Dr. Benjamin S. Carson a Seventh-day Adventist's Pediatric Neurosurgeon. - New York Times, 6/8/1993
SCIENTIST AT WORK:
Benjamin S. Carson; For Many, Pediatric Neurosurgeon Is a Folk Hero
By ROBIN MARANTZ HENIG
Published: June 8, 1993
Today, at age 41, eight years after becoming the nation's youngest chief of pediatric neurosurgery -- he is one of only three African-Americans in that position -- Dr. Carson is arguably the most famous surgeon on the Hopkins staff. As director of the 22-member team that in 1987 successfully separated Siamese twins joined at the head, he was in the national news for weeks.
As a result, he has become something of a folk hero in black neighborhoods, no less for his own story of triumph over adversity than for the dramatic operations he has attempted.
Today his surgical challenges are less bizarre than the Siamese twin separation. But they are still technically complex and emotionally demanding.
As do other neurosurgeons at leading medical centers, Dr. Carson tackles the toughest cases, from congenital dwarfism to inoperable brain tumors, from intractable epilepsy to unremitting facial pain. He tries to wield his scalpel in ways that will restore the body to something approaching normalcy.
"My philosophy is to look at a patient and ask, 'What is the worst that could happen if we do something'? " he explained during a rare free moment in his modern, uncluttered office. "It's usually that the patient ends up seriously debilitated or dead.
"Then I ask, 'What is the worst that could happen if we do nothing?' And it's usually the same thing. So with that as a background, I figure it's always worth trying to do something, if there's any chance at all that doing something might end up helping."
This attitude led Dr. Carson, in 1985, to revive the surgical procedure known as hemispherectomy, the removal of half the brain in a child who is plagued by seizures that do not respond to drugs. The hemispherectomy, first developed in the 1930's, is an operation of epic consequence, performed in the hope that the remaining one can orchestrate thought, speech and movement for the whole body.
After several hundred unsuccessful attempts, the procedure fell into disfavor in the 1970's, not because of the dysfunction resulting from the loss of brain tissue, but because of the nearly inevitable post-surgical complications, including bleeding, infection and problems with the cavity left behind.
But when Dr. Carson met Maranda Francisco, a 4-year-old girl from Denver who was racked by 120 seizures a day, he decided that medicine had advanced sufficiently to give the measure another try.
"The chief of pediatric neurology here, John Freeman, felt that Maranda was a perfect candidate for a hemispherectomy, which he had seen performed a few times while he was at Stanford," Dr. Carson said. "So I did a lot of reading on the subject, and it seemed to me the complications were mostly things we could handle now."
The odds against success were great, but Dr. Carson figured it was worth taking a chance. "I reasoned that she was having so many seizures that she had no life, so there was not really anything to risk," he said. "And there might be a whole world to gain."
Maranda is now a healthy 12-year-old who takes tap-dancing lessons. Like most of the other hemispherectomy patients at Hopkins -- 44 in all, which the hospital believes is more than at any other center in the country -- Maranda got her speech back immediately after surgery, probably because her right hemisphere had already taken over language function from the badly damaged left hemisphere.
"We can only do this operation on young children, because their brain cells haven't decided what they want to be when they grow up," Dr. Carson said. This flexibility, which neuroscientists call "plasticity," explains why certain brain cells take over the functions of damaged or missing cells.
Heroic as these hemispherectomies have been, the real media attention came after the Siamese twins case, which held a sort of lurid fascination for physicians and lay people alike. When the parents of the twins, Patrick and Benjamin Binder of Ulm, Germany, sent in a request to have their sons operated on at Hopkins, there had never been a successful separation of Siamese twins joined at the head.
It was just the kind of long shot on which Dr. Carson seems to thrive.
The operation, for which the surgical team spent five months rehearsing, lasted 22 hours and involved 70 surgeons, nurses and assistants inside the operating room, and another 70 support staff members outside.
During the operation, Dr. Carson used a new way of buying time for brain repair. It involved hypothermia, cooling the patient's body to 68 degrees to slow brain metabolism sufficiently to allow the surgeons to stop blood flow through the brain for an hour without causing damage.
"I almost didn't make it," he recalled. "After they stopped the heart and set the timer for one hour, I told everyone I didn't want to know how much time we had left."
He managed to separate the two brains in about 20 minutes and to close the skull of the twin he was working on -- with his mentor, neurosurgery chief Dr. Donlin Long, closing the other twin's skull -- in about another 40.
After the operation, the successfully separated twins went home to Ulm. But then, as far as the Hopkins staff was concerned, they disappeared. Despite repeated efforts, Dr. Carson has been unable to find out how Patrick and Benjamin, now 6 years old, are faring.
"I've written so many letters, and I've never gotten any response," he said.
(In Ravensburg, Germany, a local physician said the boys were too disabled to live at home and were staying at a facility for handicapped children in the area.)
"I still believe the surgical procedure itself was an incredible success," he said. "And whenever there's a less-than-ideal result, I feel you must always ask yourself, 'What can I learn from this? How can I do better next time'?"
Although Dr. Carson has occasionally been criticized for publishing his research only infrequently and has had his originality as a scientist questioned, he is unruffled by such comments. A mild, soft-spoken man with an unhurried manner and a ready smile, he projects a sense of confidence, which he attributes to knowing his subject cold, believing in his talent and relying on his religious faith. Beating the Odds
A Seventh-day Adventist, Dr. Carson said one of his favorite sayings is, "Do your best, and let God do the rest."
The most dramatic procedures he performs today involve large brain tumors. When the size of these encroaching tumors is significantly reduced, Dr. Carson said, the stray pieces of cancer that are impossible to remove surgically are often destroyed, even without dangerous radiation therapy.
"If you can reduce the bulk of the tumor and shave it back to normal tissue," he said, "then I believe the body's natural defense mechanisms can keep the rest of it under control."
Beating back nearly insuperable odds, which is what he attempts in the operating room, is also something of a theme in Ben Carson's personal story. His father abandoned the family when Ben Carson was 8, and he grew up in a Detroit ghetto, where his mother provided for her two sons by working several domestic jobs.
After a rocky start in elementary school -- he laughs when he recalls that he was, by universal consensus, the "class dummy" in fifth grade -- he began to excel academically, a fact that he attributes to his mother.
This demanding regimen soon made a mark on young Ben Carson, who graduated third in his high-school class and won an academic scholarship to Yale University, where he majored in psychology.
Now, in between operations and hospital rounds, Dr. Carson, the father of boys whose ages are 9, 8 and 6, frequently delivers inspirational lectures. And he sets aside an hour every month to talk to schoolchildren.
At the most recent such lecture, in mid-May, 750 youngsters from nine schools greeted Dr. Carson's arrival in the Hopkins auditorium with the fanfare usually reserved for rock stars: squeals, applause and requests for his autograph or a chance to snap his photograph.
"You're my role model," one teen-ager told him. "I want to be a brain surgeon, too."
"You hold on to that dream," replied Dr. Carson. Still trim and with a full head of hair, he appears so youthful that in his blue surgical scrubs and white coat he almost looks like someone masquerading as a doctor.
But no one mistakes him for an orderly anymore. Message to Children
At the lectern, his message was simple: "Don't let anyone turn you into a slave. You're a slave if you let the media tell you that sports and entertainment are more important than developing your brain."
The hands that have made him one of the most sought-after neurosurgeons in the country, the hands with the long tapering fingers and immaculate oval nails, gripped the microphone tighter as he delivered the message that has become almost as important to him as the operations he performs.
"You don't have to be a brain surgeon to be a valuable person," Dr. Carson said. "You become valuable because of the knowledge that you have. And that doesn't mean you won't fail sometimes. The important thing is to keep trying."
Taken from: http://query.nytimes.com/g
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