Read more of Kim Lawton’s interview with Dr. Ben Carson:
Q: You wrote that Americans have a national obsession with security these days. What do you mean by that?
A: We spend so much time focusing on different types of risk, which frankly probably are not going to happen, and really don’t pay much attention to the things that are more likely to happen and, you know, we listen to the hyped risk and then don’t do the necessary things to take care of the things that are much more likely to happen. That’s on one level. And then on another level a lot of people simply don’t realize their potential because they are so risk adverse. They just don’t want to take the risk. And there is another group of people who take all kinds of risk without ever thinking about anything, and they are the ones that will always get knocked back into the pond and never seem to make any progress so, you know, I think it’s a very wise thing for people to rationally sit down and look at what the risks are not only on a daily basis, on a weekly basis, on a monthly basis, on a yearly basis, on a lifetime basis, and then plan one’s life accordingly, you know, which is why we have these incredibly sophisticated brains. We are not like dogs who are kind of “What am I going to eat today? Oh, there is a rabbit; I am going to go chase it.” You know, that kind of thing. A lot of people act that way, of course. They just react to whatever is going on around them and really don’t plan, really don’t strategize, really don’t analyze whether the rabbit is running near the railroad tracks, whether they might get run over, or out in the open field where it’s unlikely. No, it’s just “Here is the rabbit down the road, let’s chase it.” So that was really the purpose of the book is to get people, first of all, to understand themselves. It’s very important for people to know themselves and understand what their value system is, because if you don’t know what your value system is, then you don’t know what risks are worth taking and which ones are worth avoiding. If for you the most important thing is to make a lot of money, then you don’t want to take a certain type of risk. If, on another hand, the most important thing to you is to make people around you have a more fulfilled life, then there is a different set of things that are important to you. Unless you really know that about yourself, you will never be able to appropriately assess risk.
Q. In the book TAKE THE RISK you write very movingly about the risks that you assessed with the surgery of the Bijani twins, the Iranian Siamese twins. Why did you in the end decide to take on that very risky surgery? What did you think through? What was the mental process that you used?
A: In the case of the Bijani twins, the Iranian sisters who were 29-years-old and joined at the head, taking on that was a risk that was really more than I would normally want to encounter simply because, first of all, they are adults, so even if you are successful I wondered how would they be able to survive apart having been together for 29 years. It would be very, very difficult just on that level, not to mention the complexity of the surgery and the 50/50 chance that they would die on the table. So, no, I wasn’t in any way enthusiastic about that as I assessed the risk, and my initial impression was not to get involved. It became very clear as time went on that they were going to go through with the operation whether I helped or not. So at that point, I started thinking there’s not a very good chance of success here, so I better go and help because if they die I am going to wonder for the rest of my life it could have turned out differently if I would have helped, and they are going to go through it anyway. Therefore, in terms of risk to me there was very little, except if you are worried about what people are going to say, which I quite frankly am not, and that really sort of changed the equation at that point, and that’s why I decided to get involved.
Q: When they both did die, did that cause you to say maybe I shouldn’t have done that?
A: When they died, it really didn’t cause me to say I shouldn’t have done it, because one of the things that really helped me enormously was meeting them, because I was, you know — had real severe doubts before I met them, and they were absolutely charming. They had learned how to speak English in only 7 months. That’s an amazing task. They were charming. They were very well educated. They both had bachelor’s degrees and law degrees. They said something to me that shocked me, but when I thought about it, it wasn’t so shocking. They said, “Doctor, we would rather die than spend another day together.” And that kind of takes you aback, but then I put myself in their place and I said what if you were stuck to the person you liked most in the world 24/7, and you could never get away from them for even one second, and I realized what they were going through. Now, you couple that with the fact that they had extremely different aspirations for their lives, and I said that’s an untenable situation. It helps you to understand why people who are imprisoned with no hope of parole are willing to risk their lives to escape, and basically that’s what they were willing to do. They were willing to risk their lives to escape for an untenable situation, and I had really never understood that until I had a chance to actually talk to them.
Q: You are a person of faith. I’m wondering what role God plays in risk?
A: In my own personal life, God plays a great role in the risk, because I pray before I go into the operating room for every case, and I ask him to give me wisdom, to help me to know what to do — and not only for operating, but for everything. I always think it is kind of funny when it comes to wisdom, and I say God has a sense of humor, because my middle name is Solomon, and I love the Book of Proverbs which is written by Solomon, and I have read from the Book of Proverbs to start and end every day since I was 14. He must have known that I was going to have this affinity for the Book of Proverbs so he calls my parents to give me the middle name of Solomon. And furthermore when Solomon became the king of Israel, the first act that gained him a lot of fame, two women came to him claiming to be the mother of the same baby. What did he advocate? He said divide the babies. Well, that’s when I became very well known, when I divided babies, so I really do think that God has a sense of humor. And so do I, so we get along very well together. I do, however, whenever I’m faced with a real challenge, go even more so than I would on a normal basis and ask him to give me guidance, to give me wisdom. I believe he does. I actually don’t think that I’m that much smarter than anybody else. It’s just that I frequently just seem to know what to do, and I think that’s wisdom.
Q: You prepare yourself medically and emotionally for surgery, but how do you prepare yourself spiritually as well?
A: My strong belief is that God created human beings and therefore he knows about every aspect of the human body. So if I want to fix it, I just need to stay in harmony with him. And how do you stay in harmony with God? You think about godly things, and you try to dismiss ungodly things from your mind. There’s a verse in the Book of Isaiah 26:3 that says, “I will keep him in perfect peace whose mind is stayed on Thee, because he trusteth in Thee.” And that’s what I do, I just trust him. I believe that things are always going to work out, even if in the beginning it doesn’t look like they are working out. I know in the long run they are going to work out, and it’s going to be fine. One of my associates was saying to me last week during a particular stressful time, “Yeah, yeah, I know, things always work out.” But they did! And they always do.
Q: But how do you deal then with situations like the Bijani twins, when they both died? How do you help parents deal with children with very severe physical problems, and people think why would a good creator God allow this to happen? How do you reconcile that?
A: I always say if God didn’t allow any bad things to happen we would already be in heaven, and we are not there. So there’s evil in the world, there’s bad in the world, and as long as there’s more than one force, you are not going to have one force dominating everything. I do believe that that will eventually be the case, but it’s not the case now. We don’t know the end from the beginning the way that God does. So when a child dies, sure that is incredibly difficult, and when you are the parent, there is almost nothing anybody can say to you that makes any sense. You just can’t understand how could a loving and caring God allow this to happen. However, what if you could see the end from the beginning and you might know that that was the best time for that child to go. Maybe things would have happened later on that would have been pretty awful and maybe that child would have been involved in them and maybe it would have been considerably more painful. These are just things that we don’t know, and that’s where trust and faith come in. You just say, “Lord, I don’t understand it. But one thing I do know is that you understand it and you are in control and I trust you,” and that’s the end of the story. That’s the way I felt 5 years ago when I was diagnosed with prostate cancer, and then I had an MRI and it looked like it had metastasized, and the prognosis was pretty grave at that point. And I just said, “Lord, if it’s time for me to go, you know what is best.” I don’t want to go, but if it’s time, that’s fine, I trust you,” and I was at peace. There was another time when I was on an airplane and it started shaking violently and then it flipped over and down and everything was strewn all over the place. People were screaming, and I just said — I wasn’t joining the hysteria — I just said, “Look, if it’s time, it’s been a good life.” There was a lot of snow on the ground at the time so I said maybe it will cushion the fall. I just really did not concern myself about that because I don’t worry about things that aren’t important.
Q: How did your experience with cancer in particular affect your faith?
A: It gave me real perspective, that’s for one thing. I remember the day after the MRI walking around my property and noticing so many things that I had never noticed before. You know, the beauty of just the leaves on the trees, the blades of grass, and the incredible symphonies put on by the birds that I had never listened to before. I said, wow this is really fabulous, and that is something that I have continued to look at and appreciate since that time. It did affect me in that way. It gave me more perspective and I think it really did — I think I was pretty empathetic before, but I think I am even more empathetic now when people are facing death or when they are facing really horrible things, in terms of having a real sense of how they feel. So I think it was a good thing.
Q: When you operate you see the mechanics of life — the brain and the nerves and all of that. But does surgery have a spiritual dimension for you as well?
A: When I look at the human brain I’m still in awe of it. Every single time you lift off the bone and open the durra and there it is — the human brain, the thing that gives a person a personality, that distinguishes each one of us, that there could be more than 6 billion of us here on this planet with brains that look the same, but each one being distinctly different because of what is going on in that thing. I’ll never get over my awe of that. So, yeah, that is sort of a spiritual experience when I see it, but I don’t particularly like cutting the brain. It’s such a beautiful thing, why cut it? And I’m not even sure I like surgery, but I like what it does, I like the effects. I like to be able to give people longevity and quality of life, and I also think it’s good for people to use the special gifts and talents that they have. And when I was in medical school, when I began to analyze the gifts and talents that I had, I realized that surgery would probably be a very good fit for me.
Q: Sometimes people accuse surgeons of having a God complex. How do you try to avoid that?
A: I certainly know many who do have that. In a sense I can even understand it a little bit. I mean, you think particularly about heart surgeons, neurosurgeons. You are going into these incredibly delicate places that control who people are, and you’ve got to have a fair ego to think you can do that. You know, you are not going to be one of those shy, retiring flowers that say, “Oh no, oh geez,” — you are never going to get there. So it really kind of selects out for those kinds of people, but for me personally I realize where it all comes from. All the good things come from God. I can’t really claim any of them, and I just feel privileged that I was dealt a measure of the healing arts in my life, and I continue to want to use them.
Q: You have written a lot about your background and some of the social factors that were working against you growing up. Tell us about that. Someone looking at that might have said this kid doesn’t have much of a chance.
A: Well, I was definitely an at-risk kid growing up. My parents got divorced early on. My mother only had a third grade education, was illiterate, worked as a domestic 2 to 3 jobs at a time, because she didn’t want to be on welfare, because she never saw people who went on welfare come off of welfare, and she just didn’t want to have her life controlled in that fashion, and she didn’t want that for us either, and because she was gone all the time, we were kind of left to ourselves quite a bit, and we weren’t particularly good students, and that’s a great, great understatement. I was considered the dummy in the classroom when I was in 5th grade, and I just didn’t believe that I could do the work, so I engaged myself in creating disturbances, getting kids kicked out of class. I enjoyed that. Fortunately for me, my mother was so disturbed with the fact that I was failing she prayed and she asked God to somehow give her the wisdom to know what to do. She noticed in the homes of the people where she worked, and they were wealthy people, that they read a lot, and something just clicked in her mind. She said, “I think there’s a correlation between reading and doing well in life.” So she came home one day and pronounced that we were only going to be allowed to watch two to three TV programs during the week and with all that spare time read books, two books apiece from the Detroit public library, and submit to her written book reports — not knowing she couldn’t read but she would highlight and checkmark stuff, and we’d think she was reading them. But she could always discuss them with you – “let’s talk about your book report” — and we would start the discussion and she would chime in. She was really quite smart and very wise, just didn’t have much in the way of formal education. I obviously wasn’t very pleased about this, because I was spending so much time reading and not playing, but it only really took a month maybe before I started to enjoy the reading. Something happened. I got to the point where I couldn’t wait to come home and read my books. I started reading animal stories and, you know, “Chip the Dam Builder” and “Call of the Wild.” These things were so exciting I couldn’t wait to get back there. But something else started happening. I was always looking at words, so I learned how to spell, and I was always looking at sentence structure. Grammar, syntax — all those things improved. I started getting much better grades. I had to use my imagination. I became much more creative. I became engaged, and things just started turning around very, very dramatically at that point. But then after I got things turned around, it took me a year and a half to go from the bottom of the class to the top of the class. I still had a horrible temper problem. Now many arm-chair psychologists said that it was because I was angry that my dad was gone. I don’t know why I was angry. All that I know was that I thought I had a lot of rights and therefore it was very easy for people to infringe upon my rights and when they did so, I felt that it was my duty and my obligation to hurt them. So I got in fights, I went after people with baseball bats and hammers and rocks. I almost put a guy’s eye out one time with a rock and put a three-inch gash in somebody’s head in school because they were trying to close my locker. I tried to hit my mother in the head with a hammer. It also culminated one day when I was 14 and another youngster angered me and I had a large camping knife and I tried to stab him in the abdomen and fortunately under his clothing it hit a large metal belt buckle. The knife blade struck with such force it broke and of course, he fled in terror. But I was even more terrified because it dawned upon me at that moment I was trying to kill somebody over nothing. And I locked myself in the bathroom and I just started thinking about it and I said you are not going to accomplish your dream, becoming a doctor. You are going to end up in jail or reform school or dead. Those are the only options that you have. I said I don’t like those options, and yet I can’t control this temper. I’m always in trouble. I just fell on my knees and started praying. I just said, Lord, there’s got to be something better, I can’t control this. And at that time I was reading Psychology Today, because I wanted to become a psychiatrist, and I was reading about behavioral modification and all these kinds of things, and I realized that’s what I needed. I also realized that it was incredibly expensive, and we were desperately poor. So there was no possibility of that, and I just said Lord, either you have to fix this or my life is pretty much over. And there was a Bible, and I picked the Bible up and it just opened to the Book of Proverbs and I started reading and there were all these verses about anger and what happens to angry people. But also verses like Proverbs 16:32 that says, “Greater is the man who can control his temper than a man who can conquer a city.” And I stayed in there for hours reading and contemplating and praying, and I came to an understanding during that time that to react, to lash out, was not really a sign of strength. It was a sign of weakness. It simply meant that environmental factors could easily control you, and you know, I’ve been doing a lot of reading about great people, and I said you could be a great person too if you decide that you were not going to let the environment control you, if you decide that you are not going to be a victim, and that was it. When I came out of the bathroom after 3 hours I was a different person, and I never had a problem with temper since then.
Q: You think God took away the temper?
A: There’s no question. There’s no question, in my mind, because supposedly things like that don’t happen, and yet it did. I’ve certainly heard and read stories about people who were alcoholics or addicted to cigarettes and, you know, it was just like, boom, it was gone, and they never had the desire to do it again. It was sort of like one of those kinds of things. I was very grateful, and it really changed my relationship with God, because before that he’d been my heavenly father. Now he became my earthly father, since I didn’t have one. I started praying a lot just asking for guidance and asking for wisdom, and that was the day that I started reading from the Book of Proverbs, and there are a lot of verses in there about, also, fools and how they don’t listen and how they think they know everything, and as I read all those I said, “Wow, that’s you.” And I resolved that I wasn’t going to be that way anymore, and I started listening to my mother, and I started listening to other responsible adults, and I really started to accelerate at that point. I didn’t have to make all the mistakes that they had made. I could learn from their mistakes, and I treasure the things that I learned during that time period.
Q: What do you make of the many thorny ethical issues we are dealing with as a country? Are we equipped to deal with them?
A: I’m very happy that we have a bioethics council in this country to consider some of the many thorny issues that arise, particularly with the advent of new technologies, because if someone doesn’t sit down and think about these things and recommend policies for them, we could go off on a tangent and be too far down the line before we realize it. What if we didn’t have policies about cloning, some of these things — could you imagine what the potential harm could be to our society? One of the nice things about the President’s Council on Bioethics is that it’s a diverse group with many opinions on every subject, which is good. It’s not by any means a council where everybody thinks the same way and could just kind of rubber stamp things, by no stretch of the imagination, which is good, because I always say that if two people think alike on everything then one of them isn’t necessary. In this case, we have a bunch of people with very, very good ideas. One of the issues that has been fascinating and has occupied a lot of time has been the whole stem cell issue. I think most of us would agree that the potential, if we ever learn how to use stem cells properly, for disease eradication is enormous, and I think we all want to see it move forward. But you have two camps. You have people who say [they want] absolutely nothing to do with stem cells because embryos are involved, and the other camp that says they are just embryos, they are going to be killed anyway, whatever, science is the only thing that is important. These other things are peripheral issues, red herrings. We don’t need to deal with them. I always felt and stated in my writings that we ought to be looking at ways we can make everybody happy. Dedifferentiation of mature cells back to the totipotential state where they can then be used and, of course, lo and behold, in the last couple of months this seems to be a big deal. It’s happening. I think maybe we can meld our energies together now and stop fighting each other and really make some progress in this area. This is something that needs to be done not only with stem cells, but with a lot of political issues. Why is our country at a stalemate right now? Because you have one group here, one group here, both of whom want the other to look bad, even forsaking anything that has to do with the good of the people to fight their perceived enemies. It’s just craziness. It’s worse than it’s ever been, I believe, and I have talked to people who have been around for a very long time observing the political scene, and they all say the same kind of thing. It filters through all the layers of our society, and I think it even affects how we feel about bioethical issues. We have to be able to somehow shut that out and just deal with the issue and its importance to us as human beings and how it can enhance our existence without being a detriment to our progeny.
Q: Another issue you are concerned about is health insurance. Do you see this as a moral issue?
A: I see the insurance issue, the coverage of people for health care in our country, as a huge moral issue, and for the richest country in the world to have 47 million people without health insurance is ridiculous. To have more money per capita spent for health care than anybody else and still not to have it is even more ridiculous. The amount of money that we have in the system is far more than is needed to give everybody the best health care imaginable. But of course we have so many special interest groups with their hand in the pie that there is no pie left for the people who need it, and nobody is courageous enough or willing to get in there and tackle these special interest groups, and it needs to be done, and again, the political factions are just looking for ways to make themselves good and without looking how we take care of the people. What if we were smart enough to use the electronics that we have to do all billing and collection instead of the mounds and mounds of people, the 19 or 20 year old clerks who are sitting here saying, “No, we are going to deny this,” who have no idea what they are talking about. Just zero idea. I’ve talked to some of these people on the phone. They have no clue what you are talking about. It’s absurd. And yet they have to be paid. They don’t need to be there. Multiply that by several million and you begin to see the problems that we are having. So we can save an enormous amount of money by electronic billing and collection. Some people would say that would open us up to fraud, but fraud is only a problem if you don’t punish it. Why don’t they have thieves in Saudi Arabia? Chop — they cut their hands off. Why don’t people drive drunk in Sweden? The penalties are too great, and so if the penalties were severe enough, medical fraud wouldn’t occur. End of story. It wouldn’t be worth it. People would have enough sense to do a benefit-risk analysis, and they’d say those risks are too high, I’m not taking it. What if we were to make the government responsible for catastrophic health care, and not the insurance companies? Then you could predict and control the amount of money they needed to take in and consequently the premiums would fall drastically and people could own their own health insurance, just like people own their own automobile insurance, their homeowners insurance. If people owned their own insurance, you begin to think what will happen. We could say you get an annual physical exam and get a 2 percent discount on your premium. You incentivize people to get annual physical exams. We begin to discover things early. A whole, incredible level of savings begins to occur, and then what if we take the most indigent people in our society and we treat them like we do in terms of food — we give them food stamps. We give them a health savings account which is replenished every month. Now we give them the ability to use it wherever they want. Guess what? They are not going to go to the ER where it costs five times more than it does to go to the clinic. They are going to go to the clinic where they are going to receive the same care that they would have gotten in the ER but for a fraction of the cost and where they are going to say if they’ve got diabetes, now let’s get your diabetes under control so you are not back here in 3 weeks with another problem. A whole other level of savings. All of these kinds of things would save us so much money; we would be saying, what could we spend money on? We wouldn’t know what to do with it all. Instead, we continue to be more and more inefficient, and then we say, oh we could just raise taxes. We need real, honest leadership. I think most people would respond to logical ideals if you went above the head of the special interest groups and say look, we are not dealing with the special interest groups. They might try to kill you, but hopefully the Lord will take care of you.
Q: Could you say a few words about the surgery my colleagues saw this morning, and the situation with this family?
A: Surgery this morning was a little girl from the Midwest who has spinabifida. When she was born her spinal cord did not form in the proper way. She is still quite functional, you know, walking around and doing things, but started having considerably more trouble with that and more problems with her bladder. We figured that her spinal cord was tethered, and in fact an MRI had demonstrated that it had been pulled down. It was very tight. So what we decided to do is to go in and explore it, and what we found once we got all the tissues off is some scar tissue which we were able to dissect away from the nerves, and then down at the end there were some scar tissues and fatty tissues at the very end of the sack that was stretching everything like a guitar string. After using our special electro-physiological monitoring probes, we were able to determine that there were no substantial neuro-elements in there, so we were able to cut that, and it was cut apart, everything was relaxed, and she should do great.
Q: She has had many surgeries, hasn’t she?
A: She has had number of surgeries. I think we might be the end of the road for her in terms of spinal surgeries, because it is now very relaxed,l and I don’t think it will ever tether again.
Q: Do you build special relations with patients you have had for a long time?
A: Absolutely. All the patients know when I come to clinic that I’m going to ask them how school is going, because it’s a big pet peeve of mine, and I always sit down with patients. Some people call it small talk, but I don’t think it’s small talk at all. People want to know that you are interested in more than just how is your mole today? How is your scar today? And it makes a big difference in terms of how they heal. Their mental status makes a huge difference, their attitudes about things. I remember once having a patient, a young man who was a basketball player, and his girlfriend jilted him. He had a malignant brain tumor, and he was living way beyond what everybody expected and doing great until his girlfriend rejected him. He became depressed, and he was dead in 3 weeks. I think that the attitude that a person brings in to any type of illness makes a huge difference in how they do. We are more than just flesh and bones. There’s much more to us than that. People are different than other animals in that respect. There’s a certain spiritual nature and something of the mind that we can’t measure. We can’t find it. With all our sophisticated equipment, we cannot monitor or define it, and yet it’s there, and it’s the thing that makes us into who we are. We need to treasure it and not try to diminish it.
Q: What are you passionate about?
A: The thing that I’m most passionate about, quite frankly, is the state of education in this country, and I’m very disturbed by the fact that we only produce 60,000 engineers a year, 40 percent of whom are foreigners. Countries like China produce 392,000 a year. We have to import a lot of our technical know-how from outside the country, and I think if we don’t rectify that situation, we are not going to maintain our position in the world beyond another generation, two generations at the absolute max. So I’ve spent a very great deal of my time trying to rectify that through the Carson Scholars Fund, through the placement of reading rooms in elementary schools and trying to get at children early, recognizing that 70 to 80 percent of high school dropouts are functionally illiterate, and if we can truncate that early on and have a positive impact down the road, if we can take young people who excel at the highest levels, put them on the same pedestal as the all-state basketball player and the all-state football player and begin to get the same kind of recognition, it will have a profound effect, and we are finding that it does.