Brain Surgeon: Inside The Dreaming Brain - Dr Rahul Jandial - #988

**Chris Williamson** (0:00)
You just taught me, there are left-handed surgical instruments. What's that mean?

**Rahul Jandial** (0:06)
For left-handed surgeons, the way some of the graspers click, it's released with a maneuver where your thumb pushes something outward. For left-handed surgeons, that can be sort of clunky, so they make instruments where it's outward. For the left-handed surgeon, it's actually inward towards the midline, and for the right-handed surgeon, it's this way. There are left and right-handed instruments for different surgeons. Needle drivers, really, where you click on a needle and it clasps, so you don't have to keep pressure on it, and then you can do your maneuver. Stake knives also have serrations that lean one way or the other. I just learned that.

**Chris Williamson** (0:43)
I didn't know about that at all.

**Rahul Jandial** (0:44)
I was just looking at it because I've got a buddy who's left-handed, and he's pointing all this left-handed stuff out in the world.

**Chris Williamson** (0:50)
Don't use that one. It's going to cut completely incorrectly. What I did learn was when you have a steak, I have to imagine this is slapping in the middle of your area of expertise, but you want to never cut with the grain of the meat. You want to be cutting cross grain.

**Rahul Jandial** (1:06)
Yeah. That takes me to what's beautiful about surgery.
It's not like Legos. It's not like hammers and chisels. It can be with orthopedic surgeries and spine surgery. But when you have somebody who can lightly with a tweezer, a pickup we call it, lift something up and you see some membranes that are holding two planes together. All right. Let's say you have two planes of tissue and they're held together with this fine web of membranes. You lift it up and you take a scissor upside down and you just spread lightly and the membranes fall apart and the tissue comes apart. You're not really trying to tug and pull. If you do that with finesse, when the patient wakes up, they feel less injury, they feel less pain, less anesthesia, the operation goes better, less blood time. So everybody thinks surgery is all the same steps. Do these 1000 steps. No, it's sculpting, it's art, there's a finesse to it. And at some point, when you see somebody who's good at something, it's like ballet, it's like something's being released. They're not like, and now I will do this step. And that's the part I love about it is talent. It's more talent than smarts.

**Chris Williamson** (2:12)
I love watching people in between doing the thing that they're supposed to do. So a good example of this is drummers. If you're ever watching a drummer play live, he loses a stick or he snaps or something like that. And he'll just immediately switch and he'll be playing with one hand and he'll just reach over and he'll grab another one. Or if a guitarist's playing and bing, off goes a pick like that. And you'll watch him without even thinking about it. He'll do something, grab a pick from there, roll it between his fingers and go back. And it's that liminal space. I'm just so comfortable with my working environment. And that's really cool to see.

**Rahul Jandial** (2:45)
So that's an interesting word for me, liminal, because that's kind of the thing I've been thinking about a lot. It's not the easiest thing to explain to people. But I think that in nature, let me give you an example of what I call a liminal space.
I used to dive a lot. I gave it up at a scary accident. I almost ran out of oxygen real deep off of Asian coast there, a plow. And I was like, I've got kids. I'll do this when I'm older. So now I'm older and I'm like I don't have the energy. But the place that I love diving the most was the cenotes of Yucatan, like where it's all flat, maybe the asteroid landed there and killed all the dinosaurs and that kind of thing. But they have caverns and there are underground rivers that meet the salt water. So when you go from freshwater to salt water, in our body, salt water is a massive thing that has to do with cognition and balance and a lot of fundamental things are controlled just by the salt in our blood and brain. But when you're diving and you're in freshwater and then it's called a halocline and you're now, freshwater is meeting salt water, there's like five yards, it almost feels like five meters where it's blurry. So the transition from one state to another, at hemical, psychological, it doesn't happen in a millisecond, there's a liminal state. And so when you take a look at the brain in 24 hours, I see at least four or five liminal states. When you're falling asleep, it's not a complete, I am awake and now I'm asleep. There's a little window there about 15 minutes, lucid dreaming when you're asleep asleep and I can verify it, and you have a little return of awareness. To me, those hybrid liminal transition states give us an insight. I mean, it's hard, right? Because I'm a brain surgeon. People expect everything for me to be proven, but I'm finding a lot of insight and understanding from these different liminal states. And then you can bring narcolepsy in the middle where people suddenly fall asleep. They have interesting thoughts. When you wake up, a third of the world feels sleep paralysis and have these feelings of a goblin on their chest, enough to where the stories are built around different cultures. So to me, those transition hybrid states of cognition, of feeling, of experience, I think that's where my head is really at these days.