20THANNIVERSARYEDITION

GIFTEDHANDSTHEBENCARSONSTORY

BENCARSON,M.D.withCECILMURPHEY

Thisbookisdedicatedtomymother,

SONYACARSON,whobasicallysacrificedherlife

tomakecertainthatmybrotherandIgotaheadstart.

Contents

Cover

TitlePage

ALetterfromSonyaCarson

Introduction

CHAPTER1“Goodbye,Daddy”

CHAPTER2CarryingtheLoad

CHAPTER3EightYearsOld

CHAPTER4TwoPositives

CHAPTER5ABoy’sBigProblem

CHAPTER6ATerribleTemper

CHAPTER7ROTCTriumph

CHAPTER8CollegeChoices

CHAPTER9ChangingtheRules

CHAPTER10ASeriousStep

CHAPTER11AnotherStepForward

CHAPTER12ComingIntoMyOwn

CHAPTER13ASpecialYear

CHAPTER14AGirlNamedMaranda

CHAPTER15Heartbreak

CHAPTER16LittleBeth

CHAPTER17ThreeSpecialChildren

CHAPTER18CraigandSusan

CHAPTER19SeparatingtheTwins

CHAPTER20TheRestofTheirStory

CHAPTER21FamilyAffairs

CHAPTER22ThinkBig

AbouttheAuthor

AlsobyBenCarson

Copyright

AboutthePublisher

ALetterfromSonyaCarson

DearReader,

AsthemotherofBenandhisbrother,Curtis,Ihadalotofchallenges. Being one of twenty-four children, gettingmarriedatage thirteen,and laterhaving togetadivorceafter finding outmy husbandwas a bigamistwere just afew of them. But God helpedme every step of the way,evenwhenIdidn’tnotice.

Fortunately, I could see what happens to people onwelfare and decided Iwould trymy best tomake sure itwouldnothappentomyboys.Byworkingseveraljobsatatime,Ifiguredwecouldstillhaveenoughtoeatandhavearoofoverourheads.Whileotherfamilieswouldgotothemovies or to amusement parks for entertainment, wewould go to nearby farms and pick strawberries or otherfreshproduce,offeringtopickfourbushelsforthefarmerifhe’dletuskeepone.Whenwegothome,Iwouldcanthefood sowewould have a supply to carry us through thewinter.

Many times I found myself quoting a poem called“Yourself toBlame”(byMaymeWhiteMiller) to theboysthat kept me going through those hard times. I oftenquotedone line inparticular to them:“You’re thecaptainofyourship”:

Ifthingsgobadforyou—Andmakeyouabitashamed,Oftenyouwillfindoutthat

Youhaveyourselftoblame…SwiftlywerantomischiefAndthenthebadluckcame.Whydowefaultothers?Wehaveourselvestoblame…

Whateverhappenstous,Herearethewordstosay,“Haditnotbeenforso-and-soThingswouldn’thavegonethatway.”

Andifyouareshortoffriends,I’lltellyouwhattodo—Makeanexamination,You’llfindthatfault’sinyou…

You’rethecaptainofyourship,Soagreewiththesame—Ifyoutraveldownward,Youhaveyourselftoblame.

Rememberthisasyougothroughlife.Thepersonwhohasthemosttodowithwhathappenstoyouisyou!Youmakethechoices;youdecidewhetheryou’regoingtogiveuporanteupwhenthegoinggetstough.Ultimately,it’syouwhodecides whether you will be a success or not, by doingwhatislegallynecessarytogetyouwhereyouwanttogo.Youarethecaptainofyourownship.Ifyoudon’tsucceed,youonlyhaveyourselftoblame.

SonyaCarson

M

Introduction

byCandyCarson

oreblood!Stat!”The silence of the OR was smashed by the

amazinglyquietcommand.Thetwinshadreceived50unitsofblood,buttheirbleedingstillhadn’tstopped!

“There’snomoretype-specificblood,”thereplycame.“We’veuseditall.”

As a result of this announcement, a quiet panicerupted through the room. Every ounce of type AB*negativebloodhadbeendrained from theJohnsHopkinsHospital blood bank. Yet the 7-month-old twin patientswhohadbeenjoinedatthebackoftheirheadssincebirthneededmorebloodortheywoulddiewithouteverhavinga chance to recuperate. This was their only opportunity,theironlychance,atnormallives.

Their mother, Theresa Binder, had searchedthroughout the medical world and found only one teamwhowaswillingtoevenattempttoseparatehertwinboysandpreservebothlives.Othersurgeonstoldheritcouldn’tbedone—thatoneoftheboyswouldhavetobesacrificed.Allowoneofherdarlingstodie?Theresacouldn’tevenbearthe thought.Although theywere joinedat thehead,evenat 7 months of age each had his own personality—oneplaying while the other slept or ate. No, she absolutelycouldn’tdoit!AftermonthsofsearchingshediscoveredtheJohnsHopkinsteam.

Manyofthe70-memberteambeganofferingtodonatetheirownblood,realizingtheurgencyofthesituation.The 17 hours of laborious, tedious, painstaking

operating on such tiny patients had progressed well, allthings considered. The babies had been successfullyanesthetized after only a fewhours, a complexprocedurebecauseof their sharedbloodvessels.Thepreparation forcardiovascular bypass hadn’t taken much longer thanexpected(thefivemonthsofplanningandnumerousdressrehearsals had paid off). Getting to the site of the twins’juncturewasn’tparticularlydifficultfortheyoung,thoughseasoned, neurosurgeons either. But, as a result of thecardiovascularbypassprocedures,thebloodlostitsclottingproperties.Therefore,everyplaceintheinfants’headsthatcouldbleeddidbleed!Fortunately, within a short time the city blood bank

was able to locate the exact number of units of bloodneededtocontinuethesurgery.Usingeveryskill,trick,anddeviceknown in their specialities, the surgeonswereableto stop the bleeding within a couple of hours. Theoperation continued. Finally, the plastic surgeons sewedthe last skin flaps to close the wounds, and the 22-hoursurgicalordealwasover.TheSiamese twins—PatrickandBenjamin—wereseparateforthefirsttimeintheirlives!Theexhaustedprimaryneurosurgeonwhohaddevised

theplanfortheoperationwasaghettokidfromthestreetsofDetroit.

*Bloodtypechangedforprivacy.

A

CHAPTER1

“Goodbye,Daddy”

ndyourdaddyisn’tgoingtolivewithusanymore.”“Whynot?”Iaskedagain,chokingbackthetears.

I justcouldnotaccept thestrangefinalityofmymother’swords.“Ilovemydad!”

“He lovesyou too,Bennie…buthehas togoaway.Forgood.”

“Butwhy?Idon’twanthimtogo.Iwanthimtostayherewithus.”

“He’sgottogo—”“DidIdosomethingtomakehimwanttoleaveus?”“Oh, no, Bennie. Absolutely not. Your daddy loves

you.”Iburstintotears.“Thenmakehimcomeback.”“I can’t. I just can’t.”Her strongarmsheldmeclose,

tryingtocomfortme,tohelpmestopcrying.Graduallymysobs died away, and I calmed down. But as soon as sheloosened her hug and let me go, my questions startedagain.

“YourDaddydid—“Motherpaused,and,youngasIwas,IknewshewastryingtofindtherightwordstomakemeunderstandwhatIdidn’twanttograsp.“Bennie,yourdaddydidsomebadthings.Realbadthings.”

I swiped my hand across my eyes. “You can forgivehimthen.Don’tlethimgo.”

“It’smorethanjustforgivinghim,Bennie—”“But IwanthimtostayherewithCurtisandmeand

you.”OnceagainMothertriedtomakemeunderstandwhy

Daddywas leaving,butherexplanationdidn’tmakea lotof sense to me at 8 years of age. Looking back, I don’tknowhowmuchofthereasonformyfather’sleavingsankintomyunderstanding.Evenwhat I grasped, Iwanted toreject.MyheartwasbrokenbecauseMothersaid thatmyfatherwasnevercominghomeagain.AndIlovedhim.Dadwasaffectionate.Hewasoftenaway,butwhenhe

washomehe’dholdmeonhislap,happytoplaywithmewheneverIwantedhimto.Hehadgreatpatiencewithme.Iparticularlylikedtoplaywiththeveinsonthebackofhislargehands,becausetheyweresobig.I’dpushthemdownandwatchthempopbackup.“Look!They’rebackagain!”I’d laugh, tryingeverythingwithinthepowerofmysmallhandstomakehisveinsstaydown.Dadwouldsitquietly,lettingmeplayaslongasIwanted.Sometimes he’d say, “Guess you’re just not strong

enough,” and I’d push even harder. Of course nothingworked,andI’dsoonloseinterestandplaywithsomethingelse.Even thoughMother said thatDaddyhaddone some

badthings,Icouldn’tthinkofmyfatheras“bad,”becausehe’d always been good to my brother, Curtis, and me.SometimesDadbroughtuspresents fornospecial reason.“Thoughtyou’d likethis,”he’dsayoffhandedly,a twinkleinhisdarkeyes.Many afternoons I’d pester my mother or watch the

clockuntil I knew itwas time formydad to comehomefromwork.ThenI’drushoutsidetowaitforhim.I’dwatchuntilIsawhimwalkingdownouralley.“Daddy!Daddy!”I’dyell,runningtomeethim.Hewouldscoopmeintohisarmsandcarrymeintothehouse.

I

That stopped in 1959 when I was 8 years old andDaddylefthomeforgood.Tomyyoung,hurtingheartthefuture stretched out forever. I couldn’t imagine a lifewithoutDaddy and didn’t know if Curtis,my 10-year-oldbrother,orIwouldeverseehimagain.

don’t know how long I continued the crying andquestioning thedayDaddy left; I only know itwas thesaddestdayofmylife.Andmyquestionsdidn’tstopwithmy tears. For weeks I pounded my mother with everypossibleargumentmymindcouldconceive, tryingto findsomewaytogethertomakeDaddycomebackhome.

“HowcanwegetbywithoutDaddy?”“Whydon’tyouwanthimtostay?”“He’ll begood. I knowhewill.AskDaddy.Hewon’t

dobadthingsagain.”My pleading didn’t make any difference. My parents

hadsettledeverythingbeforetheytoldCurtisandme.“Mothersandfathersaresupposedtostaytogether,”I

persisted. “They’re both supposed to be with their littleboys.”

“Yes, Bennie, but sometimes it just doesn’t work outright.”

“Istilldon’tseewhy,”Isaid.IthoughtofallthethingsDaddidwithus.Forinstance,onmostSundays,DadwouldtakeCurtisandmefordrivesinthecar.Usuallywevisitedpeople, and we’d often stop by to see one family inparticular.Daddywouldtalkwiththegrown-ups,whilemybrotherand Iplayedwith thechildren.Only laterdidwelearn the truth—my father had another “wife” and otherchildrenthatweknewnothingabout.

I don’t know how my mother found out about hisdoublelife,forsheneverburdenedCurtisandmewiththeproblem.Infact,nowthatI’manadult,myonecomplaint

isthatshewentoutofherwaytoprotectusfromknowinghowbadthingswere.Wewereneverallowedtosharehowdeeply she hurt. But then, that was Mother’s way ofprotectingus,thinkingshewasdoingtherightthing.Andmany years later I finally understoodwhat she called his“betrayalswithwomenanddrugs.”Long before Mother knew about the other family, I

sensed things weren’t right between my parents. Myparentsdidn’targue;instead,myfatherjustwalkedaway.Hehadbeenleavingthehousemoreandmoreandstayingawaylongerandlonger.Ineverknewwhy.Yet when Mother told me “Your daddy isn’t coming

back,”thosewordsbrokemyheart.I didn’t tellMother, but every night when I went to

bed I prayed, “Dear Lord, helpMother andDad get backtogether again.” Inmyheart I just knewGodwouldhelpthemmakeupsowecouldbeahappyfamily.Ididn’twantthemtobeapart,andIcouldn’timaginefacingthefuturewithoutmyfather.ButDadnevercamehomeagain.Asthedaysandweekspassed,Ilearnedwecouldget

by without him. We were poorer then, and I could tellMotherworried,althoughshedidn’tsaymuchtoCurtisorme.AsIgrewwiser,andcertainlybythetimeIwas11,IrealizedthatthethreeofuswereactuallyhappierthanwehadbeenwithDadinthehouse.Wehadpeace.Noperiodsof deathly silence filled thehouse. I no longer frozewithfear or huddled in my room, wondering what washappeningwhenMotherandDaddydidn’ttalk.That’s when I stopped praying for them to get back

together. “It’s better for them to stay split up,” I said toCurtis.“Isn’tit?”“Yeah, guess so,” he answered. And, likeMother, he

didn’tsaymuchtomeabouthisownfeelings.ButIthinkIknewthathetooreluctantlyrealizedthatoursituationwas

W

betterwithoutourfather.TryingtorememberhowIfeltinthosedaysafterDad

left, I’m not aware of going through stages of anger andresentment. My mother says that the experience pushedCurtis and me into a lot of pain. I don’t doubt that hisleavingmeantaterribleadjustmentforbothofusboys.YetIstillhavenorecollectionbeyondhisinitialleaving.

Maybethat’showIlearnedtohandlemydeephurt—byforgetting.

ejustdon’thavethemoney,Bennie.”In themonths afterDad left,Curtis and Imust

haveheardthatstatementahundredtimes,and,ofcourse,itwastrue.Whenweaskedfortoysorcandy,aswe’ddonebefore, I soon learned to tell from the expression onMother’s face how deeply it hurt her to deny us. After awhile I stoppedasking forwhat I knewwe couldn’t haveanyway.

In a few instances resentment flashed across mymother’s face.Thenshe’dgetverycalmandexplaintousboysthatDadlovedusbutwouldn’tgiveheranymoneytosupportus.IvaguelyrecallafewtimeswhenMotherwenttocourt, trying togetchild support fromhim.Afterward,Dadwouldsendmoneyforamonthortwo—neverthefullamount—and he always had a legitimate excuse. “I can’tgiveyouallof it this time,”he’dsay,“but I’ll catchup. Ipromise.”

Dad never caught up. After a while Mother gave uptryingtogetanyfinancialhelpfromhim.

Iwasaware thathewouldn’t givehermoney,whichmadelifeharderonus.Andinmychildishloveforadadwhohadbeenkindandaffectionate,Ididn’tholditagainsthim. But at the same time I couldn’t understand how hecouldloveusandnotwanttogiveusmoneyforfood.

OnereasonIdidn’tholdanygrudgesorharshfeelingstoward Dad must have been that my mother seldomblamed him—at least not to us or in our hearing. I canhardlythinkofatimewhenshespokeagainsthim.More important than that fact, though, Mother

managedtobringasenseofsecuritytoourthree-memberfamily. While I still missed Dad for a long time, I felt asense of contentment beingwith justmymother andmybrotherbecausewereallydidhaveahappyfamily.My mother, a young woman with hardly any

education,camefromalargefamilyandhadmanythingsagainst her. Yet she pulled off amiracle in her own life,and helped in ours. I can still hear Mother’s voice, nomatterhowbadthingswere,saying,“Bennie,we’regoingto be fine.” Those weren’t empty words either, for shebelievedthem.Andbecauseshebelievedthem,CurtisandIbelieved them too, and they provided a comfortingassuranceforme.Part of Mother’s strength came from a deep-seated

faith in God and perhaps just as much from her innateability to inspireCurtis andme toknowshemeanteveryword she said. We knew we weren’t rich; yet no matterhow bad things got for us, we didn’t worry about whatwe’dhavetoeatorwherewe’dlive.Ourgrowingupwithouta fatherputaheavyburden

onmymother.Shedidn’tcomplain—at leastnot tous—andshedidn’tfeelsorryforherself.Shetriedtocarrythewhole load, and somehow I understood what she wasdoing.Nomatterhowmanyhoursshehadtobeawayfromusatwork,Iknewshewasdoingitforus.Thatdedicationandsacrificemadeaprofoundimpressiononmylife.Abraham Lincoln once said, “All that I am or ever

hopetobe,Iowetomymother.”I’mnotsureIwanttosayit quite like that, butmymother, Sonya Carson,was theearliest,strongest,andmostimpactingforceinmylife.

It would be impossible to tell about myaccomplishments without starting with my mother’sinfluence. Forme to tell my storymeans beginning withhers.

T

CHAPTER2

CarryingtheLoad

hey’re not going to treat my boy that way,” Mothersaid as she stared at the paper Curtis had given her.

“No, sir, they’re not going to do that to you.” Curtis hadhadtoreadsomeofthewordstoher,butsheunderstoodexactlywhattheschoolcounselorhaddone.

“Whatyougoingtodo,Mother?”Iaskedinsurprise.Ithad never occurred to me that anyone could changeanythingwhenschoolauthoritiesmadedecisions.

“I’mgoingrightoverthereinthemorningandgetthisstraightened out,” she said. From the tone of her voice Iknewshe’ddoit.

Curtis,twoyearsmysenior,wasinjuniorhighschoolwhen the school counselor decided to place him into thevocational-typecurriculum.Hisonce-lowgradeshadbeenclimbingnicelyformorethanayear,buthewasenrolledinapredominantlyWhiteschool,andMotherhadnodoubtthat the counselor was operating from the stereotypicalthinkingthatBlackswereincapableofcollegework.

Ofcourse,Iwasn’tattheirmeeting,butIstillvividlyrememberwhatMothertoldusthatevening.“Isaidtothatcounselor woman, ‘My son Curtis is going to college. Idon’twanthiminanyvocationalcourses.’“Thensheputherhandonmybrother’shead.“Curtis,youarenowinthecollegeprepcourses.”

That story illustratesmymother’s character. Shewasnot a person who would allow the system to dictate her

life.Motherhadaclearunderstandingofhowthingswouldbeforusboys.Mymotherisanattractivewoman,fivefeetthreeand

slim,althoughwhenwewerekids I’d say shewason theplumpsideofmedium.Todayshesuffersfromarthritisandheart problems, but I don’t think she has slowed downmuch.Sonya Carson has the classic Type A personality—

hardworking,goal-oriented,driven todemanding thebestofherself inanysituation,refusingtosettleforless.She’shighlyintelligent,awomanwhoquicklygraspstheoverallsignificance rather than searching for details. She has anaturalability—anintuitivesense—thatenableshertoperceive what should be done. That’s probably her mostoutstandingcharacteristic.Because of that determined, perhaps compulsive,

personality that demanded so much from herself, sheinfusedsomeofthatspiritintome.Idon’twanttoportraymymotherasperfectbecauseshewashumantoo.Attimesher refusing to allow me to settle for less than the bestcameacrossasnagging,demanding,evenheartlesstome.Whenshebelievedinsomethingsheheldonandwouldn’tquit. I didn’t always like hearing her say, “You weren’tborntobeafailure,Bennie.Youcandoit!”Oroneofherfavorites:“YoujustasktheLord,andHe’llhelpyou.”Beingkids,wedidn’talwayswelcomeherlessonsand

advice.Resentmentandobstinancecreptin,butmymotherrefusedtogiveup.Over a period of years, with Mother’s constant

encouragement,bothCurtisandIstartedbelievingthatwereally could do anything we chose to do. Maybe shebrainwashed us into believing that we were going to beextremely good and highly successful at whatever weattempted.Even today I canclearlyhearhervoice in thebackofmyheadsaying,“Bennie,youcandoit.Don’tyou

stopbelievingthatforonesecond.”Mother had only a third-grade education when she

married, yet she provided the driving force in our home.She pushed my laid-back father to do a lot of things.Largelybecauseofhersenseoffrugality,theysavedafairamountofmoneyandeventuallyboughtourfirsthouse.Isuspectthat,hadthingsgoneMother’sway,ultimatelytheywouldhavebeenfinanciallywell-off.AndI’msureshehadnopremonitionofthepovertyandhardshipshe’dhavetofaceintheyearsahead.

By contrast,my fatherwas six feet two, slender, andheoftensaid,“Yougottolooksharpallthetime,Bennie.Dressthewayyouwanttobe.”Heemphasizedclothesandpossessions,andheenjoyedbeingaroundpeople.

“Benicetopeople.Peopleareimportant,andifyou’renice to them, they’ll like you.” Recalling those words, Ibelieve he put great importance on being liked byeverybody. If anyone asked me to describe my dad, I’dhave to say, “He’s just a nice guy.” And, despite all theproblemsthateruptedlater,Ifeelthatwaytoday.

My father was the kind of person who would havewantedustowearthefancyclothesandtodothemachokind of things like girl hunting—the lifestyle that wouldhave been detrimental to establishing ourselvesacademically. Inmanyways, I’mnowgratefulmymothertookusoutofthatenvironment.

Intellectually, Dad didn’t easily grasp complexproblemsbecausehetendedtogetboggeddownindetails,unable to see the overall picture. That was probably thebiggestdifferencebetweenmyparents.

Bothparents came frombig families:mymotherhad23 siblings, andmy father grewupwith13brothers andsisters. They married when my father was 28 and mymotherwas13.Manyyearslatersheconfidedthatshewaslookingforawaytogetoutofadesperatehomesituation.

I

Shortly after their marriage, they moved fromChattanooga, Tennessee, to Detroit, which was the trendforlaborersinthelate1940sandearly1950s.Peoplefromthe rural South migrated toward what they consideredlucrative factory jobs in theNorth.Myfathergota jobatthe Cadillac plant. So far as I know, it was the first andonly employment he ever held. He worked for Cadillacuntilheretiredinthelate1970s.Myfatheralsoservedasaminister inasmallBaptist

church.I’veneverbeenabletounderstandwhetherhewasanordainedministerornot.OnlyonetimedidDaddytakemetohearhimpreach—oratleastIrememberonlyoneoccasion.Daddywasn’toneof those fiery types likesometelevision evangelists. He spoke rather calmly, raised hisvoiceafewtimes,buthepreachedinarelativelylowkey,and the audience didn’t get stirred up. He didn’t have arealflowofwords,buthedidthebesthecould.IcanstillseehimonthatspecialSundayashestoodinfrontofus,tallandhandsome,thesunglintingoffalargemetalcrossthatdangledacrosshischest.

’m going away for a few days,” Mother said severalmonths after Daddy left us. “Going to see somerelatives.”“Wegoingtoo?”Iaskedwithinterest.“No, I have to go alone.” Her voice was unusually

quiet.“Besides,youboyscan’tmissschool.”Before I couldobject, she toldme thatwecould stay

withneighbors.“I’vealreadyarrangeditforyou.YoucansleepoverthereandeatwiththemuntilIcomeback.”Maybe I should have wondered why she left, but I

didn’t. I was so excited to stay in somebody else’s housebecausethatmeantextraprivileges,betterfood,andalotoffunplayingwiththeneighborkids.That’s theway ithappened the first timeand several

timesafterthat.Motherexplainedthatshewasgoingawayfor a few days, and we would be taken care of by ourneighbors. Because she carefully arranged for us to staywithfriends,itwasexcitingratherthanfrightful.Secureinher love, it never occurred to me that she wouldn’t beback.

It may seem strange, but it is a testimony to thesecurity we felt in our home—I was an adult before Idiscovered where Mother went when she “visitedrelatives.”When the loadbecame tooheavy, she checkedherself into a mental institution. The separation anddivorceplungedherintoaterribleperiodofconfusionanddepression, and I think her inner strength helped herrealize she needed professional help and gave her thecouragetogetit.Usuallyshewasgoneforseveralweeksatatime.

We boys never had the slightest suspicion about herpsychiatrictreatment.Shewanteditthatway.

With time, Mother rebounded from her mentalpressures,butfriendsandneighborsfoundithardtoacceptherashealthy.Wekidsneverknewit,forMotherneverletonhowithurther,buthertreatmentinamentalhospitalprovided neighbors with a hot topic of gossip, perhapsevenmorebecause shehadgone throughadivorce.Bothproblems created serious stigmas at the time.Mother notonly had to cope with providing a home and making aliving to support us, butmost of her friends disappearedwhensheneededthemmost.

Because Mother never talked to anyone about thedetails of her divorce, people assumed the worst andcirculatedwildstoriesabouther.

“I just decided that I had to go about my ownbusiness,”Motheronce toldme, “and ignorewhatpeoplesaid.” Shedid, but it couldn’t havebeen easy. It hurts tothinkofhowmanylonely,tearfultimesshesufferedalone.

Finally, with no financial resources to fall back on,Motherknewshecouldn’tkeepuptheexpensesoflivinginourhouse,modestasitwas.Thehousewashers,aspartofthedivorcesettlement.Soafterseveralmonthsoftryingtomakeitonherown,Motherrentedoutthehouse,packedus up, and we moved away. This was one of the timeswhen Dad reappeared, for he came back to drive us toBoston.Mother’soldersister,JeanAvery,andherhusband,William,agreedtotakeusin.WemovedintotheBostontenementswiththeAverys.

Their childrenwere grown, and theyhada lot of love toshare with two little boys. In time, they became likeanother set of parents to Curtis and me, and that waswonderful forweneeded a lot of affection and sympathythen.ForayearorsoafterwemovedtoBoston,Motherstill

underwent psychiatric treatment. Her trips away lastedthree or four weeks each time. We missed her, but wereceived such special attention from Uncle William andAuntJeanwhenshewasgonethatwelikedtheoccasionalarrangement.The Averys assured Curtis and me, “Your mama is

doing just fine.”After getting a letter or a telephone callthey’d tell us, “She’ll be back in a fewmore days.” Theyhandled the situation sowell thatweneverhadany ideahowtoughthingswereforourmother.Andthat’sjusthowthestrong-willedSonyaCarsonwantedittobe.

R

CHAPTER3

EightYearsOld

ats!” I yelled. “Hey,Curt, lookey there! I saw rats!” Ipointed in horror to a largeweeded area behind our

tenementbuilding.“Andthey’rebiggerthancats!”“Notquitethatbig,”Curtiscountered,tryingtosound

moremature.“Buttheysurearemean-looking.”NothinginDetroithadpreparedusforlifeinaBoston

tenement. Armies of roaches streaked across the room,impossibletogetridofnomatterwhatMotherdid.Morefrighteningtomewerethehordesofrats,eventhoughtheynevergotclose.Mostlytheylivedoutsideintheweedsorpiles of debris. But occasionally they scurried into thebasement of our building, especially during the coldweather.

“I’m not going down there by myself,” I saidadamantlymore thanonce. Iwas scared togodown intothebasementalone.AndIwouldn’tbudgeunlessCurtisorUncleWilliamwentwithme.

Sometimes snakes came out of the weeds to slitherdown the sidewalks. Once a big snake crawled into ourbasement,andsomeonekilledit.Fordaysafterwardalluskidstalkedaboutsnakes.

“You know, a snake got into one of those buildingsbehinduslastyearandkilledfourchildrenintheirsleep,”oneofmyclassmatessaid.

“Theygobbleyouup,”insistedanother.

“No,theydon’t,”thefirstonesaidandlaughed.“Theykindofstingyouandthenyoudie.”Thenhetoldanotherstoryaboutsomebodybeingkilledbyasnake.The storiesweren’t true, of course, but hearing them

oftenenoughkepttheminmymind,makingmecautious,fearful,andalwaysonthelookoutforsnakes.A lot of winos and drunks flopped around the area,

andwebecamesousedtoseeingbrokenglass,trashedlots,dilapidatedbuildings, and squad cars racingup the streetthat we soon adjusted to our change of lifestyle. Withinweeksthissettingseemedperfectlynormalandreasonable.No one ever said, “This isn’t theway normal people

live.” Again, I think it was the sense of family unity,strengthened by theAverys, that keptme frombeing tooconcernedaboutthequalityofourlifeinBoston.Ofcourse,Motherworked.Constantly.Sheseldomhad

muchfreetime,butsheshoweredthattimeonCurtisandme,whichmade up for the hours shewas away.Motherstarted working in homes of wealthy people, caring fortheirchildrenordoingdomesticwork.“Youlooktired,”Isaidoneeveningwhenshewalked

intoournarrowapartment.Itwasalreadydark,andshe’dputinalongdayworkingtwojobs,neitherofthemwell-paying.Sheleanedbackintheoverstuffedchair.“GuessIam,”

shesaidasshekickedoffhershoes.Hersmilecaressedme.“Whatdidyoulearninschooltoday?”sheasked.Nomatterhowtiredshewas,ifwewerestillupwhen

she got home,Mother didn’t fail to ask about school. Asmuchasanything,herconcernforoureducationbegantoimpressonmethatsheconsideredschoolimportant.I was still 8 years old when wemoved to Boston, a

sometimes serious-minded child who occasionallyponderedall thechangesthathadcomeintomylife.Oneday I said to myself, “Being 8 is fantastic because when

you’re 8 you don’t have any responsibilities. Everybodytakescareofyou,andyoucanjustplayandhavefun.”

But Ialso said,“It’snotalwaysgoing tobe thisway.SoI’mgoingtoenjoylifenow.”

Withtheexceptionofthedivorce,thebestpartofmychildhood happenedwhen Iwas 8 years old. First, I hadthemostspectacularChristmasofmylife.CurtisandIhadawonderful time Christmas shopping, then our aunt anduncleswampeduswithtoys.Mothertoo,tryingtomakeupforthelossofourfather,boughtusmorethansheeverhadbefore.

Oneofmyfavoritegiftswasascalemodel1959Buickwithfrictionwheels.ButthechemistrysettoppedeventhetoyBuick.Never,beforeorsince,didIhaveatoythatheldmy interest like the chemistry set. I spent hours in thebedroomplayingwiththeset,studyingthedirections,andworking one experiment after another. I turned litmuspaper blue and red. I mixed chemicals into strangeconcoctionsandwatchedinfascinationwhentheyfizzled,foamed, or turned different colors. When something I’dcreatedfilledthewholeapartmentwiththesmellofrotteneggsorworse,I’dlaughuntilmysidesached.

Second,IhadmyfirstreligiousexperiencewhenIwas8 years old. We were Seventh-day Adventists, and oneSaturdaymorningPastorFord,attheDetroitBurnsAvenuechurch,illustratedhissermonwithastory.

Anaturalstoryteller,PastorFordtoldofamissionarydoctor husband and wife who were being chased byrobbersinafar-offcountry.Theydodgedaroundtreesandrocks,alwaysmanagingtokeepjustaheadofthebandits.At last,gaspingwithexhaustion, thecouplestoppedshortat a precipice. Theywere trapped. Suddenly, right at theedgeofthecliff,theysawasmallbreakintherock—asplitjustbig enough for them to crawl intoandhide. Secondslater,when themen reached the edge of the escarpment,

they couldn’t find the doctor and his wife. To theirunbelieving eyes, the couple had just vanished. Afterscreamingandcursingthem,thebanditsleft.AsIlistened,thepicturebecamesovividthatIfeltas

ifIwerebeingchased.Thepastorwasn’toverlydramatic,butIgotcaughtupinanemotionalexperience,livingtheirplight as if thewickedmenwere trying to captureme. Ivisualized myself being pursued. My breath becameshallow with the panic and fear and desperation of thatcouple.Atlastwhenthebanditsleft,Isighedwithreliefatbeingsafe.Pastor Ford looked out over the congregation. “The

couple were sheltered and protected,” he told us. “Theywere hidden in the cleft of the rock, and God protectedthemfromharm.”Thesermonover,webegantosingthe“appealsong.”

Thatmorningthepastorhadselected“HeHidethMySoulin the Cleft of theRock.”He built his appeal around themissionary story and explained our need to flee to “thecleftoftherock,”tosafetyfoundonlyinJesusChrist.“IfweplaceourfaithintheLord,”hesaidashisgaze

sweptacrossthefacesinthecongregation,“we’llalwaysbesafe.SafeinJesusChrist.”As I listened, my imagination pictured how

wonderfully God had taken care of those people whowanted to serve Him. Through my imagination andemotionsIlivedthatstorywiththecouple,andIthought,That’sexactlywhatIshoulddo—getshelteredinthecleftoftherock.Although Iwasonly8,mydecision seemedperfectly

natural. Other kids my age were getting baptized andjoining the church, so when the message and musictouched me emotionally, I responded. Following thecustom of our denomination, when Pastor Ford asked ifanyonewanted to turn to Jesus Christ, Curtis and I both

wentup to the frontof thechurch.A fewweeks laterwewerebothbaptized.

Iwas basically a good kid and hadn’t done anythingparticularlywrong,yetforthefirsttimeinmylifeIknewIneeded God’s help. During the next four years I tried tofollowtheteachingsIreceivedatchurch.

Thatmorningsetanothermilestoneforme.IdecidedIwantedtobeadoctor,amissionarydoctor.

TheworshipservicesandourBible lessons frequentlyfocusedonstoriesaboutmissionarydoctors.EachstoryofmedicalmissionariestravelingthroughprimitivevillagesinAfrica or India intrigued me. Reports came to us of thephysical suffering the doctors relieved and how theyhelpedpeopletoleadhappierandhealthierlives.

“That’swhatIwanttodo,”Isaidtomymotheraswewalked home. “Iwant to be a doctor. Can I be a doctor,Mother?”

“Bennie,”shesaid,“listentome.”WestoppedwalkingandMotherstaredintomyeyes.Thenlayingherhandsonmy thin shoulders, she said, “If you ask the Lord forsomethingandbelieveHewilldoit,thenit’llhappen.”

“IbelieveIcanbeadoctor.”“Then,Bennie,youwillbeadoctor,”shesaidmatter-

of-factly,andwestartedtowalkonagain.After Mother’s words of assurance, I never doubted

whatIwantedtodowithmylife.LikemostkidsIdidn’thaveanyideaofwhataperson

hadtodotobecomeadoctor,but Iassumedthat if Ididwell in school, I could do it. By the time I turned 13, 1wasn’t so sure I wanted to be a missionary, but I neverdeviatedfromwantingtoenterthemedicalprofession.

Wemoved to Boston in 1959 and stayed until 1961,whenMothermoved us back toDetroit, because shewasfinanciallyonherfeetagain.Detroitwashomeforus,and

besides,Motherhadagoalinmind.Eventhoughitwasn’tpossible in the beginning, she planned to go back andreclaimthehousewe’dlivedin.Thehouse,aboutthesizeofmanygaragestoday,was

oneof thoseearlyprefabpost-WorldWarIIsquareboxes.The whole building probably wasn’t a thousand squarefeet,butitwasinaniceareawherethepeoplekepttheirlawnsclippedandshowedprideinwheretheylived.“Boys,” she told us as theweeks andmonths passed,

“justwait.We’regoingbacktoourhouseonDeaconStreet.Wemay not be able to afford living in it now, butwe’llmakeit.Inthemeantime,wecanstillusetherentwegetfrom it.” Not a day passed thatMother didn’t talk aboutgoinghome.Determinationburnedinhereyes,andIneverdoubtedthatwewould.Mother moved us into a multifamily dwelling just

across the tracks from a section called Delray. It was asmoggy industrial area crisscrossed with train tracks,housing little sweatshopsmaking auto parts. It waswhatI’dcallanupper-lower-classneighborhood.The three of us lived on the top floor. My mother

worked two and three jobs at a time. At one place shecared for children, and at the next she cleaned house.Whatever kind of domestic work anyone needed, Mothersaid, “I cando it. If I don’t knowhow right now, I learnfast.”Actuallytherewasn’tmuchelseshecoulddotomake

aliving,becauseshehadnootherskills.Shegainedalotofcommonsense education on these jobs, because she wasclever and alert. As she worked, she carefully observedeverythingaroundher.She was especially interested in the people, because

mostof the timesheworked for thewealthy.She’dcomehomeandtellus,“Thisiswhatwealthypeopledo.Thisishowsuccessfulpeoplebehave.Here’showtheythink.”She

constantlydrilledthiskindofinformationintomybrotherandme.“Nowyouboyscandoittoo,”she’dsaywithasmile,

adding,“andyoucandoitbetter!”Strangely enough,Mother startedholding thosegoals

infrontofmewhenIwasn’tagoodstudent.No,that’snotexactly true. I was the worst student in my whole fifth-gradeclassatHigginsElementarySchool.MyfirstthreeyearsintheDetroitpublicschoolsystem

had given me a good foundation. When we moved toBoston, I entered the fourth grade,with Curtis two yearsahead of me. We transferred to a small private churchschool,becauseMotherthoughtthatwouldgiveusabettereducationthanthepublicschools.Unfortunately, itdidn’twork out thatway. ThoughCurtis and I bothmade goodgrades, theworkwas not as demanding as it could havebeen,andwhenwe transferredback to theDetroitpublicschoolsystemIhadquiteashock.HigginsElementarySchoolwaspredominatelyWhite.

Classesweretough,andthefifthgradersthatIjoinedcouldoutdo me in every single subject. To my amazement, Ididn’t understand anything that was going on. I had nocompetitionforthebottomoftheclass.Tomakeitworse,IseriouslybelievedI’dbeendoingsatisfactoryworkbackinBoston.Beingatthebottomoftheclasshurtenoughbyitself,

buttheteasingandtauntingfromtheotherkidsmademefeel worse. As kids will do, there was the inevitableconjectureaboutgradesafterwe’dtakenatest.Someoneinvariablysaid,“IknowwhatCarsongot!”“Yeah!Abigzero!”anotherwouldshootback.“Hey,dummy,thinkyou’llgetonerightthistime?”“Carson got one right last time. You knowwhy? He

wastryingtoputdownthewronganswer.”

Sitting stiffly at my desk, I acted as if I didn’t hearthem.IwantedthemtothinkIdidn’tcarewhattheysaid.But I did care. Their words hurt, but I wouldn’t allowmyselftocryorrunaway.Sometimesasmileplasteredmyface when the teasing began. As the weeks passed, Iaccepted that I was at the bottom of the class becausethat’swhereIdeservedtobe.

I’m just dumb. I had no doubts about that statement,andeverybodyelseknewittoo.

Although no one specifically said anything to meaboutmy being Black, I thinkmy poor record reinforcedmy general impression that Black kids just were not assmart as White ones. I shrugged, accepting the reality—that’sthewaythingsweresupposedtobe.

Looking back after all these years, I can almost stillfeel the pain. The worst experience of my school lifehappened in the fifth grade after a math quiz. As usual,Mrs.Williamson, our teacher, had us hand our papers tothepersonseatedbehindusforgradingwhileshereadtheanswers aloud. After grading, each test went back to itsowner.Thentheteachercalledournames,andwereportedourowngradealoud.

The test contained 30 problems. The girl whocorrected my paper was the ringleader of the kids whoteasedmeaboutbeingdumb.

Mrs.Williamsonstartedcallingthenames.Isatinthestuffyclassroom,mygazetravelingfromthebrightbulletinboardtothewallofwindowscoveredwithpapercutouts.Theroomsmelledofchalkandchildren,andIduckedmyhead, dreading to hear my name. It was inevitable.“Benjamin?”Mrs.Williamsonwaited forme to reportmyscore.

Imumbledmyreply.“Nine!” Mrs. Williamson dropped her pen, smiled at

me,andsaidwithrealenthusiasm,“Why,Benjamin,that’s

wonderful!”(Formetoscore9outof30wasincredible.)Before I realizedwhatwas going on, the girl behind

meyelledout,“Notnine!”Shesnickered.“Hegotnone.Hedidn’tgetanyofthemright.”Hersnickerswereechoedbylaughsandgigglesallovertheroom.

“That’s enough!” the teacher said sharply, but itwastoolate.Thegirl’sharshnesscutoutmyheart.Idon’tthinkI ever felt so lonelyor so stupid inmywhole life. Itwasbad enough that I missed almost every question on justabout every test, but when the whole class— at least itseemed like everyone there— laughed at my stupidity, Iwantedtodropthroughthefloor.

Tears burned my eyes, but I refused to cry. I’d diebefore I let them know how they hurt me. Instead, Islappedadon’tcaresmileonmyfaceandkeptmyeyesonmydeskandthebigroundzeroonthetopofmytest.

I could easily have decided that life was cruel, thatbeingBlackmeanteverythingwasstackedagainstme.AndI might have gone that way except for two things thathappened during fifth grade to change my perception ofthewholeworld.

I

CHAPTER4

TwoPositives

don’tknow,”IsaidasIshookmyhead.“Imean,Ican’tbesure.”AgainIfeltstupidfromthetopofmyheadtothe bottom of my sneakers. The boy in front of me hadread every single letter on the chart down to the bottomlinewithoutanytrouble.Icouldn’tseewellenoughtoreadbeyondthetopline.

“That’sfine,”thenursesaidtome,andthenextchildinlinesteppeduptotheeye-examinationchart.Hervoicewas brisk and efficient. “Remember now, try to readwithoutsquinting.”

Halfway throughmy fifthgrade the schoolgaveusacompulsoryeyeexamination.

I squinted, tried to focus, and read the first line—barely.

Theschoolprovidedglassesforme,free.WhenIwentto get fitted, the doctor said, “Son, your vision is so badyoualmostqualifytobelabeledhandicapped.”

Apparentlymyeyeshadworsenedgradually,andIhadnoideatheyweresobad.Iworemynewglassestoschoolthenextday.AndIwasamazed.ForthefirsttimeIcouldactuallyseethewritingonthechalkboardfromthebackoftheclassroom.Gettingglasseswasthefirstpositivethingtostartmeonmyclimbupwardfromthebottomoftheclass.Immediately after getting my vision corrected my gradesimproved—not greatly, but at least I was moving in therightdirection.

When the mid-term report cards came out, Mrs.Williamsoncalledmeaside.“Benjamin,”shesaid,“onthewholeyou’redoingsomuchbetter.”HersmileofapprovalmademefeellikeIcoulddobetteryet.Iknewshewantedtoencouragemetoimprove.IhadaDinmath—butthatdidindicateimprovement.

AtleastIhadn’tfailed.Seeing that passing grade made me feel good. I

thought,ImadeaDinmath.I’mimproving.There’shopeforme.I’mnotthedumbestkidintheschool.Whenakidlikemewhohadbeenatthebottomoftheclassforthefirsthalfoftheyearsuddenlyzoomedupward—evenifonlyfromFtoD—that experience gave birth to hope. For the first timesinceenteringHigginsSchoolIknewIcoulddobetterthansomeofthestudentsinmyclass.Motherwasn’twillingtoletmesettleforsuchalowly

goalasthat!“Oh,it’sanimprovementallright,”shesaid.“And,Bennie,I’mproudofyouforgettingabettergrade.Andwhyshouldn’tyou?You’resmart,Bennie.”Despitemyexcitementandsenseofhope,mymother

wasn’thappy.Seeingmyimprovedmathgradeandhearingwhat Mrs. Williamson had said to me, she startedemphasizing, “But you can’t settle for just barelypassing.You’re too smart to do that. You canmake the topmathgradeintheclass.”“But, Mother, I didn’t fail,” I moaned, thinking she

hadn’tappreciatedhowmuchmyworkhadimproved.“All right, Bennie, you’ve started improving,”Mother

said,“andyou’regoingtokeeponimproving.”“I’mtrying,”Isaid.“I’mdoingthebestIcan.”“But you can do still better, and I’m going to help

you.”Hereyessparkled.Ishouldhaveknownthatshehadalreadystartedformulatingaplan.WithMother, itwasn’tenoughtosay,“Dobetter.”Shewouldfindawaytoshowmehow.Herscheme,workedoutaswewentalong,turned

outtobethesecondpositivefactor.My mother hadn’t said much about my grades until

the report cards came out at mid-year. She had believedthe grades from the Boston school reflected progress. Butonce she realized how badly I was doing at HigginsElementary,shestartedinonmeeveryday.

However,Motherneverasked,“Whycan’tyoubelikethose smart boys?”Mother had toomuch sense for that.Besides, I never felt shewantedme to competewithmyclassmatesasmuchasshewantedmetodomybest.

“I’ve got two smart boys,” she’d say. “Two mightysmartboys.”

“I’m doing my best,” I’d insist. “I’ve improved inmath.”

“But you’re going to do better, Bennie,” she toldmeone evening. “Now, since you’ve started getting better inmath, you’re going to goon, andhere’s howyou’ll do it.First thing you’re going to do is tomemorize your timestables.”

“Mytimestables?”Icried.Icouldn’timaginelearningsomuch. “Do you know howmany there are?Why thatcouldtakeayear!”

Shestoodupalittletaller.“Ionlywentthroughthirdgrade,andIknowthemallthewaythroughmytwelves.”

“But,Mother,Ican’t—”“Youcandoit,Bennie.Youjusthavetosetyourmind

toconcentrating.Youworkonthem,andtomorrowwhenIget home from work we’ll review them. We’ll keep onreviewingthetimestablesuntilyouknowthembetterthananyoneelseinyourclass!”

Iarguedalittlemore,butIshouldhaveknownbetter.“Besides”—herecameher finalshot—“you’renot to

go outside and play after school tomorrow until you’velearnedthosetables.”

I was almost in tears. “Look at all these things!” Icried, pointing to the columns in the back of my mathbook.“Howcananyonelearnallofthem?”Sometimes talking to Mother was like talking to a

stone. Her jaw was set, her voice hard. “You can’t gooutsideandplayuntilyoulearnyourtimestables.”Motherwasn’t home, of course,when school let out,

butitdidn’toccurtometodisobey.ShehadtaughtCurtisandmeproperly,andwedidwhatshetoldus.I learned the times tables. I just kept repeating them

untiltheyfixedthemselvesinmybrain.Likeshepromised,thatnightMotherwentover themwithme.Her constantinterestandunflaggingencouragementkeptmemotivated.Within days after learning my times tables, math

becamesomucheasierthatmyscoressoared.Mostofthetimemy grades reached as high as the other kids inmyclass. I’ll never forget how I felt after anothermath quizwhenIansweredMrs.Williamsonwith“Twenty-four!”IpracticallyshoutedasIrepeated,“Igot24right.”She smiledbackatme inaway thatmademeknow

howpleasedshewastoseemyimprovement. Ididn’t tellthe other kidswhatwas going on at home or howmuchtheglasseshelped.Ididn’tthinkmostofthemcared.Thingschangedimmediatelyandmadegoingtoschool

moreenjoyable.Nobodylaughedorcalledmethedummyin math anymore! But Mother didn’t let me stop withmemorizingthetimestables.ShehadproventomethatIcouldsucceedinonething.Soshestartedthenextphaseofmyself-improvementprogramtomakemecomeoutwiththe top grades in every class. The goal was fine, I justdidn’tlikehermethod.“I’ve decided you boys are watching too much

television,” she said one evening, snapping off the set inthemiddleofaprogram.

“Wedon’twatchthatmuch,”Isaid.Itriedtopointoutthatsomeprogramswereeducationalandthatallthekidsinmyclasswatchedtelevision,eventhesmartestones.

Asifshedidn’thearawordIsaid,shelaiddownthelaw.Ididn’t liketherule,butherdeterminationtoseeusimprovechangedthecourseofmylife.“Fromnowon,youboyscanwatchnomorethanthreeprogramsaweek.”

“Aweek?”ImmediatelyIthoughtofallthewonderfulprogramsIwouldhavetomiss.

Despiteourprotests,weknewthatwhenshedecidedwecouldn’twatchunlimited television, shemeant it. Shealsotrustedus,andbothofusadheredtothefamilyrulesbecausewewerebasicallygoodkids.

Curtis, though a bitmore rebellious than I was, haddonebetterinhisschoolwork.Yethisgradesweren’tgoodenough to meet Mother’s standards either. Evening aftereveningMother talkedwith Curtis, workingwith him onhisattitude,urginghimtowanttosucceed,pleadingwithhim not to give up on himself. Neither of us had a rolemodelof success,orevena respectedmale figure to lookupto.IthinkCurtis,beingolder,wasmoresensitivetothatthanIwas.Butnomatterhowhardshehadtoworkwithhim,Motherwouldn’tgiveup.Somehow,throughherlove,determination,encouragement,andlayingdowntherules,Curtis became a more reasonable type of person andstartedtobelieveinhimself.

Motherhadalreadydecidedhowwewouldspendourfreetimewhenweweren’twatchingtelevision.“Youboysaregoingtogotothelibraryandcheckoutbooks.You’regoingtoreadatleasttwobookseveryweek.Attheendofeachweekyou’llgivemeareportonwhatyou’veread.”

Thatrulesoundedimpossible.Twobooks?Ihadneverreadawholebook inmy life, except those theymadeusread in school. I couldn’t believe I could ever finish onewholebookinashortweek.

Butadayor two later foundCurtisandmedraggingourfeetthesevenblocksfromhometothepubliclibrary.We grumbled and complained, making the journey seemendless. But Mother had spoken, and it didn’t occur toeitherofustodisobey.Thereason?Werespectedher.Weknewshemeantbusinessandknewwe’dbettermind.But,mostimportant,welovedher.“Bennie,” she saidagainandagain, “if you can read,

honey, you can learn just about anything you want toknow.Thedoorsoftheworldareopentopeoplewhocanread. And my boys are going to be successful in life,becausethey’regoingtobethebestreadersintheschool.”As I think about it, I’m as convinced today as I was

back in the fifth grade, that mymother meant that. Shebelieved in Curtis and me. She had such faith in us, wedidn’tdarefail!Herunboundedconfidencenudgedmeintostartingtobelieveinmyself.Several ofMother’s friends criticized her strictness. I

heardonewomanask,“Whatareyoudoingtothoseboys,making them study all the time? They’re going to hateyou.”“They can hate me,” she answered, cutting off the

woman’s criticism, “but they’re going to get a goodeducationjustthesame!”OfcourseIneverhatedher.Ididn’tlikethepressure,

but shemanaged tomakeme realize that this hardworkwasformygood.Almostdaily,she’dsay,“Bennie,youcandoanythingyousetyourselftodo.”SinceI’vealwayslovedanimals,nature,andscience,Ichoselibrarybooksonthosetopics. And while I was a horrible student in thetraditionally academic subjects, I excelled in fifth-gradescience.Thescienceteacher,Mr.Jaeck,understoodmyinterest

andencouragedmebygivingmespecialprojects,suchashelpingotherstudentsidentifyrocks,animals,orfish.Ihad

the ability to study the markings on a fish, for instance,andfromthenonIcouldidentifythatspecies.Nooneelseintheclasshadthatknack,soIhadmychancetoshine.Initially, Iwent to the libraryandcheckedoutbooks

aboutanimalsandothernaturetopics. Ibecamethefifth-gradeexpertinanythingofascientificnature.Bytheendof theyear I couldpickup just aboutany rockalong therailroad tracks and identify it. I read so many fish andwaterlifebooks,thatIstartedcheckingstreamsforinsects.Mr. Jaeck had a microscope, and I loved to get watersamples to examine the various protozoa under themagnifiedlenses.SlowlytherealizationcamethatIwasgettingbetterin

allmyschoolsubjects.Ibeganlookingforwardtomytripsto the library.Thestaff theregot toknowCurtisandme,offering suggestionsonwhatwemight like to read.Theywould inform us about new books as they came in. Ithrived on this new way of life, and soon my interestswidened to include books on adventure and scientificdiscoveries.By reading so much, my vocabulary automatically

improved along with my comprehension. Soon I becamethebeststudentinmathwhenwedidstoryproblems.Upuntil the last fewweeksof fifthgrade,aside from

mathquizzes,ourweeklyspellingbeesweretheworstpartof school forme. I usuallywent down on the firstword.But now, 30 years later, I still remember the word thatreallygotmeinterestedinlearninghowtospell.Thelastweekoffifthgradewehadalongspellingbee

in which Mrs. Williamson made us go through everyspellingwordweweresupposedtohavelearnedthatyear.Aseveryoneexpected,BobbyFarmerwonthespellingbee.But tomy surprise, the finalwordhe spelled correctly towinwasagriculture.Icanspell thatword, I thoughtwithexcitement. Ihad

learneditjustthedaybeforefrommylibrarybook.Asthewinnersatdown,athrillsweptthroughme—ayearningtoachieve—more powerful than ever before. “I can spellagriculture,” I said tomyself, “and I’ll bet I can learn tospellanyotherwordintheworld.I’llbetIcouldlearntospellbetterthanBobby.”

Learning to spell better than Bobby Farmer reallychallengedme.Bobbywasclearly thesmartestboy in thefifth grade.Another kid named SteveKormos had earnedthe reputation as being the smartest kid before BobbyFarmercamealong.BobbyFarmerimpressedmeduringahistoryclassbecausetheteachermentionedflax,andnoneofusknewwhatshewastalkingabout.

ThenBobby, still new in school, raised his hand andexplained to the rest of us about flax—howandwhere itwasgrown,andhowthewomenspunthefibersintolinen.As I listened, I thought,Bobby sureknowsa lotabout flax.He’s really smart. Suddenly, sitting there in the classroomwithspringsunshineslantingthroughthewindows,anewthoughtflashedthroughmymind.Icanlearnaboutflaxoranysubjectthroughreading.ItislikeMothersays—ifyoucanread, you can learn just about anything. I kept reading allthroughthesummer,andbythetimeIbegansixthgradeIhad learned to spell a lot of words without consciousmemorization. In the sixth grade, Bobby was still thesmartestboyintheclass,butIwasstartingtogaingroundonhim.

AfterIstartedpullingaheadinschool,thedesiretobesmart grew stronger and stronger. One day I thought, Itmustbealotoffunforeverybodytoknowyou’rethesmartestkidintheclass.That’sthedayIdecidedthattheonlywaytoknow for surehow thatwould feelwas tobecome thesmartest.

As I continued to read,my spelling, vocabulary, andcomprehension improved, and my classes became muchmore interesting. I improved somuch that by the time I

enteredseventhgradeatWilsonJuniorHigh,Iwasatthetopoftheclass.

But justmaking it to the top of the class wasn’t myrealgoal.Bythen,thatwasn’tgoodenoughforme.That’swhereMother’s constant influencemade the difference. Ididn’t work hard to compete and to be better than theotherkidsasmuchasIwantedtobetheverybestIcouldbe—forme.

Mostof thekidswhohadgone to schoolwithme infifth and sixth grade also moved on to Wilson. Yet ourrelationshipshaddrasticallychangedduringthattwo-yearperiod. The very kidswho once teasedme about being adummy started coming up to me, asking, “Hey, Bennie,howdoyousolvethisproblem?”

Obviously I beamed when I gave them the answer.TheyrespectedmenowbecauseIhadearnedtheirrespect.Itwasfuntogetgoodgrades,tolearnmore,toknowmorethanwasactuallyrequired.

WilsonJuniorHighwasstillpredominantlyWhite,butbothCurtisandIbecameoutstandingstudentsthere.ItwasatWilsonthatIfirstexcelledamongWhitekids.Althoughnotaconscious thingonmypart, I like to lookbackandthink that my intellectual growth helped to erase thestereotypicalideaofBlacksbeingintellectuallyinferior.

Again,Ihavemymothertothankformyattitude.Allthrough my growing up, I never recall hearing her saythingssuchas“Whitepeoplearejust…”Thisuneducatedwoman,married at 13, had been smart enough to figureout things for herself and to emphasize to Curtis andmethat people are people. She never gave vent to racialprejudiceandwouldn’tletusdoiteither.

CurtisandIencounteredprejudice,andwecouldhavegottencaughtup in it,especially in thosedays—theearly1960s.

Threeincidentsofracialprejudicedirectedagainstus

standoutinmymemory.First, when I started going to Wilson Junior High,

CurtisandIoftenhoppedatraintogettoschool.Wehadfundoingthatbecausethetracksranparalleltoourschoolroute.Whileweknewweweren’tsupposedtohoptrains,Iplacated my conscience by deciding to get on only theslowertrains.My brother would grab on to the fast-moving trains

whichhadtoslowdownatthecrossing.IenviedCurtisasIwatched him in action. When the faster trains camethrough,justpastthecrossinghewouldthrowhisclarinetononeoftheflatcarsnearthefrontofthetrain.Thenhe’dwait and catch the last flat car. If he didn’t get on andmakehiswaytothefront,heknewhe’dlosehisclarinet.Curtisneverlosthismusicalinstrument.We chose a dangerous adventure, and every timewe

jumped on a trainmy body tingled with excitement.Wenotonlyhadtojumpandcatchacarrailingandholdon,butwehad tomake sure the railroad securitymennevercaughtus.Theywatchedforkidsandhoboeswhohoppedthetrainsatcrossroads.Theyneverdidcatchus.We stopped hopping trains for an entirely different

reason.OnedaywhenCurtiswasn’twithme,asIranalongthe tracks, a group of older boys — all White—camemarchingtowardme,angerwrittenontheir faces.Oneofthemcarriedabigstick.“Hey,you!Niggerboy!”Istoppedandstared,frightenedandsilent.I’vealways

been extremely thin and must have looked terriblydefenseless—andIwas.Theboywiththestickwhackedmeacross the shoulder. I recoiled, not sure what wouldhappennext.He and the other boys stood in front ofmeandcalledmeeverydirtynametheycouldthinkof.Myheartpoundedinmyears,andsweatpoureddown

mysides.I lookeddownatmyfeet,tooscaredtoanswer,

toofrightenedtorun.“Youknowyouniggerkidsain’tsupposedtobegoing

toWilson JuniorHigh. Ifwe ever catch you again,we’regoingtokillyou.”Hispaleeyeswerecoldasdeath.“Youunderstandthat?”Mygazeneverlefttheground.“Guessso,”Imuttered.“I said, ‘Doyouunderstandme,niggerboy?'” thebig

boyprodded.Fearchokedme.Itriedtospeaklouder.“Yes.”“Thenyougetoutofhereasfastasyoucanrun.And

you’dbetterbekeepinganeyeoutforus.Nexttime,we’regoingtokillyou!”I ran then, as fast as I could, and didn’t slow down

until I reached the schoolyard. I stoppedusing that routeand went another way. From then on I never hoppedanothertrain,andIneversawthegangagain.Certainthatmymotherwouldhaveyankedusoutof

schoolrightaway,Inevertoldherabouttheincident.Asecond,moreshockingepisodeoccurredwhenIwas

in the eighth grade. At the end of each school year theprincipal and teachers handed out certificates to the onestudentwhohadthehighestacademicachievementintheseventh, eighth, and ninth grades respectively. I won thecertificateintheseventhgrade,andthatsameyearCurtiswonfortheninthgrade.Bytheendofeighthgrade,peoplehadprettymuchcometoacceptthefactthatIwasasmartkid. Iwon thecertificateagain the followingyear.At theall-school assembly one of the teachers presented mycertificate.Afterhandingittomesheremainedupinfrontof the entire student body and looked out across theauditorium.“IhaveafewwordsIwanttosayrightnow,”she began, her voice unusually high. Then, to myembarrassment, she bawled out the White kids becausetheyhadallowedmetobenumberone.“You’renottryinghardenough,”shetoldthem.

While she never quite said it inwords, she let themknow that a Black person shouldn’t be number one in aclasswhereeveryoneelsewasWhite.Astheteachercontinuedtoberatetheotherstudents,

a number of things tumbled about inside my mind. Ofcourse,Iwashurt.Ihadworkedhardtobethetopofmyclass—probablyharderthananyoneelseintheschool—and shewas puttingme downbecause Iwasn’t the samecolor.OntheonehandIthought,Whataturkeythiswomanis!Thenanangrydeterminationwelledupinside.I’llshowyouandalltheotherstoo!Icouldn’tunderstandwhythiswomantalkedtheway

shedid.Shehad taughtmeherself in severalclasses,hadseemedtolikeme,andsheclearlyknewthatIhadearnedmygradesandmeritedthecertificateofachievement.Whywouldshesayalltheseharshthings?Wasshesoignorantthat she didn’t realize that people are just people? Thattheir skin or their race doesn’t make them smarter ordumber? It also occurred to me that, given enoughsituations, there are bound to be instances whereminoritiesaresmarter.Couldn’tsherealizethat?Despitemyhurtandanger,Ididn’tsayanything.Isat

quietlywhilesherailed.SeveraloftheWhitekidsglancedover at me occasionally, rolling their eyes to let meunderstand theirdisgust. I sensed theywere trying to saytome,“Whatadummysheis!”Someofthoseverykids,who,threeyearsearlier,had

taunted me, had become my friends. They were feelingembarrassed,andIcouldreadresentmentonseveralfaces.Ididn’ttellMotheraboutthatteacher.Ididn’tthinkit

woulddoanygoodandwouldonlyhurtherfeelings.The third incident that stands out in my memory

centeredaroundthefootballteam.Inourneighborhoodwehad a football league.When I was in the seventh grade,playingfootballwasthebigthinginathletics.

Naturally,bothCurtisandIwantedtoplay.NeitherofusCarsonswere large tobeginwith. In fact,compared tothe other players, we were quite small. But we had oneadvantage. We were fast—so fast that we could outruneverybody else on the field. Because the Carson brothersmade such good showings, our performance apparentlyupsetafewoftheWhitepeople.One afternoon when Curtis and I left the field after

practice,agroupofWhitemen,noneofthemover30yearsold, surrounded us. Theirmenacing anger showed clearlybeforetheysaidaword.Iwasn’tsureiftheywerepartofthegangthathadthreatenedmeattherailroadcrossing.IonlyknewIwasscared.Then one man stepped forward. “If you guys come

back we’re going to throw you into the river,” he said.Thentheyturnedandwalkedawayfromus.Wouldtheyhavecarriedouttheirthreat?CurtisandI

weren’tasconcernedabout thataswewerewith the factthattheydidn’twantusintheleague.Aswewalkedhome,Isaidtomybrother,“Whowants

to play football when your own supporters are againstyou?”“Ithinkwecanfindbetterthingstodowithourtime,”

Curtissaid.Weneversaidanythingtoanyoneaboutquitting,but

we never went back to practice. Nobody in theneighborhood ever asked uswhy. ToMother I said, “Wedecidednot toplayfootball,”Curtissaidsomethingaboutstudyingmore.We had decided to say nothing toMother about the

threat,knowingthatifwedid,she’dbeworriedsickaboutus. As an adult looking backward, it’s ironic about ourfamily. When we were younger, through her silenceMotherhadprotectedusfromthetruthaboutDadandheremotionalproblems.Nowitwasourturntoprotectherso

shewouldn’tworry.Wechosethesamemethod.

K

CHAPTER5

ABoy’sBigProblem

nowwhattheIndiansdidwithGeneralCuster’sworn-outclothes?”thegangleaderasked.“Tell us,” one of his cohorts shot back with

exaggeratedinterest.“They saved them and now our man Carson wears

them!”Anotherkidnoddedvigorously.“Surelooksit.”Icouldfeeltheheatrisingupmyneckandcheeks.The

guyswereatitagain.“Get close enough and you’ll believe it,” the first

fellow laughed, “'cuz they smell like they’re a hundredyearsold!”

New in the grade of 8-A at Hunter Junior High, Ifound capping an embarrassing and painful experience.Thetermcomesfromthewordcapitalizeandisslangthatmeanstogetthebetterofanotherperson.Theideawastomake the most sarcastic remark possible, throwing in aquickbarbtokeepithumorous.Cappingwasalwaysdonewithinearshotofthevictim,andthebesttargetswerethekids whose clothes were a little out of style. The bestcapperswaiteduntilagroupcollectedaroundtheviolator.Thenthey’dcompetetoseewhocouldsaythefunniestandmostinsultingthings.

I was a special target. For one thing, clothes hadn’tmeantmuchtomethen,andtheydon’ttoday.Exceptfora

briefperiodinmylife,I’venotbeenmuchconcernedaboutwhat I wore, because like Mother always said, “Bennie,what’sinsidecountsthemost.Anybodycandressupontheoutsideandbedeadinside.”I hated leavingWilson Junior High at themiddle of

theeighthgradebutwasexcitedtobemovingbacktoouroldhouse.AsIsaidtomyself,“We’regoinghomeagain!”Thatwasthemostimportantthingofall.Because of my mother’s frugality, our financial

situationhadgraduallyimproved.Motherwasfinallyableto get enough money, and we moved back to the housewherewelivedbeforemyparentsdivorced.Despitethesmallnessofthehouse,itwashome.Today

I see it more realistically—more like a matchbox. But tothe three of us then, the house seemed like amansion, areallyfabulousplace.Butmovinghomemeant theneed to change schools.

While Curtis went on to Southwestern High School, Ienrolled in Hunter Junior High, a predominantly Blackschoolwithabout30percentofthestudentsWhite.Classmatesimmediatelyrecognizedmeasasmartkid.

AlthoughIwasn’tquiteatthetop,onlyoneortwootherspassed me in grades. I had grown used to academicsuccess,enjoyedit,anddecidedtostayontop.Atthatpoint,however,Ifeltanewpressure—onethat

I hadn’t been subjected to before. Besides the capping, Ifaced theconstant temptation tobecomeoneof theguys.I’dneverhadtobeinvolvedinthiskindofthingbeforeinordertobeaccepted. In theotherschools,kids lookedupto me because of my top grades. But at Hunter JuniorHigh,academicscamealittlefartherdowntheline.Being accepted by the in-group meant wearing the

rightclothes,goingtotheplaceswheretheguyshungout,andplayingbasketball.Evenmoreimportant,tobepartofthein-group,kidshadtolearntocaponothers.

Icouldn’taskmymothertobuymethekindofclothesthatwouldputmeontheirsocial-acceptancelevel.WhileImaynothaveunderstoodhowhardmymotherworked, Iknewshewastryingtokeepusoffofpublicassistance.Bythe time Iwent into ninth grade,Mother hadmade suchstrides that she received nothing except food stamps. Shecouldn’t have provided for us and kept up the housewithoutthatsubsidy.

BecauseshewantedtodothebestshecouldforCurtisand me, she skimped on herself. Her clothes were cleanandrespectable,buttheyweren’tstylish.Ofcourse,beingakid,Inevernoticed,andshenevercomplained.

ForthefirstfewweeksIdidn’tsayanythingwhentheguyscappedonme.My lackof responseonlyencouragedthemtobeardown,andtheycappedonmemercilessly. Ifelt horrible, left out, and hurt because I didn’t fit in.Walking home alone, I’d wonder,What’s wrong with me?Why can’t I belong? Why do I have to be different? Icomforted myself by saying, “They’re just a bunch ofbuffoons.Ifthisishowtheygettheirenjoyment,theycango ahead, but I’m not going to play their silly game. I’mgoingtobesuccessful,andonedayI’llshowallofthem.”

Despite my defensive words, I still felt left out andrejected. And, like most people, I wanted to belong anddidn’t likebeing anoutsider.Unfortunately, after awhiletheirattituderubbedoffonmeuntileventuallythediseaseinfectedme too. Then I said tomyself, “All right, if youguyswanttocap,I’llshowyouhowtocap.”

ThenextdayIwaitedforthecappingtostart.Anditdid. A ninth grader said, “Man, that shirt you’rewearinghasbeen throughWorldWar I,WorldWar II,WorldWarIII,andWorldWarIV.”

“Yeah,”Isaid,“andyourmamaworeit.”Everybodylaughed.Hestaredatme,hardlybelievingwhatI’dsaid.Then

hestartedtolaughtoo.Heslappedmeontheback.“Hey,man,that’sOK.”Myesteemrose right then.Soon I cappedon the top

cappers throughout the whole school. It felt great to berecognizedformysharptongue.Fromthenonwhenanyonecappedonme,I’dturnit

aroundandfling it intotheir faces—whichwastheideaof the game. Within weeks the in-crowd stoppedtormenting me. They didn’t dare direct any sarcasm mywaybecause theyknew Iwouldcomeupwith somethingbetter.Onceinawhile,studentsduckedoutofthewaywhen

theysawmecoming.Ididn’tletthemgetawayeventhen.“Hey,Miller!I’dhidemyfacetooifIlookedthatugly!”Ameanremark?Certainly,butIcomfortedmyselfby

saying,“Everybodydoesit.Outcappingeveryoneelseistheonlyway to survive.”Or sometimes I’d say, “He knows Ididn’treallymeanit.”Itdidn’ttakelongformetoforgethowitfelttobethe

object of capping. My taking over the game solved onegreatproblemforme.Unfortunately,itdidn’tsolvewhattodoaboutclothes.Aside from being ostracized for my clothes, the kids

called me poor a lot. And to their thinking, if you werepoor, you were no good. Oddly enough, none of thestudents were well-off and had no right to talk aboutanybodyelse.Butasayoungteenager,Ididn’treasonthatout.IfeltthestigmaofbeingpoormostacutelybecauseIdidn’t have a father. Most of the kids I knew had twoparents,andthatconvincedmethattheywerebetteroff.During ninth grade one task brought more

embarrassment tome thananythingelse.As I’ve said,wereceived food stamps and couldn’t have made it withoutthem.

Occasionallymymother sentme to the store to buybreadormilkwiththestamps.Ihatedtogo,fearingoneofmyfriendswouldseewhat Iwasdoing. IfanyoneIknewcame up to the checkout counter, I’d pretend that I hadforgottensomethingandduckdownoneoftheaislesuntilhe left. Waiting until nobody else stood in line, I’d rushforwardwiththeitemsIhadtobuy.

Icouldacceptbeingpoor,butIdiedathousanddeathsthinking that other kids would know it. If I had thoughtmore logically about the food stamps, I would haverealizedthatquiteafewofmyfriends’familiesusedthemtoo.YeteverytimeIleftthehousewiththestampsburninginmypocket,Iworriedthatsomeonemightseemeorhearaboutmyusingfoodstampsandthentalkaboutme.SofarasIknow,nooneeverdid.

Theninthgradestandsoutasapivotaltimeinmylife.As an A student I could stand up intellectually with thebest.AndIcouldholdmyownwiththebest—orworst—ofmy classmates. It was a time of transition. I was leavingchildhood and beginning to think seriously about thefutureandespeciallyaboutmydesiretobeadoctor.

By the time I hit the tenth grade, however, the peerpressurehadgotten tobe toomuch forme.Clothesweremy biggest problem. “I can’t wear these pants,” I’d tellMother.“Everyonewilllaughatme.”

“Onlystupidpeoplelaughatwhatyouwear,Bennie,”she’dsay.Or,“It’snotwhatyou’rewearingthatmakesthedifference.”

“But,Mother,”I’dplead.“EverybodyIknowhasbetterclothesthanIdo.”

“Maybe so,” she’d patiently tellme. “I knowa lot ofpeoplewhodress better than I do, but that doesn’tmakethembetter.”

Just about every day, I begged and pressured mymother, insisting that I had to have the right kind of

clothes. I knew exactly what I meant by the right kind:Italian knit shirtswith suede fronts, silk pants, thick-and-thin silk socks, alligator shoes, stingy brim hats, leatherjackets, and suede coats. I talked about those clothesconstantly, and it seemed like I couldn’t think aboutanythingelse.Ihadtohavethoseclothes.Ihadtobelikethein-crowd.MotherwasdisappointedinmeandIknewit,butallI

could think of was my poor wardrobe and my need foracceptance. Instead of coming directly home after schoolanddoingmyhomework,Iplayedbasketball.SometimesIstayedoutuntil teno’clock,anda fewtimesuntileleven.WhenIcamehomeIknewwhattoexpect,andIpreparedmyselftoendureit.“Bennie,can’tyouseewhatyou’redoingtoyourself?

It’smore than justdisappointingme.You’regoingtoruinyourlifestayingoutallhoursandbeggingfornothingbutfineclothes.”“I’m not ruiningmy life,” I insisted, because I didn’t

wanttolisten.Icouldn’thaveheardanythingbecausemyimmaturemindfocusedonbeinglikeeverybodyelse.“I’ve been proud of you, Bennie,” she would say.

“You’veworkedhard.Don’tloseallofthatnow.”“I’llkeepondoingallright,”I’dsnapback.“I’llbeOK.

Haven’tIbeenbringinghomegoodgrades?”Shecouldn’targuewithmeonthat issue,but Iknow

sheworried.“Allright,son,”shefinallytoldme.Then, after weeks of my pleading for new clothes,

Mother said the words I wanted to hear. “I’ll try to getsomeofthosefancyclothesforyou.Ifthat’swhatittakestomakeyouhappy,you’llhavethem.”“They’llmakemehappy,”Isaid.“Theywill.”It’shardformetobelievehowinsensitiveIwasback

then. Without thinking about her needs, I let Mother go

W

without to buyme clothes thatwould helpme dress likethe in-crowd.But I neverhad enough.Now I realize thatno matter how many Italian shirts, leather jackets, oralligator shoes she bought, they would never have beenenough.Mygradesdropped.Iwentfromthetopoftheclassto

being a C student. Even worse, achieving only averagegradesdidn’tbothermebecauseIwaspartofthein-group.Ihungoutwiththepopularguys.Theyinvitedmetotheirpartiesandjamsessions.Andfun—IwashavingmorefunthanI’deverhadinmylifebecauseIwasoneoftheguys.Ijustwasn’tveryhappy.I had strayed from the important andbasic values in

mylife.Toexplainthatstatement,IhavetogobacktomymotheragainandtellyouaboutavisitfromMaryThomas.

henmymotherwasinthehospitaltodeliverme,shehad her first contact with Seventh-day Adventists.

Mary Thomas was visiting in the hospital and startedtalking toheraboutJesusChrist.Mother listenedpolitelybuthadlittleinterestinwhatshehadtosay.Later, as I’ve already mentioned, Mother was so

emotionally hurt that she checked herself into a mentalhospital.Atonepoint,sheseriouslyconsideredcommittingsuicide by saving up her dailymedication and taking allthepillsatonce.Thenoneafternoonawomanvisitedmymother in the hospital. She had met the woman oncebefore—MaryThomas.This quiet but zealous woman began talking to her

aboutGod.Thatinitselfwasnothingnew.FromthetimeshewasalittlegirlinTennessee,MotherhadheardaboutGod.YetMaryThomasapproachedreligiondifferently.Shedidn’t try to force anything on Mother or tell her howsinfulshewas.Instead,MaryThomassimplyexpressedherown beliefs and paused occasionally to read verses from

theBiblethatexplainedthebasisforherfaith.More important than her teaching, Mary genuinely

cared about Mother. And right then Mother neededsomeonetocare.

Even before the divorce, Mother was a desperatewomanwithtwoyoungkidsandnoideahowtotakecareof them if things didn’t work out. Shewas ostracized bymanywho felt shewasunconventional.Thenalong cameMaryThomaswithwhatseemedlikeasinglerayofhope.“There is another source of strength, Sonya,” the visitorsaid.“Andthisstrengthcanbeyours.”

Those were exactly the words she needed as astabilizingforceinherlife.Motherfinallyunderstoodthatshewasn’tallaloneintheworld.

Overaperiodofweeks,Marywentovertheteachingsof her church, and Mother slowly came to believe in alovingGodwhoexpressesthatlovethroughJesusChrist.

Day after day Mary Thomas talked patiently withMother,answeringquestions,andlisteningtoanythingshewantedtosay.

Mother’s third-grade education prevented her fromreadingmost of the Bible passages, but her visitor didn’tgive up. She stayed at it, reading everything aloud. Andthroughthatwoman’sinfluencemymotherbegantostudyandreadforherself.

Even though Mother could barely read, once shedecided to learn, through hours of practice she taughtherselftoreadwell.MotherstartedtoreadtheBible,oftensoundingoutthewords,sometimesstillnotunderstanding;but she persisted. That was her determination at work.Eventually she was able to read relatively sophisticatedmaterial.

Aunt Jean andUncleWilliam,withwhomwe stayedafter my parents’ divorce, had become Adventists inBoston. With their encouragement, it wasn’t long until

Mothergrewstronger inherbeliefs.Neverone togo intoanything half-heartedly, she immediately became activeandhasremainedadevoutchurchmember.Andfromthetimeofherownconversion, shestarted takingCurtisandmetochurchwithher.TheAdventistdenominationistheonlyspiritualhomeI’veeverknown.

When I was 12 and more mature, I realized thatalthough I’dbeen emotionally touchedat age8 and evenhadbeenbaptized,Ihadn’tunderstoodexactlywhatbeingaChristianmeant.

By the time I was 12, we had moved and wereattending the Sharon Seventh-day Adventist Church inInkster. After days of thinking about the matter, I spokewithPastorSmith.“AlthoughI’vebeenbaptized,”Isaid,“Ididn’treallygraspthesignificanceofwhatIwasdoing.”

“Youdounderstandnow?”“Oh,yes, I’m12now,” I said,“andIbelieve inJesus

Christ.Afterall,Jesuswas12whenHisparents first tookHimtothetempleinJerusalem.SoI’dliketobebaptizedagain,becauseIunderstandandI’mreadynow.”

Pastor Smith listened sympathetically, and having noproblemwithmyrequest,herebaptizedme.

Yet in looking back, I’m not sure when I actuallyturnedtoGod.OrperhapsithappenedsograduallythatIhadnoawarenessoftheprogression.IdoknowthatwhenIwas14,IfinallyunderstoodhowGodcanchangeus.

It was at age 14 that I confronted the most severepersonal problem of my life, one that almost ruined meforever.

T

CHAPTER6

ATerribleTemper

hatsurewasadumbthingtosay,”JerrytauntedaswewalkeddownthehalltogetherafterEnglishclass.Kids

crowdedus on all sides, and Jerry’s voice rose above thedin.

I shrugged.“Guess so.”Mywronganswer inseventh-gradeEnglishhadbeenembarrassingenough.Ididn’twanttobereminded.

“Youguess?”Jerry’slaughwasshrill.“Listen,Carson,thatwasoneoftheall-timestupidthingsoftheyear!”

I turned my eyes toward him. He was taller andheavier, not even one of my close friends. “You’ve saidsomeprettydumbthingstoo,”Isaidsoftly.

“Ohyeah?”“Yeah.Justlastweekyou—”Our words flew back and forth, my voice remaining

calmwhilehisgrewlouderandlouder.FinallyIturnedtomylocker.I’djustignorehim,andmaybehe’dshutupandgoaway.

Myfingerstwirledthecombinationlock.Then,justasI lifted the lock, Jerry shoved me. I stumbled, and mytemperflared.Iforgotthe20poundsofmusclehehadonme.Ididn’tseethekidsandteachersmillinginthehall.Iswung at him, lock in hand. The blow slammed into hisforehead, and he groaned, staggering backward, bloodseepingfromathree-inchgash.

Dazed,Jerryslowlyliftedhishandtohisforehead.Hefeltthestickybloodandcarefullyloweredhishandinfrontofhiseyes.Hescreamed.Ofcoursetheprincipalcalledmein.I’dcalmeddown

by then and apologized profusely. “It was almost anaccident,” I told him. “I never would have hit him if I’dremembered the lock inmy hand.” Imeant it too. I wasashamed. Christians didn’t lose their temper like that. IapologizedtoJerryandtheincidentwasclosed.Andmytemper?Iforgotaboutit.Iwasn’tthekindof

guywho’dsplitopenakid’sheadonpurpose.SomeweekslaterMotherbroughthomeanewpairof

pantsforme.Itookonelookatthemandshookmyhead.“Noway,Mother.I’mnotgoingtowearthem.They’rethewrongkind.”“Whatdoyoumean‘wrongkind'?”shecountered.She

wastired.Hervoicefirm.“Youneednewpants.Nowjustwearthese!”Iflungthembackather.“No,”Iyelled.“I’mnotgoing

toweartheseuglythings.”She folded the pants across the back of the plastic

kitchen chair. “I can’t take them back.” Her voice waspatient.“Theywereonspecial.”“Idon’tcare.” I spunto faceher.“Ihate them,andI

wouldn’tbecaughtdeadinthem.”“Ipaidgoodmoneyforthesepants.”“They’renotwhatIwant.”She took a step forward. “Listen, Bennie. We don’t

alwaysgetwhatwewantoutoflife.”Heat poured through my body, inflaming my face,

energizing my muscles, “I will!” I yelled. “Just wait andsee.Iwill.I’ll—”My right arm drew back, my hand swung forward.

Curtis jumped me from behind, wrestling me away from

Mother,pinningmyarmstomyside.The fact that I almost hit my mother should have

made me realize how deadly my temper had become.MaybeIknewitbutwouldn’tadmitthetruthtomyself.IhadwhatIonlycanlabelapathologicaltemper—adisease—and this sickness controlled me, making me totallyirrational.

In general I was a good kid. It usually took a lot tomakememad.ButonceIreachedtheboilingpoint,Ilostall rational control. Totally without thinking, when myanger was aroused, I grabbed the nearest brick, rock, orsticktobashsomeone.ItwasasifIhadnoconsciouswillinthematter.

Friends who didn’t know me as a kid think I’mexaggerating when I say I had a bad temper. But it’s noexaggerationandtomakeitclear,hereare just twomoreofmycrazedexperiences.

I can’t remember how this one started, but aneighborhood kid hit me with a rock. It didn’t hurt, butagain,outofthatinsanekindofanger,Iracedtothesideoftheroad,pickedupabigrock,andhurleditathisface.IseldommissedwhenIthrewanything.Therockbrokehisglassesandsmashedhisnose.

I was in the ninth grade when the unthinkablehappened.Ilostcontrolandtriedtoknifeafriend.BobandIwere listening to a transistor radiowhenhe flipped thedial to another station. “You call that music?” hedemanded.

“It’s better than what you like!” I yelled back,grabbingforthedial.

“Comeon,Carson.Youalways—”In that instantblind anger—pathological anger—took

possessionofme.Grabbingthecampingknife Icarried inmybackpocket,Isnappeditopenandlungedfortheboywhohadbeenmyfriend.Withallthepowerofmyyoung

muscles, I thrust theknife towardhisbelly.Theknifehithisbig,heavyROTCbucklewithsuchforcethatthebladesnappedanddroppedtotheground.I stared at the broken blade and went weak. I had

almostkilledhim.Ihadalmostkilledmyfriend.Ifthebucklehadn’t protected him, Bob would have been lying at myfeet, dying or severely wounded. He didn’t say anything,just lookedatme,unbelieving.“I—I’msorry,”Imuttered,dropping the handle. I couldn’t look him in the eye.Withoutaword,Iturnedandranhome.Thankfullythehousewasempty,forIcouldn’tbearto

see anyone. I raced to the bathroom where I could bealone,andlockedthedoor.ThenIsankdownontheedgeof the tub, my long legs stretching across the linoleum,bumpingagainstthesink.ItriedtokillBob.Itriedtokillmyfriend.Nomatterhow

tightly I squeezed my eyes shut, I couldn’t escape theimage—my hand, my knife, the belt buckle, the brokenknife.AndBob’sface.“This is crazy,” I finallymumbled. “Imust be crazy.

Sanepeopledon’ttrytokill theirfriends.”Therimofthetub felt coolundermyhands. I putmyhandsonmyhotface.“I’mdoingsowellatschool,andthenIdothis.”I’ddreamedofbeingadoctorsinceIwas8yearsold.

But how could I fulfill the dream with such a terribletemper?Whenangry,Iwentoutofcontrolandhadnoideahowtostop. I’dnevermakeanythingofmyself if Ididn’tcontrolmytemper.IfonlyIcoulddosomethingabouttheragethatburnedinsideme.Two hours passed. The green and brown squiggly

snakelikedesignon the linoleum swambeforemyeyes. Ifelt sick to my stomach, disgusted with myself, andashamed. “Unless I get rid of this temper,” I said aloud,“I’m not going to make it. If Bob hadn’t worn that bigbucklehe’dprobablybedead,andI’dbeonmywaytojail

orreformschool.”Miserywashedoverme.Mysweatyshirtstucktomy

back. Sweat trickled down my armpits and my sides. Ihated myself, but I couldn’t help myself, and so I hatedmyselfevenmore.

Fromsomewheredeepinsidemymindcameastrongimpression. Pray.Mymother had taughtme to pray.MyteachersatthereligiousschoolinBostonoftentoldusthatGodwould help us ifwe only askedHim. Forweeks, formonths,Ihadbeentryingtocontrolmytemper,figuringIcouldhandleitmyself.Now,inthatsmallhotbathroomIknewthetruth.Icouldnothandlemytemperalone.

IfeltasthoughIcouldneverfaceanyoneagain.HowcouldIlookmymotherintheeye?Wouldsheknow?Howcould I ever see Bob again?How could he help but hateme?Howcouldheevertrustmeagain?

“Lord,” I whispered, “You have to take this temperfromme.IfYoudon’t,I’llneverbefreefromit.I’llendupdoingthingsalotworsethantryingtostaboneofmybestfriends.”

Already heavy into psychology (I had been readingPsychology Today for a year), I knew that temper was apersonalitytrait.Standardthinkinginthefieldpointedoutthe difficulty, if not the impossibility, of modifyingpersonalitytraits.Eventodaysomeexpertsbelievethatthebestwecandoisacceptourlimitationsandadjusttothem.

Tears streamed between my fingers. “Lord, despitewhatalltheexpertstellme,Youcanchangeme.Youcanfreemeforeverfromthisdestructivepersonalitytrait.”

Iwipedmynoseonapieceof toiletpaperand let itdroptothefloor.“You’vepromisedthatifwecometoYouandasksomethinginfaith,thatYou’lldoit.IbelievethatYou can change this in me.” I stood up, looking at thenarrowwindow,stillpleadingforGod’shelp.Icouldn’tgoonhatingmyselfforeverforalltheterriblethingsI’ddone.

I sank down on the toilet, sharp mental pictures ofothertemperfitsfillingmymind.Isawmyanger,clenchedmy fists against my rage. I wouldn’t be any good foranythingifIcouldn’tchange.Mypoormother,Ithought.Shebelievesinme.NotevensheknowshowbadIam.Miseryengulfedme indarkness.“Ifyoudon’tdothis

forme,God,I’vegotnoplaceelsetogo.”At one point I’d slipped out of the bathroom long

enoughtograbaBible.NowIopeneditandbegantoreadin Proverbs. Immediately I saw a string of verses aboutangry people and how they get themselves into trouble.Proverbs16:32impressedmethemost:“Hewhoisslowtoangerisbetterthanthemighty,andhewhoruleshisspiritthanhewhotakesacity”(RSV).MylipsmovedwordlesslyasIcontinuedtoread.Ifelt

as thoughtheverseshadbeenwritten just tome, forme.ThewordsofProverbscondemnedme,buttheyalsogaveme hope. After a while peace begin to fill mymind.Myhands stopped shaking. The tears stopped. During thosehoursalone in thebathroom, somethinghappened tome.Godheardmydeepcriesofanguish.Afeelingoflightnessflowedoverme, and I knewa changeofhearthad takenplace.Ifeltdifferent.Iwasdifferent.AtlastIstoodup,placedtheBibleontheedgeofthe

tub, and went to the sink. I washedmy face and hands,straightenedmy clothes. I walked out of the bathroom achanged young man. “My temper will never control meagain,”Itoldmyself.“Neveragain.I’mfree.”And since that day, since those long hours wrestling

withmyselfandcryingtoGodforhelp,Ihaveneverhadaproblemwithmytemper.ThatsameafternoonIdecidedIwouldreadtheBible

every day. I’ve kept that practice as a daily habit andespeciallyenjoythebookofProverbs.Evennow,wheneverpossible,IpickupmyBibleandreadthefirstthingevery

morning.ThemiraclethattookplacewasincrediblewhenIstop

to think about it. Some of my psychologically orientedfriendsinsistthatIstillhavethepotentialforanger.Maybethey’re right, but I’ve livedmore than twenty years sincethat experience, and I’ve never had another flare-up oreven had a serious problem of needing to control mytemper.Icantolerateamazingamountsofstressandridicule.

ByGod’s grace, it still doesn’t require anyeffort to shakeoff unpleasant, irritating things. God has helped me toconquermyterribletemper,onceandforever.During those hours in the bathroom I also came to

realize that if people could make me angry they couldcontrol me.Why should I give someone else such powerovermylife?Over the years I’ve chuckled at people who

deliberatelydidthingstheythoughtwouldmakemeangry.I’mnobetter thananyoneelse,but I laugh insideathowfoolishpeoplecanbe,tryingtomakemeangry.Theydon’thaveanycontroloverme.And this is the reason.Fromthat terribledaywhen I

was 14 years old, my faith in God has been intenselypersonal and an important part of who I am. About thattimeIstartedtohumorsingahymnthathascontinuedtobemyfavorite,“Jesus IsAll theWorldtoMe.”Wheneveranything irritatesme, that hymn dissolvesmy negativity.I’veexplaineditthiswaytoyoungpeople,“Ihavesunshineinmyheartregardlessofconditionsaroundme.”I’mnotafraidof anythingas longas I thinkof Jesus

ChristandmyrelationshiptoHimandrememberthattheOnewhocreatedtheuniversecandoanything.Ialsohaveevidence—myownexperience—thatGodcandoanything,becauseHechangedme.From age 14, I began to focus on the future. My

mother’s lessons—and those of several of my teachers—wereatlastpayingoff.

I

CHAPTER7

ROTCTriumph

was10yearsoldwhenIfirstbecameinterestedinJohnsHopkins University Hospital. Back in those days itseemed that every television or newspaper medical storyinvolved somebody at Johns Hopkins. So I said, “That’swhere Iwant to gowhen I become a doctor. Those guysarefindingcuresandnewwaystohelpsickpeople.”

Although I had no question about wanting to be adoctor, the particular field of medicine wasn’t always soclear.Forinstance,whenIwas13myfocuschangedfrombeing a general practitioner to becoming a psychiatrist.Watching TV programs featuring psychiatrists convincedme, for they came across as dynamic intellectuals whokneweverythingaboutsolvinganybody’sproblems.AtthatsameageIwasveryawareofmoneyandfiguredthatwithso many crazy people living in the United States,psychiatristsmustmakeagoodliving.

If I had any doubts about my chosen career theydissolvedaftermythirteenthbirthdaywhenCurtisgavemeasubscriptiontoPsychologyToday. Itwas theperfectgift.Not only a great brother but a good friend, Curtis musthave really sacrificed to spendhishard-earnedmoney forme.Hewasonly15,andhisafter-schooljobinthesciencelabdidn’tpayalot.

Curtiswasgenerousbutalsosensitivetome.Becausehe knew I was getting interested in psychology andpsychiatry,hechosethatwaytohelpme.ThoughIfound

PsychologyTodaytoughreadingforakidmyage,IgraspedenoughfromthedifferentarticlesthatIcouldhardlywaitforeachissuetoarrive.Ialsoreadbooksinthatfield.ForawhileIfanciedmyselfassomesortoflocalshrink.Otherkidscametomewiththeirproblems.Iwasagoodlistener,andIlearnedcertaintechniquesforhelpingothers.I’daskquestionslike,“Doyouwanttotalkaboutit?”or“What’stroublingyoutoday?”Thekidsopenedup.Maybetheyjustwantedachance

totalkabouttheirproblems.Someofthemwerewillingtolisten.Ifelthonoredtohavetheirconfidenceandtoknowthattheywerewillingtotellmetheirtroubles.“Well, Benjamin,” I said to myself one day, “you’ve

found your chosen field, and you’re alreadymoving intoit.”Notuntilmydaysinmedicalschoolwouldthatfocus

shiftoncemore.InthesecondhalfoftenthgradeIjoinedtheROTC.I’ll

confess that I did that largely because of Curtis. I reallyadmiredmybrother,althoughIwouldneverhavetoldhimso.Whetherhe knew it or not, heprovided a rolemodelforme.Hewasoneof thepeople Iwanted toemulate. Itmade me proud to see him in his uniform, his chestplastered with more medals and ribbons than anybody Iknew.My joining the ROTC started another change in my

life,helpingmetogetbackontherighttrack.Mybrother,thenasenior,hadreachedtherankofcaptainandwasthecompanycommanderwhenIbecameaprivate.Curtis never got caught up in thepeer thing and the

demandforclotheslikeIdid.Hestayedonthehonorroleandremainedagoodstudentrightthroughhighschool.Hegraduated near the top of his class and went on to theUniversity of Michigan, eventually majoring inengineering.*

After I joinedROTC, another significant person cameintomylife—astudentnamedSharper.Hehadreachedthehighest rank given to a student— that of a full colonel.Sharper seemed so mature, so self-assured, and yetlikeable.He’sincredible,IthoughtasIwatchedhimdrilltheentireROTCunit.Thencame thenext thought. If Sharpercouldmakecolonel,whycan’tI?AtthatmomentIdecidedIwantedtobeastudentcolonel.

BecauseIjoinedROTClate(inthesecondhalfoftenthgradeinsteadofthebeginningoftheyearliketheothers),itmeantI’dbeinROTConlyfivesemestersinsteadofsix.From the beginning I realized that my chances of evermaking it to the top weren’t very good, but instead ofdiscouragingme,thethoughtchallengedme.IdeterminedthatIwouldgoasfarasIpossiblycouldinROTCbeforeIgraduated.

Mymothercontinuedtotalktomeaboutmyattitudeand began to make an impression. She didn’t lecturebecause she was discovering more subtle ways toencourageme.Shememorizedpoemsand famous sayingsandkeptquotingthemtome.

Thinking about it now, Mother was incredible,memorizinglongpoemslikeRobertFrost’s“TheRoadNotTaken.”Sheoftenquotedtomeapoemcalled“YouHaveYourselftoBlame”—apoemI’veneverbeenabletofindinprint.Butit’saboutpeopleofferingexcusesforfailingtodo their best. The bottom line was that we have onlyourselvestoblame.Wecreateourowndestinybythewaywedothings.Wehavetotakeadvantageofopportunitiesandberesponsibleforourchoices.

MotherstayedonmeuntilIfullygraspedthatIamtheoneultimatelyresponsibleformylife.IhadtotakechargeifIwantedtoamounttoanything.Soonmygradeszoomedupwardagain.DuringboththeeleventhandtwelfthgradesIrankedamongtheAstudentsagain.Ihadgottenbackontherighttrack.

Another influential person inmy life was an EnglishteachernamedMrs.Miller.Shetookapersonalinterestinme in ninth-grade English and taught me a lot of extrathingsafterclass.ShewasproudofmebecauseIwassucha good student, and she taught me to appreciate goodliteratureandpoetry.We’dgoovereverythingI’ddoneinclass that wasn’t perfect, and she stayed with me until Icorrectedeverymistake.In the tenthgradewhenmygradesdropped, shewas

disappointed. Even though I no longer had her for ateacher, she kept up with me and knew that myindifference to schoolwork caused my grades to fall,becauseIwasjusthangingoutinsteadoftrying.Ifeltbadaboutthat,becauseshewassodisappointed.AtthatpointIfelt more guilty about disappointing her than I did mymother.FinallyIbegantorealizethatIhadmyself—andonly

myself—to blame. The in-group had no power over meunless I chose to give it to them. I started pulling awayfromthem.TheclothesissuelargelyresolveditselfbecauseinROTCwehadtowearauniformthreedaysaweek.ThatmeantIhadtowearregularclothesonlytwodaysaweek,andIhadenoughofthe“right”clothesthatkidsdidn’ttalkaboutme.With my clothes problem solved and my changed

attitude,onceagainIstarteddoingverywellinschool.Several teachers played important roles in my life

during my high school years. They gave me personalattention,encouragedme,andallof themtried to inspiremetokeeptrying.I particularly admired and appreciated two men

teachers. First, Frank McCotter, the biology teacher. HewasWhite, about five feetnine,mediumbuild, andworeglasses.IfI’dfirstseenhimonthestreetwithoutknowinganything abouthim, Iwouldhave said, “That’s a biology

I

teacher.”Mr.McCotterhadsomuchconfidence inmyabilities

that he pushed me to take more responsibility, and heprovidedmewithextratutoringinthebiologicalsciences.McCotter assigned me the responsibility to designexperimentsfortheotherstudents,tosetthemup,andtokeepthelabrunningsmoothly.

Thesecondteacher,LemuelDoakes,directedtheband.He was Black, well-built, and serious most of the time,althoughhehadafinesenseofhumor.Mr.Doakesalwaysdemandedperfection.Hewouldn’tsettleforourgettingthemusicright—wehadtoplayitperfectly.

More than being a teacher with interests limitedprimarily tomusic,Mr. Doakes encouragedmy academicpursuits.HesawthatIhadmusicaltalent,buthetoldme,“Carson,youhave toputacademics first.Alwaysput firstthingsfirst.”Ithoughtthatwasanadmirableattitudeforamusicteacher.

Asmuchas forhismusic, I alsoadmiredMr.Doakesforbeingcourageous.Hewasoneofthefewteacherswhowould stand up to the bullies in the school and not letthem scare him. He wouldn’t tolerate any foolishness. Afew students challenged him, but they ended up backingdown.

earneda lotofmedals inROTC forbeingamemberoftherifleteamanddrillteam.Iwonacademicawardsandjust about every competition offered. Along with this, Ireceivedrapidpromotion.

Oneof thebig challenges camewhen Iwasamastersergeant. Sgt. Bandy, an instructor in the United StatesArmyandheadof theROTCunit at ourhigh school, putme in charge of the fifth-hour ROTC unit because thestudents were so rambunctious that none of the otherstudent-sergeantscouldhandlethem.

“Carson,I’mgoingtoputyouinchargeofthisclass,”he said. “If you can make anything out of them, I’llpromote you to second lieutenant” That was exactly thechallengeIneeded.Ididtwothings.First,Itriedtogettoknowtheguys

intheclassanddiscoverwhatreallyinterestedthem.ThenI structured the classes and the exercises accordingly. Ioffered extrapractice on fancydrill routine at the endofeachsuccessfulteachingsession,andtheguysloveddoingthat.Second, reverting to my earlier skill at capping on

peoplepaidoff.Theysoonshapedupbecause,whentheydidn’t do things appropriately, they learned I couldmakethem look bad by capping on them. This method didn’temploy the best psychology, but it worked, and they fellintoline.Itwasjustbeforesummer,andI’dbeenworkinghard

withtheclassforseveralweekswhenSgt.Bandycalledmeintohisoffice.“Carson,”hesaid,“thefifth-hourclassisthebestunitintheschool.Youhavedoneafinejob.”And, truetohisword,Bandypromotedmetosecond

lieutenant at the end of the year—unheard of in ourschool.*

The promotion allowed me to try for field grade,becauseonlyaftermakingsecondlieutenantcouldanyonesit for field-grade examinations. The normal route wentfrom second lieutenant to first lieutenant to captain andthentomajor.Afterthat,fewstudentswentontobecomelieutenant colonel, and only three in the whole city ofDetroitmadefullcolonel.Sgt.Bandysetitupformetogoupforthefield-grade

examination.IdidsowellthathescheduledmetoappearbeforeaboardofmajorsandcaptainsintherealArmy.About that time Sgt. Hunt became the first Black

sergeantinchargeofourROTCunit,replacingSgt.Bandy.

Sgt.Hunt recognizedmy leadershipabilityand,because Iwasdoingsowellacademically,hetookaspecial interestin me. He’d often take me aside and say things like,“Carson,I’vegotbigplansforyou.”Sgt. Hunt used to give me a lot of extra hints and

suggestions, sharing his own insights into things that theexaminers wouldwantme to know. “Carson,” he’d bark,“yougottalearnthisandgottalearnitperfect.”Imemorizedallof the requiredmaterial.The regular

Armyofficerswhoconductedtheexaminationaskedeverypossible question from our training manuals—questionsabout terrain, battle strategies, various weapons, andweaponsystems.AndIwasready!WhenIwentupforthefield-gradeexamination,along

with representatives from each of the 22 schools in thecity, I made the highest score. In fact, my total was (atleastthen)thehighestanystudenthadeverachieved.To my delighted surprise, I received another

promotion—all the way from second lieutenant tolieutenant colonel, again a feat totally unheard of.Naturally, Iwaselated.Evenmoreofawonder, this tookplaceduringthefirstpartoftwelfthgrade.Icouldhardlybelieve it myself. From the second half of tenth grade(10A)IhadgonefromprivatetolieutenantcolonelbythetimeIreached12B.Istillhadafullsemesterofschoolleft,andanother field-gradeexaminationwascomingup.ThatmeantIactuallyhadanopportunitytobecomecolonel.IfImadeit,IwouldbeoneofthreeROTCcolonelsinDetroit.I sat for the exam again and did the best of all the

competitors.Iwasmadecityexecutiveofficeroveralltheschools.I had realized my dream. I had gotten all the way to

colonel even though I had joined ROTC late. Several times Ithought, Well, Curtis, you got me started, and you madecaptain. I’ve passed you, but I wouldn’t have gotten into the

ROTCifyouhadn’tdoneitfirst.AttheendofmytwelfthgradeImarchedatthehead

of the Memorial Day parade. I felt so proud, my chestburstingwithribbonsandbraidsofeverykind.Tomakeitmorewonderful,wehad importantvisitors thatday.TwosoldierswhohadwontheCongressionalMedalofHonorinViet Nam were present. More exciting to me, GeneralWilliam Westmoreland (very prominent in the Viet Namwar) attended with an impressive entourage. Afterward,Sgt.Hunt introducedme toGeneralWestmoreland, and IhaddinnerwithhimandtheCongressionalMedalwinners.LaterIwasofferedafullscholarshiptoWestPoint.

Ididn’trefusethescholarshipoutright,butI letthemknow that a military career wasn’t where I saw myselfgoing. As overjoyed as I felt to be offered such ascholarship,Iwasn’treallytempted.Thescholarshipwouldhaveobligatedme to spend four years inmilitary serviceafterIfinishedcollege,precludingmychancestogoontomedical school. I knew my direction—I wanted to be adoctor,andnothingwoulddivertmeorstandintheway.

Ofcoursetheofferofafullscholarshipflatteredme.Iwas developing confidence in my abilities—just like mymotherhadbeentellingmeforatleastthepasttenyears.UnfortunatelyIcarrieditalittletoofar.IstartedtobelievethatIwasoneofthemostspectacularandsmartestpeoplein the world. After all, I had made this unprecedentedshowing in ROTC, and I stood at the top of my schoolacademically. The big colleges wrote tome and sent outtheirrepresentativestorecruitme.

Meeting representatives fromplaces likeHarvardandYale made me feel special and important because theywantedtorecruitme.Fewofusgetenoughexperienceatfeeling special and important, and I was no exception. Ididn’t know how to handle all the attention. The schoolreps flocked around me because of my high academicachievements, and because I had done exceptionallywell

ontheScholasticAptitudeTest(SAT),rankingsomewherein the lowninetiethpercentile—again,unheardof fromastudentintheinnercityofDetroit.

I laugh sometimes when I think of my secret forscoringsohighontheSAT.Backwhenmymotherwouldallowus towatchonly twoor three television showsandinsistedthatwereadtwobooksaweek,Ididjustthat.Oneprogram—my favorite—was theGeneral ElectricCollegeBowl. On that program—a quiz show—students fromcolleges around the country sat as contestants andcompetedwitheachother.Themasterofceremoniesaskedfactual questions and challenged the knowledge of thosestudents.

All week I looked forward to Sunday nights. In mymind,Ihadalreadyfocusedonanothersecretgoal—tobeacontestantontheprogram.Togetthechancetoappear,IknewI’dhavetobeknowledgeableinmanysubjects,soIbroadenedmyrangeofreadinginterests.Havinginheriteda job in the science laboratory after Curtis graduatedhelpedmetremendouslybecausethescienceteacherssawmydesiretoknowmore.Theygavemeextratutoringandsuggestedbooksorarticlesformetoread.AlthoughIwasdoing well in most of the academic subjects, I realized Ididn’tknowalotaboutthearts.

I started going downtown after school to the DetroitInstituteofArts.IwalkedthroughtheexhibitroomsuntilIknewallthepaintingsinthemaingalleries.Icheckedoutlibrarybooksaboutvariousartistsandwasreallytakinginall of that material. Before long I could recognize themasters’ paintings, name the works themselves, cite theartists’ names and their styles. I learned all kinds ofinformation,suchaswhentheartistslivedandwheretheyreceivedtheirtraining.IsooncouldrecognizethepaintingsorartistslikeaflashwhenquestionscameupaboutthemonCollegeBowl.

Next, Ihad to learnaboutclassicalmusic if Iwanted

to compete.When I started that phase, I used to receiveweird looks from people. For instance, I’d be out on thelawndiggingupweedsortrimmingthegrassandhavemyportableradioplayingclassicalmusic.Thatwasconsideredstrange behavior for a Black kid in Motown. Everybodyelsewaslisteningtojamandbebop.In truth, I didn’t much like the classical music. But

hereagain,Curtisplayedadecisiveroleinmylife.BythenhewasintheNavy,andoncewhenhecamehomeonleavehebroughtacoupleofrecords.OneofthemwasSchubert’sEighth Symphony (Unfinished). He played that recordendlessly.“Curtis,” I asked, “whydo you listen to that stuff? It

soundsabsolutelyridiculous.”“I like it,” he said.Hemight have tried to explain a

littleaboutthemusic,butatthetimeIwasn’tquitereadyto hear him. However, he played that record so oftenduring his twoweeks at home that I foundmyself goingaround humming the melody. About that time I realizedthatIhadactuallybeguntoenjoyclassicalmusic!Classical music wasn’t totally foreign to me. I had

taken clarinet lessons since the seventh grade becausethat’s whatmy brother played. And after all, thatmeantmy mother had to rent only one instrument in thebeginning,andIcoulduseCurtis’soldmusic.LaterIwenton to cornet until, in ninth grade, I switched to thebaritone.CurtishelpedmetoenjoySchubert,andthenIbought

arecordasagiftformymother.Truthfully,Iboughtitformyself. The record contained the many overtures fromRossini’s operas, including the most well-known TheWilliamTellOverture.My next step was listening to the German and the

Italianarias.Ireadbooksaboutoperasandunderstoodthestories. By then I was saying, “This is greatmusic.” I no

longer pushed myself to learn about classical musicbecause I wanted to be on College Bowl. I had gottenhooked.BythetimeIgottocollegeIcouldlistentojustabout

any piece ofmusic—from classical to pop—and I’d knowwhowrote it. I have a good ear for recognizing styles inmusic,andIcultivatedthat.During college, every evening I used to listen to a

program called The Top One Hundred. It played onlyclassicalmusic. I listened every night, and it wasn’t longbeforeIknewthetoponehundredcold.ThenIdecidedtobranchoutfromjustclassicalmusic,soImadeitapointtolistenandlearnfromawiderrangeofmusic.IdideverythingIknewtogetreadytotryoutforthe

College Bowl. Unfortunately, I never did get to appear ontheprogram.

*CurtisgraduatedfromhighschoolattheheightofthewarinVietNam.InthosedaystheSelectiveServiceusedalotterysystemtodeterminewhoshouldgointothemilitaryservice.Curtis’slowlotterynumberassuredhimthatifhewaited, the Army would draft him. After completing a year and a half ofcollege,hedecidedtojointheNavy.“ImayaswellgetthebranchofservicethatIwant,”hesaid.

Hegotintoaspecialprogram,andtheNavytrainedhimtobeanuclearsubmarineoperator. Itwas a six-yearprogram (althoughhedidnot re-enlistafter his four-year stint). He progressed quite well through the ranks andprobably would have been at least a captain by now if he had stayed in.However,hedecided togoback tocollege.TodayCurtis isanengineer,andI’mstillproudofmybigbrother.

*Imadesecondlieutenantafteronlythreesemesterswhenitusuallytookatleastfour,andmostROTCcadetsneverreachedthatrankinsixsemesters.

I

CHAPTER8

CollegeChoices

stared at the ten-dollar bill on the table before me,knowing I had tomake a choice.And since I had onlyonechance,IwantedtomakesureImadetherightone.

FordaysI’dconsideredthematterfromeverypossibleangle.I’dprayedforGodtohelpme.Butitstillseemedtocomedowntomakingonesingledecision.

An ironic situation facedme in the fall of 1968, formostof the topcolleges in thecountryhadcontactedmewith offers and enducements. However, each collegerequiredaten-dollarnon-returnableentrancefeesentwiththeapplication.Ihadexactlytendollars,soIcouldapplyonlytoone.

LookingbackIrealizethatIcouldhaveborrowedthemoneytomakeseveralapplications.Or,it’spossiblethatifI’d talked to representatives from the schools theymighthave waived the fee. But my mother had pushed theconceptofself-relianceforsolongIdidn’twanttostartoutowingaschooljusttogetaccepted.

AtthattimetheUniversityofMichigan—aspectacularschoolandalwaysinthetoptenacademicallyandinsportsevents — actively recruited Black students. And theUniversityofMichiganwaivedthefeesforin-statestudentswho couldn’t afford to pay.However, Iwanted to attendcollegefartheraway.

I lookedhardatmy future, knowing that I couldgetinto any of the top schools but not knowingwhat to do.

Graduating third inmy class, I had excellent SAT scores,and most of the top colleges were scrambling to enrollBlacks.Aftercollege,withamajorinpremedandaminorinpsychology,I’dbereadyformedicalschool,andatlastontherealroadtowardbecomingadoctor.For a long time it botheredme that I had graduated

third in my senior high school class. It’s probably acharacterflaw,butIcan’thelpmyself.Itwasn’tthatIhadto be first in everything, but I should have been numberone.IfIhadn’tgottensosidetrackedbytheneedforpeerapproval, I would have been at the head ofmy class. Inthinking toward college, I determined that would neverhappenagain.Fromnowon,I’dbethebeststudentIwascapableofbeing.Several weeks flew by as I struggled over which

collegetosendmyapplicationto,andbylatespringIhadnarrowed the choice between Harvard and Yale. Eitherwouldhavebeengreat,whichmadethedecisiondifficult.Strangelyenough,myfinaldecisionhingedonatelevisionprogram.AsIwatchedCollegeBowloneSundaynight,theYale students wiped the Harvard students off the face ofthemapwithafantasticscoreofsomethinglike510to35.Thatgamehelpedmetomakemydecision—IwantedtogotoYale.InlessthanamonthInotonlyhadmyacceptanceat

Yaletoenterinthefallof1969,buttheyofferedmea90percentacademicscholarship.IsupposeIshouldhavebeenelatedbythenews.Iwas

happy, but not surprised. Actually I took it calmly, andperhapsevenabitarrogantly,remindingmyselfthatIhadalready accomplished just about everything I’d set out todo—ahighscholasticrecord,topSATscores,everykindofhighschoolrecognitionpossible,alongwithmylonglistofachievementswiththeROTCprogram.Campus accommodations befitted students of my

stature. The student housing was luxurious, the roomsmore like suites. The suites included a living room,fireplace, and built-in bookcases. Bedrooms branched offfrom the main room. Two to four students shared eachsuite.Ihadaroomtomyself.

Istrodeontothecampus,lookedupatthetall,gothic-style buildings, and approved of the ivy-covered walls. Ifigured I’d take the place by storm. Andwhy not? I wasincrediblybright.

AfterlessthanaweekoncampusIdiscoveredIwasn’tthat bright. All the students were bright; many of themextremely gifted and perceptive. Yalewas a great levelerfor me, because I now studied, worked, and lived withdozens of high-achieving students, and I didn’t stand outamongthem.

One day I was sitting at the dining room table withseveral classmembers whowere talking about their SATscores.Oneofthemsaid,“IblewtheSATtestwithatotalofjustalittleoverfifteenhundredinbothparts.”

“That’s not too bad,” another one sympathized. “Notgreat,butnotbad.”

“Whatdidyouget?”thefirststudentaskedhim.“Oh,1540or1550, total. I can’t remembermyexact

mathscore.”It seemed perfectly natural to all of them to have

scoresinthehighninetypercentile.Ikeptsilent,realizingthatIrankedlowerthaneverystudentsittingaroundme.Itwas my first awareness of not being quite as bright as Ithought, and the experience washed away a little of mycockiness. At the same time, the incident only slightlydeterredme.Itwouldbesimpleenoughtoshowthem.I’ddo what I did at Southwestern and throw myselfcompletely intomy studies, learningasmuchaspossible.Thenmygradeswouldputmerightupinthetopechelon.

But I quickly learned that the classwork at Yalewas

difficult, unlike anything I’d ever encountered atSouthwestern High School. The professors expected us tohave done our homework before we came to class, thenused that information as the basis for the day’s lectures.Thiswasaforeignconcepttome.I’dslidthroughsemesteraftersemesterinhighschool,studyingonlywhatIwanted,and then, being a good crammer, spent the last fewdaysbefore exams memorizing like mad. It had worked atSouthwestern.Itwasashocktorealizeitwouldn’tworkatYale.Each day I slipped farther and farther behind in my

classwork, especially in chemistry. Why I didn’t work tokeepup,I’mnotsure.Icouldgivemyselfadozenexcuses,but they didn’t matter. What mattered was that I didn’tknowwhatwasgoingoninchemistryclass.It all came to aheadat the endof the first semester

whenIfacedfinalexaminations.ThedaybeforetheexamIwandered around the campus, sickwith dread. I couldn’tdeny it any longer. Iwas failing freshmanchemistry; andfailingitbadly.Myfeetscuffedthroughthegoldenleavescarpetingthewidesidewalks.Sunlightandshadowdancedon ivy-coveredwalls. But the beauty of that autumn daymockedme.I’dblownit.Ididn’thavetheslightesthopeofpassing chemistry, because I hadn’t kept up with thematerial. As the realization sunk in of my impendingfailure, this bright boy from Detroit also stared squarelyintoanotherhorribletruth—ifIfailedchemistryIcouldn’tstayinthepremedprogram.Despair washed over me as memories of fifth grade

flashed through my mind. “What score did you get,Carson?” “Hey, dummy, did you get any right today?”Yearshadpassed,butIcouldstillhearthetauntingvoicesinmyhead.What am I doing at Yale anyway? It was a legitimate

question,andIcouldn’tpushthethoughtaway.WhodoIthinkIam?JustadumbBlackkidfromthepoorsideofDetroitwho

has no business trying tomake it throughYalewith all theseintelligent,affluentstudents.Ikickedastoneandsentitflyingintothebrowngrass.Stopit,Itoldmyself.You’llonlymakeitworse.Iturnedmymemoriesbacktothoseteacherswhotoldme,“Benjamin,you’rebright.Youcangoplaces.”

There,walkingaloneinthedarknessofmythoughts,IcouldhearMotherinsist,“Bennie,youcandoit!Why,son,you can do anything youwant, and you can do it betterthananybodyelse.Ibelieveinyou.”

I turned and beganwalking between the tall, classicbuildings back to the dorm. I had to study. Stop thinkingaboutfailing,Itoldmyself.Youcanstillpullthisoff.Maybe.Ilookedupthroughascatterofflutteringleavessilhouettedagainsttherosyautumnsunset.Doubtsniggledatthebackofmymind.

FinallyIturnedtoGod.“Ineedhelp,”Iprayed.“BeingadoctorisallI’veeverwantedtodo,andnowitlookslikeI can’t. And, Lord, I’ve always had the impression Youwantedme to be a doctor. I’veworked hard and focusedmylife thatway,assumingthat’swhatIwasgoingtodo.ButifIfailchemistryI’mgoingtohavetofindsomethingelsetodo.PleasehelpmeknowwhatelseIshoulddo.”

Backinmyroom,Isankdownonmybed.Duskcameearly, and the room was dark. The evening sounds ofcampus filled the quiet room—cars passing, students’voicesintheparkbelowmywindow,gustsofwindrustlingthrough the trees.Quiet sounds. I sat there,a tall, skinnykid,head inmyhands. I had failed. I had finally facedachallengeIcouldn’tovercome;Iwasjusttoolate.

Standingup,Iflippedonthedesklamp.“OK,”IsaidtomyselfasIpacedmyroom,“I’mgoingtofailchemistry.SoI’mnotgoingtobeadoctor.Thenwhatisthereforme?”

No matter how many other career choices Iconsidered, I couldn’t thinkof anythingelse in thewholeworld Iwantedmore than being a doctor. I remembered

the scholarship offer fromWestPoint.A teaching career?Business?Noneoftheseareasheldanyrealinterest.Mymind reached towardGod—adesperateyearning,

begging,clingingtoHim.“Eitherhelpmeunderstandwhatkindofwork Iought todo,orelseperformsomekindofmiracleandhelpmetopassthisexam.”Fromthatmomenton,Ifeltatpeace.Ihadnoanswer.

Goddidn’tbreakthroughmyhazeofdepressionandflasha picture in front of me. Yet I knew that whateverhappened,everythingwasgoingtobeallright.One glimmer of hope—a tiny one at that—shone

throughmyseeminglyimpossiblesituation.AlthoughIhadbeenholdingon to thebottomrungof theclass fromthefirstweekatYale,theprofessorhadarulethatmightsaveme. If failing students did well on the final exam, theteacherwouldthrowoutmostof thesemester’sworkandletthegoodfinal-testscorecountheavilytowardthefinalgrade. That presented the only possibility forme to passchemistry.Itwasnearly10:00p.m.,andIwastired.Ishookmy

head,knowingthatbetweennowandtomorrowmorningIcouldn’tpulloffthatkindofmiracle.“Ben,youhavetotry,”Isaidaloud.“Youhavetodo

everythingyoucan.”I satdownfor thenext twohoursandpored through

my thick chemistry textbook, memorizing formulas andequations that I thought might help. No matter whathappenedduring theexam, Iwouldgo into itdeterminedto do the best I could. I’d fail but, I consoledmyself, atleastI’dhaveahighfail.As I scribbled formulas on paper, forcing myself to

memorizewhathadnomeaningtome,IknewdeepinsidewhyIwasfailing.Thecoursewasn’tthattough.Thetruthlayinsomethingmuchmorebasic.Despitemyimpressiveacademic record in high school, I really hadn’t learned

anythingaboutstudying.All thewaythroughhighschoolI’d relied on the same old methods — wasting my timeduringthesemester,andthencrammingforfinalexams.Midnight. The words on the pages blurred, and my

mind refused to take in anymore information. I floppedinto my bed and whispered in the darkness, “God, I’msorry. Please forgive me for failing You and for failingmyself.”ThenIslept.While I slept I had a strange dream, and, when I

awakenedinthemorning,itremainedasvividasifithadactually happened. In the dream I was sitting in thechemistry lecture hall, the only person there. The dooropened, and a nebulous figure walked into the room,stopped at the board, and started working out chemistryproblems.Itooknotesofeverythinghewrote.WhenIawakened,Irecalledmostoftheproblems,and

I hurriedly wrote them down before they faded frommemory.A fewof the answers actuallydid fadebut, stillremembering the problems, I looked them up in mytextbook.IknewquiteabitaboutpsychologysoassumedIwasstilltryingtoworkoutunresolvedproblemsduringmysleep.I dressed, ate breakfast, and went to the chemistry

lectureroomwithafeelingofresignation.Iwasn’tsureifIknew enough to pass, but I was numb from intensivecramming and despair. The lecture hall was huge, filledwith individual fold-down wooden seats. It would seatabout1,000students.Inthefrontoftheroomchalkboardsfaced us from a large stage. Also on the stagewas a bigdesk with a countertop and sink for chemistrydemonstrations.My steps sounded hollowon thewoodenfloor.The professor came in and, without saying much,

began tohandout thebookletsof examinationquestions.My eyes followed him around the room. It took him a

while to pass out the booklets to 600 students. While Iwaited,Inoticedthewaythesunshonethroughthesmallpanes of the arched windows along one wall. It was abeautifulmorningtofailatest.

Atlast,heartpounding,Iopenedthebookletandreadthe first problem. In that instant, I could almost hear thediscordant melody that played on TV with The TwilightZone. In fact, I felt I had entered that never-never land.Hurriedly I skimmed through the booklet, laughingsilently, confirming what I suddenly knew. The examproblemswere identical to thosewritten by the shadowydreamfigureinmysleep.

Iknewtheanswertoeveryquestiononthefirstpage.“Pieceofcake,”Imumbledasmypencilflewtowritethesolutions.Thefirstpagefinished,Iturnedtothenextpage,andagainthefirstproblemwasoneIhadseenwrittenontheboardinmydream.Icouldhardlybelieveit.

Ididn’tstoptoanalyzewhatwashappening.Iwassoexcited to know correct answers that I worked quickly,almostafraidI’dlosewhatIremembered.Neartheendofthetest,wheremydreamrecallbegantoweaken,Ididn’tget every single problem. But it was enough. I knew Iwouldpass.

“God,Youpulledoffamiracle,”ItoldHimasIlefttheclassroom.“AndImakeapromisetoYouthatI’llneverputYouintothatsituationagain.”

Iwalkedaroundcampusforoveranhour,elated,yetneeding to be alone, wanting to figure out what hadhappened. I’dneverhadadreamlikethatbefore.Neitherhad anyone I’d ever known. And that experiencecontradicted everything I’d read about dreams in mypsychologicalstudies.

The only explanation just blew me away. The oneanswer was humbling in its simplicity. For whateverreason, the God of the universe, the God who holds

galaxiesinHishands,hadseenareasontoreachdowntoacampus room on Planet Earth and send a dream to adiscouragedghettokidwhowantedtobecomeadoctor.

Igaspedatthesureknowledgeofwhathadhappened.I felt small and humble. Finally I laughed out loud,remembering that the Bible records such events, thoughtheywere few— timeswhereGod gave specific answersanddirectionstoHispeople.Godhaddoneitformeinthetwentiethcentury.Despitemyfailure,Godhadforgivenmeandcomethroughtopulloffsomethingmarvelousforme.

“It’sclearthatYouwantmetobeadoctor,”IsaidtoGod. “I’m going to do everythingwithinmypower to beone. I’m going to learn to study. I promise You that I’llneverdothistoYouagain.”

Duringmy four years at Yale I did backslide a little,but never to the point of not being prepared. I startedlearninghowtostudy,nolongerconcentratingonsurfacematerialandjustwhattheprofessorswerelikelytoaskonfinals. Iaimedtograspeverything indetail. Inchemistry,for instance, I didn’t want to know just answers but tounderstandthereasoningbehindtheformulas.Fromthere,Iappliedthesameprincipletoallmyclasses.

Afterthisexperience,IhadnodoubtthatIwouldbeaphysician. I alsohad the sense thatGodnot onlywantedmetobeaphysician,butthatHehadspecialthingsformeto do. I’mnot sure people always understandwhen I saythat, but I had an inner certainty that Iwas on the rightpath inmy life—the path God had chosen forme. Greatthingsweregoingtohappeninmylife,andIhadtodomypartbypreparingmyselfandbeingready.

When the final chemistry grades came out, BenjaminS. Carson scored 97—right up there with the top of theclass.

D

CHAPTER9

ChangingtheRules

uring my college years I worked at several differentsummer jobs, a practice I had started in high school

where I worked in the school laboratory. The summerbetween my junior and senior year of high school, Iworked at Wayne State University in one of the biologylaboratories.

Between high school graduation and entering Yale Ineeded a job badly. I had to have clothes for college,books, transportation money, and the dozens of otherexpensesIknewI’dface.

One of the counselors at our high school, AlmaWhittley, knew my predicament and was veryunderstanding. One day I poured out my story, and shelistenedwithobviousconcern.“I’vegotafewconnectionswiththeFordMotorCompany,”shesaid.WhileIsatnextto her desk, she phoned their world headquarters. Iparticularly remember her saying, “Look, we have thisyoungfellowherenamedBenCarson.He’sverybrightandalreadyhasascholarshiptogotoYaleinSeptember.Rightnowtheboyneedsa jobtosavemoneyforthis fall.”Shepaused to listen, and I heard her add, “You have to givehimajob.”*

Thepersonontheotherendagreed.Thedayaftermylasthighschoolclassmynamewent

onthelistofemployeesattheFordMotorCompanyinthemainadministrationbuildinginDearborn.Iworkedinthe

payroll office, a job I considered prestigious, or as mymother called it, big time, because they required me towearawhiteshirtandtieeveryday.That job taught me an important lesson about

employment in the world beyond high school. Influencecouldgetmeinsidethedoor,butmyproductivityandthequalityofmyworkweretherealtests.Justknowingalotof information, while helpful, wasn’t enough either. Theprinciple goes like this: It’s not what you know but thekindofjobyoudothatmakesthedifference.ThatsummerIworkedhard,asIdidateveryjob,even

thetemporaryones.IdeterminedthatIwouldbethebestpersontheyhadeverhired.After completing my first year at Yale, I received a

wonderful summer job as a supervisor with a highwaycrew — the people who clean up the trash along thehighways. The federal government had set up a jobsprogram,mostly for inner-city students. The crewwalkedalongtheInterstatenearDetroitandthewesternsuburbs,picking up and bagging trash in an effort to keep thehighwaysbeautiful.Most of the supervisors had a horrible time with

disciplineproblems, and the inner-city kidshadhundredsof reasons fornotputtinganyeffort into theirwork. “It’stoohottoworktoday,”onewouldsay.“I’mjusttootiredout from yesterday,” another said. “Whywe gotta do allthis? Tomorrow people will just litter it all up again.Who’llknowifwecleaneditupornot?”“Whyshouldwekillourselvesatthis?Thejobjustdoesn’tpayenoughtodothat.”Theothersupervisors,Ilearned,figuredthatifeachof

thefivetosixyoungmeninthecrewfilledtwoplasticbagsaday,theyweredoingwell.These guys could do that much in one hour, and I

knewit.Imaybeanoverachiever,butitseemedawasteof

mytimetoletmycrewlazearoundpickingup12bagsoflitter a day. From the first my crew consistently filledbetween 100 and 200 bags a day, and we coveredenormousstretchesofhighway.

The amount of work my crew did flabbergasted mysupervisiors in the Department of Public Works. “Howcomeyourguyscangetsomuchworkdone?”theyasked.“Noneoftheothercrewsdothatmuch.”

“Oh,Ihavemylittlesecrets,”I’dsay,andmakeajokeoutofwhatIwasdoing.IfIsaidtoomuch,someonemightinterfereandmakemechangemyrules.

Iusedasimplemethod,butIdidn’tgobythestandardprocedures — and I share this story because I think itillustratesanotherprincipleinmylife.It’slikethepopularsongof a fewyears ago that says “I did itmyway.”Notbecause I oppose rules—it would be crazy to do surgerywithoutobeyingcertainrules—butsometimesregulationshinderandneedtobebrokenorignored.

For example, the fourth day on the job I said tomyguys,“It’sgoingtoberealhottoday—”

“You can say that again!” one of them said, andimmediatelytheyalleagerlyagreed.

“So,” I said, “I’m going to make you a deal. First,beginning tomorrow,westartat six in themorningwhileit’sstillcool—”

“Man,nobodyinthewholeworldgetsupthatearly—”“Just listen to my whole plan,” I said to the

interrupter. Our crewswere supposed towork from 7:30a.m. until 4:30 p.m. with an hour off for lunch. “If youguys— and it has to be all six of you—will be ready tostartwork so thatwecangetouton the roadat six, andyou work fast to fill up 150 bags, then after that you’rethroughfortheday.”BeforeanyonecouldstartquestioningmeIclarifiedwhatImeant

“Yousee,ifyoucancollectallthattrashintwohours,I’ll takeyouback,andyou’reoff the restof theday.Youstill earn a full day’s pay. But you have to bring in 150bagsnomatterhowlongittakes.”Webashedtheideabackandforth,buttheysawwhat

Iwanted.Ithadonlytakenacoupleofdaystogetthemtopickup100bagsaday,anditwashot,hardwork intheafternoon. But they loved taunting the other crews andtellinghowmuchtheyhaddone,andtheywerereadyforthenewchallenge.Thesekidswere learningtotakepridein theirwork, as lowly asmanyof themconsidered theirjobs.Theyagreedwithmyarrangement.Thenextmorning

allsixofthemwerereadytogoat6:00a.m.Andhowtheyworked—hard and fast. They learned to clean a wholestretch of highway in two to three hours—the sameamountofworkthattheyhadpreviouslystretchedoutforthewholeday.“OK,guys,” I’d sayas soonas I counted the lastbag.

“Wetaketherestofthedayoff.”They loved it and worked with a joyful playfulness.

Theirbestmomentscamewhenwe’dbehaulingourselvesintotheDepartmentofTransportationby9:00,justastheothercrewsweregettingstarted.“You guys going to work today?” one of my guys

wouldyell.“Man, notmuch trash out there today,” another one

would say. “Supermanandhis hot shots have cleanedupmostofit.”“Hopeyoudon’tgetsunburnedoutthere!”theyyelled

asatruckpulledout.Obviously the supervisors knew what I was doing,

because they saw us coming back in, and they certainlyhad reports of our going out early. They never saidanything. If they had, all I would have had to do was

produceevidenceofourwork.We weren’t supposed to work that way, because the

rules set the specific work hours. Yet not one supervisorevercommentedonwhatIwasdoingwithmycrew.Morethan anything else, I believe they kept silent becausewewere getting the job done and doing it faster and betterthananyoftheothercrews.

Somepeopleareborntowork,andothersarepushedinto it by their moms. But doing what must be done asquickly and as well as possible has beenmy strategy foreverything, includingmedicine.Wedon’tnecessarilyhavetoplaybythestrictrulesifwecanfindawaythatworksbetter,aslongasit’sreasonableanddoesn’thurtanybody.Someone told me that creativity is just learning to dosomething with a different perspective. So maybe that’swhatitis—beingcreative.

The following summer, after my second year ofcollege, I came back to Detroit to work again as asupervisorwithmyroadcrew.At theendof thepreviousyear, Carl Seufert, the top man in the Department ofTransportation,hadleftmewiththewords“Comeonbacknextsummer.We’llhaveaplaceforyou.”

However, theeconomyhita slump in the summerof’71, especially in the capital of the automobile industry.Supervisory positions, because they paid well, wereincrediblyhardtoget.Mostofthecollegestudentswhogotthosejobshadsignificantpersonalorpoliticalconnections.TheyhadbeenhiredmonthsinadvancewhileIwasstillinNewHaven.

Since Carl Seufert had promised me a job, I didn’tconsider confirming it during the Christmas vacationperiod.WhenIappliedinlateMay,thepersonneldirectorsaid,“I’msorry.Thosejobsareallgone.”Sheexplainedthesituation of few jobs and more applicants, but I alreadyknewthat.

I didn’t blame thatwoman, and I knewarguingwithher wouldn’t get me anywhere. I should have put inmyapplicationearlierliketheothers.But I confidently reasoned that I had worked every

summer,andIwouldfindanotherjobeasilyenough.I was wrong. Like hundreds of college students, I

foundthattherewereabsolutelynojobsanywhere.Ibeatthestreetsfortwoweeks.EachmorningI’dgetonthebus,ridedowntown,andapplyateverybusinessestablishmentIcameacross.“Sorry,nojobs.”Imusthaveheardthatstatement,or

variations of it, a hundred times. Sometimes I heardgenuinesympathyinthevoicethatsaidit.Atotherplaces,IfeltasifIwasnumber8,000tocomein,andthepersonwastiredofrepeatingthesamethingandjustwishedwe’dallgoaway.In the middle of this depressing search for

employment,WardRandall, Jr.,was a bright light inmylife.Ward, a White attorney in the Detroit area, had

graduatedfromYaletwodecadesbeforeme.WemetatalocalalumnimeetingwhileIwasstillastudent.Hetookaliking to me because we both shared a keen interest inclassical music. During the summer of 1971 when I wassearchingforajobindowntownDetroit,wefrequentlymetforlunchandthenwenttothenoondayconcerts.Manyofthem were organ concerts in one of the churchesdowntown.Besides that, Ward frequently invited me to go with

his family to various concerts and symphonies, and heintroduced me to a lot of the cultural interests aroundDetroitthatIwouldn’thavehadtheopportunitytoattendbecause of my lack of finances. He was just a real niceman, a real encouragement to me, and I still appreciatehimtoday.

Afterwalkingalloverthecity,Ifinallydecided,I’mgoingto make up my own rules on this one. I’ve tried all theconventionalwaysoffindingajobandfoundnothing.Nothing.Nothing.ThenIrememberedmyregionalinterviewforentrance

intoYaleandthepersonwhohadinterviewedme—anicemannamedMr.Standart.HewasalsothevicepresidentofYoungandRubicumAdvertising,oneofthelargenationaladvertisingcompanies.First I tried the personnel office of his company and

received the familiar words “I’m sorry, we have notemporaryjobsavailable.”Castingasidemyprideandgivingmyselfanotherpep

talk, Igotontheelevatortotheexecutivesuites.BecauseMr.StandarthadinterviewedmeforYaleandgivenmeafine recommendation, I figuredhemust havehad a goodopinionofme.ButIhadn’tfiguredouthowI’dgetpasthissecretary. I remembered that nobody, absolutely nobody,gotintohisofficewithoutanappointment.ThenIfigured,“WhathaveIgottolose?”WhenMr.Standart’ssecretarylookedupatme,Isaid,

“MynameisBenCarson.I’mastudentfromYale,andI’dliketoseeMr.Standartforjustaminute—”“I’ll see if he’s free.” Shewent into his office, and a

minutelaterMr.Standarthimselfcameout.Hesmiled,andhiseyesmetmineasheheldouthishand.“Niceofyoutocomebyandseeme,”he said.“Howare thingsgoing foryouatYale?”As soon as we finished the formalities, I said, “Mr.

Standart Ineeda job. I’mhavinga terrible timetryingtofindwork. I’ve been out every day for twoweeks, and Ican’tfindathing.”“Isthatright?Didyoutrypersonnelhere?”“Nojobshereeither,”Isaid.

“We’lljusthavetoseewhatwecando.”Mr.Standartpicked up the phone and punched a couple of numbers,while I lookedaroundhismammothoffice. Itwasexactlylike the fabulous sets of executive suites I’d seen ontelevision.

Ididn’thearthenameofthepersonhetalkedto,butIheard the rest of his words. “I’m sending a young mandowntoyouroffice.HisnameisBenCarson.Findajobforhim.”

Just that. Not given as a harsh command but as asimple directive from the kind of man who had theauthoritytoissuethatkindoforder.

After thanking Mr. Standart I went back to thepersonnel office. This time the director of personnelhimselftalkedtome.“Wedon’tneedanybody,butwecanputyouinthemailroom.”

“Anything. I just need a job for the rest of thesummer.”

ThejobturnedouttobealotoffunbecauseIgottodriveallaroundthecity,deliveringandpickinguplettersandpackages.

I had only one problem. The job just didn’t payenough for me to save anything for school. After threeweeks,Itookmynextstepofaction.IdecidedthatIhadtoquitmyjobandfindonethatpaidbetter.“Afterall,”Isaidtoreinforcemydecision,“itworkedwithMr.Standart.” Iwent to the Department of Transportation and talked toCarlSeufert.

Wewere already nearing the end of June, every jobwas filled, and it seemed pretty audacious forme to try,butIdiditanyway.

IwentdirectlytoMr.Seufert’soffice,andhehadtimeto talk tome. After he heardmy summer’s tale, he said,“Ben,foraguylikeyouthere’salwaysajob.”Hewastheoverallsupervisorofthehighwayconstructioncrews,both

cleanupandhighwaymaintenance.“Sincethesupervisoryjobsareallgone,”hesaid,“we’llmakea job.”Hepausedandthoughtforafewsecondsandsaid,“We’ll justsetupanothercrewandgiveyouajob.”

That’sexactlywhatMr.Seufertdid.Byusingcreativityandalittledaring,Igotmyoldjobback.Iusedthesametactics with my new six-member crew, and it worked aseffectivelyasithadtheprevioussummer.

FrequentlyI’dseeCarlSeufertwhenIcheckedout,orhe’dvisitusontheworksite.He’dalwaystaketimetochatwithme. “Ben,”he said tomemore thanonce, “you’reagoodman.We’refortunatetohaveyou.”

Ononeoccasionheputhis armonmy shoulder andsaid,“You’reyourownman.Youcanaccomplishanythingthatyouwantintheworld.”AsIlistened,thismanbeganto sound likemymother, and I loved hearing hiswords.“Ben,you’reatalentedperson,andyoucandoanything.Ibelieve you’re going to do great things. I’m just glad toknowyou.”

I’vealwaysrememberedhiswords.Thefollowingsummer,1972,Iworkedonthelinefor

Chrysler Motor Company, assembling fender parts. Eachday I went to work and concentrated on doing my best.Somemay find this hard to believe, but with only threemonthson the job, I received recognitionandpromotion.Toward the end of the summer they moved me up toinspect the louvers that go on the back windows of thesportymodels.Igottodrivesomeofthecarsoffthefinishlinetotheplacewhereweparkedthemfortransportationto showrooms. I liked the things I did at Chrysler. AndeverydaythereconfirmedwhatIhadalreadybelieved.

That summer I also learned a valuable lesson—onethatI’dneverforget.Mymotherhadgivenmethewordsofwisdom,but, likemanykids,Ipaidlittleattention.NowIknew from my own experience how right she was: The

L

kindof jobdoesn’tmatter.The lengthof timeon the jobdoesn’tmatter,forit’strueevenwithasummerjob.Ifyouworkhardanddoyourbest,you’llberecognizedandmoveonward.Althoughsaidalittledifferently,mymotherhadgiven

methesameadvice.“Bennie,itdoesn’treallymatterwhatcoloryouare.Ifyou’regood,you’llberecognized.Becausepeople, even if they’re prejudiced, are going to want thebest. You just have to make being the best your goal inlife.”Iknewshehadbeenright.

ackofmoneyconstantlytroubledmeduringmycollegeyears. But two experiences during my studies at Yale

remindedmethatGodcaredandwouldalwaysprovideformyneeds.First, during my sophomore year I had very little

money. And then all of a sudden, I had absolutely nomoney—notevenenoughtoridethebusbackandforthtochurch. No matter how I viewed the situation, I had noprospects of anything coming in for at least a couple ofweeks.ThatdayIwalkedacrossthecampusalone,bewailing

mysituation, tiredofneverhavingenoughmoney tobuythe everyday things I needed; the simple things liketoothpasteorstamps.“Lord,”Iprayed,“pleasehelpme.Atleastgivemebusfaretogotochurch.”AlthoughI’dbeenwalkingaimlessly, I lookedupand

realized I was just outside Battell Chapel on the oldcampus.AsIapproachedthebikeracks,Ilookeddown.Aten-dollar bill lay crumpled on the ground three feet infrontofme.“ThankYou,God,”IsaidasIpickeditup,hardlyable

tobelievethatIhadthemoneyinmyhand.

The followingyear Ihit that same lowpoint again—not one cent onme, andno expectations for getting any.NaturallyIwalkedacrosscampusallthewaytothechapel,searchingforaten-dollarbill.Ifoundnone.Lackoffundswasn’tmyonlyworrythatday,however.

The day before I’d been informed that the finalexaminationpapersinapsychologyclass,Perceptions301,“wereinadvertentlyburned.”I’dtakentheexamtwodaysearlierbut,with theother students,wouldhave to repeatthetest.And so I,withabout150other students,went to the

designatedauditoriumfortherepeatexam.Assoonaswereceivedthetests,theprofessorwalked

outoftheclassroom.BeforeIhadachancetoreadthefirstquestion,Iheardaloudgroanbehindme.“Aretheykidding?”someonewhisperedloudly.As I stared at the questions, I couldn’t believe them

either. They were incredibly difficult, if not impossible.Eachof themcontaineda threadofwhatweshouldhaveknown from the course, but theywere so intricate that Ifigured a brilliant psychiatrist might have trouble withsomeofthem.“Forget it,” I heardone girl say to another. “Let’s go

backandstudythis.Wecansaywedidn’treadthenotice.Then when they repeat it, we’ll be ready.” Her friendagreed,andtheyquietlyslippedoutoftheauditorium.Immediately three others packed away their papers.

Others filtered out. Within ten minutes after the examstarted,weweredowntoroughlyonehundred.Soonhalfthe class was gone, and the exodus continued. Not onepersonturnedintheexaminationbeforeleaving.I keptworking away, thinking all the time,How can

they expect us to know this stuff? Pausing then to lookaround, I counted seven students besides me still goingoverthetest.

Within half an hour from the time the examinationbegan, I was the only student left in the room. Like theothers, I was tempted to walk out, but I had read thenotice, and I couldn’t lie and say I hadn’t. All the time Iwrotemyanswers,IprayedforGodtohelpmefigureoutwhat to put down. I paid nomore attention to departingfootsteps.Suddenly the door of the classroom opened noisily,

disruptingmy flowof thought.As I turned,my gazemetthat of the professor. At the same time I realized no oneelsewas still struggling over the questions. The professorcametowardme.WithherwasaphotographerfortheYaleDailyNewswhopausedandsnappedmypicture.“What’sgoingon?”Iasked.“A hoax,” the teacher said. “We wanted to see who

was the most honest student in the class.” She smiledagain.“Andthat’syou.”The professor then did something even better. She

handedmeaten-dollarbill.

* In the summerof1988Mrs.Whittley sentmeanote that startedout, “Iwonder if you remember me.” I was touched and tickled. Of course Iremembered her, as I would have remembered anyone who had been thathelpfultome.Shesaidshehadseenmeontelevisionandreadarticlesaboutme. She is now retired, living in the South, and shewanted to sendmehercongratulations.

Iwasdelightedthatsherememberedme.

I

CHAPTER10

ASeriousStep

’vealwaysbeencalledCandy,”shesaid,“butmynameisLacenaRustin.”MomentarilyIstared,mesmerizedbyhersmile.“Nice

tomeetyou,”Ireplied.Shewasoneofmany freshmen Imet thatdayat the

GrossePointeCountryClub.ManyofMichigan’swealthiestcitizens live in Grosse Pointe, and tourists often come toadmire the homes of the Fords and Chryslers. Yale washostingafreshmenreceptionfornewstudents,andI,alongwith a number of upperclassmen, attended to welcomestudents fromMichigan. Ithadmeanta lot tometohavesomeconnectionswhenIfirstwentawaytocollege,andIenjoyedmeetingandhelpingthenewstudentswheneverIcould.

Candywaspretty.IrememberthinkingThat’sonegoodlookinggirl.Shehadanexuberanceaboutherthat I liked.Shewasbubbly, sort of all over theplace, talking to thisone and that. She laughed easily, and during the fewminutesthatwetalkedshemademefeelgood.

Atfivefeetseven,CandywasabouthalfafootshorterthanIam.HerhairfluffedaroundherfaceinthepopularAfrostyle.Butmostofall,Iwasdrawntohereffervescentpersonality. Maybe because I tend to be quiet andintrospective, and she was so outgoing and friendly, Iadmiredherfromthestart.

AtYale,mutualfriendsoftensaid,“Ben,yououghtto

get together with Candy.” I later found out that friendswouldsaytoher,“Candy,youandBenCarsonoughttogettogether.Youjustseemrighttogether.”ThoughIwasbeginningmythirdyearofcollegewhen

wemet,Idefinitelywasn’treadyforlove.Withmylackoffinances,my single-minded goal to become a doctor, andthelongyearsofstudyandinternshipthatI faced,fallinginlovewasthelastthingonmymind.I’dcometoofartoget sidetracked by romance. Another factor entered intothe picture, too. I’m rather shy and hadn’t done muchdating. I’d gone out with small groups, dated now andthen, but had never gotten into any serious relationship.AndIdidn’tplanonanyeither.Onceschoolbegan,IsawCandyoccasionallysincewe

werebothinthepremedprogram.“Hi,”I’dcallout.“Howareyoudoinginyourclasses?”“Fantastic,”she’dusuallysay.“You’readjustingallrightthen?”Iaskedthefirsttime.“IthinkI’mgoingtogetstraightA’s.”Aswechatted I’d think,This girlmust be really smart.

Andshewas.I was even more amazed when I learned that she

playedviolinintheYaleSymphonyandBachSociety—notapositionforjustanybodywhocouldplayaninstrument.These folks were top-grade musicians. As the weeks andmonths passed by, I learned more and more intriguingthingsaboutCandyRustin.Thefactthatshewasmusicallytalented and knew classical music gave us something totalkaboutaswe’dpassfromtimetotimeoncampus.However, Candy was just another student, a nice

person, and I didn’t have any particularly warm feelingstowardher.Orperhaps,withmyheadinmybooksandmysightssetonmedicalschool,Iwouldn’tletmyselfconsiderhow I really felt about the bright and talented CandyRustin.

AboutthetimeCandyandIstartedtalkingmoreoftenand for longerperiods, thechurch inNewHavenwhich Iattendedneededanorganist.

Ihadmentionedourchoirdirector,AubreyTompkins,toCandyseveral times,becausehewasanimportantpartofmy life.After I joined the church choir,AubreywouldcomebyandpickmeuponFridayeveningsforrehearsal.During my second year my roommate Larry Harris, whowasalsoanAdventist,joinedthechoir.OftenonSaturdaynightsAubreytookLarryandmetohishome,andwegrewtoknowhis familywell.Atother timesheshowedus thesights of New Haven. An opera buff, Aubrey invited meseveral times to go with him on Saturday nights to theMetropolitanOperainNewYork.

“Say, Candy,” I told her one day, “I just thought ofsomething. You’re a musician. Our church needs anorganist.What do you think?Would yoube interested inthe job? They pay the organist, but I don’t know howmuch.”

Shedidn’t evenhesitate. “Sure,” she said, “I’d like totryit.”

Then Ipausedwitha sudden thought. “Doyou thinkyou couldplay themusic?Aubreygivesus somedifficultstuff.”

“Icanprobablyplayanythingwithpractice.”So I toldAubreyTompkins aboutCandy. “Fantastic!”

heresponded.“Havehercomeforanaudition.”Candycametothenextchoirrehearsalandplayedthe

largeelectricorgan.Sheplayedwell,andIwashappyjusttoseeherupthere,buttheviolinwasherinstrument.Shecould play anything written for the violin. And althoughCandy had played the organ for her high schoolbaccalaureate service, she hadn’t had much of anopportunity to keep in practice. She had no idea thatAubrey Tompkins liked to throw us into the heavy stuff,

C

particularlyMozart, and shewasn’t quite up to it on theorgan.Aubreyletherplayafewminutes;thenhesaidkindly,

“Look,dear,whydon’tyousinginthechoir?”She couldhavehadher feelingshurt, butCandyhad

enoughself-confidencetotakeitinstride.Amasterontheviolin, the organ wasn’t her principal instrument. “Allright,”shesaid.“IguessI’mnotsohotontheorgan.”SoCandywalkedover towhereweweresingingand

joinedin.Shehadalovelyaltovoice.AndIwasdelightedwhen she joinedus. Shewasa real addition to thechoir.Everyonelovedherfromthatfirstnight,and,becauseshelikedsingingwithus,Mt.ZionbecameCandy’schurchtoofromthenon.She wasn’t overly religious, didn’t talk much about

spiritualorreligiousthings,andhadnosignificantBiblicalbackground.Butshewasopenandreadytolearn.AfterCandystartedattendingourchurch,sheenrolled

inspecialBibleclassesthatlastedfromautumntospring.Iusedtogowithheroneortwonightseachweek,learninga great deal about the Bible myself, and enjoying hercompanyatthesametime.AsCandyreflectsonherspiritualjourney,shesaysshe

alwaysseemedtohaveahungerforGod.ButwhatmadeitdifferentforherintheAdventistchurch?“Thepeople,”shesays.“Theylovedmeintothefaith.”Herfamilythoughtitwasstrangeforhertojoinwith

ChristianswhowenttochurchonSaturday.Yeteventuallythey not only accepted her decision, but Candy’s motherbecameanactiveAdventistherself.

andy and I soon fell into the habit of meeting eachotherafterclass.Wewalkedacrosscampustogetheror

occasionallywentintoNewHaven.

IwasbeginningtolikeCandyalot.Just beforeThanksgivingof 1972,when Iwas inmy

final year at Yale and Candy was a sophomore, theadmissionsofficepaidourwaytodorecruitinginthehighschools in the Detroit area. They provided us with anexpense account, so I rented a little Pinto, and with ourextra money we were able to eat in several nicerestaurants. It was just the two of us, and we had awonderfultime.

Wespentalotoftimetogetherandtherealityslowlycame tome that I likedCandyquite a lot.More than I’dbeenawareof;morethanI’deverlikedagirl.

YalehadrecruitedCandyandmetointerviewstudentswhohadcombinedSATsofat leasttwelvehundred.Aftergoingtoalltheinner-cityschoolsinDetroit,wedidn’tfindonestudentwhohadacombinedSATscore to reach thattotal.To interviewanystudents,Candyand Ihad tovisitplaces in the more affluent communities like BloomfieldHills and Grosse Pointe. We found plenty of students tointerviewwhowantedtotalkaboutattendingYale,butwedidn’trecruitanyminorities.

On the trip Candy met my mother and some of myfriends.Consequently,weendedupstayinga little longerinDetroitthanIhadplanned.IneededtohavetherentedPinto back at the agencyby8:00 the nextmorning. ThatmeantwehadtodrivestraightthroughfromDetroit.

The weather had been cold. A light snow had fallenthe day before, although most of it had melted. Sinceleaving Yale ten days earlier, I hadn’t once had anadequatenight’ssleep,becauseofourworkandwantingtospendtimewithfriends.

“Idon’tknowifIcanstayawake,”ItoldCandywithayawn. Most of the driving would be on the interstatehighways,whichmakesdrivingmonotonous.

Candy and I later disagreed on how she answered. I

thought she said something like, “Don’t worry, Ben, I’llkeep you awake.” She hadn’t had anymore sleep than Ihad. She says her words were, “Don’t worry, Ben, you’llstayawake.”Westartedback toConnecticut.Back then, the speed

limitwas70milesperhour,butImusthavebeenhittingclose to90.Andwhatcouldbemoreboring tomysleep-starvedbodythanwatchingendlessmedianmarksflashingbyonadark,moonlessnight?By the time I crossed the line into Ohio, Candy had

driftedofftosleep,andIdidn’thavethehearttoawakenher. Though we’d had a wonderful time, the days awayfromschoolhadbeenhardonbothofus,andIfiguredthatmaybe she’d rest a couple of hours, then be fully awakeandtakeoverthewheel.About one in the morning I was zooming along

Interstate 80 and recall passing a sign that indicated wewere nearing Youngstown, Ohio. With my hands relaxedonthewheel,thecarflewalongat90milesperhour.Theheater, turned on low, kept us comfortablywarm. It hadbeenhalfanhourormoresinceI’dseenanothervehicle.Ifeltrelaxed,everythingundercontrol.ThenIfloatedintoacomfortablesleeptoo.Thevibrationofthecarstrikingthemetal illuminators that separate each lane jarredme intoconsciousness. My eyes popped open as the front tiresstruck thegravel shoulder.ThePintoveeredoff the road,the headlights streaming into the blackness of a deepravine. I yanked my foot off the gas pedal, grabbed thesteeringwheel,andfiercelyjerkedtotheleft.Inthoseaction-packedseconds,mylifeflashedbefore

myeyes.I’dheardpeoplesaythataslow-motionreviewoflifetumblesthroughthemindjustbeforeonedies.Thisisapreludetodeath,Ithought.I’mgoingtodie.Apanoramaofexperiences from early childhood to the present rolledacrossmymind.This is it.This is the end.Thewordskeptrumblingthroughmyhead.

Goingatthatspeed,thecarshouldhaveflippedover,but a strange thing happened. Because of myovercorrectionwiththesteeringwheel,thecarwentintoacrazy spin, around and around like a top. I released thewheel,mymindfullyconcentratingonbeingreadytodie.Abruptly the Pinto stopped — in the middle of the

lanenexttotheshoulder—headedintherightdirection,theenginestillrunning.HardlyawareofwhatIwasdoing,myshakinghandsslowlyturnedthewheelandpulledthecar off onto the shoulder. A heartbeat later an eighteen-wheelertransportcamebarrelingthroughonthatlane.Icutofftheignitionandsatquietly,tryingtobreathe

normally again.My heart felt as if it were racing at 200beats a minute. “I’m alive!” I kept repeating. “Praise theLord. I can’t believe it, but I’m alive. Thank You, God. IknowYou’vesavedourlives.”Candy must have really been tired, for she’d slept

through the whole terrible experience. My voice reachedinside her sleep, though, and she opened her eyes. “Whyareweparkedhere?Anythingwrongwiththecar?”“Nothing’swrong,”Isaid.“Gobacktosleep.”There must have been an edge to my voice, for she

said, “Don’t be like that, Ben. I’m sorry I fell asleep—Ididn’tmeanto—”I took a deep breath. “Everything’s fine,” I said and

smiledatherthroughthedarkness.“Everythingcan’tbe fine ifwe’renotmoving.What’s

goingon?Whyarewestopped?”Ileanedforwardandflippedontheignition.“Oh,just

aquickrest,” I saidcasually,as Ibegantoaccelerateandpullontotheroad.“Ben,please—“Withamixtureoffearandrelief,Iletthecarcometo

a stop far onto the road shoulder and turnedoff thekey.

“OK,” Isighed.“I fellasleepbackthere…”Myheartstillpounded, my muscles were tense as I told her whathappened.“Ithoughtweweregoingtodie,”Iconcluded.Icouldhardlysaythelastwordsaloud.

Candy reached across the seat and put her hand inmine.“TheLordsparedourlives.He’sgotplansforus.”

“Iknow,” I said, feeling justascertainof that factasshedid.

Neitherofus slept the restof the trip.We talked thewholetime,thewordsflowingnaturallybetweenus.

AtonepointCandysaid,“Ben,whyareyoualwayssonicetome?Liketonight.IdidgotosleepwhenIprobablyshouldhavestayedawakeandtalkedtoyou.”

“Well,I’mjustaniceguy.”“It’smorethanthat,Ben.”“Oh,Ilikebeingnicetosecond-yearYalestudents.”“Ben.Beserious.”Thefirstbrushofvioletpaintedthehorizon.I looked

straight ahead, both hands on the wheel. SomethingunfamiliarflutteredinmychestasCandypersisted.

“Why?” It was hard to stop joking, hard to let themaskfallawayandsaytheactualwords.“Iguess,”Isaid,“it’sbecauseIlikeyou.IguessIlikeyoualot.”

“Ilikeyoualottoo,Ben.MorethananybodyelseI’veevermet.”

Ididn’tanswerbutletthecarslowdown,easeditoffthe road, and stopped. It took only amoment to putmyarms around Candy and kiss her. It was our first kiss.SomehowIknewshe’dkissmeback.

Weweretwonaivekids,andneitherofusknewmuchabout dating or carrying on a romance. But we bothunderstoodonething—welovedeachother.

Fromthenon,CandyandIwereinseparable,spending

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everypossibleminutetogether.Oddlyenough,ourgrowingrelationship didn’t detract me from my studies. HavingCandy atmy side, always encouragingme,mademe justthatmoredeterminedtoworkhard.

Candydidn’tshirkherstudieseither.Shewasatriplemajor,carryingenoughcoursesformusic,psychology,andpremed. Subsequently she dropped the premed toconcentrate more on her music. Candy is one of thebrightestpeopleIknow,goodatwhatevershedoes.*

ne problem that bothered many in the premedprogram was getting into medical school after

graduation. The system for medical training requiresstudents to spend four years earning an undergraduatedegree and then, if accepted by a medical school, toundergoanotherfouryearsofintensivetraining.

“If I don’t make it into med school,” one of myclassmates said several times, “I’ve just been wasting allthistime.”

“I don’t know if I’ll get in at Stanford,” one premedsaid to me, after he had sent in his application. “Oranywhereelse,”headded.

Another mentioned a different school, but thestudents’ worries were essentially the same. I seldom gotinvolvedinwhatIcalledfreakingout,butthiskindoftalkhappenedoften,especiallyduringoursenioryear.

One timewhen this freaking outwas going on and Ididn’t enter in, one ofmy friends turned tome. “Carson,aren’tyouworried?”

“No,”Isaid.“I’mgoingtotheUniversityofMichiganMedicalSchool.”

“Howcanyoubesosure?”“It’srealsimple.MyFatherownstheuniversity.”“Did you hear that?” he yelled at one of the others.

“Carson’soldmanownstheUniversityofMichigan.”Severalstudentswereimpressed.Andunderstandably,

because they came from extremelywealthy homes. Theirparents owned great industries. Actually I had beenteasing,andmaybe itwasn’tplaying fair.AsaChristian IbelievethatGod—myHeavenlyFather—notonlycreatedthe universe, but He controls it. And, by extension, GodownstheUniversityofMichiganandeverythingelse.Ineverdidexplain.Aftergraduatingin1973fromYale,Iendedupwitha

fairly respectable grade point average, although far fromthetopoftheclass.But,IknewIhaddonemybestandputforththemaximumeffort;Iwassatisfied.Aside from my joking, I had no doubts about being

acceptedattheUniversityofMichigan,AnnArbor,intheirSchool of Medicine. I applied there and since I hadbelievedsostronglythatGodwantedmetobeadoctor,Ihadnodoubtsaboutbeingaccepted.Severalofmyfriendswrote tohalf adozenmedical schools,hopingonewouldacceptthem.FortworeasonsIappliedthereandtoonlyafew others. First, the University of Michigan was in myhomestate,whichmeantmuch lower schoolexpenses forthenextfouryears.Second,UofMhadthereputationforbeingoneofthetopschoolsinthenation.I had also applied to Johns Hopkins, Yale’s medical

school, Michigan State, andWayne State. My acceptancefrom U of M came extremely early, so I immediatelywithdrew from the others. Candy still had two years ofschooling at Yale when I began medical school, but wefound ways to bridge time and space.We wrote to eachothereverysingleday.Eventodaybothofushaveboxesofloveletterswesaved.Whenwecouldaffordto,weusedthetelephone.One

timeIcalledheratYale,andIdon’tknowwhathappened,but neither of us seemed able to stop talking.Maybewe

were both extra lonely. Maybe we’d both been having ahard time.Maybewe just needed to be together, to keepcontact when our lives were so far apart. Anyway, wetalked for six straight hours. At the time I didn’t care. Iloved Candy, and every second on the telephone wasprecious.The next day I began to worry about paying the

telephonebill. Inone letter I jokedabouthaving tomakepaymentsallthroughmymedicalcareer.Iwonderedwhatthetelephonecompanycoulddotoapoormedicalstudentwhohadevenlesssensethanmoney.I keptwaiting and dreading the daywhen I actually

sawthebill.Strangelyenough,the6-hourcallnevercamethrough.Icouldn’thavepaiditanyway—certainlynotthewhole amount — so I confess I didn’t investigate thereason.AsCandy and I talked it over later,we theorizedthat thephonecompany lookedat the charges, and someexecutivedecidedthatnoonecouldpossiblytalkthatlong.The summerbetweencollegegraduationandmedical

schoolfoundmebacktomyoldroutineofhuntinga job.And, as I had experienced before, I couldn’t find anyemployment.ThistimeIhadstartedmakingcontactsinthespring,threemonthsbeforegraduation.ButDetroitwasinthe middle of an economic depression, and manyemployers said, “Hire you? Right now we’re laying offpeople.”Atthattimemymotherwascaringforthechildrenof

theSennetfamily—Mr.SennetwasthepresidentofSennetSteel.Afterhearingmysadtales,Mothertoldheremployeraboutme.“Heneedsajobrealbad,”shesaid.“Isthereanywayyoucouldhelphim?”“Sure,”hesaid.“I’dbehappytogiveyoursona job.

Sendhimover.”Hehiredme.IwastheonlyoneatSennetSteelwitha

summerjob.Tomysurprise,myforemantaughtmehowto

operate the crane, a very responsible job, for it involvedpickingup stacks of steelweighing several tons.Whetherhe realized it or not, the operator had to have anunderstanding of physics to be able to visualize what hewas doing as hemoved the boom over and down to thesteel.Theimmensestacksofsteelhadtobepickedupinacertain way to prevent the bundles from swinging. Thentheoperatorworkedthecranetocarry thesteeloverandintotrucksthatwereparkedinanextremelynarrowspace.Somewhere during that period of time I became

acutelyawareofanunusualability—adivinegift,Ibelieve—of extraordinary eye and hand coordination. It’s mybelief thatGod gives us all gifts, special abilities thatwehavetheprivilegeofdevelopingtohelpusserveHimandhumanity.And the gift of eye andhand coordinationhasbeenaninvaluableasset insurgery.Thisgiftgoesbeyondeye-hand coordination, encompassing the ability tounderstand physical relationships, to think in threedimensions. Good surgeons must understand theconsequencesof eachaction, for they’reoftennot able toseewhat’shappeningontheothersideoftheareainwhichthey’reactuallyworking.Some people have the gift of physical coordination.

These are the people who become Olympic stars. Otherscan sing beautifully. Some people have a natural ear forlanguages or a special aptitude for math. I knowindividualswhoseemtodrawfriends,whohaveauniqueabilitytomakepeoplefeelwelcomeandpartofthefamily.For some reason, I am able to “see” in three

dimensions. In fact, it seems incredibly simple. It’s justsomething I happen to be able to do. However, manydoctorsdon’thavethisnaturalability,andsome,includingsurgeons,never learn this skill.Thosewhodon’tpick thisupjustdon’tdevelopintooutstandingsurgeons,frequentlyencounteringproblems,constantlyfightingcomplications.I first becameawareof this abilitywhena classmate

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pointed itoutatYale.Heand Iused toplay table soccer(sometimes called foosball), and, although I had neverplayed before, almost from the first lesson I did it withspeedandease.Ididn’trealizeitthen,butitwasbecauseofthisability.WhenIvisitedYaleinearly1988,Ichattedwith a former classmate who is on staff there. Helaughingly toldme that I had been so good at the gamethatafterwardtheynamedseveralplays“Carsonshots.”During my studies at medical school and the years

afterwardIrealizedthevalueofthisskill.Formeitisthemost significant talent God has givenme and the reasonpeoplesometimessayIhavegiftedhands.

ftermyfirstyearinmedschool,Ihadasummerjobasa radiology technician takingX-rays—itwas theonly

free summer I had from then on. I enjoyed it because Ilearneda lotaboutX-rays,howtheyworked,andhowtouse the equipment. I didn’t realize it at the time butsubsequentlythiswouldbeusefultomeinresearch.The medical school administration offered selected

seniorsopportunitiesasinstructors,andbymysenioryearIwasdoingextremelywell, receivingacademichonorsaswell as recommendations inmy clinical rotations. At onepoint I taught physical diagnosis to first-and second-yearstudents.Intheeveningstheycameover,andwepracticedoneachother.We learnedhow to listen to the soundsofourheartsandlungs,forexample,andhowtotestreflexes.It was an incredibly good experience, and the job forcedmetoworkhardtobereadyformystudents.

didn’tbegininthetopofmyclass,however.Inmyfirstyear of med school my work was only average. That’swhenIlearnedtheimportanceoftrulyin-depthlearning.Iused to go to lectures without getting much from them,particularly when the speaker was boring. But I didn’t

learnmucheither.Forme, itpaid to thoroughly study the textbooks for

eachcourse.DuringmysecondyearIwenttofewlectures.Normally,Igotoutofbedaround6:00a.m.andwouldgooverandoverthetextbooksuntilIkneweveryconceptanddetail in them. Enterprising individuals took extremelygoodnotesforthelecturesandthen,foralittlecash,soldtheirnotes.Iwasoneofthepurchasers,andIstudiedthenotesasthoroughlyasthetexts.

All duringmy secondyear, I did little else but studyfromthetimeIawakeneduntil11:00atnight.Bythetimemy third year rolled around, when I could work on thewards,Iknewmymaterialcold.

* It came as no surprise tome that during her senior year with the YaleSymphonyOrchestra,CandyperformedintheEuropeanpremierofthemodernoperaMassbythegiftedLeonardBernstein.SheactuallyhadachancetomeethiminVienna.

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CHAPTER11

AnotherStepForward

here ought to hean easierway, I thought as Iwatchedmy instructor. A skilled neurosurgeon, he knewwhat

hewas doing, but he had difficulty locating the foramenovale (the hole at the base of the skull). The woman onwhomhewasoperatinghadaconditioncalled trigeminalneuralgia, a painful condition of the face. “This is thehardestpart,”themansaidasheprobedwithalong,thinneedle.“Justlocatingtheforamenovale.”

Then I started to argue with myself. You’re new atneurosurgery, but already you think you know everything,huh?Remember,Ben,theseguyshavebeendoingthiskindofsurgeryforyears.

Yeah, answered another inner voice, but that doesn’tmeantheyknoweverything.

Just leave it alone. One day you’ll get your chance tochangetheworld.

I would have stopped arguing with myself except Icouldn’t get away from thinking that there must be aneasierway.Havingtoprobefortheforamenovalewastedprecioussurgerytimeanddidn’thelpthepatienteither.

OK,smartman.Finditthen.Andthat’sjustwhatIdecidedtodo.I was doing my clinical year at the University of

Michigan’sSchoolofMedicineandwasinmyneurosurgeryrotation.Eachof the rotations lastedamonth,and itwas

during this period that the surgeon commented on thedifficultyoffindingthelittleholeatthebaseoftheskull.After arguing with myself for some time, I took

advantageofthefriendsIhadmadetheprevioussummerwhen Iworked as a radiology technician. Iwent to themand explained what was worrying me. They wereinterested and gave me permission to come into theirdepartmentandpracticewiththeequipment.After several days of thinking and trying different

things, I hit upon a simple technique of placing two tinymetal rings on the back and front of the skull, and thenaligning the rings so that the foramen ovale fell exactlybetween them.Using this technique,doctors could savealotoftimeandenergyinsteadofpokingaroundinsidetheskull.Ihadreasoneditthisway:Sincetwopointsdetermine

a line, I could put one ring on the outside surface of theskullbehindtheareawheretheforamenovaleshouldbe.Ithenwouldputtheotheroneonthefrontoftheskull.BypassinganX-raybeamthroughtheskull, Icould turn thehead until the rings lined up. At that point, the foramenfallsinbetween.The procedure seemed simple and obvious—once I’d

reasoned it out—but apparently noonehad thought of itbefore.Factis,Ididn’ttellanyoneeither.Iwasthinkingofhow to do a better job and wasn’t concerned withimpressing anybody or showing my instructors a newtechnique.For a short time I tormentedmyself by asking,Am I

getting into a new realm of things that others haven’t yetdiscovered?OramI just thinking I’ve figuredouta techniqueno one else has considered before? Finally I decided that Ihaddevelopedamethodthatworkedformeandthatwastheimportantthing.I started doing this procedure and, from actual

surgery, saw how much easier it was. After two suchsurgeries, I told my neurosurgeon professors how I wasdoing it and then demonstrated for them. The headprofessor watched, shook his head slowly, and smiled.“That’sfabulous,Carson.”

Fortunately, theneurosurgeryprofessors didn’t resentmyidea.*

Fromjusthavinganinterestinneurosurgery,thefieldsoon intriguedme somuch it became a compulsion. YoumayhavenoticedthatI’dhadthathappenbefore.Ihavetoknowmore,I’dfindmyselfthinking.Everythingavailableinprint on the subject became an article I had to read.Becauseofmyintenseconcentrationandmydrivingdesiretoknowmore,withoutintendingtoIbegantooutshinetheinterns.

Itwasduringmy second rotation—my fourthyearofmedschool—thatIbecameawarethatIknewmoreaboutneurosurgery than the interns and junior residents.Whilewe were making our rounds, as part of the teachingprocedure the professors questioned us as we examinedpatients. If none of the residents knew the answer, theprofessor would invariably turn to me. “Carson, supposeyoutellthem.”

Fortunately, I always could, although I was still amedical student. And, quite naturally, knowing I excelledinthisareaproducedarealemotionalhigh.Ihadworkedhard and pursued an in-depth knowledge, and it waspayingoff.Andwhynot? If Iwasgoing tobeadoctor, Iwas going to be the best, most-informed doctor I couldpossiblybe!

About this time several of the interns and residentsstartedturningoverafewoftheirresponsibilitiestome.Idon’t think I’ll ever forget the first time a resident said,“Carson, you know so much, why don’t you carry thebeeperandanswerthecalls?Ifyougetintosomethingyou

can’t handle, just holler. I’ll be in the lounge catching alittlesleep.”Hewasn’t supposed todo that,ofcourse,buthewas

exhausted,andIwassodelightedtohavetheopportunitytopracticeandlearnthatIenthusiasticallyagreed.Beforelongtheotherresidentswerehandingmetheirbeepersorturningcasesovertome.Perhaps theywere takingadvantageofme—and ina

sense theywere—because the added responsibilitymeantlonger hours and more work for me. But I lovedneurosurgery and the excitement of being involved inactually performing the operations somuch that I wouldhavetakenonevenmoreiftheyhadasked.I’m sure the professors knewwhatwas going on but

they never mentioned it, and I certainly wasn’t going totell.Ilovedbeingamedicalstudent.Iwasthefirstmanonthelinetakingcareofproblems,andIwashavingthemostfun I’d ever had inmy life.No problems ever arose overmyworkload, and Imaintained a good relationship withthe interns and residents. Through all of these extraopportunities, I became convinced that I enjoyed thisspecialtymorethananythingelseItried.OftenasIwalkedthroughthewardsI’dthink,Ifthisis

so great now while I’m still a student, it’s going to be evenbetterwhenIfinishmyresidency.EachdayIwentonroundsor to the lectures or operating theater. An attitude ofexcitement and adventure filled my thoughts because Iknew I was gaining experience and information whilesharpeningmyskills—allthethingsthatwouldenablemetobeafirst-rateneurosurgeon.By then I foundmyself inmy fourth year ofmedical

school, ready formy one year of internship and thenmyresidency.Professionally, I was heading in the right direction,

without any question. As a kid, I had wanted to be a

missionary doctor and then got caught up in psychiatry.Nowandthen,aspartofourtraining,themedicalstudentswatched presentations in clinical medicine made byvarious specialistswho talkedabout theirparticular field.The neurosurgeons impressed me the most. When theytalked and showedus before-and-after pictures, theyheldmyattentionlikenoneoftheothers.“They’reamazing,”I’dsaytomyself.“Thoseguyscandoanything.”

But the first few times I lookeddownuponahumanbrain, or saw human hands working upon that center ofintelligenceandemotionandmotion,workingtohelpheal,I was hooked. Then realizing thatmy handswere steadyandthatIcouldintuitivelyseetheeffectmyhandshadonthebrain, I knew Ihad foundmy calling.And so Imadethechoicethatwouldbecomemycareerandmylife.

All the facetsofmycareer came together then.First,my interest in neurosurgery; second,my growing interestinthestudyofthebrain;andthird,acceptanceofmyGod-given talent of eye-and-hand coordination—my giftedhands—that fitted me for this field. When I made mychoice forneurosurgery, it seemed themostnatural thingintheworld.

In medical school during our clinical (or third) yearwedid rotationwork foramonthata time,givingusanopportunitytoexperienceeachofthefields.Isignedupforandreceivedpermissiontodotwoneurosurgeryrotations.BothtimesIreceivedhonorsinmywork.

Michigan had an outstanding neurosurgery programand except for a casual incident, I would have stayed atMichigan for my internship and residency. I believeresidency works much better if you’re in the same placeyoutookyourpreviouswork.

Oneday Ioverheardaconversation thatchanged theshape of my plans. An instructor, unaware that I wasnearby,commented toanotherabout thechairmanofour

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neurosurgerydepartment.“He’sonhiswayout,”hesaid.“Youthinkit’sthatserious?”theothermanasked.“Without question.He toldme sohimself. Toomuch

politicalstrife.”That chance conversation forced me to rethink my

future at the U of M. The change of personnel wouldseverelydamage the residencyprogram.Whenan interimchairmancomesonthescene,he’snew,uncertain,andhasno idea how long he’ll stay. Along with that, chaos anduncertainty reign among the residents, loyalties oftendivide, andpersonnel changes occur. I didn’twant to getcaught up in that because I believed it could adverselyaffectmyworkandmyfuture.Thecombinationof thatpieceof informationandthe

fact that I’d long admired the Johns Hopkins complexmademedecidetoapplyatHopkins.Ihadno trepidationat sending inmyapplication for

internshipatHopkinsthefallof1976becauseIfeltthatIwasasgoodasanybodyelseatthatpointinmytraining.Ihadmadeexcellentgradesandachievedhighscoresonthenationalboardexaminations.Onlyoneproblemfacedme:Johns Hopkins accepted only two students a year forneurosurgery residency although they averaged 125applications.Isentinmyapplicationandwithinweeksreceivedthe

marvelous news that I would be interviewed at JohnsHopkins.Thatdidn’tputmeintheprogram,butitgotmeinsidethedoor.Iknewthatwiththecompetitionasstiffasitwas,theyinterviewedbutfewoftheapplicants.

he manner of Dr. George Udvarhelyi, head of theneurosurgery training program, put me at ease

immediately.Hisofficewaslarge,tastefullydecoratedwithantiques. He spoke with a soft Hungarian accent. Thesmokefromhispipelentasweetfragrancetotheroom.He

beganbyaskingquestions,andIfelthehonestlywantedtoknowmyanswers.Ialsosensedthathewouldbefairinhisevaluationandrecommendation.“Tellmealittleaboutyourself,”Dr.Udvarhelyibegan,

lookingacrosshisdeskatme.His manner was straightforward, interested, and I

relaxed. I tookadeepbreathand lookedhimin theeyes.Did Idare tobemyself?Helpme,Lord, Iprayed. If this isYourwillforme,ifthisistheplaceYouknowIshouldbe,helpmetogivetheanswersthatwillopenthedoorstothisschool.“JohnsHopkins iscertainlymy firstchoice,” Ibegan.

“It’salsomyonlychoice.ThisistheplacewhereIwanttobethisfall.”HadIsaidthattoostrongly?Iwondered.HadIbeentoo

openaboutthatIwanted?Ididn’tknow,butIhaddecidedbeforegoingtoBaltimorefortheinterviewthat,aboveall,I wanted to bemyself and to be accepted or rejected bywho Iwas and not because I successfully projected somekindofimagethroughasuper-salesjob.Afterhegainedafewbitsofinformationaboutme,Dr.

Udvarhelyi’s questions revolved around medicine. “Whydidyouchoosetobecomeadoctor?”heasked.Hishandsrestedonhislargedesk.“What aspirations do you have? What are your

primaryfieldsofinterest?”I tried to answer clearly and concisely each time.

However,atsomepointintheconversation,Dr.Udvarhelyimadeanobliquereferencetoaconcerthehadattendedthenightbefore.“Yes,sir,”Isaid.“Iwasthere.”“You were?” he asked, and I saw the startled

expressiononhisface.“Didyouenjoyit?”“Verymuch,”Isaid,addingthattheviolinsoloisthad

notbeenquiteasgoodasIhadexpected.

He leaned forward,his face animated. “I thought thesamething.Hewasfine,technicallyfine,but—”

Idon’tremembertherestoftheinterviewexceptthatDr.Udvarhelyihoned inonclassicalmusicandwetalkedfora long time,maybeanhour, aboutvarious composersand their different styles of music. I think he was takenabackbythefactthatthisBlackkidfromDetroitknewsomuchaboutclassicalmusic.

When the interview concluded and I left his office, Iwonderedif IhadgottenDr.Udvarhelyioff trackandthedigressionwouldcountagainstme.Iconsoledmyselfwiththe thought thathehadbroughtup the topicandhehadkeptthesubjectforemostinourconversation.

YearslaterDr.Udvarhelyitoldmethathehadmadeastrong case for my being accepted to Dr. Long, thechairman. “Ben,” he said to me, “I was impressed withyour grades, your honors and recommendations, and thesplendid way you handled yourself in the interview.”Althoughhedidn’tsayit,I’mconvincedthatmyinterestinclassicalmusicwasadecisivefactor.

And I pleasantly remembered the hours of studyduringhighschoolIhadputintobeingabletocompeteonCollegeBowl. Ironically, theyear I enteredcollege,CollegeBowlwentofftheair.MorethanonceIhadscoldedmyselfforwasting a lot of time learning about the artswhen itwouldneverbeusedorneeded.

I learned something from that experience. Noknowledgeiseverwasted.ToquotetheapostlePaul:“Andwe know that all things work together for good to themthat love God” (Romans 8:28). The love I learned forclassical music helped draw Candy and me together andalso helped me get into one of the best neurosurgeryprograms in the United States. When we work hard toacquireexpertiseorunderstandinginanyfield,itpaysoff.In this case, at least, I saw how it certainly had yielded

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results. I also believe that God has an overall plan forpeople’s lives and the details get worked out along theway,eventhoughweusuallyhavenoideawhat’sgoingon.

I was elated when I received word that I’d beenacceptedintotheneurosurgeryprogramatJohnsHopkins.Now Iwasgoing toget the chance for trainingatwhat Iconsideredthegreatesttraininghospitalintheworld.

Doubts concerning the field of medicine I shouldspecialize in vanished. With confidence born of a goodmother,hardwork,andtrustinGod,IknewIwasagooddoctor.WhatIdidn’tknow,Icouldlearn.“Icanlearntodoanythingthatanybodyelsecando,”IsaidtoCandyseveraltimes.

MaybeIwasalittleoverconfident.ButIdon’tthinkIfelt cocky, and certainly never superior. I recognizedothers’abilitiesaswell.Butinanycareer,whetherit’sthatofaTVrepairman,amusician,asecretary—orasurgeon—an individualmust believe in himself and in his abilities.Todohisbest,oneneedsaconfidencethatsays,“Icandoanything,andifIcan’tdoit,Iknowhowtogethelp.”

ifewasmovingbeautifullyformeduringthistime.I’dbeenawardedavarietyofhonorsformyclinicalwork

attheUniversityofMichigan,andnowIwasenteringthelast,andperhapsmostimportant,phaseofmytraining.

Myprivatelifewasevenbetter.CandygraduatedfromYaleinthespringof1975,andwemarriedJuly6,betweenmy second and third years of med school. Until ourmarriage, I livedwithCurtis.Stillunmarriedat that time,he had received his discharge after four years of NavalserviceandthenenrolledattheUofMtofinishcollege.

CandyandIrentedourownapartmentinAnnArbor,and she easily found a job with the state unemploymentoffice.ForthenexttwoyearssheprocessedunemploymentclaimsandkeptourhomewhileIfinishedmedschool.

It was exciting to move to Baltimore from therelativelysmalltownofAnnArbor.Duringourtimethere,Candy worked for Connecticut General InsuranceCompany.Becauseofhertemporarystatusshefoundajobdoing standard clerical-type work. She also briefly had ajob selling vacuum cleaners, and then she got a job atJohns Hopkins as an editorial assistant for one of thechemistryprofessors.FortwoyearsCandytypedforseveraldifferentJohns

Hopkins publications and did some editing. During thattwo-year period, she also took advantage of theopportunityofourbeingatJohnsHopkinsandwentbacktoschool.Since she was an employee of the university and

married toa resident,Candycouldgo to school free. Shecontinued with her course work and earned her master’sdegreeinbusiness.ThenshewentovertoMercantileBankandTrustandstartedworkingintrustadministration.IworkedhardasaresidentatJohnsHopkins.Oneof

my goals was to maintain a good rapport with everyonebecause I don’t believe in one-person productions.Everyoneontheteamisimportantandneedstoknowthatheorsheisvital.However,afewofthedoctorstendedtobesnobbish,andthatbotheredme.They wouldn’t bother to talk with the “common

people” like ward clerks or aides. That attitude troubledme,andIhurtforthosededicatedemployeeswhenIsawithappening. We doctors couldn’t be effective without thesupport of the clerks and aides. From the start I made apoint to talk to the so-called lowly people and to get toknowthem.Afterall,wherehadIcomefrom?Ihadagoodteacher, mymother, who had taught me that people arejustpeople.Their incomeorposition in lifedoesn’tmakethembetterorworsethananyoneelse.WhenIhadfreeminutesI’dchewthefatonthewards

andgettoknowthenamesofthepeoplewhoworkedwithus.Actuallythisturnedouttobeanadvantage,althoughIdidn’tplanitthatway.DuringmyresidencyIrealizedthatsomeofthenursesandclerkshadbeenontheirjobsfor25or 30 years. Because of their practical experience inobservingandworkingwithpatients,theycouldteachmethings.Andtheydid.I also realized that they recognized things that were

goingonwithpatients that Ihadnowayofknowing.Byworkingcloselywithspecificpatients,theysensedchangesandneedsbeforetheybecameobvious.Oncetheyacceptedme,theseoften-unpraisedworkersquietlyletmeknow,forinstance, those I could trust or those I couldn’t. They’dinform me when things were going wrong on the ward.Morethanonceawardclerk,onherwayoutthedoorafterhershift,wouldpauseandsay,“Oh,bytheway…”andletme know of a problem with a patient. The staff had noobligationtotellanyone,butmanyofthemhaddevelopedan uncanny ability to sense problems, especially relapsesandcomplications.Theytrustedmetolistenandtoactontheirperceptions.MaybeIbegandevelopingarelationshipwiththestaff

because Iwanted to compensate for theway someof theotherdoctorstreatedthem.I’mnotsure.IknowIhateditwhen a resident disregarded a suggestion from a nurse.Whenoneofthemtongue-lashedawardclerkforasimplemistake,Ifeltbadandalittleprotectivetowardthevictim.Atanyrate,becauseofthehelpfromthelowerechelons,Iwasable tomakeanexcellent showingand todoagoodjob.Today I try to emphasize this pointwhen I speak to

youngpeople.“Thereisn’tanybodyintheworldwhoisn’tworthsomething,”Isay.“Ifyou’renicetothem,they’llbenicetoyou.Thesamepeopleyoumeetonthewayuparethe same kind of people you meet on the way down.Besides that, every person you meet is one of God’s

children.”I truly believe that being a successful neurosurgeon

doesn’tmean I’mbetter than anybody else. Itmeans thatI’mfortunatebecauseGodgavemethetalenttodothisjobwell. I also believe thatwhat talents I have I need to bewillingtosharewithothers.

* I stilluse theprincipleof thisprocedure,but I’vedonesomanyof thesesurgeries and gotten so experienced at finding the hole, I don’t need to gothroughthesteps.Iknowexactlywheretheforamenovaleis.

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CHAPTER12

ComingIntoMyOwn

he nurse looked at me with disinterest as I walkedtoward her station. “Yes?” she asked, pausing with a

pencilinherhand.“Whodidyoucometopickup?”FromthetoneofhervoiceIimmediatelyknewthatshethoughtIwasanorderly.Iwaswearingmygreenscrubs,nothingtoindicateIwasadoctor.

“Ididn’tcometopickupanyone.”Ilookedatherandsmiled, realizing that the only Black people she had seenon the floor had been orderlies. Why should she thinkanythingelse?“I’mthenewintern.”

“Newintern?Butyoucan’t—Imean—Ididn’tmeanto— “ the nurse stuttered, trying to apologize withoutsoundingprejudiced.

“That’sOK,” I said, lettingheroff thehook. Itwasanaturalmistake.“I’mnew,sowhyshouldyouknowwhoIam?”

The first time I went into the Intensive Care Unit, Iwaswearingmywhites (ourmonkey suits, aswe internscalledthem),andanursesignaledme.“You’rehereforMr.Jordan?”

“No,ma’am,I’mnot.”“You sure?” she asked as a frown covered her

forehead. “He’s the only one who’s scheduled forrespiratorytherapytoday.”

By then I had come closer and she could read my

namebadgeandthewordinternundermyname.“Oh, I’msoverysorry,”shesaid,andIcouldtellshe

was.AlthoughIdidn’tsayit,Iwouldliketohavetoldher,

“It’sallrightbecauseIrealizemostpeopledothingsbasedon their past experiences. You’ve never encountered aBlackinternbefore,soyouassumedIwastheonlykindofBlack male you’d seen wearing whites, a respiratorytherapist.”Ismiledagainandwenton.ItwasinevitablethatafewWhitepatientsdidn’twant

aBlackdoctor,andtheyprotestedtoDr.Long.Onewomansaid,“I’msorry,butIdonotwantaBlackphysicianinonmycase.”Dr.Longhada standardanswer,given ina calmbut

firm voice. “There’s the door. You’re welcome to walkthrough it. But if you stay here, Dr. Carson will handleyourcase.”At the time people were making these objections, I

didn’tknowaboutthem.OnlymuchlaterdidDr.Longtellme as he laughed about the prejudices of some patients.But therewasnohumor inhisvoicewhenhedefinedhisposition. He was adamant about his stance, allowing noprejudicebecauseofcolororethnicbackground.Ofcourse, Iknewhowsome individuals felt. Iwould

have had to be pretty insensitive not to know. The waythey behaved, their coldness, even without sayinganything,madetheir feelingsclear.Eachtime,however, Iwasabletoremindmyself theywereindividualsspeakingfor themselves and not representative of all Whites. Nomatterhowstronglyapatientfelt,assoonashevoicedhisobjectionhe learned thatDr. Longwould dismiss himonthespotifhesaidanythingmore.SofarasIknow,noneofthepatientseverleft!I honestly felt no great pressures. When I did

encounter prejudice, I could hear Mother’s voice in the

back of my head saying things like, “Some people areignorantandyouhavetoeducatethem.”

Theonlypressure I felt duringmy internship, and intheyearssince,hasbeenaself-imposedobligationtoactasarolemodelforBlackyoungsters.Theseyoungfolksneedto know that the way to escape their often dismalsituations is contained within themselves. They can’texpect other people to do it for them. Perhaps I can’t domuch, but I can provide one living example of someonewho made it and who came from what we now call adisadvantagedbackground.Basically I’mnodifferent thanmanyofthem.

AsIthinkofBlackyouth,IalsowanttosayIbelievethat many of our pressing racial problems will be takencareofwhenwewhoareamongtheminoritieswillstandonourownfeetandrefusetolooktoanybodyelsetosaveus from our situations. The culture in which we livestresseslookingoutfornumberone.Withoutadoptingsucha self-centered value system, we can demand the best ofourselveswhileweareextendingourhandstohelpothers.

I see glimmers of hope. For example, I noticed thatwhentheVietnamesecametotheUnitedStatestheyoftenfaced prejudice from everyone—White, Black, andHispanics.Buttheydidn’tbegforhandoutsandoftentookthe lowest jobs offered. Even well-educated individualsdidn’tmindsweepingfloorsifitwasapayingjob.

Today many of these same Vietnamese are propertyownersandentrepreneurs.That’s themessage I try togetacross to the young people. The same opportunities arethere, but we can’t start out as vice president of thecompany.Evenifwelandedsuchaposition,itwouldn’tdousanygoodanywaybecausewewouldn’tknowhowtodoourwork.It’sbettertostartwherewecanfit inandthenworkourwayup.

My story would be incomplete if I didn’t add thatduringmy year as an internwhen Iwas in general

surgery Ihada conflictwithoneof the chief residents, aman from Georgia named Tommy. He couldn’t seem toaccept having a Black intern at JohnsHopkins.He neversaid anything to that effect, but he continually threwcaustic remarks my way, cutting me short, ignoring me,sometimesbeingjustplainrude.Ononeoccasiontheunderlyingconflictcameintothe

openwhenIasked,“Whydowehavetodrawbloodfromthispatient?Westillhave—”“BecauseIsaidso,”hethundered.Ididwhathetoldme.Several times that day when I asked questions,

especially if theybeganwith“Why,”hesnappedbackthesamereply.Late that afternoon something happened that had

nothingtodowithme,buthewasangryand,Iknewfromexperience,wouldstay thatway fora long time.Hespuntoward me, beginning, as he often did with, “I’m a niceguy, but— “ It hadn’t takenme long to learn that thosewordscontradictedhisnice-guyimage.Thistimehereallylaidintome.“Youreallydothink

you’re somethingbecauseyou’vehadanearlyacceptanceintotheneurosurgerydepartment,don’tyou?Everybodyisalways talkingabouthowgoodyouare,but Idon’t thinkyou’reworthsaltontheearth.Asamatteroffact,Ithinkyou’relousy.AndIwantyoutoknow,Carson,thatIcouldget you kicked out of neurosurgery just like that.” Hecontinuedtorantforseveralminutes.I just lookedathimanddidn’t sayaword.Whenhe

finally paused, I asked in my calmest voice, “Are youfinished?”

“Yeah!”“Fine,”Iansweredcalmly.That’s all I said—all that was necessary—and he

stoppedranting.Heneverdidanythingtome,andIwasn’tconcerned about his influence anyway. Although he wasthe chief resident, I knew that the chiefs of thedepartmentsweretheoneswhomadethedecisions.Iwasdetermined that Iwasn’t going to let himmakeme reactbecausethenhewouldbeabletogettome.InsteadIdidmy duties as I saw fit. Nobody else ever voiced anycomplaints aboutme, so Iwasn’t overly concerned aboutwhathehadtosay.

In the general surgery department, I encounteredseveral men who acted like the pompous, stereotypedsurgeons. It botheredme and Iwanted out of thatwholething.When Imoved to neurosurgery it wasn’t like that.Dr. Donlin Long, who has chaired the neurosurgerydepartmentatHopkinssince1973,isthenicestguyintheworld. If anybodyhas earned the right tobepompous, itshould be him because he knows everything andeverybody,andtechnicallyheisoneofthebest(ifnotthebest) intheworld.Yethealwayshastimeforpeopleandtreats everyone nicely. Since the beginning, even when Iwasalowlyintern,I’vealwaysfoundhimreadytoanswermyquestions.

He is about an inch under six feet and of averagebuild.At the time Ibeganmy internshiphehad salt-and-pepperhair,heavyon thepepper.Nowhishair ismostlysalt. He speaks with a deep voice, and people here atHopkinsarealwaysimitatinghim.Heknowstheydoitandlaughs about it himself because he’s got a great sense ofhumor.Thisisthemanwhobecamemymentor.

I’veadmiredhimsincethefirsttimewemet.Foronething, when I came to Hopkins in 1977 there were fewBlacksandnoneonthe full-time faculty.Oneof thechief

A

residentsincardiacsurgerywasBlack,LeviWatkins,andIwasoneoftwoBlackinternsingeneralsurgery,theotherbeingMartinGoines,whohadalsogonetoYale.*

Manydotheirinternshipingeneralsurgerybutfewerin neurosurgery. Some years nobody from the Hopkins’general surgeryprogramsdivisiongoes intoneurosurgery.At theendofmy internyear, fiveoutofourgroupof30showed interest in going into neurosurgery. Of course,therewere also the 125 people fromother places aroundthe country who wanted one of those slots. That yearHopkinshadonlyoneopenslot.

fter my year of internship I faced six years ofresidency,onemoreyearofgeneralsurgery,andfive

ofneurosurgery.Iwassupposedtodotwoyearsofgeneralsurgery because I applied for neurosurgery, but I didn’twanttodoit.Ididn’tlikegeneralsurgeryandIwantedtogetout.IdislikedgeneralsurgerysomuchIwaswillingtosacrifice trying for a position in the neurosurgerydepartment at Hopkins and go somewhere else if theywouldtakemeafteronlyoneyear.I had gotten an extremely good recommendation

through allmy rotations as an intern. Iwas finishingmymonth rotation as an intern on the neurosurgery serviceandwasreachingthepointofwritingtootherschools.However,Dr.Longcalledmeintohisoffice.“Ben,”he

said,“you’vedoneanextremelyfinejobasanintern.”“Thankyou,”Ianswered,pleasedtohearthosewords.“Well, Ben, we’ve noted that you’ve done extremely

wellonyourrotationontheservice.Allof theattendings[i.e., surgeons] have been quite impressed with yourwork.”Despite the fact that Iwantedmy features to remain

passive,IknowImusthavebeengrinningwidely.

I

“It’s like this,” he said and leaned slightly forward.“We’d be interested in having you join our neurosurgeryprogram next year rather than your doing an additionalyear’sworkingeneralsurgery.”“Thank you,” I said, feeling my words were so

inadequate.Hisofferwasadefiniteanswertomyprayers.

was a resident at Johns Hopkins from 1978 through1982. In1981 Iwasa senior residentatBaltimoreCityHospital(nowFrancisScottKeyMedicalCenter),ownedbyJohnsHopkins.In one memorable instance at Baltimore City,

paramedics brought in a patient who had been severelybeatenontheheadwithabaseballbat.Thisbeatingtookplace during the time of a meeting of the AmericanAssociationofNeurologicalSurgeonsinBoston.Mostofthefaculty was away at the meeting, including the facultypersonwhowas covering at BaltimoreCityHospital. ThefacultymemberondutyatJohnsHopkinswassupposedtobecoveringallthehospitals.The patient, already comatose, was deteriorating

rapidly.NaturallyIwasquiteconcerned,feelingwehadtodo something, but I was still relatively inexperienced.Despite making phone call after phone call, I couldn’tlocate the faculty member. With each call, my anxietyincreased. Finally, I realized that themanwould die if Ididn’t do something—and somethingmeant a lobectomy*—whichIhadneverdonebefore.What should I do? I started thinking of all kinds of

roadblocks such as the medical/legal ramifications oftaking a patient to the OR without having an attendingsurgeoncovering.(Itwasillegaltoperformsuchasurgerywithoutanattendingsurgeonpresent.)WhathappensifIgetinthereandrunintobleedingIcan’t

A

control? I thought.Or if I comeupagainstanotherproblemIdon’t know how to handle? If anything goes wrong I’ll haveotherpeoplesecond-guessingmyactionsandasking,“Whydidyoudoit?”

ThenIthought,WhatisgoingtohappenifIdon’toperatenow?Iknewtheobviousanswer:themanwoulddie.

Thephysician’s assistant, EdRosenquist,whowasonduty knewwhat I was going through. He said just threewordstome—“Goforit.”

“You’re right,” I answered.Once Imade the decisionto go ahead, a calmness came over me. I had to do thesurgery,andIwoulddothebestjobIcould.

Hoping I sounded confident and competent, I said totheheadnurse,“Takethepatienttotheoperatingroom.”

Ed and I prepared for surgery. By the time theoperationactuallybeganIwasperfectlycalm.Iopenedupthe man’s head and removed the frontal and temporallobes from his right side because they were swelling sogreatly. Itwas serious surgery,andonemaywonderhowthemancould livewithout thatportionofhisbrain.Thefactisthattheseportionsofthebrainaremostexpendable.Wehadnoproblemsduring surgery.Themanwokeupafew hours later and subsequently was perfectly normalneurologically,withnoongoingproblems.

However, thatepisodeevokedagreatdealofanxietyinme.ForafewdaysafterI’doperated,Iwashauntedbythethoughtthattheremightbetrouble.Thepatientcoulddevelop any number of complications and I could becensuredforperformingtheoperation.Asitturnedout,noonehadanythingnegativetosay.EveryoneknewthemanwouldhavediedifIhadn’trushedhimintosurgery.

highlightformeduringmyresidencywastheresearchIdidduringmyfifthyear.Foralongtimemyinterest

had continued to grow in the areas of brain tumors and

neuro-oncology. While I wanted to stay with doing thiskindofresearch,wedidn’thavetherightanimalsinwhichwe could implant brain tumors. By working with smallanimals, researchers had long established that once theyobtain consistent results, they could eventually transfertheir findings toward finding cures, and then they couldoffer help to suffering human beings. This is one of themost fruitful forms of research to find cures for ourdiseases.

Researchers had done a lot of work using mice,monkeys, and dogs, but they encountered problems. Dogmodels produced inconsistent results; monkeys wereprohibitivelyexpensive; themurines (ratsandmice)werecheap enough but so small that we couldn’t operate onthem. Neither did they image well with CT Scans* andMRI†equipment.

Toaccomplish the research Iwanted, I faceda triplechallenge: (1) to come up with a relatively inexpensivemodel,(2)tofindonethatwasconsistent,and(3)tofindamodellargeenoughtobeimagedandoperatedon.

Mygoalwastoworkwithonetypeofanimalandletthatbethebasis(ormodel)forourdevelopmentalresearchinbrain tumors.Anumberof oncologists and researcherswhohadpreviouslyestablishedworkingmodelscounseled,“Ben,ifyougoaheadandbegintoresearchbraintumors,you’dbetterexpecttospendatleasttwoyearsinthelabontheproject.”

WhenIembarkedontheprojectIwaswillingtoworkthatlongorlonger.ButwhichanimalsshouldIuse?WhileIinitiallystartedwithrats,theywereactuallytoosmallforour purpose. And, personally, I hate rats! Maybe theytriggered too many memories of my life in Boston’stenement district. I soon realized rats did not have thequalitiesnecessaryforgoodresearch,andIbegantosearchforadifferentanimal.

DuringthenextfewweeksItalkedtoalotofpeople.OnefabulousthingaboutJohnsHopkinsisthattheyhaveexpertswho knowpractically everything about their ownfield. I startedmaking the rounds among the researchersasking, “What kind of animals do you use? Have youthoughtofanyotherkind?”After a lot of questions andmany observations, I hit

upon the idea of using New Zealandwhite rabbits. Theyperfectlyfittedmythreefoldcriteria.SomeoneatHopkinspointedmetotheresearchwork

ofDr.JimAnderson,whowascurrentlyusingNewZealandwhite rabbits. Itwasa thrill towalk into the lab there intheBlaylockBuilding.Inside,Isawalargeopenareawithan X-ray machine, a surgical table off to one side, arefrigerator,an incubator,andadeepsink.Another smallsectionhoused the anesthetics. I introducedmyself toDr.Andersonandsaid,“Iunderstandthatyou’vebeenworkingwithrabbits.”“Yes,Ihave,”heansweredandtoldmetheresultshe’d

already obtained byworkingwithwhat he calledVX2 tocause tumors in the liver and kidneys. Over a period oftime,hisresearchshowedconsistentresults.“Jim, I’m interested in developing a brain tumor

model,andIwonderedaboutusingrabbits.Doyouknowanytumorsthatmightgrowinrabbits’brains?”“Well,” he said, thinking aloud, “VX2might growon

thebrain.”We talked a littlemore and then I pushed him. “Do

youreallythinkVX2willwork?”“Idon’tseeanyreasonwhynot. If it’llgrowinother

areas, there’s agoodchance itmightgrowon thebrain.”Hepausedandadded,“Ifyouwantto,tryit.”“I’mgame.”JimAndersonaidedmeimmenselyinmyresearch.We

firsttriedmechanicaldisassociation;thatis,weusedlittlescreens to grate the tumors, much like someone wouldgratecheese.But theydidn’tgrow.Second,we implantedchunks of tumors into the rabbits’ brains. This time theygrew.Todowhatwecallviabilitytesting,IapproachedDr.

MichaelColvin, a biochemist in theoncology lab, andhesentmetoanotherbiochemist,Dr.JohnHilton.Hilton suggested using enzymes to dissolve the

connected tissue and leave the cancer cells intact. Afterweeksof tryingdifferentcombinationsofenzymes,Hiltoncameupwith just the right combination for us.We soonhad high viability — almost 100 percent of the cellssurvived.Fromthereweconcentratedthecellsinthequantities

wewanted.Byrefiningtheexperimentswealsodevelopeda way of using a needle to implant them into the brain.Soonalmost100percentof the tumors grew.The rabbitsuniformlydiedwithabraintumorsomewherebetweenthetwelfthandfourteenthday,almostlikeclockwork.When researchers have that kind of consistency they

cangoonto learnhowbraintumorsgrow.Wewereableto do CT scans and became excited when the tumorsactually showed up. The Magnetic Resonance Imaging(MRI),developedinWestGermany,wasanewtechnologyjust breaking on the scene at that time, and wasn’tavailabletous.JimAndersontookseveraloftherabbitstoGermany,

imagedthemontheMRI,andwasabletoseethetumor.Iwouldhavelovedtogowithhimandwouldhave,exceptthatIdidn’thavethemoneyforthetrip.Then we had the use of a PET* scanner in 1982.

Hopkinswas one of the first places in the country to getone.Thefirstscansthatwedidonitweretherabbitswiththe brain tumors. Through the medical journals we

receivedwidepublicity forourwork.To thisdaya lotofpeopleatJohnsHopkinsandotherplacesareworkingwiththisbraintumormodel.Ordinarily this research would have taken years to

accomplish, but I had so much collaborative effort withothersatHopkinshelpingtoironoutourproblemsthatthemodelwascompletewithinsixmonths.ForthisresearchworkIwontheResidentoftheYear

Award.This alsomeant that insteadof staying in the labfortwoyearsIcameoutthenextyearandwentontodomychiefresidency.I began my year of chief residency with a quiet

excitement. It had been a long, sometimes tough road.Long, longhours, timeaway fromCandy, study,patients,medicalcrises,morestudy,morepatients—Iwasreadytogetmyhandsonsurgicalinstrumentsandtoactuallylearnhow to perform delicate procedures in a quick, efficientway.Forexample,Ilearnedhowtotakeoutbraintumorsand how to clip aneurysms. Different aneurysms requiredifferent sized clips, often put on at an odd angle. Ipracticed until the clipping procedure became secondnature,untilmyeyesandinstincttoldmeinamomentthetypeofcliptouse.I learned tocorrectmalformationsofboneand tissue

and to operate on the spine. I learned to hold an air-powereddrill,weigh it inmyhand, test it, thenuse it tocut through bone onlymillimeters away fromnerves andbraintissue. I learnedwhentobeaggressiveandwhentoholdback.I learned to do the surgery that corrects seizures.

Learned how to work near the brain stem. During thatintense year as chief resident, I learned the special skillsthat transformed the surgical instruments along with myhands,myeyes,andintuitionintohealing.Then I finished the residency.Another chapterofmy

lifewas ready to open and, as often happens before life-changingevents,Iwasn’tawareofit.Theideacameacrossasimpossible—atfirst.

Ben’shighschoolgraduation.SonyaCarson,farright,withfamilyfriends.

CurtisandBenatateenageChristmas.

DetroitFreePress/WilliamDeKay(5-15-88)

SonyaCarsonholdsthehighschoolgraduationphotographsofhersonsBen,left,and

Curtis.

Ben’sfirstyearatYale.

BenandCurtisatBen’sgraduationfrommedicalschool.

MurrayandB.J.welcometheirnewChristmaspresent.

One-day-oldRhoeycewithhisfather.

DetroitFreePress/WilliamDeKay(5-15-88)

Benandhiswife,Candy,relaxathomeatthepiano.

Carsonserenade.Alullabybeforebedtime.

TheCarsonsathome:Ben,Murray,Rhoeyce,Candy,andB.J.

Ahemispherectomyreunion.

MarandaFrancisco,Ben’sfirsthemispherectomypatient,withballoonsathospitalparty.

WalterMcCardell/TheBaltimoreSun

Dr.Carsontalkswithyoungpatient.

J.PatCarter/JohnsHopkinsChildren’sCenter

TheBindertwinssurgerywithneurosurgeonsBenCarson,ReggieDavis,SamHassenbusch,

andDonlinLong.

DetroitFreePress/WilliamDeKay(5-15-88)

Dr.BenjaminCarsonstandsquietlywithhisassistant,CarolJames,beforestartingthe

delicatebrainsurgeryforwhichhehasbecomeinternationallyknown.

DavidB.Sherwin

BenCarsonreceivesanhonorarydoctoraldegreefromAndrewsUniversityinJune1989.

DetroitFreePress/WilliamDeKay(5-15-88)

Dr.Carsonexamines2½-year-oldMeganWikstromduringroundsattheJohnsHopkins

Children’sCenter.“Nobodycouldbemorepatientwithmyonemillionquestionsandfears,”

sayshermother,MargieWikstrom,center.

DetroitFreePress/WilliamDeKay(5-15-88)

CarsonchatswithPaulGalli,16,ofHammonton,NewJersey,whohadreturnedfora

checkupaftersurgeryforabraintumor.

JohnsHopkinsChildren’sCenter

Dr.MarkRogersandDr.CarsonwithoneoftheBindertwins.

JohnsHopkinsChildren’sCenter

AtapressconferenceaftertheSiamesetwinsurgery.

J.PatCarter/JohnsHopkinsChildren’sCenter

Manyoftheessentialplayersoftheteamthatseparatedthetwins.

*MartinGoines isnowanotolaryngologist (ear,nose,and throat)atSinaiHospitalinBaltimoreandthechiefofthedivision.

* Lobectomy means actually taking out the frontal lobe, while lobotomymeansjustcuttingsomefibers.

* Commonly called Cat Scans for Computerized Tomography, a highlytechnical, sophisticated computer that allows the X-ray beams to focus atdifferentlevels.

† The Magnetic Resonance Imaging doesn’t use X-rays but a magnet thatexcites the protons (microparticles), and the computer then gathers energysignalsfromtheseexcitedprotonsandtransformstheprotonsintoanimage.

MRIgivesaclear-cut,definitepictureofsubstancesinsidebyreflectingtheimage based on the excitation of the protons. For instance, protons will beexcitedinadifferentdegreeinwaterthaninbonesormusclesorblood.

All protons give off different signals, and the computer then translatesthemintoanimage.

*PET(PositronEmissionTomography)usesradioactivesubstancesthatcanbemetabolizedbycellsandgivesoffradioactivesignalsthatcanbepickedupand translated. Just like themagnetic resonance imagery picks up electronicsignals,thispicksupradioactivesignalsandtranslatesthemintoimages.

I

CHAPTER13

ASpecialYear

didn’texplaintherealreasontoBryantStokes.Ifiguredheknewitwithoutmyhavingtobringitoutintheopen.Instead I answered, “Sounds like a nice place.” AnothertimeIsaid,“Whoknows?Maybeoneday.”

“Beagrandplaceforyou,”hepersisted.Each time he mentioned it, I gave Stokes another

excuse, but I did think about what he said. One benefitespeciallyappealedtome.“You’dgetasmuchexperienceinneurosurgerythereinoneyearasyou’dgetinfiveyearsanywhereelse.”

ItseemedstrangetomethatBryantStokespersistedinthe idea,buthedid.Aseniorneurosurgeon in theUnitedStatesfromPerth,WesternAustralia,BryantandIhititoffatonce.FrequentlyBryantwouldsay,“YoushouldcometoAustralia and be a senior registrar at our teachinghospital.”

I tried various ways of getting him off the subject.“Thanks, but I don’t think it’s what I want to do.” OranothertimeIsaid,“You’vegottobekidding.Australiaison the other side of the world. You drill through fromBaltimoreandyoucomeoutinAustralia.”

Helaughedandsaid,“Oryoucouldflyandbetherein20hours.”

Itriedevasivehumor.“Ifyou’rethere,whoneedsmeoranyoneelse?”

A matter of deep concern for me, which I naturallydidn’t mention, was that people had been telling me foryears thatAustraliawasworsewithapartheid thanSouthAfrica.Icouldn’tgotherebecauseI’mBlackandtheyhadaWhites-onlypolicy.Didn’therealizeIwasBlack?I dismissed the whole idea. Aside from the racial

matter, frommy perspective I couldn’t see that going toAustralia for a year of residency would add anything interms of my career, although it would certainly beinteresting.If Bryant hadn’t been so persistent, I wouldn’t have

giventhe ideaanymorethought.Virtuallyeverytimewetalked, he’d make a casual remark such as, “You know,you’dloveAustralia.”I had other plans because Dr. Long, head of

neurosurgery andmymentor, had already toldme that Icould stay on the faculty of Johns Hopkins after myresidency.Thefactthatheadded,“I’dbedelightedtohaveyou,”madeitallthatmoreappealing.I couldn’t think of anything more exciting than to

remainatHopkins,wheresomuchresearchwasgoingon.Forme,Baltimorehadbecomethecenteroftheuniverse.Yet, strange as it seemed, although I’d dismissed

Australia,thetopicdoggedme.ItseemedthatforawhileeverytimeIwentsomewhere,I’dencountersomeonewiththat particular accent saying, “Ga’day, mate, how yougoing?”Turning on the television, I hit commercials saying,

“Travel toAustralia andvisit the landof the koala.”AndPBSadvertisedaspecialonthelanddownunder.FinallyIaskedCandy,“Whatintheworldisgoingon?

IsGodtryingtotellussomething?”“Idon’tknow,”sheanswered,“butmaybewe’dbetter

talkalittleaboutAustralia.”

ImmediatelyIthoughtofaloadofproblems,themainonebeing theWhites-onlypolicy. I askedCandy to go tothe libraryandcheckoutbooksonAustralia sowecouldfindoutaboutthecountry.

The next day Candy phoned me. “I found outsomethingaboutAustraliayouought toknow.”Hervoiceheld an uncommon excitement so I asked her to tell merightthen.

“That Whites-only policy that’s bothered you,” shesaid.“Australiausedtohaveit.Theyabolishedthatlawin1968.”

Ipaused.Whatwashappeninghere?“Maybeweoughttoconsiderthisinvitationseriously,”Itoldher.“MaybewejustoughttogotoAustralia.”

The more we read, the more Candy and I liked theidea. Before long we were getting excited. Next wediscussedAustraliawith friends.With fewexceptions,ourwell-intentioned friends discouraged us. One of themasked,“Whydoyouwanttogotoaplacelikethat?”

Another one said, “Don’t you dare go to Australia.You’llbebackinaweek.”

“You wouldn’t make Candy go through that, wouldyou?” asked another. “Why, she’s had such a bad timealready.It’llbeworseforherdownthere.”

I couldn’t help smiling at this friend’s words. Hisconcern was our joy—and niggling worry. Candy waspregnant,anditdidseemfoolishtoflytotheothersideofthe world at this time. The problem was that in 1981,while I was chief resident, Candy became pregnant withtwins. Unfortunately, she miscarried in her fifth month.Now,thefollowingyear,shewaspregnantagain.Becauseofthefirstexperience,herdoctorputheronbedrestafterthefourthmonth.Shequitherjobandreallylookedafterherself.

When the question about her condition came up,

Candy smiled each time but said firmly, “They do havequalifieddoctorsinAustralia,youknow.”Our friendsdidn’t realize itbutwe’dalreadydecided

togo,eventhoughwedidn’tconsciouslyknowitourselves.We had gone through the formal steps of makingapplication to the SirCharlesGardinerHospital ofQueenElizabeth IIMedical Center, themajor teaching center inWestern Australia and their only referral center forneurosurgery.I received a reply within two weeks. They had

acceptedme.“Guessthat’souranswer,”IsaidtoCandy.Bythen shewasalmostmoreexcitedaboutourgoing than Iwas. We would leave in June 1983 and were fullycommittedtotheventure.We had to be fully committed because it took every

dimewehadtobuyourtickets—oneway.Wewouldn’tbeable to come back even if we didn’t like it. I would bedoingoneyearasaseniorregistrar.*

Several reasons made the venture attractive, one ofwhichwasthemoney.IwouldbegettingagoodsalaryinAustralia—alotmoremoneythanI’devermadebefore—$65,000fortheyear.†

Andwebadlyneededthemoney.Althoughtheracialissuewassettled,CandyandIstill

flew to Perthwith a great deal of trepidation.We didn’tknow what kind of reception we’d receive. We hadlegitimate concerns because I’d be an unknown surgeonenteringanewhospital.Despiteherbravetalk,Candywaspregnant and the possibility of problems stayed in ourminds.But the Australians received us warmly. Our being

affiliated with the Seventh-day Adventist Church openedmanydoors.OnourfirstSaturdayinAustraliawewenttochurch and met the pastor and several members beforeworshipbegan.During the service, thepastor announced,

“Wehave a family from theUnited Stateswith us today.They’re going to be here for a year.”He then introducedCandyandmeandencouragedthememberstogreetus.

Anddidthey!Whentheserviceconcluded,everybodycrowded around us. Seeing that my wife was pregnant,manywomenasked,“Whatdoyouneed?”Wehadbroughtnothinginpreparationforthebaby,sincewewerelimitedin theamountof luggagewecouldcarry fromtheUnitedStates, and those wonderful people started bringing inbassinets,blankets,babystrollers,anddiapers(whichtheycallednappies).Wewereconstantlyreceivinginvitationstodinner.

Peopleatthehospitalcouldn’tfigureouthow,withintwoweeksofourarrival,wehadmeta lotofpeopleandwerereceivingaconstantstreamofinvitations.

One ofmy fellow residents,whohadbeen there fivemonths,asked,“Whatareyoudoingtonight?”

Imentionedthatwewerehavingdinnerwithacertainfamily. The resident knew that only a few days earlier adifferentfamilyhadtakenusonascenictripoutsidePerth.

“Howintheworlddoyouknowsomanypeople?”heasked.“You’veonlybeenoverhereafortnight.Ittookmemonthstomeetthismanypeople.”

“Wecomefromalargefamily,”Isaid.“YoumeanyouhaverelativeshereinAustralia?”“Sort of.” I chuckled and then explained, “In the

church,we think of ourselves as all part ofGod’s family.Thatmeansthatwethinkofthepeoplewhereweworshipas brothers and sisters— part of our family. The churchpeoplehavebeen treatingus like the familymembersweare.”

He’dneverheardsuchaconceptbefore.

Fromthedaywearrived, I likedAustralia.Not just thepeoplebutthelandandtheatmosphere.Beinghiredasa senior registrar alsomeant that I got todomost of thecases. That responsibility boosted my appreciation forbeing in the landdownunder.EvenCandybecamereallyinvolved,asafirstviolinistintheNedlandsSymphonyandavocalistinaprofessionalgroup.Afullmonthhadn’tpassedwhenanextremelydifficult

casecametoourattentionandchangedthedirectionofmywork in Perth. The senior consultant had diagnosed ayoungwomanashavinganacousticneuroma,atumorthatgrows at the base of the skull. It causes deafness andweakness of the facial muscles, eventually resulting inparalysis. This patient also suffered from frequent andextremeheadaches.The tumor was so large that, with the consultant’s

decisiontotakeitout,hetoldthepatientthathewouldn’tbeabletosaveanyofhercranialnerves.After hearing the prognosis, I asked the senior

consultant, “Do you mind if I try to do this using amicroscopictechnique?Ifitworks,Icanpossiblysavethenerves.”“Itisworthtrying,I’msure.”Whilethewordswerepoliteenough,therealflavorof

his feeling came through. I knew he was saying, “Youyoungwhippersnapper,justtry,andthenseeyourselffail.”AndIcouldn’tblamehim.The surgery took 10 straight hours without rest.

Naturally,whenIfinishedIwasexhausted,butalsoelated.Ihadcompletelyremovedthetumorandsavedhercranialnerves. The senior consultant could tell her she wouldlikelyenjoyacompleterecovery.Within a short time after her recovery, the woman

became pregnant. When the baby was born, in gratitude

she named the child after her consultant because shethoughthehadtakenouthertumorandsavedhercranialnerves.Shedidn’tknowthatIhaddonethedelicatework.Actually,thingsaredonethatway.InAustralia,theseniorregistrar works under the auspices of the consultant andhe, as the topman, gets the credit for successful surgery,nomatterwhoactuallyperformsit.Theothersonthestaff,ofcourse,knew.After that surgery, the other senior consultants

suddenlyshowedmeenormousrespect.Fromtimetotimeoneof themwouldcomeuptomeandask,“Say,Carson,canyoucoverasurgeryforme?”Eagertolearnandanxiousformoreexperience,Idon’t

recall turningdownacase—whichgavemeatremendousload, farmore thananormalcase loadwouldprovide. Inless than two months in the country, I was doing two,maybethree,craniotomiesaday—openingpatients’headstoremovebloodclotsandrepairaneurysms.It takes a lot of physical stamina to do that much

surgery. Surgeons spend hours on their feet at theoperatingtable.IcouldhandlelengthyoperationsbecausewhiletrainingunderDr.Long,Ihadlearnedhisphilosophyand techniques,which included how to keep going, hourafter tedious hour, without yielding to fatigue. I hadcarefullywatchedeverythingLongdidandwasthankfulhehad removed a lot of brain tumors. The Australianneurosurgeons didn’t know it, but I had brain surgerydown pat. The consultants increasingly gave me a freerhand than they normally would have given a seniorregistrar.BecauseIdidwellandwasalwayseagerformoreexperience, I was soon scheduling brain surgeries one ontopofanother.It’snotquitelikeanassemblylinebecauseeachpatientisdifferent,butIsoonbecamethelocalexpertinthefield.After several months, I realized that I had a special

O

reasontothankGodforleadingustoAustralia.InmyoneyearthereIgotsomuchsurgicalexperiencethatmyskillswere honed tremendously, and I felt remarkably capableand comfortable working on the brain. Before long, thewisdom of spending a year in Australia becameincreasingly clear tome.Where elsewould I have gottensuchauniqueopportunityforvolumesurgeryimmediatelyaftermyresidency?

Ididalotoftoughcases,someabsolutelyspectacular.And I often thanked God for the experience and thetraining it provided. For instance, the fire chief in Perthhadanincrediblylargetumorinvolvingallthemajorbloodvesselsaroundtheanteriorpartofthebaseofhisbrain. Ihadtooperateonthemanthreetimestogetallthetumorout. The fire chief had a rocky course, but eventually hedidextremelywell.

neotherhighlight:Candygavebirth toour first son,Murray Nedlands Carson (Nedlands was the suburb

wherewelived),onSeptember12,1983.And then, almost beforewe realized it,my yearwas

up and Candy and I were packing to return home.WhatwouldIdonext?WherewouldIwork?ThechiefofsurgeryatProvidentHospitalinBaltimorecontactedmesoonaftermyreturn.

“Ben, youdon’twant to stayover there atHopkins,”hesaid.“Youcouldbesomuchbetteroffwithushere.”

Provident Hospital concentrated on medical servicesforBlacks.“NooneisgoingtoreferanypatientstoyouatHopkins,” thechiefof surgerysaid.“Why, that institutionissteepedinracism.You’regoingtoendupwastingyourtalentsandyourcareerinthatracistinstitution,andyou’llnevergoanywhere.”

Inodded,thinking,Maybeyou’reright.Ilistenedtoeverythinghehadtosaybuthadtomake

my own decision. “Thanks for your concern,” I said. “Ihaven’tbeenawareofprejudicetowardmeatHopkins,butyoumayberight.Anyway,Ihavetofindoutformyself.”

“Youmighthave togo througha lotof rejectionandpaintofindout,”hecountered.

“Maybe you’re right,” I repeated, flattered that hewanted me to come to Provident. Yet I knew JohnsHopkinswaswhereIwantedtobe.

Then he tried another tactic. “Ben, we badly needsomeoneherewith your skills. Think of all the good youcoulddoforBlackpeople.”

“I appreciate the offer and the interest,” I told him.AndIdid.Ididn’tlikedisappointinghim.AndIdidn’thavethe heart to tell him that I wanted to help people of allraces— justpeople. Idid say, “Letmeseewhathappensduringthenextyear.Ifthingsdon’tworkout,I’llconsiderit.”

Inevercontactedhimagain.I’m not sure what I expected to happen when I

returned fromAustralia to JohnsHopkins, but itwas theopposite of the prediction of the other doctor. Withinweeks I startedgettinga lotofreferrals.SoonIhadmorepatientsthanIknewwhattodowith.

AfterreturningtoBaltimoreinthesummerof1984,itquickly became evident that others accepted me as adoctorcompetentinsurgicalskills.Theprimaryreason,forwhich I often thanked the Lord, was that I had beenblessed with more experience during my one year inAustralia than many doctors get in a lifetime of medicalpractice.

Withinmonthsaftermy return, the chiefofpediatricneurosurgery left to become the chairman of surgery atBrownUniversity.BythenIwasalreadydoingmostofthepediatric neurosurgery anyway. Dr. Long proposed to theboard that I become the new chief of pediatric

neurosurgery.*

Hetoldtheboardthat,althoughIwasonly33,Ihadawiderangeofexperienceandinvaluableskills.“IamfullyconfidentthatBenCarsoncandothejob,”helatertoldmehesaid.Notonepersonontheboardofthat“racistinstitution”

objected.WhenDr.Longinformedmeofmyappointment,Iwas

overjoyed!Ialsofeltdeeplygratefulandveryhumbled.Fordays I kept saying to myself, I can’t believe this hashappened.IthinkIwassomethinglikeakidwho’djusthadadreamcometrue.Lookatme,hereIamthechiefpediatricneurosurgeonatJohnsHopkinsat33.Thiscan’tbehappeningtome.Other people couldn’t believe it either.Manyparents

brought very sick children to our pediatric neurosurgeryunit, often traveling great distances.When I walked intothe room,more thanonceaparent lookedupandasked,“WhenisDr.Carsoncoming?”“He’s already here,” I’d answer and smile. “I’m Dr.

Carson.”I got a realkickoutofwatching them try to contain

theirexpressionofsurprise.Ididn’tknowhowmuchofthesurprise revolved aroundmy being Black and howmuchbecause I was so young, probably a combination of thetwo.Oncewegotpast the introductions, Iwouldsitdown

withthemandstarttalkingabouttheirchild’sproblem.Bythe time I finished with the consultation, they realized IknewwhatIwastalkingabout.Nooneeverwalkedoutonme.One timewhen Iwas going todo a shunt on a little

girl, her grandmother asked, “Dr. Carson, have you everdoneoneofthesebefore?”

“No, not really,” I said with a straight face, “but Iknowhowtoreadfairlywell.Iownalotofmedicalbooks,andItakemostofthemwithmeintotheoperatingroom.”She laughed self-consciously, aware of how silly her

questionhadbeen.“Actually,” I joked, “I’ve done a thousand at least.

Sometimes300aweek.”Isaiditwithasmile,forIdidn’twanthertofeelembarrassed.Shelaughedthen,realizingfromtheexpressiononmy

faceandmytoneofvoicethatIwasstillkiddingher.“Well,”shesaid,“Iguessifyouarewhoyouare,and

sinceyouhavethisposition,youmustbeallright.”She didn’t offend me. I knew that she passionately

lovedhergranddaughterandwanted tobe reassured thatthe child was in good hands. I assumed she was reallysaying, “You look like you haven’t even gone tomedicalschool yet.” After that kind of conversation took place afewtimes,IbecamesousedtotheresponsesthatIusedtolookforwardtothereactions.I frequently got more of a negative response from

Black patients, particularly the older ones. They couldn’tbelieve that Iwas chief of pediatric neurosurgery.Or if Iwas, that Ihadearnedmyposition.At first theyeyedmesuspiciously, wondering if somebody had given me mypositionasatokenexpressionof integration. Inthatcase,they assumed, I probably didn’t really know what I wasdoing.Withinminutesofourconsultations,however,theyrelaxed and the smiles on their faces toldme that I hadtheiracceptance.Oddlyenough,Whitepatients,eventheonesinwhom

I could clearly detect bigotry, were often easier to dealwith. I could see their minds working away, and theywouldultimatelyreason,Thisguymustbeincrediblygoodtobeinthisposition.I don’t face that problem nowadays becausemost of

the patients knowwho I am andwhat I look like beforethey get here. But it used to be very interesting. TheproblemisnowtheoppositebecauseI’mknowninthefieldandtoomanypeoplesay,“ButwehavetohaveDr.Carsondo the surgery. We just don’t want anybody else.”Consequently, my operating schedule stays filled up formonthsinadvance.Ihavetheprerogativeofturningdownpatientsand,of

course, Imust. It’s necessary to say no at times because,naturally, I can’t do all the surgeries. I also believe inaskingotherdoctorsifthey’dbeinterestedindoingthem.Iwouldhavenever learned the skills I have today if othersurgeons had not been willing to let me take interestingandchallengingcases.Withinayearofmyappointmentat JohnsHopkins I

facedoneofthemostchallengingsurgeriesofmylife.Thelittle girl’s name was Maranda, and I had no way ofknowing the influence shewouldhaveonmycareer.Theresults of her case also had a powerful effect on themedical profession’s attitude toward a controversialsurgicalprocedure.

*Thepositionofseniorregistrardoesn’texistinAmericabutliessomewherebetween being a chief resident and a junior faculty member. The seniorregistrarsruntheserviceandworkundertheconsultant.FollowingtheBritishmedical schools, Australia has what they call consultants, who areunquestionably the top men. Under this system, a doctor remains a seniorregistrarformanyyears.

A doctor can become a consultant only when the encumbent dies; thegovernmenthasafixednumberofsuchpositions.

Althoughtheyhadonlyfourconsultants inWesternAustralia, thesemenwere all extremely good, among the most talented surgeons I’ve ever seen.Eachhadhisownareaofexpertise.Ibenefitedfromalltheirlittletricks,andtheyaidedmeindevelopingmyskillsasaneurosurgeon.

† The salary was so attractive because I didn’t have to pay exorbitantmalpracticeinsurance.InAustraliaitwasonlyS200ayear.Iknowanumberofprominentphysicianswhopay$100,000to$200,000ayearinAmerica.Thedifference lies in the fact that in Australia relatively few malpractice casesarise. Australian law forbids lawyers to take malpractice cases on acontingencybasis.Peoplewhowanttosuehavetotakemoneyfromtheirownpockets.Consequentlytheonlypeoplewhosuearethoseuponwhomdoctorshavemadethemostterriblemistakes.

*MyofficialtitlewasAssistantProfessorofNeurologicalSurgery,Direction,DivisionofPediatricNeurosurgery,theJohnsHopkinsUniversityandHospital.

Y

A

CHAPTER14

AGirlNamedMaranda

oursistheonlyhospitalwherewe’vereceivedanyrealhope,”TerryFranciscosaid.Shemadeanefforttokeep

her voice steady. “We’ve tried so many doctors andhospitals, and they endup tellingus there’s nothing theycandoforourdaughter.Please,pleasehelpus.”

Ithadbeenalongandfrighteningthreeyears,andasthemonthshadblurredintoyears, fearturnedtodespair.Desperate, her daughter nearing death, Mrs. FranciscocalledDr.JohnFreemanhereatHopkins.

In 1985 when I first came into contact with brown-haired Maranda Francisco, I could never have guessedwhatan influenceshewouldhaveon thedirectionofmycareer: on Maranda I would perform my firsthemispherectomy.*

lthoughbornnormal,MarandaFranciscohadherfirstgrand mal seizure at 18 months, a convulsion

characteristic of epilepsy that we sometimes call anelectrical storm in the brain. Two weeks later Marandasufferedasecondgrandmalseizure,andherdoctorputheronanticonvulsivemedication.

By her fourth birthday, the seizures were becomingmorefrequent.Theyalsochanged,suddenlyaffectingonlythe right side of her body. She didn’t lose consciousness;the seizureswere focal (half a grandmal), originating intheleftsideofherbrainanddisruptingonlytherightside

ofherbody.Eachseizure leftMarandaweakonher rightside,sometimesunabletotalknormallyforaslongastwohours. By the time I heard about her situation, Marandawas experiencing up to 100 seizures a day, as often asthree minutes apart, making the right side of her bodyuseless.Aseizurebeganwithtremblingattherightcornerof hermouth. Then the rest of the right side of her facetrembled,followedbytheshakingofherrightarmandleg,untilthewholerightsideofherbodyjerkedoutofcontrolandthenwentslack.“She couldn’t eat,” her mother told us, and finally

stopped letting her daughter try. The danger of chokingwas too great, so they started feeding her through anasogastric tube. Although the seizures affected only herrightside,Marandawas forgettinghowtowalk, talk,eat,and learn, and she needed constant medication. As DonColburnof theWashingtonPostput it ina featurearticle,Maranda “lived her life in brief intervals betweenconvulsions.” Only during sleep was she seizure-free. Asthe seizures worsened, Maranda’s parents took her fromspecialist to specialist and received varying diagnoses.More than one physician mislabeled her a mentallyretarded epileptic. Each time the family went to a newdoctor or clinic with hope, they left filled withdisappointment. They tried medicine, diets, and, on theadviceofonedoctor,acupofstrongcoffeetwiceaday.“My daughter has been on 35 different drugs at one

time or another,” Terry said. “Often they’d give her somuchshewouldn’trecognizeme.”Yet Luis and Terry Francisco refused to give up on

their only child. They asked questions. They read everypieceofliteraturetheycouldfind.LuisFranciscomanagedasupermarket,so theywerepeoplewithonlyamoderateincome.Yetthatdidn’tdeterthem.“IfthereisanyplaceonearthtogethelpforMaranda,we’regoingtofindit.”In the winter of 1984 Maranda’s parents finally

learnedthenameoftheirdaughter’scondition.Dr.ThomasReilly at the Children’s Epilepsy Center at Children’sHospitalinDenver,afterconsultingwithanotherpediatricneurologist,suggestedapossibleexplanation:Rasmussen’sencephalitis, an extremely rare inflammation of the braintissue.Thediseaseprogressesslowlybutsteadily.

If the diagnosis was correct, Reilley knew time wasshort. Rasmussen’s progressively leads to permanentparalysisononesideofthebody,mentalretardation,andthendeath.OnlybrainsurgeryofferedapossibilitytosaveMaranda. In Denver, physicians placed the child in abarbituatecomafor17hoursinthehopethatbystoppingallbrainactivitytheseizureactivitymightalsostop.Whenthey broughtMaranda back out, immediately she startedseizuresagain.Thisatleasttoldthemthatthecauseofherepilepsy wasn’t owing to electrical misfiring in her brainbut a progressive deterioration. Again, this offered moreaccumulatedevidenceofitbeingRasmussen’s.

Reilley arranged for Maranda’s diagnosis at UCLAMedical Center, the nearest hospital with experience intreatmentofRasmussen’s.Abrainbiopsyenabledthemtoreach a further confirmation of the diagnosis. TheFranciscos then received the most severe blow. “It isinoperable,” doctors told them. “There is nothingwe cando.”

That might have been the end of Maranda’s storyexcept for her tenacious parents. Terry Francisco checkedon every lead she could find. As soon as she heard ofanyonewhowasanexpertinthefieldofseizuresshemadecontact.Whenthispersoncouldn’thelpher,shewouldsay,“Doyouknowanyoneelse?Anyonewhomightbeofsomehelp to us?” Someone finally suggested she contact Dr.JohnFreemanatJohnsHopkinsbecauseofhiswell-earnedreputation in the area of seizures. By phone TerryFrancisco described everything to the pediatric chief ofneurology. When she finished, she heard the most

encouragingwordsshehadreceivedinmonths.“Marandasounds like she might be a good candidate for ahemispherectomy,”Dr.Freemansaid.“Youmean it? You think—you think you can help?”

she asked, afraid to use a word like cure after so manydisappointments.“Ithinkthere’satleastagoodchance,”hesaid.“Send

me her records, CT scans, and anything else you have.”John had been at Stanford University Hospital beforehemispherectomy fell out of favor. Although he had notperformed any himself, he knew of two successfulhemispherectomies and was convinced that they wereviablesurgicaloptions.Hardly daring to hope, Maranda’s mother copied all

therecordsshehadandmailedthemthatsameday.WhenJohnFreemanreceivedthematerial,hestudiedeverythingcarefully,thencametoseeme.“Ben,”hesaid,“I’dlikeyoutotakealookatthis.”Hehandedmetherecords,gavemeachancetostudythemthoroughly,andthensaid,“Thereisaprocedure forahemispherectomy that I knowyou’veneverheardof—”“I’veheardofit,”Isaid,“butI’vecertainlyneverdone

one.” Ihadheardof it only recentlywhen, in lookingupsomeothermaterial, I flipped throughamedical textandsawthematerialabouthemispherectomyandskimmedit.The information didn’t offer much optimism about suchsurgery. “I believe a hemispherectomy could save thischild,”Dr.Freemantoldme.“You honestly have that much confidence in the

procedure?”“Ido.”Hiseyesheldmine.“Doyouthinkyoucoulddo

a hemispherectomy on this girl?” he asked. While Iconsidered how to answer, John went on to explain therationale behind his faith that such a surgical procedurecouldbedonewithoutterriblesideeffects.

“Sounds reasonable to me,” I answered, growingexcitedabouthavingachallenge.However,Iwasn’tgoingto jump into some new kind of surgery without moreinformation—andJohnFreemanwouldn’thavewantedmetoanyway.“Letmegetholdofsomeoftheliteratureandread up on it, and then I can give you amore informedanswer.”

Beginning that day, I read articles and papers thatdetailed the problems causing the high complication rateand mortality. Then I did a lot of thinking about theprocedureandexaminedMaranda’sCTscansandrecords.Finally Iwasable to say, “John, I’mnot sure,but I thinkit’spossible.Letmeconsideritalittlemore.”

JohnandItalkedandcontinuedtostudytherecords,and finally he phoned the Franciscos. Both of us talkedwithMrs.Franciscoandexplainedthatwewouldconsiderdoingahemispherectomy.Wemadehernopromises,andsheunderstoodthat.

“Youbringher forus toevaluate,” I said.“Onlythencanwegiveyouadefiniteanswer.”

Iwaseager tomeetMarandaandhappywhena fewweekslaterherparentsbroughthertoHopkinsforfurtherevaluation. I recall thinking how pretty she was and feltsuchaheavinessforthechild.Maranda,then4yearsold,was from Denver, and she used to say, “I’m fromDenverado.”

After extensive tests, a lot of conversationwith JohnFreemananda fewothers Iconsulted, Iwas finallyreadytogive themmydecision.Maranda’sdadhad flownbackhome to work, so I sat down with Terry Francisco. “I’mwilling to attempt a hemispherectomy,” I toldher. “But Iwant you to know that I’ve never done one before. It’simportantthatyouunderstand—”

“Dr.Carson,anything—anythingyoucando.Everyoneelsehasgivenup.”

“It’sadangerousoperation.Marandamaywelldie intheoperatingroom.”Isaidthewordseasilyenough,butIalso sensed how terrible theymust have sounded to thatmother. Yet I felt it was important to give her everynegative fact. “She might have significant limitations,includingseverebraindamage.”Ikeptmyvoicecalm,notwantingtofrightenher,butIalsodidn’twanttogiveherfalsehope.Mrs.Francisco’seyesmetmine.“Andifwedon’tagree

tothesurgery,whathappenstoMaranda?”“She’llgetworseanddie.”“Then it’s not much of a choice, is it? If there is a

chanceforher—evenifasmallchance—“Theearnestnessof her face showed clearly the emotion she had gonethrough in arriving at her decision. “Oh, yes, pleaseoperate.”Once they had agreed to the surgery, Terry and Luis

satdownwiththeirdaughter.Terry,usingadoll, showedMarandawhereIwouldbecuttingintoherhead,andevendrewlinesacrossthedoll.“You’llalsoendupwithareallyshorthaircut.”Marandagiggled.Shelikedthatidea.Certainher daughter understood asmuch as shewas

capable of at 4 years of age, Terry said, “Honey, if youwantanythingspecialaftertheoperation,letmeknow.”Maranda’sbrowneyesstaredathermother’sface.“No

moreseizures.”Tears shining in her eyes, Terry embraced her

daughter. She held her as if she could never let her go.“That’swhatwewanttoo,”shesaid.OnthenightbeforesurgeryIwalkedintothepediatric

playroom.Mr.andMrs.Franciscoweresittingontheedgeof theplaypit, a special area that the children especiallyenjoy. A little giraffe on wheels stood across the room.

Trucksandcarswerescatteredaroundthefloor.Someonehadlinedstuffedanimalsagainstonewall.Mrs.Franciscogreeted me calmly, cheerfully. I was amazed at hercalmness and the brightness in her eyes. Her serenityencouragedmetoknowthatshewasatpeaceandreadytoaccept whatever happened. Maranda played with sometoysnearby.Although I had warned them of the possible

complications of surgery at the time they consented, Iwantedtomakecertaintheyheardeverythingagain.Isatontheedgeof theplaypitwith thecoupleandcarefully,slowly,describedeveryphaseofthesurgery.“You’veobviouslyhadsomeinformationalreadyabout

what we need to do,” I said, “because you talked to thepediatricneurologist.Weexpectthesurgerytotakeaboutfivehours.There’sastrongpossibilitythatMarandacouldbleedtodeathanddieonthetable.There’sachancethatshe’llbeparalyzedandnever speakagain.Amultitudeofpossibilities exist of bleeding and infection and otherneurological complications.On theotherhand, shemightdoverywellandneverhaveseizuresagain.Wedon’thaveacrystalball,andthere’snowaytoknow.”“Thank you for explaining,” Mrs. Francisco said. “I

understand.”“There isonemore thingwedoknow,” I added. “I’d

like you to understand that if we don’t do anything herconditionwillcontinuetoworsenuntilyoucan’tkeepheroutofaninstitution.Andthenshewilldie.”She nodded, too emotional to risk speaking, but I

realized she had fully grasped what I said. “The risk forMarandaiscompounded,”Iwenton.“Thelesionisontheleft side—herdominanthalfof thebrain.” (Inmost right-handed people, the left hemisphere dominates speech,language,andmovementontherightsideofthebody.)“Iwant to emphasize,” I said, andpaused,wanting tomake

certain they fully understood, “the major long-term risk,evenifshesurvivessurgery,isthatshe’llbeunabletotalk,orshemightbepermanentlyparalyzedontherightside.Iwantyoutobeclearabouttheriskyou’refacing.”

“Dr.Carson,weknowtherisk,”Luissaid.“Whateverisgoing to happen is going to happen. This is our onlychance,Dr. Carson.Otherwise shemight aswell be deadnow.”

As I stoodto leave, I said to theparents,“AndnowIhaveahomeworkassignmentforyou. Igivethistoeverypatientandfamilymemberbeforesurgery.”

“Anything,”Terrysaid.“Whateveryouwantustodo,”Luissaid.“Sayyourprayers.Ithinkthatreallydoeshelp.”“Oh,yes,yes,”Terrysaidandsmiled.I always tell parents that because I believe itmyself.

I’venot yet had anybodydisagreewithme.While I steeraway from religious discussions with patients, I like toremindthemofGod’slovingpresence.IthinkwhatlittleIsayisenough.

I was a little anxious as I went home that night,thinkingabouttheoperationandthepotentialfordisaster.I had talkedabout itwithDr. Long,who toldmehehadonce performed a hemispherectomy. Step by step, Iwentovertheprocedurewithhim.OnlylaterdidIrealizethatIhadn’taskedhimifhisonesurgeryhadbeensuccessful.

Somany things could gowrongwithMaranda, but Ihad come to the conclusion years earlier that the LordwouldnevergetmeintoanythingHecouldn’tgetmeoutof,soIwasn’tgoingtospendanexcessiveamountoftimeworrying. I’veadoptedthephilosophythat ifsomebodyisgoingtodieifwedon’tdosomething,wehavenothingtolose by trying. We surely had nothing to lose withMaranda.Ifwedidn’tproceedwiththehemispherectomy,

deathwas inevitable.Wewere at least giving this prettylittlegirlachancetolive.

Ifinallysaid,“God,ifMarandadies,shedies,butwe’llknowthatwe’vedonethebestwecouldforher.”WiththatthoughtIhadpeaceandwenttosleep.

*Theprocedureknownashemispherectomywas triedas longas50yearsagobyDr.WalterDandy,oneofthefirstneurosurgeonsatJohnsHopkins.Thethree biggest names in neurosurgical history are Harvey Cushing, WalterDandy, and A. Earl Walker, who were, consecutively, the three people inchargeofneurosurgeryatHopkinsdatingbacktothelate1800s.

Dandytriedahemispherectomyonapatientwithatumor,andthepatientdied. In the 1930s and 1940s a number of people started doing thehemispherectomy.However,thesideeffectsandmortalityassociatedwiththesurgery were so great that hemispherectomy quickly fell out of favor as aviablesurgicaloption.Inthelate1950sthehemispherectomyreemergedasapossible solution for infantile hemiplegia associated with seizures. Skilledneurosurgeons started doing the operation again because they now had thesophisticated help of EEGs, and it seemed in a lot of patients that all theabnormalelectricalactivitywascomingfromonepartofthebrain.Althoughthe results of previous hemispherectomies had been poor, surgeons felt theycouldnowdoabetterjobwithfewersideeffects.Sotheytriedanddidatleast300ofthesurgeries.Butagain,themorbidityandmortalityturnedouttobehigh. Many patients hemorrhaged to death in the operating room. Othersdeveloped hydrocephalus or were left with severe neurological damage andeitherdiedorwererenderedphysicallynonfunctional.

In the 1940s, however, a Montreal doctor, Theodore Rasmussen,discovered something new about the rare disease that affectedMaranda. Herecognized that the disease was confined to one side of the brain, affectingprimarily the opposite side of the body (since the left side of the body iscontrolledmainlybytherightsideofthebrain,andviceversa).Itstillbafflesdoctors why the inflammation remains in one hemisphere of the brain anddoesn’t spread to theother side.Rasmussen,whohad longbelieved that thehemispherectomywasagoodprocedure,continuedtodothemwhenvirtuallyeveryoneelsehadstopped.

In1985whenIfirstgotinterestedinhemispherectomy,DrRasmussenwasdoingadiminishingnumberandrecordedquiteafewproblems.Isuggesttworeasons for the high failure rate. First, the surgeons selected manyinappropriate patients for the operation who, consequently, did not do wellafterward. Second, the surgeons lacked competence or effective skills. Againthe hemispherectomy fell out of favor. Experts concluded that the operationwas probably worse than the disease, so it was wiser and more humane toleavesuchproceduresalone.

Even today no one knows the cause of this disease process, and expertshavesuggestedpossiblecauses:theresultofastroke,acongenitalabnormality,a low-grade tumor, or the more common concept, a virus. Dr. John M.Freeman,thedirectorofpediatricneurologyatHopkins,hassaid,“We’renoteven surewhether it’s caused by a virus, although it leaves footprints like avirus.”

I

CHAPTER15

Heartbreak

nonesense, Iwasmovingintogroundbreakingsurgicalprocedure— if I succeeded. Surgeons had recorded sofew cases of full functional recovery that most doctorswouldn’tconsiderahemispherectomyasviable.

Iwasgoingtodomybest.AndIwentintothesurgerywith two things clear. First, if I didn’t operate, MarandaFrancisco would worsen and die. Second, I had doneeverything to preparemyself for this surgery, and now IcouldleavetheresultsinGod’shands.

To assistme I askedDr.NevilleKnuckey, oneof ourchief residents, whom I had met during my year inAustralia.NevillehadcometoHopkinstodoafellowship,andIconsideredhimextremelycapable.

Right from the beginning of the surgery we hadproblems, so that instead of the expected five hours westayed at the operating table exactly twice that long.Wehad to keep calling formore blood.Maranda’s brainwasvery inflamed, and no matter where an instrumenttouched, she started to bleed. It was not only a lengthyoperationbutoneofthemostdifficultI’deverdone.

The dramatic surgery began simply, with an incisiondrawn down the scalp. The assisting surgeon suctionedawaybloodwithahand-heldtubewhileIcauterizedsmallvessels.Onebyone,steelclipswereplacedontheedgeoftheincisiontokeepitopen.Thesmalloperatingroomwascoolandquiet.

Then I cut deeper through a second layer of scalp.Again small vessels were sealed shut, and a suction tubewhiskedawayblood.I drilled six holes, each the size of a shirt button, in

Maranda’sskull.Theholes formedasemicircle,beginningin front ofher left ear and curvingupacrossher temple,aboveanddownbehindtheear.Eachholewasfilledwithpurified beeswax to cushion the saw. Then with an air-powered saw I connected the holes into an incision andlifted back the left side ofMaranda’s skull to expose theoutercoveringofherbrain.Her brainwas swollen and abnormally hard,making

the surgerymore difficult. The anesthesiologist injected adrug intoher IV line toreduce theswelling.ThenNevillepassed a thin catheter through her brain to the center ofherheadwhereitwoulddrainoffexcessfluid.Slowly, carefully, for eight tedious hours I inched

awaytheinflamedlefthemisphereofMaranda’sbrain.Thesmallsurgicalinstrumentsmovedcarefully,amillimeterata time, coaxing tissue away from the vital blood vessels,tryingnottotouchordamagetheotherfragilepartsofherbrain. The large veins along the base of her brain bledprofusely as I searched for the plane, the delicate lineseparatingbrainandvessels.Itwasnoteasytomanipulatethebrain,toeaseitawayfromtheveinsthatcirculatedlifethroughhersmallbody.Maranda lost nearly nine pints of blood during the

surgery. We replaced almost twice her normal bloodvolume.Throughoutthelonghours,nurseskeptMaranda’sparents up-to-date on what was happening. I thought oftheirwaitingandwondering.WhenmythoughtsturnedtoGod, I thankedHim forwisdom, for helping to guidemyhands.Finally we were finished. Maranda’s skull was

carefully sewedback in placewith strong sutures.At last

Nevilleand I stoodback.TheOR technician took the lastinstrument frommyhand. I allowedmyself the luxuryofflexingmyshoulders,rotatingmyhead.NevilleandIandtherestofourteamknewwehadsuccessfullyremovedthelefthemisphereofMaranda’sbrain.The “impossible”hadbeenaccomplished.Butwhathappensnow?Iwondered.

Wedidn’tknowif theseizureswouldstop.Wedidn’tknowifMarandawouldeverwalkortalkagain.Wecouldonly do one thing—wait and see. Neville and I steppedback as the nurses lifted off the sterile sheet and theanesthesiologist unhooked and unplugged the variousinstruments that had recordedMaranda’s vital signs. Shewas taken off the ventilator and began breathing on herown.

I watched her closely, searching for any purposefulmovement.Therewasnone. Shemoveda littlewhen sheawakened in theORbutdidnot respondwhen thenursecalled her name. She did not open her eyes. It’s early, Ithought as I glanced towardNeville.She’llwakeup beforelong. But would she? We had no way of knowing forcertain.

The Franciscos had spentmore than 10 hours in thewaitingroomdesignedforthefamiliesofsurgicalpatients.Theyhadresistedthesuggestionstogoout foradrinkorto take a short walk but had stayed there praying andhoping. The rooms are cozy, decorated in soft colors, ascomfortable as awaiting roomcanbe.Magazines, books,even jigsaw puzzles, are scattered about to help pass thetime. But, as one of the nurses told me later, when themorning hours stretched into afternoon, the Franciscosgrewveryquiet.Theworrylinesintheirfacessaiditall.

I followed Maranda’s gurney out of surgery. Shelookedsmallandvulnerableunderthepalegreensheetastheorderlywheeledherdownthehalltowardthepediatricintensivecareunit.An IVbottlehung fromapoleon thegurney.Hereyeswereswollenfrombeingunderanesthesia

for10hours.Majorfluidshiftsinherbodyhadalteredtheworkingofherlymphsystem,causingswelling.Havingtherespirator tube down her throat for 10 hours had puffedherlipsbadly,andherfacelookedgrotesque.TheFranciscos,alerttoeverysound,heardthegurney

creaking down the hallway and ran to meet us. “Wait!”Terry called softly. Her eyes were red-rimmed, her facepale. Shewent to the gurney, bent down, and kissed herdaughter.Maranda’s eyes fluttered open for a second. “I love

you,MommyandDaddy,”shesaid.Terryburstintojoyfultears,andLuisbrushedhishand

acrosshiseyes.“Shetalked!”anursesquealed.“Shetalked!”I just stood there, amazed and excited, as I silently

sharedinthatincrediblemoment.We had hoped for recovery. But none of us had

consideredthatshecouldbesoalertsoquickly.SilentlyIthanked God for restoring life to this beautiful little girl.Suddenly I caught my breath in amazement, as thesignificanceoftheirconversationreachedmybrain.Maranda had opened her eyes. She recognized her

parents.Shewastalking,hearing,thinking,responding.We had removed the left half of her brain, the

dominantpart thatcontrols thespeecharea.YetMarandawastalking!Shewasalittlerestless,uncomfortableonthenarrow gurney, and stretched her right leg, moved herrightarm—thesidecontrolledbythehalfofherbrainwehadremoved!The news rippled down the corridor, and the whole

staff, includingward clerks andaides, ranup to seewiththeirowneyes.“Unbelievable!”“Isn’tthatgreat?”

TIevenheardawomansay,“PraisetheLord!”

he success of the surgery was terribly important forMarandaandherfamily,butitdidn’toccurtomethat

it was particularly newsworthy. While it was abreakthroughevent,Isawitasinevitable.IfIhadn’tbeensuccessful, in timeanotherneurosurgeonwouldhave.Yetitseemedasifeverybodyelsethoughtitwasabigitemforthenewsmedia.Reportersstartedcomingaround,calling,wanting pictures and statements. Don Colburn from theWashingtonPost interviewedmeandwrotea lengthyandremarkablyaccuratemajorarticle,chroniclingthesurgeryand following the family afterward. The TV programEveningMagazine(calledPMMagazineinsomeareas)didatwo-partseriesonhemispherectomies.

Maranda developed an infection afterward, but wequickly cleared thatupwithantibiotics. She continued toimprove and has done extraordinarily well. Since thesurgery in August 1985, Maranda Francisco has had heronewish.Shehashadnomoreseizures.However,shedoeslack fine motor coordination of the fingers on her righthand andwalkswith a slight limp. But then, shewalkedwith a mild limp before the operation. She’s taking tapdancinglessonsnow.

Maranda appeared on the Phil Donahue Show. Theproducersalsowantedmeontheshow,butIturneddownthe invitation for several reasons. First, I’m concernedabouttheimageIproject.Idon’twanttobecomeashow-business personality or be known as the celebrity doctor.Second, I’m aware of the subtlety of being called on,acknowledged, and admiredon the television circuit. Thedanger is that if you hear how wonderful you are oftenenough,youbegintobelieveitnomatterhowhardyoutrytoresistit.

Third, although I’d donemywritten examination for

M

certificationasaneurosurgeon,Ihadn’tyettakenmyoralboard exams. To do the oral examination, candidates sitbefore a board of neurosurgeons. For a full day they askeveryconceivablekindofquestion.Commonsensetoldmethat they might not look too kindly on someone theyconsideredamediahot-dog. I considered that Ihadmoretolosethantogainbyappearingontalkshows,soIturneditdown.Fourth,Ididn’twanttostirupjealousiesamongother

professionalsandtohavemypeerssay,“Oh,that’sthemanwhothinkshe’sthegreatestdoctorintheworld.”Thishashappenedtootherfinedoctorsthroughmediaexposure.Becausehewas involved, I spokewithJohnFreeman

about these public appearances. John is older, already afull professor, and aman I highly respect. “John,” I said,“there isn’t anything that anybody can do to you and itdoesn’tmatterwhatany jealousdoctormight thinkaboutyou. You’ve earned your reputation, and you’re alreadyhighlyrespected.So,inlightofthat,whydon’tyougo?”John wasn’t excited about making a television

appearance, but he understood my reasons. “All right,Ben,”hesaid.HeappearedonthePhilDonahueShowandexplainedhowthehemispherectomyworked.Althoughthatwasmyfirstencounterwiththemedia,

I’ve tended to shy away from certain types of mediacoverage on television, radio, and print. Each time I’mapproached,Icarefullylookintotheofferbeforedecidingwhether it’s worthwhile. “What’s the purpose of theinterview?” That’s themain question Iwant answered. Ifthe bottom line is to publicize me or to provide homeentertainment,ItellthemIdon’twanttohaveanythingtodowithit.

aranda manages well without the left half of herbrainbecauseofaphenomenonwecallplasticity.We

know that the two halves of the brain aren’t as rigidly-divided aswe once thought. Although both have distinctfunctions, one side has the major responsibility forlanguage and the other for artistic ability. But children’sbrainshaveaconsiderableoverlap.Inplasticity,functionsoncegovernedbyasetofcellsinthebrainaretakenoverby another set of cells. No one understands exactly howthisworks.Mytheory,andseveralothersinthefieldagree,isthat

whenpeopleareborntheyhaveundifferentiatedcellsthathaven’tdevelopedintowhattheyaresupposedtobe.OrasI sometimes say, “They haven’t grown up yet.” Ifsomethinghappenstothealreadydifferentiatedcells,theseundefined cells still have the capacity to change andreplace those that were destroyed and take over theirfunction. As we age, these multipotential or totipotentialcellsdifferentiatemoreso that fewerof themremain thatcanchangeintoanythingelse.Bythetimeachildreachestheageof10to12,most

of those potential cells have already done what they aregoingtodo,andtheynolongerhavetheabilitytoswitchfunctionstoanotherareaofthebrain.That’swhyplasticityonlyworksinchildren.However,Idon’tlookonlyattheageofthepatient.I

alsoconsidertheageofonsetofthedisease.Forinstance,because of her intractable seizures, I did ahemispherectomyon21-year-oldChristinaHutchins.InChristina’scase, theonsetof seizuresstartedwhen

shewas7 andhadprogressed slowly. I theorized—and itturned out to be correct—that since her brain was beingslowly destroyed from the age of 7, chances were thatmanyofherfunctionshadbeentransferredtootherareasduringtheprocess.Althoughshewasolderthananyofmyotherpatients,wewentaheadwiththehemispherectomy.Christinaisnowbackinschoolwitha3.5gradepoint

I

average.Twenty-one of the 22 patients have been females. I

can’t explain that fact. Theoretically, brain tumors don’toccurmore often in females. I think it’s a fluke and thatoverthecourseoftimeitwillevenout.

Carol James,who ismyphysician’s assistant andmyright-hand person, frequently teases me by saying, “It’sbecausewomen need only half of their brain to think aswell asmen.That’swhyyou cando this operation on somanywomen.”

estimate that 95 percent of the children withhemispherectomiesnolongerhaveseizures.Theother5percent have seizures only occasionally. More than 95percenthaveimprovedintellectuallyaftersurgerybecausethey are no longer being constantly bombarded withseizuresanddon’thavetotakealotofmedication.I’dsaythat100percentoftheirparentsaredelighted.Ofcourse,whentheparentsaredelightedattheoutcome,itmakesusfeelbettertoo.

Hemispherectomysurgery isbecomingmoreacceptednow.Other hospitals are starting to do it. For instance, Iknowthatbytheendof1988surgeonsatUCLAhaddoneat least six. So far as I know, I have done more thananybody else who is actively practicing. (Dr. Rasmussen,stillalive,isn’tpracticingmedicineanymore.)

OnemajorreasonforourhighsuccessrateatHopkinsis that we have a unique situation where we workextremely well together in pediatric neurology andneurosurgery.Contrary towhat Iobserveda few times inAustralia,inoursituationwedon’tneedtodependuponasuperstar.Duringmyyeardownunder,Inoticedthatsomeconsultants weren’t interested in seeing anyone elsesucceed; consequently, it seemed that those under themdidn’talwaystrytheirbest.

O

I also praise the cooperative efforts in our pediatricintensive care unit. In fact, this togetherness permeateseveryaspectofourprogramhere,includingourofficestaff.We’re friends, weworkwell together, we’re dedicated toalleviating pain, and we’re interested in each other’sproblemstoo.

We’re a team, and Ben Carson is only part of thatteam.

f all the hemispherectomies I’ve done, only onepatient died. Since then I’ve done approximately 30

others. The youngest child I’ve given a hemispherectomywas 3-month-old Keri Joyce. The surgery was fairlyroutine,butshehemorrhagedafterwardbecauseofa lackofplatelets inherblood.Thatdefectaffected theresidualgood hemisphere. Once that problem was under control,shebegantorecoverandhashadnomoreseizures.

Themost emotionally painful experience formewasJennifer.*

Wedidourinitialsurgeryonherwhenshewasonly5monthsold.

Jennifer was having terrible seizures, and her poormotherwas devastated by it all. The seizures had startedwithindaysafterbirth.

After doing EEGs, CT scans, MRIs, and the usualworkups, we discovered that most of the abnormalactivitiesseemedtobecomingfromthebackpartofbabyJennifer’s right hemisphere. After studying everythingcarefully,Idecidedtotakeoutonlythebackpart.

Thesurgeryseemedsuccessful.Sherecoveredquickly,and her seizure frequency diminished markedly. Shestarted responding to our voices and growingmore alert.Forawhile.

Thentheseizuresbeganagain.OnJuly2,1987,Itook

her into surgery and removed the rest of the righthemisphere. The operation went smoothly with noproblems. Little Jenniferwokeupafter theoperationandstartedmovingherentirebody.ThesurgerywithJenniferhadtakenonlyeighthours,

farlesstimethanmanyothers.ButIthinkthatbecauseshewasonly11monthsold,theworktookfarmoreoutofmethan usual.When I left the operating room I was totallyexhausted—andthat’snotnormalforme.ShoftlyafterJennifer’ssurgery,Ileftforhome,adrive

of35minutes.Twomilesbefore I reached thehouse,mybeeper started going off. Although the cause for theemergencycouldhaveconcernedhalfadozenothercases,intuitively I knew that something had happened toJennifer.“Oh,no,”Igroaned,“notthatchild.”Since Iwas so close, I hurried on home, rushed into

thehouse,andcalledthehospital.Theheadnursetoldme,“Shortly after you left, Jennifer arrested. They’reresuscitatinghernow.”Quickly explaining the emergencyto Candy, I jumped back intomy car, andmade the 35-minutetripin20minutes.TheteamwasstillresuscitatingtheinfantwhenIgot

there. I joined themandwekepton, tryingeverything togetherback.God,please,pleasedon’tletherdie.Please.AfteranhourandahalfIlookedatthenurse,andher

eyessaidwhatIalreadyknew.“She’snotcomingback,”Isaid.It tooka lotofwillpowernot toburst into tearsover

thelossofthatchild.ImmediatelyIturnedandhurriedtotheroomwhereherparentswaited.Their frightenedeyeslockedwithmine.“I’msorry—“Isaid,andthat’sasfarasIgot.For the first time inmyadult life Ibegancrying inpublic. I feltsobadfortheparentsandtheirterribleloss.They had gone through such a roller coaster of worry,faith,despair,optimism,hope,andgriefinthe11months

oflittleJennifer’slife.“She was one of those children with such a fighting

spirit,”Iheardmyselftellingherparents.“Whydidn’tshemake it?” Our team had done a good job, but wesometimesfacecircumstancesbeyondmedicalcontrol.Staring at the grief etched on the faces of Jennifer’s

parentswasalittlemorethanIcouldtake.Jenniferwasanonly child. Her mother had significant health problemsherselfandwasbeing treatedat theNational InstitutesofHealthinBethesda.Betweenherownproblemsandthatofherlittlegirl,Iwondered,Isn’tthisprettyclosetothetrialsofoldJobintheBible?Bothparentswept,andwetriedtocomforteachother.

Dr.PattyVining,oneofthepediatricneurologistswhohadbeenwithme during the operation, came into the room.Shewas as emotionally affected by the loss as Iwas.Wewerebothtryingtocomfortthefamilywhileovercomebypainourselves.I can’t remember ever feeling such a desperate loss

before.Thepainhurtsodeeply itseemedas ifeverybodyintheworldthatIlovedhaddiedatonetime.The family was devastated but, to their credit, they

wereunderstanding.IadmiredtheircourageastheywentonafterJennifer’sdeath.Theyhadknownthechanceswewere taking; theyalsoknew that ahemispherectomywasthe only possible way to save their daughter’s life. Bothparents were quite intelligent and askedmany questions.Theywanted togoover the records,whichweopened tothem. On more than one occasion, they talked to theanesthesiologist. After I had met with them a few moretimes, they toldme theywere satisfied thatwehaddoneeverythingpossiblefortheirlittlegirl.WeneverdiscoveredwhyJenniferdied.Theoperation

was successful. Nothing in the autopsy showed thatanything had gone wrong. As sometimes happens, the

Acauseofherdeathremainsamystery.

lthough I continued to function, for the next severaldays I lived under a cloud of depression and pain.

Even todaywhen I allowmyself todwellon thedeathofJennifer, it still affects me, and I can feel tears reachingtowardthesurface.Asasurgeon,thehardesttaskIhaveisfacingparents

with bad news about their child. Since I’ve become aparentthisisevenharderbecausenowIhavesomeinklingofhowparents feelwhentheirchild issick. Iguess that’swhat makes it so hard. When the news is bad, there isnothingIcandoorsaythatmakesthesituationbetter.IknowhowIwouldfeelifoneofmyownsonshada

brain tumor. I’d feelas if Iwereout in themiddleof theocean sinking, pleading for somebody, anybody, to throwmealifepreserver.Thereisafearbeyondwords,beyondrational thought. Many of the parents I see come toHopkinswiththatkindofdespair.EvennowI’mnotsureI’vefullygottenoverJennifer’s

death. Every time a patient dies I’ll probably carry anemotionalscar justaspeoplereceiveanemotionalwoundwhenafamilymemberdies.I moved beyond the depressive cloud by reminding

myself that there are a lot of otherpeopleout therewhoneedhelp,andit’sunfairtothemformetodwellonthesefailures.As I think of my own reaction, I also realize that

wheneverIoperateandsomethinghappensthatthepatientdoesn’t do well, I feel a keen responsibility for theoutcome.Probablyalldoctorswhocaredeeplyabouttheirpatientsreactthatway.AfewtimesIhavetorturedmyselfby thinking, If I hadn’t performed the surgery, it wouldn’thave happened. Or if someone else had done it, perhaps theresultswouldhavebeenbetter.

IalsoknowIhavetoactrationallyaboutthesethings.Often I find comfort in knowing that the patient wouldhavediedanywayand thatwemadeagallantattempt tosave her or him. As I look back on my own history ofsurgery and theworkwedo atHopkins, I remindmyselfthatthousandswouldhavediedifwehadn’toperated.Some people cope with their failures easier than

others.It’sprobablyobviousfromwhatI’vetoldyouaboutmyneed to achieve andbe thebest I canbe that I don’thandle failure well. I’ve said to Candy several times, “IguesstheLordknowsthat,soHekeepsitfromhappeningtomeoften.”DespitemygriefoverJenniferandthedaysittookfor

metothrowitoff,Idon’tbelieveinremainingemotionallydetachedfrompatients.Iworkwithandoperateonhumanbeings,allcreaturesofGod,peopleinpainwhoneedhelp.Idon’tknowhowIcanworkonagirl’sbrain—howIcanhaveherlifeinmyhands—andyetnotbecomeinvolved.Ifeelparticularly strongattachments to childrenwho seemsodefenselessandwhohaven’thadthechancetoliveafulllife.

*Thisisnotherrealname.

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CHAPTER16

LittleBeth

eth Usher fell from a swing in 1985 and received alittle bump, nothing anyone worried about then.

Shortly afterward that little bump caused her first minorseizure—or so they thought.Whatelse couldhavebeenthecause?Beth,bornin1979,hadbeenaperfectlyhealthychild.

A seizure is a frightening thing, especially to parentswho haven’t seen one before. The medical people theycontacted told them there was nothing to worry about.Bethdidn’t looksick,didn’tactsick,andthedoctorswerecomforting. “This can happen after a bump to the head,”theysaid.“Theseizureswillstop.”

The seizures didn’t stop. A month later, Beth had asecondone.Herparentsstartedtoworry.TheirdoctorputBeth onmedication to stop the seizures, and her parentsrelaxed. Everything would be OK now. But a few dayslater,Bethhadanotherconvulsion.Themedicationdidn’tstop them. Despite good medical care, the attacks camewithgreaterfrequency.

Beth’s dad, Brian Usher, was the assistant footballcoachattheUniversityofConnecticut.Hermother,KathyUsher, helped run the athletic department’s fund-raisingclub. Brian and Kathy sought every kind of medicalinformation,askingquestions,talkingtopeopleonandoffcampus, determined to find some way to stop theirdaughter’sseizures.Nomatterwhattheydid,however,the

seizuresincreasedinfrequency.To her credit, Kathy Usher is a relentless researcher.

One day at the library she read an article about thehemispherectomiesweweredoingatJohnsHopkins.Thatsame day she phoned Dr. John Freeman. “I’d like moreinformation about the hemispherectomies,” she began.Within minutes she had poured out her sad tale aboutBeth.JohnscheduledanappointmentfortheminJuly1986,

andtheybroughtBeth toBaltimore. Imet themthatday,andwe had a lengthy discussion about Beth. John and Iexaminedherandreviewedhermedicalhistory.At the time Beth was doing fairly well. The seizures

werelessfrequent,downtoasfewas10aweek.Shewasbrightandvivacious,abeautifullittlegirl.AsI’ddonewithparentsbefore,Ispelledouttheworst

possible results, believing thatwhen people know all thefactstheycanmakeawiserchoice.When she had heard everything, Kathy Usher asked,

“How can we go through with this? Beth seems to begettingbetter.”John Freeman and I understood their reluctance and

didnottrytoforceadecision.Itwasaterribledecision,tothinkofputtingtheirbright,happychildthrougharadicalkindofsurgery.Herlifewasatstake.Bethwasstillingoodshape,whichmadehersituationunusual.Whenachildisatthepointofdeath,parentshavelessstruggleinreachinga decision. They usually end up saying something like,“Shemaydie.Bydoingnothing,we’ll definitely loseher.Atleastwithsurgery,shehasachance.”With Beth, however, the parents concluded, “She’s

doingtoowell.We’dbetternotdoit.”Wedidnothingtoforceorinsistuponsurgery.The Ushers returned to Connecticut with hope,

indecision, and anxiety. The weeks passed, and Beth’sseizuresgradually increased.As theygrewmore frequent,shebegantolosetheuseofpartofherbody.

In October 1986 the family returned to Hopkins forfurthertestsonBeth.IsawaseriousdeteriorationinBeth’sconditioninjustthethree-monthinterval.Herspeechnowslurred.OneofthethingswewantedtoknowwaswhetherBeth’s speech control had transferred to her goodhemisphere. We tried to find out by giving the diseasedhemisphere an injection to put it to sleep.Unfortunately,the entire brain went to sleep, so we couldn’t determinewhetherthesurgerywouldtakeawayBeth’sabilitytotalk.

Since their interview in July, both John and I wereconvincedthatahemispherectomywastheonlyoptionforBeth. After watching her condition worsen, her parentswereclosertosaying,“Yes,tryahemispherectomy.”

Atthispoint,JohnFreemanandInotonlyurgedthemto elect the surgery, but one of us said, “The sooner thebetterforBeth.”

The poor Ushers didn’t know what to do — and Iunderstood their dilemma. At least they now had Bethalive, although she was obviously getting worse. If shecameinforsurgeryanditwasunsuccessful,shemightendup in a coma, or be fully or partially paralyzed. Or shemightdie.

“Gohomeandthinkaboutthis,”Isuggested.“Besureofwhatyouwanttodo.”

“It’ll soon be Thanksgiving,” John said. “Enjoy thetime together. Let her have Christmas at home. But,” headdedgently,“please,don’tletitgoonafterthat.”

BethplannedtobeinaChristmasplayatschool,andthepartmeanteverythingtoher.Andthenafterfaithfullypracticing her part, while she was actually on the stage,she had a seizure. She was devastated. And so were theUshers.

That day the family decided to go through with thehemispherectomy.InlateJanuary1987theybroughtBethbacktoJohns

Hopkins.TheUsherswerestillalittletensebutsaidthey’ddecided to go through with the surgery. We went overeverything that would happen. I again explained all therisks—howshemightdieorbeparalyzed.Watching theirfaces, I realized they were having a struggle to face thesurgery and the possible loss of their daughter.My heartwentouttothem.“We have to agree,” Brian Usher said at last. “We

knowit’sheronlychance.”Andsoadatewasset.Asscheduled,Bethwaswheeled

toanoperatingroomandpreparedforsurgery.Herparentswaited,hopingandpraying.Thesurgerywentwellwithnocomplications.ButBeth

remained lethargic after the operation and hard to wakeup.Thatreactiondisturbedme;thatnightIcalledforaCTscan.Itshowedthatherbrainstemwasswollen,whichisnot abnormal, and I tried to reassure her parents, “She’llprobablygetbetteroverthecourseofafewdaysoncetheswellinggoesdown.”EvenasItriedtocomforttheUshers,Icouldseefrom

the look on their faces they didn’t believe what I wassaying. I couldn’t blame them for thinking Iwas offeringtheold comfort routine.Had theyknownmebetter, theywould have realized that I don’t take that approach. IhonestlyexpectedBethtoimprove.KathyandBrianUsher,however,werealreadystarting

topunishthemselvesforallowingtheirchildtogothroughthisdrasticsurgicalprocedure.Theyhadreachedthestageof second-guessingwhere theyaskedeachother,“What if…?”Theytorturedthemselvesbygoingbacktothedayof

Beth’saccidentandsaid,“IfI’dhavebeenrighttherewith

her…”“Ifwehadn’tallowedhertoplayontheswing…”“Ifwehadn’tagreedtothissurgery,maybeshewould

havedeteriorated,andmaybeshewouldhavedied,butwestillwouldhaveanotheryearor twowithher.Nowwe’llneverhaveherbackagain.”

ForhourstheystoodbyherbedintheICU,theireyeson her still face, watching the rise and fall of her littlechest, the whir of the respirator that kept her breathingechoingintheirears.

“Beth.Beth,darling.”Finallytheyleft,theirsadeyescaressingherface.Ifeltterrible.Theyweren’tsayinganythingderogatory

tome, never once complaining or accusing. Yet over theyears,most doctors learn to grasp unstated emotions.Wealsounderstandsomeofwhathurtingrelativesgothrough.Iwashurting inside for littleBeth, and I couldn’t doonethingmoreforher.AllIcoulddowaskeephervitalsignssteadyandwaitforherbraintoheal.

BothJohnandIremainedoptimistic,andwetriedtoreassurethembysaying,“She’sgoingtocomeback.Beth’sjust like thekidswhohave severehead traumaand theirbrain stems swell. Sometimes they’re out for days, evenweeksormonths,buttheycomeback.”

Theywantedtobelieveme,andIcouldseetheywerehangingon toeverywordofcomfortDr.Freemanor Iorthenursescouldgive.YetIstilldidn’tthinktheybelievedus.

DespitethefactthatJohnandIbelievedwhatwetoldBeth’s parents, we couldn’t be positive that Beth wouldwakeuporthatshewouldn’t,finally,justslipaway.We’dnever been in that particular situation before. Yet wecouldn’t really account for Beth’s condition in any otherwayexceptthatthebrainstemwastraumatized.

The condition wasn’t so severe that she couldn’tbounceback.Yetthedayspassed,andBethdidn’tbounceback.Shestayedinacomatoseconditionfortwoweeks.DailyIexaminedBethandcheckedherrecords.Andit

becameharder everyday towalk into the roomand faceher parents. They looked at me with despair, no longerdaring tohope.Timeafter time Ihad to say, “Nochangeyet.”AndImeantyetdespitewhatwashappening.Everybody on the staff remained supportive,

constantlyofferingencouragementtotheUshers.Theyalsoencouraged me as I began to grow concerned. Otherdoctors, even nurses, would come to me and say, “It’sgoingtobeallright,Ben.”It’s always inspiring when other people try to help.

Theyknewmeand,justfrommysilence,theyfiguredoutwhattroubledme.Despitetheiroptimisticwords,itwasatoughtimeforallofusinvolvedwithBethUsher.FinallyBethimprovedslightly,enoughthatshedidn’t

havetobeonarespirator,butsheremainedcomatose.Wereleased her from ICU and sent her down to the regularfloor.The Ushers spent as much time with her as they

possibly could, regularly talking to her or playing videosfor her. Beth had especially liked the TV program Mr.Rogers’ Neighborhood, so they played video tapes of Mr.Rogers. When he heard about Beth, Fred Rogers himselfevencametovisitBeth.Hestoodbyherbed,touchedherhand,talkedtoher,butherfaceshowednoexpressionandshedidn’twakeup.One night her dad was lying on a cot in the room,

unabletosleep.Itwasnearly2.00inthemorning.“Daddy,mynoseitches.”“What?”hecried,jumpingoutofhiscot.“Mynoseitches.”

E

“Beth talked! Beth talked!” Brian Usher ran into thehallway, so excited that he didn’t realize hewaswearingonlyunderpants. Idoubt thatanyonecaredanyway.“Hernoseitches!”heyelledatthenurse.Themedicalstaffracedafterhimtotheroom.Bethlay

quietly,asmileonherface.“Itdoesitch.Alot.”Those words were the beginning of Beth’s recovery.

Afterthatshestartedgettingbettereveryday.*

ach of the hemispherectomies is a story in itself. Forinstance,Ithinkof13-year-oldDeniseBacafromNew

Mexico. Denise came to us in status epilepticus,meaningshe was seizing constantly. Because she had been inconstant seizure for two months, she had to be on arespirator.Unable tocontrolherbreathingbecauseof theconstant convulsions, Denise had undergone atracheotomy. Now paralyzed on one side, she hadn’tspokenforseveralmonths.Denisehadbeenaperfectlynormalchilda fewyears

earlier.HerparentstookhertoalltheNewMexicomedicalcentersthatwouldexamineher,andthentootherpartsofthecountry.Allexpertsconcludedthatherprimaryseizurefocuswas from the speech area (Brocha’s area) and fromthemotor cortex, the twomost important sections of herdominanthemisphere.“There isnothing thatcanbedone forher,”adoctor

finallytoldherparents.Thosemighthavebeen the finalwords except that a

family friend read one of the articles about MarandaFrancisco. Immediately she called Denise’s parents. Themother,inturn,calledJohnsHopkins.“BringDenisehere, andwe’ll evaluateher situation,”

wesaid.Transporting her fromNewMexico to Baltimorewas

no easy task because Denise was on a respirator, whichrequiredamed-e-vac—aspecialtransportsystem.Buttheymadeit.

AfterweevaluatedDenise,controversybrokeouthereatHopkinsoverwhethertodoahemispherectomy.Severalneurologists sincerely thought we would be crazy toattemptsuchanoperation.Theyhadgoodreasonsfortheiropinions. Number one, Denisewas too old. Number two,the seizures were coming from areas that made surgeryrisky, ifnot impossible.Numberthree,shewas interriblemedical condition because of her seizures. Denise hadaspirated,soshewashavingpulmonaryproblemsaswell.

Onecriticinparticularpredicted,“She’lllikelydieonthetablejustfromthemedicalproblems,muchlessfromahemispherectomy.” He wasn’t trying to be difficult butvoicedhisopinionoutofdeepandsincereconcern.

Doctors Freeman, Vining, and I didn’t agree. As thethree people directly involved with all thehemispherectomies atHopkins,wehadhadquite abit ofexperience, and we were confident that we knew moreabout hemispherectomies than anyone else. We reasonedthat,betterthananyoneelseatHopkins,weoughttoknowherchances.Shewouldcertainlydiesoonwithoutsurgery.Further,despiteherothermedicalproblems,shewasstillaviable candidate for a hemispherectomy. And, finally,wereasonedthatwethreeoughttobetheonestodeterminewhowasacandidate.

Wetalkedwithourcriticthroughseveralconferences,supporting our arguments with the evidence andexperience from our background cases. We have aconferenceofficewhereweinvitemorethanjustourinnercircle.Overaperiodofdays,wepresentedalltheevidencewe could and involved anyof the staff atHopkinswhomwethoughtmighthaveaninterestinDenise’scondition.

Because of the controversy, we delayed doing the

operation.Normallywewouldhavegoneaheadanddoneit, but we faced so much opposition we took this oneslowly and carefully. Our opposition deserved a fairhearing,althoughweinsisteduponthefinalword.

Theneurologist-criticwentsofarastowritealettertothechairmanofneurosurgery,withcopiestothechairmanofsurgery,thehospitalpresident,andafewotherpeople.He stated that, in his medical opinion, under nocircumstances should JohnsHopkins allow this operation.Hethencarefullyexplainedhisreasons.

Perhaps itwas inevitable thatbad feelingsdevelopedover Denise’s case. When these issues become importantit’s hard to keep personal feelings out of the picture.BecauseIbelievedinthecritic’ssincerityandhisconcernfornotinvolvingHopkinsinanyextraordinaryandheroicventures, I never took his arguments as personalindictments.While Iwasable to stayoutof anypersonalcontroversy, a few of our team members and supportivefriendsdidgetheatedlyinvolved.

Despiteallargumentshebroughtforth,thethreeofusremained convinced that Denise’s only chance lay inhaving the surgery.Wehadnotbeen forbidden todo thesurgery,andnoonehigheruphadtakenanyactionontheobjection,givingusthefreedomtomakeourdecision.Yetwe hesitated, not wanting to make this a personal issue,feeling that if we did, the controversy could erupt andaffectthemoraleoftheentirehospitalstaff.

FordaysIaskedGodtohelpusresolvethisproblem.Ipondered it as I drove back and forth to work. I prayedaboutitasImademyrounds,andwhenIkneltbymybedatnight.YetIcouldn’tseehowitwouldworkout.

Thentheissueresolveditself.Ourcriticleftforafive-dayoverseasconference.Whilehewasgone,wedecidedtodotheoperation.Itseemedlikeagoldenopportunity,andwewouldn’thaveanyloudoutcries.

I

IexplainedtoMrs.BacaasIdidtoothers.“Ifwedon’tdo anything, she’s going to die. If we do something, shemaydie,butatleastwehaveachance.”“At least the operation gives her a fighting chance,”

hermothersaid.The parents were amenable and had been all along.

Theyunderstoodtheissueperfectly.Denisewasseizingsomuch and deteriorating so badly, itwas becoming a raceagainsttime.AfterthehemispherectomyDeniseremainedcomatose

for a fewdays, and then she awakened. Shehad stoppedseizing. By the time she was ready to go home, she wasstartingtotalk.Weekslater,Denisereturnedtoschoolandhasprogressednicelyeversince.

didn’thaveanyanimositytowardthefellowwhocausedtheopposition,becausehestronglybelievedthatsurgerywasthewrongthingtodo. Itwashisprerogativetoraiseobjections. By his objections, he thought he was lookingout for the patient’s best interests aswell as those of theinstitution.ThesituationwithDenisetaughtmetwothings.First,

itmademefeelthatthegoodLordwon’tallowmetogetinto a situation He can’t get me out of. Second, itconfirmedinmethatwhenpeopleknowtheircapabilities,and they know their material (or job), it doesn’t matterwho opposes them. Regardless of the reputation of thecriticsortheirpopularity,power,orhowmuchtheythinkthey know, their opinions become irrelevant. I honestlynever had any doubts about Denise’s surgery. In themonthsafterwards,althoughIdidn’tknowitatthetime,Iwoulddootherandmorecontroversial surgeries.Lookingback, I believe that God had used the controversy overDenisetopreparemeforthestepsyetahead.

*In1988Beth’sparentsreportedtomethatshehascontinuedtoimprove.Shewasnumberoneinhermathclass.

Bethhasaslightleftlimp.Incommonwithotherhemispherectomies,shehaslimitedperipheralvisionononesidebecausethevisualcortexisbilateral-theonesidecontrolsvision to theotherside.Forsomereasonvisiondoesn’tseemtotransfer.Thelimphasbeenthereineverycase.

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CHAPTER17

ThreeSpecialChildren

heresidentflickedoffhispenlightandstraightenedupfromthebedsideofBo-BoValentine.“Don’tyouthink

it’s time togiveupon this littlegirl?”heasked,noddingtowardthe4-year-oldchild.

It was early Monday morning, and I was makingrounds.WhenIcametoBo-Bo,thehouseofficerexplainedhersituation.“Justabouttheonlythingshehasleftisherpupillary response,” he said. (Thatmeant that her pupilsstillrespondedtolight.)Thelightheshoneinhereyestoldhim that pressure had built inside her head. The doctorshad put Bo-Bo in a barbiturate coma and given herhyperventilationbutstillcouldn’tkeepthepressuresdown.

LittleBo-Bowasanotherof the far-too-manychildrenwho run out into a street and are hit by a car. A GoodHumor truck struck Bo-Bo. She’d lain in the ICU allweekend, comatose and with an intracranial pressuremonitor in her skull. Her blood pressure graduallyworsened, and she was losing what little function,purposefulmovement,andresponsetostimulishehad.

Before answering the resident, I bentoverBo-Boandlifted her eyelids. Her pupils were fixed and dilated. “Ithoughtyoutoldmethepupilswerestillworking?”Isaidinastonishment.

“Idid,”heprotested.“Theywereworking justbeforeyoucamein.”

“You’re tellingme this just happened? That her eyes

justnowdilated?”“Theymusthave!”“Four plus emergency,” I called loudly but calmly.

“We’ve got to do something right away!” I turned to thenursestandingbehindme.“Calltheoperatingroom.We’reonourway.”“Four plus emergency!” she called even louder and

hurrieddownthecorridor.Although rare, a plus four—for dire emergency—

galvanizeseveryone intoaction.TheORstaffclearsoutaroomandstartsgetting the instruments ready.Theyworkwithquietefficiency,andthey’requick.Noonearguesandnoonehastimetoexplain.TworesidentsgrabbedBo-Bo’sbedandhalf-randown

the hallway. Fortunately surgery hadn’t started on thescheduledpatient,sowebumpedthecase.Onmyway to theoperating room I ran intoanother

neurosurgeon—senior tomeandaman Ihighly respectbecauseofhisworkwithtraumaaccidents.Whilethestaffwassettingup,IexplainedtohimwhathadhappenedandwhatIwasgoingtodo.“Don’t do it,” he said, as he walked away fromme.

“You’rewastingyourtime.”Hisattitudeamazedme,butIdidn’tdwellonit.Bo-Bo

Valentine was still alive. We had a chance—extremelysmall—butstillachancetosaveherlife.IdecidedIwouldgoaheadanddosurgeryanyway.Bo-Bowasgentlypositionedonan“eggcrate,”asoft,

flexiblepadcoveringtheoperatingtable,andwascoveredwith a pale green sheet. Within minutes the nurses andanesthiologisthadherreadyformetobegin.Ididacraniectomy.FirstIopenedherheadandtook

offthefrontportionofherskull.Theskullbonewasputina sterile solution. Then I opened up the covering of her

I

brain—thedura.Betweenthetwohalvesofthebrainisanarea called the falx. By splitting the falx, the two halvescould communicate together and equalize the pressurebetweenherhemispheres.Usingcadavericdura(durafroma dead person), I sewed it over her brain. This gave herbrain room to swell, then heal, and still held everythinginsideherskullinplace.OnceIcoveredthearea,Iclosedthescalp.Thesurgerytookabouttwohours.

Bo-Bo remainedcomatose for thenext fewdays. It isheartbreaking to watch parents sit by the bedside of acomatosechild,andIfeltforthem.Icouldonlygivethemhope; I couldn’tpromiseBo-Bo’s recovery.Onemorning Istoppedbyherbedandnotedthatherpupilswerestartingto work a little bit. I recall thinking, Maybe somethingpositiveisstartingtohappen.

After two more days Bo-Bo started moving a little.Sometimesshestretchedher legsorshiftedherbodyas iftryingtogetmorecomfortable.Overthecourseofaweekshe grew alert and responsive.When it became apparentthatshewasgoingtorecover,wetookherbacktosurgery,and I replaced the portion of her skull that had beenremoved. Within six weeks Bo-Bo was, once again, anormal4-year-oldgirl—vivacious,bouncy,andcute.

ThisisanotherinstancewhenI’mgladIdidn’tlistentoacritic.

’ve actually done one craniectomy since then. Again Iencounteredopposition.In the summer of 1988, we had a similar situation

except thatCharles,* age10,was inworse shape.Hehadbeenhitbyacar.

WhentheheadnursetoldmethatCharles’spupilshadbecome fixed and dilated, that meant we had to takeaction.Theclinicwasespeciallybusythatday,soIsentthesenior resident to explain to the mother that, in my

judgment,weoughttotakeCharlestotheoperatingroomimmediately.Wewouldremoveaportionofhisbrainasalast-ditch effort to save his life. “It may not work,” theresidenttoldher,“butDr.Carsonthinksit’sworthatry.”The poor mother was distraught and shocked.

“Absolutelynot,”shecried.“Ican’tletyoudoit.Youwillnotdothattomyboy!Justlethimdieinpeace.You’renotgoingtobeplayingaroundwithmykid.”“Butthiswaywehaveachance—”“A chance? I want more than a chance.” She kept

shaking her head. “Let him go.” Her response wasreasonable.BythenCharleswasn’trespondingtoanything.Onlythreedaysearlierwehadregretfullytoldherthat

Charles’sconditionwassoseriousthathewouldprobablynot recover, and she should come to grips with theinevitable end. Then suddenly a man stood before her,urginghertogiveherconsenttoaradicalprocedure.Theresident could give her no assurance that Charles wouldrecoverorevenbebetter.After the resident returned and repeated the

conversation,IwenttoseeCharles’smother.Ispentalongtimeexplaining indetail thatweweren’tgoing tocut theboyinpieces.Shestillhesitated.“Let me tell you about a similar situation we had

here,” I said. “She was a sweet little girl named Bo-Bo.”When I finished I added, “Look, I don’t know about thissurgery.Itmaynotwork,butIdon’tseethatwecangiveup in a situation where we still have even a glimmer ofhope.Maybeit’sthesmallestchanceofhope,butwecan’tjust throw it away, can we? The worst thing that couldhappenisthatCharlesdiesanyway.”Once she understood exactly what I would do, she

said,“Youmeantherereallyisachance?ApossibilitythatCharlesmightlive?”“Achance,yes,ifwedosurgery.Withoutit,nochance

whatsoever.”“Inthatcase,”shesaid,“ofcourseIwantyoutotry.I

just didn’twant you cutting him upwhen it didn’tmakeanydifference—”

Notdefendingourselvesthatwedon’tdosuchthings,Iagainemphasized that thiswas theonlychancewecouldoffer her. She signed the consent form immediately. Werushedtheboyofftotheoperatingroom.

AswithBo-Bo, it involved removingaportionof theskull,cuttingbetweenthetwohalvesofthebrain,coveringthe swollen brain with cadaveric dura, and sewing thescalpbackup.

As expected, Charles remained comatose afterward,and for a week nothing changed. More than one staffmembersaidsomethingtomelike,“Theballgame’sover.We’rewastingourtime.”

SomeonepresentedCharles’scaseinourneurosurgicalgrand rounds. Neurosurgery grand rounds is a weeklyconferenceattendedbyallneurosurgeonsandresidentstodiscuss interesting cases. Previously scheduled for animportant surgery, I couldn’t be present, but I was toldwhat was said by several who had been in on theconference.

“Whatdoyouthink?”theattendingdoctoraskedoneintern.

“Isn’tthisgoingalittlebitbeyondthecallofduty?”Anotheronesaidquitefirmly,“Ithinkitwasafoolish

thingtodo.”Othersagreed.Oneoftheattendingneurosurgeons,familiarwiththe

boy’s condition, stated, “These types of situations neverresultinanythinggood.”

Anothersaid,“Thispatienthasnotyetrecovered,andhe’snotgoingtorecover.Inmyopinion,it’sinappropriate

A

toattemptacraniectomy.”WouldtheyhavebeensovocalifIhadbeenpresent?

I’m not sure, yet they were speaking from their ownconviction. And since seven days had passed with nochange,theirskepticismwasunderstandable.Maybe I’m just stubborn, or maybe I inwardly knew

the boy still had a fighting chance. At any rate, I wasn’treadytogiveup.On the eighth day a nurse noticed that Charles’s

eyelidswere fluttering. Itwas the story ofBo-Bo all overagain. Soon Charles started to talk, and before a monthended, we sent him to rehab. He has made great strideseversince.Inthelongrun,webelievehe’sgoingtobefine.Bo-Bowon’t have any seizures, but Charlesmay.His

condition was more severe, he was older, and he didn’trecover as quickly as Bo-Bo. Six months after the event(whenIlasthadcontactwiththefamily),Charleshadstillnot fully recovered, although he is active, walking andtalking, and isdevelopingadynamicpersonality.Mostofall, Charles’s mother clearly is thankful to have her sonalive.

nother case I don’t think I’ll ever forget involvedDetroitbornDanielle.FivemonthsoldwhenIfirstsaw

her, she had been born with a tumor on her head thatcontinuedgrowing.BythetimeIsawDanielle, the tumorbulgedoutthroughtheskullandwasthesamesizeasherhead. The tumor had actually eroded the skin, and pusdrainedoutofit.Friends advised her mother, “Put your baby in an

institutionandletherdie.”“No!” she said. “This ismy child.My own flesh and

blood.”Danielle’s mother was doing the herculean task of

taking care of her. Two or three times each day shechanged Danielle’s dressings, trying to keep the woundsclean.Danielle’s mother called my office because she had

read an article about me in the Ladies Home Journal inwhichitstatedthatIfrequentlydidsurgeriesthatnobodyelse would touch. She talked to my physician’s assistant,CarolJames.“Ben,”Carolreportedlaterthatday,“Ithinkthisone

isworthlookinginto.”Afterhearing thedetails, I agreed. “Have themother

sendmethemedicalrecordsandpictures.”Less than a week later, I examined everything. I

realized immediately that it was a dismal situation. Thebrain was abnormal, the tumor had spread all over theplace,andwedidn’tknowhowtheskincouldbeclosed.I called my friend Craig Dufresne, a superb plastic

surgeon,andtogetherwetriedtofigureoutawaythatwecouldremovethetumorandclosetheskullagain.Wealsoconsulted Dr. Peter Phillips, one of our pediatric neuro-oncologists who specializes in treating kids with braintumors.Together we finally devised a way that we would

actuallygetthetumorout.ThenDr.Dufresnewouldswingupmuscle/skin flaps from the back and try to cover thehead with them. Once that had healed, Doctors PeterPhillips and Lewis Strauss would come up with achemotherapy program to kill any remaining malignantcells.Weassumeditwasgoingtobeatoughcaseandwould

requireatremendousamountoftime.Wewereright.Theoperation to remove the tumor and to sew in themuscleflaps took 19 hours.We had no concern about the time,onlytheresults.Dr. Dufresne and I tag-teamed the surgery. I needed

almosthalfofthesurgeryhourstoremovethetumor.ThenDufresnespentthenextninehourscoveringherskullwiththemuscularcutaneousskin flaps.Hewasable toget theskinclosedover.

Abouthalfwaythroughthesurgery,IsaidtoDufresne,“Ithinkwe’regoingtocomeoutofthiswithoursockson.”

He nodded, and I could tell he felt as confident as Idid.

Thesurgerywassuccessful.Aswehadanticipated,intheweeksfollowingtheremovalofthetumor,Daniellehadtogobacktotheoperatingroomandhavetheflapsmovedto take tension off certain areas and to improve bloodcirculationtothesurgicalsite.

Initially,Daniellestartedtodowellandrespondedlikeanormal infant. Icouldsee thepleasureherparents tookin the everyday motions of babyhood most parents cantake for granted. Her tiny hand grasping one of theirfingers.Alittlesmile.ThenDanielleturnedthecornerandstartedgoinginthewrongdirection.First,shehadasmallrespiratoryproblem,followedbygastrointestinalproblems.Afterwecleared themup,herkidneys reacted.Wedidn’tknowiftheseotherproblemswererelatedtothetumor.

DoctorsandnursesinthepediatricICUworkedaroundtheclocktryingtokeepDanielle’slungsandkidneysgoing.Theywerejustasinvolvedaswewere.

Finallyallthatcouldbedonehadbeendone,andshedied.Wedidanautopsy,andwefoundthatthetumorhadmetastasized all over her lungs, kidneys, andgastrointestinal tract. Our surgery for the tumor in herheadwas a little too late.Hadwegotten toher amonthearlier, before things had metastasized, we might havebeenabletosaveher.

Danielle’s parents and grandparents had come fromMichigan and stayed in Baltimore to be near her. Duringtheweeksofwaitingandhopingforherrecoverytheyhad

beenextremelydedicated,understanding,andencouragingtousineverythingwetried.Whenshedied,Imarveledattheirmaturity.

“We want it to be clear that we don’t harbor anygrudges over anything you folks did here at Hopkins,”Danielle’sparentssaid.

“We’ve just been incredibly thankful,” said thegrandmother, “that youwerewilling to undertake a casethateveryoneelseconsideredimpossibleanyway.”

EspeciallyIrememberthewordsofDanielle’smother.In a voice that was barely audible, she choked back herowngrief and said, “Weknow thatyou’reamanofGod,andthattheLordhasallthesethingsinHishands.Wealsobelieve we’ve done everything humanly possible to saveour daughter. Despite this outcome, we’ll always begratefulforeverythingthatwasdonehere.”

I share Danielle’s story because not all our cases aresuccessful. I can count onmy fingers the number of badoutcomes.

*ForthesakeofprivacyIhavechangedhisname.

T

CHAPTER18

CraigandSusan

wenty-five to thirty people had jammed themselvesinto Craig Warnick’s hospital room, and they were

holding a prayermeeting when I walked in. All of themwere taking turns asking God for a miracle when Craigwentintosurgery.Notonlywasitamazingtoseesomanypeoplecrowdedintotheroom,butevenmoreastonishing,theyhadallcometopraywithandforCraig.

I stayed a few minutes and prayed too. As I wasleaving,Craig’swife, Susan,walked to thedoorwithme.Shegavemeawarmsmile.“Rememberwhatyourmothersaid.”

“I won’t forget,” I answered, only too aware ofMother’swords,becauseIhadoncequotedthemtoSusan:“Bennie, if you ask the Lord for something, believing Hewilldoit,then,Hewilldoit.”

“Andyourememberittoo,”Isaid.“Ibelieve,”shesaid.“Ireallydo.”Even without her saying so, I could read her

confidenceintheoutcomeofsurgery.AsIwalkeddownthehallwayIthoughtofSusanand

Craig and all that transpired in their lives. They hadalready gone through so much. And it wasn’t anywherenearbeingover.

SusanWarnick is a nurse—and an excellent one—onour children’s neurosurgical floor. Her husband has a

disease called VonHippel-Lindau (VHL). Individualswiththis rarediseasedevelopmultiplebrain tumorsaswellastumors of the retina. It’s a hereditary condition. Over aperiod of years, Craig’s father had developed four braintumors.Craig’s ordeal began in 1974 when he was a high

school senior.He learned thathehaddevelopeda tumor.Few people knew of VHL and, consequently, none of themedical professionwho examinedCraig anticipated othertumors. I had not yet met Craig. Another neurosurgeonoperatedandtookoutthetumor.AsIcontinuedwalkingdownthecorridor,Ithoughtof

what he had gone through the past 13 years. Then mythoughts turned toward Susan. In her own way, she hadgonethroughasmuchasCraig.Iadmiredherforbeingsodedicated in taking care of Craig and making sure thateverythingwasdoneforhim.Godhadsenthimtheperfectmate.Susan once said that she and Craig knew from the

beginning that theyhada special,heaven-sent love.Theymetinhighschoolwhenshewas14andhewastwoyearsolder. Neither ever considered anyone else as a lifetimepartner. They both became Christians in high schoolthrough theministry ofYoung Life. Since then theyhavegrown in their faith and are active members of theirchurch.BythetimeCraigwas22,theyhadfinallylearnedthe

name of his rare disease—including the likelihood ofrecurring tumors. And by then he had undergone lungsurgery, adrenalectomy, two brain-tumor resections, andtumors of the retinas. Despite all the physical roadblockshe faced, Craig had gone on to college between hishospitalizations. After the first surgery, Craig had troublewith his balance and swallowing—both results of thetumor.Andthesetwosymptomsnevertotallylefthim.

In 1978 Craig started vomiting and developingheadaches. Both symptoms persisted with alarmingregularity.BeforeCraigwent throughtestsagain,bothheand Susan knew he had developed another tumor.However, Craig’s doctor (the original physician) did notrealize itwasanother tumorand,as theWarnicks relatedthestorytome,thedoctordismissedtheirfears.

The tests, however, confirmed that theWarnicks hadbeencorrect.Thedoctorsetupasecondsurgery.Thenightbeforesurgery,theBaltimoreneurosurgeonsaidtoCraig’smother, “I don’t think I can remove the tumor withoutcripplinghim.”Whilewantingtoknowtheworstpossibleoutcome, they were devastated, feeling he offered themlittlehope.

The last thing that samedoctor said to Susan on theevening of April 19, 1978—the night before his secondsurgery—was, “Tomorrow after surgery he’ll be inintensive care.Right?”He started towalk awayand thenturnedbackandadded,“Wehopehemakesit.”Itwasoneof the few times when Susan struggled with doubt overCraig’srecovery.

Craigmadeit throughthesurgery,buthehada longlist of complications including double vision and theinability to swallow. His lack of balance was so bad hecould not even sit up. Craig was physically miserable,emotionally depressed, and ready to give up. But Susanwouldn’t give up, and she refused to allow him to stopfighting.“Youaregoingtogetwell,”shesaidconstantly.

A fewmonths later, Craigwas admitted to theGoodSamaritanRehabilitationHospital.Becauseofanumberofsignificant factors involved, it was amiracle for Craig togetadmitted.Forthenexttwoyears,Craighadsomeofthebest physical therapy available. And he improveddramatically.

“Thank You, God,” Susan, Craig, and their families

prayed, offering thanks to a lovingGod for every sign ofprogress. But for Susan and Craig, improvement was notenough.“HeavenlyFather,”theyprayeddaily,“makeCraigwell.”Craighadabadtimerecoveringandfacedavarietyof

setbacks. No longer a husky young man, Craig lost 75pounds— making him nothing but skin stretched over anearlysix-footframe.Craig continued to improve, but he still had a long

way togo.He learned to feedhimself.Mainlybecauseofhistroublewithswallowing,heneededanhourandahalfforameal.Hecouldn’twalkandhadtobeinawheelchair.Yet during that recovery period, showing remarkabledetermination,hecontinuedincollege.The faith of those two was remarkable, especially

Susan’s. “He’s going to walk,” she told people. “Craig isgoingtowalkagain.”Aftertwoyearsofphysical therapy,withtheaidofa

cane, Craig walked down the aisle with Susan, and theyweremarriedonJune7,1980.TheBaltimoreSunwroteabig story about this loving relationship and how it hadpulledCraigfromthejawsofdeath.Craigthrewhimselfintohiscollegecoursesandfinally

completed his work. He graduated in January 1981 andfound a job with the Federal government, filling ahandicapquota.But it wasn’t all good news. In late 1981 Craig

developed tumors in his adrenal glands. In surgery theglandswereremoved,andheisnowonmedicationfortherestofhislife.Shortly afterward SusanmetwithDr.NeilMiller, an

opthamologist at Johns Hopkins, who told her, “At leastyou now have a name for the disease. It’s called VonHippel-LindauorVHL.”Hesmiled.“It’snamedforthemenwhodiscovered it.”HehandedSusananarticleabout the

disease.As she started to read, Dr. Miller told her that Von

Hippel-Lindau disease strikes one person in 50,000.Characteristically,VHLcausestumorsinthelung,kidneys,heart,spleen,liver,adrenalglands,andpancreas.

In that instant,Susangrasped the impact thisdiseasewouldhaveontherestofCraig’slife.Shestoppedreading,andher gazemet that ofDr.Miller’s. Both of themwereteary-eyed.

She later said, “His crying did more to comfort methan anything he could have said. I was so impressed todiscover that therewerepeople in themedicalprofessionwhofeltdeeplyfortheirpatients.Hiscryingopenlymademefeelheunderstood.Andthathecared.”

Susan then knew the name and characteristics of thedisease. That knowledge also helped her to know whatthey could expect in the future—more tumors. “Thisdiseaseisn’tgoingtogoaway.Thisnextsurgerywon’tbetheendofit,”shesaid,moretoherselfthantoDr.Miller.“Wearegoingtohavetolivewiththisforalifetime,aren’twe?”

Tears again filled his eyes. He nodded as he saidhoarsely, “At least you know what you’re dealing withnow.”

SusandecidednottogiveCraigthisinformation.Craigis quiet by nature, and at the time he was severelydepressed.Shethoughtthatifheknewthebleaknessofhisfuture,thiswouldonlyaddtohisheavyheart.

She kept the information to herself, but shewas notsatisfied. Shehad to knowmore. For thenext 18monthsSusan read, researched, and wrote to anyone whom shethoughtmightgiveanyadditionalinformation.

Susanclaims tohaveoneof the largestVHL librariesintheworld.AndIbelieveher!ShetelephonedacrosstheUnitedStates,findingtheplaceswheretheywereactually

doing VHL research. Over the course of Craig’s illness,Susan has become highly knowledgeable about VHL andkeepsabreastofmedicaldevelopments.VHL is associated with a preventable form of

blindness.Becauseitisadominantlyinheriteddisease,thismeansthat50percentoftheoffspringofpersonswithVHLwill eventually develop it. Craig’s sister, who is now 40,hadatumorwhenshewasinhertwenties.Itappearsshewillnothaveanymore.WhenshefinallytoldCraigaboutVHL,hesaidsimply,

“Iknewsomethingseriouswaswrong.Andthetumorskeptcomingback.”About that time Susan remembered how much Dr.

Miller’s compassion had enabled her to cope. As shethought about her experience, she concluded that nursescouldbenefitpatientsbyexpressingtheircare.Itwasthenthatshedecidedtoenternurse’straining.Aftergraduatingin 1984, Susan applied for and received a job in thepediatric neurology department at Johns Hopkins whereshehas remained since.Tonoone’s surprise, Susan is anexcellentnurse.In September, 1986, Susan realized he was showing

symptomsofyetanotherbraintumor.That’swhenIcameintothepicture:SusanaskedmetotakeCraigasapatient.AfterIagreed,wedidaCTscan,andIhadtotellthem

that it appeared that he actually had three tumors. Aftersomepreparation, I removed the tumors and, fortunately,he didn’t have any surgical complications. He did,however, have endocrinological problems which requiredseveral weeks to regulate. A little while later Craigdevelopedanothertumorinthecenterofthebrainwithacystinit.A gifted chief resident namedArtWong assistedme.

We had a difficult operation becausewe had to split thecorpuscallosumthatconnects thetwohalvesof thebrain

andgorightdowntothecentertogetthethingout.Theoperationwentwellwithnoproblems.Craigdid

finepost-operatively.Theywereprayingthatthiswouldbethelastsurgerywhileknowingthestatisticsworkedagainstthem.Craigcontinuedtorecover—slowlybutmarkedly.Then in 1988 came the dreaded news: Craig had

developedanothertumor,thisoneinhisbrainstem.Itwasinthepons—anareaconsideredinoperable.Yetsomeonehadtotry.CraigandSusanaskedmetodothesurgery.“I’msorry,”Itoldthem.“Ijustcan’tfitCraigintomy

operating schedule.” As Susan well knew, I was alreadybackedupwithpatients.EventhoughIbelievedImadetherightchoice,IfeltterriblehavingtosayNo.“I’d like to have you go to one of the other

neurosurgeonshereatHopkinswhospecializesinvascularproblems,”Isaid,“becausethetumorsarevascular.”“We’dreallylikeyoutodoit,”Craigsaidinhisquiet

voice.“If there’s any way possible,” Susan said. “We know

howbusyyouare,andweunderstand…”Afteralengthydiscussionandusingallmypersuasion,

Craig did transfer to the other surgeon’s care. This manconsideredusinganewprocedure,calledthegammaknife.However, after talking with the Swedish inventor of theprocedure,hedecideditprobablywouldn’tworkonCraig’sparticulartypeoftumor.Theywouldhavetorethinktheiroptions.In themeantime,Craig started todeteriorate rapidly.

He lost the ability to swallow, having developed suchweakness in his face that it felt numb, and he startedhavingsevereheadaches.OnJune19,1988,Craighadtobeadmittedthroughthehospitalemergencyroom.Susancalledme.AsIlistened,IknewIcouldn’tstand

byandlethimgetworse.Ihadtodosomething.Ipaused

as I tried to sort out my emotional reaction from myprofessionalism. I heardmyself saying, “OK, I’m going tobump somebody off the schedule. We’ll get Craig intosurgery.”

Wescheduledhim for thenextday,June20,at6:00p.m.

Both of thembecame ecstatic. I don’t think I’ve everseen two happier people. It seemed that just knowing Iwoulddothesurgerygavethemagreatersenseofpeace.

“It’sallinGod’shands,”Itoldthem.“But we believe you let God use your hands,” Craig

said.Although Ihadconsented todo the surgery, Ihad to

explain toCraigandSusan that this tumorandcystwereprobablyinthebrainstem.“Ican’ttell forsureuntil Igoinsideandinvestigate,”Isaid.“Andifit’sinthebrainstem—“Ipaused,notwantingtotellthemIwouldn’tbeabletodoanything.

“Weunderstand,”Craigsaid.Susannodded.Theygraspedtheoddstheywerefacing.“But,”Iadded,“anypartofthetumornotinthebrain

stem,I’lltakeout.”“It’sgoingtobeallright,”Susansaid.Andshemeant

it.Itfeltalittlestrangehavingthepatient’swifeencourageme—formetobeonthereceivingendofmoraleboosting.

AlthoughIagreedtothesurgery, Istilldidnotknowthe best course of action. I had bandied some thoughtsaround, and I consulted other neurosurgeons. Nobodyknewwhattodoaboutthisparticulartumor.

“I’m going to go in there and at least investigate,” Ifinally said. Ididn’tpromise theWarnicksanything—howcould I? They didn’t seem to need any kind of extraassurance—theyweremoreatpeacethanIwas.

ItwasthelateafternoonbeforesurgerywhenIfoundallthoseprayingpeoplegatheredinCraig’sroom.

It was a tough operation. The tumor had so manyabnormalbloodvesselscomingtoandgoingfromitthatIhadtouseamicroscopetoseepreciselywherethetumorbegansoIcouldremoveit.Ilookedupanddownthebrainstemateveryanglebutcouldn’tfindanythingexceptthathisbrainstemwasbadlyswollen.

I thought, The tumor has got to be in there within thebrainstem.SoIstuckneedlesintothebrainstem.Thebrainstem is considered untouchable because it has so manyimportant structures and fibers that even the slightestirritation can cause major complications. I had alreadysuspectedthatthetumormighthaveacystinit.Ifso,ifIcould reach the cyst and withdraw some fluid, it wouldreleasesomeofthepressureonCraig’sbrain.

I did not find a cyst but instead provoked terrificbleedingfromthesitesoftheneedlepunctures. Icouldn’tgetanythingelsetocomeout.Aftereighthours,sometimearound2:30 in themorning,weclosedCraigupand senthim back to the ICU. He had gone through a lot, and Iassumedhe’dbetotallywipedout.

IwasastonishedwhenIwalkedintotheroomthenextmorning. Craig behaved as if he were preoperative.Although lying in bed, he was smiling, moving around,evenmakingjokes.

Once past my shock, I told Susan and him that Ithoughtthistumorwasclearlyinthemiddleofthepons—partofthebrainstem.

“I’m willing to open the pons up,” I said, “but Icouldn’tdoitlastnightbecauseI’dalreadybeenoperatingonit foreighthours,andIwastired.Iprobablywouldn’tbethinkingright.IliketomakesureIhaveallmyfacultiesworkingwhen venturing into no-man’s-land—something Ijustdon’twanttoattemptinthemiddleofthenight.”

“Doit,”Craigsaid.“Thereisn’tmuchchoice,isthere?”Susanasked.“Thereisatleasta50–50chancethatCraigwilldie

righton the table,” I toldSusanandCraig.Thoseweren’teasy words to say, and yet I had to tell them all of thefacts,especiallytheunpleasantone.“Andifhedoesn’tdie,hecouldbeparalyzedordevastatedneurologically.”“We understand,” Susan said. “We want you to go

ahead anyway.We are praying for amiracle.We believeGodisgoingtodoitthroughyou.”“Whathavewegottolose?”Craigadded.“Otherwise

it’sdeathanyway.”Ischeduledthesurgeryforafewdayslater.AlthoughI’dknownCraigandSusanwerebothstrong

Christians,morethanatanyothertime,Isawitevidencedthen. They kept saying, “We want a miracle, and webelievewe’re going to get one.We’re praying forGod togiveusone.”AnorderlywheeledCraig to theoperatingroom,and

theprocedurebegan.Craiglayfacedownontheoperatingtable,hisheadheldtightontoaframesoitcouldn’tmove.Onceagain,doctorsshavedandscrubbedhishead.Anurseplaced a sterile drape over Craig with the small plasticwindowoverthesurgicalsite.Andthesurgerybegan.Againitwastoughgoing.EventuallyIgotdowntothe

sideofthebrainstem.“I’mgoingtoopenupalittleholeinthebrain stem,” Imurmured tomystaff. I tookabipolarinstrument(asmallelectricalcoagulating instrument)andopened up the brain stem. It began to bleed profusely.Every time I touched the stem, it bled. My assistantcontinued to suction up the blood to keep the site clearwhile I askedmyself,Whatdo Idonow? Iprayed silentlyandfervently,God,helpmeknowwhattodo.Ialwayspraybeforeanyoftheoperations,asIscrub,

standingatthetablebeforeIbegin.ThistimeIwasacutelyconscious of praying during the entire surgery as I keptthinking,Lord,it’suptoYou.You’vegottodosomethinghere.Ihadnoideawhattotry.Ipausedandstaredintospaceas IsaidtoGod,Craig

will die unless You showme what to do.Within seconds, Iknew—akindofintuitiveknowledgefilledmymind.“Letmehavethelaser,”Isaidtothetechnician.Iaskedforalaserbeamsimplybecauseitseemedlike

themostlogicalchoice.Usingthelaser,cautiously,Itriedopening a littlehole in thebrain stem.The laser enabledmetocoagulatesomeofthebleedingvesselsasIwentin.At last I got a tiny hole opened withminimum bleedingandwentinside.Feelingsomethingabnormal,Iteasedouta little piece of it. It was probably tumorous, but it wasstuck. I tugged gently, but nothing came out. Again Ihesitated,notwantingtobecometooaggressive.Icouldn’topenup thehole any larger because Iwas right downatthebrainstem.The anesthesiologists checked their evoked potential

monitors,whichshowedtheelectricalactivitycomingfromthebrain.“Theevokedpotentialsaregone,”oneofthemsaid.Theevokedpotentialhaddied—just thewayanEKG

goes flat when the heart stops beating. This flatnessindicated no brain waves or activity on one side of hisbrain— a sign of severe damage. The brain operates onelectrical activity, and the activity coming through thebrain stemon that sidewasgonealthough theother sideremainedundamaged.“We’re in here. We’re going to persist,” I said, not

allowingmyselftoconsiderhowseverethedamagemightbe.God,Ijustcan’tgiveup.Pleaseguidemyhands.Ikeptatthe tiny hole in the stem, my hands easing, pleading,begging, pulling gently. Finally the tumorous growth

T

started coming out. Gently I tugged, and suddenly it allcamefreeinonegiganticblob.Immediately the brain stem shrunk back closer to its

normal size. But while I felt pleased that I’d gotten thegrowth, the damage to Craig had been done. Although Itried to keep from thinking about what would happen, Iknewtoowell.EvenifCraigdidsurvive(whichwashighlyunlikely), he would be a “total train wreck.” He wouldcertainlybecomatoseandlikelyparalyzed.YetIhadkeptonbecauseIknewitwastherightthingtodo.Thesurgerycontinuedfor fourmorehours.Whenwe

closed up, I felt terrible. Aloud I said, “Well, we did ourbest.”IknewIhad,butmywordsbroughtmenocomfort.

he next part of the story is told by Susan, who latertaped a record of Craig’s story, including her

experience during the first 1988 surgery that I have justdescribed.

SUSANWARNICK:Alotoffriendsandfamilymemberscametostaywithmeduringthesurgerythatnight,andIwasthankfulfortheirpresence.Whenpeopleweren’ttalkingtome,IspentmostofthetimereadingmyBible.IwantedtotrustGodandtopush away all my doubts. But the doubts were there,gnawing at me. I couldn’t grasp what was happening orunderstand why I was falling to pieces. I had had realconfidence in God for such a long time. I was so certainthat we would have a miracle. Over the years, anytimeCraig showed signs of discouragement I was there tomotivatehim,tolethimknowIwaswithhimandthatwecouldfaceanythingtogetherbecauseGodwasinchargeofourlives.Ihadbeensostrong,andnowIwasfallingapart.Thatnightnothingsnappedmeoutofmydepression.I

remembersayingtosomeofthepeopleintheroom,“I’ve

never said this before, or felt this way before either, butrightthisminuteIfeeltotallydefeated.MaybeGodwantsmetounderstandthatenoughisenough.MaybeCraigandIcan’thandlethisanymore.Maybe…maybeit’sbestifitendsthisway.”Naturally they tried to comfort me, but I could do

nothingbutwaitandworry.Sometimeinthemiddleofthenight,I lookedupand

sawDr.Carsoncoming into thewaitingroomwhere I satwith my family. He explained about the location of thetumor, the brain damage, and said something like, “As Isaid before, thiswas likely to happen.At best, Craigwillprobablyliveafewmoremonthsandthendie.”Dr.Carsonhasa reputationofbeingunflappableand

showing no emotionwhen he talks to families. He has asoft, kindvoice, so quiet thatmany timespeoplehave tostraintohearhim.Mostofall,heisalwayssocalm.Iheldmyself rigidas I listened towhatamounted to

Craig’sdeath sentence.ThemoreDr.Carson toldme, themore upset I became. I didn’t cry, but my whole bodystarted trembling. I was aware of this shaking and, themore I tried to control it, themoreconvulsive itbecame.Craig is going to die… Over and over that sentence rangthroughmyhead.Dr. Carson did say that hewould try to remove this

tumor if Craig and I were willing to go back to surgeryagain.Buthe also toldme thatCraigwoulddefinitelybeparalyzed on one side of his body, “ … and there’s apossibilitythathewilldie.”For a few minutes I hardly noticed Ben Carson or

heardanything.Craigwasgoingtodie—afterthatnothingmuch registered.Dr. Carsonwas standing in front ofme,tryingtocomfortme,andIknewhecouldnever findthewords that would bring me peace. After 14 years ofresearchingVHLandhavingitdrilledintomyheadthatif

Craigeverhadatumorinhispons,hewoulddie, Iknewwhatwas happening.My Craig. Iwas going to lose him.Craigwasgoingtodie.

“Thetumorwasinthemiddleofthepons,”Dr.Carsonrepeated. At that moment I looked up and saw Dr.BenjaminCarson,thehumanbeing.Naturallyhewastired,and Icould see thewearinessaroundhiseyes.But itwasmorethanthat.

Thisisn’tthewayheusuallylooks,Ithought.Something’sdifferentabouthim.ThenIknew.Dr.Carsonwasdiscouraged.Defeated.

I realized that Ihadbeensocaughtupwithmyownconfusion and pain, I had only thought of Craig andme,never considering what might be going on inside Dr.Carson.

Herewas amanwhomaskedhis emotionswell, andyethewasn’tdoingitwellrightthen.Ithought,Thismanremoveshalfofpeople’sbrains.Hedoessurgicalproceduresnooneelsecando.Yet I readasadness inhis face,a lookofdespair.

MomentarilyIforgotaboutCraigandmyselfandIfeltsorry for the doctor.He had tried hard, and nowhewasfrustratedandreallydown.

Hefinishedtalking,turned,andwalkeddownthehall.AsIwatchedhim,Ikeptsayingtomyself,“Ifeelsosorryforhim.”

Irandownthehallandcaughtupwithhim.Ihuggedhimandsaid,“Don’tfeelsobad,Ben.”

Iwentbacktotheroom.Apatienthadgonehomethatday,and thenurses letme spend thenight in theunusedroom. As I lay on the bed, I stared at the ceiling. I wasangry—soangry.

I couldn’t remember feeling that much emotion atanytimebefore.

“God,” Iwhispered in the semidarkness, “we’ve beenthroughsomuch.We’veseenalotofpositivethingscomeoutofallofthis.

“EventhoughI’vehadmomentswhen itwasdifficultforme, especially in our early years together, this is theworst. I’mmadatYou,God.You’regoingto letCraigdieand do nothing about it. If Youwere going to take him,why didn’t You do it in 1981? Or when he had his firsttumor? IfYou’reso loving,howcanYou letaperson likeCraiggothroughthismuchonlytoendupdying?

“Nothingmakessenseanymore.You’regoingtomakeme a widow at 30. Craig and I will never even have achild.”Irecalledotherwomenwhohadlosttheirhusbandstellingmethathavingchildrenaftertheirhusbands’deathgave them purpose, a reason to live. “They at least havechildren!Idon’thaveanything!”

Ihurtsodeeplyinside,Iwantedtodie.AfewminuteslaterIwentintothebathroomandsaw

myreflectioninthemirror.Ididn’trecognizethefacethatstared back atme. Itwas such aweird experience, and Istaredatthestrangerbeforeme.

Iwalkedbacktothebed,moremiserablethanever.Ifeltasifmywholelifehadbeenamistake.“Useless!That’sme.Alltheeffort,allthecaring—fornothing.AndhowcanI live without Craig? How can You expect me to go onwithouthim?”

Thevenompouredoutofme.IblamedGodforputtingmeinthepositionofmakingCraigmywholeworld.NowGodwasgoingtotakehim.Icriedandletmyangerspewout.

Exhausted, I finally stopped talking. In a moment ofquietness, God told me something. Not a voice, and yetdefinitelywords.Craig isnotyours thatyoushoulddemandtokeephim.Hedoesn’tbelongtoyou,Susan.Heismine.

As the truth came through to me, I realized how

foolishIhadbeen.CraigandIhadsurrenderedourlivestoJesus Christ back in high school. Both of us belonged toGod,andIhadnorighttotrytoholdonnow.

Only a few days before I had been listening to aChristian radio program. The preacher told the story ofAbraham taking Isaac up the mountain and of hiswillingness to sacrifice him—the person Abraham lovedmostinlife.*

Ithoughtofthatstoryandsaid,“Yes,God.CraigismyIsaac.And,likeAbraham,IwanttoofferhimuptoYou.”

As I lay on the neat hospital bed, a wave of peaceslowlywashedoverme,andIslept.

BENCARSON:The afternoon following the second brain-stem surgery, IwasmakingmyroundsandwentintoseeCraig.Icouldn’tbelieveit—hewassittingupinbed.Istaredathimseveralseconds and then, to covermyamazement, I said, “Moveyourrightarm.”

Hemovedit.“Nowyourleft.”Again,quitenormalreactions.IaskedhimtomovehisfeetandanythingelseIcould

thinkof.Everythingwasnormal.Icouldn’texplainhowhecouldbenormal,buthewas.Craigstillhadproblemswithswallowing,buteverythingelseseemedOK.

“IguessGodhadsomethingtodowiththis,”Isaid.“I guess God had everything to do with it,” he

answered.The next morning we were able to remove the

breathingtube.“Going to empty me out?” Craig laughed. He was

crackingjokes,havingafinetimeoutofallofthis.

“Yougotyourmiracle,Craig,”Isaid.“Iknow.”Hisfaceglowed.Iwasathomewithmy familyoneeveningabout six

weeks later when the phone rang. As soon as Susanrecognizedmyvoice,withoutbotheringtoidentifyherself,she shouted, “Dr. Carson! You won’t believe what justhappened! Craig ate a whole plate of spaghetti andmeatballs!Heateitall.Andheswallowedeverything!Thatwasmorethanhalfanhourago,andhe’sfeelinggreat.”

Wetalkedforsometime,anditfeltgoodtoknowthatIhadbeenapartoftheirlivesduringoneoftheirspecialmoments. Itmademethinkofhowwetakesimplethingsforgranted—liketheabilitytoswallow.OnlypeoplelikeCraigandSusanunderstandhowwonderfulthisis.*

*SeeGenesis,chapter22.

*What’sahead forCraig?WeexpectCraig togetback tohispreoperativestate.Thatmeansthathewillbehighlyfunctional.AslongasI’veknownhim,hehasbeenneurologicallyimpaired.Hehastremors,andhestillhasproblemswithswallowingthatresultedfromthedevastatingneurologicaleffectsofthesecondsurgery,inwhichhealmostdied.

Unfortunately,Craigwillprobablyhaveothertumors.ButIthinktheoddsofonerecurringinthebrainstemaresmall.HeiscurrentlyworkingonanMAinpastoralcounseling.

I

CHAPTER19

SeparatingtheTwins

wantedtokillthemandmyselfaswell,”TheresaBindersaid. In January 1987, during her eighth month ofpregnancy, the 20-year-old woman received the terriblenews—shewouldgivebirthtoSiamesetwins.*

“Oh,myGod,” she cried, “this can’t be true! I’mnothaving twins! I’mhavinga sick,uglymonster!”Sheweptalmost continuously for the next three days. In her painthis mother-to-be contemplated every possible way toavoidgivingbirthtothetwins.

Theresafirstthoughtofoverdosingonsleepingpillstokill the unborn twins and herself. “I just couldn’t go onand,forawhile,itseemedliketheonlysolutionforthemandforme.”Butwhensheactuallyfacedthisanswer,shecouldn’t bring herself to swallow the pills. Some of herthoughts bordered on the bizarre, contemplatingsomething,anything, justtohavepeaceandtogetherselfout of this nightmare. She had considered running away,jumping out of thewindow of a tall building. Nomatterwhat she contemplated, she heard herself saying, “I justwanttodie.”

OnthefourthmorningTheresasuddenlyrealizedthatshecouldkillherself—thatwouldbebadenough—butthatby her suicide she was murdering two other beings whohadtherighttolive.

TheresaBindermadepeacewithherself,knowingthatshewouldhavetofacewhateverhappened.Nowshecould

movebeyond the tragedyand livewith the results.Otherparentshad.Yet,onlymonthsbefore,Theresaandher36-year-old

husband,Josef,wereoverjoyedat theprospectofababy.Earlyinherpregnancyherdoctorinformedthemthatshewas carrying twins. “I was filled with joy,” Theresarecalled,“andthankedGodforthiswonderfuldoublegift.”In anticipation, this couple in Ulm, West Germany,

bought identical baby clothes, a double cradle, and adoublebabycarriageastheyawaitedthetwins’arrival.The twins, Patrick and Benjamin, were born by

Cesarean section on February 2, 1987. Together theyweighedatotalofeightpoundsfourteenounces,andtheywerejoinedatthebackofthehead.Immediately after birth the twins were taken to the

children’shospital,andTheresadidn’tseethemuntilthreedayslater.Whenshefinallysawherbabies,Josefstoodatherside,readytocatchherandcarryherfromtheroomifnecessary.Shestaredatthejoinedinfantsinfrontofher.Words

likemonster fledfromher,andTheresasawonlytwotinyboys—herbabies—andherheartmelted.Tearsstreameddownherface.Herhusbandembracedher,andthentheyhugged their sons. “You are ours,” she said to the boys,“andIalreadyloveyou.”Mother love never deserted Theresa Binder, although

thedaysaheadweredifficult—heartbreakingattimes.Herprotectivecaregrewstronger.Theparentshadtolearnhowtoholdthebabiestobe

sure they were both well supported. Because their headsturned away from each other, Theresa had to sit themagainstacushionandholdabottleofmilkineachhandtofeedthem.Althoughthetwinssharednovitalorgans,theydidshareasectionoftheskullandskintissue,aswellasamajor vein responsible for draining blood from the brain

andreturningittotheheart.Fiveweeksaftertheirbirth,theBinderstooktheirsons

home. “Not once didwe ever not love them,” Josef said.“Theywereoursons.”

Because of their being joined at the heads, the boyscouldn’tlearntomovelikeotherinfants,andyet,fromthebeginning,theyactedliketwoindividuals.Oneoftensleptastheothercried.

The Binders lived with the hope that their chubby,blondsonswouldonedaybeseparated.AstheyconsideredthefutureofPatrickandBenjamin,theylearnedthatiftheboys remained attached theywouldnever sit, crawl, turnover, or walk. The two beautiful children would remainbedriddenandrelegatedtolyingontheirbacksforaslongastheylived.Notmuchofaprospectforthem.

“I have livedwith a dream that has keptme going,”Theresa told me when we first met. “A dream thatsomehow we would find doctors able to perform amiracle.”

Night after night as Theresa went to bed, her lastthoughts centered on cuddling and holding each of hersons separately, playing with them one at a time, andputtingthemindifferentcradles.Manyofthosenightsshelay in bed, her eyes wet with tears, wondering if therewould ever be a miracle for her sons. No one hadsuccessfullyseparatedSiamesetwins joinedatthebackofthecraniumwithbothsurviving.*

“ButIdidn’tgiveuphope.Icouldn’t.Theseweremysons,andtheywerethemost importantthinginmylife,”shesaid.“IknewIwouldfightfortheirchanceaslongasIlived.”

Thebabies’physicians inWestGermanycontactedusat Johns Hopkins, asking if the pediatric surgical teamcoulddeviseaplan toseparate theBinder twinsandgivethemtheirchancetolivenormal,separatedlives.

That’swhenIcameintothisstory.After studying theavailable information, I tentatively

agreedtodothesurgery,knowingitwouldbetheriskiestand most demanding thing I had ever done. But I alsoknew that it would give the boys a chance—their onlychance—to live normally. My making that decision wasonly one phase, because this would not be a one-doctorprocedure. Doctor Mark Rogers, Director of PediatricIntensive Care at Hopkins, coordinated the massiveundertaking. We assembled seven pediatricanesthesiologists, five neurosurgeons, two cardiacsurgeons, five plastic surgeons, and, just as important,dozensofnursesandtechnicians—seventyofusinall.Wewould also undergo five months of intensive study andtraining-preparationforthisuniquesurgery.Craig Dufresne, Mark Rogers, David Nichols, and I

plannedtoflytoWestGermanyinMay1987.Duringourfour days there, Dufresne would insert inflatable siliconeballoonsunderthescalpsofthebabies.Thisdevicewouldgradually stretch the skin so that enough tissuewouldbeavailable to close thehuge surgicalwounds following theseparation.When it came to the surgery, I would do the actual

separating,andthenDonlinLongwouldworkononeboywhile I took the other. To make our chances for successbetter,I’dhavethebestqualifiedmedicalteamatmyside,all from Johns Hopkins, and they included Bruce Reitz,Director of Cardiac Surgery; Craig Dufresne, AssistantProfessor of Plastic Surgery; David Nichols, PediatricAnesthesiologist; and Donlin Long, chairman ofNeurosurgery; with Mark Rogers as coordinator andspokesman.SinceIhadseenonlyX-raysofthechildren,Ineeded

personallytoassesstheirneurologicalability,soIwouldbepart of the team going to Germany to determine if thesurgerywasstillfeasible.

Thentwoweeksbeforethefourofuswerescheduledtogo,thievesbrokeintoourhouse.Asidefromthingslikeelectronicequipment, theyalsostoleour safe,which theycouldn’tgetopen.Thesmall safe,notmuch larger thanashoebox, contained all our important documents andpapers,includingourpassports.

While realizing it would be difficult to replace thepassport in two weeks, I didn’t know it Would beimpossible.When I called the state department, the kind-but-efficientvoicesaid,“I’msorry,Dr.Carson,butnothingcanbedoneinsuchashortperiod.”

I then asked the police investigator, “What are thechances of getting back my papers, especially thepassport?”

“No chance,” he snorted. “You don’t ever get thosekindsofthingsback.Theytrashthem.”

After hanging up, I prayed, “Lord, somehow You’vegot togetmeapassport ifYouwantme involved in thissurgery.”Itriednottothinkaboutthepassport.BecauseofmycaseloadIbecamesoabsorbedinotherthings,Iputthematteroutofmymind.

Twodayslaterthesamepolicemanphonedmyoffice.“You won’t believe this, but we have your papers. Andyourpassport.”

“Oh,Ibelieveit,”Isaid.In an amazed tone, he told me that a detective had

beenrummagingthroughgarbage.Inabigplasticbag,hefound a paper with my name on it and started diggingfurther. Then he found all the other things, every singleimportantstolendocument.Fromthatdiscoverytheywereable to bust a large crime ring in the Baltimore-Washington, D.C., area and to recover all of our otherequipment,alongwithitemsstolenfromotherfamilies.

Our teamspent thenext fivemonths inplanningandworking through every contingency we could envision.

S

Partof thepreparation required the rewiringof an entiresection of a large operating roomwith emergency powerready in case of power failure. The OR had two ofeverything—anesthesiamonitors,heart-lungmachines,andtablesthatwouldliesidebyside,butthatwecouldmoveapartonceImadetheincisionthatseparatedtheboys.Attheendofthefive-monthperiod,everythingwasso

organized that at times it felt as if we were planning amilitaryoperation.Weevenworkedoutwhereeach teammemberwould stand on the operating room floor. A 10-page, play-by-play book detailed each step of theoperation. We endlessly discussed the five 3-hour dressrehearsalswe’d had, using life-sized dolls attached at theheadbyVelcro.Fromthetimewestarteddiscussingit,wealltriedto

keepinmindthatwewouldn’tproceedwithsurgeryunlesswebelievedwehadagoodchanceofseparatingtheboyswithoutdamagingtheneurologicalfunctionofeitherbaby.NeitherDonlinLongnor I couldbecertain thatparts

ofthecriticalbraintissue,suchasthevisioncenter,werewhollyseparate.Fortunately,aswehadexpected,theboysshared only a main drainage system, called the superiorsagittalsinus,acriticallyimportantvein.

urgery on the 7-month-old twins began on Labor Dayweekend, Saturday, September 5, 1987, at 7:15 a.m.

Wechosethatdaybecausethehospitalitselfwouldbelessbusy with plenty of staff available. (We don’t scheduleelectivesurgeryonweekends.)MarkRogers had advised theparents to stay in their

hotel room during the operation so they could get somerest.AsIwouldhaveexpected,theyrestedverylittle,andone of them was sitting next to the phone at all times.During the next 22 hours, one of the doctors called theBinderstoupdatethemateachstageoftheordeal.

HeartsurgeonsReitzandCameron,afteranesthetizingthe twins, inserted hair-thin catheters inmajor veins andarteriestomonitortheboysduringtheoperation.Withthechildren’s heads positioned to prevent them from saggingandcausingunduepressureontheskullsafterseparation,we cut into the scalp and removed the bony tissue thatheldthetwoskulls,carefullypreservingitsothatwecoulduseitlatertoreconstructtheirskulls.Next,weopenedthedura—thecoveringofthebrain.

This was quite complex because of a number ofconvolutionsortortuousareasintheduraandintheduralplains between their brains, aswell as a large, abnormalartery running between the two brains which had to besectioned.We had to complete all the sectioning of adhesions

between the two brains before we made any attempt toseparate the large venous sinuses. We isolated the topportionofthesinusandthebottomportionjustbelowthetorqula, the place where all the sinuses come together.Normally this ranges in size from that of a quarter to ahalf-dollar.Unfortunatelyitwasmuchlarger.Whenwecutbelowtheareawherethetorqulashould

haveended,weencounteredfiercebleeding.Wecontrolledthebleedingbysewingmusclepatchesintothearea,butitwasfrighteningbleeding.Weproceededfurtherdown,andI recall saying aloud, “The torqula can’t extend muchfurther.” Yet each time we met with the same scenario.Eventually we got all the way to the base of the skullwhere the spinal cord and the brain stem meet, and wewerestillhavingthesameproblem.We concluded that the torqula, instead of being the

size of a half-dollar, covered the entirety of the backs ofbothoftheirheadsandwasagigantic,highlypressurized,venouslake.Thissituationforcedustogointohypothermicarrest

prematurely. In the planning sessions we had carefullytimedittotakefromthreetofiveminutestoseparatethevascularstructuresandtheremainingtimesimultaneouslyreconstructingtheminbothinfants.

Wehad each childhookedup to aheart-lungbypassmachine andpumped their blood through it to cool theirtemperaturesfrom95degreesFahrenheitto68degrees.

Slowlyweremovedbloodfromtheboys’bodies.Thisdeepdegreeofhypothermiabringsmetabolicfunctionstoanearhalt,andallowedustostoptheheartandbloodflowforapproximatelyanhourwithoutcausingbraindamage.We had to stop the blood flow long enough to constructseparateveins.DuringthistimetheBindertwinsremainedinastatesimilartosuspendedanimation.

Wehadfiguredthatafteranhourthetissues’demandfor nourishment supplied by the blood would causeirreparable tissue damage. This meant that once we hadlowered the boys’ body temperatures, we had to workquickly. (Interestingly, this technique canonlybeused ininfantsunder18monthswhenthebrainisstilldevelopingandisflexibleenoughtorecoverfromsuchashock.)

Just before 11:30 p.m., 20 minutes after we startedlowering their body temperatures, came the criticalmoment.Withtheskullsalreadyopen,Ipreparedtoseverthethinbluemainveininthebackofthetwins’headsthatcarried blood out of the brain. It was the last linkremaining between the little boys. That completed, wepulledthehingedtableapart,andLonghadoneboyandIhad the other. For the first time in their young lives,PatrickandBenjaminwerelivingapartfromeachother.

Although free, the twins immediately faced apotentially deadly obstacle. Before we could restore theblood flow,workingas twounits,bothLongand Iwouldhave to fashion a new sagittal vein from the pieces ofpericardium(thecoveringoftheheart)removedearlier.

Someonestartedthebigtimeronthewall.Wehadonehour to completeourworkand to restart theblood flow.Wewereracingagainsttime,butIsaidtothenursingstaff,“Pleasedon’ttellmewhattimeitisorhowmuchtimewehave left.” We didn’t want to know; we didn’t need theextra pressure of someone saying “You’ve only got 17minutesleft.”Wewereworkingasfastaswecould.

Ihadinstructedthem,“Whenthehourisup,justturnthepumpsbackon.Iftheybleedtodeaththenthey’llhaveto bleed to death, but we’ll know we did the best wecould.”NotthatIfeltsoheartless,butIdidn’twanttotakethe chanceof braindamage. FortunatelybothLongand Iwereusedtoworkingunderpressure,andwestayedatit,notlettingourattentionwaver.

It was an eerie experience, starting the surgery,becausetheirbodiesweresocolditwaslikeworkingona

I

cadaver. Inonesensethetwinsweredead.MomentarilyIwonderediftheywouldeverliveagain.

n the planning sessions I had anticipated that itwouldtake about three to five minutes to cut through thesinuses. Then we would spend the remaining 50 – 55minutes reconstructing the sinuses before we could turnthebloodbackon.“Oh, no,” I mumbled under my breath—I had hit a

snag. I would need more time than I had planned toreconstructthehugetorqulaonmytwin.Thetorqulaisthedreaded area for neurosurgeons because the blood rushesthrough that area under such pressure that a hole in thetorqulathesizeofapencilwouldcauseababytobleedtodeathinlessthanaminute.After hypothermic arrest it took 20 minutes to

separate all of the vascular tissue, which meant we hadusedatleastthreetimesasmuchtimeaswehadplanned.We hadn’t been able to predetermine this situation

becausethepressureinthisvascularlakewassohighthatitwashedoutthedyeduringtheangiogram.Byusing20minutestoseparatethevessels,thisgave

usonly40minutestocompleteourwork.Fortunatelythecardiovascular surgeons had been looking over ourshouldersandobservingtheconfigurationofthesinusesasI was cutting through them. From pericardium they cutpiecestoexactlytherightdiameterandshape.Althoughtheywereestimating,thesetwomenwereso

skillful that when they handed the pericardium to Longandme,allofthepiecesfittedperfectly.Wewereabletosewthemintoplacealongtheaffectedareas.Atonepoint,perhaps45minutesintothehour,Iknew

we were moving close to the deadline. Without lookingaround I sensed the tension level around me increasing,almost as if individuals were whispering to each other,

“Arewegoingtofinishintime?”Long completed his baby first. I completed mine

withinsecondsbeforethebloodstartedtoflowagain.Wewererightontarget.Asilencemomentarilyfilledtheoperatingroom,andI

wasconsciousonlyoftherhythmichummingoftheheart-lungmachine.“It’sdone,”somebodysaidbehindme.I nodded, exhaling deeply, suddenly aware that I’d

beenholdingmybreathduringthoselastcriticalmoments.The strainwas tellingonallofus,butwehad refused togiveintoit.Once we restarted the infants’ hearts, we hit our

second big obstacle, profuse bleeding from all the tinyblood vessels in the brain that had been severed duringsurgery.Everything that could bleed did bleed.We spent the

next three hours using everything known to the humanmindtogetthebleedingcontrolled.Atonepointwewerecertainwewouldn’tmakeit.Pintafterpintofbloodflowedthroughtheirbodies,soonexhaustingthesupplyonhand.Wehadexpectedthebleeding,becausewehadtothin

theirbloodwithananticoagulantinordertousetheheart-lung machine. When we restarted their hearts the bloodwas effectively anticoagulated, and we faced intensebleedingintheareaofthewound.Their traumatized brains began to swell dramatically

—whichactuallyhelped to sealoff someof thebleedingvessels—butwedidn’twantittocutoffthebloodsupply.Themost harrowingmoment camewhenwe learned

that the supplyofbloodmight runout.Rogers called thehospitalbloodbank.“I’m sorry, butwe don’t havemuch blood on hand,”

saidthevoiceontheotherendoftheline.“We’vechecked

andthere’snomoreanywhereinthecityofBaltimore.”“I’llgivemineifyouneedit,”someonesaidassoonas

MarkRogersreported.Immediatelysixoreightpeopleintheoperatingroom

volunteered on the spot to donate their blood, a noblegesturebutone thatwasn’t practical. Finally theHopkinsbloodbankcalledtheAmericanRedCross,andtheycamethroughwithtenunits—exactlywhatweneeded.Bythetimetheoperationwasover,thetwinshadused

60 units of blood—several dozen times more than theirnormal blood volume. The extensive head woundsmeasuredapproximately16inchesincircumference.Whilethiswasgoingon,someonefromtheteamwas

stayingintouchwiththeparents,whohadlefttheirhotelandwerenow in thewaiting room.We alsohad staff onhandmakingsurethoseofusontheteamhadfoodtoeatduringourinfrequentbreaks.We had planned to fit the twins immediately with

Dufresne’s creation of a titanium mesh covering mixedwith a paste of crushed bone from the babies’ sharedportionoftheskull.Onceinplace,thebabies’skullboneswould grow into and around the mesh, and it wouldn’tneedremoval.First, however,we had to be able to get their scalps

closedbeforetheirswellingbrainscamecompletelyoutoftheir skulls. We put the boys into a barbiturate coma toslowdownthemetabolicratetothebrain.ThenLongandImoved back, and Dufresne and his plastic surgery teamwentintoaction,workingfuriouslytryingtogetthescalpbacktogether.Finallytheygotthingsprettymuchtogetherononeboywithafewgapsontheother.Dufresnewouldhavetowaitforalaterdatetoinstall

thetitaniumplates.*

We also ran into the problem that we didn’t haveenoughscalptocoverbothinfants’heads;wetemporarily

closedBenjamin’swithsurgicalmesh.Dufresnewouldplanasecondoperationtocreateacosmeticallyacceptableskulliftheinfantscontinuedtorecover.Iftheinfantscontinuedtorecover.

*Siamesetwinsoccuronceinevery70,000to100,000births;twinsjoinedattheheadoccuronlyoncein2to2.5millionbirths.Siamesetwinsreceivedtheirnamebecauseofthebirthplace(Siam)ofChangandEng(1811-1874)whomP.T.BarnumexhibitedacrossAmericaandEurope.

MostcraniopagusSiamesetwinsdieatbirthorshortlyafterward.Sofarasweknow,notmorethan50attemptshadpreviouslybeenmadetoseparatesuchtwins.Ofthose,lessthantenoperationshaveresultedintwofullynormalchildren.Aside from the skill of the operating surgeons, the success dependslargelyonhowmuchandwhatkindoftissuethebabiesshare.Occipitalcraniopugustwins(suchastheBinders)hadneverbeforebeenseparatedwithbothsurviving.

OtherSiamesetwinsjoinedatthehiporchesthadbeendonesuccessfully.Even so, when any two children are born with their bodies together, anattempt to separate them is an extremely delicate operationwith chances ofsurvivalnormallynogreaterthanfifty-fifty.Thetwinssharecertainbiosystemsand,ifdamaged,wouldresultinboththeirdeaths.

*OnMarch6,1982,AlexHalleranda21-memberJohnsHopkinsmedicalteam had performed a successful separation of twin girls born to Carol andCharlesSelvaggioofSalisbury,Massachusetts, ina ten-houroperation.Emilyand Francesca Selvaggio were joined from the chest to the upper abdomen,sharing an umbilical cord, skin,muscle, and rib cartilage.Haller’s team hadtheirmajorproblemwithintestinalobstructions.

* Benjamin and Patrick would have to make another 22 trips into theoperatingroomfor thecompleteclosureof their scalps.While Idida fewoftheoperations,Dufresnedidmostofthem,includingsomefancyflapstocoverthebackofBenjamin’shead.

I

CHAPTER20

TheRestofTheirStory

ftheyrecover.Ineveryphaseofthesurgery,thiswastheunderlyingquestion. If.Oh,God, Iprayedsilentlyagainandagain,letthemlive.Letthemmakeit.

Even if they survived the surgery,weekswould lapsebefore we could fully assess their condition. The waitingwouldbeaconstantstrainbecausewewouldbeconstantlylookingforthefirstsignsofnormalcy,allthewhilefearingthatwemightdetectsignsofbraindamage.

Togive their severely traumatizedbrainsachance torecover without any lasting ill effect, we used the drugphenobarbital to put the babies into an artificial coma.Phenobarbital drastically reduced their brains’ metabolicactivity.We hooked them up to life-support systems thatcontrolledtheirbloodflowandrespiration.Thebrainswellwas severe, but not worse than we had expected. Weindirectlymonitoredtheswellingbymeasuringchangesinheart rate and blood pressure and by periodic CT scanswhichgiveathree-dimensionalX-raypictureofthebrain.

Thesurgeryendedat5:15a.m.onSundaymorning.Ithadtaken22hours.Andthebattlewasn’toveryet.

Whenourteamemergedfromsurgerytothesoundoftheapplauseofotherhospitalstaffmembers,Rogerswentdirectly to Theresa Binder and, with a smile on his face,asked,“Whichchildwouldyouliketoseefirst?”

Sheopenedhermouthtorespond,andtearsfilledhereyes.

Onceweset inmotion theplan toseparate theBindertwins, the public relations office at Johns Hopkins

informed the media of what we were doing. This was ahistoric operation. Although we hadn’t known it, thewaiting room and corridors were alive with reporters.Naturally, none of them got into the operating room.Heavy security in the hospital would have stopped themeven if they had tried to get inside. Several of the localradio stations gave updates on the surgery every hour.Naturally,with this kindof coverageuntold thousands ofthe general public suddenly became involved in thissurgical phenomenon. Later, I learned that many of thepeoplewho followed the updates had stopped during thedayandprayedforoursuccess.Onceoutoftheoperatingroom,exhaustiontookover,

andwewantedtocollapse.Intheminutesaftersurgery,Icouldn’tthinkofansweringanybody’squestionsortalkingabout what we had done. Rogers delayed a pressconferenceuntillaterthatafternoon,givingusachancetorestandcleanupa little.At4:00when Iwalked into theconferenceroomthemagnitudeofthissurgeryhitme.Theroom was wall-to-wall reporters with cameras andmicrophones.Itmayseemstrange,butwhenoneisdoingajob—nomatterwhat the job is—it’s hard to comprehendtheimportanceofit.That afternoon, only a few hours out of surgery,my

thoughts centered on Patrick and Benjamin Binder. Themediaattention thehistoric surgerygeneratedwasoneofthelastthingsonmymind.Infact,Idoubtthatanyofuswerepreparedfortheresponseofreportersandthemyriadquestions they asked. We must have looked strangestanding in front of themedia people,with ourwrinkledclothes and fatigue-filled faces.Wewere tired but elated.Thefirststephadbeenagiantone,andwe’dmadeit.Butitwasonlythefirststeponalongroad.

“Thesuccessinthisoperationisnotjustinseparatingthetwins,”MarkRogerssaidatthebeginningofthenewsconference.“Successisproducingtwonormalchildren.”

As Rogers answered questions, I kept thinking howgratefulIfelttohavebeenapartofthismagnificentteam.For fivemonthswehadbeenoneunit, all specialists andall tackling the same problem together. The staff at thepediatric ICU and the consultants in the children’s centerreacted spectacularly. They rallied behind us and spentcountless hours without charge, working to make thisoperationsuccessful.

IlistenedasRogersexplainedthestepsofthesurgeryandadded,“Itshookmethatwewereabletoperformasateamat this levelof complexity.Wearecapableofdoingevenbetterthingsthanwebelieveweare,ifwechallengeeachothertodoit.”

Although some of the others responded to questions,as thechiefspokesmenMarkRogersandIansweredmostofthem.Whenreportersaskedmeabouttheboys’chancesforsurvival,Itoldthem,“Thetwinshavea50–50chance.Wehadthoughtthewholeprocedureoutwell.Logicallyitought to work, but I also know that when you do whathasn’t been done before unexpected things are bound tohappen.”

One reporter raised the question about their vision,“Willtheybeabletosee?Bothofthem?”

“Atthispoint,wesimplydon’tknow.”“Whynot?”“Numberone,”Isaid,“thetwinsaretooyoungtotell

us themselves!” I did get a laugh from some of them.“Number two,” I continued, “their neurological conditionwas impaired, and that would delay our ability to assesstheirvisualcapabilities.Theboyswerenotyetcapableoflookingatthingsorfollowingobjectswiththeireyes.”

(The next day all over the world, headlines blared,

TWINS BLIND FROM SURGERY. We never said that orimpliedanysuchstatement.Wesaidwecouldn’ttell.)“Butwilltheysurvive?”askedareporter.“Cantheylivenormallives?”askedanother.“It’sallinGod’shandsnow,”Isaid.Besidesbelieving

thatstatement,Ididn’tknowwhatelsetosay.AsIwalkedoutof thecrowdedroom, I realized Ihadsaideverythingthatneededtobesaid.AspessimisticasIwasabouttheeventualoutcomeof

thesurgery,Istillfeltaglowofprideinbeingabletoworksidebysidewiththebestmenandwomeninthemedicalfield. And the end of the surgery wasn’t the end of ourteamwork.Thepostoperativecarewasasspectacularasthesurgery. Everything in the weeks following the surgeryconfirmedagainourtogetherness.Itseemedasifeveryonefrom ward clerks to orderlies to nurses had becomepersonallyinvolvedinthishistoricevent.Wewereateam—awonderful,marvelousteam.Patrick andBenjaminBinder remained in a coma for

ten days. This meant that for a week and a half nobodyknewanything.Wouldtheyremaincomatose?Wouldtheywakeuptostartlivinganormallife?Behandicapped?Weallwaited.Andwewondered.Probablymostofusworriedalittleandprayedalot.Wehadn’tdoneanythingunusualbyputtingtheminto

comas. We had put individuals in barbiturate comas forperiodsthatlongbefore.Forinstance,childrenwithseverehead trauma need the comas to keep their intracranialpressures down. We constantly checked the twins’ vitalsigns, we felt the skin flaps to see how tense they were.Initially they were quite tense, and then they started tosoften—a good sign that said the swelling was lessening.Occasionally when the barbiturate concentration woulddecrease,andwewouldseeamovement,we’dsay,“Well,they can move.” At this point we needed every sign of

hope.“It’s all in God’s hands,” I’d say, and then remind

myself,“That’swhereit’salwaysbeen.”Foratleastthenextweek,wheneverI’dgooffdutyI

expectedsomeonetocallmeandsay,“Dr.Carson!Oneofthetwinshashadacardiacarrest.We’reresuscitatinghimnow.”Icouldn’trelaxmuchathomeeither,becauseIjustknew the phone would ring and I’d hear the terrible,dreadedmessage. Itwasn’t that I didn’t trust God or ourmedical team. It’s just that wewere in unchartedwatersand,asdoctors,knewthatthecomplicationswereendless.Ialwaysexpectedthebadnews;fortunately,itnevercame.

In the middle of the second week, we decided tolightenuponthecoma.

“They’removing,”IsaidacoupleofhourslaterwhenIstoppedbytocheck.“Look!Hemovedhisleftfoot!See!”

“They’removing!” someone besideme said. “They’rebothgoingtomakeit!”

We were beside ourselves with joy, almost like newparentswhomustexploreevery inchof theirnewbabies.Every movement from a yawn to the wiggling of toesbecameacauseofcelebrationthroughoutthehospital.

Andthencamethemomentthatbroughttearstomanyofus.

Thatsameday,assoonasthephenobarbitalworeoff,both boys opened their eyes and started looking around.“Hecansee!Theycanbothsee!”“He’slookingatme!See—see what happens when I move my hand.” We wouldhave sounded crazy to anyonewho didn’t know the five-month history of preparation, work, worry, and concern.Butwe felt exhilarated. In thedays that followed I’d findmyselfsilentlyasking,Isthisreal?Isthishappening?Ihadn’texpected them to survive for 24 hours, and they wereprogressingnicelyeveryday.“God,thankYou,thankYou,”Iheardmyselfsayagainandagain.“IknowYouhavehad

Yourhandinthis.”We did have some postoperative emergencies but

nothing that didn’t come under control quickly. Thepediatric anesthesiologists run the ICU. The people whohad invested a tremendous amount of their time in thisoperationwerethesameoneswhohadbeentakingcareofthem postoperatively, so they really stayed on top of thesituation.Thenquestions arose about theirneurological ability.

Whatwouldtheybeabletodo?Couldtheylearntocrawl?Walk?Toperformnormalactivities?Week by week Patrick and Benjamin started doing

more andmore things and interactingmore responsively.Patrickinparticulargottothepointwherehewasplayingwithtoys,rollingfromonesidetotheotheranddoingwellwithhisfeet.Oneday,however,aboutthreeweeksbeforehewentbacktoGermany,Patrickunfortunatelyaspirated(sucked)hisfoodintohislungs.Anursediscoveredhiminbed in respiratory arrest. Her quick thinking enabled anemergencyteamtoresuscitatehim,butnooneknewhowlonghehadbeenwithoutbreathing.Hewasalreadyblue.Hewasn’tthesameafterthat.Sadly,withoutsayingit,weknew thismeant somekindofbraindamage,butwehadnoideahowextensive.Thebraincan’ttoleratemorethanafew seconds without oxygen. At the time the twins leftJohnsHopkins,Patrick,despitehis respiratoryarrest,wasmakingstrides.Benjamincontinuedtodoquitewell,eventhough his responses were slower at first. He was soondoingthethingsPatrickwasdoingbeforehehadhisarrest,suchasrollingfromsidetoback.Unfortunately, because of the parents’ contractural

agreementwithBuntemagazine,IcanwritenothingabouttheprogressofthetwinsaftertheyleftJohnsHopkins.OnFebruary2,1989,Idoknowthattwoseparatedandmuch-lovedtwinboyscelebratedtheirsecondbirthdays.

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CHAPTER21

FamilyAffairs

andy’svoice,near,urgent,calledmefromadeepsleepat2:00o’clockinthemorning.“Ben!Ben!Wakeup.”Iburroweddeeperintomypillow.Ithadbeenatiring

day. I’d spent the day—May 26, 1985—at our church,involved in an event for runners called Healthy Choices.Wehad invitedpeople to runone kilometer, five, or ten.OtherdoctorsandIgavequickphysicalexaminationsandpersonal health profiles while experts provided tips onhealthierlivingandbetterrunning.

Candy,waitingoutherfinalmonthofpregnancy,hadwalked in theOneK.Nowshenudgedmeand said, “I’mhavingcontractions.”

Iforcedmyeyestocrackopen.“Howfarapart?”“Twominutes.”Itonlytookamomentforthatmessagetoleapintomy

brain. “Get dressed,” I commanded as I leaped from thebed.We had a half-hour drive ahead of us to get her toHopkins. Our first son, born in Australia, had come aftereight hours of labor.We figured this onewould arrive alittlefaster.

“The pains started just a fewminutes ago,” she said,swinging her feet to the floor and pulling herself out ofbed.Halfwayacrosstheroom,Candypaused.“Ben,they’recomingmore frequently.”Her voicewas somatter-of-factshecouldhavebeencommentingontheweather.

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Idon’t recallwhat Ianswered. Iwas fairlycalm,stillmethodicallygettingdressed.“Ithinkthebaby’scoming,”Candysaid.“Now.”“You’re sure?” I jumped up, grabbing her shoulders

and helping her back into bed. I could see that the headwas starting to crown. She lay quietly and pushed. I feltperfectlyfineandnotparticularlyexcited.Candybehavedasifshedeliveredababyeveryothermonth.Irecallbeingthankfulformyexperienceindeliveringbabies,awarethatthey had all been brought into this world under bettercircumstances.WithinminutesIhadcaughtthebaby.“Aboy,”Isaid.

“Anotherboy.”Candytriedtosmile,andthecontractionscontinued.I

waited for the placenta.Mymotherwas stayingwith us,and I yelled to her, “Mother, bring towels! Call 911!”AfterwardIwonderedifmyvoicesoundedlikeitdidwithafourplusemergency.Once Ihad theplacenta, I said,“Ineedsomething to

clip theumbilicalcord.Wherecan I findsomething?”Mymainconcernthenwastoclamptheumbilicalcord,andIhadnoideawhattouse.Without answering me, Candy pulled herself out of

bedandwalkedfairlysteadilyintothebathroom,returningimmediatelywitha largebobbypin. Iput iton thecord.AboutthattimeIheardtheparamedicsarriving.TheytookCandy and our newborn, whom we named BenjaminCarson,Jr.,tothelocalhospital.Later my friends asked, “Did you charge a delivery

fee?”

oo busy,” I told myself for the hundreth time.“Something’s got to change.” It was an echo, a

bouncingoffthewallecho,thatI’drepeatedtimeandtime

before.ThistimeIknewIhadtomakechanges.LikeothersatHopkins,Ifacedaseriousdilemmawith

an active neurosurgical career. Working in a teachinghospital demanded a greater commitment to time andpatients than I would have faced if I’d had my ownpractice. “Howdo I findadequate time to spendwithmyfamily?“Iaskedmyself.

Unfortunately, neurosurgery is one of thoseunpredictable fields. We never know when problems aregoing toarise, andmanyof themareextremely complex,requiring a tremendous investment of time. Even if Idevotedmyself exclusively to a clinical practice, I wouldstill have bad hours. When I throw on top of that thenecessityofcontinuinglaboratoryresearch,writingpapers,preparing lectures, remaining involved in academicprojects, andmore recently, presentingmotivational talkstoyoungpeople,thereweren’tenoughhoursinanydayorweek.ItmeantthatifIwasn’tcareful,everyareaofmylifewouldsuffer.

For days I thought about my schedule, mycommitments, my values, and what I could eliminate. IlikedeverythingIwasdoing,butIsawtheimpossibilityoftrying to do it all. First, I concluded thatmy topprioritywasmyfamily.ThemostimportantthingIcoulddowastobe a good husband and father. I would reserve myweekendsformyfamily.

Second, I wouldn’t allow my clinical activities tosuffer. I decided to go all out to be the best clinicalneurosurgeonIcouldbeandcontributeasmuchasIcouldto thewell-beingofmypatients.Third, Iwanted toserveasagoodrolemodeltoyoungpeople.

Although I believe it was the correct decision, theprocesswasn’teasy.Itmeantbudgetingmytime,givingupthingsIenjoyeddoing,eventhingsthatwouldfurthermy

career.For instance, I’d like todomorepublishing in themedical field, sharing what I’ve learned and pushingtowardmore intense research. Public speaking appeals tome,andmoreopportunitieswerecomingmywaytospeakat national meetings. Naturally, these outlets also wouldenable me to advance rapidly through academic ranks.Fortunately many of those things seem to be happeninganyway, but not as fast as they would if I were able todevotemoretimetothem.Importantalsowastheneedtospendtimeinmyown

church.RightnowI’manelderatSpencervilleSeventh-dayAdventist Church. I’m also Health and TemperanceDirector, which means I present special programs andcoordinate the other medical workers in our church. Forinstance, we sponsor activities such as marathons, and Ihelp in coordinating such events and organizing themedicalscreening.Ourdenominationstresseshealth,andIpromote the health-conscious magazines Vibrant Life andHealthamongourcongregation.IalsoteachanadultSabbathschoolclassinwhichwe

discusstheissuesofChristianityandtheirrelevancytoourdailylives.The first step toward freeing my time took place in

1985.Wehadgottensobusyatthehospitalthatwehadtobring in another pediatric neurosurgeon. This additionalstaff member took some pressure off me. Hiring anotherman was quite a step for Hopkins because, since thebeginning of the institution in the last century, pediatricneurosurgery had been a one-person department. Eventoday few institutions have two professionals on staff. AtHopkins we’re talking about three, and possibly afellowshipinpediatricneurosurgery,becausewehavesuchahighvolumeofcases,andweseenosignsofitsabating.Additional personnel didn’t really solvemy dilemma,

however.Earlyin1988IadmittedtomyselfthatnomatterhowhardIworkedorhowefficiently,Iwouldneverfinish

B

the work, not even if I stayed in the hospital untilmidnight.ThenImademydecision—onethat,withGod’shelp,Icouldstickto.Iwouldleaveforhomeeveryeveningat7:00o’clock,8:00atthelatest.ThatwayIcouldatleastseemychildrenbeforetheywenttobed.

“I can’t finish everything,” I said to Candy, who hasbeen totally supportive. “It’s impossible. There’s alwaysjustalittlemoretobedone.SoImayaswell leaveworkunfinishedat7:00p.m.insteadof11:00.”

I’ve held to that schedule. I finish my work at thehospitalby7:30,andI’mbackattheoffice12hourslater.It’s still a long day, but working 11 or 12 hours isreasonableforadoctor.Stayingatit14to17hoursisn’t.

As more speaking opportunities come, they involvetraveling.When I have to go a great distance, I take thefamilywithme.Whenthechildrengetintoschoolthatwillhavetochange.Fornow,wheneverI’minvitedtospeak,Iaskiftransportationandaccommodationscanbeprovidedformyfamilytoo.

We’reanticipatingthatmymotherwillbelivingwithus soon, and she can take careof the children sometimeswhileCandyandItravel.AsbusyasIam,asmanypeopleas requiremytime, I think itwillbegood forCandyandme to be alone together. Without her support my lifewouldnotbethesuccessitistoday.

efore wemarried I told Candy that she wouldn’t seemuchofme.“Iloveyou,butI’mgoingtobeadoctor,

andthatmeansI’mgoingtobeverybusy. If I’mgoingtobeadoctorI’llbeadrivenperson,andit’sgoingtotakealotof time. If that’s somethingyoucan livewith thenwecangetmarried,butifyoucan’t,we’remakingamistake.”

“Icandealwiththat,”shesaid.Did I sound selfish? Did my idealism cloud my

commitment to the woman who would be my wife?

PerhapstheanswerisYesonbothquestions,butIwasalsobeingrealistic.Candyhascopedextremelywellwithmy longhours.

Maybe it’s because she is confident and secure in herselfthatshecansupportmesowell.Becauseofhersupport,Ihandlethedemandsmoreeasily.While I was an intern and a junior resident, I was

seldomaroundbecauseIworked100to120hoursaweek.Obviously,Candy seldom sawme. I’d call her, and if shehadafewminutesshe’dcomeoverandbringmymeal.I’deat, and we’d spend a few minutes together before shewenthome.Duringthatperiod,Candydecidedtoreturntoschool.

Shesaid,“Ben,I’mathomeeverynightbymyselfsoImayaswellgoanddosomething.”Candyhasalotofcreativeenergy,andsheput it touse.Atonechurchshestartedachoir,andaninstrumentalensembleinanother.Duringouryear in Australia, she started a choir and instrumentalensemble.We now have three children. Rhoeyce was born

December21,1986,makingusafamilyoffive.Igrewupwithout a father and I don’t want my sons to grow upwithout one. It’s vitally important that they know me,rather than just looking atmypictures in a scrapbookormagazineorseeingmeontelevision.Mywife,mysons—theyarethemostimportantpartofmylife.

C

CHAPTER22

ThinkBig

andyand I shareadream,adreamunfulfilledasyet.Ourdreamistoseeanationalscholarshipfundsetup

foryoungpeoplewhohaveacademictalentbutnomoney.This scholarship would help them to gain any type ofeducationtheywantinanyinstitutiontheywanttoattend.Most philanthropic funds are too politically oriented anddepend toomuch on knowing the right people or gettingimportantpeoplebehindyou.

We dream of a scholarship program that recognizespure talent in any field. We dream of seeking out thosegiftedyoungpeoplewhodeserveachanceforsuccessbutwouldneverbeabletogetnearitbecauseoflackoffunds.

I would very much like to be in a position where Icoulddosomethingtohelpmakethatdreamareality.

IputTHINKBIG intopractice inmyown life.Asmylifemoves forward, I want to see thousands of deservingpeople of every race moving into leadership because oftheir talents and commitments. People with dreams andcommitmentscanmakeitpossible.

“What’s the key to your success?” the teenage boywiththeAfroasked.

Itwasn’t a new question. I’d heard it somany timesthatIfinallyworkedoutanacrosticanswer.

“Thinkbig,”Itoldhim.I’dliketobreakthisdownandexplainthemeaningof

eachletter.

THINKBIG

T=TALENTLearntorecognizeandacceptyourGod-giventalents(andweallhavethem).Developthosetalentsandusetheminthecareeryouchoose.RememberingTfortalentputsyoufaraheadofthegameif

youtakeadvantageofwhatGodgivesyou.

Talso=TIMELearntheimportanceoftime.Whenyouarealwaysontime,people

candependonyou.Youproveyourtrustworthiness.Learnnottowastetime,becausetimeismoneyandtimeiseffort.Timeusageisalsoatalent.Godgivessomepeopletheabilitytomanagetime.Therestofushavetolearnhow.Andwecan!

H=HOPEDon’tgoaroundwithalongface,expectingsomethingbadto

happen.Anticipategoodthings;watchforthem.

Halso=HONESTYWhenyoudoanythingdishonest,youmustdosomethingelse

dishonesttocoverup,andyourlifebecomeshopelesslycomplex.Thesamewithtellinglies.Ifyou’rehonest,youdon’thavetorememberwhatyousaidthelasttime.Speakingthetrutheachtimemakeslife

amazinglysimple.

I=INSIGHTListenandlearnfrompeoplewhohavealreadybeenwhereyouwanttogo.Benefitfromtheirmistakesinsteadofrepeatingthem.ReadgoodbooksliketheBiblebecausetheyopenupnewworldsof

understanding.

N=NICEBenicetopeople—allpeople.Ifyou’renicetopeople,they’llbenicetoyou.Ittakesmuchlessenergytobenicethanitdoestobemean.Beingkind,friendly,andhelpfultakeslessenergyandrelievesmuch

ofthepressure.

K=KNOWLEDGEKnowledgeisthekeytoindependentliving,thekeytoallyour

dreams,hopes,andaspirations.Ifyouareknowledgeable,particularlymoreknowledgeablethananybodyelseinafield,youbecome

invaluableandwriteyourownticket.

B=BOOKSIemphasizethatactivelearningfromreadingisbetterthanpassivelearningsuchaslisteningtolecturesorwatchingtelevision.Whenyouread,yourmindmustworkbytakinginlettersandconnectingthemtoformwords.Wordsmakethemselvesintothoughtsandconcepts.Developinggoodreadinghabitsissomethinglikebeinga

championweightlifter.Thechampiondidn’tgointothegymonedayandstartlifting500pounds.Hetonedhismuscles,beginningwithlighterweights,alwaysbuildingup,preparingformore.It’sthesamethingwithintellectualfeats.Wedevelopourmindsbyreading,bythinking,byfiguringout

thingsforourselves.

I=IN-DEPTHLEARNINGSuperficiallearnerscramforexamsbutknownothingtwoweekslater.In-depthlearnersfindthattheacquiredknowledgebecomesapartofthem.Theyunderstandmoreaboutthemselvesandtheirworld.Theykeepbuildingonpriorunderstandingbypilingonnew

information.

G=GOD

NevergettoobigforGod.NeverdropGodoutofyourlife.

I usually concludemy talks by telling young people,“If you can remember these things, if you can learn toTHINK BIG, nothing on earth will keep you from beingsuccessfulinwhateveryouchoosetodo.”My concern for young people, especially

disadvantaged young people, first hit me the summer IworkedasarecruiterforYale.WhenIsawtheSATscoresof those kids and how few of themmade anywhere near1200,itsaddenedme.ItalsobotheredmebecauseIknewfrommyownexperiencesgrowingupinDetroitthatscoresdidn’talwaysreflecthowsmartpeopleare.Ihadmetalotof bright youngsterswho could grasp things quickly, andyet, for a variety of reasons, they scored poorly on theirSATexams.“Something’s wrong with a society,” I’ve told Candy

morethanonce,“thathasasystemprecludingthesepeoplefromachieving.Withtherighthelpandtherightincentive,many disadvantaged kids could achieve outstandingresults.”I made a commitment to myself that at every

opportunity, I’d encourage young people. As I becamemorewell-knownandstartedgettingmoreopportunitiestospeak, I decided that teaching kids how to set goals andachieve them would be a constant theme of mine.NowadaysIgetsomanyrequests,Ican’tacceptanywherenearallofthem.YetItrytodoasmuchasIcanforyoungpeople without neglecting my family and my duties atJohnsHopkins.I have strong feelings on the subject of American

youth and here’s one of them. I’m really bothered at theemphasisgivenbythemediaonsportsintheschools.Fartoomanyyoungsters spendall theirenergiesand timeonthebasketballcourts,wantingtobeaMichaelJordan.Orthey throw their energies toward being a Reggie JacksononthebaseballdiamondoranO.J.Simpsononthefootballfield. They want to make a million dollars a year, not

realizing how few who try make those kinds of salaries.Thesekidsendupthrowingtheirlivesaway.

Whenthemediadoesn’temphasizesports,it’smusic.Ioftenhearofgroups—andmanyofthemgood—whopourout their hearts in a highly competitive career, notrealizingthatonlyonegroupin10,000isgoingtomakeitbig. Rather than putting all their time and energy intosportsormusic,thesekids—thesebright,talentedyoungpeople—shouldbespendingtheirtimewithbooksandself-improvement, ensuring that they’ll have a career whenthey’readults.

I fault the media for perpetuating these grandiosedreams.Ispendquiteabitoftimetalkingtothefreshmengroups and trying to help them realize that they have aresponsibility to each one of the communities they havecomefromtobecomethebesttheycanbe.

While going to schools and talking to these youngpeople,Itrytoshowthemwhattheycandoandthattheycanmakeagoodliving.Iurgethemtoemulatesuccessfuladultsinthevariousprofessions.

To the successful professionals I say, “Take youngpeople to your house. Show them the car you drive, letthem see that you have a good life too. Help them tounderstandwhat goes into getting that good life. Explainthat there aremanyways to a fulfilled life besides sportsandmusic.”

Alotofyoungpeopleareterriblynaive.I’veheardoneafteranothersay,“I’mgoingtobeadoctor,”or“alawyer,”ormaybe, “president of the company.” Yet they have noideawhatkindofworkgoesintoachievingsuchpositions.

I also talk to parents, teachers, and anybody elseassociated with the community, asking them to focus onthe needs of these teens. These kids must learn how toachieve change in their lives. They need help. Otherwisethingswillnevergetbetter.They’lljustgetworse.

Here’sanexampleofhowthisworks.InMay1988theDetroit News ran a feature story on me in their Sundaysupplement.Afterreadingthearticle,amanwrotetome.Hewasasocialworkerandhada13-year-oldsonwhoalsowanted to be a social worker. However, things had notbeengoingwell.Thefatherhadbeenevicted,thenlosthisjob.Heandhis sonwere looking for theirnextmeal andhis world had turned upside down. He was so depressedthat hewas ready to commit suicide. Then he picked uptheDetroitNewsandreadthearticle.Hewrote:“Your story just turnedmy life around and gaveme

hope.Yourexampleinspiredmetogoonandputmybesteffortsintolifeagain.Inowhaveanewjob,andthingsarestartingtoturnaround.Thatarticlechangedmylife.”I’ve also gotten a number of letters from students in

various schools who were not doing well, but, throughtheirreadingaboutme,seeingmeontelevision,orhearingme speak, were challenged to redouble their efforts.They’remakinganattempttolearnthingsandthatmeansthey’regoingtobethebesttheycanbe.Asingle-parentmotherwrote,tellingmeshehadtwo

children,oneofwhomwantedtobeafireman,theotheradoctor.Shesaid theyhadall readmystoryandhadbeeninspired. Learning about my life and how my motherhelpedmeturnmylifearound,actuallyinspiredhertogobacktoschool.Bythetimeshewrotetome,shehadbeenaccepted into law school. Her children had turned theirgradesaroundandweredoingverywell.Letters like thatmakemefeelverygood.AtOldCourtMiddleSchool in theBaltimore suburbs

they’ve started the Ben Carson Club. To be a member,studentshavetoagree that theywillwatchnomorethanthreetelevisionprogramseachweek,andtheywillreadatleast two books. When I visited that school, they did aunique thing. Club members had previously receivedbiographical information about my life and they held a

contest. The winners were those students who correctlyansweredthemostquestionsaboutme.Onmyvisit,thesixwinners came to the stage and answered questions aboutmeandmylife.Ilistened,amazedathowmuchtheyknewaboutmeandhumbledthatmylifehadtouchedtheirs.ItstillseemsunrealtomewhenIgoplacesandpeople

are excited to see me. While I don’t fully understand, Irealize thatparticularly forBlackpeople in this country Irepresentsomethingthatmanyofthemhaveneverseenintheirlifetimes—someoneinatechnicalandscientificareawhohasrisentothetop. I’mrecognizedformyacademicandmedicalachievementsinsteadofforbeingasportsstaroranentertainer.

While this doesn’t happen often, it does happen,reminding me that I’m not the one big exception. For

instance, I have a friend named Fred Wilson who is anengineer in the Detroit area. He’s Black, and the FordMotor Company selected him as one of their top eightengineersworldwide.

He’sincrediblybrightandhasdoneoutstandingwork,yetfewknowabouthisachievements.WhenImakepublicappearances,IliketothinkI’mholdingupmyownlifeandallof theotherswho’ve shown thatbeingamemberof aminorityracedoesn’tmeanbeingaminorityachiever.

I tell a lot of the students that I talk to about FredWilsonandotherBlackhighachieverswho justdon’t getmedia attention or have a high profile.When you’re in afield likemine at a place like Johns Hopkins and you’reputtingoutyourbest,it’shardtohide.Wheneveranyofusheredoanythingoutstanding,themediafindsoutandtheword spreads. I know a lot of people in other, less-glamorous fields, who have done significant things, buthardlyanyoneknowsaboutthem.

Oneofmygoals is tomake sure that teenagers learnaboutthesehighlytalentedindividualssotheycanhaveavarietyofrolemodels.Whenyoungpeoplehavegoodrolemodels,theycanchangeandsettheirsightstowardhigherachievements.

Another goal is to encourage teenagers to look atthemselvesandtheirGod-given talents.Weallhave theseabilities. Success in life revolves around recognizing andusingour“rawmaterial.”

“I’m a good neurosurgeon. That’s not a boast but awayofacknowledgingtheinnateabilityGodhasgiventome. Beginning with determination and using my giftedhands,Iwentonfortrainingandsharpeningofmyskills.

ToTHINKBIGandtouseourtalentsdoesn’tmeanwewon’thavedifficultiesalongtheway.Wewill—wealldo.Howweviewthoseproblemsdetermineshowweendup.Ifwechoosetoseetheobstaclesinourpathasbarriers,we

stop trying. “Wecan’twin,”wemoan.“Theywon’t letuswin.”

However,ifwechoosetoseetheobstaclesashurdles,wecanleapoverthem.Successfulpeopledon’thavefewerproblems. They have determined that nothing will stopthemfromgoingforward.

Whatever directionwe choose, ifwe can realize thateveryhurdlewejumpstrengthensandpreparesusforthenextone,we’realreadyonthewaytosuccess.

AbouttheAuthor

Dr.BenjaminCarsonisaprofessorofneurosurgery,plasticsurgery, oncology, and pediatrics, and the director ofpediatric neurosurgery at Johns Hopkins MedicalInstitutions. He is also the author of three bestsellingbooks–Gifted Hands, Think Big, and The Big Picture. Heserves on the corporate boards of the Kellogg Company,Costco Wholesale Corp., and American’s Promise, amongothers,andisanEmeritusFellowoftheYaleCorporation.He and his wife, Candy, are the parents of three grownsonsandliveinBaltimoreCounty,Maryland.

AlsobyBenCarsonGiftedHandsTheBigPictureThinkBigTaketheRisk

ZONDERVAN

GiftedHands

Copyright©1990byReviewandHerald®PublishingAssociation“A Letter from Sonya Carson” copyright© 2011 by Sonya Carson All rights reserved underInternational and Pan-American Copyright Conventions. By payment of the required fees, youhavebeengrantedthenon-exclusive,non-transferablerighttoaccessandreadthetextofthise-bookon-screen.Nopartofthistextmaybereproduced,transmitted,down-loaded,decompiled,reverseengineered,orstoredinorintroducedintoanyinformationstorageandretrievalsystem,in any form or by any means, whether electronic or mechanical, now known or hereinafterinvented,withouttheexpresswrittenpermissionofZondervan.

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I.Murphey,CecilB.II.Title.RD592.9.C37A31990b617.4’8092–dc2090-8326

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