This Is Brain Surgery

When Dr. Benjamin S. Carson gets exasperated at the office, he can't shout to his colleagues, "Come on, this isn't brain surgery!"

That's because Carson is one of the world's most celebrated brain surgeons. In 1984, at age 33, he was named chief of pediatric neurosurgery at Baltimore's Johns Hopkins Hospital - becoming the youngest U.S. doctor to hold such a position. Three years later, he made headlines by leading a 22-hour operation to separate Siamese twins joined at the head - the first such procedure ever to succeed for both patients.

Today Carson is a legend within the medical community. He performs as many as 500 operations per year - more than twice the caseload of a typical neurosurgeon. Yet he focuses on the most fragile patients - children, newborns - and on the most difficult brain-related conditions. Most notably, he revived and refined a radical form of surgery, called a hemispherectomy, that was developed in the 1930s and then abandoned because doctors saw it as too risky. In this procedure, Carson treats children suffering from debilitating seizures by removing half their brain. Because the patients are so young, the remaining half is able to assume the functions normally performed by the missing half. He has done 65 of these daring procedures over the last 12 years.

Carson is more than a medical marvel. He is a folk hero to young people in Baltimore and beyond. His mother, who was married at age 13, had two sons before her husband abandoned the family. But Sonya Carson made sure that her sons defied the odds. She insisted that young Ben and his brother, Curtis (now an engineer), read two books a week and write book reports for her. (Only later did Ben and Curtis learn that their mother, with just a third-grade education, had struggled to read the reports they had written.) Carson has written his own inspirational book, Think Big (HarperPaperbacks, 1992), and an autobiography, Gifted Hands (Zondervan, 1990), which describe his personal journey and religious convictions. Over the last four years, a Maryland theater group has been performing a play, Ben Carson, M.D., that brings his story to life for audiences in schools, churches, and community centers.

Fast Company turned to Carson for advice about living and working on the cutting edge - about handling pressure, planning for problems, and dealing with risk.

Don't Pretend There Isn't Pressure

This may sound strange, but I never downplay the pressures of this work. Every one of our actions has consequences, and unless you are aware of those consequences, you are going to get into trouble. The brain is much more fragile than the heart. When you advance the drill next to that craniotomy - what happens if it slides into the brain? Or when you put in the retractor and start pulling back - what's happening to a blood vessel three centimeters away? You can do some extraordinarily complex, dangerous things, but only if you're always thinking about the consequences.

When we separated the Siamese twins, the most difficult part was having just one hour to divide and reconstruct the sinuses. To do this, we had to put the two patients in hypothermic arrest: You pump the blood out of their bodies, do the procedure, and then pump the blood back in and restart the heart. It's like operating on cadavers. They could tolerate that condition for as long as one hour. We had planned on taking three minutes to cut through the sinuses. But when we got in there, we found the sinuses stretched all the way to the base of each skull; it took us 20 minutes to cut through them. So we had only 40 minutes to complete everything else before the blood was turned back on. We sewed like crazy and finished in 59 minutes plus a few seconds.

Now, that doesn't mean the operating room is always packed with pressure. We play Bach, Schubert, Vivaldi. We talk about the Orioles. My attitude is, we're going to be in this room for many, many hours, so everything should be as pleasant as possible. If I want to create tension, all I have to do is to insist that everyone stay quiet and watch me work. That's not what I want to do.

Plan for Problems

Another way I handle pressure - and this may sound strange too - is to focus clearly on what can go wrong. I seldom do just one operation in a day; I may do as many as five or six. I think through every procedure: how I expect it to go, how long each phase will last, when I can move on to the next one. But the real value of planning comes when things don't go the way I expect. I always anticipate the worst-case scenario: What's the worst thing that could happen? What can I do to make sure it doesn't? What will I do if it does?