If neurosurgery were Mount Kilimanjaro, with a broad base rising volcanically toward a single snowcapped peak, Keith Black would stand poised, virtually alone, at its summit. Of the 4,500 or so practicing neurosurgeons in the United States, only about 100 work routinely within the brain; the other 4,400 stay within the relatively safer, lower base camps of the neck and spine. Of those who venture into the skull, about half restrict themselves to repairing blood-vessel damage on the brain’s surface. That leaves about 50 who delve deeper into the brain’s recesses. Each performs an average of 100 surgeries a year. A handful, including Black, perform closer to 250 operations a year. Alone among that handful, Black won international acclaim for his research as a neuroscientist by the age of 39. A man who thrives on challenge, Black once climbed the actual Kilimanjaro, but the struggle that consumes him is his daily search for a cure for the deadliest form of brain cancer.
As he sits across the conference table in his corner office at Cedars-Sinai Medical Center in Los Angeles, it is clear that such descriptions make him nervous. Like most men who scale high mountains, he has had close calls with hubris. He knows the double edge of outsize ambition—its power both to set one’s course and to undo it. In fact, he remembers the precise day on which his course was set—and the day, several years later, when it was undone, then reset.
“I was 19,” Black says, in a soft-spoken voice that bears traces of his Alabama boyhood, “in my first year at the University of Michigan, when I opened up my first neuroanatomy textbook, and knew what I wanted to do.” Until then, he had devoted himself precociously to the heart, publishing his first scientific paper, on damage to red blood cells from open-heart surgery, at age 17. “But it took just one look into that neuroanatomy book,” Black says, “and I sort of forgot about the heart. If you look at the anatomy, the structure, the function, there’s nothing in the universe that’s more beautiful, that’s more complex, than the human brain.”
What compelled his interest was the mystery of consciousness. “I wanted to understand how sensory information enters the brain and gives rise to thought,” he says.
And so, Black says, “I studied everything I could get my hands on about neuroanatomy, neurochemistry, neurophysiology, but at some point I realized I was just learning more and more about less and less. I wasn’t getting any closer to explaining consciousness.” In medical school, he expanded his studies to include philosophy but hit dead ends like the classic paradox, How can a brain ever understand itself if an organism has to be more complex than the organism it is trying to comprehend? The next avenue for Black was “studying different religions, looking for common truths.”
“I became very spiritual,” he says. He began meditating, hoping to stumble upon a secret route to understanding consciousness. “One day, when I was about 24, I was meditating, and I had this out-of-body experience. I felt myself sort of rising up to the ceiling, looking down on myself, and I heard this voice saying, ‘If you want to understand consciousness, go through the ceiling.’ And I remember being very afraid.
“Then the voice said, ‘But if you go through the ceiling, there’s no need to come back,’ as if the message was: If you actually understood consciousness, you would also understand there was no reason to be here on Earth anymore.
“I said, ‘I think I want to stay here.’ ”
That day Black decided to leave the mystery of consciousness alone for a while and to apply himself instead to doing some earthly good for the human brain.
If he couldn’t master what he calls the sacred brain, he could at least serve it. And with that attitude, he embarked on a neurosurgical residency at the University of Michigan in 1982. He focused almost immediately on the challenge of defending the brain against its deadliest enemy—glioblastoma multiforme, the most common and rapacious form of primary brain cancer. Mean survival time without surgery is five months, and if a tumor is located near parts of the brain that control essential functions, like speech, perception, or motor activity, most surgeons consider it inoperable.
Black’s goal was to develop the skills to operate on the inoperable, and the awe with which he regards the brain helped him develop those skills. During his residency, he saw the damage done to the brain by the instruments of surgery. His approach: “I never touch the brain.” His goal is to touch only the tumor.
“The whole concept,” he says, “is to slip in and out like a thief in the night, stealing the tumor without ever waking the sleeping brain.” Advances in imaging technology over the past two decades have greatly enhanced the precision of neurosurgery, but as Black says, “you still have to integrate that technology in a way that allows you to decide what the safest corridor is into the brain, and you still have to remove the tumor.”