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CNN Live Event/Special
Interview With Dr. Benjamin Carson
Aired July 11, 2003 - 20:01 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ANDERSON COOPER, CNN ANCHOR: New details tonight about the final moments in the lives of conjoined twins Ladan and Laleh Bijani. As an international medical team struggled to separate the 29-year-old twins, one of the lead surgeons, Dr. Benjamin Carson, asked the other doctors whether they should stop. Dr. Carson is the director of pediatric neurosurgery at Johns Hopkins. He returned from Singapore today.
For him, a crucial moment came 50 hours into the surgery when the separation was nearly complete, but the twins were bleeding to death. In his words, the game had changed.
(BEGIN VIDEOTAPE)
DR. BENJAMIN CARSON, NEUROSURGEON: Well, obviously, I was personally quite concerned at that point and would, under normal circumstances -- and this was not normal circumstances, by any stretch of the imagination -- but under normal circumstances, would have halted at that point, closed them up, and restudied the situation, so we could find out exactly where the blood had been rechanneled, so that we could then create a new plan for dealing with it.
COOPER: At that point, did you suggest to the other doctors involved, because there were -- this was a huge surgical team -- did you suggest stopping?
CARSON: I did suggest that.
And, at that point, it was brought to my attention that the twins had stated that they wanted us to proceed under all circumstances, regardless of what things were discovered during the surgery, at which point, we then said, well, since they can't make that decision right now, let's talk to the family. So we went out and discussed with the family at that point, recognizing that there had been some substantial changes.
And would the twins, in fact, knowing that there had been major anatomical changes in the vascular flow, would they want us to proceed under those circumstances or would they want us to stop, restudy the situation, create an alternative plan based on the new circulatory changes, and then proceed, which would give them a much better chance? And the family felt very strongly that they would not want us to stop under any circumstances, even if it meant that they both would die.
COOPER: I'm sure you know, in the wake of their deaths, their adopted father has released a statement. And I'm going to read it to you. He said -- quote -- "They took them and they killed them. Me and my brother, who is a doctor in Germany, we told everyone that this separation surgery was impossible. No one would listen to us."
Your reaction to that?
CARSON: Well, my reaction to that is that I wish he said that ahead of time. I would pay a lot more attention to it.
But the fact of the matter is, I didn't hear anything coming from him or anybody else prior to this. And, in fact, if everything had turned out successfully -- and I said from the beginning that there was no better than a 50/50 chance -- I'm sure he would be singing a very, very different tune. That's something that you will always find in medicine, outside of medicine, people second-guessing, saying, I told you so. That goes with the territory.
(CROSSTALK)
COOPER: Did you have any ethical concerns going into this? And now, looking back on this, do you have any? Would you have done things differently?
CARSON: Well, I was very satisfied with the ethical decision. The ethics team that had been put together was extensive and came from many different areas, different arenas. They had free access to the twins.
They had many, many people to talk to them about the fact that this was extraordinarily high risk, that there was a high chance that they would die. And we wanted to make sure...
COOPER: And I understand it was important for you personally to hear from the twins yourself that they wanted to do this, even if they would -- if they might die.
CARSON: I did want to hear them say that myself, because, before I went, I had to depend on what other people were telling me they had said. And I did get an opportunity to ask them point blank. And they did in fact confirm that for me. So I was satisfied.
(CROSSTALK)
COOPER: Finally -- I'm sorry -- but has anything good come out of this? Has this all been for naught? Or will doctors learn from this? What do you take away from it?
CARSON: Well, I've learned a tremendous amount from it, in terms of -- if I had to do this again tomorrow, there are many things the I would do differently, based on what has been learned here. You have to recognize that this was the first attempt to ever do something like this.
And if you go back historically and look at first attempts to do very complex things, they frequently do not turn out well. However, over the course of time, as the learning curve increases, they do turn out well. the first 13 posterior fossa operations that were done, operating on a compartment of the brain that contains the brain stem and the cerebellum, they died. There were many people who said: This is impossible. You can't do it.
Now it is done routinely. And I can say that of heart transplants and many other things that, early on, had a dismal failure rate. The fact of the matter is, we have now learned that adult brains are going to be extremely adherent, that the bone is going to be massively thickened, that they do have the ability to change their drainage pattern in a very substantial way, and that perhaps you don't need to be creating new channels, but taking advantage of that ability to change, but also giving yourself an opportunity to learn what those changes are.
And all of those things are going to be very important in the future. And, eventually, this type of surgery will be quite possible.
COOPER: All right, Dr. Benjamin Carson, I know it has been a rough couple days for you, a long couple days. You just got back. We appreciate you taking the time to talk to us. Thank you.
CARSON: Thank you.
(END VIDEOTAPE)
COOPER: Well, based on what he said, should doctors have put a stop to the groundbreaking surgery, even though the twins and their family knew the risk, but remained adamant?
I'm joined by the associate director for education of the University of Pennsylvania Center for Bioethics, Glenn McGee. He joins me now.
Welcome. Thanks for being with us.
What do you think? Should this surgery have been stopped?
GLENN MCGEE, ETHICIST: Anderson, good even.
I don't think there is any question that the surgery should have been stopped. But the question that is raised about stopping it 50 hours into the operation, an operation that was really, as was said, unprecedented, unheralded. It was the kind of an operation that no one could have projected would work. The idea that you could have stopped in the middle, no matter what parents said, sewed them back up, and sent them out with a band-aid, strikes me as remarkably naive.
(CROSSTALK)
COOPER: Well, I don't think he was suggesting that. I think he was suggesting sort of, stabilize the situation, do some more tests, figure out where these other pathways of the blood is being drained from.
MCGEE: Well, let me be blunt. I think the reason that, not only did the brother of the adoptive father, who is a German physician, say no to this operation, but clinician surgeons at the Mayo Clinic, Cleveland Clinic, Lahey Clinic Penn, Johns Hopkins, and a variety of other institutions, including colleagues of the surgeon with whom you just spoke, all turned these twins down, there is a clear reason why they all turned them down. It is because this was unsurvivable from the start.
(CROSSTALK)
COOPER: Let me just jump in here, because the doctors who were involved with this said early on they believed there was a 50/50 chance of survival, a 50 percent chance of success. You think, I guess, they were being overly optimistic.
But what they will say, in their defense, is: Look, we had as many people as we could who knew this -- who were experts in this field.
MCGEE: I think that's the question.
COOPER: We had the consent. And we had a good hospital.
MCGEE: I think those are the key questions. Is that true? And time will tell that that isn't in fact the case.
This is a 380-bed hospital in a poor part of Singapore. The ethics team that was referred to was a group of four people, none of whom are ethicists. The informed consent that was discussed, we have absolutely no idea whether or not these twins were told that there was a nearly 100 percent chance they would die.
But, for example, in the world of medicine where drugs are concerned, something like this is called an experiment. It is not described as therapy or an operation or an attempt to separate twins. We make it very clear that the only reason anyone is ever allowed to attempt something like this is if they're trying to find out whether or not, as an experiment, this could work in principle.
COOPER: Very briefly, let me just jump in. Does it concern you at all that there was no way to get independent verification from each of the twins independently that they wanted to go ahead with the surgery? Obviously, they could not be separated.
MCGEE: Right. Of course. Of course.
COOPER: You had to ask them in the company of the other. And we know, one of the twins who wanted to go law school pressured the other to study law, even though she ultimately wanted to be a journalist.
MCGEE: That's right. Well, yes.
And you raise a very good point, which is that this was an incredible couple. In the recorded history of conjoined twins, the longest living couple who are preserved forever, life-size -- they've been stuffed literally at the Mutter Museum at the College of Physicians -- lived to be in their 50s. They were married to sisters and lived together in a farmhouse. This was a couple of individuals who had very different ambitions and who really were already very successful independently. So, yes, it is very problematic that you couldn't ask them individually: How do you feel honestly about making this kind of potential -- taking this kind of potential risk for your sibling?
And, to be honest, there is something funny, fundamentally funny, about -- not in the sense of being humorist, but funny strange, funny Captain Kirk "Star Trek" -- about conjoined twins in, especially, where a connection is made at the brain. They really are connected in a fundamental sense, in that you -- even if you put up a curtain and walled one off with sound, often conjoined twins who are connected at the brain who have lived this long have reported that they actually can think and feel things and experience something across that connection.
COOPER: You raise a lot of fascinating points. Obviously, this is not the last we will have heard about...
MCGEE: Bottom line, really, it's a bottom-line issue. A lot of people are saying, it is their choice. They said they wanted it. The family said they wanted it. They should be able to have it.
I think it is a simple answer. If I walked into my doctor and said, I would like you to do something completely untried, I'd like you to cut off my arm, because, although it is really helpful and necessary, I don't like it anymore, no doctor would do it. In Singapore, I would have no trouble finding a panel of ethicists and doctors to do so. And the fact that a guy visiting from Johns Hopkins scrubbed in, saw the operation, and thinks it went well doesn't persuade me that this was ethical.
COOPER: All right, Glenn McGee, again, appreciate you joining us. Interesting points. Thank you.
MCGEE: Sure.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired July 11, 2003 - 20:01 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ANDERSON COOPER, CNN ANCHOR: New details tonight about the final moments in the lives of conjoined twins Ladan and Laleh Bijani. As an international medical team struggled to separate the 29-year-old twins, one of the lead surgeons, Dr. Benjamin Carson, asked the other doctors whether they should stop. Dr. Carson is the director of pediatric neurosurgery at Johns Hopkins. He returned from Singapore today.
For him, a crucial moment came 50 hours into the surgery when the separation was nearly complete, but the twins were bleeding to death. In his words, the game had changed.
(BEGIN VIDEOTAPE)
DR. BENJAMIN CARSON, NEUROSURGEON: Well, obviously, I was personally quite concerned at that point and would, under normal circumstances -- and this was not normal circumstances, by any stretch of the imagination -- but under normal circumstances, would have halted at that point, closed them up, and restudied the situation, so we could find out exactly where the blood had been rechanneled, so that we could then create a new plan for dealing with it.
COOPER: At that point, did you suggest to the other doctors involved, because there were -- this was a huge surgical team -- did you suggest stopping?
CARSON: I did suggest that.
And, at that point, it was brought to my attention that the twins had stated that they wanted us to proceed under all circumstances, regardless of what things were discovered during the surgery, at which point, we then said, well, since they can't make that decision right now, let's talk to the family. So we went out and discussed with the family at that point, recognizing that there had been some substantial changes.
And would the twins, in fact, knowing that there had been major anatomical changes in the vascular flow, would they want us to proceed under those circumstances or would they want us to stop, restudy the situation, create an alternative plan based on the new circulatory changes, and then proceed, which would give them a much better chance? And the family felt very strongly that they would not want us to stop under any circumstances, even if it meant that they both would die.
COOPER: I'm sure you know, in the wake of their deaths, their adopted father has released a statement. And I'm going to read it to you. He said -- quote -- "They took them and they killed them. Me and my brother, who is a doctor in Germany, we told everyone that this separation surgery was impossible. No one would listen to us."
Your reaction to that?
CARSON: Well, my reaction to that is that I wish he said that ahead of time. I would pay a lot more attention to it.
But the fact of the matter is, I didn't hear anything coming from him or anybody else prior to this. And, in fact, if everything had turned out successfully -- and I said from the beginning that there was no better than a 50/50 chance -- I'm sure he would be singing a very, very different tune. That's something that you will always find in medicine, outside of medicine, people second-guessing, saying, I told you so. That goes with the territory.
(CROSSTALK)
COOPER: Did you have any ethical concerns going into this? And now, looking back on this, do you have any? Would you have done things differently?
CARSON: Well, I was very satisfied with the ethical decision. The ethics team that had been put together was extensive and came from many different areas, different arenas. They had free access to the twins.
They had many, many people to talk to them about the fact that this was extraordinarily high risk, that there was a high chance that they would die. And we wanted to make sure...
COOPER: And I understand it was important for you personally to hear from the twins yourself that they wanted to do this, even if they would -- if they might die.
CARSON: I did want to hear them say that myself, because, before I went, I had to depend on what other people were telling me they had said. And I did get an opportunity to ask them point blank. And they did in fact confirm that for me. So I was satisfied.
(CROSSTALK)
COOPER: Finally -- I'm sorry -- but has anything good come out of this? Has this all been for naught? Or will doctors learn from this? What do you take away from it?
CARSON: Well, I've learned a tremendous amount from it, in terms of -- if I had to do this again tomorrow, there are many things the I would do differently, based on what has been learned here. You have to recognize that this was the first attempt to ever do something like this.
And if you go back historically and look at first attempts to do very complex things, they frequently do not turn out well. However, over the course of time, as the learning curve increases, they do turn out well. the first 13 posterior fossa operations that were done, operating on a compartment of the brain that contains the brain stem and the cerebellum, they died. There were many people who said: This is impossible. You can't do it.
Now it is done routinely. And I can say that of heart transplants and many other things that, early on, had a dismal failure rate. The fact of the matter is, we have now learned that adult brains are going to be extremely adherent, that the bone is going to be massively thickened, that they do have the ability to change their drainage pattern in a very substantial way, and that perhaps you don't need to be creating new channels, but taking advantage of that ability to change, but also giving yourself an opportunity to learn what those changes are.
And all of those things are going to be very important in the future. And, eventually, this type of surgery will be quite possible.
COOPER: All right, Dr. Benjamin Carson, I know it has been a rough couple days for you, a long couple days. You just got back. We appreciate you taking the time to talk to us. Thank you.
CARSON: Thank you.
(END VIDEOTAPE)
COOPER: Well, based on what he said, should doctors have put a stop to the groundbreaking surgery, even though the twins and their family knew the risk, but remained adamant?
I'm joined by the associate director for education of the University of Pennsylvania Center for Bioethics, Glenn McGee. He joins me now.
Welcome. Thanks for being with us.
What do you think? Should this surgery have been stopped?
GLENN MCGEE, ETHICIST: Anderson, good even.
I don't think there is any question that the surgery should have been stopped. But the question that is raised about stopping it 50 hours into the operation, an operation that was really, as was said, unprecedented, unheralded. It was the kind of an operation that no one could have projected would work. The idea that you could have stopped in the middle, no matter what parents said, sewed them back up, and sent them out with a band-aid, strikes me as remarkably naive.
(CROSSTALK)
COOPER: Well, I don't think he was suggesting that. I think he was suggesting sort of, stabilize the situation, do some more tests, figure out where these other pathways of the blood is being drained from.
MCGEE: Well, let me be blunt. I think the reason that, not only did the brother of the adoptive father, who is a German physician, say no to this operation, but clinician surgeons at the Mayo Clinic, Cleveland Clinic, Lahey Clinic Penn, Johns Hopkins, and a variety of other institutions, including colleagues of the surgeon with whom you just spoke, all turned these twins down, there is a clear reason why they all turned them down. It is because this was unsurvivable from the start.
(CROSSTALK)
COOPER: Let me just jump in here, because the doctors who were involved with this said early on they believed there was a 50/50 chance of survival, a 50 percent chance of success. You think, I guess, they were being overly optimistic.
But what they will say, in their defense, is: Look, we had as many people as we could who knew this -- who were experts in this field.
MCGEE: I think that's the question.
COOPER: We had the consent. And we had a good hospital.
MCGEE: I think those are the key questions. Is that true? And time will tell that that isn't in fact the case.
This is a 380-bed hospital in a poor part of Singapore. The ethics team that was referred to was a group of four people, none of whom are ethicists. The informed consent that was discussed, we have absolutely no idea whether or not these twins were told that there was a nearly 100 percent chance they would die.
But, for example, in the world of medicine where drugs are concerned, something like this is called an experiment. It is not described as therapy or an operation or an attempt to separate twins. We make it very clear that the only reason anyone is ever allowed to attempt something like this is if they're trying to find out whether or not, as an experiment, this could work in principle.
COOPER: Very briefly, let me just jump in. Does it concern you at all that there was no way to get independent verification from each of the twins independently that they wanted to go ahead with the surgery? Obviously, they could not be separated.
MCGEE: Right. Of course. Of course.
COOPER: You had to ask them in the company of the other. And we know, one of the twins who wanted to go law school pressured the other to study law, even though she ultimately wanted to be a journalist.
MCGEE: That's right. Well, yes.
And you raise a very good point, which is that this was an incredible couple. In the recorded history of conjoined twins, the longest living couple who are preserved forever, life-size -- they've been stuffed literally at the Mutter Museum at the College of Physicians -- lived to be in their 50s. They were married to sisters and lived together in a farmhouse. This was a couple of individuals who had very different ambitions and who really were already very successful independently. So, yes, it is very problematic that you couldn't ask them individually: How do you feel honestly about making this kind of potential -- taking this kind of potential risk for your sibling?
And, to be honest, there is something funny, fundamentally funny, about -- not in the sense of being humorist, but funny strange, funny Captain Kirk "Star Trek" -- about conjoined twins in, especially, where a connection is made at the brain. They really are connected in a fundamental sense, in that you -- even if you put up a curtain and walled one off with sound, often conjoined twins who are connected at the brain who have lived this long have reported that they actually can think and feel things and experience something across that connection.
COOPER: You raise a lot of fascinating points. Obviously, this is not the last we will have heard about...
MCGEE: Bottom line, really, it's a bottom-line issue. A lot of people are saying, it is their choice. They said they wanted it. The family said they wanted it. They should be able to have it.
I think it is a simple answer. If I walked into my doctor and said, I would like you to do something completely untried, I'd like you to cut off my arm, because, although it is really helpful and necessary, I don't like it anymore, no doctor would do it. In Singapore, I would have no trouble finding a panel of ethicists and doctors to do so. And the fact that a guy visiting from Johns Hopkins scrubbed in, saw the operation, and thinks it went well doesn't persuade me that this was ethical.
COOPER: All right, Glenn McGee, again, appreciate you joining us. Interesting points. Thank you.
MCGEE: Sure.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
