- [Announcer] "Your Fantastic Mind," brought to you in part by Sarah and Jim Kennedy.

(dramatic music) - Welcome to "Your Fantastic Mind," I'm Jaye Watson.

Two years into the COVID-19 pandemic, vaccines are curbing the spread and life-saving drugs, reducing the severity.

But there is a lasting impact of COVID changing the health and lives of people everywhere.

In the US, the American Academy of Physical Medicine and Rehabilitation estimates more than 11 million people are living with long COVID.

You're about to meet some of those people and some of the people working to understand the virus that continues to wreak havoc on our collective health.

(dramatic music) There is something you begin to realize when you meet someone living with the virus that has changed their life.

How sick did you get?

- I almost died.

(knocking on door) - [Jaye] You see it when you are with them in exam rooms.

- Any chest pain or chest tightness?

(Norma speaking in foreign language) - [Jaye] When you are in their homes.

- It's like, "But you look fine."

I understand I look fine, but I'm not fine.

- [Jaye] You realize that what has taken the place of the initial COVID-19 infection.

- I miss her a lot, 'cause she was a healthy woman.

(pensive music) - [Jaye] What has settled into the bodies and lives of millions of people is devastating and can vary from one person to the next.

You'll meet four of the estimated 400,000 people in Georgia, living with long COVID.

They are different races and sexes and ages.

- I think I'm probably considered a long hauler at this point.

- [Jaye] But they share the same struggle of living with long COVID in all its manifestations.

- A lot of people say, "It's just a flu.

It's gonna be fine.

I'll get it and I'll move on."

And that's what I thought last August.

Here I am 14 months later with my life completely upended.

- The way I look at it is you have a hurricane that comes in, the hurricane may last for three to four days.

It goes away, but the damage it leaves in its wake, it takes years before that destruction is made up and you go back to life as normal.

- [Jaye] With each passing month, we are learning more about how dramatically COVID can impact the brain.

- Especially in people that have long COVID, 50 to 80% of them have neurologic symptoms.

- [Jaye] People experiencing long COVID have been told it's in their head, or their doctors admit they don't know how to help them.

- And that's one of the challenges in long COVID right now.

We don't have good, there's no single diagnostic test.

- Were you're like waking up because you were really anxious?

- [Jaye] There are fewer than 50 long COVID clinics around the country, and pulmonologist, Dr. Alex Truong, helps to run one of them at Emory University Hospital in Midtown, Atlanta.

- I think by the time they get to us, they have suffered for quite a while.

More often than not, six months, nine months a year of daily symptoms.

I think they're exhausted.

I think that they're beaten.

Ms. N. Perez?

Hey, how are you doing?

(Norma speaking in foreign language) - [Jaye] 55-year-old Norma Leone Perez collapsed in her home on Christmas Eve of 2020.

Her whole family had COVID.

Perez, a diabetic, wound up hospitalized on a ventilator for a month and in rehab for another two months.

- Could I take a quick listen to you?

Can I examine you?

Your heart seems very fast.

Does it always run very fast?

- [Jaye] In a wheelchair now, she is a shadow of her former healthy, active self.

- She used to work at the church, help the kids and she helped the community.

We used to do a lot of things, like for food bank.

She can hardly eat, as well.

Everything she eats, she throws it up.

And walking right now, you've seen her, she can hardly walk.

She tries to, but she faints too much, she gets too dizzy.

- [Jaye] In the hour, Dr. Truong spends with Norma, with a translator on the phone, (Translator speaking in foreign language) the long list of symptoms are revealed.

Her hands are weak and they hurt.

Her joints ache.

She has tingling and numbness all over.

Her heart races.

She faints when she stands.

She has pain in her chest.

- Have you been losing hair?

- [Jaye] Perez has brain fog and anxiety.

She says she was never anxious before COVID.

This is nine months after she got the virus.

- There's a lot of what you are telling me that I see in patients who've had COVID infection like yourself.

So I think that a lot of your symptoms may be a combination of both, being in the ICU, as well as having COVID.

I'm gonna give you a second inhaler to use.

- [Jaye] Dr. Truong orders more blood tests, prescribes medication, physical therapy, and refers her to a cardiologist and neurologist.

- I always thought that I could take care of really sick patients and the patients I've taken care of, I thought were very sick.

I've never taken care of this level of illness.

I have never seen patients this sick.

I haven't had many moments where I panicked in the ICU as much as I did last year.

I've never had so many patients die on me.

(pensive music) - [Jaye] What Truong and healthcare workers and COVID patients across the country have come to discover is that the worst of COVID does not always go away.

They are just now figuring out how to treat it, to alleviate the suffering for people who cannot get their health or their lives back.

- We've been really frustrated in trying to treat it, because all their lab work looks okay.

All the testing have looked fine.

All the imaging is looking fine.

There's no blood count, nothing that we can point to that's causing it.

- [Jaye] PASC, Post-Acute Sequelae of SARS-CoV-2 infection, is the name the NIH gave to what most people call long COVID.

Some call themselves long haulers.

Millions of Americans never recovered from their COVID infections or they recovered and then relapsed, sometimes with new symptoms.

- Yes.

- [Jaye] Truong says brain fog and fatigue are two of the most common symptoms in his patients.

- Patients tell me a very similar story.

What they say is they have problems remembering words.

So words will escape them.

They will forget that the coffee maker is called a coffee maker, and they'll say that thing.

They will also lose track of information in the middle of sentences or conversation.

- [Jaye] Patients also report not being able to sleep or needing to sleep 12 to 14 hours, and that the smallest task or effort exhausts them.

- Horrible, horrible fatigue.

I could cook dinner, but clean up the kitchen, it's like, "No, that's not happening."

Get some coffee rolling.

- Pat Aaronson and her husband, Neil, got COVID in December of 2020.

- My husband started showing symptoms a few days after Christmas.

My symptoms started showing New Year's Day.

- Me, I'm feeling fine.

- [Jaye] After a few weeks, Pat's husband got better.

She did not.

Debilitating joint pain, fatigue, and brain fog remained.

- Everything just tingles and hurts and you know there's no relief.

And so the only relief you can think of is like, "Well, if I rip off my skin, rip off the nerve endings, then I won't hurt anymore."

It's just awful.

Okay.

I struggled this morning getting up.

- [Jaye] Aaronson waited six weeks to see Dr. Truong.

- I did get relief once I got vaccinated.

Every now and then I'll get the smell of burning cigarettes.

- [Jaye] Truong runs her through some cognitive testing.

- Over the next minute, can you give me as many words as you can, starting with the letter F?

Go.

- Fog, fall, fell, fail, fat, fun, jeez.

- I'm not going to promise that everything's going to be easy about any of this, because nothing has been easy over the last year and a half.

- [Jaye] Truong prescribes Pat, ADHD medication.

Some patients say it improves their brain fog and fatigue.

- It is difficult to talk to patients, to say, "I don't know what's going on and I don't know what we can do to help, but we're going to try these things."

Or, "I've taken care of X number of patients who've had similar stuff and this is what seems to have worked, so I'm going to try it on you, but I can't promise you that this is going to be the magic bullet."

- [Jaye] The CDC describes long COVID as a wide range of new, returning, or ongoing health problems people can experience four or more weeks after first being infected with COVID-19.

The CDC's website lists 18 of the more common symptoms, but there are many more that people report experiencing.

The challenge is to understand the aftereffects of COVID and what can be done to help those living with it.

The first goal is to prevent it.

- Vaccinations cut down the rate of long COVID by about 50%.

The drugs that he used- - [Jaye] Dr. Vikas Sukhatme has spent a good portion of his career in cancer research.

His wife, Vidula, has a background in epidemiology.

And together, they've been exploring how certain FDA approved, widely available and affordable drugs taken by millions of people for various conditions, might be helpful to cancer patients.

So they founded a non-profit to do clinical trials for drug repurposing.

- GlobalCures, by the way, I run from my dining table.

So it's a very homegrown entity.

And so we decided that we needed a bigger sandbox because we have so many things we want to do as part of this drug repurposing effort.

- [Jaye] For years, the Sukhatme's have worked to engage the medical establishment with repurposed drugs.

- Many of the drugs we're thinking about are now generic.

There is no patent protection.

And so there's no drug company that's really driving the need and desire to find out if any of these drugs do work for some of the new ideas that we'd like to investigate.

There's no financial sponsor, basically.

- [Jaye] So there's no money to be made?

- There's not money to be made, yes, absolutely.

There'll be a lot of mixing of ideas, I hope, and that should be the spirit of this meeting.

- [Jaye] Dr. Sukhatme is the Dean of Emory School of Medicine.

And when he and Vidula came to Emory from Harvard four years ago, they founded the Morningside Center for Innovative and Affordable Medicine focusing on repurposed drugs.

But that focus has also pivoted for now to COVID, drugs to treat acute COVID and long COVID.

Take fluvoxamine, a widely available inexpensive drug used to treat depression and obsessive compulsive disorder.

A recent study shows that in those who followed the protocol, when taken in the early stages of COVID, hospitalizations fell by 65% and deaths fell by 90%.

- We've written a recent review on this.

And there are properties where it may be directly antiviral, but also, probably most important property, is that it dampens the immune response in a way that we feel is helpful for the treatment of COVID patients.

- I can tell you right now, in my long COVID folder, that we have about 30 drugs that I have come up with, and I'm sure if you talk to other people, there may be other drugs that they could add to it that we could test for long COVID.

- [Jaye] To understand long COVID, you have to understand other conditions that look a lot like it, and not by coincidence.

- People think that long COVID is a new entity, but I would venture to say that it is actually a new incarnation of an old entity.

- [Jaye] Host viral syndromes have been around a long time.

The most common one is myalgic encephalomyelitis, also known as chronic fatigue syndrome, a long misunderstood condition whose symptoms of debilitating fatigue, disrupted sleep, brain fog, and a sense of being unwell after even the smallest physical or mental exertion, looks strikingly similar to long COVID.

Researchers are exploring the overlapping nature of these conditions.

There is some evidence that COVID-19 can also trigger another syndrome, POTS, postural orthostatic tachycardia syndrome.

- These are folks whose heart rate goes up dramatically when they sit up or stand up and can also feel dizzy and a whole bunch of other sort of symptoms.

- [Jaye] Many long COVID patients like Norma Perez are living with these symptoms.

(Norma speaking in foreign language) - [Jaye] Researchers believe COVID may also trigger mast cell activation syndrome.

Mast cells are blood cells that are part of your immune system and when an infection occurs, these cells send out chemicals like histamine or serotonin to other cells to alert them to the intruders.

But in mast cell activation syndrome, the cells go haywire and send out too much of the chemicals, which can cause chronic itching, rashes, headaches, pain, digestive issues, a fast heart rate, fatigue and fainting.

Once again, symptoms as long COVID.

- I'm gonna give you one medication called Asmanex.

- [Jaye] People like Dr. Truong are using this information to treat patients symptomatically, patching together treatment plans based on individual symptoms like ADHD medications, or antidepressants for the brain fog and fatigue or antihistamines and allergy medications for other patients to help their symptoms.

- The drugs I'm talking about are drugs like famotidine, which is taken for acid reflux by many people, cetirizine for allergies, beta blockers, and other high blood pressure medications.

All of these drugs are very well known, taken by millions of people for different diseases that are very common.

- There is no reason why, that physicians can not prescribe some of the things that we're talking about and that there be tools available to gather that data.

- [Jaye] The medical world lives by hard data and these repurposed drugs, FDA approved and largely safe, do not have that hard data for treating long COVID.

- The studies cost money.

That's one problem and it's a big problem, but it's not the only problem.

The other is there's competition for these sorts of trials, because pharma who is developing new drugs and we're all for developing new drugs, generally pays more to these physicians to do their trial.

And so one is money, one is finding the right physicians to get engaged and be supportive of these trials.

And the third is just having the patience.

That's how we got into this.

- [Jaye] The Sukhatme's talk about the need for real-world data.

- I know she's gone through several rounds of testing.

- [Jaye] Pat Aaronson is one of those real-world examples.

- Yet they were really, really diligent.

- [Jaye] We visited her at home one week after Dr. Truong put her on ADHD medication for her brain fog and fatigue and gabapentin for the pain and tingling.

- The meds, really, I'm shocked at how quickly they have helped.

'Cause I'm on the lowest dose of Ritalin and I'm on the lowest dose of gabapentin, but those have made a huge difference.

- My name is Dr. Karima Benameur, I'm a neurohospitalist.

- [Jaye] Dr. Benameur is a neurologist who practices in the hospital.

And during COVID she was seeing something in some patients she had never seen before.

- We noticed that a lot of patients who had COVID, who were in the ICUs, were very confused and a lot of them were very agitated, requiring massive doses of sedation.

It turned out that that agitation was actually part of a spectrum of what we know now as dysautonomia or autonomic dysfunction, and the agitation was one facet of it, at least in a subset of patients.

- [Jaye] The autonomic system regulates involuntary body functions, such as heartbeat, blood flow, breathing, and digestion.

Dysautonomia means a dysfunction of that system.

- I remember very clearly a nurse in the COVID unit.

She was walking by me and she said, "Here he goes again.

My patient gets pissed off every 40 minutes on the clock."

And this rhythmic cyclic thing is something that we see in dysautonomia.

So it perked me up right away and I said, "What do you mean every 40 minutes?"

And she said, "I don't know what it is, but every 40 minutes, his heart rate goes up.

He starts breathing really fast.

We can't control it with medications and he gets very agitated."

And that was what, it was a red flag for me that these patients are having dysautonomia.

- [Jaye] Dr. Benameur says the patient was having part of a dysautonomia syndrome called paroxysmal sympathetic storming.

She worked with neurologist and researcher, Dr. William Hu at Rutgers, doing MRIs and gathering spinal fluid from these patients.

- We started looking into any signs of brain dysfunction in the spinal fluid.

And we found that not only did we see signs of positive COVID serology, so antibodies in the spinal fluid, but we also saw very high levels of cytokines.

- [Jaye] These cytokines seen in the spinal fluid are a sign that there's inflammation going on in the brain.

Benameur and Hu published the first series on COVID encephalitis, inflammation of the brain.

In long COVID, the autonomic system is sometimes still malfunctioning.

- The autonomic dysfunction, the brain fog, all these symptoms that we are seeing in long COVID are neurologic.

- [Receptionist] Thank you for calling Emory Healthcare.

- [Jaye] Dr. Benameur says the high number of long COVID patients with anxiety and depression is also neurologic, part of the disease process.

- Deep breath in and out.

- [Jaye] Truong says 40 to 50% of his patients have some level of anxiety and depression.

- So I think that COVID is probably doing something to the brain or the brain activity in the acute phase.

And now when you look at these post-COVID folks, you can also see that there is a weird hyperactivation, if you want to believe it, in terms of the brain fog activity, and then this whole anxiety and depression issue that's happening to these patients.

- [Jaye] A study by Oxford researchers found that a third of people who got COVID, wound up with long COVID.

Anxiety and depression being the most common symptom reported.

- I loved the fast pace.

I loved seeing 100 different complaints in the same day.

I love being there at people's hardest moment and being able to help them through it.

- [Jaye] 41-year-old Dr. Jeff Siegelman is an ER doctor at Grady Hospital in downtown Atlanta.

He was on the front lines of the pandemic from day one.

(Jeff sighs) - It was just, it seemed to be just like a plague, like running through the city.

- [Jaye] In August of 2020, he got COVID.

- And when I did get sick, I never thought that it would become this.

- [Jaye] But Jeff did more time than he or his family ever imagined.

- 40 days.

So I had fevers for 40 days and the CDC guidance was you had to be 10 days after the first symptom, plus 24 hours fever free, and I couldn't make it to being 24 hours.

Melissa and the kids would leave my food and the groceries on the landing there.

- [Jaye] He isolated in his basement for 40 days, unable to be with his wife, Melissa, and their children, Emma and Ari.

He would talk to them on the phone.

- So this is how we communicated each day.

- [Jaye] Or through the banisters.

The fevers finally subsided, replaced with long COVID.

- So I wake up feeling well many mornings and just as it has for this whole 14 months, it sort of gets worse during the day, depending on what I've done.

The more I exert myself physically or cognitively, meaning watching Zoom, having phone calls, the more I get brain fog, the more I get dizziness.

Headaches and palpitations can come if I've really done way too much.

I still can't taste a glass of wine.

That's reason enough to get vaccinated.

- [Jaye] After being out of work for five months, he is back at Grady.

- Since January, I've been able to work four hours of shift, when normally my shift would be eight hours.

- [Jaye] Jeff says he's benefiting from repurposed drugs to treat his long COVID.

- For me, one of the things that my cardiologist actually recommended was taking antihistamine, so I'm on Allegra and Pepcid and that really was what tipped me over the edge to be able to go back to work part-time.

It helped lessen the fatigue and lessen the fog to a level that I could function.

- [Jaye] He also uses deep breath training to help him manage symptoms.

- [Jeff] Four in, four holds, four out and four hold.

- [Jaye] In the middle of our interview, Jeff asked to take a break.

- I may just take a second to breathe now if that's okay.

- [Jaye] Yeah, do it.

Do whatever you gotta do.

Was that just helpful to you?

- Yep.

- What did it just do?

- I don't know if you notice, I was starting to develop a tremor.

I still have it a little bit.

And that's part of when I get really, when I've exerted to myself.

When I've exerted myself, I start getting a tremor and the fog starts setting in, and so the deep breathing will help reset that a little bit.

- [Jaye] To be a physician who treated the worst of COVID, then to become the patient with long COVID, has been eyeopening.

- It's common for those people to be sort of shooed out of the doctor's office and told that they're fine, but they're not fine.

And I regret that it's taken this for me to realize that.

- [Jaye] Jeff is still caring for patients, most of them now unvaccinated.

- A lot of people say, "It's just a flu.

It's gonna be fine.

I'll get it and I'll move on."

And that's what I thought last August.

Here I am 14 months later with my life completely upended.

The only way we know to not get long COVID is to not get COVID, and the only way we know to not get COVID is to get a vaccine.

- Brandon it's good to see you.

- Same.

- [Jaye] 34-year-old, Brandon Bryant is a Court TV photographer.

- [Brandon] But right now I'm in Brunswick, Georgia.

I'm getting ready to cover the Ahmaud Arbery murder trial here.

- [Jaye] Bryant was not vaccinated when he got COVID in June of 2021.

He was vaccine hesitant at first, but was planning to get vaccinated after a work trip.

He got COVID on the trip.

- I almost died.

- [Jaye] In a suburban Atlanta hospital, he says doctors told him it didn't look good.

- The doctor told my mom and I right there that not only did I have COVID really bad, but I had pneumonia really bad.

My right kidney was failing and I had multiple blood clots at the same time.

- [Jaye] Brandon, who had no underlying conditions, tweeted from his hospital bed and says many friends and strangers told him they got vaccinated after they saw his story.

Brandon went from 190 to 111 pounds, but he survived, and credits his medical team and the prayers of his family.

- I'm going to get checkups.

- [Jaye] Bryant was off work for three months and is still on blood thinners and living with long COVID symptoms.

- Somebody tells me like something five minutes from now, and I forget it, it's almost kind of like a fog where I kind of catch myself zoning out a little bit and then coming back to.

- [Jaye] Brandon has not received treatment for his long COVID symptoms, but as soon as his doctors cleared him, he got vaccinated.

The vaccines protect against COVID and long COVID.

Molnupiravir, the drug developed at Emory, reduces hospitalizations and deaths.

The hope is that drugs could be created for long COVID.

- There may not be one pill for all of the folks who have long COVID, there may be five pills, each one based upon the different biology of the disease and which one is most active in that particular patient.

- [Jaye] There aren't enough clinics to treat people with long COVID, and most are near academic centers.

The goal is to educate family physicians so they can begin to treat a condition that for some, may have lifelong effects.

Part of that education will be to encourage the immediate use of existing drugs, tailored to the symptoms a patient has.

Government agencies, such as the NIH and the FDA are beginning to support such efforts, along with providing tools to keep track of the results.

The National Institutes of Health has dedicated over a billion dollars to fund research into long COVID and could involve tens of thousands of patients.

Many of the more than 11 million people living with long COVID have begun their own movement.

Grassroots organizations, such as Body Politic, Survivor Corps and Long COVID Alliance, serving as patient-led organizations dedicated to supporting, educating, and partnering in research.

The epidemic has taken a toll on healthcare workers.

Many are burned out and some have left the profession.

Those who remain, like Dr. Truong, are pioneers by necessity, learning on the job.

- I think it's maybe grateful for the training I've had.

I'm grateful for the physicians who have put me through the wringer and have pushed me and have challenged me, because I think that that's really helped.

Sorry.

It's really helped when things were hitting the fan and chaos was just coming down on us.

I think those of us who've gone into it, do it because we wanna help people, we wanted to be that person that runs in when everybody runs away.

And I felt like we did that in this pandemic.

When everybody was scared and worried about being infected, we were gowning up and going in.

The worst you've gone through, you've already gone through.

- [Jaye] Not to be lost in all of this is the need for hope that life won't always be this way.

- You're gonna be okay.

- Gracias, thank you.

- [Alex] You're okay.

- Gracias.

- And my hope really is that I can just return to working a full-time job, not relying on disability payments, and being the dad and husband that I wanna be.

My son who's seven will say, "You know, Dad, if you get better from long COVID, I'd like to do XYZ," and it really pulls at you.

(dramatic music) - [Jaye] We are in the aftermath of a viral hurricane, still picking up the pieces, but making progress with each study, each new discovery.

- [Karima] Science is always evolving and improving and we did not know how to treat COVID when it started and now we're pretty good at it, so I don't lose hope.

(pensive music) - Hope is in that billion dollar investment from the federal government.

We will continue to follow advances made in long COVID.

(machine beeping) Switching gears now to a story where we had the unique opportunity to literally take you behind the curtain.

Have you ever heard someone say, "Well, at least it's not brain surgery"?

Well, what about when it is brain surgery?

What about the people who perform those surgeries, the neurosurgeons, what does it take to do their jobs?

We decided to find out and spent some long days and nights with a brand new crop of brain surgeons in the making.

(dramatic music) There is something comforting about routine, about familiar tasks done the same way in the same order each day.

These home routines are pretty much all that will remain as four people from different corners of the country, with different upbringings and opportunities and struggles are about to spend the next seven years working toward a goal attained by very few people.

- I wish I could've just said, "Relax, you're not the first person who's done this."

- [Jaye] There are fewer than 3,700 neurosurgeons in the United States.

That's one for every 61,000 people.

Neurosurgery is one of the most prestigious, difficult and stressful specialties in all of medicine.

(tool buzzing) - I think anyone who's not intimidated is weird or strange.

- [Jaye] It also has the longest program to train residents to become neurosurgeons, seven years.

- I don't know, seven years is a long time.

- Today is the birthday of- - [Jaye] These four, Hunter Futch, Kwanza Warren Vivek Sudhakar and Megan Cosgrave are overachievers.

They have already completed college and med school, and now they have defied steep odds, as there are far more applicants than positions and have been chosen to be the next class of residents at Emory University School of Medicine.

- Trust your elders and listen to their advice.

- [Jaye] They will work 80-hour weeks with one day off.

- I think it really tests your limits and lets you know like, "Where are my breaking points?"

And that's an important thing to know.

- You can also see- - I would never do that.

- There are a lot of things to consider.

- [Jaye] They will learn from everyone around them because teaching and learning and making mistakes is done on the clock at an academic institution.

- Try your best not to complain, because everyone who is in your shoes or ahead of you has gone through exactly what you're experiencing, and they know that it's hard.

- This new chapter of their lives will often begin and end in darkness, the brightest lights, those of the hospital, or the OR.

In the days before they officially begin, at the home of the chairman of neurosurgery, Dr. Daniel Barrow.

- I wanna welcome everybody here.

- [Jaye] They get a glimpse of what it looks like to reach the seven-year summit.

- After graduation, she initially followed in her mother's footsteps.

- [Jaye] Four are graduating, now full-fledged neurosurgeons.

- I do have some people I want to thank.

- In front of mentors who helped them learn the scientific and the technical and the artistic parts of their craft, they harken back to the beginning.

- We need to reframe that.

- [Jaye] While the new quartet in the crowd hangs on every word.

- I remember coming to this as an intern, just kind of like starry-eyed and not really sure what to expect.

- [Jaye] Even for the head of neurosurgery, almost 40 years into his chosen vocation, gratitude remains for his mentor.

- I wanna welcome a very special guest.

- [Jaye] The retired first chairman of the Department of Neurosurgery, Dr. George Tindall, now 93 years old.

- I owe everything that I've ever achieved in my career, whatever that might be, to George Tindall.

And so George, thank you for being here with us.

- I realized that that was considerable potential in him.

- [Jaye] 60 years ago, when Dr. Tindall was a new neurosurgeon, the field itself was still new and good outcomes were often hard to come by.

- I asked him one day, I said, "Whatever possessed you to go into the field of neurosurgery back in that era, when there was so little that you could do for patients?"

And he responded immediately and said, "Because we knew it had to get better."

(crowd clapping) - [Jaye] The neurosurgeons and the new residents at this party, are tasked with continuing that pursuit of better, pioneered by the George Tindalls of the neurosurgery world.

- I miss the process.

- [Daniel] I don't care if the patient owns the bridge, if they built the bridge, or if they live under the bridge, we treat them all with exactly the same respect.

- [Jaye] Orientation.

- What are some of our rules and responsibilities?

- [Jaye] There are hours of presentations.

(attendees clapping) - [Jaye] Introductions.

- Going to be your best friends and your worst enemies.

- [Jaye] Instructions.

- Some of these patients are in like, he said it, they're scared, they don't know what's going on.

They'll nod there head like, "Yes, yes," but they don't really know.

- [Jaye] A reminder it's okay not to know.

- Don't feel like you have to have the answers, because you're not gonna have the answers.

- Slide your glasses off for me.

- [Jaye] The four are fit with their surgical loupes, which provide magnification during brain surgery.

- Every neurosurgeon, pretty much on the planet, has a pair of these.

This frame's gonna last year your career.

Perfect.

- Oh, wow.

- Do you like black, do you like red?

Look right here, I'm gonna rest this on the bridge of your nose.

- [Jaye] And then an unexpected surprise.

- [Vivek] Oh, awesome.

- [Jaye] The delivery of their white coats.

- Oh, my gosh, I'm so excited.

- [Jaye] These four won't be together for a while.

Each will rotate, beginning to compile a necessarily massive amount of knowledge and experience.

- Welcome to Emory.

It's going to be a fast seven years.

(knocking on door) - [Tracy] You can come in.

- Hello, hello?

- For new trainees, every encounter is a learning experience, right?

Every little thing, just how I relate to the patient.

You know, what we're gonna do is pretty straight forward.

- While we're here, I do want you to introduce to Hunter.

- [Jaye] Hunter is with neurosurgeon, Dr. Edjah Nduom.

- I'm a neurosurgical oncologist, so I operate on brain tumors.

- [Jaye] Dr. Nduom is removing a benign tumor from the brain of Tracy Anderson, a school teacher.

- [Edjah] See the midline, there was a golf ball-sized lesion sitting right at the junction between the frontal lobe and the temporal lobe, which could become a problem.

Oh, I expect we'll detach it from the top, peel it off, get it out of there, put the bone back in place.

(machine beeping) - [Jaye] A tumor is why Hunter Futch decided he wanted to become a neurosurgeon.

- When I was in middle school, I started having seizures.

And so I had epilepsy for a couple of years.

And then when I was 16, they figured out that I had a brain tumor.

And so I had a medial right temporal lobectomy, which took out the brain tumor and the part of my brain that was causing me to have epilepsy, and for me, that was just a one day surgical cure.

And so after that I was like, "Yeah," I woke up and I was like, "Yeah, I'm gonna do that."

(tool whizzing) - I wanna say two hands in it, yeah, one hand is stabilizing here.

- One hand here?

- [Hunter] Yeah.

- And it's graduate responsibility.

You have to show me that you can safely cut the skin before you can drill a piece of bone.

You have to show me you can drill a piece of bone before you can cut open the coverings of the brain.

You have to show me that you can do that safely before you're going to get anywhere near a lesion in a patient's head.

- [Bryan] There's the brain, there's the tumor.

- [Jaye] The chief resident, Dr. Bryan Buster, in his seventh year of residency, along with other residents, assist in the OR.

- [Bryan] Okay, to evaluate the play, you're gonna get to bone and you're not gonna outrun the end of our fingers here, okay?

- I mean, this is something that I literally have been thinking about for the last 10 years.

Since I was 16 years old, I have been like just working towards this moment.

And that moment was, what?

It was like three days ago.

And Dr. Gutierrez was like, "All right, here's the scalpel."

And for me, that was kind of a big moment.

(gentle music) Sorry, you got to give me a second.

I'll be honest, like I am like over the moon about it.

- My mom always said, "Megan, stay in school, go to college."

Both my parents didn't go to college, so I'm a first generation college grad.

And it's so funny because I always say that I took my mom's advice so seriously that I went to school from the age of three to 31.

There was a lot of things that I considered, the work-life balance, what it's like to be a woman in neurosurgery, 'cause there's not many of us, and whether or not I really wanted to go through with it.

Every day I wake up and have to go to work.

This past week and every day that I've ever had to go in to do neurosurgery in my rotations in medical school, they've been like the happiest days of my life.

- [Jaye] Megan's 12-hour ICU shift begins at 7:00 am with updates on how the patients did overnight.

- [Megan] In the late evening, her ICP shot up and she started putting out bright red blood from her EVD.

- She is like one out of five in her right upper.

(students chattering) - The neuro ICU is a place where people with severe brain, spinal cord, nervous system issues come to get cared for.

And you're trying to help people through the worst nightmare of their life and their families, in a humane, effective, hopefully be able to offer a cure.

- Let me ask Mony when she wants to round.

- [Jaye] Neurologist, Dr. Owen Samuels, is the director of the Neuroscience Critical Care program at Emory.

- You need to dissolve some of these clots.

How much?

- I'm not sure.

- Right, she put in probably a milligram, every eight to 12 hours.

For the first several years, you just get your butt kicked.

You're working all the time.

You are on such a steep learning curve that every time you know something, you realize that there's a lot more to know.

You want to just go in there for a minute.

- [Jaye] Dr. Samuels has trained scores of residents and is fluent in all that can go wrong and right with the brain.

- We're just devastated that he died.

- [Jaye] Part of how this neurologist wound up spending his career in an ICU for brain issues is personal.

- So my dad died, sorry, at Yale New Haven Hospital.

And I was shut out and, sorry.

And I'd like to say now, that I swore that if I had anything to do with it, I would never let it happen again to someone else.

But that stuck with me.

And I remember as a resident in neurology, just sitting outside his room, just waiting for the doctors to come by and being totally helpless and out of the loop and peripheral to his entire care.

Good morning.

- [Jaye] With the help of Georgia Tech environmental technology and architects, he redesigned the ICU so families could stay together.

- I didn't know then that there was a sea of evidence that the design of the ICU would not only help families and patients have a better experience and do better, but also the nurses and the doctors would make less mistakes and patients would need less pain medicine if you provided light.

And if you lowered the sound burden, nursing would have, they would stick around longer.

There would be less attrition.

There would be less on the job problems.

What do we need before you stick a drill hole in the head and pass a catheter.

- [Jaye] Megan is going to perform an emergency bedside procedure for a patient with a brain hemorrhage.

- And it is terrifying drilling a hole in somebody's head.

- Yeah.

- Megan was doing what all young new neurosurgeons do is assessing a patient, understanding what's going on.

In this case, it was a brain hemorrhage.

The hemorrhage essentially bled into the fluid-filled cavities of the brain, obstructing their normal flow.

And if you obstruct the normal flow, then your pressure in your head will go up and you can die.

- There is hyperdensity showing, which is usually indicative of a new bleed.

- Just use your words carefully.

Someone's going to jump all of you if you say fresh blood, and they're gonna spend 45 minutes questioning you on what the heck you mean by fresh blood.

- With everyone else.

It's sorta like bootcamp, you have to get broken down a little bit and built back up.

Let's go up on it, yeah.

- [Jaye] Drew Albers, a third year resident, has been working with Megan.

- I vividly remember them.

And I was about as terrified as you are.

But you're doing awesome.

- You want to be dead on to bone.

- [Jaye] Dr. Samuel's joins Drew and Megan, as she puts in an external ventricular drain to relieve pressure in the patient's brain.

- Okay.

(sighs) (machine beeping) (shaver whirring) - [Jaye] After shaving a patch of hair and sterilizing the skin and making an incision, she drills the hole in the patient's skull.

(machine beeping) - [Megan] All right, ready?

- [Owen] Most importantly, remember get perpendicular.

You're gonna keep on drilling forward like this.

- Uh-huh.

- Right.

You're never gonna, when you get stuck, you're not gonna- - [Megan] Oh yeah, yeah, of course.

- [Owen] And why aren't you gonna do that?

'Cause the drill bit will leave the drill and stick in the skull.

(intense music) - [Jaye] Through the hole she has drilled, she places a catheter, which is like a flexible straw.

She guides the catheter into the fluid-filled cavities in the middle of the brain.

- [Drew] But for now, just take your time.

Slide it up under- - [Owen] You stop right around five.

- [Drew] Yep, stop.

Stop, put in the stylet.

- [Megan] Stylet is in.

- [Drew] Good.

- [Owen] Now, put the stylet down.

- [Drew] Yep.

- [Megan] Okay.

- Ooh, there you go.

- There you go.

All right, soft pass a little bit more for me.

- Virtual high five.

(Drew laughs) - [Megan] Okay.

- [Nurse] It's done.

All over.

- [Megan] Thanks.

Bye, guys.

- See ya.

- [Jaye] It's an early victory, which is not the way it will always be over the next seven years.

- [Megan] I'm really excited.

- Intense, stressful.

- Hopefully the next 100 go just as smoothly.

(laughs) I'm like sweating a little bit though.

(laughing) I need a shower I think.

It takes a lot of muscle to, at least, maybe I need to go to the gym more, I don't know.

But I didn't cross, right?

- [Drew] Didn't cross, there's your framing.

- [Jaye] The procedure worked.

- That's where you wanna be.

- Okay.

- It's draining well.

She's getting benefit from it.

- [Megan] So I'm really excited.

(laughs) This is the best day for me.

- [Nurse] Awesome.

Awesome.

- [Matt] I mean, he's got severe lower extremity weakness.

- [Jaye] When most people think of neurosurgery, they think brain surgery, but a big part of the job is this.

- [Matt] Hey there, how you doing?

- [Jaye] Seeing patients, assessing and advising people who are in pain, scared, and would rather not be seeing a neurosurgeon.

- Through the years has just been injury after injury.

- [Jaye] Vivek is seeing patients in clinic with neurosurgeon, Dr. Matt Gary, who specializes in spinal surgeries.

- There's only so many patients that I can help by touching them, right?

But there's so many more patients I can help by teaching the next generation of neurosurgeons.

- His history is significant- - [Jaye] Hunter is with Dr. Barrow.

- [Daniel] Alrighty, so where are his images?

(knocking on door) - [Jaye] Vivek and Hunter have daunting tasks, to glean all pertinent and important information from the patient and to fully relay it to doctors, Gary and Barrow.

- And then just follow my finger with your eyes.

Going to be a bright light, okay?

- [Jaye] Vivek debriefs Dr. Gary on a veterinarian living with chronic pain.

- [Vivek] This is a 3/6 inch X-ray.

You can see that he does have scoliosis.

- And does it radiate down his legs or it's only in the back?

- I forgot to ask that.

- Okay.

- I'm sorry.

- It'd be foolish to try and pretend that it's not gonna be difficult, that there aren't going to be struggles, that there aren't gonna be times where I'm gonna get frustrated or upset, but you really got to keep your eyes on the bigger picture, that even though today, maybe it was a bad day or today, things didn't go exactly how you want.

You really have to look at the big picture, look at what the training program is turning you into.

Look at at the end of all of this, I'm gonna be someone who is a neurosurgeon.

I'm able to help people with these neurologic diseases get better.

- [Jaye] Vivek knew before he graduated high school in San Francisco, that he wanted to become a neurosurgeon.

- So for him it's going to be scoliosis.

- Okay.

You know, like a week ago, I didn't know how to put in orders or even like work the EMR.

But now I like to think I'm really like somewhat capable of doing that.

Okay.

So it's all about the smaller victories.

I was the only resident in the OR, and they were looking to me like, what antibiotics do you want for this patient?

I was looking over my shoulder like, "Oh, you're asking me."

- You've been on treatment the whole time but- - [Jaye] Hunter sees Dr. Barrow's patients in a clinic, a few miles away from Vivek.

- Now, it was a completely homonymous right sided hemianopsia, and now on my exam, it's really just the right quadrant, right lower- - [Jaye] There are things they get right.

- Right, which you would expect.

- [Jaye] And things they will remember to do the next time.

- Kind of your diagnoses here.

- [Jaye] Part of learning is also watching these experts care for patients.

- I definitely want to take a look at some CAT scans to see what the bony anatomy looks like.

- This is probably nothing, but even if it is a small aneurysm, it's in a very, very safe place.

I am glad we have good news for you.

The artistic side is recognizing that we're treating human beings.

And that's the side of medicine that involves the clinical decision-making, which requires experience and requires knowledge and putting that all together to treat human beings as individuals, to be compassionate about their conditions, to be humble about what you're capable of doing and to be able to guide them through something that quite frankly is very, very frightening for them.

- But I really resisted it from a very early age.

- [Jaye] Emily Barrow will tell you she didn't want to become a neurosurgeon like her father or an oral surgeon like her mother.

- I saw the late nights.

I saw them working all the time, being on call 24/7.

They had to sacrifice time with their family, because the patient always came first.

- [Jaye] The American Medical Association Journal of Ethics says one in five medical students has a parent who was a physician, 20%.

- [Daniel] Non-functional tumor or?

- Yeah.

It was a non-functional tumor.

- [Jaye] Emily joined that club, despite resisting it as she grew up.

- I'm a rhinologist and an anterior skull base surgeon.

- Interestingly, she works with my colleagues and I.

The neurosurgery and otolaryngology work together collaboratively on a lot of conditions.

- [Emily] Eventually went to med school and I'm so happy that I did, because now I love it.

I mean, now it's everything.

- This morning, I'm going to be helping Dr. Hoang with a tumor resection.

- [Jaye] Kwanza Warren did her first year of residency at Columbia University, so unlike the other three, she has six, not seven years left to go.

She's working with the sole female neurosurgeon at Emory, Dr. Kimberly Hoang.

- I focus in primarily brain tumors and intra axial brain tumors.

Clinically, I really like minimally invasive techniques.

I do awake brain surgery.

(gentle music) I had a personal connection.

My mom got breast cancer when I was in high school and just trying to figure out what I wanted to do.

I knew I was probably going to be a surgeon because I liked to build things, right?

And to use my hands and to fix things in a very concrete way.

- [Jaye] We heard that over and over from neurosurgeons, that they like to build things, that they're good with their hands, which is also why they love to operate.

- That is my thing I love most, and that is purely based on adrenaline.

I can be in the operating room for five, six hours and it flies by in 10 minutes.

We're doing a craniotomy to remove a benign brain tumor, called a meningioma.

- [Surgeon] Like at least two like centimeters, at least with your incision behind the interior, because it's going to be one centimeter for the bone.

- [Jaye] Over the course of half a day, the team successfully removes the tumor.

- [Kimberly] So when it bleeds, to help them see the source of the bleeding, you squirt some water on there without splashing in their face.

- [Kwanza] And just stay on the pedal while I'm doing it?

- [Surgeon] Uh-huh.

- [Jaye] Kwanza is tasked with cleaning and attaching hardware to the piece of skull that will be put back on at the end of surgery.

- That is not tumor, right?

That's just brain.

Training is very hard, it's long hours.

And I think it may have been just a little intimidating when everybody else was sort of a male in the field, if you were trying to be that first female.

Surgery went well, as expected.

And it is like a particular goal of mine to make sure that there's increased representation of women.

- [Jaye] According to The American Board of Neurological Surgery, there are 219 female neurosurgeons in the country.

They make up 5% of practicing neurosurgeons.

- It's been well-documented.

Sometimes we have imposter syndrome, a little bit more than males do or less confidence.

And so I'm very aware of that.

I mean, I feel it myself.

So I have to make sure my trainees don't feel it, right?

- [Jaye] When we were at home with Kwanza, she volunteered this.

- There's a lot of imposter syndrome, I guess, (laughs) that I have.

I still feel like I'm talking about somebody else.

- [Jaye] Of those 219 female neurosurgeons nationwide, only 33 are African American female neurosurgeons, .6%.

- [Surgeon] You can find- - [Jaye] Kwanza is the first African American female neurosurgery resident ever at Emory.

- One of the reasons I went into medicine is because I have always been interested in a career in service.

Both of my parents were in the military.

(gentle music) - [Jaye] Kwanza's mother was one of 12 children, who grew up in rural Alabama sharecropping.

- She tells me some horror stories, for sure.

They did not treat them well from what I understand.

And they didn't have a lot.

- [Jaye] Her father was homeless at times, raised by a single mom in New Jersey.

- [Kwanza] He basically joined the army so that he wouldn't starve, 'cause his mom kicked him out the day he graduated high school.

(gentle music) I think my mom, she was teaching me to multiply before I started school.

And she was like, "You will do well."

And I was like on the honor roll since kindergarten, because of her.

(gentle music) - [Jaye] Do you feel pressure for all African American women, that you're forging this path?

Do you feel like you're carrying that weight to a degree?

- Absolutely.

(gentle music) - [Jaye] Kwanza feels that anything people think of her, they will think of all African American women and that it's not like that for the other residents.

- You can just be yourself and people will look at you and say, "You have this personality trait, and that's just who you are, and that's fine."

But I sort of feel like I can't have my own personality.

I have to have the right personality so that you think as highly of me as you can so I don't ruin anything for anybody else.

- [Jaye] It's something most people cannot understand because they have never had to.

Kwanza has a lot of support at Emory.

She also has someone who has been there.

- [Edjah] See that enhancement?

- [Jaye] Dr. Nduom shared a story of a high level class he did not drop at Stanford because he was the only black student in it.

- There was no way I could give anybody the impression that the black kid couldn't hack it in the honors physics class.

So I stuck it out because I knew that I had to represent and I would finish my exam and I'd finish it quickly and I'd finished it confidently, and I needed everybody to see that.

- [Kimberly] Kwanza.

- [Edjah] Kwanza's gonna do amazing here.

It's not because of me, but I'll certainly help.

- [Jaye] Most of all, for the parents who fought and struggled to give their daughter a life they never had, Kwanza's success is also for them.

- I feel like they deserve to have a neurosurgeon as a daughter because they worked so hard, way harder than I'll ever work.

So I mean, yeah.

(gentle music) - [Jaye] The hard truth is you won't save everyone, no matter how hard you try.

- Early in my career, there were occasional times when I would just go home and cry.

And those patients would walk across the foot of my bed at night, and it was difficult.

(gentle music) - [Jaye] But the ones you save, change your life too.

- When you've seen people a year later, come back to the ICU and say, "My daughter or my son, my mother and my father told me that you guys saved my life."

I mean, that's everything, right?

I mean, it's a reason to live.

It's not a job anymore.

It's a mission.

- [Jaye] And in between death and life is the rest of life.

- Now you're colleagues with them, you're working across the table.

You're doing a case together.

You both have ownership at that end.

- [Jaye] Where residents unwind, but still talk shop.

- What did you guy's think of it?

- [Jaye] Where new residents do more listening than speaking.

- You can't take too long- - And where Thursday mornings at 6:30 am, it's school again.

- Okay, so we closed the layer of nervous systems, as you- - [Jaye] The whole department gathers for grand rounds, two hours a week for education.

- In medicine, education's a lifelong commitment.

- [Jaye] These four are at the beginning, part of a group for whom it will never end for it's their purpose.

How mysteries of the brain are slowly revealed.

Each new thing learned, could improve or save a life.

- [Doctor] Welcome to the journey.

- [Jaye] And that is worth everything.

- [Doctor] Welcome to neurosurgery.

- And that's gonna do it for us.

See you next time on "Your Fantastic Mind."

(dramatic music) - [Announcer] "Your Fantastic Mind," brought to you in part by Sarah and Jim Kennedy.