A highlight for me during my residency was the research I did during my fifth year. For a long time my interest had continued to grow in the areas of brain tumors and neuro-oncology. While I wanted to stay with doing this kind of research, we didn’t have the right animals in which we could implant brain tumors. By working with small animals, researchers had long established that once they obtain consistent results, they could eventually transfer their findings toward finding cures, and then they could offer help to suffering human beings. This is one of the most fruitful forms of research to find cures for our diseases.
Researchers had done a lot of work using mice, monkeys, and dogs, but they encountered problems. Dog models produced inconsistent results; monkeys were prohibitively expensive; the murines (rats and mice) were cheap enough but so small that we couldn’t operate on them. Neither did they image well with CT Scans* and MRI† equipment.
To accomplish the research I wanted, I faced a triple challenge: (1) to come up with a relatively inexpensive model, (2) to find one that was consistent, and (3) to find a model large enough to be imaged and operated on.
My goal was to work with one type of animal and let that be the basis (or model) for our developmental research in brain tumors. A number of oncologists and researchers who had previously established working models counseled, “Ben, if you go ahead and begin to research brain tumors, you’d better expect to spend at least two years in the lab on the project.”
When I embarked on the project I was willing to work that long or longer. But which animals should I use? While I initially started with rats, they were actually too small for our purpose. And, personally, I hate rats! Maybe they triggered too many memories of my life in Boston’s tenement district. I soon realized rats did not have the qualities necessary for good research, and I began to search for a different animal.
During the next few weeks I talked to a lot of people. One fabulous thing about Johns Hopkins is that they have experts who know practically everything about their own field. I started making the rounds among the researchers asking, “What kind of animals do you use? Have you thought of any other kind?”
After a lot of questions and many observations, I hit upon the idea of using New Zealand white rabbits. They perfectly fitted my threefold criteria.
Someone at Hopkins pointed me to the research work of Dr. Jim Anderson, who was currently using New Zealand white rabbits. It was a thrill to walk into the lab there in the Blaylock Building. Inside, I saw a large open area with an X-ray machine, a surgical table off to one side, a refrigerator, an incubator, and a deep sink. Another small section housed the anesthetics. I introduced myself to Dr. Anderson and said, “I understand that you’ve been working with rabbits.”
“Yes, I have,” he answered and told me the results he’d already obtained by working with what he called VX2 to cause tumors in the liver and kidneys. Over a period of time, his research showed consistent results.
“Jim, I’m interested in developing a brain tumor model, and I wondered about using rabbits. Do you know any tumors that might grow in rabbits’ brains?”
“Well,” he said, thinking aloud, “VX2 might grow on the brain.”
We talked a little more and then I pushed him. “Do you really think VX2 will work?”
“I don’t see any reason why not. If it’ll grow in other areas, there’s a good chance it might grow on the brain.” He paused and added, “If you want to, try it.”
“I’m game.”
Jim Anderson aided me immensely in my research. We first tried mechanical disassociation; that is, we used little screens to grate the tumors, much like someone would grate cheese. But they didn’t grow. Second, we implanted chunks of tumors into the rabbits’ brains. This time they grew.
To do what we call viability testing, I approached Dr. Michael Colvin, a biochemist in the oncology lab, and he sent me to another biochemist, Dr. John Hilton.
Hilton suggested using enzymes to dissolve the connected tissue and leave the cancer cells intact. After weeks of trying different combinations of enzymes, Hilton came up with just the right combination for us. We soon had high viability — almost 100 percent of the cells survived.
From there we concentrated the cells in the quantities we wanted. By refining the experiments we also developed a way of using a needle to implant them into the brain. Soon almost 100 percent of the tumors grew. The rabbits uniformly died with a brain tumor somewhere between the twelfth and fourteenth day, almost like clockwork.
When researchers have that kind of consistency they can go on to learn how brain tumors grow. We were able to do CT scans and became excited when the tumors actually showed up. The Magnetic Resonance Imaging (MRI), developed in West Germany, was a new technology just breaking on the scene at that time, and wasn’t available to us.
Jim Anderson took several of the rabbits to Germany, imaged them on the MRI, and was able to see the tumor. I would have loved to go with him and would have, except that I didn’t have the money for the trip.
Then we had the use of a PET* scanner in 1982. Hopkins was one of the first places in the country to get one. The first scans that we did on it were the rabbits with the brain tumors. Through the medical journals we received wide publicity for our work. To this day a lot of people at Johns Hopkins and other places are working with this brain tumor model.
Ordinarily this research would have taken years to accomplish, but I had so much collaborative effort with others at Hopkins helping to iron out our problems that the model was complete within six months.
For this research work I won the Resident of the Year Award. This also meant that instead of staying in the lab for two years I came out the next year and went on to do my chief residency.
I began my year of chief residency with a quiet excitement. It had been a long, sometimes tough road. Long, long hours, time away from Candy, study, patients, medical crises, more study, more patients — I was ready to get my hands on surgical instruments and to actually learn how to perform delicate procedures in a quick, efficient way. For example, I learned how to take out brain tumors and how to clip aneurysms. Different aneurysms require different sized clips, often put on at an odd angle. I practiced until the clipping procedure became second nature, until my eyes and instinct told me in a moment the type of clip to use.
I learned to correct malformations of bone and tissue and to operate on the spine. I learned to hold an air-powered drill, weigh it in my hand, test it, then use it to cut through bone only millimeters away from nerves and brain tissue. I learned when to be aggressive and when to hold back.
I learned to do the surgery that corrects seizures. Learned how to work near the brain stem. During that intense year as chief resident, I learned the special skills that transformed the surgical instruments along with my hands, my eyes, and intuition into healing.
Then I finished the residency. Another chapter of my life was ready to open and, as often happens before life-changing events, I wasn’t aware of it. The idea came across as impossible—at first.
Ben’s high school graduation. Sonya Carson, far right, with family friends.
Curtis and Ben at a teenage Christmas.
Detroit Free Press/William DeKay (5-15-88)
Sonya Carson holds the high school graduation photographs of her sons Ben, left, and Curtis.
Ben’s first year at Yale.
Ben and Curtis at Ben’s graduation from medical school.
Murray and B.J. welcome their new Christmas present.
One-day-old Rhoeyce with his father.
Detroit Free Press/William DeKay (5-15-88)
Ben and his wife, Candy, relax at home at the piano.
Carson serenade. A lullaby before bedtime.
The Carsons at home: Ben, Murray, Rhoeyce, Candy, and B.J.
A hemispherectomy reunion.
Maranda Francisco, Ben’s first hemispherectomy patient, with balloons at hospital party.
Walter McCardell/The Baltimore Sun
Dr. Carson talks with young patient.
J. Pat Carter/Johns Hopkins Children’s Center
The Binder twins surgery with neurosurgeons Ben Carson, Reggie Davis, Sam Hassenbusch, and Donlin Long.
Detroit Free Press/William DeKay (5-15-88)
Dr. Benjamin Carson stands quietly with his assistant, Carol James, before starting the delicate brain surgery for which he has become internationally known.
David B. Sherwin
Ben Carson receives an honorary doctoral degree from Andrews University in June 1989.
Detroit Free Press/William DeKay (5-15-88)
Dr. Carson examines 2½-year-old Megan Wikstrom during rounds at the Johns Hopkins Children’s Center. “Nobody could be more patient with my one million questions and fears,” says her mother, Margie Wikstrom, center.
Detroit Free Press/William DeKay (5-15-88)
Carson chats with Paul Galli, 16, of Hammonton, New Jersey, who had returned for a checkup after surgery for a brain tumor.
Johns Hopkins Children’s Center
Dr. Mark Rogers and Dr. Carson with one of the Binder twins.
Johns Hopkins Children’s Center
At a press conference after the Siamese twin surgery.
J. Pat Carter/Johns Hopkins Children’s Center
Many of the essential players of the team that separated the twins.
* Martin Goines is now an otolaryngologist (ear, nose, and throat) at Sinai Hospital in Baltimore and the chief of the division.
* Lobectomy means actually taking out the frontal lobe, while lobotomy means just cutting some fibers.
* Commonly called Cat Scans for Computerized Tomography, a highly technical, sophisticated computer that allows the X-ray beams to focus at different levels.
† The Magnetic Resonance Imaging doesn’t use X-rays but a magnet that excites the protons (microparticles), and the computer then gathers energy signals from these excited protons and transforms the protons into an image.
MRI gives a clear-cut, definite picture of substances inside by reflecting the image based on the excitation of the protons. For instance, protons will be excited in a different degree in water than in bones or muscles or blood.
All protons give off different signals, and the computer then translates them into an image.
* PET (Positron Emission Tomography) uses radioactive substances that can be metabolized by cells and gives off radioactive signals that can be picked up and translated. Just like the magnetic resonance imagery picks up electronic signals, this picks up radioactive signals and translates them into images.
CHAPTER 13
A Special Year
I didn’t explain the real reason to Bryant Stokes. I figured he knew it without my having to bring it out in the open. Instead I answered, “Sounds like a nice place.” Another time I said, “Who knows? Maybe one day.”
“Be a grand place for you,” he persisted.
Each time he mentioned it, I gave Stokes another excuse, but I did think about what he said. One benefit especially appealed to me. “You’d get as much experience in neurosurgery there in one year as you’d get in five years anywhere else.”
It seemed strange to me that Bryant Stokes persisted in the idea, but he did. A senior neurosurgeon in the United States from Perth, Western Australia, Bryant and I hit it off at once. Frequently Bryant would say, “You should come to Australia and be a senior registrar at our teaching hospital.”
I tried various ways of getting him off the subject. “Thanks, but I don’t think it’s what I want to do.” Or another time I said, “You’ve got to be kidding. Australia is on the other side of the world. You drill through from Baltimore and you come out in Australia.”
He laughed and said, “Or you could fly and be there in 20 hours.”
I tried evasive humor. “If you’re there, who needs me or anyone else?”
A matter of deep concern for me, which I naturally didn’t mention, was that people had been telling me for years that Australia was worse with apartheid than South Africa. I couldn’t go there because I’m Black and they had a Whites-only policy. Didn’t he realize I was Black?
I dismissed the whole idea. Aside from the racial matter, from my perspective I couldn’t see that going to Australia for a year of residency would add anything in terms of my career, although it would certainly be interesting.
If Bryant hadn’t been so persistent, I wouldn’t have given the idea any more thought. Virtually every time we talked, he’d make a casual remark such as, “You know, you’d love Australia.”
I had other plans because Dr. Long, head of neurosurgery and my mentor, had already told me that I could stay on the faculty of Johns Hopkins after my residency. The fact that he added, “I’d be delighted to have you,” made it all that more appealing.
I couldn’t think of anything more exciting than to remain at Hopkins, where so much research was going on. For me, Baltimore had become the center of the universe.
Yet, strange as it seemed, although I’d dismissed Australia, the topic dogged me. It seemed that for a while every time I went somewhere, I’d encounter someone with that particular accent saying, “Ga’day, mate, how you going?”
Turning on the television, I hit commercials saying, “Travel to Australia and visit the land of the koala.” And PBS advertised a special on the land down under.
Finally I asked Candy, “What in the world is going on? Is God trying to tell us something?”
“I don’t know,” she answered, “but maybe we’d better talk a little about Australia.”
Immediately I thought of a load of problems, the main one being the Whites-only policy. I asked Candy to go to the library and check out books on Australia so we could find out about the country.
The next day Candy phoned me. “I found out something about Australia you ought to know.” Her voice held an uncommon excitement so I asked her to tell me right then.
“That Whites-only policy that’s bothered you,” she said. “Australia used to have it. They abolished that law in 1968.”
I paused. What was happening here? “Maybe we ought to consider this invitation seriously,” I told her. “Maybe we just ought to go to Australia.”
The more we read, the more Candy and I liked the idea. Before long we were getting excited. Next we discussed Australia with friends. With few exceptions, our well-intentioned friends discouraged us. One of them asked, “Why do you want to go to a place like that?”
Another one said, “Don’t you dare go to Australia. You’ll be back in a week.”
“You wouldn’t make Candy go through that, would you?” asked another. “Why, she’s had such a bad time already. It’ll be worse for her down there.”
I couldn’t help smiling at this friend’s words. His concern was our joy—and niggling worry. Candy was pregnant, and it did seem foolish to fly to the other side of the world at this time. The problem was that in 1981, while I was chief resident, Candy became pregnant with twins. Unfortunately, she miscarried in her fifth month. Now, the following year, she was pregnant again. Because of the first experience, her doctor put her on bed rest after the fourth month. She quit her job and really looked after herself.
When the question about her condition came up, Candy smiled each time but said firmly, “They do have qualified doctors in Australia, you know.”
Our friends didn’t realize it but we’d already decided to go, even though we didn’t consciously know it ourselves. We had gone through the formal steps of making application to the Sir Charles Gardiner Hospital of Queen Elizabeth II Medical Center, the major teaching center in Western Australia and their only referral center for neurosurgery.
I received a reply within two weeks. They had accepted me. “Guess that’s our answer,” I said to Candy. By then she was almost more excited about our going than I was. We would leave in June 1983 and were fully committed to the venture.
We had to be fully committed because it took every dime we had to buy our tickets—one way. We
wouldn’t be able to come back even if we didn’t like it. I would be doing one year as a senior registrar.*
Several reasons made the venture attractive, one of which was the money. I would be getting a good salary in Australia— a lot more money than I’d ever made before—$65,000 for the year.†
And we badly needed the money.
Although the racial issue was settled, Candy and I still flew to Perth with a great deal of trepidation. We didn’t know what kind of reception we’d receive. We had legitimate concerns because I’d be an unknown surgeon entering a new hospital. Despite her brave talk, Candy was pregnant and the possibility of problems stayed in our minds.
But the Australians received us warmly. Our being affiliated with the Seventh-day Adventist Church opened many doors. On our first Saturday in Australia we went to church and met the pastor and several members before worship began. During the service, the pastor announced, “We have a family from the United States with us today. They’re going to be here for a year.” He then introduced Candy and me and encouraged the members to greet us.
And did they! When the service concluded, everybody crowded around us. Seeing that my wife was pregnant, many women asked, “What do you need?” We had brought nothing in preparation for the baby, since we were limited in the amount of luggage we could carry from the United States, and those wonderful people started bringing in bassinets, blankets, baby strollers, and diapers (which they called nappies). We were constantly receiving invitations to dinner.
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