EXPERTS ON EXPERT: Dr. Rahul Jandial

[0] Welcome to Experts on Expert.

[1] I'm your resident friend and family member, Dan Shepard.

[2] I'm joined by our mother and our baby, Monica Pladman.

[3] Today we have a really fascinating person.

[4] I don't know that we've talked to a brain surgeon.

[5] We haven't.

[6] Gets in there and tinkers with the CPU, the central processing unit.

[7] The source of all of our everything.

[8] What could require more confidence other than landing an airplane?

[9] Oh, what you haven't done, okay?

[10] Yet.

[11] No, not knock on what I want to happen.

[12] No, I don't ever want that to happen.

[13] Okay, okay, okay.

[14] Dr. Rahul Jondiol is a dual -trained brain surgeon and neuroscientists at City of Hope in Los Angeles, a hospital for cancer treatment.

[15] You know, he's your last line.

[16] He's going to get in there and cut that stuff out.

[17] It's really impressive work.

[18] Yeah, it is.

[19] And he talks a lot about anatomy in this and kind of breaks it down in a really digestible way.

[20] It's really good.

[21] Yeah, it's a super fascinating conversation.

[22] and really enjoyed them.

[23] I hope you do too.

[24] Please stay tuned for Dr. Rahul, John D 'all.

[25] Wondry Plus subscribers can listen to Armchair Expert early and ad free right now.

[26] Join Wondry Plus in the Wondry app or on Apple Podcasts.

[27] Or you can listen for free wherever you get your podcasts.

[28] I'll be interested what your takeaway is with the amount of nicotine and caffeine you watch me consume over the next 90 minutes.

[29] for some kind of diagnosis at the end of this.

[30] Both are good.

[31] Both are good.

[32] If you can get nicotine without all the other shit in the cigarette, there's nothing wrong with it.

[33] Dr. Rahul, John Dial, what is the origin of that name?

[34] I was born in northern India.

[35] Caught here about 8, 7 or 8.

[36] We took a Pan Am flight.

[37] Parents told me, we'd just go for a day trip.

[38] They did.

[39] Nice of you know, we're in Torrance, California.

[40] By the 405, you know, where it looks like Mad Max.

[41] So that's where I landed.

[42] Where the Lakers used to play.

[43] So you don't have any beef with anyone from southern India.

[44] Do you, Monica's Southern Indian?

[45] Yeah.

[46] There's no kind of like north -south beef.

[47] I'll hide it for this episode.

[48] Okay, good.

[49] We can iron it out in the parking lot afterwards.

[50] Why did Mom and Dad leave?

[51] I mean, there was all this strife going on in Northern India with the Muslims and the Hindus, and we lived in Kashmir.

[52] They'd have curfews and sirens go off and bombs would go off.

[53] That's where the border is, yeah, with Pakistan?

[54] And they're gnarly up there.

[55] They'll attack each other.

[56] They'll cut off each other's ears and where they're...

[57] necklace it's pretty raw and the mountains are gorgeous but it's like the most beautiful and violent place on the planet yeah what did dad do for a living he was an engineer so when they had a chance to come out here they needed engineers he took the gig we came with him and we went for it as civil engineer mechanical oh mechanical engineer with a lean towards aerospace so he was working for moog and those sort of companies moog the synthesizer company no no it was like the next thing after Boeing and some of the missile parts for some of the airplanes oh okay again Monica's father is a civil engineer.

[58] But that's the way they got the chance to come over because you had to buy a ticket, you know.

[59] Yeah.

[60] And if you had a skill, obviously, that the U .S. desired, it helped out with emigrating here, I would imagine.

[61] Right.

[62] And the way they learned in their books, it was English -based.

[63] So just like they're doing with tech now, if you're learning in English, easier to jump over.

[64] So the education there was in English.

[65] Yeah.

[66] And did you have any siblings?

[67] I have an older brother.

[68] Older.

[69] How much older?

[70] Two years.

[71] Okay.

[72] Were you guys close or was it a battle royale at all times?

[73] Both.

[74] both battle hard and now we're older and he lives in Pasadena and it's good what did he go into he's also in medicine is that by accident or was that by design he was the first one okay the way it went down was this i was getting a lot of trouble in los angeles and he was paying attention to the books he got into uc berkeley i wanted to get away from home yeah i just went where he went so i drafted for a while whatever he did i did whether i liked it or not right because that would keep people off my back yeah and then i pivoted into surgery he stayed in general General Medicine, and I did a bunch of other things.

[75] But he's sort of the one that kind of, like roller derby, he swung me in a positive direction just by chasing him around.

[76] We're very similar in age, I think we're a year and a half.

[77] Yeah, I just turned 46.

[78] In fact, are you December, baby?

[79] Christmas.

[80] Yeah, I'm January 2nd.

[81] Are you Capricorn?

[82] I am.

[83] You are.

[84] I don't know what that means for either of us, but it's nice to share it, isn't it?

[85] You're trying to stay in shape, too.

[86] I see that.

[87] Oh, God, yes.

[88] It's 80 % mental for me, 20 % the body.

[89] To work out?

[90] Yes.

[91] Oh, yeah.

[92] I will go crazy.

[93] It's my Prozac.

[94] 100%.

[95] I have three boys.

[96] Just go out, do some pull -ups, and you'll chill the fuck out.

[97] Yes.

[98] Start with that.

[99] If that doesn't work, then we can get to all the other things.

[100] They can go that way during all times, all seasons of their life.

[101] Life is going good.

[102] They want to look good for a party.

[103] They're winning the Oscars, the Grammys.

[104] Uh -huh.

[105] Go work out.

[106] Right.

[107] Girlfriend dumps you, boyfriend, dumps you, you're having a hard time dealing with it.

[108] Go work out.

[109] Yes.

[110] It works every time.

[111] You didn't get that job promotion.

[112] Go work out.

[113] Go work out.

[114] You got the job.

[115] job promotion, go work.

[116] Yeah, yeah.

[117] To me, it's a real, it's a cure -all.

[118] I have kind of an armchair theory on it.

[119] I'm going to float it by you.

[120] Tell me if you think this holds any water.

[121] Hunting and gathering societies, we're out doing some kind of physical labor, be it four to six hours a day, minimally just to survive.

[122] And of course, we get a reward for that physical activity, right?

[123] We get dopamine and serotonin and all these things as a reward.

[124] And now we're just a very stagnant species that evolved to get this reward for physical activity.

[125] So I think the pandemic kind of mental illness is really reflective of our lack of moving around.

[126] It's a good thought, but it's not an original thought.

[127] Oh, okay, great.

[128] Well, none of mine are.

[129] At best, they're synthesized other people's ideas.

[130] There's something to that too.

[131] You know, like when we think about science, you have to take what's out there and synthesize something that's the space in between.

[132] But physical activity and even a little bit of food scarcity sharpens our mind.

[133] Uh -huh.

[134] We're not.

[135] We're not.

[136] We're not, meant to be sitting around and stuff in ourselves.

[137] So if we weren't good at finding food in desperate situations, you wouldn't procreate.

[138] So those people that were sharper under stress.

[139] Pass their genes along.

[140] Potentially.

[141] So that kind of thought is out there.

[142] And there's some biology behind it, too, you know, just to jump into it.

[143] I don't mean food scarcity.

[144] Like so many people in the world are struggling to find good food, find food, find safety.

[145] But I mean, at about 10, 12, 14 hours, your body switches.

[146] So in 16 hours, your liver can't squirt out glucose anymore.

[147] Your glucose.

[148] The glucose reserve is gone, and it starts squirting out these things called ketones.

[149] Your brain's a hybrid vehicle.

[150] It likes switching between glucose and ketones.

[151] And hardcore neuroscience literature, it shows that people have increased cognition, focus, and attention.

[152] So it does for you what coffee does without sort of the crash afterwards.

[153] Increased during keto or increased during glycogen.

[154] The process of intermittent fasting, that switching between being hungry for 16 hours, let's say you skip dinner, and the next thing you eat is lunch or the dinner afterwards, that switch going back and forth is the only diet shown to increase attention and focus, intermittent fasting.

[155] Okay.

[156] That's what I've read.

[157] I'm not a diet guy.

[158] Right.

[159] But if you go in Journal of Neuroscience, Nature, Neuroscience reviews where you have to be hardcore science to get in it, they're writing big, big papers about this.

[160] This isn't just on pop science.

[161] Right.

[162] And so walk us through in a very fundamental way, what is the energy for brain?

[163] And obviously, oxygen is traveling there via the blood.

[164] And what else is happening?

[165] What's the other food for the brain?

[166] That's a good question.

[167] This is old experiment.

[168] I don't mess with animals in my lab.

[169] Okay.

[170] But they took a dye, a blue dye, and a mouse maybe 50 years ago.

[171] I don't know where it is.

[172] But they injected the dye into the blood.

[173] And then like a piece of garlic, they cut the mouse up.

[174] Uh -huh.

[175] The whole mouse is blue except the brain.

[176] So just because it's in your blood, just because you eat it and it gets into your blood, doesn't mean it gets in your brain.

[177] So there's an extra filter there.

[178] Blood brain barrier.

[179] Yeah, very good.

[180] BBB or blood brain barrier.

[181] So it demands a little bit of extra nuance when thinking about what gets through.

[182] It's a very fine filter.

[183] From a food point of view, glucose is its main fuel.

[184] Okay.

[185] And they have little holes in the wall, if you will, let that through.

[186] Oxygen gets through.

[187] Ions get through and certain vitamins get through.

[188] And then food in its building blocks.

[189] You don't get like a piece.

[190] piece of sausage ground up microscopic form getting through.

[191] But when you digest it down to protein, certain proteins can get through.

[192] So you're dissembled to your building blocks in your blood and guts.

[193] You're let through into the brain and then you're put to use.

[194] Right.

[195] And then explain quickly the difference between glucose and ketones.

[196] They're different fuel sources.

[197] They're not amino acids.

[198] They're not proteins.

[199] They're actually carbon and hydrogen -backed chemical compound.

[200] So they would lean towards carbohydrates or starches if you had the idea.

[201] in your mind.

[202] But they're not fats, they're not proteins.

[203] They're in the broken down carbohydrate category.

[204] Okay.

[205] And so when the brain is using ketones for fuel, is that the time that it gets increased sharpness or clarity?

[206] No, the switching back and forth, like a hybrid vehicle, not on all electric, not all gas, but you're parked and it's an electric.

[207] You're driving.

[208] It's in gas.

[209] They actually call it a metabolic switch.

[210] Okay.

[211] And intermittent fasting creates that metabolic switch.

[212] I've talked to a lot of people.

[213] A, we live in Los Angeles, so many people are doing intermittent fasting.

[214] Jimmy Kimmel or I think you might be the most prominent one.

[215] Now, my fear of it is ultimately your metabolism is adjusting, right, for the amount of calories that are coming in and the amount that you're expending.

[216] Why isn't the net result of this a reduced metabolic rate?

[217] I don't know.

[218] I'm not sure I buy into all the reduced metabolic rate, like the thermostat thing.

[219] Right.

[220] jump in a cold river if I run around a lot, I'll burn more in idle, right?

[221] That's what metabolic rate is.

[222] I'm not sure I understand or buy into that completely.

[223] But the way that intermittent fasting, and I don't necessarily do it all the time, I'm not saying everybody should do it.

[224] But if you're asking me, what's the thing that's backed by science is intermittent fasting and there's some literature about it.

[225] But all the other diets, there's nothing about it that says this can help you actually be sharper.

[226] And this isn't about losing weight because you still have to cut the calories.

[227] to lose weight.

[228] Well, yeah, and this is what's so frustrating for all of us in the world.

[229] We're looking to scientists and doctors to tell us.

[230] And there's really no consensus, right?

[231] The very traditional conventional wisdom is the calories burned, calories consumed.

[232] That was the model, right?

[233] And then some other folks have come around recently and said, no, no, it's a lot more complicated than that.

[234] If you eat 2 ,000 calories of pure sugar, you're going to have heightened insulin levels.

[235] It's going to function differently in your body so that it's an incomplete analysis.

[236] It is with a well -balanced diet cutting the calories.

[237] Right.

[238] I was in San Diego and I remember when this Atkins' craziness was coming around.

[239] I saw so many people say, I'm not getting the toast and just a plate is filled with sausage and bacon.

[240] Yeah.

[241] That's not.

[242] I did it in the 90s.

[243] My girlfriend and I full on had the Atkins book.

[244] I did it.

[245] I totally lost weight.

[246] It was miserable.

[247] I remember we were one time at Kukaroo.

[248] Do you remember Kukaroo chicken?

[249] I don't.

[250] Oh, wow.

[251] Well, you really missed out.

[252] They were a great little franchise that was all around L .A. for a while.

[253] I think they've since vanished.

[254] But my ex -girlfriend and I brie would, we'd put the roll in her mouth, and we would chew it up, and then we'd just spit it in our napkin and then consume our chicken and our broccoli.

[255] But for that, that's what it takes to hot in Los Angeles.

[256] 20 seconds of chewing that piece of bread was so luxurious.

[257] I was a bus boy when I was in college, and some people would do nasty shit like that to the napkins.

[258] You had to learn how to pick the napkins up.

[259] And then they're clustered form.

[260] Yeah, one dangled them.

[261] I like to think we were really considerate to the step.

[262] And, in fact, I will add that at Cuckaroo, you cleared your own place.

[263] Or just go with moderation and don't fill your plate.

[264] Just take the side plate and just eat that.

[265] Yeah.

[266] You can get away with eating what you want to eat.

[267] I hear that, and that would be the goal for sure.

[268] But I certainly know enough people that have a similar relationship with food that I have to drugs and alcohol.

[269] And they are smart enough and honest enough with themselves to say, I will never have portion control.

[270] So given that I can't, I will not have portion control, what is the healthiest thing for me to over consume?

[271] Oh, me, you think food is an addiction?

[272] I certainly think all things can become addictions.

[273] How do you feel about that?

[274] You know, I don't know.

[275] I will tell you the addiction I see in the hospital of people who are, you know, shooting crystal meth or, you know, speedballing.

[276] That's a different kind of addiction than even alcohol.

[277] And alcohol is a different kind of addiction than smoking weed.

[278] and even cigarettes, you know, and then food and compulsive behavior and those sort of things can seem addictive.

[279] But, you know, I see the gamut.

[280] And when crack cocaine was popping up, to me, I think, oh, addiction.

[281] Sure.

[282] And not that food can't get like that.

[283] I understand food is quite a challenge.

[284] But I think it's just a continuum of compulsions, willpower, and combinations, and different people in different environments find themselves in a different situation.

[285] Sure.

[286] So I would imagine the frustrating.

[287] thing being someone that has studied empirical, peer -reviewed things your whole life, and that's what we come to trust, as I do personally, to not have a genetic marker, to not have any kind of indicators that you could replicate the test.

[288] It gets frustrating to label it as a disease, or at least I would imagine having a reservation to do that.

[289] Yeah, and it starts pivoting into this your personalized diet, genetic test for your personalized cuisine.

[290] Then that gets into only rich folk can afford that, you know.

[291] It's got to be an equation that works for all.

[292] all folks.

[293] Yes.

[294] And in fact, we had this great chef on Samin, who has this great documentary.

[295] Salt, fat, acid heat.

[296] Salt, fat acid heat on Netflix.

[297] She made the great point that somehow this notion of healthy food has been correlated with elitism or rich people, which is crazy because it's kind of a flip from where it started, which is in the 60s, you have all these people rediscovering heirloom seeds and getting into micro farming.

[298] And this movement was a very hippie movement that was for the proletariat, not for rich people, and it got kind of hijacked, and it has now this branding of being elite, which is really unfortunate because there shouldn't be any kind of social, ecionomic structure precluding you from eating good food.

[299] Well, my boys, I've got three teenage boys.

[300] It doesn't make sense to them today's telling plants and protein.

[301] So I call it the fight diet.

[302] We go to Costco, salmon, chicken breast, at great prices.

[303] I mean, you get like...

[304] Oh, yeah.

[305] I mean, we're just...

[306] I couldn't be more in.

[307] with Costco, just as a side now.

[308] Oh, dude.

[309] I mean, Costco.

[310] What a place.

[311] I love Costco.

[312] We've got chicken breast, chicken skewers, salmon, and it doesn't have to be salad.

[313] It can be fruit.

[314] Right.

[315] So the fight diet is not expensive.

[316] It works.

[317] You're not hungry.

[318] And you can be strong on it.

[319] I just worry about the packaging and the websites and the yoga mats in Malibu.

[320] And people feel like, you know what, that's not accessible to me. Yeah, it's very triggering.

[321] I think people in all of us, yeah, in general, are striving to eat and exercise in a manner that is probably mostly unobtainable, even for myself.

[322] I have goals that are not reachable.

[323] I take the endeavor recognizing that I'm only looking for progress and not perfection, right?

[324] But some people just stop even aiming in that direction.

[325] You aim in that direction, you only get their 60 % cool.

[326] We see, I give you the stark examples of being in the hospital, we see obesity.

[327] And as a surgeon, I have to operate on people that are 3, 400 pounds.

[328] We have to bring in specialized beds, specialized MRI.

[329] MRI scanners.

[330] Yeah.

[331] And they just quit on trying to be healthy.

[332] I have a friend who's in ER doctor at Cedars, and she was telling me that some reason, some of those folks that come in that were shut -ins or whatnot and that's their first trip to the hospital, that just some general anesthesia that would be fine for us is too much for them.

[333] I haven't heard that.

[334] I know redheads need more anesthesia.

[335] That's not really known in the anesthesia world.

[336] Oh, yeah.

[337] The reason we know that is if you run patients light on anesthesia, they'll actually start, it's called bucking.

[338] Okay.

[339] And they'll buck and flop around.

[340] like a fish while they're open.

[341] Oh, boy.

[342] You know, we have this thing like, patients is light, patient's light, patient's bucking, and they know.

[343] So based on your weight, based on how much Prozac you're on, based on how much, you know, opiates you use, based on if you're redhead, your weight.

[344] Yeah.

[345] The anesthesia, they have to dial.

[346] It's a, it's a gas, so it's like a little dial and it mixes in with the breath you breathe.

[347] So they have to time it.

[348] So I guess the question would be, why not just snow everybody?

[349] But everyone in the sunken place right away.

[350] Exactly.

[351] Exactly.

[352] If you do that too much, then their blood pressure and heart rate is dropping.

[353] You've got to find that sweet spot where they're under, but not too under.

[354] And I haven't heard that about obese people or shut -ins means people who are 8, 900 pounds probably locked into a house.

[355] But they also have a hard time getting that tube in their neck.

[356] It's kind of a left -handed turn or right -handed depending on which hand you use.

[357] But you have to slither that in.

[358] And there's like the esophagus, there's a feeding tube, and then there's the trachea going to the lungs.

[359] You don't want to put it in the feeding tube.

[360] You want to put in the trachea.

[361] So that can be tricky and heavy people.

[362] Right.

[363] So when I see that, you know, you failing to achieve your full goal, you having cheat day diet, just the fact that you're paying attention to this, to me, that's a victory.

[364] But I'm seeing too many people just letting it go.

[365] Just quitting on even trying.

[366] Okay.

[367] And again, now that to me, so if you want to label something in addiction, this is how I personally label it is, you cannot manage what you're doing.

[368] They've lost their ability to manage it, which seems pretty obvious from the state you're describing that they're in.

[369] They have consequences, severe consequences.

[370] And in the face of all that, this thing is giving them enough comfort that it's worth all that wreckage.

[371] And to me, once that calculus is that for somebody, that to me is an addiction.

[372] So that could be, you know, what's the fine line between you like gambling in Vegas six times a year?

[373] And what's the line where you're going to Commerce Casino three times a week and you've lost the kids college funds?

[374] Now you have wreckage.

[375] You're endangering your loved ones.

[376] You may lose insurance.

[377] You may lose the family house.

[378] All these things, really clear consequences from your habitual behavior.

[379] To me, once it becomes pathological, I would say, oh, you have an addiction.

[380] My hunch is you're trying to treat some internal trauma and depression with some external things.

[381] And generally, that doesn't work.

[382] And I'd say the reason it fits the description of a disease is that it's chronic and it has a pretty predictable trajectory for most people that are addicted to something, you know.

[383] But again, you're right.

[384] that there's still a spectrum oh a hundred percent i'm sober and i'm in a a i'll hear someone share and i'll go oh thank god i don't have it that bad like i remember watching a documentary about addiction i HBO in this addict in manhattan was buying crack then melting it in a spoon then shooting up the crack and i was like okay well there always be someone that did it worse than me and if that's you know what's gonna make my decision of whether or not to enter this program that someone's worse than me, I'll always be able to find someone worse than me. That's an interesting example because the amount of addiction that goes with combustible cocaine crack, free basing made cheap, is sky high.

[385] So if you had 100 twin brothers, let's just say, and you had 200, 100 over here, and 100 over here, and you gave everybody a bottle of tequila on the left, and you gave everybody some rock on the right, the amount of people that would be addicted just from that one exposure would be quite different.

[386] For sure.

[387] So there's the whole range in how addictive a material is.

[388] But then some people have a greater rush when they drink than they do other drugs.

[389] So it's also how we're sensitized.

[390] And you're bringing in the context of family life and real life.

[391] And so, again, it's a continuum.

[392] But there are some drugs that are just.

[393] And biochemistry.

[394] So if you're someone who has ADHD, cocaine for you feels like medicine.

[395] You can go to sleep on cocaine.

[396] That's a great point.

[397] That's what Ritalin is.

[398] Right.

[399] I was like, wait a second.

[400] The kid is hyper.

[401] And you're giving them baby meth?

[402] Yes.

[403] just a touch.

[404] But if you give too much, then they get jittery and they have issues with it.

[405] But that's an excellent point that being hyperactive, you can actually focus with a little bit of stimulant, right?

[406] That is the nuance and subtlety that is lost in the discussions about drugs and addiction.

[407] So I love that you hit on.

[408] And then back to gambling.

[409] Wait a second.

[410] You don't put anything inside you, but you will still sell mama's TV to get some money to go gamble.

[411] Right.

[412] So the pharmacy is already inside us.

[413] Oh, 100%.

[414] That ecstasy does not get you high.

[415] Ecstasy is a uptake inhibitor of our two best chemicals that make us feel euphoric.

[416] Yeah, or what you have without the real experience driving it.

[417] You don't hit the World Cup gold, but they have the same feeling.

[418] Right.

[419] You take something that simulates that chemically inside you, but it's your own chemicals that you're jacking up.

[420] That's right.

[421] I think a lot of people think, oh, cocaine itself, but cocaine is a triple uptake inhibitor.

[422] And it does something different.

[423] and it does dopamine, not serotonia.

[424] And dopamine is elusive euphoria.

[425] You can have crystal meth.

[426] You'll be hyper and you'll be awake.

[427] You know, you'll be a tweaker and all craziness that comes with that.

[428] But dopamine is that feeling of victory, that feeling of delight.

[429] The feeling like if you did hit the game winning shot last night in basketball, that's more dopamine.

[430] And so it's addictive because it really makes you feel fantastic, not just hyper.

[431] Why would you not take that?

[432] The reason you can't take that is because it doesn't last and then you chase it.

[433] Diminish.

[434] Take more and then your blood pressure goes up and then you start getting it's untenable.

[435] Excellent.

[436] Two other uses for cocaine.

[437] I've been to Peru quite a bit and the old timers they were telling me like in their ancient history, it numbs things up.

[438] You know, like you put it on your gums and it numbs you up.

[439] So they were trying to operate and they chew coca leaves.

[440] Coca is not cocaine.

[441] They'll tell me that too.

[442] Right.

[443] But they'll spit into the wound to numb the patient.

[444] But everybody died because they got infected from their gnarly spit.

[445] Right.

[446] And then the other use that's still allowed is still in American operating rooms.

[447] Maybe not today, but when I was training, it's a blood vessel shrinker, constrictor.

[448] So we would actually take these little tampons and soak them in cocaine and jam them up people's nostrils.

[449] Uh -huh.

[450] And it would, you look at you.

[451] Yeah, I can't wait.

[452] I love this conversation.

[453] And it would shrink the blood vessels because the nasal lines are bloody.

[454] And then we'd stick a speculum in there and tap into the bottom of the skull and get to the particular.

[455] So cane is a vasoconstrictor.

[456] It's also an anesthetic in the sense that it numbs you.

[457] So it's a flexible chemical, and it comes from mother nature.

[458] Its docking station is naturally built within us.

[459] We have things called nicotinic receptors, opiate receptors, cannabinoid receptors.

[460] There are nicotinic receptors on the tissues in your brain and body.

[461] The nicotine, just the compound nicotine, not all the 200 million other things that all the cigarette companies have in their tobacco.

[462] Yeah.

[463] But just nicotine binds into a receptor in your body like a perfect lock and key.

[464] It is not a foreign substance.

[465] And neither is, you know, cocaine, neither is the things that come from poppy leaves.

[466] Oh, neither.

[467] Yeah.

[468] We are one and the same with the plants around us.

[469] Yeah, it's so fascinating.

[470] And yes, we see this in the animal kingdom.

[471] Elephants hide fruit until it ferments and they eat it and get drunk.

[472] Chimpanzees get high.

[473] You know, a lot of primates are getting high.

[474] They know what stuff is good out there for them to eat.

[475] and experiment with.

[476] And somehow they do it without addiction.

[477] I don't know.

[478] Is there addiction in animals?

[479] Or is the way that it's offered in plants without our manipulation, just not that pop into where they get hooked?

[480] Yeah.

[481] So to your point back to Peru, so I had an archaeology teacher who did all their work in Peru.

[482] Yeah, all the locals chew, coca leaves.

[483] I was in Bolivia six months ago, my teenage son.

[484] We were visiting a hospital.

[485] Show up.

[486] There's coca leaves.

[487] It doesn't get you high.

[488] But it does allow you to function without headaches and fatigue at an altitude where your blood cells are not fully docked with oxygen because there's just not enough oxygen up there for you.

[489] Right.

[490] So it's not illegal.

[491] It's not unethical.

[492] And my son and I didn't.

[493] I actually mention it in something that I wrote.

[494] But coca leaves right on the side with some coca tea.

[495] Yeah.

[496] You're less winded.

[497] It's not as much of a stimulant as caffeine.

[498] If you think it's going to keep you up on a long drive across the country, that's not what it does.

[499] It does more about, you know, not feeling winded.

[500] Uh -huh.

[501] From being at a high altitude.

[502] So it's a very interesting, again, nuance to, you know, COCA.

[503] Yeah, I wonder what's going on respiratoryly if it's actually having any effect on the cells in your lungs or anything there that's allowing more oxygen to enter the bloodstream.

[504] I don't know.

[505] My guess is it's not more oxygen entering the bloodstream.

[506] That's where Lance Armstrong was actually making more oxygen carriers by shooting EPO.

[507] The red blood cells are the shuttles that carry the oxygen.

[508] They get low.

[509] We give them EPO, they get high.

[510] His were normal.

[511] He raised him up as if he was training in Colorado.

[512] But us being in Bolivia, there's no way that our carriers were higher.

[513] So it's something about the way that even despite having a lower delivery of oxygen to our cranking tissues, we didn't feel fatigue going back to the brain.

[514] The feeling of fatigue was reduced by chewing on coqually.

[515] That's my guess.

[516] I just made that up.

[517] Right, right, right.

[518] But I haven't read about that.

[519] But that's how I'm thinking about it.

[520] Let me throw on one other thing, maybe.

[521] Okay.

[522] I have taken my heart rate many, many times at like 10 a .m. being awake all night doing coke, 10 a .m. I'd usually sit down at the computer and write some emails, like some seven, eight page emails.

[523] That was kind of my routine.

[524] So I would sometimes be like, a little sweaty.

[525] It's only 68 in the apartment.

[526] I'm going to just check in with my heart rate and quite regularly sitting there, you know, doing some emails.

[527] It'd be like 135.

[528] So I do wonder if the Coke had all raised the heart rate enough that it offset the reduction in, in, you know what?

[529] That's a very smart point.

[530] The way our heart rate goes up is a way to deliver more half full carriers of oxygen.

[531] Well, they're half full, so we're going to send you twice as much.

[532] Quantity over quality.

[533] You're going to get about the same amount of oxygen, but I'm having to pump more rapidly send you more carriers over that.

[534] That's a good thought.

[535] Now, the chewing coca leaves doesn't raise your heart rate.

[536] Otherwise, I wouldn't have given it to the youngsters.

[537] Right.

[538] But that's a, that's the way to think, smart, common sense about how the body works.

[539] it's mechanical man that's what fascinates me about it when you understand an engine and it won't run you go through a very simple checklist right you need compression you need fuel and you need spark so one of those three things it's that simple and now you have eight different parts that are in charge of all three of those things so you're dealing with potentially 40 issues whatever it's all going to boil down to those three things if you have all three of those things you have a running engine so i would imagine that's the heart that's the heart so you named it right there so compression is the squeezing of the heart squeezes like a fast ringing of a towel.

[540] Oh, it twists.

[541] Yeah, it twists because that's better ejection fraction.

[542] You get more out.

[543] Like if we're going to take all the water out of a towel, you twist it, right?

[544] Instead of bawling it.

[545] Yeah, so that's compression.

[546] Fuel is blood.

[547] Inside the blood, there's stuff that fights infections, like white blood cells and all that.

[548] And then you get blood cancers from that.

[549] But the fuel is actually the oxygen and the glucose that's swimming around being delivered to Usain Bolt's thighs to run.

[550] So that's very mechanical.

[551] It's not a magic show.

[552] And then the spark is an interesting one.

[553] The heart is under the dominion of these fine web of nerves on its surface.

[554] And those nerves, they literally send little sparks to the heart muscle, and the heart muscle compresses.

[555] Those nerves are only partially connected to our brain.

[556] If you knock me out, they'll still going to keep firing.

[557] But if I meditate like a Buddhist monk for 10 years, I can get them to behave a little bit.

[558] That's so fascinating, isn't it?

[559] Now, I want to go into your history a little bit because when you, when you're come here at eight you go to torrents there's not a lot of kids from india and torrents are there no but i was brown so i never saw it as uh i am brown i mean yeah yeah yeah existential crisis i never saw it as kid from india but it was like brown kid there were other brown kids there i always felt connected to people despite my gender despite my color you didn't feel excluded i didn't you know i think that's the narrative it's a well -worn one If I didn't feel that way, I don't want to make it my narrative because it's convenient.

[560] No. Well, your story is your story.

[561] There's no right or wrong.

[562] Yeah, but people morph their stories because I think it fits a certain narrative that's going to get them a press hit or a little, you know, a little bit more pop on their website.

[563] I like it messy.

[564] I didn't feel excluded.

[565] At one time, some shit happened and I went home and told my pops.

[566] I was like, man, they were in family with me. They were making fun of this or this and that.

[567] He's like, did they throw stones or rocks at you?

[568] And I was like, no. He's like, why the fuck are you complaining?

[569] He was a funny guy.

[570] Like, do you know where we were?

[571] Yeah.

[572] Look how open -minded everybody is here.

[573] Like how, you know, liberated people are here compared to the region of the world we just left.

[574] Yeah, he had that disposition where he was in a place of gratitude and perspective.

[575] Now, how about kids coming over?

[576] Were you ever embarrassed that it was like Indian food was being cooked in the house?

[577] Any of that?

[578] I wasn't that guy.

[579] My parents were super progressive.

[580] Okay.

[581] And your brother also assimilated and fit in beautifully?

[582] No, we had our issues, but they weren't culture.

[583] and race -based.

[584] Okay.

[585] There were individual conflict -based.

[586] It was me not liking being underestimated as a person, not because I was brown, male, or you still have your struggles.

[587] They just weren't in the conventional box of race and culture.

[588] My parents were very progressive.

[589] They were laid back.

[590] We did a bunch of cool stuff.

[591] But did I have beef with people in high school?

[592] Absolutely.

[593] Did I have heartbreak with my girlfriend?

[594] Of course.

[595] Those were the driving forces of my life, not, I was underestimated as an immigrant.

[596] I know that's a strong narrative and a good narrative.

[597] And so there's this deeper layer of struggle and conflict that doesn't fit the conventional boxes, and I think that applied to me. Stay tuned for more armchair expert, if you dare.

[598] We've all been there.

[599] Turning to the internet to self -diagnose our inexplicable pains, debilitating body aches, sudden fevers, and strange rashes.

[600] Though our minds tend to spiral to, worst -case scenarios, it's usually nothing, but for an unlucky few, these unsuspecting symptoms can start the clock ticking on a terrifying medical mystery.

[601] Like the unexplainable death of a retired firefighter, whose body was found at home by his son, except it looked like he had been cremated, or the time when an entire town started jumping from buildings and seeing tigers on their ceilings.

[602] Hey listeners, it's Mr. Ballin here, and I'm here to tell you about my podcast.

[603] It's called Mr. Ballin's Medical Mysteries.

[604] Each terrifying true story will be sure to keep you up at night.

[605] Follow Mr. Ballin's Medical Mysteries wherever you get your podcasts.

[606] Prime members can listen early and ad free on Amazon Music.

[607] What's up guys?

[608] It's your girl Kiki, and my podcast is back with a new season, and let me tell you, it's too good.

[609] And I'm diving into the brains of entertainment's best and brightest, okay?

[610] Every episode, I bring on a friend and have a real conversation.

[611] And I don't mean just friends.

[612] I mean the likes of Amy Polar, Kill, Mitchell, Vivica Fox.

[613] The list goes on.

[614] So follow, watch, and listen to Baby.

[615] This is Kiki Palmer on the Wondery app or wherever you get your podcast.

[616] For me, L .A. was too intense.

[617] The male -to -male interaction was always too combative.

[618] Right.

[619] Sure.

[620] I mean, I don't know if you grew up here or not.

[621] Well, I grew up in Detroit.

[622] So very blue collar, very culture of pride, lots of fighting.

[623] Yeah, exactly.

[624] So happy to be away from that aspect.

[625] Well, you know, that's exactly what happened to me. That's what I found here in L .A. in Torrance or at Long Beach.

[626] It was just us dudes being tense with other dudes, and it wasn't because we were black, white, brown.

[627] It was sort of a bravado.

[628] Sure.

[629] And chauvinism against other men.

[630] Uh -huh.

[631] That was the strife and the conflict that I wanted to escape.

[632] And then I got to the barrier.

[633] Everybody was smoking weed at Berkeley.

[634] Yeah.

[635] There were no cars to be, you know, road raging on each other with.

[636] You take the bart. And you know what?

[637] I said, I didn't need some extra time up here.

[638] So I took six years to get through college.

[639] Uh -huh.

[640] To me, it was therapeutic to go to the Bay Area.

[641] And it was great to be around increasing diversity.

[642] I was there during a time where there was the AIDS epidemic and I volunteered to San Francisco General Hospital and I was in Oakland.

[643] I dropped out.

[644] I got a tattoo and I took the bar to volunteer San Francisco General.

[645] And they're like, no, you can't donate because you got a tattoo.

[646] But it was never about intimidation.

[647] It wasn't about psychologically stifling other men.

[648] Yeah.

[649] And I was picking the fights myself.

[650] I was part of the issue.

[651] Yes.

[652] It wasn't like I was Mr. Johnny Dugood walking around and people were giving me a hard time.

[653] I fell into that world and that way of engaging other people.

[654] I was 17 when I had to Berkeley and I was like, wow, this is therapeutic.

[655] Yes, me too.

[656] And I've now been on a mission for, I'm 44, so 24 years of trying to chisel away at that identity I created back in Michigan.

[657] And it's very hard for me. And only through my wife of 12 years who regularly rewarding when I'm kind and peaceful and let people in.

[658] And I don't know that if I had not linked up with someone who was so expressively against my alpha aggressive tendencies.

[659] What happened with me was I met a badass woman.

[660] And she said, stay badass.

[661] Okay.

[662] Just directed to something else.

[663] Uh -huh.

[664] Just take all that heat and apply it to something else.

[665] So I still channel that bravado and that intensity.

[666] and it would make me a horrible pediatrician with, you know, doctors around with koala bears on their stethoscope and I'm just like, oh, nuts and psycho.

[667] But it does make me a good cancer surgeon when there's a tough case.

[668] Yeah.

[669] Because I approach it with the same adversarial intensity I had when I was younger.

[670] I've just redirected it in a constructive way.

[671] Yeah.

[672] She was great that way.

[673] She was like, no, just turn this into a strength.

[674] You're just directing it to the wrong place.

[675] So I think increasingly I am embracing that the traditional, role of the male is largely not needed anymore.

[676] It's not like we're getting attacked from another tribe.

[677] There's not a bear coming into camp.

[678] A lot of the skills that we brought to the table in our current society aren't that valuable, to be honest.

[679] The bears probably came to camp as we were eating the fermented getting hunting.

[680] The women were like, fuck these guys, man. They create the problems and they pretend to solve them.

[681] And let me also just state for the record, the whole just the utopian hunting and gathering society.

[682] I'll also point out that anthropologists know that 90 % of the food was from women.

[683] Men rarely caught anything.

[684] They weren't really the foundation of the diet was not men.

[685] And some people think shellfish, high protein, accessible, reliable was the original farming.

[686] And that maybe that's where the brain started getting bigger and better.

[687] It is bigger, it's better.

[688] But in the brain, that's not true.

[689] Right.

[690] We want some convolutions and a big neocortex and all these things.

[691] Because in the antithals had bigger actual cranial vaults.

[692] Yes, 1 ,150 cc.

[693] They're not around.

[694] No. So whatever that is.

[695] But the sublimation of my intensity, I attribute to my wife.

[696] And my mother a little bit because she was always like, no, I know you're a good person.

[697] You're doing crazy shit right now, but I know you're a good person.

[698] She believed at your core.

[699] That served better than being strict.

[700] You know, I didn't respond to coaches.

[701] I didn't respond to cops.

[702] I didn't bring the best out of me. I mean, it wasn't obedient based on her interaction.

[703] But my wife was, you know, wife now, girlfriend at that time, she didn't want to dial me down.

[704] She just wanted to point me in a different.

[705] different direction.

[706] I thank you for that.

[707] What a lovely partner to get.

[708] I have the same exact issues.

[709] You've never seen anything more grotesque than me in a TSA line.

[710] It's the hardest half hour of my year is when I'm so I'm, I feel bad for us.

[711] I feel bad that we grew up in an area where that toughness, at least I perceived, was a necessity.

[712] Now maybe I'm wrong and maybe 90 % of the direction I did as a kid but I did and I felt like it was a response to my environment it was eat or be eaten I feel that way again objectively I could be wrong obviously other kids didn't do that but wouldn't you have liked if you could go back in time and put you an environment where that that exterior wasn't even required to grow that I think that would be nice but again I'm not sure I fit into that box because my pops used to say no you're a confrontational personality even in the old country.

[713] Okay.

[714] You're just applying that to a new spot and it ended up in that similar ecosystem here.

[715] But he saw that as a young person's response to anything competitive, anything adversarial was something dialed into me. Right.

[716] And he was waiting for me to grow up and realize to tamp that down.

[717] And my wife was in that way.

[718] They're very indebted to her.

[719] They're like, man, we had to fuck.

[720] He was going the wrong way.

[721] She gets all the credit.

[722] And she should get most, but not all.

[723] I didn't know to.

[724] Right.

[725] The head of children's brain surgery in San Diego.

[726] He's in the, when James Tony was boxing, he was the cut man. He lived in a station wagon, a big sur for a long time.

[727] He is not who you would expect to be a doctor.

[728] He is not who you would expect to be a general surgeon.

[729] But with a gnarly tumor inside your kid's head where you just need a savant type, psycho -adversarial focus, certain surgery, certain operations require that.

[730] Like in Hurt Locker where he's a complete F -Up, except.

[731] when it's time to dismantle a bomb and the general's like, how many have you done?

[732] So this medicine drifted into surgery, dipped into cancer surgery, gave me a place to have those fights I was having in Torrance, but doing it in a constructive way now.

[733] Yeah.

[734] So it's a sublimation for me, not a tamping down of my energy.

[735] Right.

[736] And now there's a zone that a human can get into, which is like time to do the dirty work.

[737] I imagine at least, it's a little bit of a switch flips where it's like, I'm going to be a little bit of a sociopath right now and I'm going to be singularly task oriented and I'm going to forget I'm cracking someone's skull open.

[738] I'm going to forget there's blood everywhere.

[739] Not everyone's drawn to what you do.

[740] Back to your original point, when you go to the gym, you put in work and it does something cathartic therapeutic for you.

[741] But the operating room can be that way.

[742] You've got a headlight on.

[743] You've got these magnifying glasses.

[744] There's pain in your neck.

[745] You got somebody next to you handing you medieval instrument.

[746] but they've got surgical steel and German design on it, it's gnarly, it's physical.

[747] And then when you look at the work that has to be done and you realize the challenges, you know, it elevates you.

[748] And I always say that, I would have been a horrible pediatrician.

[749] Every kid with a cough, or I said, it's just a cough, it's just a cough.

[750] A couple of them are dying from moving coffee.

[751] Right.

[752] But when the challenge I know is clear, I bring my A game, otherwise I can be a little sloppy.

[753] I can be a little unfocused.

[754] So having that as one to two days of my week, I look forward.

[755] to it.

[756] Some people look forward to golf.

[757] Some people look forward to working out.

[758] But it is a physical thing.

[759] And I think there's this harmony where you're not actually thinking.

[760] There's this harmony of where you're like flow.

[761] It's like flow.

[762] Whether it's piano or ballet or the two minute drill at the end of football, what's going down right there is not intellectual.

[763] It requires intellect.

[764] It requires high level of training.

[765] But the synthesis is this metal release of energy.

[766] And and some surgeons are just slick.

[767] Uh -huh.

[768] I mean, and when I saw that for the first time, I wanted to compete to be that.

[769] Imagine getting to compete like an athlete, like a ballerina, but at the same time, you walk out afterwards and there's a whole family thanking you for helping somebody.

[770] I shouldn't have it this good.

[771] Right.

[772] I could be badass and be a good guy.

[773] I imagine in the moment it's a selfish endeavor for you.

[774] Better I get at something I actually want to do.

[775] Yeah.

[776] The better my patients do.

[777] I compete at something I enjoy to get my complication rates lower than my competitor at UCLA or Cedars or Stanford.

[778] And then I go out there and the patients are thankful for it, right?

[779] It shouldn't be this good.

[780] Imagine the better you got to golf, the more starving children you save.

[781] Right.

[782] You know, people ask, oh, you have a stressful job.

[783] You're a cancer surgeon.

[784] I was like, yeah, but I drive away and my patients are dying.

[785] I don't get that twisted.

[786] Right.

[787] And so the singular focus of dedicated work, challenging work, relevant work, dangerous work, is in its own way a drug, because I'm not going to sit there and meditate about Mount Everest and get my heart rate down.

[788] I can elect to do something challenging and sort of get the same psychological relief and catharsis from it.

[789] And the best part about it is, no, you don't operate like a little bit every day.

[790] We get blocked days.

[791] Where you do a bunch in one day.

[792] Right.

[793] And so my day is Wednesday.

[794] I just, Wednesday, you know, I got a Tuesday night.

[795] There's a certain ritual like gym work.

[796] Wednesday morning, roll in, same parking spot.

[797] Take the stairs, get a little tone and legs.

[798] You know, have my locker room where I change.

[799] And patients see me in, you know, a casual suit.

[800] Nothing shiny, but something put together.

[801] So they remember me from clinic.

[802] And I change into my gear.

[803] And there's a ritual of changing in my gear.

[804] I actually have the same kind of underwear.

[805] I mean, it's too much for you.

[806] No, I love it.

[807] But, you know, it's like baseball.

[808] You know, battle underwear.

[809] Right.

[810] And that's a wonderful Wednesday for me to have.

[811] Now, what is the feeling when it doesn't go well?

[812] It hasn't gotten easier.

[813] I'll tell you that.

[814] It hasn't.

[815] Hurting kids, especially, it hasn't gotten easier.

[816] I do a lot of pediatric brain surgery overseas.

[817] It depends on the context.

[818] This is getting deep into the layers here.

[819] But each patient is different.

[820] If you're having surgery and you're trying to preserve your ability to speak, but your timeline's already built in because of the disease you have and you're going to die in a year, and you hurt that person's speech ability, that does hit differently that somebody coming in with a benign thing, they're going to live 60.

[821] But if you shell it out and you hurt them, they're going to have trouble talking and understanding for those 60, it does hurt a little bit differently.

[822] Each injury and complication is individualized to the person, as is the pain that comes with hurting somebody.

[823] Yeah, and this is a terrible analogy.

[824] It just made me think of it.

[825] I host a game show.

[826] Sometimes they give them a lot of money and sometimes they go home with nothing.

[827] I can't help but be on the emotional a ride with them.

[828] I would like it if I wasn't on the ride with them, but I'm just on the ride with them.

[829] I really can't stop it.

[830] On the ride with them is, you know, I crash airplanes, but I've got survivors guilt because I was parachute out before the crash, you know.

[831] Right.

[832] You know, I keep going and they don't.

[833] So I'm partially on the ride with them.

[834] What would a great surgeon's percentage be of success when specifically dealing with cancerous tumors in the brain?

[835] What would be a great surgeon's number.

[836] If it's simple, you injure, just call it injure 3%.

[837] You might be horrible because everybody in town, the average is 1 % injury.

[838] If it's complicated and you injure 80 % that actually might be like you're some Beriznikov because the other surgeons in town can't even tackle it.

[839] Right.

[840] At least you've helped 20.

[841] Yeah.

[842] So again, there's a big gradient.

[843] Therein lies this giant landscape of disease and humanity.

[844] Layers that never get out.

[845] that can never be distilled into just simple numbers.

[846] So it is, again, contextual and it is a gradient.

[847] So it depends on the cancer, the disease, and the age you're talking about.

[848] Yeah.

[849] Is it easier for you when you have a patient that you go, oh, this person's terminal, they're going to die.

[850] They're absolutely dead unless I get in there and do this.

[851] So the risk, weirdly, and this sounds a little bit dispassionate, there really is no risk.

[852] This person's going to die of this shortly.

[853] Or I'm going to get in there, and I might have, to your point, maybe a 20 % to you, chance of fixing that.

[854] To me, I feel like emotionally, I'd be better entering that scenario than we're going to do this.

[855] They could live maybe without treatment for another eight years, but, you know, the complexity of it changes, right?

[856] If they're that terminal, we won't cut on them.

[857] Oh, you won't.

[858] Yeah.

[859] I mean, so at some point, you start telling patients, no, because I'm not going to be able to help you, and then my complications are worse than you're just taking your chance with fate.

[860] Right.

[861] Alternatively, sometimes this patient, She's trying to get to her granddaughter being born.

[862] Uh -huh.

[863] Cure is not in the discussion.

[864] I just, man, can you get me a couple of months?

[865] And I'm starting to have problems staying awake.

[866] And it's my third brain surgery.

[867] Can you at least take out some more of the tumor burden so I can make it a few more months, see my granddaughter and then die?

[868] Yeah.

[869] Now, they're terminal, but you're not any less invested.

[870] And every patient's a new story.

[871] And every cancer on like a broken knee is a new enemy.

[872] Doesn't grow the same way.

[873] You know, like Kobe Bryant's knee pops a cartilage.

[874] they always pop in the same, you know, suspenders break in a similar way, blazers tear in a certain way, cartilage tears in a certain way.

[875] A cancer is growing inside you in myriad, mirage shapes.

[876] And so every time it's just a little bit different.

[877] And that requires creativity, not just I have completed the 62 steps to complete this engine rebuild.

[878] Right.

[879] You're kind of making up moves when you're inside.

[880] And to me, again, that makes me pay attention and I get meditative relief from it.

[881] Yeah.

[882] And probably your personality type would require.

[883] you to do something back to torrents yeah yeah that you need a challenge like that to keep you focused really quick question has nothing to do with anything have you ever operated on someone that had acromegaly like have you ever taken out that tumor that is pushing on the pituitary i've operated on a gorilla oh you what really i was in san diego the seal program the the military asked us about a tumor in a sea lion they had like these sea lions that go down and drop a cuff on an intruder and they reel them back with like a fishing line that sea lion died before we had a chance to help it.

[884] But there was a gorilla named Avila at the San Diego Zoo.

[885] Oh, boy.

[886] After some domestic guerrilla violins.

[887] By the silverback, she had a broken back of sorts.

[888] And there are no neurosurgical vets.

[889] There are no vets that operate in the spinal cord.

[890] Usually put the animal down, right?

[891] Right.

[892] But this is a gorilla.

[893] And so they didn't have any neurosurgeons, so they asked who could help.

[894] And we were like, we'll do it.

[895] And so we gathered all these instruments because you can't bring the instruments back.

[896] The interesting part was, it was like Jurassic Park.

[897] more than half of the zoo is hidden in the back and then these little flatbed trucks and I said San Diego Zoo on the side and we got out there and the veterinarian was all serious and he had like a rifle and he hit the kid with a ketamine dart the same ketamine that kids use and razze and going to a special okay special care or the new one for quick treatment of depression that's a nasal spray ketamine, quick acting anesthetic they hit it with a ketamine dart and they brought it into this medieval operating room with these giant gates that shut like it was a prison It was an amazing experience Much love for animals And those who care for animals Yeah Because these are magnificent creatures And deserve our attention The thing on top of the gorilla So when the gorilla was under anesthesia We kind of touched it You know Yeah, yeah It's just a fat ball Their skulls are that round off the top like ours The little extra bump is Almost like a breast It's like a fat ball on top of it I think it's just for like physical prowess Well but the males right They have the parietal crest where it actually juts up at the fusion and then the occipital bun, right?

[898] Yeah, they do have that.

[899] Different bony.

[900] This was a female.

[901] Right.

[902] She still, her, that crest was actually just soft tissue.

[903] Oh, it was.

[904] Knowing everything that's going on with the brain and the body at all times, do you have hypochondria?

[905] No. I would have, I would have it, but I would definitely have it if I knew everything.

[906] I don't know everything, but when my wife was training in surgery and OBGYN, she was pregnant.

[907] You know, patients have HIV.

[908] now it's under control the viral load is down but we were operating in blood that could infect us and my first born was in her belly or it's just not like that if you don't get cut and you don't stick your fingers in your eye hole or your nose hole or ear hole it's not going to get inside you you can dunk your hand in a bucket of blood with you know the HIV virus in there it just doesn't get in through all ports so i actually look at the other way i've been moving through hospitals across the world for decades, and I don't get coughs and colds anymore than the next person.

[909] So I'm actually, I don't think about it that way.

[910] But really quick, back to the moment in med school where you're like, I think I'm the person that wants to be cutting into something.

[911] Was there an exact moment?

[912] Did you have like some kind of autopsy class or something?

[913] They were like, oh, I'm handling this better.

[914] First of all, that shit is so disgusting.

[915] Okay.

[916] Doctors, they get into anatomy 101.

[917] All these carcasses, it smells horrible.

[918] Anatomy is not pretty.

[919] It's all just decomposing.

[920] It's wet cardboard.

[921] And they're like vultures clamoring.

[922] I don't even know if it's out of interest.

[923] I think it's just to outdo each other.

[924] So I was actually not going to go into surgery until I was at L .A. County.

[925] And if you fall off a skyscraper and you're being, you know, choppered in, the trauma surgeons are hit with the pager.

[926] And they're waiting there for you.

[927] They're the ones that are going to be slashing and gashing and sticking tubes in you.

[928] It's not the ER docks.

[929] Right.

[930] And there was this one kid.

[931] He don't know which gang he was in, but he was East L .A. oil heights.

[932] I can't remember, but he came in.

[933] He was shot in the butt.

[934] And his blood pressure was dropping like altitude on an airplane.

[935] And in that situation, there's like this rare maneuver you can do called an open cardiac massage.

[936] And then the trauma surgeon, they're waiting.

[937] And they're like, hey, let's do open cardiac massage.

[938] There's so much finesse to it is what I remember.

[939] It wasn't frenetic like everybody around them.

[940] Just a quick slice from about the nipple to the back.

[941] And then he stuck his hand in, rotated it.

[942] And it was like squeezing in the blood pressure.

[943] It was like, all right, let's go up to the OR.

[944] Oh, wow.

[945] That wasn't even the work.

[946] That's what I liked about it.

[947] I was like, wow.

[948] You do that, and all the doctors were watching.

[949] And I was like, ooh, I like that.

[950] So I started thinking, man, they do some gnarly stuff out here.

[951] And I started thinking, you know, this is nice.

[952] And then I don't personally enjoy clinic.

[953] I don't want to spend five days a week seeing 40 patients a day.

[954] I think that would deplete me of a certain energy.

[955] And so surgeons have clinic, but they also have the operating room.

[956] A clinic one or two days a week.

[957] I'm the operating we wanted to it.

[958] So I'm just like moving around different spaces.

[959] Right.

[960] Dialing up different energy for the different environment.

[961] I found that appealing as well.

[962] So that was when I started thinking, hmm, surgery could be kind of fun.

[963] As a surgeon, you are a medicine that only can be accessed through your efforts.

[964] There are operations only certain surgeons can do.

[965] Sure.

[966] But if you need chemotherapy, the same bag in New York is the same bag you're going to get here in L .A. Yeah.

[967] Quadruable bypass.

[968] Someone's got to make that thing work.

[969] Yeah.

[970] And some people are better.

[971] So you're flying there to get that person.

[972] Yeah.

[973] The medicine can't be just shipped to you.

[974] Right.

[975] I found that appealing too.

[976] There's ownership.

[977] There are moments, right, when you're operating on someone where you have control, you have total control, and then you start losing that control, right?

[978] In that moment where it occurs to you, this now is a runaway train, must be the worst feeling that you have as a surgeon.

[979] It is.

[980] I wrote this thing for Vice called Lonely's Place is uncontrollable bleeding.

[981] Two hours I'm trying to run maneuvers to stop this blood flow.

[982] Every so often, you stop to let the anesthesia doctors tank the person up again.

[983] It's called catching up.

[984] You're letting the damn bleed as you're trying to stucco it.

[985] And then you have to wait for the lake to fill.

[986] Because if you get below 50 % blood volume ballpark, the patient's going to have a heart attack or die.

[987] So you can't just let it flow indefinitely.

[988] You get limited maneuvers at fixing the problem, you know, with the anesthesia.

[989] You coordinate.

[990] So, okay, ready, you tanked up?

[991] How much hemoglobin is there?

[992] And you get up to a certain number.

[993] You say, okay, then you do your maneuver.

[994] And it's, you know, blood is running.

[995] You're trying to control something.

[996] And they're like, no, no, the blood pressure is dropping.

[997] Then you put your finger in there and you put a piece of gauze and then you stop.

[998] Uh -huh.

[999] And then they give the patient more blood.

[1000] Yeah.

[1001] You say, ready to go again?

[1002] And you go again.

[1003] So you're running maneuvers.

[1004] Yeah.

[1005] In coordination with bleeding the dam, right?

[1006] That's exciting.

[1007] Some people are better at fixing those problems.

[1008] Mm -hmm.

[1009] And operations in which those problems may arise should only, be done by those people, but in America, they're not.

[1010] Anybody can get there, whether you suck or good at it.

[1011] Right.

[1012] What I say is, if you want to be a surgeon and you're not good under pressure, stick with the ACL repair.

[1013] You'll make more money.

[1014] Right.

[1015] Do some plastic surgery.

[1016] Don't even get into the cavity.

[1017] No chance of death, and they were going to run their credit card on the way in.

[1018] Don't force yourself in a box that you think is going to give you more prestige when you're putting people at risk because you don't have that unique skill for that.

[1019] Those complex operations don't pay more.

[1020] We do it for the glory.

[1021] Right.

[1022] For sure.

[1023] Your own identity.

[1024] Yeah.

[1025] Do you think you're good at pinpointing that moment of no return where you go, I need to quit now.

[1026] This is not.

[1027] Never had that.

[1028] It's called an interoperative death.

[1029] What's it called?

[1030] Intra operative, intra -operative meaning inside operative meaning.

[1031] That's when somebody goes cold on the table.

[1032] While you're working on it.

[1033] You've never had that.

[1034] And thank God and not trying to get there.

[1035] But I've entered a type of surgery where I don't want to go there.

[1036] But it's, it wouldn't be something unethical or necessarily a mistake because I'm taking on dangerous surgery.

[1037] But on an ACL, if that happens, that's a crime.

[1038] Yes, absolutely.

[1039] Have you prepared yourself for the impending depression when you stop operating on people?

[1040] I have to imagine it's going to be a huge shock to your identity.

[1041] I know.

[1042] I don't think I'll ever stop being a, I might stop operating, but.

[1043] Right.

[1044] I should hope.

[1045] I don't want 95 -year -old version of you.

[1046] Well, there's no, unlike pilot, it's still going hard.

[1047] Can't get it out of the car.

[1048] But they don't shut you down.

[1049] Old timers can keep operating.

[1050] There's no regulation for it like pilots.

[1051] Really?

[1052] No, not at all.

[1053] Some people even have mild dementia.

[1054] There's a wild world out there.

[1055] That's great news.

[1056] Did you listen to Dr. Death?

[1057] No, I read about it.

[1058] You are on the good side of what it takes.

[1059] Let me just say, I say this is about actors.

[1060] I say this about politicians.

[1061] There is a prerequisite arrogance, which is helpful.

[1062] and it's almost required because who would think they're special enough to do any of these things?

[1063] So there is an implicit arrogance and then it needs to be throttled, right?

[1064] And it needs to be monitored and policed.

[1065] If you listen to Dr. Death, here's a guy that had that arrogance and had that confidence and did not have the skill set.

[1066] Right.

[1067] And I would add there's an analysis that people haven't presented.

[1068] we take medical students into surgical training without ever seeing their hands.

[1069] We're just going to take quarterbacks because of the Wonderlich.

[1070] We're just going to take ballerinas because of their knowledge of the bullshoy, whatever.

[1071] Well, then we'll see if they can dance.

[1072] Then we'll see if they can throw.

[1073] And we're going to take them into surgical residency.

[1074] But we are not allowed to fire any of them if they suck.

[1075] So what are you going to get?

[1076] You'll get dudes like this guy.

[1077] Uh -huh.

[1078] And then they go to these little hospitals.

[1079] where there's a shortage of doctors, and they go.

[1080] Sure.

[1081] The things that I heard he was doing, what I thought to myself was, I don't know if he's malicious, he just way past his depth, and nobody told him you're not allowed to do this because you're not capable because he was freaking the F out.

[1082] Like, you hit a blood vessel in the neck when he was doing some of these neck surgeries.

[1083] Surgery's about backup maneuvers.

[1084] Run of this, already I do this.

[1085] This doesn't go.

[1086] I go through plan B, plan C, plan D. He did not know the backup maneuvers.

[1087] He did the wrong backup maneuvers.

[1088] So there's a certain, like, he wasn't trained properly.

[1089] He would lose his shorts.

[1090] He was a raging addict, too.

[1091] So he is, no, he has the perfect storm of total incompetence and a raging cocaine addiction.

[1092] So he is operating on people on day four of being awake.

[1093] On top of being incompetent, he got out of medical school.

[1094] And the reporter calls the, like, dean of that school and says, hey, I got his records.

[1095] You know, he only participated in 150 surgeries during his training.

[1096] in residency.

[1097] The professor goes, that's not possible.

[1098] And he said, no, no, I have the records.

[1099] That's what he participated in.

[1100] But that's the flaw in the system.

[1101] He shouldn't have been launched.

[1102] No, yeah, this, this dean said, no, minimum would be 2 ,000 surgeries.

[1103] Yeah, there's a certain number like that, 13, 1 ,400.

[1104] Yeah.

[1105] And here's a guy who had been a part of 150.

[1106] So there's systemic problems with the training.

[1107] And then you add his addiction and incompetence.

[1108] He was assaulting people.

[1109] It's a crime.

[1110] And then he moved to another from hospital.

[1111] Well, yes, what it told me is, oh, wow, there's a lack of surgeons in this country because why on earth with a guy with this record be so employable?

[1112] It tells me there's a huge demand for surgeons and not enough of them.

[1113] And there's a lack of understanding by the administrators that you need to have more whistleblowers.

[1114] You need to give nurses and texts.

[1115] The operating is a fun place, by the way.

[1116] Anthony Bourdain wrote about like the what's in a kitchen.

[1117] The kitchen's boring compared to the operating room.

[1118] And we got techs two years out.

[1119] You got MD PhDs like myself.

[1120] You don't have to have strong language skills because it's international language when we talk about surgery.

[1121] I'm not talking to an awake patient.

[1122] So you get a wild room in there.

[1123] Yeah.

[1124] Patients under anesthesia for four or five hours.

[1125] We're talking.

[1126] We're hanging.

[1127] We're working.

[1128] Mm -hmm.

[1129] You need to allow them to be whistleblowers.

[1130] Somebody should at least come by and watch his next five surgeries.

[1131] Yes.

[1132] A couple of nurses said, you know, you've been getting into some false passages and some stumbles.

[1133] We're just going to stand here in the room with you and see how you're doing.

[1134] It's not hard to see when somebody knows what they're doing in the operating room.

[1135] The conclusion of this podcast seemed to be pointing towards we do need to empower some of these surgical nurses because they're seeing more operations than anyone else.

[1136] Like they know what should be happening for the most part.

[1137] They're the ones to ask when you want to see which surgeon you want to go to.

[1138] Anesthesiologists and the surgical scrub test.

[1139] They're shoulder and shoulder with you handing you stuff.

[1140] Yeah.

[1141] They know.

[1142] You're not allowed to see them.

[1143] If you want to get surgery, you go to Cedars or UCLA.

[1144] You can't say, I'm thinking of my surgeon X, Y, Z. May I meet the anesthesiologist first to see what they think?

[1145] Because they know.

[1146] Well, I just had listened to Dr. Death and got a toe surgery.

[1147] And I said to the nurse as we were prepping, I was laying on the bed and doing all the intake stuff.

[1148] And I was like, hey, I empower you.

[1149] If you see something crazy, I am power.

[1150] Fucking call it.

[1151] And then I'm happy to defend you.

[1152] Please advocate for me. I will not be awake.

[1153] I empower you.

[1154] I empower you.

[1155] Good stuff.

[1156] Stay tuned for more armchair expert, if you dare.

[1157] You have a book called Neuro Fitness, a brain surgeon's secrets to boost performance and unleash creativity.

[1158] Let's just start with a very broad.

[1159] Here's my stupid layman's understanding is that your brain, unlike the rest of your body, the rest of your body is made up of somatic cells, right?

[1160] They're going through mitosis every second of the day, reproducing.

[1161] Your brain is not doing that, right?

[1162] For the most part, no, but 20 years ago, that's what I got my Ph .D. on.

[1163] There is a little region.

[1164] We call it a germinal niche that sprouts new brain cells.

[1165] And they particularly like to stream to olfaction smelling and memory regions.

[1166] There are new brain cells being built, even though we didn't think that for 100 years.

[1167] Oh, wow.

[1168] And are there things we can do?

[1169] The simplest thing I can tell you about the brain is, do you ask you, Usain Bolwell, can we do anything to run faster?

[1170] You should run, run uphill.

[1171] Uh -huh.

[1172] You know, the brain, you should live, get out.

[1173] think, challenge it, not get into too many habits, shake it up once in a while, and it'll pull from different recesses of your mind.

[1174] It is that elemental.

[1175] And how you do that is up to you.

[1176] High power career, great.

[1177] Learning a new musical skill, great.

[1178] Traveling great.

[1179] There's not one secret shortcut, one secret food that's going to do all these things for you.

[1180] But exiting your routine seems to be consistent.

[1181] Yes, it is.

[1182] It burns a lot of fuel.

[1183] It wants to drop into idle.

[1184] It doesn't want to be running in third year.

[1185] It's a big power suck, this huge brain of ours.

[1186] Three or four pounds, but it burns 20 % of the fuel and only weighs three or four pounds.

[1187] It's burning.

[1188] Yeah.

[1189] So by design, even though it's a hog, it still will find habits to grab itself down a little bit.

[1190] And that's when you start getting to mental ruts.

[1191] And those corners that are not accessed, they'll say, maybe we don't need those to be so robustly populated with brain cells and brain tissue and brain activity.

[1192] So it'll start shutting down corners, your mind that That happens if you go blind.

[1193] That happens if you get a certain paralysis, that region that controls it will physically wither.

[1194] Extending that, you know, pull yourself left and right.

[1195] Try to get to all the corners of your mind and life.

[1196] And that's the best way.

[1197] You're using an area of your brain a lot.

[1198] Let's just say you're a lawyer in the part of your brain that's forecasting doom or whatever.

[1199] The evil part should be in.

[1200] Using that part actually strengthens that area, right?

[1201] The very important nuance.

[1202] whereas your biceps will bulk up.

[1203] You don't deposit more muscle cells.

[1204] The ones you do have get bigger.

[1205] Okay.

[1206] In the brain, what happens is the networks become more synchronized.

[1207] The way, like, you go to a symphony, if one does, and everybody's all playing in a discord and fashion, and then you get into a rhythm with the music.

[1208] The same way, the electrical discharge of the chemicals, in a behavior, become more efficient, more ingrained, and strengthened, not in the conventional sense, like more of your brain is being applied to that actually less of your brain is being applied to it because it's more efficient at carrying out that task and your brain says hey I drive to work a lot and I'm going to pay attention to it I'm going to give it a dedicated space and I'm going to become efficient and using it so I'm not burning a lot of fuel on this task so by strengthening that part of your brain you're actually making certain networks and connections more efficient is there any exercises people can do And I don't mean physical.

[1209] I mean like mental exercises.

[1210] Whatever you do, it can't be too easy and it can't be too hard.

[1211] It's just like video games.

[1212] You've got a one level up.

[1213] If it's too hard, you're checked out.

[1214] If it's too easy, you're not pushing yourself.

[1215] So if you do puzzles and all those things and you're doing it for this purpose, just go at one level past your comfort zone.

[1216] Not too many levels past.

[1217] Again, that's thinking.

[1218] If you're an old timer and you're sitting there, you're doing puzzles, great.

[1219] If you have a podcast and it's a turn on to talk to a lot of different people, that's thinking you don't it's not one or the other it's about just engaging the brain and what it designed to do we just think and feel and get out well i read some article at some point that was suggesting like take a different route places i will kind of force myself like go another way because that just kind of forces your brain to be online a little bit yeah and and that would apply to something like navigation so that that's not going to necessarily make you more creative Navigation skills are from the temporal lobe and those are the ones that patients, when they do get Alzheimer's, they wither.

[1220] So nothing wrong with practicing your spatial orientation.

[1221] So that's a basic skill that people have.

[1222] Language is an important one.

[1223] Music is an important one.

[1224] Even though you're going to see the headlines, this one food will make use part of it.

[1225] Yeah, brain superfood.

[1226] I don't believe in that.

[1227] You know?

[1228] I don't.

[1229] What I do believe is in what has been shown with the mind diet, which is basically, you know, salmon and chicken and fruits and vegetables.

[1230] in some red wine that you get thousands of thousands of people over over a decade or two they'll have a little less dementia right since we don't have a pill for Alzheimer's that's all you've got and then the other thing is exercise it's flesh you clog the arteries in your heart arteries in your brain launch off from your heart you clog those and you irrigate that flesh less well that flesh is going to physically wither so thinking is keeping the electricity and the chemicals engaged exercise is keeping the irrigation of the actual flesh of the brain engaged and a proper diet is actually giving it the nutrients and needs omega -3s in particular those essential things are free they're not expensive and they work in a glacial way it's not like i've got to be on a popular game show this weekend today i'm going to have some salmon right i wish it were that easy right yeah yeah i got a test tomorrow morning i'm at blueberries before bed exactly just one we're going to have a blueberry A blueberry to ace a test.

[1231] And I imagine sleep, obviously, is something people underestimate, right?

[1232] You can catch up on it.

[1233] That's what we're seeing now.

[1234] Oh, really?

[1235] Yeah.

[1236] That weekends off, catching up can mitigate some of the health risks of dementia as well as heart disease and diabetes.

[1237] You know, I wrote this chapter on creativity.

[1238] I thought, man, I gave the conventional stuff, get out play, whatever.

[1239] You know, Salvador Dahlia had this one book, and he used the transitions between from falling asleep and waking up to solve a lot of creative puzzles.

[1240] And I love that because I kind of do that myself a little bit.

[1241] Like, we're all wildly creative when we sleep.

[1242] Right.

[1243] And so that hypnagogic, hicknipompic state that 10, 15 minutes while you're drifting off into sleep or waking up is a good time to rotate a problem in your mind that you've been trying to solve.

[1244] Several people and several studies, as well as Salvador Dali have mentioned that is a non -drug -based way to access problem solving and creativity.

[1245] I do TM or I used to before I had kids.

[1246] I'm a writer, and I can't tell you how many times in that 20 -minute evening session, an entire act of a story comes to me. Just like it got downloaded from the sky, because my brain's in some place that has allowed that to happen.

[1247] I have a notes app that I leave on my phone.

[1248] I just jot random stuff down.

[1249] Uh -huh.

[1250] When you're in one of those zones.

[1251] Yeah, or just falling asleep.

[1252] I'll have a thought or two.

[1253] I'll wake up and look at it and write a few things.

[1254] And then get to my, what time, I have to be somewhere.

[1255] You know, because once you engage that procedural part of your day, that free flow thing, is it's got to take a back seat because you've got to safely get to wherever you're getting.

[1256] Yeah.

[1257] So it's those moments where you're actually not doing something routine that you can access creativity the best.

[1258] Now, you are a surgeon at City of Hope Hospital.

[1259] Tell us why City of Hope is fantastic.

[1260] Because I'm probably going to have to schedule a brain surgery at some point.

[1261] That's called psychosurgery.

[1262] You can treat mental health with these brain catheters and stuff like that.

[1263] And addiction to.

[1264] Oh, really?

[1265] They're trying a lot of these things.

[1266] Not at City of Hope, but at other places in that instinctive part of the brain, If the brain is a mushroom cap, that's sort of underneath of the mushroom cap, there are these nuclei.

[1267] They look like large marbles stuck in between these neurons.

[1268] And they can tickle them and stop obsessive OCD.

[1269] They can tickle them and stop a tremor.

[1270] They can trickle it and for depression.

[1271] Really?

[1272] It's like the emotional thermostat, if you will.

[1273] And that's done through these deep brain stimulation at other centers, not at City of Hope.

[1274] Well, it is conceivable at some point in our future, right?

[1275] We'll just wear like a leather helmet.

[1276] and the leather helmet will start interacting with the neurons and giving its own electrical impulses.

[1277] And really, we could do all the things drugs are doing electrically, right?

[1278] Because that's ultimately all that's happening when we take a drug is there's some kind of electrical storm.

[1279] I read this crazy thing about, like, centuries ago, they should try to treat headaches with these electric fish.

[1280] And somebody had that's a bad headache.

[1281] And they try to zap it with an eel.

[1282] Similar concept, just like sophisticated.

[1283] But the thought's always been there.

[1284] Well, you must love to that the Aztecs were doing brain surgery.

[1285] that they were surviving.

[1286] Oh, man, that's one of my opening slides when I teach classes.

[1287] You can't go down the middle.

[1288] There's a giant vein that's a Mohawk.

[1289] So if you look at those holes they make, they're always off to the side.

[1290] Yeah, yeah.

[1291] The first couple that were in the middle, they're like, this isn't going so well.

[1292] Yeah, that's a lot of blood.

[1293] That's a lot of blood.

[1294] That's a lot of blood.

[1295] Am I writing that cancer just in its basic form is your cells are going through mitosis all the time, and then sometimes they don't make an identical copy, and then that cell itself will start replicating, and that itself is cancer.

[1296] It's just a mutant cell, right?

[1297] When you're making billions and billions of new cells throughout your life, some of them will have a genetic change.

[1298] And they won't behave.

[1299] Behave means when I bump into my neighbors, Mr. Liver Cell, I'm not going to crawl all over it and kill it.

[1300] Right.

[1301] The tumors are basically growing at and damaging their neighbors.

[1302] They lost the playbook from your genome, right?

[1303] They lost the playbook and they will grow despite bumping into neighbors.

[1304] They won't just hang on the liver.

[1305] they'll go rogue and get into the blood vessel and try to take over your kidney.

[1306] Uh -huh.

[1307] So they lose properties that make it a tissue.

[1308] They lose those properties and become a malignant tissue.

[1309] Uh -huh.

[1310] And that malignant tissue, in the beginning, your immune system's like, you've lost the playbook, you're not one of us.

[1311] We're going to explode.

[1312] We're going to destroy you by a lot of different mechanisms, by attacking you, or they've got some suicide genes that are already built in for this.

[1313] When you can veil your surface and hide from yourself.

[1314] Right.

[1315] Right.

[1316] Those cancer cells that make those two babies now, they're going to have more and more cancer cells and cancer tissues that have lost the ability to be detected by the immune system.

[1317] And those will be the ones that take over.

[1318] And this is just real -time evolution.

[1319] Yeah, billions of cells try different strategies.

[1320] Cancer is just a malignant species, just like the boa in Everglades, just like the dark finch or the light finch when the factories change the colors of the tree.

[1321] Right.

[1322] It wants to live.

[1323] It's just not following the playbook.

[1324] It is evolution inside us.

[1325] And then it ultimately gets so big that it either takes up so much space inside of an organ that the organ can't function.

[1326] And it is also, I would imagine, stealing surrounding nutrients from healthy cells.

[1327] Yes and yes.

[1328] The worst cancers, without getting big and bulky, they send off little enemies, little spies, actual pieces of themselves swimming around you.

[1329] And they take root and form new colonies in your brain and your liver and your, you know, in other parts of your body.

[1330] That's metastasis.

[1331] A cancer is a malignant species that goes and competes for soil in other organs.

[1332] So it's not like it's landing in the brain and saying, hey, Mr. Brain Cell, you too should become cancerous.

[1333] It's just saying there's a billion of you and now there's a million of us and give us a few years we're going to be billion strong.

[1334] Right.

[1335] We're going to outproduce you.

[1336] It is repopulating the soil inside you, the organs inside you.

[1337] Some cancers, despite being small, they love to send those malignant cells, those circulating tumor cells, so you can have, I've seen patients with a hundred spots inside them without a big gumba.

[1338] That's metastasis.

[1339] Some of them have, it's called migratory capacity, yeah.

[1340] Some of them have that.

[1341] I've seen patients with hundreds of little spots and still alive, and I've seen patients with just one, and they're struggling.

[1342] So it doesn't fit an exact protocol, and there are over 200 types of cancers.

[1343] So it should be cancers.

[1344] Right.

[1345] Like cancer.

[1346] And there's this other phenomena, right, that they're starting to look into is that some organs seem to be innately hospitable to certain cancers and some organs are not.

[1347] So you'll see it in like five organs and then it's not at all in one of the organs, right?

[1348] So they're starting to look at the actual, to your point, the soil of your organs and what's happening in that organ that makes it inhospitable for the cancer.

[1349] That's the basis of my recent funding from the government in my laboratory is the environment.

[1350] Really?

[1351] We're just trying to find the Achilles heels of these cancers.

[1352] Because we've been trying to generally invent to fight it and to beat it and to kill it in the body, right?

[1353] The approach has been to just napalm it.

[1354] Right.

[1355] But then the ones that survive are stronger.

[1356] The more modern approach, the ways in which we are looking for potential future treatments, is to actually to bomb it a certain way knowing which ones are going to survive this assault and then drive them right into our next attack.

[1357] Right.

[1358] So like a three -staged approach.

[1359] Synergistic combinatorial treatment.

[1360] Right.

[1361] But that work better together.

[1362] This one drug will kill 40 % of the cancer.

[1363] This one drug will kill 40 % of the cancer alone.

[1364] Together they kill 90.

[1365] Right.

[1366] So they're greater than the sum of their parts.

[1367] Right.

[1368] That's today.

[1369] The new wave.

[1370] And also aren't we learning to also, get far more specific with our own immune system and turn on certain T cells that are good at one thing and not turn all the T cells on where they start attacking your own organs and stuff.

[1371] Absolutely.

[1372] So that story we're talking about how the cancer cells that learn to cloak themselves from our immune system.

[1373] So what we do now at City of Hope is we take that cancer out, grind it up, take your T cells out, your immune cells out, your cancer fighting cells out.

[1374] And we let them see each other in a petri dish, like almost letting the bloodhound smell the rag.

[1375] get sensitized, get primate.

[1376] Then we put those your own cells back into you, but now they're supercharged and they're hungry looking for your cancer that up until now had been hiding behind that cloak immune system, hence immune therapy one time.

[1377] Yeah, so fascinating, man. It's cool, right?

[1378] Yeah, you picked a really good era to be born to be trying to fight cancer.

[1379] Yeah, I think there's a lot of cool things on the horizon for everyone.

[1380] Yeah, my mom had breast cancer a long time ago.

[1381] She's fine.

[1382] She's living with me and got her name tattooed in Oakland when I was 20 thinking he had a terminal disease and it's a living memory now on my right arm.

[1383] Yeah.

[1384] Well, that's amazing.

[1385] Well, I think we're all really grateful.

[1386] There are people like you that dedicate themselves to this and it's incredibly impressive and I hope you don't get dementia for at least another 50 years so you can carry on your work.

[1387] Maybe when I'm an old man and you're an old man, you'll crack this fucker open and start tinkering around.

[1388] I had fun.

[1389] Okay, great.

[1390] Great having you.

[1391] And please, everybody, give your book Neuro Fitness of Brain Surgeon's Secrets to boost performance and unleash creativity.

[1392] Give that a read.

[1393] Not unlike your biceps, quads, trapezias, latissimus.

[1394] Think about that brain and keeping it healthy and fit.

[1395] Thanks, everyone.

[1396] And now my favorite part of the show, the fact check with my soulmate, Monica Padman.

[1397] Get your facts up on the wall.

[1398] Dance.

[1399] Come on.

[1400] I'll get your facts off.

[1401] off the wall dance come on you recognize that get your back up off the wall dance come on i do i think i only do though because you sing that sometimes i do but i don't know it and i used to sing it compulsively when we live together oh yeah well we'd add a bunch of words and stuff sure yeah get your back up off the wall freaky chicken dance come on well i enjoyed that thank you we're back we're back we're back again.

[1402] To talk about Dr. Rahul.

[1403] Yes, Dr. Rahul.

[1404] He was very interesting.

[1405] He was.

[1406] Yeah.

[1407] He had a very alpha energy.

[1408] He did.

[1409] Mm -hmm.

[1410] I've been accused of bringing an alpha energy to things.

[1411] And so I don't know if you notice, but I kind of laid off my alphanus for long enough to let everything simmer.

[1412] By the end of it, I thought, were on a very even footing.

[1413] You probably didn't notice any of these subtle things that were happening.

[1414] Because they're probably, they probably weren't.

[1415] These were primitive.

[1416] These were primitive tribal jungle things that were happening no they went right over your head oh they were happening no but if we called him and asked him he'd say they were happening too what just man stuff stupid man stuff don't act like oh god what don't act like there's specific man stuff that other people are impervious to i'm not saying that for everyone i'm saying it was happening and you missed it so if you miss it i'm assuming it's because you're female i think he's an alpha dude and i think i'm an alpha dude and often when two alpha dudes get together it's a blowhard session and they both try to outdo each other and top one another and then i took a back seat for a while until that all subsided and i was kind of basically going you can be alpha here and then through that i think some trust came about and some things so uh -huh yeah so look he grew up in compton in south central torrents torrents bordering all that and i think in his neighborhood he had to take a stance for himself And I think that's proceeded throughout his life.

[1417] And I think I came from a similar background where you, this whole bullshit, stand your ground kind of.

[1418] Yeah.

[1419] Ultra -prudy thing.

[1420] I think it was just all happening.

[1421] Yeah.

[1422] That upset you?

[1423] I guess what I wrestle with a little bit in these conversations sometimes.

[1424] But I feel like when we have these conversations about Alpha, it's with this intense pride.

[1425] Well, for myself?

[1426] Well, in general about the idea of Alpha.

[1427] No, I don't think it's something someone should aspire to.

[1428] I don't think it's a way to be.

[1429] I think we're evolving away from it.

[1430] But I think I can acknowledge that I am a certain way.

[1431] I'm not in the dark about who I am.

[1432] Got it.

[1433] Yeah.

[1434] I'm not holding it up as a virtue at all.

[1435] And I think some people through environment and then also just genetically.

[1436] I mean, again, my dad was just, you could smell his musk.

[1437] He just was genetically that way.

[1438] Mm -hmm.

[1439] And so was my grandpa, and I never met beyond that, but seems to be in the genes a bit.

[1440] Yeah.

[1441] We see babies playing all the time, and there's just some that are kind of outwardly more aggressive.

[1442] Yeah.

[1443] It seems to be their genetics, at least half of it.

[1444] Maybe I bristle a little bit about, or maybe we're just moving away from alpha meaning that.

[1445] Like if we're at a tech company or something, if we're at Apple, Steve Jobs is alpha.

[1446] He is running the show.

[1447] He's dominating everybody.

[1448] He actually was Alpha in the most conventional sense as well.

[1449] Not in his physical.

[1450] No, but no, Alpha has nothing to do with your physical exterior.

[1451] I'm not saying because my dad was big, he was Alpha.

[1452] My stepdad, Dave, was the same exact size, but he was just not Alpha at all.

[1453] Okay.

[1454] So I'm glad that you clarify that because in my head, I feel like you equate like big guys with Alpha.

[1455] Not at all.

[1456] No. In fact, I would argue many of the most alpha men I've ever met are short, bald, hairy, aggressive.

[1457] Too much testosterone.

[1458] Well, maybe too much testosterone or compensation.

[1459] Sure.

[1460] Who knows?

[1461] Yeah.

[1462] There's a lot in the recipe.

[1463] But no, it has nothing to the physical size thing.

[1464] I mean, it just comes from dogs, right?

[1465] We're just co -opting that term from dog packs.

[1466] Yep.

[1467] And dog packs have alphas and they're the ones who decide which way they're going to chase the buffalo when they're chasing it.

[1468] Yeah.

[1469] That's the leader.

[1470] Right.

[1471] Yeah.

[1472] Now, you could say I'm saying, oh, being a leader is inherently desirable.

[1473] Right.

[1474] But there's a way to be a leader and not be alpha, as is proven now.

[1475] I think the current cook is not like jobs at all who's running Apple.

[1476] He doesn't seem to give me a big alpha vibe at all, yet he's doing just fine.

[1477] Right, right, right.

[1478] Well, anyway, so yes, he definitely came in, Dr. Rahul.

[1479] Mm -hmm.

[1480] came in and had a big alpha energy energy yeah BDE no that's different although he might have BDE we're not levying a verdict whether or not he had BDE I don't even really understand BDE to be honest I do big dick energy I know it means big dick energy right I think it's often used to explain guys who have some confidence and no one can really explain just by looking at them but they have this incredible confidence, and that confidence they're saying is BDE.

[1481] But I mainly hear it in a negative context.

[1482] Oh, really?

[1483] Yeah.

[1484] They'll include it in aggression, in toxic masculinity conversations, in all of that.

[1485] Oh, I haven't.

[1486] I've only seen online tweets.

[1487] They're always funny.

[1488] It seems to always be funny.

[1489] Well, we were talking about Bernie.

[1490] So, like, Bernie, there's no toxic masculinity with Bernie Sanders.

[1491] Right.

[1492] But I was arguing that he's so confident.

[1493] And so open to being controversial going against the grain, I said it must be that huge hog.

[1494] And that made sense to everybody.

[1495] That's how I think of BDE.

[1496] Maybe.

[1497] I don't know.

[1498] I've just heard it in the context that men who feel entitled to the things around them because they have a penis.

[1499] Well, if that were my understanding of BDE, yeah, I would think it was a crappy negative saying as well.

[1500] Yeah.

[1501] Oh, I'm not saying you're saying anything.

[1502] I just don't know what it is actually.

[1503] Well, I definitely think that boys are obsessed with penis size.

[1504] Let's start with some things we agree on.

[1505] Boys are obsessed with penis size.

[1506] They're obsessed with each other's penis size.

[1507] Little kids show each other their penises.

[1508] Little kids know when they have a bigger penis than all their friends very early on.

[1509] And if you have a bigger penis than your friends, your friends envy that.

[1510] So that gives you some kind of boost in your confidence.

[1511] So I can see it actually being a thing for some people.

[1512] Not all people.

[1513] It's not the only way to be confident, et cetera.

[1514] But I definitely see some people...

[1515] It's just such a silly way to be confident.

[1516] Of course.

[1517] We've talked about it a million times.

[1518] Girls don't care.

[1519] That's great.

[1520] Guys do care.

[1521] Guys care about penis size.

[1522] Girls don't and it's stupid that they think about it, but they do.

[1523] It's just the reality of the world we live in.

[1524] Okay.

[1525] So among their peers, if they're known as the dude in the circle with the biggest dick, they're going to have a certain level of confidence because of that, because of having that moniker.

[1526] Yeah, maybe.

[1527] what well i don't think you say maybe yeah is to me a little dismissive of me having been a boy i think you're all other boys yes there's a ubiquitous idea around yes guys and their penises and loving the size of it or not or whatever definitely a thing right do you think it transcends into adulthood yeah for some people i'm not talking about everybody i'm talking there's a significant enough people that it affected in a positive way that they knew their dick was bigger than their peers, that it's worth giving a funny name to and acknowledging.

[1528] Right.

[1529] But do you think those people, if and when, I'm sorry, not if, when that turns out to mean almost nothing in life, in their job, in relationships or whatever, do you think that goes away?

[1530] They reevaluate?

[1531] Yeah.

[1532] No, because they're friends even in their friends.

[1533] 50s are still bringing up Mike's big dick.

[1534] It's happening nonstop, no matter what achievement they've had with work or education.

[1535] Right.

[1536] Dudes who know one of their friends is a big dick is going to bring it up all the time.

[1537] So they're always going to hear that from their friends.

[1538] Got it.

[1539] All right.

[1540] So is Cuckaroo still in existence?

[1541] Cuckaroo was a fast, casual restaurant chain, specializing a charboiled chicken founded in 1988 by LA -based restaurateur is Mike and Ray Bandalion.

[1542] I wish to God their last name was Cuckaroo.

[1543] I know.

[1544] Would have made more sense.

[1545] Although the name Cuckaroo was an anatopoeia to the crow of a rooster.

[1546] Oh.

[1547] We love onomatopoeia here.

[1548] We embrace it.

[1549] After a series of expansions and ownership changes in which Cuckaroo struggled for profitability throughout the 1990s, the last location in Santa Monica.

[1550] Oh, that was the last location.

[1551] Close in 2014.

[1552] Oh.

[1553] And I mentioned to you that I used to see Lisa Bonay there.

[1554] No. You did.

[1555] You did not say that.

[1556] Liliqui Moon.

[1557] Oh, wow.

[1558] Oh, yeah, my 20s.

[1559] She was there.

[1560] At Cuckaroo?

[1561] Yes, are there twice?

[1562] Was she by herself?

[1563] Yeah.

[1564] Yeah.

[1565] Getting takeout.

[1566] I got to now ask myself how much of my love for Cuckaroo was maybe connected.

[1567] Connected to having seen her there twice.

[1568] But I'll maintain.

[1569] It was damn good chicken.

[1570] I wish it was still around.

[1571] I bet I would like it.

[1572] You'd love it.

[1573] They had a great chicken salad.

[1574] Oh, they did?

[1575] Yeah, phenomenal.

[1576] Oh, I love chicken salad.

[1577] Beautiful macaroni and cheese.

[1578] Really delicious.

[1579] Kind of like a Boston market?

[1580] Well, yeah.

[1581] Well, let's just say it.

[1582] Similar architecture.

[1583] Oh, but tasted better.

[1584] Much different.

[1585] Although I enjoyed a Boston market.

[1586] It's really good, Boston market.

[1587] When I was doing idiocracy and I was gaining lots of weight in a hurry, I was a regular at the Boston market.

[1588] at Austin.

[1589] Oh, you were?

[1590] What'd you get?

[1591] The meat love platter and then a couple exercises of that macaroni and cheese.

[1592] Oh my God.

[1593] I am so hungry.

[1594] But the cuckaroo macaroni cheese was real cheese that like when they scooped it out, there are big strings of cheese attached to it.

[1595] Yes, I love that.

[1596] I got.

[1597] I wish they relaunch.

[1598] Should we do it?

[1599] Let's start a Kickstarter or whatever people do, a petition something to get it back.

[1600] Okay, so he said Redheads need more anesthesia.

[1601] That was interesting because I've already done some research on redheads, and I do know they have a low pain tolerance.

[1602] Yes.

[1603] So this all adds up.

[1604] Mm -hmm.

[1605] Redheads are strange.

[1606] It's weird that they never subdivided them into their own race.

[1607] I mean, of all the dumb ways we've categorized race that are based on one or two genes of melatonin.

[1608] Yeah.

[1609] Now, that was one to single out as its own species.

[1610] That's true.

[1611] We could lump them in with East Asian.

[1612] Okay.

[1613] You'll take them on?

[1614] Yeah.

[1615] I'm happy to take on the redheads.

[1616] Okay.

[1617] Is there addiction in animals?

[1618] I read a bunch of stuff on this.

[1619] And it basically looks like there is some evidence that there is, but there's not very much research in this.

[1620] So it's hard to make a full conclusion.

[1621] Who's abusing what?

[1622] Well, they know it from like research.

[1623] When the stimulant is artificially introduced.

[1624] Addiction can quickly take over and often and consume the animal mice have been known to starve to death when faced with an choice between cocaine and food.

[1625] Yeah.

[1626] I thought you were more sane in the wild chimps have figured out suicide mushrooms and they trip every single day or something like that.

[1627] Yeah, no, but I think the only way to really know is when they're in a lab and you can see their options and where are they picking and is there a dependency and things like that.

[1628] Yeah.

[1629] It's hard to know in the wild.

[1630] Well, let's just say that addiction in the sense that it's compulsive behavior and obsessive behavior is very beneficial in the wild.

[1631] Oh, yeah.

[1632] You know, like someone who's fishing a stream that's just taking all fucking day long and the obsession and to do it over and over again is beneficial.

[1633] That's true.

[1634] Yeah.

[1635] Do you think they're the same?

[1636] I think addiction is a level above obsession and compulsion.

[1637] Well, for me, that would just be an artificial line to try to separate them.

[1638] I think addiction is compulsive behavior.

[1639] Well, part of being an addict is having compulsive behavior.

[1640] Mm -hmm.

[1641] But you can have compulsive behavior, I think, and not be an addict.

[1642] Sure.

[1643] Yeah.

[1644] I think there's levels to it.

[1645] Yeah.

[1646] But I feel like I have a lot of obsession tendencies.

[1647] Mm -hmm.

[1648] But I don't think I'm addicted to anything.

[1649] I agree.

[1650] But if, you know, a zero is a teetotaler and a ten.

[1651] 10 is me, you're not a one.

[1652] No. Yeah, you're like a five, let's say, or four or something, whatever it is.

[1653] You don't drink destructively or pathologically, but you also drink a lot.

[1654] Yeah.

[1655] Or frequent.

[1656] Let's say that.

[1657] I don't want to say a lot.

[1658] Yeah.

[1659] And I mean, quantity -wise, just frequency -wise, you like to have a wine.

[1660] Uh -huh.

[1661] I would harken a guess that you're a similar spot on the compulsive spectrum.

[1662] Or do you think you're high on the compulsive?

[1663] I think I'm much higher on the obsession.

[1664] compulsion.

[1665] Oh, compulsion.

[1666] Like propulsion.

[1667] Spectrum.

[1668] I think I'm much higher.

[1669] Right.

[1670] Where are you on the palsy spectrum?

[1671] A zero so far.

[1672] So far.

[1673] Knock on hold.

[1674] I feel like I've had some light facial freezing at times.

[1675] Yes.

[1676] Just like in and around my eyebrow once or twice.

[1677] That's scary.

[1678] It is scary.

[1679] Well, you know Bell's palsy.

[1680] People can just get.

[1681] Like you can just wake up with Bell's palsy.

[1682] Oh, my God.

[1683] I know.

[1684] I one time had, I think I told you.

[1685] you in college, I got frozen in my sleep.

[1686] Yes, yes, I remember this.

[1687] Yeah, I woke up, but my body was still stuck.

[1688] It was paralyzed, sleep paralysis.

[1689] Right.

[1690] It's a real thing.

[1691] And Callie was nearby.

[1692] I knew she was there, but I couldn't talk to her, tell her.

[1693] It was so scary.

[1694] Yeah.

[1695] The next day I was napping.

[1696] I took a lot of naps in college.

[1697] Oh, great.

[1698] And I was napping, and I woke up, and her face was just hovering over.

[1699] over my face.

[1700] Oh, to see if you're in the sunken place.

[1701] Yeah, she was wondering if I was stuck.

[1702] Uh, that was kind of her to take that seriously.

[1703] Well, she should have taken it seriously.

[1704] Well, I probably wouldn't have.

[1705] I'm like, oh, yeah, Monica, that happens to me all the time.

[1706] I'm, like, trying to wake myself up and I can't.

[1707] I'm trying to get out of it.

[1708] So I'm alert enough, but I haven't woken up fully to activate my body.

[1709] You don't take any of my stuff seriously.

[1710] Not a ton of your medical stuff.

[1711] You're right.

[1712] I would say none.

[1713] None of it.

[1714] No, nothing.

[1715] None of.

[1716] I take your anxiety seriously.

[1717] I've always been very sincere about when you've explained that to me. Yeah.

[1718] But I wish you would take my sleep paralysis.

[1719] Yeah.

[1720] Seriously, it was scary.

[1721] And my peeing in the bed.

[1722] And again, so I've peed the bed twice as an adult.

[1723] I know.

[1724] So I would just, you know, it'd be hard for me now to go like, yeah, yeah, me too.

[1725] I did it too.

[1726] I did it.

[1727] I've done it twice.

[1728] It's not the same thing.

[1729] Well, right.

[1730] I was heavily intoxicated.

[1731] Exactly.

[1732] Yeah.

[1733] It wasn't like, this is where once there's a narrative about you, it gets unfair.

[1734] Like, you have a narrative about me that I make up a whole bunch of stuff about my medical conditions.

[1735] I don't have a narrative about you that you haven't yourself told me. You've said you're a hypochondriac.

[1736] We both have acknowledged we're hypochondriks.

[1737] I'm not mad at you that you didn't take my brain tumor thing seriously.

[1738] You were right.

[1739] I was right.

[1740] Right.

[1741] And everyone was right.

[1742] And I didn't have a brain tumor.

[1743] I did take it very seriously.

[1744] I had a long conversation with you.

[1745] But I didn't say, oh, that happens to me. And then I was done with it.

[1746] I told you I've experienced the same thing.

[1747] And it was this and this and this.

[1748] And it was those things.

[1749] And when I object, what do you think my motive is when I do that?

[1750] I think your motive is to make me not worry.

[1751] Uh -huh.

[1752] Is it?

[1753] Yes.

[1754] To comfort you.

[1755] Right.

[1756] And to try to tell you not to worry so much.

[1757] Right.

[1758] Yeah.

[1759] I know.

[1760] But do you think that works?

[1761] It's clearly not working, no. Obviously not.

[1762] And now I have to also make it sort of like a joke when I'm telling people things, except certain people who do seem to take it a little bit more seriously.

[1763] Uh -huh.

[1764] Allison takes it seriously.

[1765] Uh -huh.

[1766] Or she handles it in a way where she's considering, okay, well, this could be these things.

[1767] It's probably not.

[1768] Yeah.

[1769] She acknowledges that weird stuff is happening.

[1770] Mm -hmm.

[1771] She also gets esteem from being a medical caregiver.

[1772] Yeah.

[1773] So she's excited to like explore that with somebody that's part of her identity.

[1774] Sure.

[1775] Yeah, mine's not really.

[1776] So I'm not that, you know, incentivized to explore whether or not you have a brain tumor.

[1777] You got to admit you come to very dramatic conclusions.

[1778] It's never like you go, I have a virus.

[1779] or I have a bacteria, it is always a terminal disease.

[1780] This is your conclusion.

[1781] No, I didn't, I, when I had the peeing thing, I didn't know what it was.

[1782] Right.

[1783] And what were your theories?

[1784] I thought at first I thought this is a kidney thing, so I should just go to the doctor.

[1785] I probably have kidney stones or a kidney infection, which I've had before.

[1786] And I didn't think I got to go to the hospital.

[1787] I just, and I had a lot of pain.

[1788] So another person might have gone to the hospital in the middle of the night when they peed and was disoriented.

[1789] But wasn't your pain unrelated to the peen?

[1790] Wasn't your pain like you hurt your neck somehow in the middle of the night?

[1791] No, my back.

[1792] Your back.

[1793] My lower back.

[1794] Your low back.

[1795] Which is, see, you're doing it right now.

[1796] You're doing it.

[1797] I'm just made lower back funny by saying low back.

[1798] Anyway, it's fine.

[1799] I'm sorry I'm I am sorry I'm not good at that I'm not naturally a nurturer I ignore stuff I'll have a fucking I should get stitches and I don't go but you talk about it let's be honest I do but I have no expectation of what you're supposed to do I'm just sharing I'm just sharing like what I'm wrestling with and if your conclusion is your hypochondriac that's not going to make me mad at you not mad at you for thinking I'm a hypochondriac but I there's a lot of dismissal and I don't think I do that too.

[1800] you.

[1801] And I don't think anyone does that to you, if I'm being honest.

[1802] I think you get a lot of ears when you have an issue.

[1803] Mm. You're probably right.

[1804] But you're right.

[1805] Not everyone.

[1806] I'm not, I'm just not that way.

[1807] I can fake it for you, but I don't think you want me to fake it for you.

[1808] I'm not actually worried about you when you tell me you peed the bed.

[1809] It doesn't make me scared for you.

[1810] I think you're so healthy and you're going to live a long time in your set.

[1811] That's what I think about you.

[1812] So when you tell me that you have tumors or muscular dystrophy or whatever, I did not say that.

[1813] I know you didn't.

[1814] But what I'm saying is I don't believe that.

[1815] I believe you're healthy.

[1816] You don't smoke cigarettes.

[1817] You exercise.

[1818] I think you're healthy.

[1819] I think you're going to live forever.

[1820] And I don't think you're going to have a terminal disease in your 30s.

[1821] That's what I think about you.

[1822] I'm not good at just getting wound up about stuff.

[1823] Right.

[1824] It's a complaint Kristen has about me as well.

[1825] I'm a bad person to have a cold around.

[1826] I'm like, you have a cold take some fucking something with suit a fed in it and go to work i don't have a ton of compassion laying in bed i need soup all this kind of stuff yeah i was raised in a household well that was not cool right yeah so i wish i were different it it would be nicer to the people around me but i recognize i have limits yeah in that department my mother does too as she has admitted to me And we can relate on that topic.

[1827] I was in a rollover accident.

[1828] I was driving home from Toledo, Ohio, seeing this girl, Jenny.

[1829] I met on spring break.

[1830] My friend Ron driving back to Detroit, he's driving.

[1831] You know the story.

[1832] He has the cruise control on 85.

[1833] I'm in the back of a Ford probe.

[1834] We got the seats folded down.

[1835] So I can go to sleep because I have to wake up at 5 in the morning and drive to New York for work.

[1836] I'm in high school.

[1837] And he falls asleep.

[1838] We roll in the median seven times.

[1839] it's insane.

[1840] The car's flattened.

[1841] I crawl out of the back of the hatchback.

[1842] I don't know how I wasn't flung from the vehicle.

[1843] I get taken to the Yipsliani Hospital.

[1844] I call my mother.

[1845] I wake her up.

[1846] I say, Mom, everything's cool, but I'm in the hospital.

[1847] I wasn't hurt.

[1848] Ron's getting X -rayed.

[1849] We were in a rollover.

[1850] She goes, okay, are you going to be able to do the car run?

[1851] And I go, mom, I'm probably not going to make it to the car run because it's 3 a .m. and I'm in Yipsalini at a hospital.

[1852] Right.

[1853] And then she hung up.

[1854] And I was like, that's my mom.

[1855] Now, mind you, she then became fully awake.

[1856] Maybe she had sleep paralysis.

[1857] She fully came awake.

[1858] And then she called back to the hospital to, like, double check that.

[1859] But when she just said, are you going to make it to work at five?

[1860] I was like, yep, that's my mom.

[1861] Yeah.

[1862] Yeah.

[1863] And you were sad about that a little bit?

[1864] Not at all.

[1865] No. That was just, I didn't expect anything other than that from her.

[1866] Although you did preface with everything's fine.

[1867] So that's good, right?

[1868] So it's not like you were like, I'm in the hospital.

[1869] Well, again, I said that because in my family, it would be selfish and self -centered and an act of not loving to need something from one of the other family members.

[1870] Were you lying?

[1871] I was fine.

[1872] I was pretty sure I was fine.

[1873] I refused medical treatment.

[1874] I didn't get an x -ray or anything.

[1875] Got it.

[1876] Yeah.

[1877] He got put on a board in the whole line.

[1878] I rode in the ambulance.

[1879] He was in back on a board.

[1880] I was up in the passenger seat talking to the ambulance driver.

[1881] Okay.

[1882] Okay, so he was talking about the gorilla, the top of their head that's, like, sort of a point when he did surgery on the female gorilla, and there was like a fleshy, boob -like substance there, bat -like substance.

[1883] Now, here's an area where I just let that lie.

[1884] Uh -huh.

[1885] I know for sure there's a parietal crest in.

[1886] Sagittal.

[1887] Sagittal.

[1888] It's called sagittal crest.

[1889] Oh, sagittal crest.

[1890] where the parietal's meat.

[1891] Sagedal Crest, prominent ridge of bone.

[1892] It is not in females, though.

[1893] Right, it's just the males.

[1894] Yeah, that projects superiorly upwards from the cranial vault along its midline.

[1895] Most commonly seen in adult male gorillas and orangutans.

[1896] However you like it.

[1897] Sagital Cress are rare in adult male chimpanzees and female gorillas.

[1898] Oh, so I guess maybe they do exist every now and then.

[1899] and are unknown in female chimpanzees, female orangutans, and humans and bonobos of both sexes.

[1900] The crest provides a surface for the attachment of the large chewing muscle.

[1901] The mastoid.

[1902] Temporalus.

[1903] Uh -huh.

[1904] In humans who have large brains, and hence large cranial vaults, relative to their body size, the temporal muscles occupy a position on the lateral walls of the cranial vault and extend only about halfway up the vault surface.

[1905] In apes, the superior extent of the temporalis muscles is positioned higher on the cranial vault because brain size is smaller, and the muscles of mastication are larger than those found in humans, such that the right and left side superior temporal lines approach one another at midline.

[1906] In male gorillas and orangutans, in which very large chewing muscles are anchored to a relatively small cranial vault, the right and left superior temporal lines not only converge at the midline of the top of the cranial vault along the sagittal suture, but you know, but but also require the development of a sagittal crest to provide sufficient attachment area for the temporalis muscles.

[1907] Hmm.

[1908] Very.

[1909] There probably is a fatty thing on there as well, but I did.

[1910] I've handled those skulls in anthro.

[1911] Yeah.

[1912] Although he was handling as well.

[1913] He was.

[1914] But he was a female, so they don't have that.

[1915] Right.

[1916] Or rarely.

[1917] So maybe that gorilla just had a lot of fat up there.

[1918] Yeah.

[1919] Yeah, maybe they carried weight in their head.

[1920] Yeah, like, I carry it my midsection.

[1921] She did have some domestic abuse, it said, so maybe it was part of that.

[1922] Yeah, they're violent.

[1923] Poor gorilla.

[1924] Yeah.

[1925] Poor gal.

[1926] Poor galila.

[1927] Poor galila.

[1928] That's all.

[1929] That was it?

[1930] Yeah.

[1931] I never have any guess of where you're at in the list.

[1932] Oh.

[1933] Yeah, I don't know if there's like 12 bullet points or.

[1934] Sure.

[1935] Yes.

[1936] It's a surprise.

[1937] Yeah.

[1938] The only.

[1939] part that's not great about it is there are times where, like, if I knew that was the last one, I would dig in more on it.

[1940] Oh.

[1941] And then if I think you've got five more, I'm like, oh, I'll just let her get to the next one.

[1942] Oh, I see.

[1943] Yeah, I never really know how to play my hand, as it were.

[1944] Well, I'm not going to tell you because I like the surprise.

[1945] Yeah, yeah, just keep me on my toes.

[1946] Exactly.

[1947] All right.

[1948] I love you.

[1949] Love you.

[1950] Boy, I was wrong.

[1951] Sagital crust.

[1952] Now you say it five times.

[1953] I'm like, yeah, that is what it is.

[1954] Sounds familiar?

[1955] Yeah, big time.

[1956] All right.

[1957] This is the point of all this, learning.

[1958] Learning, growing, evolving.

[1959] Phelomath or philomath.

[1960] Or unifile.

[1961] Oh, big time, yeah.

[1962] All right, this is two unifiles, signing off.

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