How Surgeons Balance Hope with Honesty

Summary

Chasing Life: How Surgeons Balance Hope with Honesty

Episode Overview

In the July 4, 2025 episode of Chasing Life, CNN’s Chief Medical Correspondent, Dr. Sanjay Gupta, delves into the intricate balance surgeons must maintain between hope and honesty. Featuring a profound conversation with Dr. David Sandberg, a retired pediatric neurosurgeon and author of Brain and the Triumphs and Struggles of a Pediatric Neurosurgeon, the episode explores the emotional and ethical challenges faced by medical professionals in high-stakes situations.

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Personal Reflections and Introduction

Dr. Sanjay Gupta opens the episode with a deeply personal story from his early days as a surgical intern. On Christmas Eve 1993 in Ann Arbor, Michigan, Gupta recounts a failed thoracentesis procedure that resulted in the death of an elderly patient. Reflecting on this experience, he shares, “I believe that that reminder makes me a better physician” (00:01). This story sets the stage for the episode's exploration of the emotional burdens carried by surgeons.

Gupta introduces Dr. David Sandberg, highlighting his new memoir, which provides a glimpse into the life of a pediatric neurosurgeon. He poses critical questions: How do surgeons make life-and-death decisions? How do they navigate hope amidst the harsh realities of their profession?

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Garrett’s Story: A Case Study in Decision-Making

Dr. Sandberg shares a pivotal case from his career involving a 15-year-old boy named Garrett. Garrett suffered a severe head injury after an ATV accident while not wearing a helmet. Dr. Sandberg explains the initial grim prognosis: “His pupils were large and unreactive, a terrible sign” (05:15). Despite the bleak outlook, slight neurological signs led him to opt for surgery, ultimately saving Garrett’s life without lasting neurological deficits.

Reflecting on this decision, Sandberg admits the emotional toll it took: “His case haunts me, and I wonder, I can't think of examples, but have I made mistakes like that, that I could have saved a life and didn't?” (06:55). This introspection underscores the perpetual uncertainty and the heavy responsibility surgeons bear in their decision-making processes.

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Balancing Hope and Honesty

The core of the conversation revolves around the delicate balance between maintaining hope and delivering honest assessments to families. Dr. Sandberg emphasizes the necessity of transparency, stating, “You gotta have the honest conversation and convey the uncertainty” (08:46). He illustrates how, in gray areas where outcomes are uncertain, physicians must communicate the potential risks and benefits without swaying towards false optimism or undue pessimism.

Dr. Gupta adds depth to this discussion by highlighting the intrinsic value of hope, suggesting that it may even contribute to better patient outcomes: “I think there's something there” (10:14). Together, they explore how hope can coexist with honesty, providing families with the strength to face difficult medical decisions while being fully informed of the possible outcomes.

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The Role of Morbidity and Mortality Conferences

A significant portion of the episode is dedicated to the concept of Morbidity and Mortality (M&M) conferences. Dr. Sandberg explains their importance in medical training and continuous improvement: “It's very hard. Imagine yourself, you have the worst day of your life, and then that worst day of your life is presented with a room of 50 to 100 people” (23:15). These conferences serve as critical learning opportunities, allowing surgeons to analyze adverse outcomes openly and constructively.

Dr. Gupta shares his own early experience presenting a surgical complication, highlighting how mentorship in these settings can provide solace and guidance: “He had thrown me a lifeline in many ways” (26:42). This mutual support system is essential in helping medical professionals cope with the emotional fallout of surgical errors or complications.

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Prevention and Societal Responsibility

Transitioning from personal and professional experiences, the conversation shifts to the broader topic of prevention. Dr. Sandberg passionately advocates for societal measures to protect children, such as helmet use, gun safety, and regulations in contact sports. “We should be doing more and we're not doing enough” (19:15), he asserts, underscoring the preventable nature of many traumatic injuries he encounters in his practice.

Dr. Gupta echoes this sentiment, expressing frustration over preventable accidents and advocating for proactive measures to safeguard children’s health and lives. This segment highlights the intersection of medical practice with public health and policy, emphasizing the role of physicians in advocating for safer environments.

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Coping with Surgical Outcomes

Addressing the personal struggles surgeons face when outcomes do not meet expectations, Dr. Sandberg discusses the emotional burden of patients experiencing worsened conditions post-surgery. He shares, “I've lost a lot of sleep on nights that follow when a patient wakes up worse after surgery” (21:15), revealing the profound psychological impact of surgical complications.

He advocates for a balanced approach: acknowledging mistakes without internalizing undue blame, and continuously seeking improvement through reflective practices and peer discussions. This honest portrayal sheds light on the human side of medicine, demonstrating that even highly skilled professionals grapple with self-doubt and guilt.

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Hope in the Face of Incurable Diseases

The dialogue culminates with a discussion on hope amidst daunting medical challenges, particularly in cases of incurable diseases like diffuse midline glioma. Dr. Sandberg contemplates the role of hope when outcomes are bleak: “Is hope useful in that circumstance? I don’t know” (28:36). He recognizes the delicate balance between fostering hope and maintaining realistic expectations, especially when clinical trials offer limited prospects.

Dr. Gupta adds a critical perspective on maintaining integrity in hope, cautioning against the exploitation of vulnerable families by dubious treatments. He emphasizes the physician's role in guiding families through these emotional landscapes with empathy and honesty.

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Conclusion and Reflections

As the episode draws to a close, Dr. Sandberg reflects on the significance of his memoir’s title, encapsulating both the triumphs and struggles inherent in pediatric neurosurgery. “There are situations that make us question ourselves, even the most confident among us” (31:15), he muses, highlighting the profound emotional and ethical dimensions of surgical practice.

Dr. Gupta commends Dr. Sandberg’s contributions and the candid portrayal of a surgeon’s life, reinforcing the episode’s central theme: the essential interplay between hope and honesty in the pursuit of preserving life while acknowledging its fragility.

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Notable Quotes:

• Dr. Sanjay Gupta [00:01]: “I believe that that reminder makes me a better physician.”

• Dr. David Sandberg [05:15]: “His case haunts me, and I wonder, I can't think of examples, but have I made mistakes like that, that I could have saved a life and didn't?”

• Dr. David Sandberg [08:46]: “You gotta have the honest conversation and convey the uncertainty.”

• Dr. Sanjay Gupta [10:14]: “I think there's something there.”

• Dr. David Sandberg [19:15]: “We should be doing more and we're not doing enough.”

• Dr. David Sandberg [21:15]: “I've lost a lot of sleep on nights that follow when a patient wakes up worse after surgery.”

• Dr. David Sandberg [28:36]: “Is hope useful in that circumstance? I don’t know.”

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This episode of Chasing Life offers a compelling exploration of the ethical and emotional complexities faced by surgeons. Through heartfelt storytelling and insightful dialogue, Dr. Sanjay Gupta and Dr. David Sandberg illuminate the human side of medicine, emphasizing the vital balance between maintaining hope and delivering honest, compassionate care.

Transcript

[Dr. Sanjay Gupta]

Welcome to chasing life Today. I like to start with a quick story, a very personal one for me. It was Christmas Eve, 1993 in Ann Arbor, Michigan. Snowy night. It was my first year out of medical school. I was an intern in the surgery department there at Michigan. And that night I happened to be taking care of a very sick elderly gentleman who had started to develop some fluid in his chest. I was doing a procedure known as a thoracentesis. You basically put a needle into the chest to try and drain the fluid. It's a commonly done procedure and relatively simple if you know what you're doing. And frankly, by that point in my training, I was sort of a pro at thoracentesis. I knew how to do it just by the book. But for whatever reason, something went wrong that night. There was bleeding, and the patient had to be rushed off to the operating room. Again, this is Christmas Eve. I had already been in the hospital for a full day, full night, and now another full day. But I couldn't allow myself to leave. I needed to see what would happen to this man. Well, he came back from the operating room and then developed something known as coagulopathy. That means his blood would not clot. Sometimes that can happen when you have a lot of bleeding. It can be this really vicious cycle. And it was for him, because a day later, he died. Now, I'm telling you this because 32 years later in my life, if you look up in the top right drawer of my desk in my office, you're only going to find a single piece of paper. I've only allowed one piece of paper into that drawer, and that is the autopsy report on that patient. I know that sounds grim, and I don't mean to make it sound that way, but it's just my reality. I'm not exactly sure why I keep it, but I think it's because it's a reminder. It's a reminder of what this job entails and how it can truly humble you. I believe that that reminder makes me a better physician. I think about that guy all the time. And I was thinking about this story when I read the new memoir of my guest today, Dr. David Sandberg. He's a retired pediatric neurosurgeon at Memorial Herman Hospital in Houston. And he has a new book. It's called Brain and the Triumphs and Struggles of a Pediatric Neurosurgeon. And I wanted to share it with you today because I think it offers a really powerful glimpse into the mind of a surgeon. I asked him to come on the podcast to share that glimpse with you. How do surgeons make decisions? How do we carry the weight of those decisions? How does a doctor like David, who meets children and parents at their absolutely worst times in life, how does he navigate all the good in in all the tough that that job has to offer? How does he land on hope with all that? I think there's a lot of lessons in this conversation that extend way beyond medicine. These are questions, I think, about our very humanity. I'm Dr. Sanjay Gupta, CNN's chief medical correspondent, and this is Ch.

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[Dr. Sanjay Gupta]

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[Dr. Sanjay Gupta]

You start the book. I gotta say, everyone should read this book. Whether you're interested in neuroscience or neurosurgery or not, you should read this book because I think these are incredible human stories. And and I have three teenagers, so when I start reading about a 15 year old named Garrett, right out of the gates, the story starts. It grabbed me and I'm wondering if you can just transport us to that point. You get a call about this child. Just talk us through what happens.

[Dr. David Sandberg]

Garrett was riding an ATV without a helmet. It flipped over, he hit his head, he was unconscious. He was transported by helicopter to our hospital. He had a CT scan that showed what was what is a very simple problem. And I chose his case because it's so simple. We have much more complicated decisions to make than Garrett's case. This is a straightforward bread and butter epidural hematoma, a blood clot between the skull and the dura, which is the leathery covering of the brain. The problem was, when I examined him, I didn't initially detect any neurological function. His pupils were large and unreactive, a terrible sign. When I put a piece of. Of gauze to touch his cornea, he had no corneal reflex. When I pinched him as hard as I could, he didn't move at all. And I was afraid that he had progressed to brain death. And I pinched him as hard as I could, multiple times, not to be mean, but to assess for neurological function. And the very last time I did, he had slight, what we call extensor posturing, where his arms went straight ahead. A sign of a severe brain injury, but a sign that he had some life. And then the question was, what to do? And, you know, I wound up taking him to surgery. We saved his life, and, you know, I just had a book event in Houston, and he was there, and he's amazing. He's perfect. He has no neurological problems, and I get to be the hero. But his case has haunted me because I advised his parents, I said, if he were my child, I would not take him to surgery. I think the likely outcome is he's going to progress to brain death or be neurologically absolutely devastated. Not the child you've known or loved. And what a mistake I almost made. His case haunts me, and I wonder, I can't think of examples, but have I made mistakes like that, that I could have saved a life and didn't? I don't know the answer to that question.

[Dr. Sanjay Gupta]

That's existential sort of thinking there. The idea that you then reflect on other cases and say, let me think through my decision tree. Did I make the right decision based on everything? You made the right decision. Obviously, Garrett did really well. I think you're right about the fact that he became an athlete, was on the golf team, and obviously nuclear power study.

[Dr. David Sandberg]

He works in a nuclear power plant. He's happy, he's perfect. You would never know anything happen to him.

[Dr. Sanjay Gupta]

What's the lesson? What's the lesson for other people who will read the book? What's the lesson for other physicians?

[Dr. David Sandberg]

There are so many lessons. One lesson is that I think the public thinks that everything we do is based upon good science. The brain is so precise. We have so many tools at our disposal, technology to use. But the decisions we make are uncertain. And they're not all made with our brains. Some of them are made with our gut or maybe with our heart. And of course, I'm not talking about the heart as the organ that pumps blood through the body. I'm talking about the heart as the center of. Metaphysically, of love, of emotion and uncertainty.

[Dr. Sanjay Gupta]

How explicit do you think physicians should be when they're guiding a family through this question of whether to operate or not? So, you know, the family's going to ask you. You're obviously the expert, what should we do? Should we operate or not? And as you point out with Garrett's case, the initial instinct was not to operate. Because I think the concern, as you're sort of describing it now and in the book, is that, are you prolonging his death or are you extending his life? How do you convey that to a family?

[Dr. David Sandberg]

It's hard. I mean, in terms of the parents, you know, there are some cases that are very black and white where it would be wrong to deny surgery or it would be wrong to do surgery. The hard ones are the gray ones. And I think you gotta just be honest. You gotta say, listen, this is great. This could go terribly. He could progress to brain death or perhaps worse still, he might not be the child that you've known and loved and raised. We might do this operation and save his life, and he may never talk or walk again, may never be the same child you've loved, may not understand commands when spoken to, may be fed by tubes and require 24. 7 nursing care. There are some who would. At all costs, they want their child to be alive, and that's okay. There are many who wouldn't for their loved one, and that's okay, too. So you have to have the honest conversation and convey the uncertainty. And I tried to do that with Garrett's parents. I told them I'm not sure. You know, I'm not sure what the right thing is to do here. I haven't seen anybody in Garrett's exact circumstance have as good of an outcome as he has had. For every Garrett, there are many, many children who are neurologically devastated. Who, you wonder, did you do the right thing operating? And so there is no right answer. You just have to convey the truth. In most circumstances, parents don't have a lot of time to make a decision. It's their whole world. And they will ask you to do everything that is possible to save their child's life. And it's a judgment call whether to proceed with surgery or not. In many circumstances.

[Dr. Sanjay Gupta]

There is a inflection point between hope and honesty, and they both have value. Honesty has obvious value, objective, intrinsic value. I have come to believe that hope has value in and of itself. As well, just as a sort of another thing to add into the mix, just hope. Maybe hope leads to better outcomes. Hard to objectify that, but I think there's something there. As a pediatric neurosurgeon, how do you find that balance between hope and honesty?

[Dr. David Sandberg]

I try not to take away hope except when there is no hope.

[Dr. Sanjay Gupta]

In Garrett's case, it did feel like there was no hope. I mean, he essentially had an exam that revealed that he was brain dead. So it was very, very difficult to find hope there, I imagine.

[Dr. David Sandberg]

Yeah, by the grace of God, I pinched him one last time and got some slight neurological function, and his brain looked good on the ct. And I thought maybe we should give him a chance. This is what his parents want. And so we went ahead and did that. My biggest interest within neurosurgery has been in pediatric neuro oncology in children with malignant brain tumors. I find hope so important in those circumstances. I've taken care of many children who've been told that their brain tumor is incurable at this point and they should pursue palliative care. And we've enrolled some children like that in some of our clinical trials, and some of those patients have gained extra months or even years of life. Most of them have failed miserably. And we did provide hope to some families, and I think that hope was important, even if the ultimate outcome is the child died because the family felt as if they left no stone unturned and that hope, even if temporary, was incredibly meaningful to them.

[Dr. Sanjay Gupta]

Yeah, it's tough. These are big topics that we're sort of delving into. But the idea of preserving life at all costs versus being the honest broker as a pediatric neurosurgeon and saying, look, life is the ultimate goal, obviously here, but let me lay down some of the scenarios of what may happen. These are brutal conversations to have with people. You do it all the time as a pediatric neurosurgeon. I do it sometimes as well as an adult neurosurgeon. But these are tough conversations.

[Dr. David Sandberg]

Yeah. And the hard thing is that, you know, families deserve days to weeks to make those decisions. But in an acute setting, you've got minutes, you know, because if you are going to take out that blood clot, you better do it quickly, because time is brain. It matters how quickly you get that blood clot out and take the pressure off the brain. So imagine you're a parent and you have to make that decision which has so much weight, and you have no time to do it. You have no time to call a friend. You have no time to, you know, get advice from anybody except for the neurosurgeon who you've literally just met two seconds ago. It's an impossible situation for parents.

[Dr. Sanjay Gupta]

You train residents and obviously teach medical students. Now, do you explicitly teach them about this? The idea of having these tough conversations, is that trainable?

[Dr. David Sandberg]

Oh, it certainly is. You know, I received no training in any time in my medical career on how to have a difficult conversation with family. I take that responsibility very seriously. I'm in academic medicine. Every time I have a conversation with a family, that is going to be a difficult conversation. I look around and I grab the nearest resident medical student, whoever's the youngest person, and I come, come with me and I tell them what I'm going to say as I'm walking quickly into the room. And afterwards, first I check on them to make sure they're okay. And then I tell them, these conversations are really important. You should absorb the things that I did that you think are positive and maybe some of the things you struck you the wrong way. But you should watch other people have these difficult conversations with families and take the best of what you see and discard the worst and develop your own style. But think very carefully about how you're going to talk to a family who's undergoing the worst tragedy and imagine yourself in their shoes. Yeah, I take that responsibility incredibly seriously. I hope that's something I've done over the course of the decades for a number of people.

[Dr. Sanjay Gupta]

I'm talking with pediatric neurosurgeon and author Dr. David Sandberg. We'll be right back.

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[Dr. Sanjay Gupta]

I am curious. Going back to Garrett's story, first thing you said was you get this call about a 15 year old who was ejected from an ATV not wearing a helmet. You threw that into the first line of description. So when you hear not wearing a helmet, what's the first thing that goes through your mind?

[Dr. David Sandberg]

What a shame. As a neurosurgeon who's taken care of trauma patients for years, I haven't seen anyone who's had a devastating head injury who is wearing a helmet. But I've seen so many kids and Adults who are riding bikes, they're hit by cars and they hit their head on the pavement and they're never the same person or they die as a result of that injury. So some parents will tell me their teenager won't wear the helmet. I say, well, then take away the bicycle. You know, this is that important.

[Dr. Sanjay Gupta]

Do you think that we do enough as a society to protect our children? I mean, you have this entire chapter of the book just basically about keeping children safe. So this is the preventative aspects of neurosurgery, right? You think about prevention and infectious diseases and primary care. But as neurosurgeons, we have to think about prevention as well. Helmets, seat belts, tackle football, keeping guns in the house. As a society, should we be doing more to keep our kids safe?

[Dr. David Sandberg]

We should be doing more and we're not doing enough. You know, gun safety is a big thing in Texas. You know, you can argue about, you know, gun regulations and this and that, but I think one thing that everybody can agree upon is if you're going to have guns in your home, please lock them up in a safe that is away from children they have no access to. I've seen four year olds who have access to a gun who shoot themselves in the head and they die. I've seen, you know, a twin shoot his brother. These are kids under the age of 10. They have no idea what they're doing. They think it's a toy. And that family is devastated. That kid will never be the same. How will he live with himself that he shot his twin brother? How do you recover from that? These are such preventable tragedies. You know, tackle football is a little more controversial. I think there are some things we can all agree on. We can talk about football if you wish, but I think some things we should all agree on. Bicycle, helmets, guns, safety, things like that.

[Dr. Sanjay Gupta]

Yeah, I just often struggle with the idea that we do all these amazing things in medicine, develop new therapeutics and new techniques and all that, and yet sometimes we just don't get the little stuff right. It breaks my heart when I see somebody who has a totally preventable injury. And I've seen ATVs go cruising by in places that I've been and bunch of kids on there without helmets and it just makes my heart stop. And I don't know how to find that balance. I don't want to be the guy that goes out there and yells at him, like, get off my lawn, that kind of guy. But on the other hand, I feel like we're sort of obligated to do it, and in a tough way. You have this another chapter in the book, the Triumphs and Struggles of a Pediatric Neurosurgeon. And we've talked about a lot about this already, but what aspects of the job do you think you struggled with the most? What are you still bad at? If I can ask that?

[Dr. David Sandberg]

I don't know what I'm bad at, but I think what I've struggled with the most is coming to terms with when a child is worse after surgery than before. You know, you can take two children with brain tumors in the same location of the brain. You operate on one of them, and they wake up perfectly. You know, you get an mri. Afterwards, the tumor's out. The parents are so grateful, Everything's wonderful. You can do the exact same operation the next day in a child with an MRI that looks the same. The tumor's in the same location, and the child wakes up with a profound neurological deficit. And you wonder, I did the same operation in these two children. Why does one of them have this problem? And sometimes, if you're honest, you have an answer. You did something that you shouldn't have done. More often than not, you don't. And that's something that was hard to come to terms with.

[Dr. Sanjay Gupta]

Yeah, that's got to be pretty profound if you're that far in your career and you just think, maybe it was me. If this patient had been cared for by somebody else, they wouldn't have had that sort of outcome. What do you do with that information then, if you think that that might be the case?

[Dr. David Sandberg]

I think there are some neurosurgeons who, you might say, you have a terrible complication. And you might say, you know what? I trained at the best places. I did my very best. There's nothing anybody else could have done differently. And you kind of wash your hands of it. Right. And you don't think further about it. I think if you take that attitude, you probably shouldn't be a neurosurgeon or a surgeon or maybe a doctor at all if you're that flippant about it. The other extreme is there are some who take so much shame and internalize it so harshly that they can't go on and do the next operation. They don't offer that difficult surgery to the next patient. After going through all the years of training. I don't think that's doing anybody any favors either. I think there's a happy medium in between those two extremes. The happy medium is you have deep, honest reflection. I've lost a Lot of sleep on nights that follow when a patient wakes up worse after surgery and you're honest with yourself about every step of the process. You know, did I assess the case carefully? Was surgery the right thing to do? Did I choose the right surgical approach? Did I discuss the risks adequately with the. With the family? Did I discuss the risk that actually happened? Did I make the right decisions in surgery? And then afterwards, you present that case in a morbidity mortality conference, which is one of the most important things we do. It's very hard. Imagine yourself, you have the worst day of your life, and then that worst day of your life is presented with a room of 50 to 100 people. Your boss is in the room, There are students in the room, there are strangers, there are people you don't know, and they outline the worst day of your life with pictures and video. And you have to sit there and listen and absorb it. It's actually hard to do, but it's such an important thing. And I learned so much. And ultimately, what I learned is, you know, I'm not going to not do a case because I'm worried it's going to end up in Morbidity and Mortality Conference. I'm going to do the right thing for every child. And if there's a small amount of hope, if I can help someone, even if someone like Garrett would be a good example of that, there was a high probability of Garrett's case ending up in Morbidity and Mortality Conference because there was a high probability of him progressing to brain death or devastating devastating outcome. And then somebody in that conference is going to say, Dr. Sandberg, why did you do that operation on that kid with blown pupils who had no neurologic status? But I was. You know, Morbidity and Mortality Conference was the farthest thing from my mind when making that difficult decision. But it's out there.

[Dr. Sanjay Gupta]

M and M. Morbidity and Mortality. Some institutions call it dnc, Death and Complications Conference. It is one of the more unique traditions, I think, in medicine where, as you say, people get up and talk about the worst sort of outcomes in their patients, and it's incredibly humbling. It's all done in the spirit of learning, I think, for the individual to learn, but also everyone else in the room to learn from this so these types of things don't happen again. I gotta tell you, going back to the story I told you at the beginning about this thoracentesis procedure I did, where, again, putting a needle into the chest to drain fluid and the patient had bleeding. I had to present that I was an intern, and it was presenting it to all the senior residents, chief residents, attendings, everyone else that was in the room. And I remember it was. I was, you know, incredibly nervous up there. I'd never done that before. And I finished outlining the entire presentation of what exactly happened. And the room was just silent for it felt like 10 minutes, but it was probably like 30 seconds or 15 seconds. And then Dr. Laser Greenfield, who was our chairman of surgery at the point, was sitting there, sort of moderating, and he says to me, he goes, what size needle did you use for the thoracentesis? And I told him, I said, yes, I use this size needle. It's the same needle that comes in the kit, thoracentesis kit, the standard needle. A long pause, and he says, the reason I ask is because when this exact same thing happened to me back when I was a resident, blah, blah, blah, blah, and I remember the air just came out of the room. Everyone just exhaled. Because it had happened to Dr. Laser Greenfield, this exact same thing, he had thrown me a lifeline in many ways, I think, just to sort of help me get over that, because I wanted to quit. I was an intern, and I thought, maybe this isn't right for me. Maybe this field isn't right for me. I hurt somebody, and I'm not sure that I can bounce from that.

[Dr. David Sandberg]

But.

[Dr. Sanjay Gupta]

But then you get a well intentioned, well meaning professor. I'm sure you've done this for your residents as well, who in their own way throws you a lifeline and says, hey, it happens. You're a good doctor. You're going to get beyond this and you're going to do a lot of good in the world. It's really important.

[Dr. David Sandberg]

Oh, yeah, I remember one of the most impactful experiences of my early residency. There was a patient who had had a spine surgery, and the patient had a drain that needed to be pulled. A very simple procedure that's done by residents at the bedside. And I tried to pull out the drain and it snapped off and broke. And that required a second operation. And it was a very big deal because it was a patient who was very upset, had been through a lot, and it was going to be hard to talk to her about it, and she was going to need another surgery. And I was young and it was a mistake that I made. And the attending neurosurgeon, his name is Mark Bilski, he was so kind to me, but he treated me with such kindness that I think it led to me being kinder to Residents who made mistakes when I was the attending, when I was the boss. And I'm so grateful to Dr. Bilski for that.

[Dr. Sanjay Gupta]

See, we get to give shout outs to our mentors here today as well. So, Dr. Greenfield, if you're listening, Dr. Bielski, if you're listening, you made an impact on us, you know, so we appreciate it. We're getting close to the end here, but I just wanted this idea of finding that inflection point again between hope and honesty. We talk a lot about this in the book the Power of Hope. It drives parents to do these incredible things, search the world, travel the world in search of clinical trials, oftentimes at great personal expense. Children battling cancer inspires people to keep researching. Is hope always a good thing in medicine?

[Dr. David Sandberg]

It's hard to say. I think I'll give you one example where it's the most difficult, the most challenging. The worst disease I treat is called diffuse midline glioma. This is the equivalent or worse of pancreatic cancer in a child. It happens to children typically in the second half of the first decade of life. They have tumors that are intrinsic to the brainstem that cause the brainstem to swell. They're not amenable to surgical resection. You can't do surgery on them. Radiation therapy helps temporarily for a few months, but never cures anybody. And no chemotherapy drug alone or in combination has ever worked. And there are clinical trials that are available, but the overwhelming results of those clinical trials are disappointing. It's essentially a death sentence. And so is hope useful in that circumstance? I don't know. You know, I tell parents always that I am not God. And there are no hundred percents in life or in medicine. But in this circumstance, I know it's going to happen. And, you know, I haven't seen a child be a long term survivor of this particular condition. It doesn't eliminate anyone's hope. It doesn't eliminate their prayers. I don't know if it's well served, but who am I to deny hope to a family even in the very, very worst circumstance?

[Dr. Sanjay Gupta]

Yeah, as we talked about earlier, I think hope has intrinsic value. I do worry sometimes, David, that people prey on vulnerable families in those situations, offering up miracle cures and things like that, oftentimes for their own profit motivations and things like that. And I think we do, as physicians have to insulate from that. But it's challenging because if you think, hey, I'm willing to do anything to save my child, I'm willing to do anything, even if it's got no data behind it or even negative data behind it. I'm willing to give it a shot. It's tough. And I think sometimes as physicians, obviously we're caring for them, we're operating on them, but I think we often have to be guiding them and their families as well as they navigate that. And I think one of the things that I do, I will just really empathetically try and put myself in their shoes, just truly put myself in their shoes. And it's hard to do that. Is my kid on the table, that is my kid who's in the office and say, what would I do? It's tough to sort of navigate that. Give us one last plug on the book. Why did you title it the way that you did?

[Dr. David Sandberg]

So I titled it's called Brain and the Triumphs and Struggles of a Pediatric Neurosurgeon. I go through the triumphs, which are the amazing highs to save a child's life. It's like saving the entire world. And to do an operation and go out and tell a family that their child, loved one, is going to be okay is a high that I've been so blessed to experience and struggles because I let you into my mind to know that some of what we do is really hard to cope with. You know, there are situations that make us question ourselves, even the most confident among us. And there are situations in which, you know, we're affected, we shed tears. We are humans. That's the title of the book.

[Dr. Sanjay Gupta]

It's a great book, David. I congratulate you. I hope everyone gets a chance to read it, whether you're interested in medicine or not, whether you're interested in neurosurgery or not. These are human stories. And congratulations and thank you for sharing it with us.

[Dr. David Sandberg]

Thank you. Coming from you, it's an incredible honor to hear those words. Thank you so much, Dr. Gupta.

[Dr. Sanjay Gupta]

Chasing life is a production of CNN Audio. Our podcast is produced by Aaron Mathewson, Jennifer Lai, Grace Walker, Lori Galleretta, Jesse Remedios, Sophia Sanchez, Kira Daring and Madeleine Thompson. Andrea Kane is our medical writer. Our senior producer is Dan Bloom. Amanda Seeley is our showrunner. Dan Dijulla is our technical director. And the executive producer of CNN Audio is Steve Lichtai with support from Jamis Andrest, John Dionora, Hayley Thomas Thomas, Alex Manasseri, Robert Mathers, Lainey Steinhardt, Nicole Pessarou and Lisa Namaro. Special thanks to Ben Tinker and Nadia Kanang of CNN Health and Wendy Brundage.

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[Dr. David Sandberg]

The HBO original series the Gilded Age is back, and so is the official companion podcast. Are you curious about how they brought Gilded Age New York to life? I don't understand. Which bit is not clear?

[Dr. Sanjay Gupta]

None of it is clear.

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Want to know where the writers branched off from history?

[Dr. Sanjay Gupta]

Well, when you set your mind on a thing, no one can stop you.

[Dr. David Sandberg]

I take that as a compliment. Watch or listen to the official Gilded Age podcast. Wherever you find podcasts.