Chapter 4
The Unsung Heroes Behind Success
While surgeons often receive the acclaim, Carson recognizes that success depends on countless individuals whose contributions typically go unnoticed. Georgia Simpson exemplifies how everyone contributes to success at Johns Hopkins, not just high-powered neurosurgeons. When confronted with an agitated patient upset about waiting, Georgia calmly explained the emergency situation and reassured her that the doctor was worth waiting for. Her ability to communicate genuine care transformed the woman's attitude completely.
Pat Brothers, initially Carson's secretary and later his senior administrative assistant, transformed his office into a model of efficiency. Despite facing personal challenges as a single mother, Pat demonstrates remarkable intelligence and versatility-even explaining complex neurosurgical procedures to patients' families with professional precision. Her loyalty and discretion allow Carson to work without worry, making her truly indispensable to his success.
Carol James, Carson's senior physician assistant, knows him better than anyone except his wife and mother. With remarkable intuition, she anticipates his thoughts and decisions, often completing his sentences. Carol spends countless hours with patients explaining complex procedures, answers most of Carson's mail perfectly, screens referrals, supervises residents in surgery, and gathers research materials. Her practical nature balances Carson's soft-heartedness, preventing people from taking advantage of him. By handling these responsibilities, she effectively doubles Carson's productivity, staying as late as 11 p.m. when needed without complaint.
Mary Kay Conover, Hopkins' first neurosurgeon nurse practitioner, demonstrated exceptional dedication from the start. Despite being fresh from school, she absorbed everything about neurosurgery with sponge-like eagerness. She quickly became invaluable, helping Carson manage up to a hundred patients efficiently. On one occasion when Carson was detained in surgery, Mary Kay completed all the accumulated work, prepared patients for the delay, and even left him a candy bar knowing he wouldn't have time to eat.
Carolyn Childs, the neurosurgery OR head nurse during the 1987 Binder Siamese twins' operation, contributed significantly to this historic event with her exceptional organizational skills and ability to anticipate surgical needs for both routine and extraordinary procedures.
These individuals represent the often-invisible infrastructure that enables great achievements. Their dedication, competence, and willingness to extend themselves beyond job descriptions create the foundation upon which medical breakthroughs happen. Carson's recognition of their contributions reflects his understanding that true excellence is always a collaborative achievement.
Chapter 5
Taking Calculated Risks to Save Lives
Sometimes giving our best and Thinking Big involves taking risks, especially in neurosurgery. Carson performs what some consider adventurous procedures because they give dying patients a chance to live. His approach to risk isn't reckless but calculated-weighing the certain outcome of doing nothing against the potential benefits of intervention.
In 1985, infant Dusty Phillips came to Johns Hopkins from West Virginia with a "primitive neuroectodermal tumor"-a highly malignant, fast-growing brain tumor. After failed chemotherapy elsewhere, his parents brought him as their last hope. Carson explained the significant risks of surgery: fatal bleeding, infection (especially concerning since chemotherapy had weakened his immune system), paralysis, sensory changes, personality changes, or even coma. When Dusty's mother asked what would happen without surgery, Carson remembered Dr. Taren's words: "Sure, it's a dangerous procedure, but look at the alternative if we do nothing."
Carson performed a subtotal hemispherectomy, removing every part of the brain affected by the tumor, including the dura. Follow-up chemotherapy with a specialized medication combination proved successful. Five years later, Dusty was neurologically normal with no evidence of tumor recurrence.
David Troutman represents another case where medical professionals refused to give up despite terrible odds. At age twenty-one when Carson met him in 1988, David had been battling a primary brain stem tumor since 1984. Another Hopkins neurosurgeon had biopsied the tumor and treated it with radiation, then switched to chemotherapy when it continued growing. By the time Carson saw him, David was bloated from steroids and confined to a wheelchair. The neuro-oncology team noticed on MRI scans that the brain stem tumor appeared to have borders, suggesting it might be removable despite its dangerous location.
The case of Amber Kyle began with a call about twin girls in utero, one with rapidly expanding hydrocephalus threatening premature labor. Carson decided to perform an experimental procedure using a special shunt developed by Robert Broadner that had only been tested on animals. Working at Sinai Hospital to avoid lengthy approval processes at Hopkins, they inserted the shunt while monitoring via ultrasound. The moment they saw the hydrocephalic baby's head shrinking on screen was triumphant. Three weeks later, both babies were delivered by C-section with good neurological function. Though initially criticized for performing experimental surgery, Carson's critics eventually conceded he'd made the right choice when both babies thrived.
These cases illustrate Carson's approach to risk: thorough assessment, clear communication with families about both risks and alternatives, innovative thinking, and willingness to attempt procedures others might avoid-all driven by the fundamental question: "What happens if we do nothing?"
Chapter 6
Discovering and Developing Your Talents
Carson believes everyone possesses unique talents that, when properly identified and developed, can lead to extraordinary achievement. He criticizes our society's overemphasis on sports and entertainment, noting the slim odds of becoming a professional athlete (only seven out of a million make it as NBA starters, with careers averaging just 2-3 years). Instead, he encourages people to discover their intellectual talents-the natural abilities that, when cultivated, can lead to meaningful contributions and personal fulfillment.
He shares the story of A.G. Gaston, a Black man who built a business empire in the segregated South by recognizing needs and filling them, starting with burial insurance and eventually founding a bank. Gaston succeeded because he never sought excuses, accepted and used his talent, and focused on helping others while building wealth.
Carson discovered his own talent for hand-eye coordination and three-dimensional thinking that led him to neurosurgery. He provides a practical exercise for discovering one's talents through self-reflection and consultation with trusted advisors. Find a quiet place to think, then honestly answer questions about what you do well, which school subjects you excel in, what activities others compliment you on, and what "work" you find fun. Compare others' perceptions with your self-assessment, then spend several days reflecting on these insights.
He warns against parents who push children into careers regardless of their natural abilities, sharing the story of his friend Chip Moses, who broke his family's multi-generational tradition of Harvard-trained lawyers to become a physician and vice-president at Johns Hopkins Hospital. Carson emphasizes that everyone must recognize and use their God-given talents regardless of socioeconomic background or external pressures.
Carson recounts speaking at a middle school in Washington state with many Native American and migrant worker students. Despite warnings about potential disruption, the students connected deeply with his story of academic failure and transformation. When he shared how he went from being the worst student with mostly F's to becoming a neurosurgeon, the previously rowdy crowd gave him a standing ovation. Carson realized these students needed hope-someone to tell them "You can do it." He emphasizes that ethnic minority or socioeconomic status has nothing to do with innate ability, and that all young people need mentors to help them realize their intellectual talents.
Carson concludes: "If we recognize our talents and use them appropriately, and choose a field that uses those talents, we will rise to the top of our field."
Chapter 7
The Foundation of Character: Honesty and Insight
Carson emphasizes that honesty is an essential ingredient of character for those who want to Think Big. He outlines four crucial points: 1) When we act dishonestly, we cheat ourselves; 2) Dishonesty cannot be hidden for long; 3) Dishonest people get treated dishonestly; and 4) Honest thinkers can Think Big while dishonest thinkers remain small-minded. He cites examples from Richard Nixon to Saddam Hussein to illustrate the inevitable consequences of dishonesty.
Equally important is developing insight-the ability to understand what makes people successful. Carson's mother gained wisdom by observing the wealthy families she worked for, noticing they spent more time reading than watching TV and bought quality clothing rather than following fads. Despite her limited education, she managed their finances brilliantly, stretching every dollar to make ends meet.
When teenage Carson became obsessed with expensive Italian knit clothes, his mother wisely handed him the family budget to manage. After allocating money for necessities and finding nothing left for luxury items, he gained profound insight into his mother's financial wizardry and stopped asking for expensive clothes.
Carson explains that insight can be developed through a process similar to what mathematician Henry Poincare described: saturation (research), incubation (reflection), illumination (sudden solution), and verification. He believes insight can be cultivated through listening to achievers, recognizing that achievement is accessible to all, learning from any source, and studying others' mistakes and successes.
This approach led to his breakthrough in separating Siamese twins. After studying failed historical attempts and recognizing that bleeding was the main problem, he had an "Aha!" moment-combining hypothermic arrest techniques from cardiovascular surgery with cranial facial surgery could reduce the risk of exsanguination during separation.
Carson emphasizes that successful people share key insightful ideals: they decide to use their abilities to achieve, they observe and question everything, and they develop more intelligent work methods. In his medical work, particularly controversial surgeries, he follows four steps: questioning feasibility and importance, consulting experienced colleagues, researching extensively, and evaluating all options before making decisions.
Most successful people are keen observers who apply the scientific method to their fields, watching carefully and identifying patterns. Through reflective observation, they build knowledge incrementally. Carson concludes that insight comes from observation, reflection, and commitment to excellence.
Chapter 8
Knowledge, Reading, and In-Depth Learning
Carson refutes common arguments against learning: that too much learning overtaxes the brain and that certain knowledge is irrelevant. He emphasizes that the human brain has fourteen billion cells and cannot be overloaded, retaining everything we encounter. The challenge lies not in input but in retrieving information. He argues that all knowledge is important, translating across disciplines and leading to deeper understanding.
"Knowledge is power"-power to overcome the past, change situations, fight obstacles, and make better decisions. He illustrates how seemingly irrelevant subjects like history and geography broaden mental horizons and help understand current events. Knowledge makes people special and valuable regardless of appearance or background. He shares the story of a Black female executive whose knowledge made her so indispensable that when she married a professor in another state, her company bought her a second home and provided transportation between both locations.
Reading is central to knowledge acquisition. Books activate the mind, force discrimination between letters, words, and concepts, and push us to use our imagination creatively. Developmental psychologists estimate 98% of babies are born creative, but less than 5% remain so by age eighteen. Our society's preference for packaged entertainment over intellectual stimulation has led to America's decline in science and math education. Students who excel academically are invariably avid readers.
Carson's example of reading two books weekly while limiting television has inspired Ben Carson Reading Clubs nationwide, where members commit to reading two books weekly, submitting reports, and limiting TV time. These clubs function like support groups, with members encouraging each other and offering tips to overcome TV addiction. Students discover their intellectual potential through reading, with many reporting dramatic academic improvement and newfound self-confidence.
In-depth learning means mastering a subject thoroughly rather than merely studying for tests or to impress others. People learn differently-some through audio, others through dialogue, rote memorization, or hands-on experience. The best learners combine multiple methods. To discover your optimal learning style, reflect on three things you've mastered and analyze how you learned them.
At Yale, Carson faced two harsh realities: he wasn't as smart as he thought, and his last-minute cramming approach wouldn't work anymore. After nearly failing chemistry, he developed a personalized learning system that emphasized his strengths. He discovered he learned best through solitary reading rather than lectures, so he often skipped classes to study independently from multiple textbooks on each subject. In-depth knowledge distinguishes true professionals from "surface skimmers" in every field.
Chapter 9
The Role of Faith and Humility in Achievement
For Carson, faith isn't separate from his professional life but integral to it. In the operating room, when a four-year-old girl named Christine suddenly went into cardiac arrest during brain tumor surgery, Carson silently prayed, "Fix it, God, please." Miraculously, her heart restarted just as he was about to turn her over. This experience reinforced his belief that God cares about every area of our lives and wants us to ask for help, especially when we become helpless.
Carson warns that some successful people become overly confident, developing an exaggerated sense of importance that makes collaboration difficult. These "swollen-headed types" often cease learning, believing they already know everything. True humility isn't groveling but understanding who we are in relation to God. Carson's simple formula for humility: recognizing that God created the universe, demonstrates power beyond our own, and gives us abilities we cannot supply ourselves.
Growing up without many adult male role models after his parents separated when he was eight, Carson found heroes in the Bible. Jesus Christ who sacrificed himself for others, Daniel and the Hebrew boys who stood by their principles despite threats, and especially Joseph, who rose from slavery to become Egypt's prime minister. He deeply believed that God could take anyone from any circumstances and transform their life.
Carson begins and ends each day with prayer and reading Proverbs, frequently asking God for wisdom and perspective, especially in difficult situations. He's experienced God's intervention in critical moments, like when an artery broke during brain surgery and the bleeding mysteriously stopped after his prayer, or when he couldn't thread a needle through a tiny skull opening until asking for divine guidance.
As his relationship with God has matured, Carson has discovered "God is a nice guy"-not the stern bookkeeper of mistakes he imagined in his youth, but a loving father who wants to fulfill our lives. Having children helped him understand this relationship better. His simple philosophy: Do your best and let God do the rest.
Carson has witnessed remarkable recoveries that defy medical explanation. Marian, an accomplished musician, underwent a temporal lobectomy that should have destroyed her musical abilities, yet after rehabilitation, she fully regained her violin, piano and organ skills. Similarly, Beth, who had half her brain removed to treat seizures, became the top math student in her class despite losing her left hemisphere. These outcomes, while medically unexpected, reinforced his belief in divine intervention.
Chapter 10
The THINK BIG Philosophy: A Path to Meaningful Success
Carson's THINK BIG philosophy encapsulates the principles that guided his journey from poverty to pioneering neurosurgeon. Each letter represents a crucial element:
**T - Talent**: Recognize your unique abilities and use them appropriately. Everyone possesses talents that, when properly identified and developed, can lead to extraordinary achievement. Carson discovered his talent for hand-eye coordination and three-dimensional thinking that made him ideally suited for neurosurgery.
**H - Honesty**: Live with integrity in all circumstances. When we act dishonestly, we ultimately cheat ourselves. Dishonesty cannot remain hidden for long, and dishonest people inevitably get treated dishonestly. Honest thinkers can think big while dishonest thinkers remain small-minded.
**I - Insight**: Develop the ability to understand what makes people successful through observation, reflection, and commitment to excellence. Carson's mother gained wisdom by observing the wealthy families she worked for, noticing they spent more time reading than watching TV. His own surgical breakthroughs came through studying historical attempts and identifying new approaches.
**N - Nice**: Treat everyone with kindness and respect regardless of their status. Carson spent many late nights conversing with cleaning staff, clerks, and nurses' aides during his residency, realizing that being a doctor at Johns Hopkins didn't make him any better in God's sight than those without such educational opportunities. Being nice "always comes back to repay us in the long run."
**K - Knowledge**: Pursue learning continuously across diverse fields. "Knowledge is power"-power to overcome the past, change situations, fight obstacles, and make better decisions. All knowledge is important, translating across disciplines and leading to deeper understanding.
**B - Books**: Make reading a priority to expand your mind and possibilities. Books activate the mind, force discrimination between letters, words, and concepts, and push us to use our imagination creatively. Carson's transformation began when his mother required him to read two library books weekly and write reports on them.
**I - In-depth Learning**: Master subjects thoroughly rather than superficially. At Yale, Carson developed a personalized learning system that emphasized comprehensive understanding rather than cramming for tests. In-depth knowledge distinguishes true professionals from "surface skimmers" in every field.
**G - God**: Acknowledge your need for divine guidance and help. Carson begins and ends each day with prayer, frequently asking God for wisdom and perspective, especially in difficult situations. His simple philosophy: Do your best and let God do the rest.
True success isn't about accumulating wealth but making meaningful contributions to our world by reaching beyond ourselves to help others. Some people complain they can't succeed because everything is stacked against them due to ethnicity, language, or socioeconomic background. Whether this is true isn't the real issue. What matters is giving our best at everything we undertake. If we trust in God's guidance while doing our best, we'll automatically conduct our affairs better than most others. Success isn't about comparing ourselves to others but simply asking: "Have I given my best?"
