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BRAIN SURGEON Reveals How To STOP NEGATIVE THOUGHTS & Reduce Stress | Rahul Jandial

Today I'm delighted to welcome one of the world's leading neurosurgeons, Dr Rahul Jandial back onto the podcast. I first spoke to Rahul back on episode 76 about the simple things that we can all do to improve and optimise our brain health.

Dr Rahul JandialguestDr. Rangan Chatterjeehost

May 26, 20211h 44mWatch on YouTube

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Transcript

85 min read · 17,351 words

0:00 – 5:54
A Neurosurgeon's Night-Before Ritual
1. RJDr Rahul Jandial
  So I've operated on more than several thousand people, and I've met them all in their crises. And they have shown me that difficult times, they hold a reservoir for growth. [upbeat music]
2. RCDr. Rangan Chatterjee
  You are a world-class brain surgeon. You deal with incredibly complex patients. You do high-pressure operating where the stakes really could not be higher. What do you do the night before and the morning of one of these big operation days?
3. RJDr Rahul Jandial
  That's a g- that's a great question to open up with. I think, first of all, just to give context, uh, most surgeons don't do dangerous operations. So I chose to be a cancer surgeon. I chose to take on the big cases. That's what drives me. That's what is a meditative state for me, when I have to focus that much. So I have a lot of gratitude for my patients for trusting me. That said, I always wanna bring my A game to the case, to the operation. So the night before, there is a ritual, um, and it, it involves a little bit of physical exercise because often not realized by people is that a long operation is a physical endeavor. I mean, you're hunched over, I'm wearing a headlight, I've got loops on my eyes. You're, you're moving. You're in awkward positions. So I, I will do some light weight training the night before. Nothing that wears out my, my hands and forearms, but just postural stuff. And what that does is it's sort of like a pre-game prep. So I bring a physical, uh, preparation to that. And then mental or psychological, uh, the ritual is the last 10 minutes before I fall asleep, I'm running through the shape of the cancer and the dangerous anatomy that it's ensconced in. So you have to dissect out a cancer from not normal anatomy, right? When the cancer grows, it distorts the blood vessels, so it doesn't look like an anatomy book. So you have to imagine around this corner you might bump into this. Around this way, if I hit this vessel, what's my next maneuver? So I do a pre-falling asleep, uh, run-through of the shape, the process, and then I let, I sort of let my dreams and my, you know, put my mind to work at night, and that's the way I focus for the case the next day.
4. RCDr. Rangan Chatterjee
  Hearing you describe your, you know, your, your pre-game ritual, is, is quite reminiscent of sports people, you know-
5. RJDr Rahul Jandial
  Mm
6. RCDr. Rangan Chatterjee
  ... who may have a certain ritual to allow peak performance the following day. I've heard this from golfers before, from, from all-
7. RJDr Rahul Jandial
  Mm
8. RCDr. Rangan Chatterjee
  ... kinds of athletes.
9. RJDr Rahul Jandial
  Mm.
10. RCDr. Rangan Chatterjee
  But you don't tend to hear it as much from people in non-sporting professions.
11. RJDr Rahul Jandial
  Yeah.
12. RCDr. Rangan Chatterjee
  A- and I would imagine all of us, on some level, could benefit from looking at our day-to-day work with the same kind of microscopic precision that, that you do. Yes, the stakes are high for the job that you've chosen, but I guess it's all relative 'cause in our own lives-
13. RJDr Rahul Jandial
  Yeah
14. RCDr. Rangan Chatterjee
  ... we all want peak performance in whatever we're doing.
15. RJDr Rahul Jandial
  Yeah. That stress you're feeling the next day, whether it's trying to navigate a fight with a lover or trying to navigate a conversation with a boss or get to work on time, stress and pain, these things are personal dimensions. So the approach to a challenge, the lessons apply to all of us, whatever our individual challenges are. And, uh, it is like sport. I think that's often, uh, not understood, that surgery is a physical task. That's why it was called an operating theater. It's a performance. Some of us are better at it. It's not always the same 100 steps. Some people are slicker and have softer touch and can get the work done in 60 steps. So I love that technical aspect of it, but whatever the challenge, I have found, I have found a little bit of physical activity mixed with a little bit of thought. Not total step-by-step preparation for... You know, not engineering or sort of micro planning the next day, but something about being physically active the day before improves my sleep. Something about running through what the next day will bring gives me sort of a background preparation because what I do, you can't always anticipate what's gonna happen. But that's life for most people. And so I think the pre-falling asleep window is a unique portal to some of the subconscious things we do in our dreams and our sleep. And if, a- as a sort of digression, creativity, a lot of people have used the, the falling asleep period and the waking up period as a one, as a way to sort of introduce fresh approaches and new thinking to a problem that they've been struggling with. So I, you know, whether it's Einstein or the guy that des- you know, designed the Louvre, um, you know, Inception, the movie, was based on that. So I try to take real science, biology, um, electrophysiology to guide my process. Now, people may have other ways of doing it, but I like it to be anchored in something, um, uh, scientific.
16. RCDr. Rangan Chatterjee
  The way you describe it, it sounds very much to me as though you have experimented with-
17. RJDr Rahul Jandial
  Mm
18. RCDr. Rangan Chatterjee
  ... different techniques over the years before sort of falling upon this one that currently gets you into peak performance. So I guess I'm interested, is it quite unique what each individual needs to do? And then can that approach change and evolve over time as we change and evolve, you know, over time?
19. RJDr Rahul Jandial
  Yeah. I mean,
5:54 – 10:02
Systemic vs. Processive Resilience
1. RJDr Rahul Jandial
  I think you have to stay adaptive, but we're talking about a certain thing here where I have an anticipated challenge. But what this last year has shown us is what do we do when we've- I had no preparation, no anticipation. And, and I think that takes a different set of skills. So there's crisis management in something you're going in prepared for, and then there's crisis management for a crisis you've never anticipated. Uh, and I think those, uh, require two different skill sets. One, you can have some rituals that become a portal to your peak performance or your, you know, optimum technical ability or optimum stress management for yourself, whether that's through breathing techniques or a ritual before you go to sleep. That's what I do in an operation. But what happens when there's a crisis you don't anticipate? That's harder. [smacks lips] Uh, that's harder to be prepared for. But what you can draw on is sort of the... It's, it's often a, um, overused word, so I just wanna add some nuance to it, but, uh, resilience, there's two types. And r- peak performance, resilience, emotional regulation, all these things tie in together, but I really liked taking apart the term resilience in this book. And so there's the physics and engineering definition where you take, you know, there's a, you know, you get deformed and you return to original state. But the psychological definition, and going back to crisis management for things you haven't seen before, the psychological definition is fascinating to me. So there's two types of resilience: processive, uh, resilience and systemic. Let's start with systemic. Systemic resilience means you got it in you. It's what you bring to the fight. That's-- Systemic resilience is what I bring to the operating room on Wednesdays. Systemic resilience is what we had in us before 2020 rocked the world. But that's not your final story because there's also processive resilience, and that's what the fight brings out in you. So I think that's very powerful for me because it leaves us thinking, no matter where you are in your life, whether you're getting rocked and whether you're struggling because of something difficult going on, or whether you're feeling triumphant, that tomorrow is always possible because of processive resilience, what the fight, what the struggle will bring out in you that you may not even recognize in yourself. And I bring that to crisis management. When I go to the OR, it's planned. I've seen it. Uh, and plan for the uncertainty. But relationships, uh, raising children, life-
2. RCDr. Rangan Chatterjee
  Yeah
3. RJDr Rahul Jandial
  ... that requires a, a resilience that you have yet to demonstrate based on the struggle in front of you. When I think of it that way, I feel very optimistic regardless of the place I might find myself in today.
4. RCDr. Rangan Chatterjee
  Yeah, it's a beautiful way at looking at the, the two kinds of uncertainty that we face in life, that predictable uncertainty and the, and the-
5. RJDr Rahul Jandial
  Very good
6. RCDr. Rangan Chatterjee
  ... unpredictable. And-
7. RJDr Rahul Jandial
  Very good
8. RCDr. Rangan Chatterjee
  ... I guess I wonder when I hear that, [clicks] does your diligent practice of attention to ritual, attention to your performance for that predictable uncertainty in the operating room, does that transfer over to help you be more resilient to that unpredictable uncertainty? You know, are there-- Is there a unified skill set there? Is, is some of, is some of that skill transferable across? And therefore, does that mean all of us should, in some ways, try and do certain practices on a daily-
9. RJDr Rahul Jandial
  Mm-hmm
10. RCDr. Rangan Chatterjee
  ... weekly, monthly basis to prepare for when those uncertain events happen as they always do?
11. RJDr Rahul Jandial
  It's an excellent question. Um, a difficult one. Um, but I think one where I can just offer you my understanding. Um, so the crises, crisis management, whether in the operating room or outside of the operating room, uh, there is
10:02 – 21:51
Breathing as a Crisis Tool
1. RJDr Rahul Jandial
  a physiologic response that happens in our skulls, you know, the chemicals, hormones, electricity, blood flow. There's a... It's not just, um, wiring. It's the, it's an ecosystem and there's a response that happens. And what I've learned from the operating room is when I get into a tricky situation, the first thing I do is just prevent myself from hyperventilating. I think everybody thinks, "Oh, you're born with nerves of steel." No, you train yourself to be calmer, to allow that calmness to release the ability to come up with good solutions and behavior that you, you, that's not reactive, that's not freaked out. So what the operating room has taught me is the cadence of breathing, and I think a lot of people are thrown off. They're like, "This is a brain surgeon talking about breathing." You know? It's like... But that's, there's, there, again, there's physiology about that. And if I may, um, when we freak out, for whatever reason, we breathe faster. And in the past, it was p- probably a saber-toothed tiger, and we'd appropriately freak out, and it was usually accompanied by running or movement. And as you know, when our muscles churn, we make carbon dioxide, which is the stuff we blow out and the things that, you know, plants absorb. But so we hyperventilate to, to get rid of that, that m- metabolic waste from the muscles churning. But if we hyperventilate or freak out and we're not running, we're just in the operating room or we're sitting in our car or we see something on our phone, well, now you're, you're blowing off or, you know, evacuating carbon dioxide that you haven't built up from churning muscles. And that kind of hyperventilation, um, which actually lowers the levels of carbon dioxide in your blood, okay? That's, that leads to twitchiness, frenetic thoughts, irritability. It's physiologic. Hyperventilating without also accompanied physical activity- Makes us nervous, um, gets in the way of our thinking. And so when we know that that's the biology and the physiology, I mean, you can measure it, um, then the first step in crisis management in the operating room is just slow it down and get it through my nose. Just, just two, three seconds in, two, three seconds out. My, my mind is racing. My mind is all over the place, but what I'm doing is not exacerbating my inner panic through hyperventilation. So the first thing I do, [inhales] just slow it down, my breathing, and then just keep thinking, keep, keep, keep thinking. And I didn't always do that. I'd fog up my glasses when I was operating, and now people, after the pandemic, know what it is to have [laughs] mask and gla- And imagine operating through that, right? You're f- you're, you're nervous, you're panicking, you're learning how to operate. You're, and you're s- you're getting in the way by hyperventilating. Not only are you making yourself twitchy, you're fogging up your, your, the glasses you're operating, looking through as you operate. So I have to really get my breathing under check, and that's a thought process. Now, I don't have to worry about fogging up my, my glasses because of my breathing. But that is my go-to move for crisis management in the operating room. Now, back to your question, um, unanticipated challenges and crises, you can't prepare for them the night before, right? That we can't do. But wherever you are in your moment and you feel that fear or panic or anxiety grip you, [inhales] the, the weapon you have against that, it's not gonna be equally effective in everybody. But your, the biology and the physiology that you can control with thought is to get that breathing under control, get that breathing under check. Whatever you do through that, you may still make a bad decision. I'm not trying to get to people having outcomes. But you'll be in the best position for you as that individual to think clearly and to have the most emotional regulation you can.
2. RCDr. Rangan Chatterjee
  Yeah. I mean, there's, uh, there's so much there to unpack. I think the key point that I'd love to just-- What you just emphasized for, for everyone listening or watching is that you are a leading neurosurgeon. When the stakes are high, when the pressure start to mount up, you start to focus on your breathing through your nose, three seconds in, three seconds out. That is what gets you through and able to perform, or one of the things I should say.
3. RJDr Rahul Jandial
  Mm-hmm. Mm-hmm.
4. RCDr. Rangan Chatterjee
  And for people who are skeptical of breathwork and the power of controlling your breath like that, I think the example you just demonstrated should shatter any skepticism-
5. RJDr Rahul Jandial
  Yeah
6. RCDr. Rangan Chatterjee
  ... remaining in someone to go, "Look-"
7. RJDr Rahul Jandial
  [laughs]
8. RCDr. Rangan Chatterjee
  "... Rahul Jandial is doing it when he's operating."
9. RJDr Rahul Jandial
  Yeah.
10. RCDr. Rangan Chatterjee
  Well, maybe you might wanna think about it when you're having a row with your partner, or when the kids-
11. RJDr Rahul Jandial
  Right
12. RCDr. Rangan Chatterjee
  ... are starting to wind you up and you're starting to react.
13. RJDr Rahul Jandial
  Right.
14. RCDr. Rangan Chatterjee
  So whatever it is, uh, that's what I think is so p- one of the powerful things about what you just said.
15. RJDr Rahul Jandial
  Thank you, brother. And the, and it's free.
16. RCDr. Rangan Chatterjee
  Yeah.
17. RJDr Rahul Jandial
  You know? That's just, that's the thing is I just struggle so much. You know, I'm f- I live in Los Angeles, and I-
18. RCDr. Rangan Chatterjee
  The wellness capital of the world, man.
19. RJDr Rahul Jandial
  [laughs] And, uh, I think I saw you on TV down here at the local TV station that I do stuff at one time, and they asked me about you. I said, "Yeah, he set me up with a wonderful opportunity and interview and interaction in London," so they were, they were glad to have you. And, um-
20. RCDr. Rangan Chatterjee
  KCLA, I think that was
21. RJDr Rahul Jandial
  ... Los Ang- Yeah, yeah.
22. RCDr. Rangan Chatterjee
  Yeah.
23. RJDr Rahul Jandial
  I've been doing that for 12 years. That's where I got my start, and it bounced off and it ricocheted into different things. But, you know, LA, Los Angeles is fascinating because-- And I'm gonna come back to this breathing. You know, we h- It's not just Hollywood. Actually, if you look at it, it's such a huge place, and only the Hollywood Hills and small pockets are what most people, uh, have in mind when they think of Los Angeles. But there are also major, major university centers. UCLA, USC, JPL, Caltech, City of Hope, uh, even Cedars. Then you go south, you get to Irvine. I mean, there's just a lot of powerhouse, uh, academics going on. And, and I think that's where I saw that, that breath and breathing, th- both, both edges. I saw it being sold at niche m- meditation yoga clubs. They charged people for it. And I felt, you know, that's too much, because this is a power that we're endowed with. And then on the other side, I saw it being applied to teaching patients how to calm down before their, they get their cancer diagnosis or in their MRI machine every three months waiting to see, has the cancer spread? So you see, like, the spectrum of, of what, how breath and breathing control is presented. But absolutely. I mean, if I don't, if I don't get my breathing right, I'm not at my best. And I don't mean just like, oh, my fingers are sh- You know, people are like... I'm not talking-- My fingers don't shake. That's not the point. My thinking, my focus, m- the balance between my thought and emotion. You don't want all thought when you're operating. You have to have guts. But if it's too [laughs] if it's all emotion, it's not tactical. So that fine thermostat that f- for all of us, right? The, the, that, that balance between thought and emotion. The way to find that balance, to turn those knobs, to control those knobs, is to get breathing under control. That's a-- I mean, I can show you and draw out the physiology with fancy little molecules, and we can put little tubes, uh, you know, a mask, and show you breathing and measure it. This is not, uh, this is not something I'm talking about figuratively. I'm talking about literally. If you hyperventilate and you're not physically active, you're just gonna freak yourself out even more.
24. RCDr. Rangan Chatterjee
  Yeah. In the moment of stress, you apply a certain technique to help you Is that something you practice outside the operating room? Is it, do you have a daily practice that, to, to, to get better at it so that when you need it-
25. RJDr Rahul Jandial
  Mm
26. RCDr. Rangan Chatterjee
  ... you can apply it better? Or is this just something you've picked up over time? That, that was one point. The other point, which is from your new book, which I'm definitely gonna get into shortly, 'cause it's absolutely brilliant, what I've read of it so far. There's this section where you talk about surgeons and how they often use a bit of tape at the side to prevent-
27. RJDr Rahul Jandial
  Mm-hmm
28. RCDr. Rangan Chatterjee
  ... the fogging up.
29. RJDr Rahul Jandial
  Mm-hmm.
30. RCDr. Rangan Chatterjee
  But you don't use that tape because the message I was getting is that you use it as a, almost like an alarm sign. If you're starting-
21:51 – 30:43
Life on a Knife's Edge: What Patients Teach
1. RCDr. Rangan Chatterjee
  I'd love to turn my attention to your new book, uh, Life on a Knife's Edge, which wasn't what I was expecting after your last book, and I've gotta say, it was a really pleasant surprise. It's so personal. The storytelling is incredible, and I thought some of the concepts in it are well worth exploring in our conversation today. Um, so sort of as a primer, I've, I've been thinking a lot about you over the last few days in preparation for this and, you know, your job, you know, as a neuroscientist and as a neurosurgeon. And, and I thought, and I wonder what has your job given you with respect to an insight on this incredible organ? Not only have you studied the organ, you are literally looking at that organ-
2. RJDr Rahul Jandial
  Mm
3. RCDr. Rangan Chatterjee
  ... in an operating theater several times a week. What sort of insight does that give you about how powerful this organ is that the rest of us who don't have the opportunity possibly fail to grasp?
4. RJDr Rahul Jandial
  I would take that in a slightly different direction. I'll show you how I get there. You know, when I first started, I mean, um, [laughs] just seeing s- you know, just seeing somebody's f- forehead removed and seeing, like, the glistening white frontal lobes with those beautiful arteries, so, so fine and tortuous, I just, it was mesmerizing. I al- I almost thought, is that even possible? Um, so the first now, you know, the first part of my career, I was fascinated by the actual craft, the work, the anatomy, the, the structure itself. But along the way, there's been an evolution in my, um, focus, if you will, or purpose even. That, um, I saw it as really a window to study humanity. Now, it's, I've operated on thousands. I mean, imagine opening thousands of skulls, and as you know, that means I've met a lot more people. You don't operate on everybody that comes to see you, and you don't operate every day of the week. So I've met over 10,000 people, operated on more than several thousand skulls and brains and things like that. You could look at it that way, or you could see it as- Think about all the different people I've met, and I've met them all in their crises. I've met them all in their most difficult times in their lives, and they've let me come aboard, uh, and partner with them and, and journey with them for a little bit. And so I started to see the ways in which they coped. I started to see the ways in which they suffered badly. I started to see some that were triumphant in, in moments where I think I would just flail. And so what I've learned as a brain surgeon and neuroscientist is sort of the, the human story of, of these, these people who see growth in their own lives based on their description when we would perceive it as calamity. A cancer diagnosis, a scan where the cancer has spread. And they sh- have shown me that, not always, but that difficult times, you know, they hold a reservoir for growth. Nobody wishes they, they go through difficult times like these, but those are the lessons I've seen, and that's sort of what I get into with the stories in the book is the optimism, the heroism, and the, um... And just sort of the transcendence of the things that usually encumber us, the little thought, the little steps, the little frustrations. So in some ways they're set free. It's not, it's not something they choose for themselves, but when that finish line comes into view, because I take care of advanced cancer patients, they live differently, and they often wonder, "Why did not we f- have these focuses, you know, focus on these kind of things, quality of life, before the cancer diagnosis?" So I've gone from a surgeon to a neuroscientist to somebody who now really appreciates the human story through my patients.
5. RCDr. Rangan Chatterjee
  It's fascinating that your job, you know, y- you say that it enables you to study humanity.
6. RJDr Rahul Jandial
  Mm.
7. RCDr. Rangan Chatterjee
  And I wonder, given that you see incredibly sick patients and challenging patients and people who really might be at the end of the road, and actually, this is the last-gasp hope when they-
8. RJDr Rahul Jandial
  Mm
9. RCDr. Rangan Chatterjee
  ... come to see you, does that give you a skewed view of humanity? If your professional life is full of a certain type of person in, in need, do you think that is a beautiful lens through which to see all humanity, or does it potentially, you know, skew that view where you only see one particular aspect of humanity?
10. RJDr Rahul Jandial
  Yeah, no, it's, it's definitely a skewed view. Um, I've taken care of thousands of patients, and I've helped hundreds of people pass away, um, end of life. Uh, it's definitely a skewed view. But what I would say is it offers us insight and perspective to a fate that one-- that we will all face. You know? That, that the finish line and death and mortality is unavoidable, and the lessons I have learned from people who are facing it, some young, some old, but there is clarity in those moments that I want to share with people, um, who have yet to face that, that final moment or those final struggles. And so it is definitely a skewed perspective, but a rare one, I think, that can shed light on, uh, how to live fully and how to live your life, uh, realizing that, uh, it does end one day, and I think those insights are positive and optimistic and triumphant. They're not negative. They're not, um, pessimistic. And so they, they inspire me. They enlighten me with their-
11. RCDr. Rangan Chatterjee
  Yeah
12. RJDr Rahul Jandial
  ... uh, descriptions of what they wish they would have done differently now that the end is within sight.
13. RCDr. Rangan Chatterjee
  What are some of the insights that you've learnt that have changed you and changed the way that you live your life? Because it's that, it's that frustrating thing about the human experience that we often need to-
14. RJDr Rahul Jandial
  Mm
15. RCDr. Rangan Chatterjee
  ... confront our own mortality-
16. RJDr Rahul Jandial
  Mm
17. RCDr. Rangan Chatterjee
  ... before we start truly living. Yet I wonder, because you have seen that so many times, has that infused into your brain and you thought, "You know what? I don't wanna wait till I'm confronting-
18. RJDr Rahul Jandial
  Mm
19. RCDr. Rangan Chatterjee
  ... my own mortality. I wanna start living now"?
20. RJDr Rahul Jandial
  Yeah. I, I didn't get there. I mean, it takes age. It takes your own life experiences. There is no, there is no shortcut. Um, just because I take care of cancer patients doesn't mean I think of death all the time. In fact, only recently have I started to put, put it together and have a synthesis of what I've been seeing and experiencing, and I'm 48 years old. Um, but what, what it means for me is not just to live well or live fully, because that's sort of a personal dimension, but what are the lessons we can take from the approach cancer patients implement when they're facing those crises? So I can't bring people to, "Hey, life's gonna end one day. Make the most of it." That's not, that's not my intention. Um, and people have had struggles in many different ways. I used to be-- I do pediatric neurosurgery, and I've seen parents lose children. I've done trauma surgery. I mean, there are insights from all of those patients. But the techniques, the approaches that I see cancer patients employ, utilize, to me, that's fascinating. So let's take one example. After the cancer diagnosis- He has to get scans all the time. I mean, it's every three months for life. And I always think, [laughs] how, how scary must that be to be in that scanner? What are they gonna find? Has it come back? Has it grown? Is it the same? It's a lot of uncertainty to face that. Not just having a trauma that you survive and say, "That's in the rear view. Remember five years ago, we got in a car accident, and it was a very difficult experience."
30:43 – 36:29
Compartmentalizing Scanxiety and Thinking in Seasons
1. RJDr Rahul Jandial
  Their, their trauma unfolds every three months. And so what I saw was they started to do sort of a compartmentalization of the three months, and I started guiding my patients about that too. Like, "Listen, three months, [laughs] when you see that invitation for the MRI from Rahul Jandial, it's gonna, it's gonna dis- it's gonna be disruptive." Of course it is. You can't be mindful when you see the MRI request come in. You can't be centered. It's gonna rock you a little bit. So what we do is we, we try to limit that disruption so it doesn't eat into the 11 weeks in between. So we come up with this plan. You're gonna get a request. That week is gonna suck. [laughs] You're gonna have to come in, wait in long lines, just be miserable. Let it be disruptive. Put yourself first. We'll get in the scanner, and you'll see me afterwards or I'll call you, and let's just brace for that week. But what we do is we protect the time before and after that. So there's a structure in which they say, "Okay, it's gonna be a rough week because I have a scan and I have something called scanxiety, and, and that's a difficult time." So we compartmentalize, 'cause you can't just say, "Don't stress out." That's not fair, especially with their situation.
2. RCDr. Rangan Chatterjee
  Yeah.
3. RJDr Rahul Jandial
  So they have little release valves and time points when they allow themselves to stress out, um, that, "Hey, I've got a, I've got a brain scan this week. It's gonna be a rough week for me," and that's okay. But after and before, let's protect that time to live fully. So that's like one technique I learned from cancer patients that, uh, I try to apply to my life as well.
4. RCDr. Rangan Chatterjee
  There's a certain intentionality, isn't there-
5. RJDr Rahul Jandial
  Mm
6. RCDr. Rangan Chatterjee
  ... living like that? And, uh, as-
7. RJDr Rahul Jandial
  Yeah
8. RCDr. Rangan Chatterjee
  ... you describe that, I'm struck by, you know, how many of us just live on autopilot. We don't really think about what we're doing day to day. We're just existing. Before we know it, it's the end of the month. Before we know it, the season has changed. But what I'm hear-
9. RJDr Rahul Jandial
  Season
10. RCDr. Rangan Chatterjee
  Yeah. But what I'm hearing from these patients is that because of the three monthly scan, they have to, I guess, like an athlete in some ways-
11. RJDr Rahul Jandial
  Yeah
12. RCDr. Rangan Chatterjee
  ... um, live with intention. Now, that's the stressful part. Like, that could be if for an athlete, the performance. The- that's when you're having your race. But whilst you're training, you're gonna have some build weeks, you're gonna have some rest weeks. You know, I'm super conscious that I'm, I'm not trying to say being an athlete and suffering from cancer-
13. RJDr Rahul Jandial
  I get it
14. RCDr. Rangan Chatterjee
  ... is the same thing at all, just to be super clear. But there's something about that rhythm that they-
15. RJDr Rahul Jandial
  There you go
16. RCDr. Rangan Chatterjee
  ... they, they have a certain rhythm to life because of these fixed points.
17. RJDr Rahul Jandial
  Brother, that's, that's-- You captured it well. The s- the word season. So, um, I'm just gonna go on a random riff here. [laughs] I hope you don't mind. It's not, you know-
18. RCDr. Rangan Chatterjee
  That's what the show's all about. You go for it.
19. RJDr Rahul Jandial
  [laughs] Look, man, the, the, the problem is thinking in terms of something being linear or wires, and what, what I, what I w- have learned from patients and what is true neurobiology, I mean, you take a piece of brain, you put it under a microscope, the neurons branch towards each other. We call it arborization. The ones you don't engage, the brain trims them. We call it pruning. So seasons and gardens and ecosystems is the right way to think of your brain, and that's something cancer patients do. There will be a, a season of growth, but there'll also be a winter. That doesn't mean the winter puts you back. It's not two steps forward and one step back. It's you're, you're pulsing through your life. There are moments of triumph, but that's not forever. Maybe that's springtime. And there are moments of tragedy or difficulty, and that's not forever either. So if we really start to see our brains, and I just wish I could show people they're like a l- it's like 100 billion electric jellyfish cram- crammed into a skull that's floating in clear liquid, spraying chemicals and electricity like it's aurora borealis. If we knew we are like that in our skulls, I think we would see our mind and reactions and behavior differently, and I think the, your word season is spot on. There are seasons of, of growth, and there are seasons of, you know, sort of winter and loss, and there are also sort of seasons, uh, within the brain where things are dormant. There are brain cells that are dormant until you have a certain stress, and that's the cue for them to activate. If the stress is too high, they stay dormant. If there isn't any stress, they stay dormant. So if we start to think of our, our, our brains as gardens, it fits more with the patterns of life that cancer patients have.
20. RCDr. Rangan Chatterjee
  Yeah.
21. RJDr Rahul Jandial
  A very difficult diagnosis. What do you do next? Just suffer for the three years ahead or the 13 years ahead? So they, they bring in this concept of the seasons of their year. Difficult moments, surgery, chemotherapy, radiation, that was a difficult season. After that, they have some vitality and a good window to see family and travel. That's springtime in their life. I think if we do it that way, our stumbles and our difficulties don't feel like setbacks. They just feel like something that we, we push through, we brace through, uh, we manage through that crisis for this next springtime in our life that will arrive. That, that approach in their minds serves them well.
36:29 – 45:31
Facing the End of Life and Rethinking Surgery
1. RCDr. Rangan Chatterjee
  What about the patients who are not gonna be coming back for the three-month scan? For those who it literally is the end of the road, what can or what have you learnt from their outlook, and therefore, you know, what can we learn-
2. RJDr Rahul Jandial
  Mm-hmm
3. RCDr. Rangan Chatterjee
  ... um, fr- from hearing their stories?
4. RJDr Rahul Jandial
  Well, that's harder, you know, um, 'cause last year there was nobody at their bedside in hospitals in America. They, th- you couldn't have, you come in for cancer surgery or even end of life things were happening on FaceTime and stuff like that. So I, um, you know, it's hard to say. I mean, I've, I've, I've helped over 100 people at their end of life journey, and most of them, um, have left their intentions, um, written, and most of them have family or friends that guide those final decisions. But I would rewind maybe three months before that moment where they come to the place in their l- in their mind where they realize they don't want more treatment. They're not surrendering, they're not giving up, but they're realizing that the hospital, as far as treatments, and there's still s- pain control and hospice and, but that the hospital cannot serve them anymore in their journey. And that's actually a pretty intense moment because then they have to say, "Okay, now there is no partner for these final moments." You can have loved ones, those sort of things. And, uh, in their eyes at those, those discussions I have in clinic or in those conversations, it's interesting that most often I see them sort of running through a film tape of their life and how f- quickly it has gone by. You know, where they were born, the, the key places they lived, their family, friends, achievements, failures. And, um, that's an intense interaction to see that, that at some point you have to say, "Medicine and surgery, I don't choose that anymore." And that, that time with them has been very illuminating for me personally, that that time will come for me as well. And I don't live in, in fear or darkness. Actually, it creates an optimism. Like I'm-- this morning I got up and I was like, "Man, I'm thankful to be here today, and what am I gonna do with this today?" I take my days less for granted after seeing patients look up, uh, as my father did. And you can sort of like, a- almost like a windshield, you can see, like, the journey of their life. And when I see that in patients, I think there's no time to waste, and that's very important for me that there's no time to waste.
5. RCDr. Rangan Chatterjee
  Yeah. It must be very humbling. You know, you're someone who has achieved a lot in the conventional Western medical model, and therefore to hear... Or what was it like when you heard patients for the first time saying to you, "Yeah, you know, I'm, I'm kind of, I'm done with surgery and medicine."
6. RJDr Rahul Jandial
  Yeah.
7. RCDr. Rangan Chatterjee
  "Uh, this is not the path for me." Was there a struggle on some level because that's what you had been trained to do-
8. RJDr Rahul Jandial
  Yeah
9. RCDr. Rangan Chatterjee
  ... your medical school, residency, your exams, your peers. W- tell me about that 'cause that sounds like a super interesting moment in one's career where you maybe start to look at your training or certainly what you're here to do-
10. RJDr Rahul Jandial
  Um
11. RCDr. Rangan Chatterjee
  ... through a different lens.
12. RJDr Rahul Jandial
  That's a great question. That is the evolution of a surgeon. Um, in the beginning, I thought my skill had more potential to help than it does, and so I would, I would guide patients towards surgery, surgery that they can get at other places. But I always believed that surgery could do something, um, helpful. And then when you take care of enough patients, you also see that surgery has risks and complications too. And that is the, the nuance that's taken 15, 20 years to learn, is that for each patient, um, what do I offer? How do I explain? And whereas n- you can always cut things out, [laughs] you know, that's, it's the person that's left after I'm done with surgery that matters to me. And I always did, but especially now. So for example, I take care of women who have breast cancer that spreads to the brain. Now, when they have like a 12 or 13-year-old because they get breast cancer some- you know, in their 40s, and they're, they're at a different point in their life. They're individuals. And that's where you have to study humanity to be a, a, a cancer surgeon because your tool should not be offered or applied to everybody. But when they say to me, "He's f- my son is 14. I mean, I just really just, you know, I'd love to see him, uh, graduate high school." So now that menu for them, I say, "Okay, I just want you to know there are a lot of treatment options, and there are some surgical options that will help and keep you going and these sort of things." So w- we lean a, a bit different i- uh, in my toolkit, in our momentarium. On the other hand, if I have somebody who's 78, 84, we-- I do talk to them about that some of my patients, after choosing surgery, have had issues and never left the hospital. Not because the surgery didn't go well. The surgery, it's just that medical complications after surgery in people in their 70s and 80s, that's what, uh, keeps them from getting out of the hospital and-
13. RCDr. Rangan Chatterjee
  Yeah
14. RJDr Rahul Jandial
  ... and so from within that range, I would say there's another whole spectrum of considerations. And I actually feel good about, look, man, I, I-- first thing is you can choose nothing at all. That's what I say to my cancer patients. You, you, you are driving, and here are the different ways, different approaches. But you really have to become an expert in, in people and their stories and what they want and what they're fighting for to be the best surgeon for them-
15. RCDr. Rangan Chatterjee
  Yeah
16. RJDr Rahul Jandial
  ... more than just something technical.
17. RCDr. Rangan Chatterjee
  You know, a- as a fellow medical doctor, I'm not a surgeon, but I, I share a very similar view to you. That is also my experience. You know, you need to understand humanity. You need to understand people. You need to be respectful. You need to treat people with kindness, with compassion, with, with real respect. That's what medicine for me actually is all about, and it's-
18. RJDr Rahul Jandial
  Mm
19. RCDr. Rangan Chatterjee
  ... it's really f- fantastic for me to hear that, um, you know, coming from a neurosurgeon and someone who, who I respect a lot. It's really, it's really wonderful. That was one of the wonderful things about, about reading your new book actually is the, the humility that's there. And I've got to say, humility is not something typically people associate with surgeons, you know?
20. RJDr Rahul Jandial
  Right.
21. RCDr. Rangan Chatterjee
  And, and that is a prejudicial thing to say-
22. RJDr Rahul Jandial
  Yeah. A generalization-
23. RCDr. Rangan Chatterjee
  Just to be super clear. Yeah
24. RJDr Rahul Jandial
  ... but prejudicial.
25. RCDr. Rangan Chatterjee
  I, I get that. But within the medical profession and also outwith the medical profession, there is a certain stereotype of-
26. RJDr Rahul Jandial
  Mm-hmm
27. RCDr. Rangan Chatterjee
  ... surgeons, particularly high-powered surgeons like brain surgeons. But what's interesting for me as I reflect on that is one of my best friends, a guy called Steve, is a spinal surgeon on the south coast of England. And the compassion and empathy that he shows his patients i, is second to none. Um, and he's a very, very well-respected, competent, highly technical surgeon. But those people skills, I think, elevate him in certainly in, in my eyes and his patients' eyes. And with you as well, there's this real compassion. There's this real understanding that empathy with your patients is important, that you have to treat the person, that individual, rather than necessarily the scan.
28. RJDr Rahul Jandial
  Mm.
29. RCDr. Rangan Chatterjee
  And it's striking to me that there is that generalization out there, yet my good buddy Steve, who I know well, and now you-
30. RJDr Rahul Jandial
  Mm-hmm
45:31 – 51:09
Humility, Connection and Compassion in Surgery
1. RJDr Rahul Jandial
  surgeons are known to be more interested in the procedure than the patient. Um, and when I was learning, there's just so much to learn that it can appear that way. And I think for me, I think for me, I, I never thought I'd become a physician. I mean, I didn't-- [laughs] I think we talked about it last time. You know, I dropped out of university for a little while, fumbled my way back in, went to medical school, uh, became a surgeon, became a neurosurgeon, became a neuroscientist. It's just been haphazard going forward. I'm extremely grateful for the tremendous, uh, career and life that I have now. I have a big life. I don't know if it's a good life or a bad life, but it's a big life. I'm talking to you in London. I do things in Eastern Europe and South America and Asia. I, I, w- I think what makes me connect with my cancer patients is that I bring a lot of my own life to my interaction with them. It's okay for them to see that their, their surgeon has also struggled or having difficult times or had a, a parent pass away or-- I connect with them about that. And people say, "Well, how do you do that?" It's n- well, it's not storytelling. It's not, "Here, read these five questions to get a high patient satisfaction." They read your energy. They read your eyes. They read your-- They just, they just get it. And I think as a cancer surgeon, it's also sometimes-- in the beginning, I felt depleted sometimes because you can't just walk into a room and talk to a patient who has cancer in a some formulaic way. "Hey, nice to meet you. How are you doing?" These, you know, that's not, that's not the guy I am. That's not what they deserve. Um, but at first, I used to-- I felt like I, maybe I was losing some of the empathy, and then the more I tried to just bring, um, not my problems, but my complexities and share them also with them, that, uh, about my family, about the way I'm thinking, my journey, it became a strange [laughs] sort of reciprocal therapy session, you know? They're going through a lot. I was like, "Look, I'm going through a lot." And I would just share what was going on in my life, good and bad. And, and that was the, that was the thing is, um, to be a cancer surgeon, I mean, what greater connection? You meet me. You meet somebody, you say, "Nice," you know, "go ahead and open my skull. Take me through the last few years of my life." That to me is an incredible, uh, privilege, [laughs] just by from the curious side, an opportunity. How do you connect in 20 minutes? Do you hold their hand before they go back to surgery? How do you, how, how do you make them feel? Um, so I've learned to say things because, oh my gosh, with these masks and things going on, can you imagine? They were like, "Who are these people around me?" And I would always say to them, you know, "The minute before you roll back to surgery after having seen a lot of different people, you'll see me there. I'll hold your hand, and I'll look in your eyes, and I'll do the whole operation myself. You know I'm there with you." And that was something that they-- You know, so you start to see that they have concerns like, "Who's my surgeon? Who's, who's gonna be in there?" So I would, I would try to address that. Um, I would give their family a call before and after. Certain, you know, certain rituals that- Surgery doesn't start for, like, an hour and a half later. And for many of them that were praying, they're praying at 7:30, but the surgery by the time I get started is, you know, 8:45 because you have to set things up. So I would let them know that I'll be beginning around 8:00. They just feel connected, that this person is attentive. And the other thing I, I learned to show them, share with them, is, um, "I am with you, and I don't know where your journey goes." Because they're cancer patients [laughs] , you know? It's not a knee replacement where I can tell you, "You're gonna be walking, you're gonna be fine." I don't know where your journey goes, but you... I always tell them, you'll, "You'll never feel stranded." And I've even learned to use, like, physical cues after watching, like, the Sound of Metal and different people with sign language. Like, there's a lot to-
2. RCDr. Rangan Chatterjee
  Yeah
3. RJDr Rahul Jandial
  ... there's a lot to capturing a patient than s- that, and so there's the body language. I, I, I, "You'll never be stranded." I do this, you know, and there's a certain way I hold their hand, and just, just there's a certain firmness, just for a moment. And there's a, there's a, there's a way I've developed to connect with them.
4. RCDr. Rangan Chatterjee
  Yeah.
5. RJDr Rahul Jandial
  And, um, I thank them for teaching me that, you know? I thank them for teaching me that, that that's what works. There's always flexibility in how I do it, but it's a difficult position they're in, and, uh, I feel so grateful that they let me into those moments in their lives.
6. RCDr. Rangan Chatterjee
  I mean, it's wonderful to hear what you do. I c- I can only imagine how comforting that is for a scared patient about to go into theater, and you sort of, beforehand you're looking them in the eye. You're telling them, "I'm gonna be here with you. I'm the one doing your operation." You know, that-
7. RJDr Rahul Jandial
  Mm-hmm
8. RCDr. Rangan Chatterjee
  ... the comfort, you know, that sort of connection, I think it's the missing link in medicine.
9. RJDr Rahul Jandial
  Yeah.
10. RCDr. Rangan Chatterjee
  It's not what we get taught. It's not what tends to be valued. But, you know, you're a few years older than me, but in my 20 years experience of seeing patients-
11. RJDr Rahul Jandial
  Hmm
12. RCDr. Rangan Chatterjee
  ... the number one thing that I can do for a patient is to connect with them. Because everything I can offer them comes on the other side of connection. Now, I appreciate-
13. RJDr Rahul Jandial
  Hmm
14. RCDr. Rangan Chatterjee
  ... you are hands-on. You are sometimes removing tumors from the brain. There's a technical skill that is involved there. But
51:09 – 57:38
Connection, Awake Surgery and an Unconventional Path
1. RCDr. Rangan Chatterjee
  how important do you think in your role that that connection is, not only to how a patient feels, but also, like, to the outcome of what happens?
2. RJDr Rahul Jandial
  Hmm. That's a fascinating question. The, so there are people are looking at preoperative, which means before surgery, uh, meditation, faith. All these things have been shown before and after surgery, um, to lower the need for narcotics. So clearly they feel less pain. Uh, taking it a little deeper into the biological level that when you go into, it doesn't matter if you're gonna be getting the sleeping medicine and all of that, or the, the anesthetic, that if you go in with your stress response activated, that, um, that maybe the medicine doesn't work as well.
3. RCDr. Rangan Chatterjee
  Yeah.
4. RJDr Rahul Jandial
  And there's even some small papers suggesting that maybe cancer cells swim a little better when the body's under stress in that moment beforehand. Now, that's not completely proven, but we are looking in that way. Um, and so bringing them in calmly, uh, is, is essential. And I'll give you a more specific example. Sometimes we do awake brain surgery [laughs] , so that takes a lot of coaching. Before, when you see them in clinic, "Look, you're gonna wake up. It's gonna be a bit weird. Um, your skull will be open, and I'll be talking to you as I'm operating."
5. RCDr. Rangan Chatterjee
  Yeah.
6. RJDr Rahul Jandial
  That's a lot to walk into [laughs] . Just even when I still try to describe it or, I'm not laughing out of any, any, like, something disrespectful. I'm just thinking if I was on the other side, I'd be like, "What? What are you talking about?"
7. RCDr. Rangan Chatterjee
  Yeah.
8. RJDr Rahul Jandial
  You know? But to operate in the language region on the left temporal lobe, that is required. You're risking their humanity by, if you don't do an awake brain surgery. But coming back to connecting, that's a lot to walk people through. And then you wake them up under, when they're in the operating room, the scalp is numbed up, the skull is off, and they're talking to you. And you're tickling the brain. It doesn't feel on its own. It, so you can tickle it. It only feels through the nerves. You can touch the surface of the brain, and the person doesn't notice it. And you walk them through counting and reading words and different things, and you have to have a connection to take them through that. And so it doesn't have to be only an awake brain surgery. I try to bring that to all of my patients. Um, but that connection also, you know, I don't know if you can just teach empathy in a class. I used to always say, "Make these medical students do other things before."
9. RCDr. Rangan Chatterjee
  Yeah.
10. RJDr Rahul Jandial
  You know? Work in a, work in a coffee shop. Live and work a little bit. 'Cause you have to bring your own life exper- I mean, I was 35 consenting 75-year-olds for brain surgery. Well, I mean, you got to bring something from your own life that isn't just college and university and medical school.
11. RCDr. Rangan Chatterjee
  I, I-
12. RJDr Rahul Jandial
  And that's important
13. RCDr. Rangan Chatterjee
  ... I, I wonder if that's why your approach seems to be so different.
14. RJDr Rahul Jandial
  Mm-hmm.
15. RCDr. Rangan Chatterjee
  Because you had that unconventional path to neurosurgery.
16. RJDr Rahul Jandial
  Right.
17. RCDr. Rangan Chatterjee
  You know, most people who end up being, who end up, you know, performing well, certainly in medicine and in surgery, you know, often they went to the right schools. Um-
18. RJDr Rahul Jandial
  Mm-hmm
19. RCDr. Rangan Chatterjee
  ... they knew from a young age, maybe their family did the same job.
20. RJDr Rahul Jandial
  Right.
21. RCDr. Rangan Chatterjee
  And they go to the, the right college, the right university. They're, they're sort of at, they're on this sort of path, and they often end up getting there. I mean, of course, not everyone, but that is certainly-
22. RJDr Rahul Jandial
  That happens
23. RCDr. Rangan Chatterjee
  ... that happens. But you didn't do that. You worked in different jobs. You were a security guard while your school buddies were off at college, right? So this is, that is not conventional. So in, I, I just wonder how much of that-
24. RJDr Rahul Jandial
  [laughs]
25. RCDr. Rangan Chatterjee
  ... plays into what you bring
26. RJDr Rahul Jandial
  The security guard thing is funny. Not, not, not only were they off in college, I was a security guard at the cafeteria in their college. [laughs] So one day we... [laughs] And they were like, "Hey." I was like, "Hey." I mean, one day you're in class, [laughs] and the next day I've got my, like, uniform on. And I was like, "This is bizarre." But I, you know, I'd never [clicks tongue] ... You know, what other people think of me is none of my business, is one of my, and one of, you know. And at that moment I was trying to hold onto that. But I saw it as an adventure, you know? Everybody keeps talking about, like, adjustment, but I saw this life, and I still see this life as an adventure. Um, and that unconventional path, I mean... And then, you know, then I, I took the long road, and it's been unconventional, but during those times I was seeking unique interactions. I mean, I worked at an, I mean, volunteered at an Alzheimer's clinic. I worked at Marie Callender's as a busboy in Los Angeles. I mean, I was seeking those opportunities out. I mean, I think I've been a student of human nature since I was young. And then I went into, became, then the career thing, and now I'm back to being a student of human nature, and I realize I've been, uh, you know, I, the master class has been my career as a cancer surgeon. So, um, that's fascinating to me, that I fell forward into these things. And I feel very, again, fortunate for my life. But going back to, you know, the system selects for people who are spending all day, all night in the library. You c- the marks required to become a physician and surgeon is so high that you actually can't have fun. [laughs] Most people aren't, not gonna have fun and pull off the marks. So it ki- it's kind of a weird thing that you're almost selecting for bookworms in some sense. And then you're saying, "Here's, here's the hospital where you'll find [laughs] everything from addicts to CEOs, CEOs that are addicts, addicts that are coming in and out of..." You know, there's just such a wide range of humanity, and then you're putting bookworms in there. I think that there's a flaw-
27. RCDr. Rangan Chatterjee
  Yeah
28. RJDr Rahul Jandial
  ... in, in that. Um, and maybe they just need to say, "Hey, listen. Six months, you're gonna have to do some odd job. You gotta get out there a little bit before we throw you in the hospital," you know? I, I don't have a solution, but I see, I, I see where there might be an issue, a connection-
29. RCDr. Rangan Chatterjee
  Yeah
30. RJDr Rahul Jandial
  ... between physicians and patients.
57:38 – 1:04:44
Vicarious Fortification and Learning from Patients
1. RCDr. Rangan Chatterjee
  I went to medical school, like, maybe two weeks after I turned 18.
2. RJDr Rahul Jandial
  Mm. Young.
3. RCDr. Rangan Chatterjee
  And, you know, you can come out five years later. So, you know, I, I, I think, I know you were on Julia Samuels' podcast recently. Julia's a, a, a good friend. Um, and you know, I remember chatting to her about this when she was on the show. I said, "Listen, I was seeing patients when I was, like, 23 years old."
4. RJDr Rahul Jandial
  Mm.
5. RCDr. Rangan Chatterjee
  Like, I didn't have any life [laughs] experience to offer to bring to the, to the table. Like, they were telling me about personal stuff.
6. RJDr Rahul Jandial
  Right.
7. RCDr. Rangan Chatterjee
  They were a lot older than me. Things were going on. And look, I certainly did the best that I could, but I genuinely think I was too young to actually-
8. RJDr Rahul Jandial
  They're teaching you.
9. RCDr. Rangan Chatterjee
  Well, you know what? They've always taught me, and I've, I've said this in all of my books, that my, my patients have taught me-
10. RJDr Rahul Jandial
  Yeah
11. RCDr. Rangan Chatterjee
  ... a hell of a lot more than I've taught them. And that is something that I've noticed with your language throughout this conversation. You have said on multiple occasions, "What I learned from them. What I learned from them." It's something that comes up-
12. RJDr Rahul Jandial
  Yeah
13. RCDr. Rangan Chatterjee
  ... through your book as well, and I love that sort of humility and that sort of idea that actually we are learning just as much, if not more, from our patients-
14. RJDr Rahul Jandial
  Mm
15. RCDr. Rangan Chatterjee
  ... than they are from us.
16. RJDr Rahul Jandial
  Look, the, I think towards the end I have, I say something about, I, now, it's almost the... You know, 'cause I'm evolving, I'm changing. I mean, it's been an intense couple of years. I've had some... Everybody's going through difficult times. Um, I guess that's one of the, the, one of the things I've also learned from them. There may not be a time in your life when things aren't difficult. So, but you can't stop living and enjoying. It's sort of both. For me, the seasonal concept works well. Like, there are times of growth, and then there's times of, you know, where winter, and there's times of, you know, fall. And I, that helps me understand the, the almost cyclical nature of things in our lives. But they say, "Hey, yeah. I mean, I, I'm living with cancer. What, what am I supposed to do? In fact, because time is limited, I've got to party, rock out, travel, see people. I'm living with cancer." I mean, gosh, that is such an interesting phrase. So why can I not live when I don't have cancer, you know? I just, such, so, such insightful stuff you get from them. And back to thanking them, in the last, I've, now I'm like, "Why are you thanking me?"
17. RCDr. Rangan Chatterjee
  Yeah.
18. RJDr Rahul Jandial
  I should thank you for letting me come into this moment in your life for a few months or a few years. And I'm, you know, there's this concept of vicarious trauma, traumatization where people see trauma or fe- you know, nearby, and they're affected by it. But I feel the opposite. I feel like I've had vicarious fortification. I have learned through my patients' struggles without actually having to bear the real weight of the diagnosis and the treatments, right? I'm there with them. I'm learning with them. I'm partnering with them. I'm getting wiser from them. So I thank them.
19. RCDr. Rangan Chatterjee
  Yeah.
20. RJDr Rahul Jandial
  I thank them for allowing me to learn from their lives.
21. RCDr. Rangan Chatterjee
  Yeah.
22. RJDr Rahul Jandial
  I mean, and think about the sheer number of patients. I'm like, gosh, I was, when I was writing this book I was like, thousands.
23. RCDr. Rangan Chatterjee
  Yeah.
24. RJDr Rahul Jandial
  I'm 48, and I've at least shook hands... [laughs] People are like, what? You know, the, the different way of thinking about it is I've pro- I've met over 10,000 people for [laughs] for at least 15 minutes. I mean, that's a lot of volume of human interaction, right? It may be skewed, but not all of them. There's other... Before I was a cancer surgeon, we'd p- see people for routine things. And then I've opened thousands of human bodies, and what's interesting is not the anatomy, is that the interactions with them before and after. Don't get me wrong, I had to think about the anatomy and the procedure and the craft and getting talented at it, but along the way, it's, it's their journeys-
25. RCDr. Rangan Chatterjee
  Yeah
26. RJDr Rahul Jandial
  ... before and after the surgery that matter.
27. RCDr. Rangan Chatterjee
  In some ways, you know, you, we, we get the, we get the, the best deal out of it, right? We go along with their journey. We, we, we get to share, we get to learn, but we don't have to-
28. RJDr Rahul Jandial
  Mm
29. RCDr. Rangan Chatterjee
  ... deal with the quite severe consequences sometimes.
30. RJDr Rahul Jandial
  That's right.
1:04:44 – 1:14:02
Thought, Emotion and the Layers of the Brain
1. RCDr. Rangan Chatterjee
  I, I wanna shift gears a little bit. Um, earlier on in the conversation, you mentioned balance between thoughts and emotions, and I think that's a really interesting concept to unpack a little bit.
2. RJDr Rahul Jandial
  Mm.
3. RCDr. Rangan Chatterjee
  I've heard in a previous conversation that you've had that you said that depression, anxiety, OCD, and overeating all come-
4. RJDr Rahul Jandial
  Mm
5. RCDr. Rangan Chatterjee
  ... from a similar part of the brain, and that, again, with these conditions, there can be a problem with this balance. So-
6. RJDr Rahul Jandial
  Right
7. RCDr. Rangan Chatterjee
  ... I wonder if you could explain some of that, please.
8. RJDr Rahul Jandial
  Yeah. So I mean, this is, um... It's gonna take a little while for me to set up, but I, if, you know, if-
9. RCDr. Rangan Chatterjee
  Hey, if you got time.
10. RJDr Rahul Jandial
  [laughs] Okay. But it's very important, um, to me, um, that we've lost the nuance in our understanding. So let's just take a few simple examples. Inflammation's bad. Is it? I don't know. I mean, certain types of inflammation are bad, yes. If you are constantly stressed out, and you've, that's also generating an inflammatory response, that's horrible for you. Certain types of inflammation are necessary. But now let's get deeper with emotions and feelings and anxiety and these sort of things, right? There's a certain amount of anxiety that is appropriate. You should have situational anxiety. That's by design. That's protective. But when there isn't a threat and you're too vigilant and too anxious, not only is that unnecessary [laughs] and wasting precious calories if, if, you know, you're in the savanna or, you know, thousands of years ago, it actually is unhealthy for your brain and mind. You're not living well because you're anxious, but there isn't a cue for that. If you're anxious on the s- the day of the scan, hey, that's, that's what you're s- that's normal.
11. RCDr. Rangan Chatterjee
  Yeah.
12. RJDr Rahul Jandial
  That's what you, you want. Otherwise, then, otherwise I get worried that you're not really understanding the gravity of the situation. So, so there, the, the, the thermostat or the dial or the balance is very important to understand, that there is no... Let's take another one. ... addiction. That's a, that's, the balance is off. But those same pathways, the same chemicals, uh, the branching in, in the gardens of our mind that, that lead to addiction are also the ones that get you after your friend's spinal surgery to get up and try to walk. Also the ones that get you to try to go to the cancer center despite the odds, right? So that reward is a double-edged sword.
13. RCDr. Rangan Chatterjee
  Yeah.
14. RJDr Rahul Jandial
  Anxiety and vigilance is a double-edged sword. Inflammation is a double-edged sword. That's the efficiency of the design. It isn't, it's not on/off, it's- it's- it's tone. It can be modulated. Uh, that way everything inside us can help or hurt. With that comes responsibility. So now that if we think about, um... Let's get back to, uh, you know, OCD, anxiety. Let's think about these things. These are... The simplest way I can prove to you that they are a product or an outcome or they come from the ether of our emotional brains, it's a simple term, but I'll get into that, is that when we manipulate them with little electrodes called deep brain stimulation, you- you- we don't tickle the surface right under the skull. We don't tickle the- the frontal lobes where cognition, executive function, thought, um, creativity even is. We- we tickle deeper to the emotional brain, limbic system structures. Words you've heard before, amygdala, hippocampus, these kind of things. Structures that, uh, animals have also.
15. RCDr. Rangan Chatterjee
  Yeah.
16. RJDr Rahul Jandial
  So tho- that tells us that, that the- the emotional brain is not in balance with the thinking brain in some of these situations. And so let's- let's get deeper into that. So when the reptilian brain, which is through your mouth, it's through your mouth and, like, in this direction, it- it didn't morph into the emotional brain. The emotional brain [laughs] is sort of like a babushka doll or a mushroom. It was on top of it. You can see three structures. If you took a side picture of an MRI, there's, like, the cortical canopy. We call it the cortical canopy. What a beautiful word. And it, [clears throat] and it's like an accordion because it's just so big it had to be wrinkled to pack into the skull. Cortical canopy, underneath it is the emotional brain, behind it is the reptilian brain. Reptilian brain is triggering breath when you're unconscious and basic functions. Emotional brain is, "Should I jump when I'm at the edge of a cliff? Should I pull back when I see a snake on the ground?" You don't think about that, you react to that. And then the cortical canopy, the prefrontal lobes, they give the emotional brain context. Now stay with me here. How is it that we don't keep jumping at a rubber snake? Just, it's also first time, right?
17. RCDr. Rangan Chatterjee
  Yeah.
18. RJDr Rahul Jandial
  And then we say, "Wait a second." That's the interplay between cognition, the frontal lobes, and the emotional brain. There are actual pictures of branching of neurons between these regions.
19. RCDr. Rangan Chatterjee
  Wow.
20. RJDr Rahul Jandial
  And that is, that- that- that growing that garden, tending to that garden, however you do it, I don't have a simple answer for that. But if you know there's a physical interface between your thinking brain and your emotional brain trying to find that dance, then what you see is you f- you feel empowered. You feel empowered that maybe I can have a new perspective on fear. Maybe I can have a new perspective on PTSD through therapy and through other things we can talk about. Maybe this anxiety is something [inhales deeply] by controlling my breathing I can tamp down. So that's- that's powerful, that you can, you can dance with your emotional brain. You don't have to get rid of it, 'cause life without emotion is not lush. But you don't have to have the emotional brain take over your behavior and decisions and get you into trouble. And the last thing I wanna say about that is, the last example for people to know that this is possible, if you go to a movie and you get scared, it's the same, uh, amygdala, which is simplified. The amygdala is not the fear center, it's a vigilance center. It just pays attention to uncertainty. But the same emotional brain goes off, whether you're being actually chased by an axe murderer in the street or watching one in a movie theater. But when you watch in a movie theater and that adrenaline pulses through and your emotional brain [gasps] you actually, like, you get scared, but you don't run away because that's your frontal lobe branches coming down to your emotional brain saying, "Don't- don't run away, it'll be embarrassing. This is actually just a movie." That's context. So the, whether, how we stop jumping at the plastic snake on the second time, how we know the difference between a real attack and a fake attack on a movie, there is thought and emotion, those two examples, uh, beautifully working with each other. The emotion protection in the beginning, where thought would be, uh, too much of a delay, but then thought also says, "You know what? [laughs] Maybe these emotions are not, haven't earned their place in our lives." So that is emotional regulation. Um, and that- th- that being off is anxiety, OCD, uh, those sort of things. That's my understanding of it.
21. RCDr. Rangan Chatterjee
  I mean, firstly, I just love the, the awe and wonder with which you speak about-
22. RJDr Rahul Jandial
  [laughs]
23. RCDr. Rangan Chatterjee
  ... the brain. Like it is-
24. RJDr Rahul Jandial
  Yeah, man. It's a trip
25. RCDr. Rangan Chatterjee
  It's just incredible 'cause you've obviously studied it, but you've seen it. You've seen all these parts. I love hearing you describe the anatomy and you're sort of pointing through your mouth. It's-
26. RJDr Rahul Jandial
  Yeah, I mean-
27. RCDr. Rangan Chatterjee
  This is n- this is not, like, stuff you just read in a book. You- you-
28. RJDr Rahul Jandial
  [laughs]
29. RCDr. Rangan Chatterjee
  ... you literally know where it is and it's- it's... Yeah, it's wonderful to hear actually. It certainly gives it a certain something. Um, when the balance is off- between those two parts of the brain. Uh, and you said there's no simple answer.
30. RJDr Rahul Jandial
  Mm-hmm.
1:14:02 – 1:20:13
Regulating Emotions: Breathing, Medication and Brain Chemistry
1. RJDr Rahul Jandial
  And I think the, the things that I can answer with go back to the original part of our conversation, um, that turning your thought inward on whether these emotions are justified is step one. Um, and controlling your breathing, especially for anxiety i- is, is the go-to move there. Now, can you just think down, um, OCD, uh, depression? Not really. Because now you're in an, you're in an altered, you- you've- you're in an altered balance that becomes a feed forward. The, the inward-directed thoughts about your life, time to reflect daily, the breathing to control the anxiety, those are prevention and maintenance things coming up. Uh, if you find yourself in a, in a depression, uh, that's hard to do because now the balance is, is turned so far off that it's spiraling and gaining momentum, and that's where you need to have a, you know, you need to think about medicine, therapy, um, physical activity. So it, it really matters what we're talking about. Is it a daily maintenance of mental health, which we all need, right? We, I mean, we, we know so much about the heart and our skin, but from a young age, daily maintenance and tending to our mental health is important. But if you come in and you have significant mental health issues, there's a different approach for that. Now let me g- let me give you some biology about significant mental health issues. Let's say you have anxiety and somebody prescribes you Valium. Um, Valium is a benzodiazepine. It's an anxiolytic, okay? It can also make you stop breathing. It's dangerous as y- but, but I wanna go back to that interface between thought and emotion. Inside our skulls, with a microscope it would look like two trees with branches going into each other. I mean, it's... You can see it. It's not a ma- it's not an, it's not something you imagine. Well, when those neurons branch and connect to each other, they don't touch. They, they... When the, when two neurons come to each other, they pause and they spray chemicals. Chemicals you might have heard about, dopamine, serotonin, these sort of things. So when you take Valium for anxiety or seizures, what it's doing is it's manipulating GABA, the chemical that chills things down. So you've, you've exogenously put in a medicine that goes to those branching interconnections and quiets the electricity, so y- 'cause it's, it's, it's glitching out and you feel calm. And I think when people start to see that, okay, that's how this medicine, where it goes, how it works, it's powerful because the other thing that turns down that glitchy electricity [inhales] is meditative breathing. And I, I need people to know when I, when I, when I talk about breathing, I can explain it down to the chemicals being sprayed by those branches. Breathing or Valium do the same thing at the, at the molecular level in your brain. And you say, "How do you, how do you know?" Well, the first book showed that. When we do some surgeries, we put electrodes in and to look for seizure. I mean, we have hardcore surgical and, and biological data for that. Now let's take another example. So you, you take an antidepressant. Well, what is that? I mean, what, what is... Well, well, just like we were talking about reward, uh, getting you to get up in the morning to go and get your treatments or leading to addiction, mood can make you feel good or bad, okay? That makes sense. But when people are depressed, there's a, a, a paucity or lack... You know, serotonin isn't just right. So when you take, if somebody takes Prozac, we're back at those branches of brain cells and what they're spraying at each other between one neuron. There's a hundred billion and they have 10 bi- 10,000 connections each. What a SSRI is, selective serotonin reuptake inhibitor, Prozac, whatever it is, is when serotonin is sprayed from one neuron to another, the vacuum to evacuate it is turned off by that medicine, so you have more ambient serotonin and your mood gets better, and it takes time for that to happen globally. That's why antidepressants take, you know, a couple of months. So I'm not asking people to go on antidepressants or not, but just to start to think of your brain as an electrical and chemical garden. And so when you breathe, you affect the electricity and chemistry of your brain. When you take Valium or Prozac, you affect the chemistry of your brain. And when, uh, people wear those helmets and, and those things on their head, they're trying to learn about the electricity of the brain. So everything, if we have an understanding of anatomy, chemistry, the, the chemicals are being sprayed, and then electrical currents are being generated like a, like a jellyfish and it, but the pattern is more like Aurora Borealis, you can start to think about when I do this or I take this How does it fit within the garden of my mind and the garden of my brain? I think it's important when people know how it works, they're more likely to implement that measure.
2. RCDr. Rangan Chatterjee
  Yeah. For sure. Uh, I'm gonna certainly hope that everyone listening and watching will understand the importance of being able to manipulate and control your breath-
3. RJDr Rahul Jandial
  Mm
4. RCDr. Rangan Chatterjee
  ... um, i- to help them in, in their day-to-day lives. Rahul, if we think about this second book, certainly second book here in the UK. I know you've had other publications, uh, i- in America. It's a very different book. It's a very reflective book, and I, I like the way you've structured the chapters with, around different topics. You know, loss, grief, performance. You know, they, they... It's, it's a beautiful way of getting these ideas out there.
1:20:13 – 1:32:33
What Is the Self? Body, Mind and Narrative
1. RCDr. Rangan Chatterjee
  The chapter that I, I sort of got stuck on and kept reading was the one on self, I think chapter seven.
2. RJDr Rahul Jandial
  Mm.
3. RCDr. Rangan Chatterjee
  And I wanna talk about the self, because I thought you had an interesting way of talking about it, describing it, seeing it through-
4. RJDr Rahul Jandial
  Mm
5. RCDr. Rangan Chatterjee
  ... different operations and how people saw themselves after some, some pretty brutal operations actually. Um, so there's a couple things there. You know, you have said in the book that it is a combination of body, mind, and autobiographical narrative. You said our sense of self rarely changes through life. So, you know, what is our sense of self? What is different about it from the mind? What is different about that from the brain? And what have these various procedures and operations taught you about it?
6. RJDr Rahul Jandial
  Yeah. That's a, that's a big question and, and what I would say is there is no right or final answer, that this was my best effort to shed n- new light on a topic that has, you know, been relevant and, uh, inquired about since antiquity. The word neurophilosophy a decade ago caught me by surprise. Neurophilosophy. They put neuro in front of everything now, like neuroeconomics, neuro... [laughs] But neurophilosophy caught me by, uh... And it was actually in San Diego where I did, uh, my PhD. What is neurophilosophy? So the concept of identity and self, people have written about that for a long time, but in a certain operation where the brain is like a, a walnut, there's a bridge in the middle, there's hemispheres, we do something called disconnection surgery, and that's to keep electricity from one side from going to the other side if it's, um, you know, if it's, uh, related to epilepsy. So epilepsy is aberrant electricity. It's too much. If we can't cool it off with Valium and things that cool down the electricity, then at least we prevent it from going to the other side of the brain where a person will be, you know, knocked out and lose consciousness. But when you do those disconnection surgeries, sometimes people don't recognize... They, they were... Normally, they don't recognize halves of their body, and different types of injuries have done this too, and Oliver Sacks has written about this a little bit. So what happens, um, when you ha- take a small sort of band of neurons that connect the two hemispheres of your brain and you dissect through that and the person can no longer recognize a part of their own body, right? Not phantom limb, not this kind of stuff, but they have a, a... They just can't recognize own, their own part of their body. And they had, somebody had written, like, "Well, maybe this corpus callosum, this structure, can be argued as the seat of self and identity. You disrupt it and people don't recognize halves of their body." And I thought, "Okay, that's interesting," but my patients have shown me something else. Um, and so I try in this chapter to add to that. That's, that's established. You can read about that. Um, and so what I've seen is there is sort of the body's relevance, uh, to a sense of self, there's the mind's relevance to the sense of self, and I'll take you through three examples, and then there's also sort of, uh, having a sense of self of your own life and journey, your autobiographical memory, that you are on this journey and somehow you don't remember the details of 20 years ago, but you're still that person moving through all those life events. Uh, the first one that really rocked me was, uh, a very challenging operation where the cancer was taking over the pelvis and half the body was removed. It's called a hemicolectomy. And when you read about those operations and how those patients do afterwards, uh, there's a lot of suicidal ideation. Uh, it's in a pursuit for a cure. Sometimes they are, sometimes they aren't. But this one patient taught me that, that the connection between body and mind is not just something figurative, that it's literal, and the connection of his lower half of his body to his mind, when he lost that bottom half, when he chose to have that bottom half of his body surgically removed, it, it altered his h- sense of self. Not just a, a limb, not just an amputation, uh, not an appendage, uh, but the bottom half of his body. And what I learned from him was that everybody's got a unique sense of self when it comes to their body, and it shed a lot of light about people who... They do self-harm, they do tattoos, they do piercing. There's a lot of ways that how we feel about ourselves is connected to the ways- We manipulate our bodies or feel connected to our bodies. And for him, not all patients, but many, um, losing the pelvis and below was just too much. It was, um, it was something he regretted and something I regretted. I mean, he, he's, you know, he signed consent for the surgery, and there was a whole team involved, and it's in the book. But after that, he went into a depression that just couldn't be fixed. And, um, medicines didn't work. Nothing worked. And that gave me a, an interesting insight on, wait, the body and the mind, at some point, that is important. Other people are paralyzed, they haven't had this issue. So something about they can't move their body and it's connected, they feel whole.
7. RCDr. Rangan Chatterjee
  Mm-hmm.
8. RJDr Rahul Jandial
  But this guy, he could move his arms, he just lost belly button below, but that, that dismembering of half of his body left him in a psychological state that he could not reconcile with his former self. Whereas I've seen a lot of patients who are paralyzed, they don't have that same experience. So that was one example that shed light. And just briefly, the other example was operating on the insula. The, the brain actually can be opened up without being entered, and there's a little island of cortical canopy in there. And operating in that area, people wake up not only not recognizing other parts of their body, usually the other side, but denying its existence, like throwing their own arm out of the bed. And, and then you start to think about a sense of self as that's interoception, the cohesion with which we, uh, experience our body, as well as the extent we'll go to even throwing part of our body out of the bed to keep our, our, our perception of reality intact. And so the, if you manipulate the insula, and this gets-- Thanks for letting me go a little deeper into this. When you manipulate the insula, there's the, the brain looks fine. The mind has decided, "This arm isn't mine." It's not like the part of the brain that controls that arm is, is damaged. The insula, in wanting to feel whole, will actually, um, disregard the physical inputs coming from the whole half of the body, and that's called confabulation. That can happen with a certain type of drinking and stuff like that. Like, people will create lies to keep a, um, a perception, um, psychological perception of being whole and intact. So those are the, the two main examples that I can give you that I think shed light on-
9. RCDr. Rangan Chatterjee
  Yeah
10. RJDr Rahul Jandial
  ... body and mind.
11. RCDr. Rangan Chatterjee
  I mean, that, that last example, what you said there i, is just incredible because you're saying structurally-
12. RJDr Rahul Jandial
  Mm-hmm. Beautiful.
13. RCDr. Rangan Chatterjee
  Beautiful.
14. RJDr Rahul Jandial
  It's perfect.
15. RCDr. Rangan Chatterjee
  Intact, no problem. You know, we know everything required to do this particular function, it is all there. It's looking pristine.
16. RJDr Rahul Jandial
  Mm-hmm.
17. RCDr. Rangan Chatterjee
  Yet another part of the, the brain or the mind, I guess, is sort of-
18. RJDr Rahul Jandial
  Mind
19. RCDr. Rangan Chatterjee
  ... the mind is bringing a bit of nuance and context and going, "Hey, hey, structure's okay. That's cool. But you know what? I'm not happy. I need to make some changes to how I'm experiencing-
20. RJDr Rahul Jandial
  Mm-hmm
21. RCDr. Rangan Chatterjee
  ... my life and my body." For whatever reason, it's, it's, it is, it is incredibly... It's a bit scary. It's inspiring.
22. RJDr Rahul Jandial
  Mm.
23. RCDr. Rangan Chatterjee
  It's-- I guess it all speaks to the incredible-
24. RJDr Rahul Jandial
  It's magical
25. RCDr. Rangan Chatterjee
  ... it's, yeah. But the-
26. RJDr Rahul Jandial
  It's magical
27. RCDr. Rangan Chatterjee
  ... incredible power that-
28. RJDr Rahul Jandial
  Of the mind
29. RCDr. Rangan Chatterjee
  ... our mind has, and also then speaks to potentially the untapped potential-
30. RJDr Rahul Jandial
  Potential
1:32:33 – 1:38:55
Brain-Mind Reciprocity and Keeping the Brain Healthy
1. RJDr Rahul Jandial
  So if, if my children were to ask me this question, or a patient or a loved one or a friend or, [laughs] or even a foe, it doesn't matter. The answers from what we know are clear. Um, so I'll, I'll tell you what and then why. And, and please and, uh, allow me to explain why.
2. RCDr. Rangan Chatterjee
  Sure.
3. RJDr Rahul Jandial
  I, I feel that when people understand why, they're more likely to follow through with the change. Otherwise, it's, you know, it's sorta like fad psychology or do these three steps and life will be better, and when it isn't, there's this frustration that things that work for others aren't working for me. So with that caveat, with that disclaimer that your life is individual and your inner, inner life and your inner experiences are yours, and I don't know where you are a- at the sta- the station in your life, um, triumphant, struggling, somewhere in between, whatever season. That said, the brain is flesh, okay? So to keep flesh healthy in the body, it needs to be irrigated. Blood is delivered by blood vessels. If those blood vessels are clogged, the flesh that it irrigates, much like a sprinkler to a part of the, part of the lawn, will wither and die off. So, um, poor-- It's not heart health. I just wanna be very clear. Poor vascular health. If your blood vessels going into your brain are clogged and not delivering all the blood flow they can, parts of your brain will start to die. Little swaths of it will start to die. I see it on MRIs in people as they get older. Micro strokes, white matter changes, these sort of like technical things. So the first thing is, if we're talking about brain health and mental health, you gotta keep the flesh irrigated. Okay? How do you do that? A lot of other people can tell you that. Some people take cholesterol medicine. You exercise. You keep your blood vessels healthy. Same thing for heart blood vessels, same thing applies for brain blood vessels. Now let's zoom in. So, okay, so we're just gonna take this from, you know, just like the solar system, but I'm gonna go-- I wanna go flesh to, to molecules. So keep your f- [laughs] keep the white flesh healthy. I think that people understand. Um, then let's zoom in. What neurons look like, okay, so we've gone from like the beautiful garden from a distance to now we're actually looking at one plant, one neuron. Neurons send chemicals and electricity all around. The speed with which that electrici- electricity travels is improved by having the tentacles of those jellyfish, if you will, wrapped in a certain fat. Insulation, just like your wires or cables that you're looking at are wrapped in something, not just to protect you, but sometimes also to improve the conduction, the speed. That's where fatty fish or omega-3s come in. The myelin sheath, that's what it's called, wrapping those tentacles or those neurons, the hundred billion, requires a fatty substance. And you don't have-- You can be vegan and get this. So fatty fish twice a week, like salmon, or chia seeds and other things will provide the nutrients, [laughs] okay? First you got the irrigation to the garden. That's blood vessels, vascular health. Now you've got the nutrients that fertilize and keep, keep the-- Not fertilize, actually. I don't wanna say that one. That, that help build the branches of those plants in your garden, those neurons in your garden. So that's a certain dietary thing you wanna do. Mostly vegetarian with, with fatty fish or, if you're vegan, with something that supplements omega-3s. That's, that's the s- the second thing you wanna do. Now, at the third thing you wanna do is you wanna fertilize that garden, that ecosystem in your skull, and the best fertilizer is exercise. So exercise, not that like something comes up from your muscles and lands in your brain. Your brain has its own pharmacy. When you exercise, it starts spraying all the, the, the, the brain, the neurons with things like growth factors like BDNF. And so now you're h- you're globally tending to the garden. And then the fourth thing you wanna do is the most important thing, is think and challenge yourself. If you get into habits and ruts and don't keep expanding the corners of your life and thought, what happens is parts of that garden become dormant. You don't need them. You can get home on the tube or on the freeway with just using a small part of the garden. Why would you engage at all? It's very inefficient. So you actually have to consciously Thought has to say, "I wanna try new things, learn new things." You don't have to get good at it, but the process of learning, of challenging yourself, changes the concentration and patterns of the chemicals that are being sprayed, uh, between those neurons. And to me, that's the most powerful thing, that thought is the ultimate, ultimate tender cultivator of, of the human brain and the mind. And I can't tell you how your journey will go, whether you'll reflect or, you know, take time to reflect, turn your attention inward, you know, deep bre- meditative breathing. Like, I don't know how you'll put it all together, but I just want people to know that's how, that's how it is, and s- those are the skull contents, if you will. And I'll conclude with, to me, the understanding is the gift. Um, the possibility is the gift. And now if everybody has that in their mind, when they deploy it, when they rely upon it, is up to them. And that's what, uh, I've learned from my patients and from the science I've been working on in my own life journey.
4. RCDr. Rangan Chatterjee
  Yeah. I mean,
1:38:55 – 1:44:03
Use It or Lose It, and Closing Reflections
1. RCDr. Rangan Chatterjee
  it reminds me a little bit of a conversation I had yesterday evening actually with my mom, right? So my mom-
2. RJDr Rahul Jandial
  Mm
3. RCDr. Rangan Chatterjee
  ... lives about five minutes away. She's, she lives by herself. She's certainly not as mobile as she used to be, and I feel that there's been a decline recently because I think there's been a lot of help. Like, I go round and give her-
4. RJDr Rahul Jandial
  [laughs]
5. RCDr. Rangan Chatterjee
  ... uh, breakfast most days, and-
6. RJDr Rahul Jandial
  Mm
7. RCDr. Rangan Chatterjee
  ... the last few days I've noticed Mom's not going to get things herself.
8. RJDr Rahul Jandial
  Mm-hmm.
9. RCDr. Rangan Chatterjee
  She's waiting for people to come. And I had a, I made sure I was in a, in a good state of mind yesterday in the evening, but I thought, "Let me have a calm conversation." I tried to explain. I said, "Hey, Mom, listen. Look, I, I know it's easier if I get you this or, you know, my brother gets you this, but at your age and the way your health is, I actually think you'd go a few days of us getting stuff for you and your brain's just gonna go, 'Ah, I don't need to do that anymore.'
10. RJDr Rahul Jandial
  Yeah.
11. RCDr. Rangan Chatterjee
  I'm gonna just-
12. RJDr Rahul Jandial
  Hibernating.
13. RCDr. Rangan Chatterjee
  Yeah. And I said, "Mom..." And I, and I saw a difference this morning, actually. I went round and she actually said, "No, no, I'm, I'm gonna get it." And I was... It, it was really nice, but I guess you would sort of, you would say that that was the right thing. You would sort of, y- you know, you definitely subscribe-
14. RJDr Rahul Jandial
  L- [laughs]
15. RCDr. Rangan Chatterjee
  ... to that use it or lose it.
16. RJDr Rahul Jandial
  Yeah. Unless you're trying to hide from your mom and you're using this as an excuse [laughs] but I don't think you are. I think the, the most important thing is that with, uh, with moms and loved ones, you know, if we said... You know, we know with kids we don't wanna baby them, otherwise they won't develop or culti- you know, mature. I think with older folks, isolation is a big issue, so i- if, you know, spending time is great for them. The connection is great for them. But doting on them in the way where you're doing their activities of daily living for them, I think that gets in the way, and that's exactly what you're hitting on. Great, you know, ground-level life example. Like, they gotta go to the patience. Like, look, you gotta go to the [laughs] bathroom on your own. I know it's easier to have a commode next to your bedside. No, you gotta walk to the kitchen. You gotta walk to the bathroom. Don't sit on the... That, that part you have to keep them where they are, if not more. Yet with older folks, uh, loneliness and isolation can weigh in, so let [laughs] let her do her stuff and then just hang out with her.
17. RCDr. Rangan Chatterjee
  Yeah.
18. RJDr Rahul Jandial
  You know?
19. RCDr. Rangan Chatterjee
  For sure.
20. RJDr Rahul Jandial
  Good stuff, man.
21. RCDr. Rangan Chatterjee
  Well, Rahul, look, I've, I've really enjoyed our conversation. Um, I, I really big fan of both of the books here in the UK. Uh, I really hope people rush out to get your new one, Life on a Knife's Edge. Um, this podcast is called Feel Better, Live More. When we feel better in ourselves, we get more out of life. You've, you've beautifully gone through some practical things that people can actually do in their day-to-day lives. But I thought a, a really nice way to, to close off this conversation is your sort of final higher level thoughts and wisdom. Because what I really get from the new book and our conversation today is, yeah, the, the things we do day to day, yes, they are important of course. But the way we think about our life-
22. RJDr Rahul Jandial
  Mm
23. RCDr. Rangan Chatterjee
  ... the way we prioritize our life, the way we can learn from people who feel that they may be at the end of their life-
24. RJDr Rahul Jandial
  Mm
25. RCDr. Rangan Chatterjee
  ... I feel there's some real powerful wisdom there, so I wonder if you could just share some of your closing thoughts on that for my audience.
26. RJDr Rahul Jandial
  Thank you. First of all, I'm honored just to [laughs] be asked that question, you know? Um, again, I, I, I would like to share that, um, that life at its depths also reveals its heights, meaning that people who are struggling can also tre- demonstrate tremendous powers and strength and growth that they didn't know they had in them, and to witness that has been powerful. And the second thing I would say is, um, that no triumph or tragedy is forever, and I have seen that in, in families going through very difficult stuff. And so if we see our lives and the moments in our lives as seasons, um, enjoy where you're at, and if you find yourself in a difficult place, you know, that too shall pass and there will be a new season after that. Uh, those are the lessons I've learned.
27. RCDr. Rangan Chatterjee
  Rahul, thanks for making time for the conversation today, and I hope I get a chance to speak to you in person at some point in the future.
28. RJDr Rahul Jandial
  Thank you. [upbeat music]
29. RCDr. Rangan Chatterjee
  If you enjoyed that conversation, I think you are really going to enjoy the one I had with the former monk Jay Shetty on the simple things that you can do to train your mind. It's right there. Give it a listen and let me know what you think. The monk mindset is about pursuing your truest goals, your truest self, and your most authentic aligned goals