Gifted Hands

by Ben Carson, M. D.

  People at the hospital couldn’t figure out how, within two weeks of our arrival, we had met a lot of people and were receiving a constant stream of invitations.

  One of my fellow residents, who had been there five months, asked, “What are you doing tonight?”

  I mentioned that we were having dinner with a certain family. The resident knew that only a few days earlier a different family had taken us on a scenic trip outside Perth.

  “How in the world do you know so many people?” he asked. “You’ve only been over here a fortnight. It took me months to meet this many people.”

  “We come from a large family,” I said.

  “You mean you have relatives here in Australia?”

  “Sort of.” I chuckled and then explained, “In the church, we think of ourselves as all part of God’s family. That means that we think of the people where we worship as brothers and sisters — part of our family. The church people have been treating us like the family members we are.”

  He’d never heard such a concept before.

  From the day we arrived, I liked Australia. Not just the people but the land and the atmosphere. Being hired as a senior registrar also meant that I got to do most of the cases. That responsibility boosted my appreciation for being in the land down under. Even Candy became really involved, as a first violinist in the Nedlands Symphony and a vocalist in a professional group.

  A full month hadn’t passed when an extremely difficult case came to our attention and changed the direction of my work in Perth. The senior consultant had diagnosed a young woman as having an acoustic neuroma, a tumor that grows at the base of the skull. It causes deafness and weakness of the facial muscles, eventually resulting in paralysis. This patient also suffered from frequent and extreme headaches.

  The tumor was so large that, with the consultant’s decision to take it out, he told the patient that he wouldn’t be able to save any of her cranial nerves.

  After hearing the prognosis, I asked the senior consultant, “Do you mind if I try to do this using a microscopic technique? If it works, I can possibly save the nerves.”

  “It is worth trying, I’m sure.”

  While the words were polite enough, the real flavor of his feeling came through. I knew he was saying, “You young whippersnapper, just try, and then see yourself fail.” And I couldn’t blame him.

  The surgery took 10 straight hours without rest. Naturally, when I finished I was exhausted, but also elated. I had completely removed the tumor and saved her cranial nerves. The senior consultant could tell her she would likely enjoy a complete recovery.

  Within a short time after her recovery, the woman became pregnant. When the baby was born, in gratitude she named the child after her consultant because she thought he had taken out her tumor and saved her cranial nerves. She didn’t know that I had done the delicate work. Actually, things are done that way. In Australia, the senior registrar works under the auspices of the consultant and he, as the top man, gets the credit for successful surgery, no matter who actually performs it.

  The others on the staff, of course, knew.

  After that surgery, the other senior consultants suddenly showed me enormous respect. From time to time one of them would come up to me and ask, “Say, Carson, can you cover a surgery for me?”

  Eager to learn and anxious for more experience, I don’t recall turning down a case—which gave me a tremendous load, far more than a normal case load would provide. In less than two months in the country, I was doing two, maybe three, craniotomies a day — opening patients’ heads to remove blood clots and repair aneurysms.

  It takes a lot of physical stamina to do that much surgery. Surgeons spend hours on their feet at the operating table. I could handle lengthy operations because while training under Dr. Long, I had learned his philosophy and techniques, which included how to keep going, hour after tedious hour, without yielding to fatigue. I had carefully watched everything Long did and was thankful he had removed a lot of brain tumors. The Australian neurosurgeons didn’t know it, but I had brain surgery down pat. The consultants increasingly gave me a freer hand than they normally would have given a senior registrar. Because I did well and was always eager for more experience, I was soon scheduling brain surgeries one on top of another. It’s not quite like an assembly line because each patient is different, but I soon became the local expert in the field.

  After several months, I realized that I had a special reason to thank God for leading us to Australia. In my one year there I got so much surgical experience that my skills were honed tremendously, and I felt remarkably capable and comfortable working on the brain. Before long, the wisdom of spending a year in Australia became increasingly clear to me. Where else would I have gotten such a unique opportunity for volume surgery immediately after my residency?

  I did a lot of tough cases, some absolutely spectacular. And I often thanked God for the experience and the training it provided. For instance, the fire chief in Perth had an incredibly large tumor involving all the major blood vessels around the anterior part of the base of his brain. I had to operate on the man three times to get all the tumor out. The fire chief had a rocky course, but eventually he did extremely well.

  One other highlight: Candy gave birth to our first son, Murray Nedlands Carson (Nedlands was the suburb where we lived), on September 12, 1983.

  And then, almost before we realized it, my year was up and Candy and I were packing to return home. What would I do next? Where would I work? The chief of surgery at Provident Hospital in Baltimore contacted me soon after my return.

  “Ben, you don’t want to stay over there at Hopkins,” he said. “You could be so much better off with us here.”

  Provident Hospital concentrated on medical services for Blacks. “No one is going to refer any patients to you at Hopkins,” the chief of surgery said. “Why, that institution is steeped in racism. You’re going to end up wasting your talents and your career in that racist institution, and you’ll never go anywhere.”

  I nodded, thinking, Maybe you’re right.

  I listened to everything he had to say but had to make my own decision. “Thanks for your concern,” I said. “I haven’t been aware of prejudice toward me at Hopkins, but you may be right. Anyway, I have to find out for myself.”

  “You might have to go through a lot of rejection and pain to find out,” he countered.

  “Maybe you’re right,” I repeated, flattered that he wanted me to come to Provident. Yet I knew Johns Hopkins was where I wanted to be.

  Then he tried another tactic. “Ben, we badly need someone here with your skills. Think of all the good you could do for Black people.”

  “I appreciate the offer and the interest,” I told him. And I did. I didn’t like disappointing him. And I didn’t have the heart to tell him that I wanted to help people of all races — just people. I did say, “Let me see what happens during the next year. If things don’t work out, I’ll consider it.”

  I never contacted him again.

  I’m not sure what I expected to happen when I returned from Australia to Johns Hopkins, but it was the opposite of the prediction of the other doctor. Within weeks I started getting a lot of referrals. Soon I had more patients than I knew what to do with.

  After returning to Baltimore in the summer of 1984, it quickly became evident that others accepted me as a doctor competent in surgical skills. The primary reason, for which I often thanked the Lord, was that I had been blessed with more experience during my one year in Australia than many doctors get in a lifetime of medical practice.

  Within months after my return, the chief of pediatric neurosurgery left to become the chairman of surgery at Brown University. By then I was already doing most of the pediatric neurosurgery anyway. Dr. Long proposed to the board that I become the new chief of pediatric neurosurgery.*

  He told the board that, although I was only 33, I had a wide range of experience and invaluable skills. “I am fully confident that Ben Carson can do the
job,” he later told me he said.

  Not one person on the board of that “racist institution” objected.

  When Dr. Long informed me of my appointment, I was overjoyed! I also felt deeply grateful and very humbled. For days I kept saying to myself, I can’t believe this has happened. I think I was something like a kid who’d just had a dream come true. Look at me, here I am the chief pediatric neurosurgeon at Johns Hopkins at 33. This can’t be happening to me.

  Other people couldn’t believe it either. Many parents brought very sick children to our pediatric neurosurgery unit, often traveling great distances. When I walked into the room, more than once a parent looked up and asked, “When is Dr. Carson coming?”

  “He’s already here,” I’d answer and smile. “I’m Dr. Carson.”

  I got a real kick out of watching them try to contain their expression of surprise. I didn’t know how much of the surprise revolved around my being Black and how much because I was so young, probably a combination of the two.

  Once we got past the introductions, I would sit down with them and start talking about their child’s problem. By the time I finished with the consultation, they realized I knew what I was talking about. No one ever walked out on me.

  One time when I was going to do a shunt on a little girl, her grandmother asked, “Dr. Carson, have you ever done one of these before?”

  “No, not really,” I said with a straight face, “but I know how to read fairly well. I own a lot of medical books, and I take most of them with me into the operating room.”

  She laughed self-consciously, aware of how silly her question had been.

  “Actually,” I joked, “I’ve done a thousand at least. Sometimes 300 a week.” I said it with a smile, for I didn’t want her to feel embarrassed.

  She laughed then, realizing from the expression on my face and my tone of voice that I was still kidding her.

  “Well,” she said, “I guess if you are who you are, and since you have this position, you must be all right.”

  She didn’t offend me. I knew that she passionately loved her granddaughter and wanted to be reassured that the child was in good hands. I assumed she was really saying, “You look like you haven’t even gone to medical school yet.” After that kind of conversation took place a few times, I became so used to the responses that I used to look forward to the reactions.

  I frequently got more of a negative response from Black patients, particularly the older ones. They couldn’t believe that I was chief of pediatric neurosurgery. Or if I was, that I had earned my position. At first they eyed me suspiciously, wondering if somebody had given me my position as a token expression of integration. In that case, they assumed, I probably didn’t really know what I was doing. Within minutes of our consultations, however, they relaxed and the smiles on their faces told me that I had their acceptance.

  Oddly enough, White patients, even the ones in whom I could clearly detect bigotry, were often easier to deal with. I could see their minds working away, and they would ultimately reason, This guy must be incredibly good to be in this position.

  I don’t face that problem nowadays because most of the patients know who I am and what I look like before they get here. But it used to be very interesting. The problem is now the opposite because I’m known in the field and too many people say, “But we have to have Dr. Carson do the surgery. We just don’t want anybody else.” Consequently, my operating schedule stays filled up for months in advance.

  I have the prerogative of turning down patients and, of course, I must. It’s necessary to say no at times because, naturally, I can’t do all the surgeries. I also believe in asking other doctors if they’d be interested in doing them. I would have never learned the skills I have today if other surgeons had not been willing to let me take interesting and challenging cases.

  Within a year of my appointment at Johns Hopkins I faced one of the most challenging surgeries of my life. The little girl’s name was Maranda, and I had no way of knowing the influence she would have on my career. The results of her case also had a powerful effect on the medical profession’s attitude toward a controversial surgical procedure.

  * The position of senior registrar doesn’t exist in America but lies somewhere between being a chief resident and a junior faculty member. The senior registrars run the service and work under the consultant. Following the British medical schools, Australia has what they call consultants, who are unquestionably the top men. Under this system, a doctor remains a senior registrar for many years.

  A doctor can become a consultant only when the encumbent dies; the government has a fixed number of such positions.

  Although they had only four consultants in Western Australia, these men were all extremely good, among the most talented surgeons I’ve ever seen. Each had his own area of expertise. I benefited from all their little tricks, and they aided me in developing my skills as a neurosurgeon.

  † The salary was so attractive because I didn’t have to pay exorbitant malpractice insurance. In Australia it was only S200 a year. I know a number of prominent physicians who pay $100,000 to $200,000 a year in America. The difference lies in the fact that in Australia relatively few malpractice cases arise. Australian law forbids lawyers to take malpractice cases on a contingency basis. People who want to sue have to take money from their own pockets. Consequently the only people who sue are those upon whom doctors have made the most terrible mistakes.

  * My official title was Assistant Professor of Neurological Surgery, Direction, Division of Pediatric Neurosurgery, the Johns Hopkins University and Hospital.

  CHAPTER 14

  A Girl Named Maranda

  Yours is the only hospital where we’ve received any real hope,” Terry Francisco said. She made an effort to keep her voice steady. “We’ve tried so many doctors and hospitals, and they end up telling us there’s nothing they can do for our daughter. Please, please help us.”

  It had been a long and frightening three years, and as the months had blurred into years, fear turned to despair. Desperate, her daughter nearing death, Mrs. Francisco called Dr. John Freeman here at Hopkins.

  In 1985 when I first came into contact with brown-haired Maranda Francisco, I could never have guessed what an influence she would have on the direction of my career: on Maranda I would perform my first hemispherectomy.*

  Although born normal, Maranda Francisco had her first grand mal seizure at 18 months, a convulsion characteristic of epilepsy that we sometimes call an electrical storm in the brain. Two weeks later Maranda suffered a second grand mal seizure, and her doctor put her on anticonvulsive medication.

  By her fourth birthday, the seizures were becoming more frequent. They also changed, suddenly affecting only the right side of her body. She didn’t lose consciousness; the seizures were focal (half a grand mal), originating in the left side of her brain and disrupting only the right side of her body. Each seizure left Maranda weak on her right side, sometimes unable to talk normally for as long as two hours. By the time I heard about her situation, Maranda was experiencing up to 100 seizures a day, as often as three minutes apart, making the right side of her body useless. A seizure began with trembling at the right corner of her mouth. Then the rest of the right side of her face trembled, followed by the shaking of her right arm and leg, until the whole right side of her body jerked out of control and then went slack.

  “She couldn’t eat,” her mother told us, and finally stopped letting her daughter try. The danger of choking was too great, so they started feeding her through a nasogastric tube. Although the seizures affected only her right side, Maranda was forgetting how to walk, talk, eat, and learn, and she needed constant medication. As Don Colburn of the Washington Post put it in a feature article, Maranda “lived her life in brief intervals between convulsions.” Only during sleep was she seizure-free. As the seizures worsened, Maranda’s parents took her from specialist to specialist and received varying diagnoses. More than one physician mislabeled her a mentally retard
ed epileptic. Each time the family went to a new doctor or clinic with hope, they left filled with disappointment. They tried medicine, diets, and, on the advice of one doctor, a cup of strong coffee twice a day.

  “My daughter has been on 35 different drugs at one time or another,” Terry said. “Often they’d give her so much she wouldn’t recognize me.”

  Yet Luis and Terry Francisco refused to give up on their only child. They asked questions. They read every piece of literature they could find. Luis Francisco managed a supermarket, so they were people with only a moderate income. Yet that didn’t deter them. “If there is any place on earth to get help for Maranda, we’re going to find it.”

  In the winter of 1984 Maranda’s parents finally learned the name of their daughter’s condition. Dr. Thomas Reilly at the Children’s Epilepsy Center at Children’s Hospital in Denver, after consulting with another pediatric neurologist, suggested a possible explanation: Rasmussen’s encephalitis, an extremely rare inflammation of the brain tissue. The disease progresses slowly but steadily.

  If the diagnosis was correct, Reilley knew time was short. Rasmussen’s progressively leads to permanent paralysis on one side of the body, mental retardation, and then death. Only brain surgery offered a possibility to save Maranda. In Denver, physicians placed the child in a barbituate coma for 17 hours in the hope that by stopping all brain activity the seizure activity might also stop. When they brought Maranda back out, immediately she started seizures again. This at least told them that the cause of her epilepsy wasn’t owing to electrical misfiring in her brain but a progressive deterioration. Again, this offered more accumulated evidence of it being Rasmussen’s.

  Reilley arranged for Maranda’s diagnosis at UCLA Medical Center, the nearest hospital with experience in treatment of Rasmussen’s. A brain biopsy enabled them to reach a further confirmation of the diagnosis. The Franciscos then received the most severe blow. “It is inoperable,” doctors told them. “There is nothing we can do.”