Why brain cancer is no match for neurosurgeon Charlie Teo

Brilliant yet divisive, trailblazing neurosurgeon Charlie Teo continues to push the boundaries – inside and outside the operating theatre.

Neurosurgeon Charlie Teo is an enigma: widely embraced by his patients as a hero, lauded by some colleagues and decried by others.

Over the past 30 years, the gifted Teo has become one of the most sought after brain surgeons in the world. He operates on tumours that other surgeons dismiss as untreatable. During 10 years in the US, he refined a minimally invasive keyhole surgical technique that transformed the way neurosurgery is performed, giving countless patients precious extra months or even years.

Having set up the Centre for Minimally Invasive Neurosurgery at the Prince of Wales Private Hospital in Sydney, Teo seeks to deliver the most technologically advanced neurological care to his patients.

There are some in the medical fraternity, however, who regard him as a maverick who gives false hope to people. Teo believes there’s no such thing as false hope. He tells patients the truth, but he’s more prepared to take a risk, to question dogma, than most of his peers.

Some Australian hospitals have refused to hire him despite his credentials, and Teo admits the acrimony is of his own making. But he says he can’t do what he doesn’t believe in, and diplomacy is not his forte.

He may not be a diplomat, but he is fearless. As a child, he regularly fought off racism; as a part-time bouncer at university, he talked down a man with a gun.

Teo says he doesn’t like failing, but even his surgical skills cannot always conjure miracles. Brain cancer has a high mortality rate; it kills more people under 40 in Australia than any other cancer.

Teo’s ongoing quest to improve the outcomes for his patients extends beyond the operating theatre. He spends hours with his patients; they dine at his house, he attends their funerals. Some say he’s too attached. He also spends months each year doing charitable work – be it pro bono surgery, teaching budding surgeons in developing countries or raising money for brain cancer research through his Cure Brain Cancer Foundation (a sponsored climb up Tanzania’s Mt Kilimanjaro in July is the latest fundraising venture).In recognition of his work, he was made a Member of the Order of Australia in 2011.

During an interview with CPA Australia chief executive Alex Malley for INTHEBLACK and Nine Network Australia’s In Conversation with Alex Malley, Teo – in typical style – challenges conventional wisdom on cancer treatment. We should, he says, “always be trying to think outside the square”.

Alex Malley: Your parents came out from Singapore and China in the early 1950s. They were Buddhists and were keen for you to recognise that you came in as guests to the country and you needed to behave. Was that really a strong part of your upbringing?

Professor Charlie Teo: Oh absolutely, that all-encompassing view of life where don’t feel like you’re anything special”. It was “learn from your environment and those around you”. They wanted me to have a Christian upbringing in a Buddhist household.

Malley: I understand mum and dad were reasonably strong disciplinarians …

Teo: The family weren’t just strong disciplinarians, they were incredibly strict disciplinarians! Children were there to be seen and not heard. I can remember if we were ever at a dinner and we were to join in the conversation, we’d be pinched by my mum under the table until there was blood drawn.

Malley: When you were about 12, mum and dad had a rather unhappy divorce. Mum took the reins, was a kitchen hand and did everything she had to do.

Teo: Yes, it was dramatic in retrospect, but at the time when you’ve got one parent who is incredibly strong and acts like a Rock of Gibraltar for you and anchors you … I can’t remember at the time being that perturbed by it. On reflection … I wished I had a father to have guided me through that difficult time.

Malley: In your younger years, you had racism thrust upon you.

Teo: There wasn’t a day that I can remember where we would go out in public and not be mocked for being Chinese. It was bad in those days. I can’t remember too many times when I was a university student where I’d go into a public setting and not be identified as being Asian. They’d make sure that I knew I was the outsider.

Acrimony in the ranks

Malley: After graduating from medical school, transitioning into a medical career wasn’t that simple for you. There were attempts to deregister you, to move you into another program. What caused that and did you make a contribution to those scenarios?

Teo: I take full responsibility for the acrimony that I’ve created and the stormy path that I’ve had. It’s very easy to be conciliatory and to stay on everyone’s good side, but you’ve got to live with yourself. I could never do that … I’ve decided to stand up for what I believe in. I’ve done that ever since I was an intern right up until today.

Malley: You went to the US for a good decade or so where you learnt some minimally invasive techniques that, to this day, are regarded as at the forefront of your profession. Tell me about that US experience.

Teo: America is a great country in that it runs on a meritocracy. The better you are, the more you’ll achieve, and people applaud you for rising above and doing something different. If you’re a tall poppy, they just love it: they all gather around you to build you up and support you.

“I take full responsibility for the acrimony that I’ve created and the stormy path that I’ve had.”

So you can go over there and say, “Listen, I think I’m the best neurosurgeon in the world and because of that, I think I can do tumours that no-one else can do, and I’d like to set up an international brain tumour site that attracts international patients. Are you behind me?” “Oh my god, yes.”

So, within six weeks I had a building built, nurses employed, advertising out and we set up an international brain tumour centre in Little Rock, Arkansas. Very few countries will allow you to do that. Of course, if you’re not good in America you learn very quickly and if you don’t publish, you perish. If you don’t work hard then you won’t survive.

Malley: So you return to Australia [with wife Genevieve, three daughters and a fourth daughter on the way] and you’ve made a name for yourself and there are two jobs…

Teo: I interviewed at the Royal Children’s Hospital in Melbourne. They were asking me funny things like, “Do you like neurologists? Do you get on with people?” I think they’d been warned about me before I got there… “This guy is a bit of a loose cannon. He’s not a team player. I wouldn’t take him if I were you even though he may look good on paper.”

I didn’t get the job. They withdrew the position, because no-one else applied.

Same thing happened in Sydney. I applied for my ex-boss’s job. He was my mentor, a guy called Ian Johnston. Loveliest man you’ll ever meet; superb neurosurgeon. “Charlie, I’m retiring from Westmead Children’s Hospital. Would you like to apply for my position? I’ll support you.” And I did. Again I was the only applicant. They withdrew the position.

Professional Development: Achieving goals through perseverance and resilience

Malley: So 20 years on, is there a better sense of where you belong in that fraternity or is it much the same?

Teo: In terms of the opposition to me, it’s as strong – if not stronger – than it was when I first came back. In terms of the acceptance of something different, looking outside the square, pushing the boundaries – no, it’s exactly the same. And it’s very upsetting, very depressing, because it means that the next generation has been as bad as the past generation.

The controversy that you’re hearing lately about medical bullying, vexatious claims against colleagues and false peer reviews, it’s all true. And it’s swept under the carpet.

Developing a bond with patients

Malley: Do you get any better at speaking to people who are that close to the edge of their life?

Teo: I’m not sure if I’m better than I was before. I can share more wisdom with patients now that I’ve been in the game for 30 years. I’ve always treasured the relationship that you can nurture with your patients in that terrible, vulnerable period. Other people are fearful of it, other people try and put a barrier up, but to me it’s a real privilege. It has a huge impact [on me]. If we have a set amount of emotion that we can give to our patients, I’m going to run out of it a whole lot sooner than most, because I do invest my emotions and my passion into those patients.

Doctors who see their patients for five or 10 or 15 minutes, I don’t know how they do that, because it starts off by developing some sort of communication with the patient, and to do that you’ve got to find some common bond. You’ve got to go right back into their social history, their medical history, their demographic … So immediately I get a feeling of the risk propensity of that patient.For example, a single mother caring for two children and you’re going to do an operation that could make her paralysed – you’re going to think twice about that. But a 60-year-old man whose children have left home, he’s got a caring and loving wife, his hobby is reading and watching TV. Of course, the risk propensity for that person for a paralysis is going to be far less than for someone who is so dependent on their hand working or their leg working.

You are developing a relationship with your patient, where they are going to have to trust you. If you lie to them upfront, it ruins the relationship. Even with a disease as bad as brain cancer, there is hope. There may not be hope for cure, but there is hope for longevity at least.

Figures show that most people are dead within a year. But thankfully, 5 per cent of people live more than five years. My job is to make sure that you’re in that 5 per cent. I can’t make any guarantees, but I can guarantee one thing and that is I’ll be with you on this journey and I’ll be there for you if you need me. The rest is up to them.

Commitment and perseverance

Malley: So let’s go into the operating theatre. You’ve got 10 hours or 12 hours ahead of you. What are you thinking?

Teo: You have to be in the zone just like a sportsman. I sit down to get in my zone, I look at the X-rays, I think of my approach and what hurdles lie ahead. Then I start operating. Then you get tired in the shoulders and arms and you’ve got to think to yourself, “This is a person’s life or a person’s arm or a person’s sight that is in your hands; you can’t let them down.”

“I do invest my emotions and my passion into those patients.”

Then there’s times when it’s just all too hard. You get to the 10-hour mark, you’re really tired… you don’t think you’re winning the case, and that’s the time when I draw on everything. You start thinking about your mentors, about what your mother had to tell you as a child about tenacity and perseverance.

The cure brain cancer foundation

Charlie Teo established the Cure Brain Cancer Foundation in 2001.

He says he raised close to A$300,000 in the first year; that has now risen to more than A$2 million or A$3 million every year.

“We became the largest funder of brain cancer research in Australia about eight years ago, and we maintain that position,” says Teo.

“We’re a global entity now so we are funding global initiatives.

“In July, I’m going to walk Kilimanjaro and I’m inviting 10 CEOs to come with us.

“They’ve each got to raise A$100,000, so that we’ll hopefully raise a million dollars for the foundation.”

The foundation’s mission is to increase the five-year brain cancer survival rate to 50 per cent by 2023. You can donate at
www.curebraincancer.org.au/donations

Looking within to beat cancer

Malley: Cancer, it’s such a big word. Where do you think the answer lies in beating this dreaded disease, particularly in the brain?

Teo: It lies in ourselves. We all produce cancer cells every day of our lives, thousands of them. They are identified as cancer cells and foreign by our own immune system and it goes to work to destroy them. So that’s why we don’t get cancer.

Those people who do get cancer have a failed mechanism: they either have a genetically failed mechanism or their immune system is depressed for some reason and cancer takes over. So all the treatments that we throw at our patients today – chemotherapy, radiotherapy, surgery – they all depress the immune system … and I think we’re probably doing the wrong thing. We should be identifying the flaw in our immune system that’s created the cancer in the first place and then targeting that by boosting our immune system and helping it fight itself. Thankfully, that is the way most innovative cancer treatments are going.

[We should] always be trying to think outside the square, challenging dogma and saying, “I was told that was gospel but maybe it’s wrong.” We should be questioning our forefathers and questioning our mentors.

Malley: Leukaemia once had a 90 per cent mortality rate; it now has 90 per cent cure rate. Breast cancer treatment has improved immeasurably. Brain cancer still kills more children than any other disease. It kills more people under 40 than any other cancer. What does one have to say to up the ante on research and funding?

Teo: My foundation did a survey and 90 per cent of the public don’t know those figures. So it’s all about education. I am sure if you told the average person that brain cancer is killing our kids more than any other cancer and yet receives the least amount of funding, they’d be aghast.