(Disclaimer: This transcript is using AI technology. Please excuse any errors.)

Music 0:00
Welcome to the Atheists in Recovery podcast, where we talk about finding hope in recovery. And now your host, Dr. Adina Silvestri

Adina Silvestri 0:11
Konichiwa Atheists in Recovery and welcome to Episode 104 of the Atheists in Recovery podcast. And today we have neurosurgeon Dr. Paul Kaloostian on the show. And this episode was an interesting one, I never would have paired a neurosurgeon with medical poetry actually, up until this point, I had never even heard of medical poetry. But what we talked about in our episode today was, you know, the best way to support your recovery and resilience is to keep your brain on your side. And as I'm sure you're aware, if the brain sees that the body wants certain drugs, or is engaging in certain maladaptive behaviors, and the brain will adapt, it wants to be on your side. And so the inverse is also true. And we talk a little bit about the brain and how addiction affects the brain. And Dr. Paul says, Our brains are going to heal. That's a fact. And he also wants us to believe that there's never a time that we can't overcome any adversity, or trauma, or addiction. We're never too old. This is this is not about age, this is about about having hope, and he stresses that in the episode. So we talk a little bit about how to intentionally do this both in terms of where we direct our attention and in terms of daily life habits. And then we focus on Dr. Paul's writing how he developed this habit early on, and his grueling I think he said 130 hours a week of residency to get all of all of the stress out. So perhaps this will encourage you to pick up a pencil or a pen sorry, who uses pencils, and a pad today or maybe to start a new habit, one that that you find joy in. Okay. On to our guest. Dr. Paul Kaloostian is a neurosurgeon in Los Angeles as well as an author, researcher and scientist having authored over 70 peer reviewed scientific manuscripts. Over 100 book chapters 12 peer reviewed scientific textbooks, two poetry books in a novel, which has been nominated for a California Book Award. His books include the young neurosurgeon lessons from my patients and two different poetry books from the eyes of a doctor and my surgical cases told in poems. As a neurosurgeon for over 17 years, Dr. Paul has had the privilege of interacting with numerous patients in a myriad of significant neurological diseases. By sharing his experiences through writing, he is able to convey his duty as a neurosurgeon in a clear and meaningful way in order for patients to understand the healing they're about to go through. And in return, he learned so much from his brave and courageous patients about what it means to be a human struggling with the greatest fight of their lives. Alright guys, on to the show. Paul, Kaloostian, welcome to the show.

Paul Kaloostian 3:15
Thank you so much for having me. Good to be here.

Adina Silvestri 3:17
Yes, I am very excited for you to be on today. So I thought we would start this conversation, like I start all my conversations, most of them anyway, and just get a idea of your deepest roots from childhood. And I think this will really help set the framework for where we're going today.

Paul Kaloostian 3:39
Well, I come from a family of physicians. And growing up, we, as you can imagine, talked a lot about medicine. And that was a huge part of our lives. My brother, my sister, and I, as you may imagine, we were pushed hard on school in subjects like math and science and, and we really excelled in that. And as time went on and on, we got to experience a variety of different educational endeavors such as studying at Harvard, at Brown University, taking courses even at Stanford and other places, and traveling around the United States, before college so so I think through all of that, I really was a sponge for knowledge and was motivated to learn more about the nervous system, which includes the brain and the spinal cord and our peripheral nerves, like the nerves that our elbows and wrists and knees. I think once you really learn about what makes up the brain and the spinal cord, down to the cellular level, and you learn about how those cells function, it's literally, I call it a universe in a cell. One cell is really like a universe. And it's just so impressive, and how it functions in a normal state and then how it doesn't function when there's a lot when there's disease going on in our job. As neurosurgeons is to try to be detectives and figure out what's going on with those, those cells and how we can try to preserve as much of that as possible for our patients, so that they have a good quality of life.

Adina Silvestri 5:15
Yeah, yes. And I know that we're going to dig into that in a minute. But I was looking at your, your book think it was young neurosurgeon lessons from my patients. And you start this, you start the chapter by saying, I never thought I would say all those words in one sentence. I'm a neurosurgeon. But as far back as I can remember, I've always wanted to be a neurosurgeon. And so I'm just curious, just looking at or reading about what it's like, for even just residency. This is intense, like 80 hour weeks, you know, is there ever a chance that you thought maybe I'll do something nice, like, general practice or?

Paul Kaloostian 5:57
Yes, that that happens and, and you know, where I got that line from, you know, the movie Goodfellas, the intro, I think it's the intro, kind of the opening scene, he the guy never thought he'd be, you know, associated with those guys. He thought those those guys in the mafia were cool. And all that, well, I kind of felt the same way about neurosurgery. You know, and, and I kind of looked up to a lot of people that were the honest people doing good neurosurgical work, and really changing the way we practice neurosurgery. And I looked up to them. And I reached that level through a lot of hard work. And yes, it's actually not even 80 hours a week, it's 120, sometimes 130 hour weeks, believe it or not, I can't believe it. But you can't tell anyone because that's against the rules. The rules are that in neurosurgical training programs, you cannot go above 80 hours a week. And actually, I think neurosurgery was the only field where they said 88 hours, I believe, for some reason, neurosurgery is different. So they allowed 88 hours for us to to be in the hospital in a week. But really, we worked 130 sometimes just didn't report it Unfortunately, because of other issues I won't go into but a lot of overnights a lot of sacrifice away from family. Fortunately, I was not married during those times. I don't know how people do it when they're married, have kids and are doing that kind of hours and training because you're literally kind of I guess I can say neglecting in a sense your family because you have to there's there's no alternative when you're doing in training to become a neurosurgeon. So it's a lot of time, it's a lot of hard work. It's a lot of great, great moments that that are such amazing feelings, like the highest feelings that you could possibly feel saving someone's life. Other things like that taking out a huge tumor, and they're doing great. And then there's like the obviously the lows, you know, the worst lows, you can have people succumbing to their disease, people not improving people in worst pain. I've seen gunshot wounds to the head to the spine. I mean, you could just anything you could imagine I've done I was just on call. Last night, we were talking before we got on the air. I was just on call last night and quite a few car accidents last night with very sick patients, a couple of older women collapsed because of hemorrhages in their brain. And they're not doing very, very well at all. So. So in a nutshell, that's kind of neurosurgery for you.

Adina Silvestri 8:27
Yeah, it doesn't sound very glamorous. But But I guess when you talk about the highest highs, that's probably what keeps you going.

Paul Kaloostian 8:36
Totally, I mean, there, I don't think that I felt anything in life as good as being able to with your heart, your mind and your hands. And time go in there and help someone save their life. I mean, it's, it's really a almost like a, like, you have to go into the structure of the body, the brain or the spinal cord. And kind of rob it, you'd have to kind of steal that tumor, or you have to, you have to take out that blood clot without anyone knowing that you're there like the brain to the spine, you don't want to wake them up or hurt them in any way, you've got to take the problem off those areas, in a stealth manner. And you got to know how to do that. It's almost like the way I think of it as like, you know, on those those movies, there's like a series of movies, Ocean's 11, all of that, where they're going to steal something, they go to a room where there's all these, these lasers, and you have to you have to know where those lasers are and where they're not. And so you have to, the only way to get through that is to, to kind of have a pathway that's safe so that you won't get hurt and you won't hurt the tissue. That's kind of how it is with with taking out tumors in the brain and spine and doing other things like that. To help patients you have to avoid key structures, like the speech area. The motor area, but yet at the same time you have to get the job done.

Adina Silvestri 10:05
Yes. I love it. I love that answer. I love that answer. Yeah, you have to be very stealth like I get this picture you like in the you know the map of the mind and like, with your laser like trying to, like go in and rabbit rob the tumor and get like a Jetta you are Paul, that could be your new nickname the surgery. Yeah. I was wondering if we could switch gears a little bit and talk a little bit about the just addiction, and more specifically, maybe how addiction affects the brain structure? Maybe you could talk a little bit about that.

Paul Kaloostian 10:47
Yeah, I mean, there's a lot of smart people doing a lot of great work out there a lot of great scientists, really helping people in need. That's a big problem. Now big homeless population and a large, large population of those have psychological problems have addiction issues. And it's a it's a big burden on society on the world. Honestly, we need to fix this needs to needs to change. And no one obviously wants to have these issues. But it's, it's a problem that we can't control in some cases. And that's why people end up on the street or end up with serious problems because the brain is so powerful, and the brain what I believe wants to do good for us, it wants to keep us in a routine. And the body will do that the brain will do that. it'll it'll keep us as happy as it can, until there's some sort of insult that's put into our body, for example. You put cigarettes in your body, your cigarette smoke in your body, like nicotine, tobacco, or heroin or whatever other drugs out there. Alcohol, that's an insult. And the brain starts to think, Hmm, okay, so you're doing it more and more often. So, Hmm, this must be what the body wants. So the brain starts to say, okay, it secretes all these hormones through the blood, the memory area of the brain, like the hippocampus starts to become activated, the frontal lobes start to become activated. So the brain's like, yeah, you know, this is what I guess what this what this person wants. So the brain's gonna want that constantly. Because apparently, that's what the person wants by putting that in his or her body. So when that happens, the brain starts to keep that routine going. So now you have that new norm, that's a new norm for that person, because of these external influences, that are now causing the brain to have these hormones secreted, often more often than usual. And then, on top of that, you know, you have you have these memories of events, like you're at a party and you're associated a great time at a party with alcohol, because you've had a fun, you know, you're drinking getting drunk and the great time. And so now the brain is is correlating alcohol with fun. Yeah. Okay. So alcohol equals fun. from there on out. And same with cigarettes. Same with heroin, even marijuana, you know, the this is what happens when you have these external influences that take over in a sense, and that's why addiction is a problem. Hmm.

Adina Silvestri 13:27
Yeah. And I just know, from personal experience for people coming into my office and me just knowing people, there's this, this need to fix the pain, right to heal. The not feeling good enough to heal the being different than others and not knowing what to do. So they turn to this addiction to fill that hole. And then it's almost impossible for them to stop. You know,

Paul Kaloostian 13:55
it's a real problem, unfortunately, I see a lot in my neurosurgical patients just because, as you may imagine, alcohol abuse drug abuse leads to activities, I'll just say that may be problematic, okay. So assaults, accidents, car accidents, falls, etc. So I see a lot of head injury and spinal injury patients with a lot with a high, let's say, blood levels of ethanol, alcohol, lots of patients with the urines positive for cannabinoids, opiates, all these things so. So it's a big problem in my field. Absolutely.

Adina Silvestri 14:34
So how can the brain and the body sort of heal from addiction? And I know this isn't like an easy formula. But, you know, I'm thinking about specifically the patients that come to see me and maybe they are sober for a couple of weeks. Maybe it's been a couple of months, but they're never going to feel as good as they felt when they took those drugs. What can you say? Maybe to those People about how the brain heals a little. Yeah.

Paul Kaloostian 15:03
A little bit about that. Yeah. Huh? Well, we could talk forever really about that. But really. But the first thing that I always like to say in this instance, is that the brain is on your side, okay? The brain will try to heal, always, just like you have a cut on your skin, it's going to heal. More often than not, in rare cases, you get an infection that doesn't heal, and you may need surgery. But as far as I can recall, when I fall and cut myself, it's sealed. That's the body's response to external conflict and problems is to heal. And so the brain is going to want to get to that point to have that homeostasis, we call it or the kind of that ability to just get back to its normal level. And the other thing I always tell patients is that you have to be confident that you can solve that problem of addiction you can get through it, you need to have that confidence that you can do this first of all, and you can't everyone can, there's, there's there's never a time where it's too late to beat any addiction at all. No, there isn't. And so having that confidence can then now get you number one, moving forward into let's say, a variety different programs, you know, with alcohol, there's, you know, a 12 step program with smoking cessation counseling with a variety of other things that that are out there for a variety of different problems. But getting into these sort of self help groups and having colleagues and people that are also addicts, and in communicating with them, and, and socializing with them. And making your lifestyle a life that is positive without those external influences, I think is the is the solution. Yeah. And avoiding activities that will bring you back to the dark side, kind of like the Jedi warrior. analogy. Yeah, you don't want to go back to that dark side, you want to stay away from those issues, that may mean not going to these big parties that used to go to and, or it may mean you can go to those parties just just maybe have a sprite in your hand as opposed to a gallon of beer, you know, or something like that. So there's, there's methods of, in essence, tricking the brain back to its homeostasis, its normal, average level, and just people need to know that the normal lifestyle is not meant for us to be like feeling high all the time. That's just not how it is. You know, it's just that's not life. Life is full of ups, it's full of a lot of downs. But most of the time, it's like average, it's like, it's like an average day. No matter who you are, it could be worth $10 trillion or homeless, but but it's the same. We're all we're all human, we all feel the same way. And it's an average lifestyle. That is how the how we're meant to be. And we're not meant to be highlight that all the time. That's just not healthy.

Adina Silvestri 18:08
Yeah, well, I liked what you said about having hope, you know, hope that you are going to beat it that you are going to heal. The brain is on your side. And it sounds like time time to get to the root cause of the suffering, making sure that you're connecting with people finding finding your tribe, and working with other professionals. I agree. Yeah. Yeah. So I know, we're, we have a certain amount of time here to talk. I really could. There's so many things that I can say and ask you, but I think maybe we should now go to, to your books, you know, the my surgical cases told them poems, the young neurosurgeon lessons for my patients. Maybe you could talk a little bit now about how did you get into this to this writing? Yeah, why did you start to do it? How did you get into it? Yeah,

Paul Kaloostian 19:03
we often get that question. It's a very good question. And I think it comes it kind of ties in well, to what you had said earlier about the 80 Hour Workweek and the 130 Hour Work Week. It was a safety zone for me, I guess, is the best way to put it. In other words, putting in all that time and seeing probably 30,000 patients in my lifetime so far, literally, and seeing every one of them, examining them looking at their films, most with good outcomes, some with not so good outcomes because of what they had. It takes a toll on you. So and I always tell people, I was telling my students, my family members got to have some means of getting out all this distress, I guess this these feelings that you have, and get it out of you and show the world also at the same time. What we as neurosurgeons what we have doctors do. So I feel like a lot of people don't know what we do people think we're a certain character that they see on on er, on this TV show or not? Yeah. I mean, we do wear those scrubs, okay, don't get me wrong, like I'm wearing it now, but, and, you know, some of those shows, so show these scenes where they're operating while the patient's awake, we do that, that that does happen. But we don't certainly do that, in the room that the patient's in, it's an operating room. So a lot of their shows, they exaggerate, you know, all the relationships that people have with one another, you know, that can't happen. But but most of the time, it's not that exaggerated. And so, you know, like I said, everything's kind of down a notch, you know, that's like reality, things down a notch. But you know, I needed to, to just get that out there. And so for me, writing was my catharsis, to, to just kind of decompress. And people kind of know me now, as the medical poet, it's kind of my thing is medical poetry. And people don't know what that really is. But it's really quite simple. It's really me conveying the surgeries that I'm doing in the form of a poem. And I think there's a lot of big words that we use, and we confuse a lot of people. Sometimes I confuse my myself and with all words, and it's like, why do we do that, you know, we need to talk to people, because most people are not in medicine. 99% people we interact with are not in medicine. And we lose people, and we don't communicate, and we, we don't bring people together, because we're just losing them with all this jargon that we use, I think poetry is a way to, to use simple words that rhyme, but yet convey, I think, a message of what we do as doctors, and I'm also trying to show how, how brave my patients are there really brave to go through what they go through. And we'll never know that until we actually have those problems that they have, and are in that situation that they are in. So that's kind of why I've been writing.

Adina Silvestri 22:01
So you see it as is cathartic. It's getting all the stress out. So I can definitely see you wanting to write, right? When did so then maybe when did you start? Or what is your practice? Like? Is it an everyday situation? or?

Paul Kaloostian 22:15
Yeah, I started writing in my residency training, because that was when I was just being killed. Like, literally, you wouldn't believe it. But it was it was it was a lot, you know, it was a lot of a lot of good times, a lot of bad times, but a lot of a lot of blood, sweat and tears. And my practice is, I'm in private practice, which I love. I love the autonomy of private practice, you make your own decisions, you do what you feel is right, without any sort of bureaucratic control over it. Medicine is I think in a in a danger zone, I think doctors unfortunately don't have a means of coming together. In fact, I think we're more more separated, unfortunately. And like, for example, there's no union and men in medicine, unfortunately, it's I think, illegal, I think there may be a law out, I think that prohibits that. So we're kind of like cattle in a sense that we follow the whims of what society throws your way. And to me, I just feel like autonomy is so valuable in medicine, I think we, we need to keep that going. And always stick with doing what's right for the patient, without really any thought about the monetary issues or about anything else checking

Adina Silvestri 23:35
those boxes?

Paul Kaloostian 23:37
Yeah, it really needs to be focused on treating the patient, what do you have, and you may not have a lot of patients that may need surgery. That's just the bottom line. And that may hurt you financially. But if that's what is the right thing to do, that's what you should always focus on, do the right thing. For the patient. It's never the wrong time to do the right thing. As I always like to say.

Adina Silvestri 24:02
Thank you for that. How do you think your writing has helped others? Because, you know, as you've mentioned, already, people don't know what neurosurgeons do. They don't really understand a lot of the jargon. It can be very intimidating. You know, what's so maybe some of the feedback that you've gotten or like, what's your sense?

Paul Kaloostian 24:26
I've gotten great feedback from around the world, really, from people that have read my books. I think they've told me that they enjoyed the use of medicine in poetry, and they've enjoyed understanding more about each of these specific cases that I that I described that are actual cases of mine that I worked on. A lot of patients enjoy reading these either before surgery that I do or after surgery when they're recovering. So it kind of, I guess, allows them to spend time kind of healing while Reading, I think it just gives them a more in depth understanding that their doctor is someone cares, their doctor, someone who wants to do the right thing for them, and that most doctors are in it to help people and not to hurt people in any way.

Unknown Speaker 25:17
Hmm.

Adina Silvestri 25:19
Yes. Yeah, definitely. How do you think you've changed from the beginning of your writing journey until now?

Paul Kaloostian 25:26
Hmm. Well, we always change all of us. on an hourly basis, we're changing, literally, but I think macroscopically as each day goes by, I really come to appreciate medicine more and more. But I also come to understand a lot of the difficulties in medicine more and more on a more fine tuned with looking a little bit for, for the problems in hopes of trying to fix it, you know, unfortunately, unfortunately, medicine is a broken system, in my opinion, and it's been that way for a while. And I really want to work with people that are willing to help change medicine for the better. And there, there's so many ideas I have, that we can collaborate on to do that, there, there needs to be a better system that will help not only patients, but doctors as well, a lot of doctors are unhappy. Obviously, a lot of patients are unhappy. And, and a lot of it stems from, you know, insurance issues and coverage issues, and hospital based issues. But I think as I've gone through medicine, I've seen those issues more and more, and I see them kind of as they happen to kind of live. And so I'm more cognizant of those issues. Also more knowledgeable about the legal issues in medicine, lot of doctors go into medicine, and we're thrown into the wolf's den honestly, is kind of how I think about it. We don't get any training in the legal system. We don't, we don't really at all get told how to document rights, for the most part, or how to avoid lawsuits. You know, or if you do get involved in a lawsuit, how do you protect yourself? Those things we, we don't get taught that, you know, and it's really something that I've learned more and more about going through my practice and going through medicine. And so I think those are, those are a couple of ways how I've grown over time.

Adina Silvestri 27:36
Yeah, that. So I encourage a lot of my listeners and the people that I see my practice to write, whether it's in a journal or creative writing, I've started a writing practice, I love it. And so, you know, I think that I was drawn to you initially, because you're working is creative, you know, whether you're, you know, wielding a scalpel or, or a pen, you know, you're sharing a part of yourself with the greater population. And so, you know, and then also, I feel like, a lot of what you do, mimics a lot of the recovery principles, you know, you're working in the community, you're giving back, you're definitely being vulnerable, you know, right. All those things that are incredibly scary.

Paul Kaloostian 28:30
Yeah, no, we're certainly not taught to be vulnerable in medicine. You're right.

Adina Silvestri 28:35
No, to the 10th degree. Yeah, that's exactly. You know, and then you're, you know, you're male, you know, so that's even more of a like a stigma there. Yeah. So as we kind of wrap up, Paul, I'm wondering, you know, is there Do you have any last words that you want to leave with the audience?

Paul Kaloostian 28:56
I would say, as the famous Joseph Campbell would say, follow your bliss. You can never go wrong if you truly follow your bliss in life.

Adina Silvestri 29:07
Very good. Seems like a really good place to end. How can people find you, Paul on the social and say, Hi, and check out your books?

Paul Kaloostian 29:17
Sure. You can go to my website, Dr. Paul writing, that's drpaulwriting.com, you'll find all of my, my books I've written. I've written numerous textbooks, as well as a lot of the interviews that I've been on over the last few years.

Adina Silvestri 29:35
Great. Okay, well, I'll definitely link to all of that in the show notes. So, Paul, thanks again for being on.

Paul Kaloostian 29:43
It's been a lot of fun. Thank you so much.

Adina Silvestri 29:44
Thank you.

Paul Kaloostian 29:45
Thank you for listening to the Atheists in Recovery podcast. For more great info and to stay up to date, head over to atheistsinrecovery.com.