The letter, in slightly awkward English, came from Dortmund, Germany, typical of dozens UCLA neurosur geon Keith L. Black receives from around the world each year:
My husband . . . is suffering since 10 months from a malign tumor in the right hemisphere of his brain. As I trust and hope that you will be able to cure this tumor with your new medical technique, I look forward to receiving your advice.
Black knows intimately the devastation brain tumors wreak on patients and their families.
"I think a malignant brain tumor is the worst disease you can have," he says. "A tumor can strike you in the prime of your life. You're healthy, you're thriving, but you lose the things that make you human, that make you the person you are. Your personality isn't the same. You lose the ability to understand your environment, to even manipulate language."
He picks up a glass of water, slowly turning it in his hand.
"To be able to use your physical ability to pick up this glass of water, but to not know what it is . . . I cannot think of a worse tragedy that can happen to you."
The UCLA School of Medicine recruited Black, 37, just more than seven yearsago from the University of Michigan to lead its efforts to relieve that tragedy--to build a brain tumor program where none had existed.
"His contribution is spectacular," says Dr. Donald Becker, UCLA's chief of neurosurgery, who co-directs the program with Black. "He has exceeded all expectations. He's a superstar in our field."
Others echo that assessment: One patient calls him "a miracle worker," a colleague calls him "a brilliant surgeon," and a UCLA staffer treads to the threshold of blasphemy, whispering: "He's a god."
And those familiar with his flying, sky-diving, scuba-diving, mountain climbing and white-water rafting only half-jokingly call him "Indiana Black," a nod to the swashbuckling adventurer within the compassionate healer.
Tramping through freezing Himalayan streams and plucking leeches from his sodden feet were once as irresistible to Black as his work developing techniques to deliver higher concentrations of drugs to a tumor. Plunging into a South Asian jungle aboard an elephant or watching a meteor light up the sky from atop Tanzania's Mt. Kilimanjaro touched an important corner of his psyche.
"My basic philosophy ever since high school has been that I want to have as many experiences in life as I can," Black says. "I wanted to be able to incorporate into my way of thinking all the knowledge I could acquire."
But three years ago, he put aside jumping out of airplanes and dodging avalanches. "I felt I owed it to my kids to not do that anymore," he says. So he now focuses on sailing with his wife, Dr. Carol Bennett, a urologist at USC's medical school, their 6-year-old daughter, Teal, and son, Keith, 4.
"A couple of years ago, we never saw each other," says Bennett, who met Black during her residency at the University of Michigan.
Weekends are now jealously guarded "family time," devoted to exploring museums and bookstores or just enjoying their Bel-Air home on a ridge above the new Getty Center. They have spent carefully planned summer vacations sailing the Caribbean and will take time off this year to sail in the South Pacific with their children.
Sitting at the dining room table on a recent afternoon, Bennett kids her husband about working on the affluent Westside while she goes "Downtown, where the real people are. I make the commute. He runs down the hill."
At work in the operating rooms in the bowels of UCLA Medical Center, Black has become what is known in sports jargon as the "go to guy," the clutch player to whom other neurosurgeons send their toughest cases.
"Guys with big reputations usually can't do surgery worth a damn because they got those reputations by writing a lot of journal articles," says Dr. James Ditchick, 40, an Encino anesthesiologist whose tumor Black removed four years ago. "Keith walks the walk. He's doing these surgeries every day. That's why he's as good as he is."
Rosemarie Rabin Epstein went to Black last year in a wheelchair, which was the result, she says, of steroids prescribed after brain surgery three years ago. She had lost the use of her right leg and the peripheral vision on her right side.
"Dr. Black, to me, was a miracle worker," says Epstein, 71, an environmental planner from Marina del Rey. "I had been everywhere with this thing, and he was able to do what several doctors could not. He brought me from the jaws of death and gave me back a life almost like the one I had."
Dr. Jack Barchas, formerly dean of research and neuroscience at UCLA School of Medicine, calls Black a "brilliant surgeon with extraordinary compassion."
UCLA's brain tumor program, with five surgeons and four residents, performs 400 surgeries a year--up from 50 a year when Black arrived. He does half the operations and has helped recruit a research team that, Black says, puts the program "on the verge of making some really major breakthroughs" in the treatment of tumors.
Perhaps because of the gravity of his work, Black maintains an exterior cool. But he can barely contain his excitement when talking about UCLA's gene therapy research. He predicts that advances made there and at such centers as UC San Francisco and Johns Hopkins University will make malignant brain tumors curable within 10 years.
"He has led the development of a very exciting program in laboratory and clinical research at UCLA," says Dr. Edward Oldfield, chief of surgical
neurology at the National Institutes of Health in Bethesda, Md. "Certainly UCLA is one of the national centers in the research and treatment of brain tumors."
Black was born in Tuskegee, Ala., only because no hospital in the family's hometown of Auburn would admit African Americans. This was an Alabama where outdated, hand-me-down textbooks were sent to black schools after white students had worn them out.
But at Boykin Street Elementary School, where Black's father was principal and his mother taught first grade, the books were new.
"My dad would not compromise," Black says. "They wanted to deliver stale bread for the lunch program, but fresh bread to white schools. He just said, 'I'm not going to [accept] that.' "
Instead, Black's father integrated his staff, built the best library in the system and offered French to elementary school students.
"He was quite ahead of his time for Alabama," Black says.
So was his son.
By third grade, Keith was dissecting birds and frogs, studying the hearts of chickens and cows, building rockets and weather stations--all on his own.
"I still played basketball, football and did all those things," he says. "I didn't grow up isolated, but there was always a very clear affinity for science."
By eighth grade, after his family moved to the Cleveland suburb of Shaker Heights, Keith was hanging around medical research labs. In high school he did organ transplants and heart valve replacements on dogs at a lab where he worked.
"At first I was suturing," he says. "Pretty soon, I was doing the entire operation myself. That gave me a tremendous exposure to surgery and a lot of confidence to work with my hands and operate at a very early age."
As a senior at Shaker Heights High School, he delivered a scientific paper to a conference of cardiologists--a project that won him a Westinghouse National Science Award--before heading off to a six-year program leading to a medical degree at Michigan.
In Ann Arbor, he met Dr. Otelio S. (O.T.) Randall, an African American cardiologist, who became his mentor. "He was, in my mind, the ultimate academic physician," Black says. "He had a real compassion for teaching, for advancing African Americans--particularly in medicine but also in other areas. He was a fantastic doctor, a great scientist . . . everything I wanted to be. I wanted to be O.T. Randall."
Black went to work in Randall's lab, designing his own research projects, talking through the night about navigating medical school politics, listening to John Coltrane.
"Keith did not have his drive blunted by some big lab telling him he was not smart enough," says Randall, now a professor of medicine at Howard University in Washington, D.C. "He came to my lab. I was stupid enough to tell him we could do anything. It didn't take long for him to begin to see how he could make my lab better."
Black, who graduated in the top 5% of his med school class, had planned to become a cardiologist, but he was soon seduced by the brain.
"To me, the brain is just the most fascinating system in the universe--biological, physical or otherwise," he says. "Once I began to see that, I said, this is the way I want to go."
That voyage took him into computer science, electrical engineering, courses in artificial intelligence, philosophy, religion and up to the brink of mysticism.
"What I really want to do--if I can do anything with my life--is define consciousness," he says. "What is this whole mind/brain phenomenon?"
He found himself studying more and more, he says, but learning less and less; details heaped upon minute details--but still no answers. He confronted the question: Does an organism have to be more complex than the one it is trying to understand in order to understand it?
"I may be able to completely understand an amoeba, but can I completely understand myself?" he wonders.
He eventually put the question aside, choosing to turn his attention to "something where I can do some good for people. I started working on strokes."
But a trace of the mystic remains.
"Scientists are basically art critics, in my view," he says. "If you want to understand the artist, look at his art. When I operate and look at the structure of the brain under the microscope, what I'm looking at is God's art."
About 20,000 people die each year in this country from primary brain tumors, those which originate in the brain, Black says. Factor in tumors that migrate to the brain from other sites, and that number jumps to 200,000.
Half of all primary brain tumors are benign, but even those can be fatal, Black says. In the past 10 years, breakthroughs in research and new surgical techniques have enabled neurosurgeons to cure benign tumors. Such advances have also allowed many patients with aggressive malignant tumors to enjoy years of quality life.
During his study of strokes at Michigan, Black began exploring how to breach the blood-brain barrier, which prevents toxic levels of drugs from reaching normal tissue. "That defense is great under normal conditions," he says. But it also prevents cancer-fighting drugs from reaching tumors.
Once at UCLA, Black continued to focus on the blood-brain barrier, using compounds called leukotrienes to pioneer a technique to penetrate it. The more effective compounds he has since developed can deliver even higher concentrations of drugs directly to the tumor without harming healthy brain tissue.
UCLA is also one of only two brain tumor centers in the country developing an open magnetic resonance imaging (MRI) scanner that will ultimately give surgeons a real-time image of the brain as they operate. Using the scanner, surgeons can already insert a probe through a pinhole in the skull and destroy some tumors with lasers or radio waves, Black says.
Aerospace engineers can create a cruise missile that can hit a small target 200 miles away, he says. "What we're saying is that we need that kind of accuracy in surgery."
Ten years ago, patients "wouldn't come out of brain surgery in good shape," he says. Loss of vision or paralysis was common. "Complications are very rare now in the 400 surgeries done at UCLA each year," he says. Patients typically spend only one night in intensive care, and many go home the next day.
As UCLA forges ahead on the blood-brain barrier and the open MRI scanner, Black expects the research team's work on gene therapy to contribute to a cure for malignant tumors.
"The way a brain tumor survives, unlike most other cancers, is that it suppresses the immune system," Black says. "A brain tumor cell says: 'I'm going to make a chemical compound that's going to turn your immune system off so that it cannot get to me.' "
The body constantly develops cancer cells, he explains, but a healthy immune system detects and kills them. The gene therapy research involves taking tumor cells from dead laboratory mice and implanting a gene in them that blocks the cells' ability to turn off the immune system. These cells are then re-injected in mice with brain tumors. Now, the animals' immune systems can recognize all the tumor cells and destroy them. In tests so far, all of the animals have lived.
UCLA researchers can now say to tumor cells: "I understand how you work. I understand how you live," Black says. "I can insert a gene that will now allow my immune system to recognize you--to divide up and build an army of cells that will seek and find and kill you. And only you."
He expects UCLA to receive permission from the National Institutes of Health to begin human trials with the therapy early next year.
Brain surgeons now have "tremendous technical ability," Black says. "We do things now that are really quite amazing, that we didn't think we could do five, 10 years ago."
But there are times, he says, when part of his role is to be "friend, adviser and family counselor," to tell patients and relatives when to back off.
"If I can keep your intellect intact, if I can keep you functioning at a high level, we'll do whatever we can," he says. "But when the quality isn't there anymore, and I don't have the ability to give it back to you, then it's not worth pushing forward."
Los Angeles attorney Cynthia McClain-Hill says her mother was one of those cases. She learned of her mother's tumor about a month after giving birth to son Gregory.
"He maintained her quality of life for as long as he could," she says of Black. "He treats patients, and he treats families."
Her mother died two years ago, but Gregory, now 5, can talk about his grandmother, and recognizes her picture.
Black gave her mother three "very good years," McClain-Hill says. "He doesn't play a death game. He plays a life game."
(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)
Dr. Keith L. Black Age: 37.
Background: Born in Tuskegee, Ala. Lives in Bel-Air.
Family: Married to Dr. Carol Bennett, a urologist at the USC School of Medicine. Two children: daughter Teal, 6, son Keith, 4.
Passions: Research, surgery, teaching, patient care.
Hobbies: sailing, collecting African art, exploring museums.
On patients: "They're the real heroes, some of the bravest people I've ever met, and some of the best teachers. I've learned that if you understand what real quality of life is, you can live a lifetime in a year."
On working with physicians in research labs as a teen-ager: "The key is persistence. A lot of labs would just say, 'Go away.' But if you knock on 100 doors, you're going to find one guy who'll say, 'Come on in.' "
On the art of surgery: "It takes more than just understanding the techniques [to be a great surgeon]. That comes from inside. You cannot teach someone to be John Coltrane."
On living in Los Angeles: "L.A. is, I think, one of the best cities--particularly if you're African American--to raise a family, although people say the reverse. It's hard to find a place, at least in the United States, that's more tolerant of diversity than Los Angeles."