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For this brain surgeon, the operating room is 'the ultimate in mindful meditation'

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For this brain surgeon, the operating room is 'the ultimate in mindful meditation'

“Everything that we are as human beings is in our brain,” Dr. Theodore Schwartz says.

Brian Marcus
/Penguin Randomhouse


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Brian Marcus
/Penguin Randomhouse

Neurosurgeon Theodore Schwartz still remembers the first time he witnessed brain surgery in person. He was in medical school, and the surgeon sat in a special chair that was designed to hold the arms up while they worked under a microscope.

It reminded Schwartz of the way an astronaut looked in the cockpit of a spaceship — except, he says, “[The surgeons] were traveling into the microcosm of the brain instead of traveling into the macrocosm of another planet.”

“When I first saw that, it was nothing but awe and excitement and the fact that they were doing it to help another human being and going into the brain and the mind,” Schwartz says. “Everything that we are as human beings is in our brain.”

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Schwartz has since spent nearly 30 years treating people with neurological illnesses. When he was first getting started, he worried about keeping his hands and body steady during long surgical procedures that might stretch on for hours. But he says over time he’s trained his body to enter what he describes as a surgical “flow state.”

“It’s sort of the ultimate in mindful meditation,” he says. “The external world does not exist for that period of time. And the same is true of your bladder. … And then at the end of the operation, You kind of realize, ‘Oh my goodness, I have to go to the bathroom. I’m tired, my neck hurts, my back hurts.’”

Schwartz writes about the past, present and future of neurosurgery in his book, Gray Matters: A Biography of Brain Surgery. He notes that while traditional brain surgery involves opening up the side of the skull, the practice of “minimally invasive brain surgery” — whereby the brain is accessed via the nose or by the eye socket — has become more mainstream over the course of his career.

“We can do surgeries now by making a small incision in the eyelid or the eyebrow and working our way around the orbit in order to get to the skull base,” he says. “And that allows us to get to these very delicate parts of the brain much more quickly, and without disrupting as much of the patient’s anatomy so that they heal much faster.”

When it comes to brain health, Schwartz recommends the basics: exercise, a healthy diet and plenty of sleep. “And besides that, I don’t know that we really know what we can do to keep our brains healthy. So that’s the recommendation I would give,” he says.

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Gray Matters, by Theodore Schwartz

Gray Matters, by Theodore Schwartz

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Interview highlights

On the need for power tools for such delicate surgery

We think of brain surgery as something that’s very fine and delicate … but the brain is housed in the skull, and the skull is very, very strong. And that’s what protects our brains from injury. And so part of what we have to do as brain surgeons is first get through the skull. And that work is often very physical and involves drills and saws in order to get through the bone. We obviously do it very carefully, because the trick is to get through the bone and not damage the underlying contents. But we have to use power tools, and that’s how we start out every operation, with saws whirring and buzzing and making noise and sort of bone smoke going in the air before we transition to the careful, delicate microsurgery that we do after that.

On trying a new method of surgery when the stakes are so high

You realize the gravity and the importance and the significance of the fact that this other person’s life is in your hands and you’re trying something on them that you think will be better, for sure, but you’re not sure yourself of your own ability because you haven’t done it 100 times. And that’s really terrifying. And it’s something that we have to deal with as neurosurgeons. Not just when we try something new, but essentially every time we do an operation, we’re taking on that enormous responsibility of another human being’s life.

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While the majority of our surgeries go extremely well, occasionally they don’t. And when that happens, it weighs on you tremendously. And it affects how you think about all the subsequent cases that you’re going to do that are similar, because you never forget those cases that didn’t go quite the way you wanted them to go.

On relieving pressure in brain by cutting a hole in the skull

One of the most common surgeries that neurosurgeons do is head trauma. And head traumas are very common. But these are neurosurgical emergencies. Anyone who has hit their head severely enough, they will have swelling in their brain. And we can now save these people’s lives just by opening up the skull. Because as the brain swells, if it has nowhere to go, that’s when the pressure goes up. So neurosurgeons can go in very quickly and remove part of the skull, and let that pressure out and then put the skull back, maybe, two or three weeks later, or maybe even a few months later when the swelling has gone down and we can save lots and lots of lives that way.

On how the field of neurosurgery is changing

One of the things I love is that, some days or weeks I’ll come in and I’ll be training a fellow and we’ll go through six, seven, eight operations and I’ll tell them, all these operations that we just did together, I didn’t learn how to do any of these in my training 25 years ago. They’re all completely new operations. And that’s a wonderful thing about a field like brain surgery, is that we are constantly applying new technology and the field is changing and you have to stay up to date, but it also keeps you active. It keeps you thinking. You’re constantly working with engineers and people in other fields to figure out what’s the latest technology going on in, you know, oncology and orthopedics and OB/GYN that we can apply to neurosurgery? To try to make what we do better.

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On seeing his father’s stroke and aphasia when he was in residency

It was just this profound moment of seeing my father’s brain appear before me and fearing I was going to see a problem. And sure enough, there was this sort of dark spot which I know to be a stroke, and he had had a horrible stroke that took away his ability to speak. As a result of the surgery he had, and unfortunately passed away a few weeks later. But it was just [a] devastating experience for me. And as much as I know about the brain, I knew too much about what was going on. I also knew that at that moment in time, there was nothing we could do for him.

On the union of the brain and the mind

I think everything that a human being experiences, in the external world and the internal world is all your brain. I think that’s all that there is. I don’t think there’s some mystical second substance called “mind.” … We think the mind and the brain are different things because it’s built into our language. It’s how we talk about the mental world around us. We were raised speaking a language with words that refer to things that may not exist in the real world — and one of those things is mind. … I do not think we have as much agency over what we do, if any. And I think the brain is processing information, below our radar, unconsciously, subconsciously, whatever you want to call it, and creating behaviors. And we are just along for the ride to some extent.

Sam Briger and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.

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‘Dead but Dreaming of Electric Sheep’ is full of beautifully written grotesqueries

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‘Dead but Dreaming of Electric Sheep’ is full of beautifully written grotesqueries

Paul Tremblay has made a career of pushing the horror genre – and the novel format – in strange and exciting new directions.

In his latest, Dead but Dreaming of Electric Sheep, the author offers an amalgamation of genre elements that can be best described as psychological-dystopian-science-fiction horror. It’s a mouthful, but the narrative does all of that and more in a way that defies categorization.

Julia Flang is a former semiprofessional gamer working two mediocre jobs she dislikes and living in a modest ranch house in a San Fernando Valley suburb with her retired uncle, whom she calls Uncle Fun. Julia likes movies and gaming but there’s little else going on in her life, so when her estranged mother, the CFO of a large tech company, contacts her with a possible job offer – a “once-in-a-lifetime thing” that pays handsomely just for doing the interview – she hesitantly agrees.

The job is relatively simple and perfect for someone with gaming skills: using a controller built into a phone to get a man, who is stuck in a vegetative state, from California to the East Coast. It will require her to learn how to control his body – walking, moving, sitting, standing, using his arms – so she can maneuver him out of the facility where he is located and into cars and planes and through crowded airports. A fan of movies, Julia decides to call the man Bernie – after the movie Weekend at Bernie’s. When the ethics of the job start to bother her, Julia realizes it’s too late and she must go through with it. However, she’s soon contacted by people interested in sabotaging the whole thing, people who, like her, don’t align with the shady interests of conglomerates and those set to make “gobs of money” from this new, somewhat inhuman technology.

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As with every Tremblay novel, any synopsis barely scratches the surface. The novel’s chapters alternate between Julia and you (yes, you). Julia’s chapters are “normal” in the sense that they obey a chronological order and have action, basic descriptions of movement and places, and dialogue. The chapters in second person are like fever dreams from a shadow world; the desperate experiences of a man trapped inside his own body with no control of it, no clue what’s happening to him, and only a few fragmented memories of his life. Also, Tremblay uses a similarly fragmented style of storytelling (including words and sentences trapped in boxes and/or “moving” on the page) to keep things interesting but also confusing and creepy.

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At Mindful Archery, L.A. women take aim at their exes, toxic jobs and Donald Trump

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At Mindful Archery, L.A. women take aim at their exes, toxic jobs and Donald Trump

Give a girl a bow and arrow, take her to the woods, and anything feels possible.

That’s what I was thinking as I positioned myself in front of bales of hay in an open field at the Woodley Park Archery Range in Van Nuys. Channeling my inner Katniss, I took a “power stance:” shoulders back, legs slightly bent, bow cradled in my upper body. I slid a small but fierce-looking arrow bearing orange feathers onto the bow “nock,” filled my lungs with air, then heaved the tense bowstrings back to my jaw, one eye closed and the other narrowed in concentration.

Then I did what often feels impossible for me: I let go.

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The arrow hurdled forward, unleashing an audible woosh followed by a distant thwack. I missed my target entirely, stabbing the hunk of hay more than a foot away from the bull’s-eye. But the feeling of release as the bowstrings were left vibrating in my arms was palpable, intensely satisfying.

This was Mindful Archery.

Angie Fadel, founder of Soulcare, leads Mindful Archery.

Angie Fadel, founder of Soulcare, leads Mindful Archery.

(Eric Thayer / Los Angeles Times)

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The seemingly militaristic act of archery and peaceful meditation may seem diametrically opposed. But at Angie Fadel Soulcare, they make perfect sense together. Fadel leads workshops in Mindful Archery that combine meditation, somatic practices such as breathwork, immersive nature therapy and archery instruction.

The idea, Fadel says, is for participants to gather in a healing nature setting while becoming mindful of something they want to either let go of (an unfulfilling job or toxic relationship, for example) or something they’re aiming for and want to bring into their lives. Fadel leads a short guided meditation at the start of the workshop for participants to relax and get grounded, followed by a nature walk so they can further sink into the moment and become clear on what, exactly, their targets will be for the day — what they’ll be shooting for, or at. Then participants draw their individual targets on paper with colored markers that Fadel provides.

Attendees hold up their targets during a Mindful Archery class.

Attendees hold up their targets during a Mindful Archery class.

(Eric Thayer / Los Angeles Times)

One target might look like an abstract drawing representing a feeling, another might be a jumble of words and symbols such as “Love,” “$” and “Health.” Or an illustration of Donald Trump, as one past archer aimed for.

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“I’ve seen everything,” Fadel says. “People have put their parents, their exes, people have put rapists — the most damaging things that have happened to them — on a target because if you can hit that thing, it feels better in your body. The same thing happens when you hit something good, it’s a hopeful mechanism in the body.”

Fadel’s archery instruction is as much about how the sport feels in the body as it is about technical precision. The slow and steady, intentional steps of deep breathing, taking aim and shooting at a carefully considered target is a powerful act, she says.

“Even if the arrow doesn’t go where you want, there’s this immediate thing that happens in your body that feels good,” Fadel says. “When you let go of that string, there’s an energy, there’s a movement — actual, physical energy moves. Something magical happens. It helps the things that are stuck in the body get unstuck. It’s somatic. Then it’s an extra bonus if you do hit your target, because the slap of the paper feels even better.”

Angie Fadel readies bows.

Angie Fadel readies bows.

(Eric Thayer / Los Angeles Times)

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Fadel, who lives in Portland, Ore., and calls herself “a soul-collaborator,” has a masters in spiritual companionship and spent a decade working as a pastor in a Portland church helping members find untraditional spiritual paths. She’s also been an archer for more than 15 years. She came to both practices — spiritual companionship and archery — separately before they organically entwined. Midway through pursuing her master’s in 2011 she discovered a friend was a master archer. She’d always wanted to learn archery, since she was a kid growing up in rural Washington, and she persuaded him to give her a lesson.

“It was just one lesson, but it changed my life,” Fadel says. “I was doing something that I’d always dreamed of doing. It unlocked something I didn’t realize could be unlocked.”

Targets pinned to a hay bale allow participants to take aim at what they want to bring into their lives.

Targets pinned to a hay bale allow participants to take aim at what they want to bring into their lives.

(Eric Thayer / Los Angeles Times)

Fadel found archery increasingly therapeutic. She was doing a lot of introspective Jungian journaling at the time. As life challenges came up in her journaling — the stress of school or a difficult roommate, “or just society as a whole,” she says — she’d put them on targets in the form of words. Shooting at them helped her process the conflict. She thought the beneficial side effects of archery were particular to her, however. Then she took a struggling friend out for her first archery lesson and the response was profound.

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“I realized, you know what? This works. I can take you from never touching a bow to your leaving with your nervous system relaxed. I thought: I have to figure out how to give this to other people.”

Now with Soulcare, Fadel conducts multiple types of archery workshops in Portland and around the country, including in Colorado, Texas and throughout California. She comes to Los Angeles to lead workshops several times a year. One workshop is a Mindful Archery class, not to be confused with her other course Meditative Archery, which involves Jungian journaling; and there’s a one-on-one archery session with spiritual guidance.

Empowering women and minorities, Fadel says, is a key part of her archery workshops.

“An archery range can be a very white, male-dominated space,” she says. “And the stance, with a bow and arrow in your hand, shooting — it’s very male. And [men] don’t have any problem, most of the time, taking up space. So it is a practice to remind ourselves, as a queer woman, a trans person, nonbinary person, anybody that’s kind of othered in our society, to be able to take up space. To adopt a power stance and be, like, I’m allowed to be here.”

Inside the Mindful Archery workshop

Our workshop began with gentle stretching in an open field. It was a cool, overcast day and as the wind rustled the tree leaves, a baby coyote raced across the lawn in the distance. During introductions, attendees shared why they were here.

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Archery is about "letting go" and here, a student lets her arrow fly.

Archery is about “letting go” and here, a student lets her arrow fly.

(Eric Thayer / Los Angeles Times)

“I’m actually a very anxious person,” said Rachel Clipper, 26, “so I’m always looking for something to help me feel more grounded and promote mind-body connection.”

Kati Lee, 29, said that as a “‘Hunger Games’ girlie,” she’d always thought archery was cool. “But what drew me to keep coming back was the mindful part of it,” she said. “My favorite part is that we make our own targets.”

During the nature walk, we ambled down a tangle of dirt trails as Fadel pointed out wild rose bushes, Aspen trees and elderberry, giving a recipe for syrup. When we came to a body of water in a clearing — the Woodley Park Wetlands — we watched as a majestic-looking cormorant stretched its wings in the distance.

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“Think about what would feel good to either annihilate,” Fadel said as we returned to the range. “Or bring in, or let go of, or make peace with. You can put all of it on your target.”

And so we did. We hunkered down at a picnic table by the archery range for crafting and snacks that Fadel provided, every one of us falling into silent sketching and scribbling as we munched on peanuts and granola bars. It felt like summer camp.

Lee set her markers down. “Done,” she said, contemplating her target. It was adorned with words such as “Health,” “Love,” “Family” and “Friends” inside concentric hearts.

Yvonne Golomb, 70, said she’d done archery as a high school student in gym class. She was shy back then, but archery had made her feel bold. Now that she’s retired, she’s craving that feeling again and is returning to the sport for sustenance.

“It’s this nice memory, it made me feel strong, it was freeing,” she said. “Now that I’m retired I’m exploring it. I wanted to bring back those memories.”

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When it was time for our archery lesson, Fadel conducted one last somatic exercise to loosen us up. She had us tap up and down our body parts, from our feet to our ears, before shaking out any remaining stress.

Then she coached us, individually, as we took aim at our targets in sets of three.

“Breathe, zero in on your target, OK, now smooth …,” she said, hovering over one attendee.

May Claire La Plante, 31, said she was doing archery today, in an “adaptive stance” Fadel had taught her, to build up her arm strength after a surgery.

Kati Lee, right, and Tristan Gonzales affix their targets during a Mindful Archery class.

Kati Lee, right, and Tristan Gonzales affix their targets during a Mindful Archery class.

(Eric Thayer / Los Angeles Times)

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“I was feeling very frustrated that I couldn’t get it at the beginning,” La Plante said. “I didn’t even finish my arrows. But getting back up and the act of trying again — despite the injury and all the baggage that comes with it — is really empowering.”

“Bull’s-eye!” Clipper cheered nearby, her anxiety seemingly dissipated. She’d hit her target, dead center. What was on it? A labyrinth-like spiral of words with “Peace,” “Love” and “Creative Control” at the epicenter.

I wasn’t having as much luck and was missing my target repeatedly.

“Try loosening your grip,” Fadel coached. She adjusted my stance. “Now breathe.”

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It seemed counterintuitive to slacken my grip given such a precise goal — to land a slender arrow in the epicenter of a black dot. But I did, letting the edge of the bow sit loosely, even wobbly, between my fingers. I took aim and shot. This time the arrow flew strong and straight.

One participant hit the bull's-eye, which calls for "peace" and "love," dead center.

One participant hit the bull’s-eye, which calls for “peace” and “love,” dead center.

(Eric Thayer / Los Angeles Times)

Another round later and it landed smack on the paper target, just above my bull’s-eye.

“See?” Fadel said, elated. “Archery isn’t about doing it right, it’s about repetition. The more you can be in your body, and relaxed with the repetition, the better you are. Rarely do I have someone not hit their target at least one time.”

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She squinted at my target, then turned to me.

“It’s because they’re relaxed and it’s because they trust me,” she added. “And they learn to trust themselves more.”

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How should we behave online? : It’s Been a Minute

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How should we behave online? : It’s Been a Minute
How do you practice good etiquette online?Your online life shapes your offline life — including how you talk, listen, and interact with the world. But often, good behavior offline doesn’t necessarily translate to good behavior online.  So when we get online, how do we uphold some social norms and common decencies we practice in the real world?  Brittany chats with Senior Writer at Wired, Jason Parham, to discuss what it means to establish boundaries and social etiquette within our online worlds. Want more about good etiquette? Check out these IBAM episodes:Is your neighborhood riddled with dog poop?Who needs to know where you are?Support Public Media. Join NPR Plus.Follow Brittany on Instagram: @bmluseFor handpicked podcast recommendations every week, subscribe to NPR’s Pod Club newsletter at npr.org/podclub.
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