration of time. I love it every
39:34
Speaker 2: time in the theater. He needs to just get sick
39:36
Speaker 2: of me talking about this. I'm like, do you just
39:39
Speaker 2: realize what you've just done. They're putting that patient to sleep,
39:41
Speaker 2: and like, what, You've just disconnected their brain from consciousness.
39:44
Speaker 2: That is where the magic is, that connection between the
39:47
Speaker 2: brain and conscious You have literally just disconnected them at
39:50
Speaker 2: that critical point. What have you done? How did you
39:53
Speaker 2: do that?
39:54
Speaker 1: Well?
39:54
Speaker 2: I don't know. It just gave them the drugs.
39:58
Speaker 1: Wow. But I love how intelligent anesthetis or shit.
40:02
Speaker 2: I've got patients who like, I'm going to resist this anesthetic.
40:05
Speaker 2: I'm going to count and I'm going to stay awake
40:07
Speaker 2: for as long as possible. And they're great, they go,
40:09
Speaker 2: you just even go ten, nine, eight, set, sit, and
40:16
Speaker 2: then they're gone, yes, And then the magic happens somewhere.
40:19
Speaker 2: That propofile, that that white milky drug that we give
40:23
Speaker 2: them HiT's right at the target and disconnects and nothing
40:27
Speaker 2: else disconnects. I mean, obviously a whack to the head
40:29
Speaker 2: does and things like that. But you know, such an
40:31
Speaker 2: incredible thing. You have ten thousand people in the stadium.
40:34
Speaker 2: Consciousness is not there's no distortions like a Wi Fi
40:38
Speaker 2: signal or anything like that. It's it's just one hundred
40:40
Speaker 2: percent pure, strong signal of that connection between the physical
40:44
Speaker 2: brain and the non physical consciousness. The signals one hundred
40:47
Speaker 2: percent and it's always there unless you're dead or we
40:52
Speaker 2: have a journal anesthetic. And there's just something very magical
40:55
Speaker 2: about that that is hitting at that gap between the
40:57
Speaker 2: physical and the non physical, and it is it's a
41:00
Speaker 2: complete obliteration of time. You sleep, like even a deep sleep,
41:04
Speaker 2: you feel like, oh, you know, that was a good sleep,
41:06
Speaker 2: and you wake up and feel refreshed. Sure it doesn't
41:08
Speaker 2: feel like sitting around waiting for something for eight hours,
41:10
Speaker 2: but you sort of have a general sense that time
41:12
Speaker 2: has passed. And you might sort of have the general
41:15
Speaker 2: vague awareness during the sleep perhaps or maybe you dream,
41:19
Speaker 2: but with a general anti it is a complete obliteration
41:22
Speaker 2: of time. It is literally like that, go to sleep
41:25
Speaker 2: and bang, your wake up. It's just gone.
41:27
Speaker 1: It's like you're it's like you're pulling out the plug
41:31
Speaker 1: on an appliance and the appliance might not be turned on,
41:36
Speaker 1: but it's still connected to the power. And then but
41:39
Speaker 1: when you this is a terrible analogy, so correct me.
41:42
Speaker 1: But then like when you go under general anesthetic, like
41:46
Speaker 1: you're not connected to anything, there is no there's no
41:50
Speaker 1: energy in or out or no no connection.
41:55
Speaker 2: It's just super bizarre. It's so bizarre. And I can
41:58
Speaker 2: spend two hours doing an operation and looking at the
42:01
Speaker 2: just looking at the brain. It looks exactly the same
42:03
Speaker 2: as if someone's awaken. I've done an operation with a
42:06
Speaker 2: patient awaken, I've done them under a general anesthetic, and
42:08
Speaker 2: the brain looks exactly the same, exactly the same. It's
42:11
Speaker 2: pulsing away, it looks the same color, it's got the
42:13
Speaker 2: same consistency. So what's different, Like what's actually been switched off?
42:18
Speaker 2: Where is that switch that that propofol is actually done?
42:22
Speaker 2: I don't know who knows.
42:24
Speaker 1: That's so amazing, and so nobody I know the answer
42:28
Speaker 1: to this, But I'm just double. So nobody ever dreams
42:30
Speaker 1: in surgery. Nobody ever wakes up and says I had
42:33
Speaker 1: a dream.
42:35
Speaker 2: Never, There's some people like that the anesthetic doesn't work
42:39
Speaker 2: for whatever reason, so that switch doesn't get flicked. And
42:41
Speaker 2: like there's those horror stories I was awake during my
42:44
Speaker 2: entire operation, but I couldn't move because of the paralysis drugs.
42:48
Speaker 1: Fuck that.
42:49
Speaker 2: And then there's some people have a theory, well, actually,
42:51
Speaker 2: we're all we're all awake during anesthetic. All it does
42:54
Speaker 2: is just wipe our memory, so we just don't remember it.
42:58
Speaker 2: So whenever we have an operation, we're all skin and
43:00
Speaker 2: screaming in an agony. But then somehow it wipes our
43:02
Speaker 2: brain when we wake up, so we never remember the pain.
43:05
Speaker 2: I don't think that's a good theory.
43:07
Speaker 1: You told you told a story in one of your
43:10
Speaker 1: reels about thirty four year old lady named Chloe who
43:15
Speaker 1: had a grain a brain tumor that grew I think,
43:20
Speaker 1: very slowly, but it ended up being a big brain tumor.
43:24
Speaker 1: But she didn't have like she had only minor headaches
43:27
Speaker 1: despite this fucking massive tumor. Why is that? Why wasn't
43:32
Speaker 1: she an excruciating pain?
43:35
Speaker 2: Yeah, it's really interesting. We call it the cliff face.
43:38
Speaker 2: If something grows really slowly, the brain can adapt and
43:41
Speaker 2: if it goes super slowly and get really massive and
43:45
Speaker 2: push the brain right over to the other side of
43:47
Speaker 2: the head literally, And in this case, that's what happened.
43:49
Speaker 2: To her, but it was okay because the tumor grew
43:53
Speaker 2: millimeters per year, and so the brain just would adapt
43:56
Speaker 2: to the pressure and adapt to the pressure and adapt
43:58
Speaker 2: to the pressure and adapt to the pressure. And it's
44:01
Speaker 2: a hallmark of benign pathology when it gets super large,
44:03
Speaker 2: and they're relatively well as opposed to cancer, which goes
44:06
Speaker 2: really fast, and so usually pick up cancer as a
44:10
Speaker 2: much smaller size because because it grows so fast, the
44:13
Speaker 2: brain just can't adapt to the rapid growth and it
44:15
Speaker 2: starts reacting straight away and really early on in the piece.
44:19
Speaker 2: So she had this massive tumor, a benign tumor, but
44:25
Speaker 2: the cliff face and that is basically that is when
44:27
Speaker 2: the brain suddenly stops adapting it it runs out of
44:31
Speaker 2: its reserves. It's adapted. It's adapt that is adapted a
44:35
Speaker 2: bit like the straw that breaks the camel's back, right,
44:37
Speaker 2: and then it just runs out and people crash and
44:39
Speaker 2: burn really quickly. And that was the risk with her.
44:43
Speaker 2: So she was well that she was getting close to
44:45
Speaker 2: that cliff face. You never know exactly where it's going
44:48
Speaker 2: to be, but you know it's coming and they're getting close.
44:51
Speaker 1: How big was that? Like? Give us like compared to
44:54
Speaker 1: say a golf ball, one golf ball, half a golf ball,
45:00
Speaker 1: two gogars.
45:01
Speaker 2: No, we're talking like a mango. Really yeah, and like
45:05
Speaker 2: you know a mango inside that is huge, like it
45:07
Speaker 2: took up it took I would say it took up
45:09
Speaker 2: about fifth nearly a quarter of her crani or space.
45:14
Speaker 1: And how this is a dumb question, but how do
45:18
Speaker 1: you get that tumor out? Does it? Is it sucked out?
45:22
Speaker 1: Is it? Do you? I don't know how. I mean,
45:26
Speaker 1: I know this is a much more complicated than my
45:29
Speaker 1: very lame question, but yeah, how do you get it out?
45:34
Speaker 2: There's this beautiful instrument, so I don't use a scalpel.
45:37
Speaker 2: I use the scalpel on the skin and then I
45:39
Speaker 2: never used the scalpel ever again during the operation, which
45:41
Speaker 2: is strange. Everyone thinks it's all scalpel. Yeah. There's something
45:44
Speaker 2: called accuser CUSA, which stands for uh cavetron ultrasonic aspirate. Essentially,
45:51
Speaker 2: it's like holding a pen and the tip of it
45:53
Speaker 2: vibrates at a very high frequency which shatters the tissue
45:57
Speaker 2: at its tip, and then after shattering the tissue, it
45:59
Speaker 2: then suck the tissue up. So basically fragments a solid
46:03
Speaker 2: object and it's just beautiful and you can change the setting.
46:06
Speaker 2: And so basically I just hollow out the center of
46:10
Speaker 2: the tumor. It's like it's called a witch's caldron technique.
46:12
Speaker 2: Hollow out the center of the tumor using the cavetron
46:15
Speaker 2: and just get it so it's all hollowed out, and
46:18
Speaker 2: then collapse the capsule of the tumor in on itself
46:21
Speaker 2: away from the brain. So you turn a solid lump
46:25
Speaker 2: into a witch's caldron, which is essentially an empty vessel,
46:29
Speaker 2: and the wall of the thing is now the capsule
46:32
Speaker 2: of the tumor. And then that's when I start collapsing
46:36
Speaker 2: the wall of the tumor in on itself and dissecting
46:38
Speaker 2: it away from the brain.
46:40
Speaker 1: Oh my god, Oh my god. Your job is the
46:44
Speaker 1: fucking weirdest job, the most terrifying job. How long before
46:49
Speaker 1: again this could be a night naive question, but how
46:53
Speaker 1: long before that cavity, that space that you've just created
46:56
Speaker 1: with the removal of the tumor gets for one of
46:59
Speaker 1: a better term, reinhabited by the brain, that gets filled
47:05
Speaker 1: up again, or does it? Or is there a permanent
47:08
Speaker 1: kind of spare room in there.
47:11
Speaker 2: I've seen her scan four years later, and I would
47:14
Speaker 2: say ninety percent of that space the brain has re expanded,
47:17
Speaker 2: like the brain almost always reexpands, but there is always
47:20
Speaker 2: some evidence that there has been something there. So there's
47:22
Speaker 2: a there's a gliotic cavity or a cavity lined by
47:26
Speaker 2: scar tissue. So it's never one hundred percent. I would
47:30
Speaker 2: say that her cavity is it would be the size
47:33
Speaker 2: of a ping pong ball something like that. That's something small.
47:38
Speaker 1: Why do Why did benign tumors grow? What are they
47:43
Speaker 1: made of? I feel like they're made of fat or something.
47:47
Speaker 1: What are they made of?
47:48
Speaker 2: You can get light pomer, like a liightpomer is a
47:50
Speaker 2: fat tumor in the brain, but hers was basically collagen fiber. Wow,
47:57
Speaker 2: it's like fiberglasts and lots and lots of college and
48:00
Speaker 2: so it's a really fibrous, fleshy type tumor metastasis like
48:05
Speaker 2: a lung met to the brain or breast smetastas to
48:07
Speaker 2: the brain. That's really what we call psychomatists, which is
48:11
Speaker 2: another word for saying a fleshy tumor, And that's mainly
48:15
Speaker 2: just all cells that under a microscope. It's just a
48:17
Speaker 2: whole heap of cells stacked on top of each other,
48:19
Speaker 2: and it's really fleshy like liver. Basically, they come out
48:23
Speaker 2: really easily, but meningioma is a really fibrous, dense tumor.
48:28
Speaker 2: It takes a while to hollow those things out. This
48:33
Speaker 2: is his typathology man all pathology. As part of our exam,
48:38
Speaker 2: look at a slide and say what tumors is based
48:40
Speaker 2: on looking at the cells and the structure. It's the
48:43
Speaker 2: thing we learned last.
48:45
Speaker 1: Do you do you ever get you know, when you're
48:48
Speaker 1: just about like is there a This is a weird question,
48:51
Speaker 1: but do you enjoy it? Like when you're getting rid
48:54
Speaker 1: of that shit and you're basically healing this person or
48:58
Speaker 1: at least opening a doorway to healing for this person.
49:04
Speaker 1: Does it give you joy in the moment or are
49:06
Speaker 1: you just too caught up in the focus and the
49:08
Speaker 1: process to enjoy it.
49:10
Speaker 2: Not thinking about the patient at all, not once to
49:13
Speaker 2: even think of their face, remember talking to them. It's
49:16
Speaker 2: just purely a game of biological chess. So that is
49:21
Speaker 2: it's a goal to be achieved, and I absolutely love
49:25
Speaker 2: the challenge of doing that, of using a surgical technique,
49:30
Speaker 2: whatever that technique might be, to get that thing out
49:33
Speaker 2: without causing a problem. And that's just how I see it.
49:36
Speaker 1: Now when said that, When you just said that, I'm
49:38
Speaker 1: not thinking of the patient at all. Some people are like, oh,
49:41
Speaker 1: he's a fucking sociopath. Tell us why you're not a sociopath.
49:47
Speaker 2: Well, it'd be like you saying bolt after all that
49:50
Speaker 2: training at the one hundred meters the Olympics final, looking
49:53
Speaker 2: across and feeling sorry for or worrying about how the
49:57
Speaker 2: other guys are going, Are you okay? Are you going
49:58
Speaker 2: to be all right? You know you want me to
49:59
Speaker 2: slad whatever. He's not thinking about that, he's thinking about
50:03
Speaker 2: he's thinking about the squad is about the push off
50:05
Speaker 2: the gun, you know, the first ten meters and then
50:07
Speaker 2: getting upright, and then it's about an execution of a
50:09
Speaker 2: skill that gives the best results. So in surgery, it's
50:12
Speaker 2: an execution of a of a of a technique or
50:15
Speaker 2: a skill that leads to the best results. So if
50:17
Speaker 2: you're thinking about the patients, it's actually it actually puts
50:22
Speaker 2: you off your game. And maybe some surgeons do, but
50:25
Speaker 2: you know I certainly don't. And all the great ones
50:28
Speaker 2: that I trained with, certainly don't. It's very much about
50:31
Speaker 2: executing the plan and that's all all the focus.
50:35
Speaker 1: Is whatever you need to do to get the best result.
50:38
Speaker 1: That's what I think. Like and I think, yeah, maybe
50:42
Speaker 1: because I'm an mpath, right, I'd be a terrible surgeon
50:46
Speaker 1: for more reasons than that. But I'd be a terrible surgeon.
50:50
Speaker 1: But I think that, which is not to say you
50:52
Speaker 1: don't care. I know you care because I know how you.
50:56
Speaker 1: I know how you liaise with your patients and meet
50:58
Speaker 1: with your patients.
51:00
Speaker 2: Know that.
51:00
Speaker 1: But I guess in that moment, if you were worried
51:04
Speaker 1: or you know, you were feeling certain feelings about the patient,
51:09
Speaker 1: that's taking away from your focus and therefore from the
51:14
Speaker 1: execution of what needs to be done.
51:16
Speaker 2: I guess absolutely. But that's that's it's a very different
51:20
Speaker 2: game before the operation and after the operation. Sitting in
51:24
Speaker 2: the room, talking to them in my room, it's it's
51:27
Speaker 2: a it's a complete opposite. I'm talking to them as
51:30
Speaker 2: if they are my family.
51:32
Speaker 1: Yeah, yeah, And.
51:34
Speaker 2: They always asked me like if I was your dad
51:37
Speaker 2: or your mum, what would you do? Yes, So before
51:40
Speaker 2: the before and after the operation is exactly it's the
51:42
Speaker 2: exact opposite, Like I'm talking to them as if they
51:45
Speaker 2: are family, Like I look at them and go, if
51:48
Speaker 2: that was my dad or my mum, what would I
51:51
Speaker 2: want them to have done? Yes, So it's all I'm
51:54
Speaker 2: thinking about is them and their quality of life. I'm
51:58
Speaker 2: always struck. I'm always struck after just say the simplest operation,
52:02
Speaker 2: I do a micro diskectomy. It might take me fifteen
52:06
Speaker 2: twenty minutes, no sweat, routine operation, and I ring up
52:11
Speaker 2: the family and go Dlex here, I've just reading to
52:14
Speaker 2: let you know I finished the operation. It's all gone well,
52:18
Speaker 2: and the wife or the husband or the daughter or
52:22
Speaker 2: the whatever on the phone. The relief that comes off
52:25
Speaker 2: their shoulders is completely disproportionate to what I feel like
52:28
Speaker 2: I have just done. But what I feel like I've
52:30
Speaker 2: done is it's been a walk in the park and
52:32
Speaker 2: super easy. And for them, it's like they've just had
52:36
Speaker 2: this incredible weight on their shoulders worrying about this operation.
52:40
Speaker 2: And I really like that because it just reminds me
52:42
Speaker 2: about the human side of what's going on here. Like, yes,
52:46
Speaker 2: it is an operation, but ultimately it's about someone's life.
52:50
Speaker 2: And when you're talking about their health it's a huge
52:52
Speaker 2: thing and you don't really fully appreciate it, I suppose
52:56
Speaker 2: to until you're a patient. In fact. Henry Marsh is
52:58
Speaker 2: a neurosurgeon in the UK who has just written his
53:02
Speaker 2: last book. He's an eminent neurosurgeon, and his last book
53:06
Speaker 2: he talks about having prostate cancer and the idea of
53:09
Speaker 2: going from being a surgeon and the apex predator in
53:12
Speaker 2: a hospital basically to being the prostate guy in bed
53:16
Speaker 2: seven and feeling what it's like to suddenly just be nothing,
53:22
Speaker 2: irrelevant and just a patient, not even by naming he's
53:25
Speaker 2: the prostate cancer guy in seven and that is just
53:30
Speaker 2: the sense of inevitability, the sense of almost not being
53:35
Speaker 2: even human. I found that really quite an interesting insight
53:41
Speaker 2: from a surgeon who's subsequently become a patient. And I've
53:44
Speaker 2: just made it my goal never to make someone feel
53:47
Speaker 2: like that because happening to you and even like, you know,
53:52
Speaker 2: one of my parents had surgery and you just realize
53:55
Speaker 2: what it's like on the other side of the fence.
53:57
Speaker 2: You know, it's it's that's your mum. It's like that's
54:00
Speaker 2: everything you've lived with him in your entire life. And
54:03
Speaker 2: I get that. I didn't get it at the start
54:05
Speaker 2: of my career, but I definitely get that now, so
54:08
Speaker 2: I have a good balance now before and after. It's
54:10
Speaker 2: it's all about the patient, their life and everything that
54:12
Speaker 2: they represent during the operation. It's it's you know, it's
54:18
Speaker 2: it's a game of biological chests and pure focus.
54:22
Speaker 1: Mate. I've got another ten things on my list. I
54:25
Speaker 1: think we might have to come back next week and
54:27
Speaker 1: do another one. So doctor Alex kofeman ko e f
54:33
Speaker 1: m A n on in to go follow him, give him,
54:36
Speaker 1: give him a little bit of love and as always, enlightening, informative,
54:42
Speaker 1: great edutainment by you and we will. I'm coming to
54:48
Speaker 1: Brisbane soon, by the way, I'm coming to hang on
54:51
Speaker 1: checks whiteboard July twenty five, so you and I'll have
54:55
Speaker 1: to do dinner and we'll get together. Put it in
54:58
Speaker 1: your diary. Probably I'll be on July twenty five. I'm
55:03
Speaker 1: up July twenty five, doing a corporate gig on on
55:08
Speaker 1: the twenty sixth, but I'm doing a public workshop on
55:11
Speaker 1: the twenty fifth, by the way, Brizzy people. That'll be
55:14
Speaker 1: announced soon, so booking only twenty people. Private workshop called
55:18
Speaker 1: Stop Wasting Your Potential. Alex might come and do a cameo.
55:21
Speaker 1: Who the fuck knows, but you and I will definitely
55:24
Speaker 1: have to do food, coffee and spooning on the couch.
55:28
Speaker 2: Yep, you be wearing those cargo shorts, so you gotta
55:30
Speaker 2: WACKPD some jeans Fordeo, you get a effort.
55:35
Speaker 1: I'll be wearing some spandex and yeah, no, of course
55:39
Speaker 1: I'll be in mate. I don't have any other clothes.
55:42
Speaker 1: I'm all about function, all about function. Thanks mate, Thanks Craig.
55:46
Speaker 2: There's awesome mate thinking