A Smooth Operator
This neurosurgeon banishes tumors with the same determination as one of his most famous patients conquers the Tour de France.
As the early-morning sun lit up the hospital conference room, Lance Armstrong and Dr. Scott Shapiro (AB '77, biology) took each other's measure. To Shapiro, a neurosurgeon at Indiana University Medical Center in Indianapolis, the bicycle racer seemed "cocky and confident, but scared." With good reason. By that October day in 1996, his testicular cancer had spread to his brain, producing two grape-sized brain tumors that threatened to kill him within weeks. Shapiro had been brought onto the case to remove the cyclist's brain tumors. "He was going down quickly."
Armstrong, who was accompanied by his mother, his coach, and his manager, began to grill Shapiro. "Why should you be the person who operates on my head?" Armstrong demanded. Shapiro had removed dozens of brain tumors like Armstrong's. It would be a straightforward operation, he said. He looked Armstrong in the eye. "As good as you are at cycling, I'm a lot better at brain surgery."
For Shapiro, those were not empty words. For more than 25 years, he's banished brain tumors, disarmed aneurisms, helped heal spinal injuries, and more, saving hundreds of lives and preventing chronic disability in others. He's also developed new treatments to repair injured spines and help heal damaged spinal cords. Shapiro, says Richard Borgens of Purdue University, a neuroscientist who works with him on several research projects, is a bold and innovative neurosurgeon, one of a rare breed "who trust in their skills enough to do heroic things."
Shapiro's fascination with the nervous system started early. He grew up in Indianapolis, the son of a prominent ophthalmologist who wanted him to go to medical school and join the family ophthalmology practice. Instead, as a freshman at the U. of I., Shapiro rebelled, charting a career in physics. (He worked briefly for famed U. of I. physicist and Nobel laureate John Bardeen.) But in a biology class, Shapiro grew entranced with the beauty and intricacies of the nervous system, and he switched his major to biology.
An avid athlete, Shapiro played on a successful intramural water-polo team and was runner-up in a university-wide racquetball tournament. He married his college sweetheart, Linda Glickman ('77), soon after they graduated. (She died of breast cancer in 1990, and he's since remarried.) By his third year at Indiana University School of Medicine, he'd decided to specialize in neurosurgery. Shapiro immersed himself in neural physiology and anatomy, learning the body's web of neural connections the way a cab driver learns city streets. The late nights and long hours of medical training "weren't a chore but a desire. It was something I wanted to do for the rest of my life," Shapiro says.
He had a knack for surgery, too. He had the precise hand-eye coordination and steady hand needed to nudge the brain's soft gyruses and sulcuses to probe deeper areas, to manipulate thin nerves and tiny blood vessels, to repair spines without harming spinal cords. What's more, says Shapiro, "I think in three dimensions pretty well. I map out strategy. I even dream about it."
In Armstrong's case, Shapiro's strategy called for brutal honesty and quick action. On October 25, 1996, Shapiro removed a portion of Armstrong's skull, carefully excised two "very angry" brain tumors from areas of Armstrong's brain that controlled vision and coordination. Then he reattached the skull bone with titanium screws, and stitched his skin.
When Armstrong awoke, Shapiro was leaning over him, Armstrong recalls in his book, It's Not About the Bike. "Can you tell me your name?" Shapiro asked. "Lance Armstrong. And I can kick your ass on a bike any day." Shapiro visited Armstrong regularly in his hospital room while he underwent chemotherapy. The two became friends. Shapiro, Armstrong wrote, "was one of those physicians who make you understand the meaning of the word ‘healer.'"
Shapiro cares the same way for all his patients, he says. Every Tuesday, Thursday, and Friday, he arrives by 7:00 a.m. at one of Indiana University Medical Center's several hospitals in downtown Indianapolis. By 8:00 a.m., he's in the operating room, quarterbacking a team that includes two anesthesiologists, one or two neurosurgery residents, one medical student, two nurses, and other assistants. He operates on two or sometimes three patients a day, often until after 6 p.m. On Monday, he does research and takes care of administrative duties; on Wednesday, he teaches, and, accompanied by residents, sees patients.
His titles reveal his many roles: Robert L. Campbell Professor of Neurosurgery, chief of neurosurgery at Wishard Memorial Hospital, co-director of Wishard's Stroke Center, director of adult craniospinal neurotrauma and spinal instrumentation at the medical center. Shapiro also provides hands-on instruction to neurosurgery residents. "One of the biggest pleasures I get is seeing young residents improve until they're so good they make me unnecessary," Shapiro says.
Shapiro's equally dedicated to his research. Recently, he and Borgens have developed an implantable device that applies an oscillating electrical field to help reconnect severed spinal nerve fibers. The device helped dogs with accidental spinal-cord injuries to walk again; it has so far proven safe for people with recent spinal-cord injuries, and, compared with existing treatments, it seems to do more to help patients recover sensation and an ability to move their limbs. The two hope to combine the treatment with two others they've developed that protect and regrow injured nerve fibers. The goal: to improve the current dismal prognosis for spinal-cord injuries.
Shapiro is proudest of some of his toughest cases. Three years ago, he treated a young woman who'd fractured her spine in a car crash and who entered the hospital a quadriplegic. Just three hours after the crash, Shapiro replaced the shattered portion of her vertebra with banked lower-leg bone from a cadaver—a procedure he'd developed a decade earlier. Amazingly, the woman was soon walking.
But, like all neurosurgeons, Shapiro regularly faces failure. "Sometimes a quadriplegic or paraplegic is asking you if they're going to walk again…. You have to be empathetic and supportive, but you have to be honest. … When [surgeries] don't go well, I usually lose sleep trying to figure out what the hell to do better next time."
Much more pleasant are cases like Armstrong's, whose cancer is now in complete remission. On a sunny day in 2004, Shapiro and his wife sat near the finish line of the Tour de France with Armstrong's family, Robin Williams, and other notables as the cycling legend crossed the finish line and won his sixth Tour de France. "He just dominated," Shapiro recalls. For Shapiro, like Armstrong, it was yet another victory.
By Dan Ferber