His Global Patient Load
“You wouldn’t want me to be late for the man who saved my life, would you?”
My 13-year-old son, Eli, puckishly smiled, urging my wife, Laurette, and me into the car. Six years ago on a clear night in January, a compact fellow with confident hands had sliced out a tumor and a cyst--together the size of a tennis ball--from Eli’s brain. Now, on a recent Saturday evening, we were heading for dinner with Jorge Antonio Lazareff, the UCLA pediatric neurosurgeon who had operated on Eli.
Since that time, much had happened. In addition to a deep bond that had developed between my family and the doctor, Lazareff had become world famous. In 2002 at UCLA Medical Center, he separated conjoined twin girls from Guatemala. The nearly 23-hour procedure proved both intellectually and physically demanding, in the end consuming some 50 UCLA staff members and costing more than $1.5 million. But as Lazareff remarked soon after its success: “There will be two passports, two boyfriends, two weddings.”
The subsequent media attention turned Lazareff, then a year shy of 50, into a celebrity--a secular saint whom everyone adored. This was underscored by Secretary of Labor Elaine L. Chao, who, while dropping in on the newly twained twins, told the medical team, “The nation is spellbound by what you’ve done.” In fact, this sentiment resonated worldwide.
Now, nearly a year and a half since Maria Teresa and Maria de Jesus Quiej Alvarez were granted two lives, Lazareff is spearheading a worldwide nonprofit organization, Global Neuro Rescue, which helps youngsters who suffer from debilitating neurological diseases. Lazareff cites a recent report by the Institute of Medicine--a private research and advisory arm of the National Academy of Sciences--which found neurological disorders accounting for 15% of the total disease burden in the world’s poorest nations, while less than 1% of global health funding goes toward these often treatable conditions. For Lazareff, medicine’s lasting legacy is not as an academic science but as a social force for healing. As the proverb goes, “Con virtud y bondad se adquiere autoridad,” or, “With virtue and goodness one acquires authority.”
When Lazareff first captured headlines for operating on the twins--at a time when corporate captains were pilfering widows’ and retirees’ savings, the Middle East was re-erupting in bloodshed and cynicism was eroding America’s psyche in the lingering wake of the controversial 2000 presidential election--the heroic separation of two helpless baby girls suggested nothing less than the victory of the virtuous. The public face of this determined compassion was Lazareff, an Argentine with American citizenship who had pulled together an elite medical team, many of whom, like himself, had volunteered their time. Consequently, Lazareff, boyishly handsome and possessed of a shy, seductive grin, was proffered as medicine’s Lindbergh; a plucky lone eagle who had piloted through clamorous extremes to touch down on a safe shore. To play off the old joke, this was brain surgery--and then some.
Yet for Lazareff, freeing the “Little Marias,” as they came to be called, had nothing to do with celebrity buoyed by high-minded metaphors. To the contrary, Lazareff never took his sudden stardom seriously. “I don’t pay much attention to my intervention . . . because I am fully aware that I am just one of the many,” he says. Lazareff considers surgery a chorus, the outcome sustained by the grace notes of all. He offers another analogy by way of a quote, something he is fond of doing: “I think Camus said that everything he learned from life he learned from playing soccer. Here in the United States, where we are accustomed to American football, you stop the play. [But] I am used more to soccer where you have 90 minutes and everyone runs up and down. And sometimes the winning goal comes out of the blue. So we look at the whole soccer game.”
Modesty prevails with Lazareff, who often closes his personal correspondences with “a big abrazo"--a hug. He prefers casual slacks and a golf shirt to a coat and tie. And while he is deeply and cross-culturally informed about art, literature and history, he never plays the obvious intellectual and is earnest and accessible.
“My dad was a very socially oriented individual, and I was raised by him with this idea that the plumber was as important as the physician,” Lazareff says. “Everyone is so vital, so critical. I believe if you’re a humanistic human being, you will be a humanist, whether you are a plumber or a physician. If you have a hard, cold heart, then the [medical] degree will not soften you. You bring to it what you are.”
Of course, not all who are wheeled into the operating room are saved. Last July, conjoined twins from Iran, who were operated on in Singapore by a renowned team of doctors, died during a two-day ordeal that failed to control bleeding. Also, post-surgical conditions can be difficult and challenging. The Guatemalan girls required occupational and physical therapy. (Maria Teresa is still recovering after having contracted meningitis, and Lazareff believes that she will need further assistance as she grows; however, he reports that Maria de Jesus is doing well and he thinks her development is relatively on track.)
When the outcome does not match expectations, Lazareff finds himself seeking answers within: “When there is a patient who does not come out the way that you wanted, those are the things that make you wonder, ‘Why did I not do something with less of a sense of responsibility?’ You just want everybody to be healed.”
Outwardly easygoing, Lazareff, now 51, is a tenacious tennis player who competes to win. His Spanish-accented English frequently is studded with “ums” and “ers,” as if he is trying to slow down the words so they might catch up with his ideas. At other times, Lazareff appears distracted, his attention elsewhere, wrestling with private conflicts and arguments. At such moments one recalls his Russian roots, which would explain the Chekhovian brooding. Lazareff’s father abandoned the then-Soviet Union at the close of World War II, vowing to resettle as far as possible from his homeland. So he and his young wife left for Argentina, a place wholly new and foreign. There Jorge was born, their only child. To his friends he was affectionately nicknamed “El Ruso"--"The Russian.”
Lazareff grew up in El Galpon, some 1,600 miles northwest of Buenos Aires. His father was the local doctor and, as a boy, Lazareff was so embarrassed by his social status that he would remove his shoes and secretly park them under a tree, walking to school barefoot so he could be like his friends. As a young medical student at the Universidad Nacional de Buenos Aires, Lazareff’s outlook changed when he discovered the incisive modernism of American poet William Carlos Williams. Here was an artist “who not only had a medical degree, but actually practiced medicine every day,” Lazareff says. Through Williams and fiction writers such as Fyodor Dostoevsky and Marcel Proust, Lazareff came to discover his own compelling reason for engaging in medicine. No longer could he look at the afflicted as a problem in need of fixing, but rather “as somebody who had a story to tell, who had planned a future for himself or his family life.” Lazareff says this came to mean that he “wanted the child to ride the bike that his grandfather had bought for him, even though the child was paraplegic.”
From 1988 to 1993, Lazareff was the chief of pediatric neurosurgery at the Hospital Infantil de Mexico Federico Gomez, where he received a prestigious award for excellence in research and also set in motion the mechanism for the first residency in pediatric neurosurgery. In 1993, Lazareff was recruited by Dr. Warwick Peacock, his mentor and then-director of pediatric neurosurgery at UCLA. Lazareff went on to coordinate the creation of the Pediatric Brain Tumor Program, and four years later he succeeded Peacock at UCLA. In 1999, Lazareff became an associate professor in the department of surgery, division of neurosurgery.
Assessing Lazareff’s professional rise, Henry K. Kawamoto, the surgical director of the UCLA Craniofacial Clinic who worked alongside Lazareff during the twins’ procedure, says it was not something that he could have predicted. Kawamoto contends that in the highly hierarchical trade of medicine, Lazareff did not advance in the orthodox fashion. Rather, he “short-circuited that.” Consequently, “When he came on the scene with the twins, people were saying, ‘Who the hell is that?’ ” The plastic surgeon quickly adds that Lazareff commands great “physical dexterity” and knows precisely “what needs to be done, and does it.”
Dr. Andrew F. Cannestra, a UCLA neurosurgery resident, has been close to Lazareff for the last four years. He calls Lazareff “charismatic,” with an empathetic and caring nature. Dr. Itzhak Fried, a UCLA professor of neurosurgery and one of Lazareff’s closest friends, says his buddy is not averse to acting the gadfly outside of the operating room, eschewing the customary and the conventional. Lazareff possesses a “benevolent irony” that might go undetected by some, Fried says. However, he cautions that those who underestimate Lazareff would be “in for a big surprise,” adding that Lazareff’s ego is not preoccupied with trying to haul itself atop any sort of pedestal.
The first time Julie Byrd glimpsed Lazareff, a child was being readied for surgery. “I saw him talking to the parents and telling them, ‘It’s going to be OK,’ ” says Byrd, the UCLA nurse in charge of neurosurgery for the main operating room. “Just seeing the look in their eyes of total trust, and then they hand their child to him, and then he’s the one who carries the child back into the operating room. I never saw a surgeon carry the child back himself.”
Susan Milliken first met Lazareff on a Friday in July 1997. Her 8-year-old daughter Amber had been diagnosed with a brain tumor. When Milliken saw her daughter after the operation, Amber “opened her eyes as if she came from heaven, her eyes lighting a cathedral with a single candle.” Today, Milliken says, “I cheer [Lazareff] for his optimism and the edge it gave me in expecting my daughter to fully recover.”
“Life,” says Lazareff, “is larger than neurosurgery.” Turning this belief into action, Lazareff has volunteered to help children in Romania through the Romania Outreach to Christ’s Kids Foundation and also has worked to better the lives of youngsters in Central America through the Healing the Children Foundation. Yet through it all, Lazareff minimizes his role as well as surgery’s larger significance.
“You can toy with the idea of wiping out surgery, and you still have civilization--Michelangelo, man on the moon.” He pauses for a beat. “Imagine I don’t go to work tomorrow? I’m absolutely sure there will be some inconveniences,” he says, suggesting that all would then go on. “So once you understand this you actually try to figure, ‘How can I improve? How can I get things done better?’ ”
To that end, Lazareff launched Global Neuro Rescue, which helps medical personnel in developing nations understand and treat infants and children suffering from central nervous system diseases. He and the organization’s volunteers--which have included Dr. Barbara Van de Wiele, Byrd, Cannestra and Milliken, who now serves as the group’s director--have seen scores of seriously sick children in such countries as Guatemala, China and Romania. So far, Lazareff and his colleagues have operated on more than 100 of these youngsters.
Their mission, however, is not to relieve and leave. In the long run, Lazareff believes it is futile for foreign physicians to serve as “parachute tourists,” jumping into a situation and then departing. Local doctors must eventually take the lead, so Global Neuro Rescue also runs hands-on clinics that train local health workers.
A recent trip to Central America underscores the great need for this work. Milliken recalls the line of mothers, some having traveled by bus for two days, surrounding the project’s small clinic in Guatemala City. In hammering heat they silently cradled their babies, many whose heads were swollen and deformed by hydrocephalus, leaving some unable to close their eyes. Milliken says she can still see the women waiting in the lengthening afternoon. “The mothers do not speak or beg,” Milliken explains. “They have heard that one man can help them.”
Perhaps Global Neuro Rescue sprang from that venerable modern cliche of the midlife crisis, Lazareff half-jokingly suggests. He also cites a movie that he watched as a child. Though he cannot remember its name, he knows it starred Burl Ives and Rock Hudson and was about a young doctor who moves to an impoverished land to help the stricken. The movie, it turns out, is “The Spiral Road,” a 1962 film based on Jan de Hartog’s fiction about an atheist medical man who fights a leprosy epidemic and eventually becomes a missionary.
The thought that a hokey old Hollywood movie might have motivated him to save some small part of humanity, to rescue those without a dream to their name, is not lost on Lazareff. He harbors a keen sense of irony and--like a fellow Argentine with the same first name, writer Jorge Luis Borges--is well aware that this world is a hash of the poetic and the prosaic. As Borges wrote: “Reality is not always probable, or likely.”
And reality can pivot. Until recently, Lazareff lived with his family in Westwood. However, he is now separated from his wife. “As physicians we are trained to repress our emotions, to ‘control them,’ ” Lazareff says, weighing his words. The demanding lifesaving work of Global Neuro Rescue has brought his emotions close to the surface, he explains, making him more deeply aware of his feelings, of what is going on inside.
Several months after my son Eli’s surgery, his teacher asked him and his classmates to each nominate someone for the Nobel Prize. Eli chose Lazareff, explaining: “I wouldn’t be writing this essay if it weren’t for him.” He then told how his surgeon friend “is very good at making scary surgeries comfortable.” Eli concluded by quoting his doctor’s prescription for a true life. It was simple but profound, this advice to a child who had fought his way back from a brain tumor. It was advice that raised hope higher than despair, lifted optimism over gloom: “Be good, be happy,” Jorge Lazareff told my son, “and things happen.”