BY KAREN BOSSICK

Dr. Theodore Schwartz works in a space where few people ever go.

He gets inside people’s heads—their brains, to be precise—wielding scalpels, saws and drills to extract a tumor, fix a bullet hole and remove a blood clot. All things where every second can mean life or death but where the operations are hours long.

The neurosurgeon and neuroscientist has written a book offering a window onto his work titled “Grey Matters: A Biography of Brain Surgery.” It’s a must read, according to CNN medical correspondent Sanjay Gupta. And on Monday, July 21, Schwartz will discuss “Identity and the Brain” at the Sun Valley Writers’ Conference.

Schwartz will talk at 9:30 a.m. Monday at the Sun Valley Pavilion on what is the third and final day of the conference. Pavilion tickets are sold out, but the talk will be livestreamed and shown at the Writers’ Conference Live Watch Party at The Argyros (see https://svwc.com/ for more information).

“I did not go to med school thinking I was going to be a brain surgeon,” Schwartz said. “I majored in philosophy and English and thought I might go into international public health or  medical anthropology--something more academic than the nuts and bolts of brain surgery. But the first time I saw surgeons working meticulously--like watchmakers under microscopes for hours at a time--I was smitten. Here they were sitting in a special chair like an astronaut in the cockpit of a spaceship, except they were going into the microcosm of the brain instead of another planet.”

Schwartz added that his father was a Freudian psychoanalyst, so he grew up thinking about the brain and how it controls our behaviors and desires.

“So, maybe this is my Oedipal way of one-upping my father, if you will, and really getting my hands on what makes us human.”

Schwartz has used brain surgery to give people back their eyesight and to remove a cyst from a teenager with debilitating headaches that made her feel as if someone was bashing her head against concrete.

A hundred years ago, mortality from brain surgery was 50 percent. Now it’s down to 8 percent,” he said. One of the most common surgeries that neurosurgeons perform on the 3.5-pound brain involves head trauma.

“Anyone who has hit their head severely enough will have swelling in their brain. And we can now save these people's lives just by opening up the skull and removing part of the skull temporarily to let the pressure out. And we can save lots of lives that way.”

Gunshot wounds to the brain are as if someone put an explosive device in the head and blown it up, Schwartz said.

“The skin is serrated and bleeding; the bone, fragmented into tiny pieces. The sharp bone  digs into the brain, and it’s an unholy mess. As the brain swells, the bone and skin ooze out  like toothpaste in a purple gooey mush. And you know that mushrooming mass of purple tissue contains someone’s memories.”

Often, all a neurosurgeon can do is remove damaged brain, Schwartz said.

“That saves the rest of brain, but you know that that damaged brain is irreplaceable because it’s part of who that person is. Our frantic efforts to save what we can are like being in a sinking ship trying to plug all the holes of the blood vessels. And no two cases are the same, so we have to think on our feet because we never know where the fragments are going to be. And then we worry about infection because, if skin gets stuck in brain, it can have bacteria in it.”

Neurosurgeons are very much in favor of gun control because they see the devastation of guns, Schwartz said.

“I’m also in favor of bicycle helmet regulations and autonomous cars, too. Robots aren’t going to fall asleep and get distracted by phones like humans.”

Schwartz has to cultivate the body of an athlete to do what he does.

“I had horrible back pain whenever I stood more than 20 minutes, and I wasn’t sure I would physically be able to do the job--standing motionless is a kind of physical ordeal most people are not really prepared for. But if I’m looking into a microscope, gently dissecting rubbery  tumor from a delicate part of the brain, it takes 45 minutes to an hour to open up the skull, then another three to four hours, or maybe even eight to nine hours for the operation.

“I do core exercises to strengthen my core. I make sure to get a good night’s sleep and not drink alcohol. I do a lot of mental visual preparation, and I do a mindful meditation when I’m in surgery to keep my hands steady.”

Schwartz also has to put on psychological armor to deal with the diseases and tragedies he sees, as well as the burden of having someone else’s life in his hands.

“I try to keep my work life and private life separate as best I can. But I’m constantly thinking about cases that may have had a complication. We want perfect outcomes for every one of our patients. And it goes well 97 percent of the time. But we’re facing operations where the known complication rate could be as high as 10 percent. Still, the disease we’re dealing with is so severe that the risk of doing nothing worse. It’s like batting in the major leagues--you know you’re going to strike out sometimes, but you have to get up and do your best to save lives.”

Schwartz’s book profiles the cases of celebrities who have had brain surgery, such as actress Natasha Richardson, who died after hitting her head on the bunny slope while skiing; Michael J. Fox, who had surgery for Parkinson’s, and Joe Biden, who had surgery to repair two aneurysms.

He also writes about his own research creating minimally invasive ways to do surgery that before involved drilling through large pieces of bone.

“Rather than open the side of the head, we can go right up through the nostrils and make little incisions in the eyebrow and use endoscopes to see deep in the brain.”

Schwartz has also done brain mapping and other techniques to research and treat epilepsy.

“Now, we’re stimulating brains with electrodes, but surgery is still a major way to treat epilepsy.”

As for personal brain health? Exercise as much as you can, get a good night’s sleep and avoid trauma.

“I don’t think we have a good grasp of how supplements, or even diet, affect the brain yet,” he said.