Guy McKhann grew up playing in a neurosurgery department, but he never thought he’d end up working in one.
Weekends, a young McKhann would tag along as his father, chair of neurology at Johns Hopkins, conducted his daily rounds. Young McKhann didn’t use that time at the hospital to get a jump on his neurosurgery studies, though. Instead he spent his time, as kids will, racing the secretaries’ wheeled chairs up and down the deserted hallways.
He had his eye on a different career altogether: marine biology.
Duke’s strong marine biology program attracted McKhann to that university for his undergraduate work. But as he took classes and learned more about the subject, he realized he had the wrong idea about it. “There aren’t very many Jacques Cousteaus,” he laughs. “Most people are studying plankton DNA rather than out in interesting boats, looking for great things.”
He thought a career in medical research might be a better fit for him–maybe he could explore the unknown frontiers of science and look for “great things” that way. He took a year off school, spending half the time doing research at a lab at the National Institutes of Health (NIH) and the other half working in oil fields in Texas.
Each half of the year taught him something valuable. The NIH experience showed him that a career in research might lack the interpersonal dimension that Dr. McKhann so enjoys in his work today. And the oil fields? “School became really easy after that,” he says. “If you’ve ever really, really worked hard at manual labor, it gives you insight into the fact that a university is a pretty nice place to be.”
He began to think more seriously about medical school and realized it could be a great option for him. He enrolled at Yale School of Medicine, unsure yet of what his medical specialty would be. He was interested in neurosurgery, but he was also interested in urology. As his decision point neared, he arranged to spend a day with a leading doctor in each specialty.
At the end of his day with the urologist, the two sat down. “In urology, you can truly become a master of your field,” said the doctor. “There’s something deeply satisfying in that. Whereas, if you go into neurosurgery, you’re never going to be able to know it all.”
McKhann spent the following day with the neurosurgeon. At the end of their day together, the two had coffee. “The great thing about neurosurgery is that you can never learn it all,” said this doctor. “You’re always going to be a student.” McKhann thought about these perspectives and realized that it was still his dream to be more like Cousteau. He wanted to explore, to have room to “look for great things.” Neurosurgery it would be.
Dr. McKhann did his neurosurgery residency training at the Department of Neurological Surgery at the University of Washington, in Seattle. He was excited and invigorated by the faculty, the training, the research and the surgical techniques. “The chairman, Richard Winn, had built just a stellar group of senior and junior faculty… all these superstars,” he recalls. Many were at the top of their particular surgical sub-specialties, and others were applying surgical techniques in innovative new ways.
For example, faculty members Dr. George Ojemann and Dr. Mitchel Berger were among the first American neurosurgeons to extensively apply brain-mapping techniques during epilepsy and brain tumor surgery. This technique involves patients being awake for part of their surgery. These days, “awake surgery is something we do all the time” when it can help a patient, explains Dr. McKhann. (The brain has no pain receptors, so patients don’t feel anything.) But at that time, such surgeries were still not very common in the United States.
Dr. McKhann was driven to understand, master and ultimately improve this technique. “It was clear to me from the very beginning that he was different,” recalls Dr. Berger. “He wanted to achieve greatness, and he proved that–by challenging me, by asking me questions and by trying to do everything possible to dream of ways to make the techniques better. And he’s done that. So I’ve been very impressed by that from the very beginning of his career.”
Dr. McKhann thrived on the opportunity for innovation. He also found that he thrived on the camaraderie and collegiality in Seattle’s residency program. Dr. Matt Howard, chief resident when Dr. McKhann was a junior resident, recalls Dr. McKhann’s role among the residents. “When you’re in a demanding environment like that, working as part of a team, each individual either lifts the team or drags the team down. And Guy was a huge lift to our team.”
Dr. McKhann appreciated the opportunity to work as part of a close-knit team. “Not all training programs are like that,” he reflects. “It makes an incredible difference.” He felt he would be interested in working throughout his career in a team-like setting.
One of the junior neurosurgeons at Seattle, Dr. Michel Kliot, had just finished his training at Columbia. Over the years that Dr. McKhann spent training in Seattle, Dr. Kliot introduced him to many of the Columbia neurosurgeons at national meetings. Dr. McKhann remembers having dinner with Columbia Neurosurgery department chair Dr. Robert Solomon, Dr. Jeffrey Bruce and Dr. Michael Sisti. “These are really great people,” he remembers thinking.
When it came time to search for jobs, he took a close look at Columbia. He was attracted by everything: the top-notch medical setting, the group of expert surgeons, the opportunity for research and the atmosphere of cooperation. His intuition was right. These elements made Columbia a good fit for Dr. McKhann, and made Dr. McKhann a good fit for Columbia.
Dr. McKhann values his position at a teaching and research department like Columbia’s because he can not only treat patients’ problems, using techniques like brain mapping, but he can also research ways to improve that treatment.
For this reason, Dr. McKhann maintains a research laboratory at Columbia. A lot of the research in the lab is on the relationships between the brain’s nerve cells and its astrocytes, or support cells.
“We’re really trying to understand some of these interactions, especially in epilepsy,” he explains. “And the other thing we’ve really started doing [in the lab] over the last several years is taking advantage of just the wealth of intellectual talent that we have in the residents and the medical students.” In this way, the lab has studied topics such as how the brain processes what it reads vs. what it hears, or the activity of certain brain structures during decision-making.
Between treating his patients, doing research and working with residents, Dr. McKhann experienced all the interaction with other people that he missed while working at the NIH years ago. He very much enjoys his role as a teacher of the residents, whether in the lab or in the operating room. “I say to resident applicants who come here that I don’t think they’re going to find another place in the country where people get along as well, resident to resident, attending to attending and across the gap.”
He continues, “I’m sure the residents would say I can be demanding. But I have a real enthusiasm for what I do, and I try to impart that.”
His excitement about the work he does is clear. Today Dr. McKhann is a Cousteau in his operating room, his consultation room and his laboratory, still searching for great things. He hopes his investigations will improve the lives of his patients and advance scientific understanding of the brain.
He treasures the opportunity to apply his knowledge and skills to help people with problems as diverse as epilepsy, Parkinson disease, brain tumors and adult hydrocephalus. And he gets to do it all in a top-notch medical setting, among colleagues he truly respects and enjoys.
His enthusiasm and gratitude for this state of affairs is contagious. When Dr. Guy McKhann says, “I have the best job,” he means it.
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