Interview: Keith Black
Pioneering Neurosurgeon

In your life, you've combined a career as a brain surgeon, surely the most difficult specialty in medicine, with a career as a research scientist. What drew you to such difficult choices? What drives you?

Keith Black: There is, I think, an innate drive in humankind to create, to develop something new, to build on what we already know as a body of knowledge. The second is that there is something very spiritual. There is something very special about healing, about helping someone in need that's sick and trying to make them whole, to help their families. That's what's special about being a physician. And what's special about being a physician scientist is that you take that to one additional level, and that we know now that there are some diseases that we cannot cure, so we're limited. We know that we can only go so far with current technology to help our patients and help our families. So when we run up against our limitation, the drive in the researcher in me is to say, "We can do better. The next patient that I see is not going to die from this cancer. We're going to have them live a longer and better life." And that's the drive, to find the technologies to cure the diseases that are killing my patients.

What gives you your greatest sense of satisfaction?

Keith Black: In terms of work, I would have to say there are three or four global things that I really enjoy. Two are in work. And in terms of the work...

There is an immediate gratification that you get when a patient comes to you with a very complex brain tumor and you can go and you can remove that brain tumor successfully, restore function in that patient, and have them go home in two or three days. I mean, you have given that patient and their family something, and that makes you feel good. And again, I may allow myself to enjoy that for a few minutes, but then you realize you have four other patients. You need to go and do exactly the same thing for the next day. So you never allow yourself to become cocky or conceited -- "Look how great I am!" -- but that's sort of an immediate gratification. There is a different gratification that comes in research and science, and it's longer term. It's the thrill of the discovery. "Wow! We figured out how this works, now that we have been working on it for five years," and that's it. That's how it comes together. That feeling can last for a longer time. It takes a longer time to get to, but you can feel good about that for six months or a year, because the discoveries are longer in between. So those are really sort of the two drives. And then if you can convert that discovery towards a better treatment for your patients... For example, we're now working on developing what we call a "vaccine for brain cancer" that we've taken into clinical trial, and translating that for better care for patients with a disease that we do not have a cure for at this time.

So in terms of professional gratification, those are the two things. Family, in terms of sort of enjoying your kids, there's nothing like it. And then there's a fourth for me, which I think is just the sense of adventure with life. Being on the top of Mt. Kilimanjaro and watching the sun rise, or white water rafting down the Zambezi. Those kinds of experiences are just fantastic.

When did you know you wanted to be a brain surgeon?

Keith Black: I think it was after my first course in neuroanatomy.

I went into an accelerated program, out of high school, at the University of Michigan, where they took 50 students, and we were admitted to both the medical school and undergrad out of high school, and you got your M.D. degree in six years, in addition to your undergrad degree. In the first year there I had an opportunity to take a course in neuroanatomy, and I knew right away. As soon as I looked and started studying the anatomy of the human brain, I realized how incredibly fascinating the human brain is, and that that's what I wanted to study. That's what I wanted to do.

How did you manage to qualify for that kind of program in Michigan? What did you have to do to be one of the 50?

Keith Black: In addition to just having the grades and the test scores, I had demonstrated an aptitude really for research and science early on. When I was with my father one summer at the University of Pennsylvania, I would hang around the research labs at the University of Pennsylvania, which led me ultimately to try to seek out a position in a research lab when I went back to Cleveland, which I actually had an opportunity to start in the tenth grade. So I was doing research at one of the hospitals -- St. Luke's Hospital in Cleveland -- in tenth and eleventh grade, and essentially spent half of my twelfth grade year doing research in a surgical research lab, and published my first paper when I was 17 years old. So you know, I had demonstrated really a focus on science and research, which I think made me competitive for the program.

Did you feel that you were different from other kids? Did it affect your social life, or the way you interacted with your classmates?

Keith Black: No. I was happy. I was social. I was popular. I liked girls. I liked sports. I had a lot of friends. Actually, I became more focused when I was in the ninth grades -- in the seventh and eighth grade, my focus was really having a great time on the weekends and doing sports -- and I knew that I wanted to be competitive so I became more disciplined. I would get home and study, and try to spend more time with my friends on the weekends. I didn't consider myself to be not well-rounded and well-balanced. I had a good time.

Didn't you win a Westinghouse Prize?

Keith Black: Yes. It was actually for my research that I was doing in the tenth and eleventh grade.

I was working in the lab of a heart surgeon who had developed his own artificial heart valve, and I had a concept that the heart valve might be damaging red blood cells, so I asked to do a research project using a scanning electron microscope at the time. When I was trying to basically learn the technique, I took some blood from the heart-lung bypass machine from patients undergoing heart-lung bypass, and when I incubated the red blood cells overnight, I noticed that a certain percentage of these cells change from their normal discoid shape to one that resembled a porcupine, called an econocyte. What I did was to describe the discocyte-econocyte transformation in patients undergoing heart-lung bypass, as an index of sub-lethal red blood cell damage. The importance being that the blood cells could not parachute through the small capillaries. Normally a capillary is about five microns and the blood cell is seven, and it has to parachute through. The econocytes get stuck and can cause blockage in those capillaries.

You were doing this at the age of 17?

Keith Black: Yes.

What was it like getting through college, both bachelor's degree and medical school, in six years?

Keith Black: When I got into the six-year medical program I was actually scared. I said, "I'm not a genius. All these kids coming into class are going to be geniuses. I'm going to get blown away. This isn't going to be a lot of fun at all." But I remember the first class that we had, it was sort of an accelerated chemistry class, especially for our group, and it was essentially inorganic chemistry. Basically moles and molecules.

We had a professor who had both a Ph.D. in chemistry and biology at the age of 23. I remember studying with my classmates for the first quiz that he had and, you know, you were all in the same dorm, and you go to their room and ask a question about this problem, and they said, "Oh yeah, on page 45. There's this equation like this on page 45." Oh my goodness, this isn't going to be good! And I walked into the quiz and we looked at it. And the quiz was, "If you have two organisms -- organism A and organism B -- and organism A utilizes carbohydrate as its main energy source and organism B utilizes protein, and you put them both in a capsule with two liters of oxygen and you shoot them off the moon, which one is going to run out of oxygen first?" And I said, "Well, this doesn't have anything to do with what we were studying." And then I realized what it was. It's a conceptual problem. You take what you had learned, and you apply it, and then you figure out -- you convert the moles to oxygen and so forth, and figure out how many moles can be converted to carbon dioxide. But the people that had memorized all the equations had a very difficult time. Conceptually, I was very good, so I figured it out very quick and wrote it down and walked out after about 15 minutes, and everybody thought I was a genius.

I found it very easy, because they wanted you to conceptualize, and to think, and not just to memorize. I had a good time. I enjoyed it. I could get done what I needed to do. I actually started doing research, because I had additional spare time, and I also had time during those years to learn to fly. I got my pilot's license and traveled around and did a lot of scuba diving and so forth. So I had a great time.

Spare time? You were going to class during the day, and we've read that you used to work in the research lab from 11:00 at night to 3:00 or 4:00 in the morning!

Keith Black: Right.

What kind of life was that? How did you manage that?

Keith Black: It's play.

In medical school, you're required to memorize a body of facts. You go to gross anatomy, and you learn what muscles attach where and what goes where. You memorize it. When you go into the research lab you're creating new knowledge, and it was play for me. It was like doing art, or writing poetry, or painting on a canvas. So it wasn't work. When I was in the research lab from 2:00 to 4:00 o'clock in the morning, it wasn't work for me. It was play. It's what I enjoyed doing. Now for someone that didn't like research it would be really hard work, but for someone who enjoyed it, it was fun.

Was that an important early lesson, that memorization isn't enough? That you have to be creative. You have to be imaginative.

Keith Black: I think it depends on what you want to do.

If you are an infrastructure person, and if what is required of you is to just sort of give back the facts, then it may not be important to be creative. You certainly don't have to be creative to be a good doctor. In fact, you don't necessarily want a doctor that's sort of creating as he goes. You want a doctor who is going to sort of follow the cookbook. There's a big difference between being a doctor and being a scientist, but being a good scientist is all about creativity. I mean it's all about creating what we don't know, so that the creative aspect of it really becomes critical. But in addition to being creative -- I mean it's not enough to be creative. You have to sort of be creative, and you have to figure out how you're going to prove what your creative concept is, which is different from an artist. An artist can just paint and say, "Here, go out and interpret it." A scientist has to create and then prove that his concepts are correct, and have the discipline to do that. And then, after he proves his concepts are correct, he then has to go out and communicate to the rest of the world what he has proven, because if he keeps it to himself then it's not a discovery.

Let's talk about your early years. Where did you grow up? Was that in Cleveland, Ohio or Alabama, or both?

Keith Black: Both. In the early years, Alabama; later years, Cleveland. I was born in Tuskegee. I grew up in Auburn, Alabama until I was ten and my family moved to Cleveland. So I spent essentially from ten years until 17, when I went to college, in Cleveland.

What was it like for you as a young boy growing up in Alabama?

Keith Black: Growing up in the South, for an African American it has some advantages and disadvantages. One of the advantages was that you had a lot of role models. You had black teachers, black principals, black doctors, black lawyers. I mean you saw people like yourself in roles of leadership within your community, because your community was isolated. In the fifth grade we integrated the school system, and I actually only spent a year in the fifth grade in an integrated setting at the time. My family was very active in the South. My father had done his graduate training in education at the University of Pennsylvania, went back to Auburn, Alabama as principal of the all-black elementary school there, and was very active in integrating the staff, teaching French to the students in the fourth grade. The black school, you know, having the best library even though we had, you know, not the best books at the time in the school system. And also, instilling in his students a sense of civil disobedience to speak out against injustice. So it was an interesting time. Sort of the best of times and the worst of times, in that there were some advantages and that you did have a very supportive community, but you were not a part of the larger community. You were isolated from the larger community and some larger opportunities.

How would you describe yourself as a kid? What kind of kid were you?

Keith Black: I was happy. I was happy and I was inquisitive.

As early as I can remember, I always had a sense of fascination with biology -- anything related to biology. Even though it's not politically correct to say now, when I was eight years old one of the things I would enjoy doing was to go out with my BB gun with my friends and shoot birds to get them back to the house to operate on them. To save them, to get the BB out, you know, to do the surgery to remove the BB. And, you know, dissected frogs. My father actually saw me dissect a frog heart, and observed my sense of curiosity with science, and then went out and got me a chicken heart and I dissected that. And then he went to the slaughterhouse and got me a larger cow heart -- which was really incredible, because here is this big, huge heart with all these different chambers -- and allowed me to dissect that. It really instilled a sense of curiosity in me, but my love was always science and always biology, and I had a sense of fascination with that.

How do you explain that? Kids get fascinated by a lot of things, but rarely do you hear about someone that young doing the kinds of things you did with respect to science and biology.

Keith Black: I think I was lucky.

I think one of the true gifts that one can have is to find out what it is that they truly love to do. For some people it's playing the piano. For others it might be swimming, or some sort of athletic event. To me it was science, and I happened to get lucky enough to find my love for science, which I still love. What that allows me to do essentially is -- as a scientist and as a neurosurgeon -- I don't work when I go to work. I mean it's what I love to do. If I didn't get paid for what I wanted to do, I would want to pay to do it. So one is very blessed to find what it is that they love to do. The other thing that it does, it allows you to really devote the focus, the hours, the intensity into whatever it is, to become very good at it. Whatever you do, you're going to have to spend a lot of time perfecting your craft, perfecting your art. So if I'm up late working on a research project, or working to save a patient's life, it's not work for me. It's what I enjoy doing, and it's not difficult to do if you're having fun.

When you were growing up, was there any event, or a teacher or role model that influenced you or inspired you to do what you ended up doing?

Keith Black: I wouldn't say it was one event. I had a very supportive family. I consider my father to be the ultimate educator. So even though there was never any pressure -- you know, "You got to bring home this grade..." or "You have to go do this." He was sort of the invisible hand. He would observe what one loved to do and he would cultivate that. He was a teacher.

My brother is very different for me. My brother is in an entirely different field. He's pursuing business. We were both sort of cultivated and challenged in the environment. I grew up in an intellectually challenging environment, in that when we sat down for dinner at the table, it was always some sort of intellectual debate with my father, at a very young age. You would come in and say, "The sky is blue." He would say, "No, it's not blue." You would sit there for 30 minutes trying to convince him that the sky was blue.

Were there any books you read in childhood that were particularly important to you?

Keith Black: Some of the books that I really enjoyed were books by some of the African American authors. You know, (James) Baldwin, Go Tell it on the Mountain. It sort of gave a sense of warmth and understanding of one's own environment in some of those books. There was never any book, except for one, related to medicine. I remember reading The Making of a Surgeon when I was in probably about the sixth or seventh grade. And that was a book that kind of got me focused, I think, on the career path. And I remember, one thing in there I still remember is that you can always tell you've really arrived as a surgeon when the nurses in the hospital ask you to be their physician.

Any there are particular teachers that you remember?

Keith Black: There were a few teachers along the way, but it was a combination. It was more of a mosaic, rather than one teacher that really stood out.

There are many young, talented, smart people who do not achieve. How do you explain the fact that you were able to do what others were not?

Keith Black: I think it's a combination of luck, discipline, the right nurturing and the right environment. Luck, in the sense in that I found what I love to do. Had I been directed to a different career I might not be as successful. If Michael Jordan was playing baseball, he might not be Michael Jordan as we know him. I think one of the most important things is to find what you love to do, and if you're lucky enough that what you love to do is also what you have a talent at doing, that's a real plus. And then, having the right nurturing, and having the drive. You have to have the drive. It's not good enough just to say, "Oh, I'm really good at this." You have to work at it. You have to develop your craft, to develop your art, and to perfect it.

You spoke of your initial reaction showing up at the University of Michigan, being scared. Do you ever have doubts, fear of failure?

Keith Black: Not anymore. You know, you've sort of been through it all in terms of a career. I've done almost 4,000 operations for brain tumors. I'm thinking of what's going to happen ten or 12 steps before. I'm anticipating what's going to happen in the operation, and I'm comfortable with where we are. I have an intensive drive to find a cure, but I know that we can only do the best that we can do. I think there are other things I have more of a fear about, trying to be the man that my father was in terms of being a good father, really providing the inspiration, nurture, and foundation to my kids that he provided to his.

How do you find time to do all that? To be the doctor, the scientist, the father and the husband?

Keith Black: You just try to be very disciplined in your schedule and get lucky enough to have a wonderful wife and an incredible mother for your kids.

In most careers there are setbacks and disappointments. Have you had those?

Keith Black: There's certainly been ups and downs.

I think one of the hopes that we all have is that the world will recognize us for what our talents are, and you work hard and you do a good job and that's it. Unfortunately, as we all know, there's politics. There are people with different political agendas that are not necessarily motivated by the same moral sort of drives that you might have. I mean, people do things not necessarily for the best interest of patients, or for humanity. They may do it for the best interest of themselves, so we have to deal with those political obstacles, which can divert a lot of time and energy. That can be annoying sometimes, because as you say, it's hard enough trying to find a cure for cancer, and have to step back and say, "Wait a minute. What is this political agenda here?" And have to be wise enough to circumnavigate those to achieve your objective.

What about criticism, controversy? How do you deal with that?

Keith Black: I think that's good. I think that it keeps one in check. I think one should be their worst critic, and when criticism comes from the outside, I think it makes one tougher in a way. As they say, a strong wind makes for a strong tree.

Did you learn that from your father?

Keith Black: I did.

We have talked about dealing with failure and criticism. What about success? How do you handle success? Can that be a problem?

Keith Black: I think you never read your news stories. I've had a fair amount -- for a physician scientist -- of media exposure, and one of the things I tend to do is to ignore it, and to essentially stay focused on the ball, to stay focused on what the objective is, and to not let that become part of what you are, because it's not really who you are. I mean, who you are is what you do and what your work is. I think the notoriety is important, because it shows other people the path, but besides that, what's really important is what you do.

How did it feel when you were named one of TIME magazine's "Heroes of Medicine?"

Keith Black: It felt great. You say, "Wow! I'm on the cover of TIME magazine!" And what you do is sit back and take a few days and just enjoy it and celebrate it, and then you say, "You know what? I've got to get back to work."

What do you know now about achievement that you didn't know when you were younger, or when you were starting out?

Keith Black: Not much. I think that it's important to just follow a couple of principles: Doing what you love to do, being in the right environment, making the right environment for yourself.

If you want to do something, one of the smartest things that you can do is go find someone that's done it and to try to get them to show you how they did it, to show you where the potholes are. What are the right steps to get there? If you want to be an NBA basketball star, go try to find people that are stars, and to try to get them to become your mentors. If you want to become a brain surgeon, go find a brain surgeon or brain surgeons, and to try to have them be your mentor. And not just in terms of where to go to school, but what are the things that are really tough that you have to overcome, and how did you overcome it. Just having the drive and the discipline and the focus to not take no for an answer.

When you run up against an obstacle, to do what I call the principle of tai chi. You know, karate takes a force and it opposes with a force, but in most obstacles that you run up against, you're outgunned and you're outnumbered, so you're not going to overcome it with force. One of the smartest things that you can do is to take that force and turn it back against itself, which is what tai chi does. And to enjoy what you do, because if you're not having fun at it you're going to get tired real quick. But if you do what you enjoy, and if you're disciplined, if you find mentors, if you use your head when you come up against an obstacle, and find a way to overcome that obstacle and to keep moving forward -- or to move around and move forward -- you'll get to where you want to go.

What do you say to a young person who asks you what you had to overcome and how you did it?

Keith Black: Well, if a person asks me that, they're probably not going to get a lot of information, because it's not something I could really say in five or ten minutes.

One of the great mentors that I had was a doctor by the name of O.T. Randall, when I was a medical student at the University of Michigan. He was a professor in cardiology, and I was working in his research lab. But the best time with him was not designing the research project, but it was at the end of the day, when we would sit in the lab and listen to some John Coltrane or Miles Davis, and he would tell me about the obstacles that he had just faced in, for example, getting promoted from assistant professor to associate professor with tenure, or the politics in doing that, and the strategy that he used to sort of overcome that, and I would listen. And then I realized, ten years later, when I was facing the same obstacles, that I would use some of his same strategies that I was listening to him talk about ten years ago. That's what being a mentor is all about. It's sort of building up that repertoire, so that when you have to use it five years or ten years later, you have it sort of in that background.

What haven't you done that you would like to do?

Keith Black: That's a long list. Find a cure for brain cancer. I would love to do that. I would love to develop two great kids, a daughter and a son, who are doing something that they love to do and are happy and successful doing it. One of my interests now is actually getting to move into the whole field of developing a biotechnology company, which is something that I haven't done before. I've been professor, I've been teacher, I've been surgeon, I've been researcher. But moving into the realm of business now, taking the technology and creating a business enterprise from it is a new venture for me, because the skill set becomes very different and it's a new challenge.

I think essentially the real economic boom in the next five or ten years is in the area of biotechnology. I think it's going to be unlike anything that we've ever seen before, and the major breakthroughs are going to be with biotechnology firms, simply from an economic standpoint. If you're working as a researcher in a research lab, you're lucky if you get a grant for a half-million dollars to a million dollars a year. It takes $100 million to get one compound from the lab into clinical practice. So as a researcher relying on grants, you would never have the resources that you'd need to rapidly accelerate your discoveries into clinical treatments. The only way to do it is with dollars from the private enterprise sector. So one of the things that we're looking at doing now, is to build a biotechnology company where we would have the resources to take the technologies from the bench to the bedside.

Looking ahead into the 21st century, how do you see our priorities as a nation? Do we have our priorities straight?

Keith Black: I think that it really becomes a national question. I don't think that any one individual has the answer in terms of whether we have our national priorities straight, because we are a collection of about 300 million individuals. What are the priorities of those 300 million individuals that make them unique from China, or from Italy, for example?

I would like to see us, though, in a real sense, take some of the money that we spend on the military. I think the concept of war is obsolete. I mean war is not going to be waged with guns. It's going to be waged on the economic business front. And to convert some of those dollars, number one, into saving our environment, to figuring out how we're going to cut down on the greenhouse effect and global warming, and not pollute our oceans. You know, nothing matters if we cannot inhabit this planet. To really begin to make health care a national priority, because we have an opportunity now unlike anything that we've ever had in history. The national budget spends about $2.8 billion a year on cancer research. You take a couple of B-2 bombers, and you can double the national cancer budget, for example, which is killing half a million people a year. So you could save a million lives -- one million lives -- by accelerating and finding a cure for cancer by two years. I mean, we are concerned because we lost 30,000 people in Vietnam, for example. I think it's 60,000. But the numbers are staggering in comparison. I think, you know, the billions of dollars we spent landing an astronaut on the moon that really had no real scientific objective, because we wanted to beat the Russians, and Kennedy said in '62, "We're going to land a man on the moon by the end of the decade," really is sort of a sibling rivalry between two countries. If we had that same sense of urgency about finding a cure for cancer, or Alzheimer's disease, or neurological disorders, spinal cord injury, head injury, the results would be staggering, and the impact on humanity -- in comparison to a couple of moon rocks in the National Space Museum, to saving millions of lives -- would be incomparable.

There's another question we like to ask our honorees. If you had to choose one or two books to read to your grandchildren, what would they be?

Keith Black: That's a tough one. One book that I would read to them is The Art of War, because it teaches certain lessons in life that they can apply throughout their life, in terms of overcoming obstacles -- and learning how to deal with confrontations in a strategic way -- that are placed in front of them, and it would probably give them a better chance of success.

There's a program at Stanford where faculty and students get together, and the students ask the faculty members this question: What's important to you and why?

Keith Black: I think that what's ultimately important to me is growth, and I would have to say the most important thing is spiritual growth. I think that we're given so many years to inhabit this planet, whether it's 20 or 40 or 60 or 80 years in which we can learn something. Now I have to believe that, or else why are we here? So we have an opportunity to come to a place to experience a lot of things during the time that we have, and hopefully to grow and to learn something from that experience, and to leave it a better place than I think we found it, and for us to leave as better individuals than what we were when we first arrived. And ultimately, what it really ends up being in the end is spiritual growth. It's not about money. It's not about fame, and the only thing that we can really hope for -- because there is no safety in the end, we never know when the end is up for us -- but the only thing that we can hope for is that our soul and our spirit is in order, and that we've grown, and that we've helped people along the way.

This our last question. What does the American Dream mean to you?

Keith Black: I think that the American Dream is an evolving concept, because it has never been entirely true, particularly for minority groups. I mean the concept that there is equal opportunity never really meant equal opportunity for everybody. And it still doesn't mean equal opportunity today. If you're an African American child in South Central L.A., in a school without the sort of capabilities as a student in Beverly Hills who is going to a private institution, even though you may have the same intellectual capability, you do not have the same opportunity. I think, in an idealized fashion, what the American Dream means is that there's equal opportunity for every American. We're a long ways from achieving that dream, and I think as a society I would have to say the American Dream is an evolving concept. The American Dream should really be, "How do we, actually, as a nation, get to the concept where the American Dream is a reality?"

Thank you. That was great.

Keith Black: Thank you.

It was a privilege.