Mr Noor ul Owase Jeelani is a world-renowned neurosurgeon, philanthropist, and entrepreneur. With a surgical career spanning 20 years, he is currently Consultant Paediatric Neurosurgeon at Great Ormond Street Hospital (GOSH), world leader in craniopagus twin separation, and Founder of Gemini Untwined. Mr Jeelani was the Head of the Department of Neurosurgery at GOSH from 2012 until 2018 and is currently an Honorary Associate Professor at the Institute of Child Health at University College London (UCL). He undertakes between 200-300 paediatric neurosurgical and craniofacial cases per year and has been the lead neurosurgeon for the successful separation of multiple craniopagus twins including the cases of the Sudanese twins Rital and Ritag in 2011, Pakistani twins Safa and Marwa in 2019 and Turkish twins, Yigit and Derman in 2020.
In 2019, he co-founded Gemini Untwined, a global charity dedicated to supporting research and the treatment for CPT twins as well as other complex craniofacial and neurosurgical conditions. In 2021, the Charity is supporting three further sets of Craniopagus twins, their families, and medical teams to secure the treatment they need. He is a Co-Director and leader of FaceValue, a research team of scientists and biomedical engineers based at the Institute of Child Health, UCL. The research focus is in defining Craniofacial Morphology in the normal and affected populations and developing techniques and distractors to achieve this change in a less invasive and more predictable manner.
In this interview, I speak to Owase Jeelani about what we can learn from the mindset of surgery, how to make decisions in life and death situations, and how to overcome our biases to enable better strategic thinking.
Q: What does it take to be a successful surgeon?
[Owase Jeelani]: Surgery, like many other disciplines, is primarily about facts, your relationship with the facts, how you manage, handle, interpret and use those facts. This is something we all begin to do very early in life, in our childhood. We look at information coming in from the external world, determine what is useful, determine how we understand it, build a fuller picture and effect change. A surgical mindset is very much that.
It’s also important to ask yourself why you want to be a surgeon. If you are there to serve the patient, if you’re there to serve the child (in my example), that makes life much easier – as your goal is clear, and you know what to do.
Q: How do you maintain focus in surgery?
[Owase Jeelani]: You need clarity of vision and purpose. You need to know the reason you’re there at that surgical table with a knife in your hand. You have to be clear that you are using these sophisticated tools (tools which can cause a lot of harm) to fundamentally and primarily help that entity, that child in front of you. That mindset provides the energy and focus needed to carry out the task. It doesn’t come overnight, it’s a huge process and one which is ongoing. As a surgeon, you can never say, ‘I’ve arrived’ – it’s an ongoing process with good days and bad.
Let me share with you a personal story. I’m someone who’s always had a hyperactive bladder. I remember being a junior surgical trainee about to take part in a 10-12 hour procedure. I was worried about how I would be able to pause to go to the loo! How could I ask my Professor that I needed a break every few hours. This was huge for me, and played on my mind. Many years later I realised that I was there doing 10, 12, 14 hour procedures without even thinking about this issue. It’s when you finish an operation that you zone back into your body, start to feel your muscles, joints and human needs again.
It’s difficult to pinpoint what happened during those years of training that enabled it, but instead of worrying about me and my biology, I zoned into the patient. Once you’ve arrived in that mindset, you know you can do it, and you can repeat it on a daily basis. It’s like the concept of flow; that is one practical way to understand the feeling you have whilst undertaking surgery.
When you have sharp focus and clarity of vision, it also goes a long-way to address any biases and insecurities you may carry with you to the table along with addressing the inherent noise in the world around us.
We all have good days and bad days- some days you’ve not slept well! If I’m not feeling 100% and if I have a big case that day, as soon as I leave home for work I’ll focus my mind on telling myself that I have to do my best for Sophie, for David, for Aaron, for whomever the child is on the table that day. That thinking starts at home – and by the time I get to the hospital, all that other baggage goes to the background. In the hospital, it’s just me, Sophie, and everything else I need to help Sophie. Then you move on to the next patient the same way. That’s how I carry on.
Q: How are you able to think around otherwise insurmountable cases?
[Owase Jeelani]: I’m really fortunate that I spend most of my time with children. At work, I’m with kids. At home I’m with kids. I’m surrounded with them. When you spend so much time around kids, you really do understand that they are inquisitive enough to handle facts in a very unbiased fashion. At some point, when we grow-up, we take on the baggage of the world, develop biases and lose that faculty. We have to remain acutely aware of how we are changing, and try to correct for any biases we develop.
If we talk about the conjoined twin operations I carry out. We know that a lot of conjoined twins, if not separated, will not survive. We know that even if they do survive, life joined-together can be quite difficult. So the task is clear. If we are able to separate these twins while keeping harm to a minimum (noting there will always be a degree of trauma), we have a mandate to do it. That’s the first thing that’s really important. We’re fundamentally thinking of those two kids. There’s often a lot of external pressure with such high profile cases, but if your focus is razor sharp on the question of doing the right thing for the kids, you will likely make the best decisions.
When thinking about dealing with the seemingly insurmountable it’s important to to remember that insurmountable is relative. What was impossible 20 years ago, is possible today. What is impossible today, will be possible x-years from now. We are always in change. Instead of thinking of the various steps needed to go from where you are to where you want to be, think of it the other way around. Break that journey down into smaller, simpler steps. As surgeons we do this routinely in our daily practice. We take out big brain-tumors, we perform cranio-facial reconstructions, but with the twins we took these steps and put them into a new paradigm – innovating, and achieving something that hadn’t been done before.
[Vikas: is there where we also run the risk of hyper-specialisation reducing innovation ability?]
[Owase Jeelani]: Super-specialisation at the expense of a breadth of knowledge is a modern-day fallacy. Fundamentally, we need to be able to address facts in an unbiased fashion. If you’re super-specialised in one particular area, at the expense of that breadth, at the expense of clarity of vision, it is natural you will accumulate biases that will factor into your decision making. If you are super-specialised in one particular task or field, you are quite likely to make errors in other, bigger fields.
Q: How do you deal with the ethical challenges that occur in medicine with the advance of technology?
[Owase Jeelani]: With technology, we’re creating a lot more hammers – and with more hammers, we’re able to find more nails. That’s what we do. The question is whether those hammers are being made for the right purposes, and whether they will serve the right purpose. I often worry that when we talk about health-tech – it almost seems that in certain areas the tech is taking over the health. Don’t get me wrong – there are huge gains to be made by using technology, but it’s fundamentally important to keep that patient at the centre of that revolution.
Let’s say you’re building a new platform which uses AI for some healthcare purpose. You have to go back to basics and think about how it will help that one patient. It’s fine to go global, but you have to clearly identify – at that microscopic level- how you are gong to help that one person, that one child. That’s a question I would ask on a regular basis when I’m faced with new challenges and technologies.
Q: How do you deal with mistakes and errors in surgery?
[Owase Jeelani]: Words like mistake, error and complication are not helpful. They carry visceral, emotive, weight which hampers learning and thus obscures what you may be able to take from an event. Over the past 20 years, we’ve moved away from that terminology towards the language of adverse events.
As a patient, if something hasn’t gone according to plan, it doesn’t really matter whether it was the surgeon, nurse, cleaner or pathway which was at fault. It doesn’t matter if it was God, who was at fault. The facts are that you have had an adverse event which shouldn’t have happened.The first thing we need to do is to distill away emotions and analyse that event with clarity, working backwards, to ensure that it never happens again. We need to change the paradigm in healthcare around adverse events. If you look at Tesla for example, every mile that a car has driven in Timbuktu, helps cars in California drive more safely. We need that kind of paradigm for surgical practice.
I’m a firm believer that all knowledge is essentially one. It doesn’t matter whether you are a paediatric neurosurgeon, pilot, policy maker or a vaccine scientist. It’s about how you look at facts, address those facts, and keep biases away from your decision making.
We cannot see the future, but we can get much better at predicting it. We do this by addressing our biases, and giving facts the correct weight within our decision making algorithms; it’s the reason self-driving cars will be much safer than human drivers, we need to learn from them!
Q: Has surgery taught you anything about life and death?
[Owase Jeelani]: Working with children is hugely rewarding, but at the same time, there are a whole bunch of kids i’ve not been able to help, and I’ve lost a whole bunch too. That’s something you carry with you, it’s something that becomes a part of you. You hope these things make you a better doctor, but I would be lying if I said these things don’t play on you.
The life and death aspects of surgery have taught me to focus on what’s really important. Why are we here? What are we here to do?
For me- I think we’re all here to uplift the human condition, making lives better for ourselves and others.
Q: What inspired you to enter the worlds of entrepreneurship and philanthropy?
[Owase Jeelani]: I feel I’ve always been an innovator in the way I think about things…the way I’ve addressed the problems I’ve come across. I’ve always been an entrepreneur, and philanthropy is something I’ve always cared about. My life is anchored around helping others. Philanthropy came along for me because there was a need. We had a set of twins from another part of the world who didn’t have the resources to get the treatment they needed. As a surgeon, I was able to deliver the treatment, but we didn’t have the logistical framework to help the kids. That was the impetus to set-up the charity and to go into philanthropy. The next time we have a set of twins in that situation, I hope we can do better, and better again the next time. I’ve also been involved in innovation and entrepreneurship for some-time. It was some 14 years ago when I innovated CranioXpandTM, a surgical spring distractor system which has made surgery safer and smaller for children.
I think all of us have these capacities within us. We have to maintain a degree of clarity to achieve something. It doesn’t matter what the question is- you set yourself a task, and move forward. Imagine thinking that ‘x’ cancer needs to be cured. You may know that you can’t cure all cancers, but this ‘x’ cancer could be cured in ‘n’ years. You may then research how you do it- work backwards- and work hard to maintain the level of clarity you need to carry on that path.
Q: What do you hope your legacy will be?
[Owase Jeelani]: I don’t think about legacy in any active fashion, but I hope my work is remembered. I hope that my children, and other children around the world, when they look at my work, say, ‘here’s someone who really did care… someone who tried… someone who had respect for the facts… someone who addressed problems without bias… dealt with their insecurities… and never compromised on our future…’
The human race is fundamentally one, but we still continue to use knowledge to create asymmetries, and continue to do the exact opposite of what knowledge tells us we should be doing. We use knowledge to create boundaries, and then we have all the imbalances and inequalities we see around us. We need to get to the stage where we consider a child born today in another part of the world as being equally important to a child born in our own neighbourhood. We need to get to that level to take the human race to the next step in our journey. ‘Until every child matters, and every child matters, enough’.