As surgical director of the Lou and Jean Malnati Brain Tumor Institute at Northwestern Memorial Hospital in Chicago, Dr. James Chandler leads one of the country’s most respected brain tumor centers—in the top 10 of U.S. News & World Report’s latest medical guide. In addition to heading a team that performs hundreds of delicate operations a year, using state-of-the-art equipment, he continues to see his own patients—over the course of a 25-year career, having performed more than 6,500 surgeries.
“I wish everyone could experience the inner fulfillment and gratification you get in my role,” he says, likening it to saving someone who is dangling over a 200-foot-high cliff. “You pull them up to safety, and it’s the way they look at you. No words; just the way they look at you, and then you walk and do the next person, the next person, the next person.”
Chandler’s highly skilled rescue work makes him part of an elite community of specialist doctors where he, in turn, holds another notable place—according to the American Society of Black Neurosurgeons, less than 4% of the 5,600 or so active neurosurgeons in the U.S. are Black.
That lack of representation matters on several fronts. Because of his specialty, Chandler is acutely aware of two health challenges of particular concern for the Black community. “There are a lot of issues that revolve around brain health that plague our community in particular,” he says. Take strokes: Black people are 50% more likely to have a stroke than white people. For Black males, it’s 70% more likely.
Chandler isn’t just citing impersonal data here; both his parents’ deaths were tied to stroke. “It’s a real difficult problem in our community, tied to diet and blood pressure and exercise and just generally taking good care of yourself,” he notes.
The other big issue is dementia, whether that’s Alzheimer’s or another common factor, multi-infarct dementia (which means a lot of little strokes). With people living longer, dementia is becoming “a really significant health crisis because it’s such a difficult problem to manage,” Chandler says. “They’re really difficult patients to take care of. It just really challenges physicians and family members because there’s not a lot you can do.”
Though he and his peers are skilled at dealing with brain tumors, they are less confident about the causes. “I suspect at some point in time we will be able to tie this to environmental exposures and some genetic aberration,” he says, “but that hasn’t been sorted out [yet].” Many of his patients want to know why they developed a tumor: was it caused by a head injury or because they used a cellphone? “It’s none of the above,” he tells them. “It’s just a random event.”
One type of tumor, a meningioma—the most common primary tumor in the brain—is associated with radiation exposure. “So, individuals who may have had radiation for tonsils or acne back in the day, we see a lot of these individuals developing these meningiomas, but other than that association, it’s purely random.”
Finding purpose
Family tragedies played a significant part in turning Chandler’s general interest in medicine (“In high school, I’d enjoyed the sciences, and I thought it might be nice to be a doctor.”) into neurosurgery in particular. Between Chandler’s first and second years of college, his younger brother was struck by a car and paralyzed from the neck down. Remarkably, he recovered about 90% of his functioning over the next year, in large part due to the care he received from Dr. Charles Mosee, a respected Black neurosurgeon at Howard University Hospital in Washington, D.C.
Taking advantage of the connection, Chandler’s mother asked if he could spend time with the surgeon. Mosee invited Chandler to accompany him on his rounds and even let him sit in as he performed a major surgery that involved removing part of a woman’s skull and using a microscope to peel away a tumor that was robbing her of her sight.
“Later [Dr. Mosee] was sitting at her bedside, talking to her, and she was reporting that she could see better,” Chandler recalls. “After you see something like that, you think that would be kind of cool to do.” Chandler returned to college and took up a major in neurobiology, studying the brain and psychology. “I found it all fascinating to the point that when I went into medical school, I went in with the clear plan to become a neurosurgeon.”
There was a further nudge on his path. In his last year of training, when he had to decide which subspecialty to focus on, his first-born nephew was diagnosed with a brain tumor. The boy was operated on by Dr. Ben Carson, the renowned Black neurosurgeon who later served as Secretary of Housing and Urban Development in the Trump administration.
Sadly, despite Carson’s skills and follow-up radiation and therapy, the 7-year-old died a few months later. “I believe that everything happens for a reason, and losing my nephew really has given me empathy and sympathy for families and patients diagnosed with brain tumors,” says Chandler. “The passion that evolved in me during that whole experience, I’ve applied to my practice, and though I lost my nephew, it’s resulted in me saving thousands of lives over the years.”
Chandler’s career path was a long one. Graduating with a degree in neurobiology and behavioral science from the University of California, Berkeley, he then studied medicine at the University of Maryland School of Medicine. Seven years of neurosurgery residency followed, including fellowships in Sao Paulo, Brazil, and at George Washington University.
As well as leading the Malnati Brain Tumor Institute, Chandler is professor and vice chair of the Department of Neurological Surgery at Northwestern’s Feinberg School of Medicine. In 2016, he founded the hospital’s Skull Base Laboratory, which provides residents and practicing surgeons with specialist training.
“A big part of my responsibility is to teach the next generation, and that includes both medical students, but more commonly trainees. So every day I have neurosurgery residents, kind of in an apprenticeship situation, in the operating room, and then also in the outpatient clinic, seeing patients with me.”
Looking at incoming students, Chandler is concerned that the number of Black men following in his footsteps is decreasing. “It’s actually at crisis level,” he says, citing how enrollment at his school has dropped from 10 to 12 maximum per entering class to just two or three. It’s a trend that can be traced all the way back to elementary school, “where kids are not being encouraged to go into science.”
Chandler sees a couple of reasons for that decline: lack of awareness of the opportunities and lack of money. “I was fortunate to have parents who invested a lot in me and supported me on my journey and a good mentor in Dr. Mosee,” he says. “Most young children don’t have parents with the financial resources to help them through college, medical school, and beyond, and then they don’t have the mentors.”
Keeping on
While there’s an emphasis on academic excellence from an early age in those looking to pursue a career in medicine, Chandler speaks of “many individuals I’ve come across who are late bloomers.” So don’t count yourself out too early, he urges. “You could be an average student up until your last couple of years of college and do well and potentially get into medical school,” he says. “What I tell medical school applicants looking to get into neurosurgery is the most important thing is to be a hard worker, have compassion, have grit. Being brilliant helps, but it’s not mandatory.”
Though he eventually won his Northwestern position over hundreds of other applicants, Chandler didn’t shine immediately as he studied medicine. “Like many people, I had my failures along the way, and it wasn’t clear to me early on that I could overcome them and succeed,” he admits. “I had professors in college tell me, ‘You ought to maybe think about a career in nursing. I wouldn’t consider neurosurgery if I were you; it’s a very competitive field.’”
From that experience, Chandler offers this advice to his younger self: “Don’t let your failures define you, but let them refine you.” With the benefit of hindsight, he also emphasizes the importance of maintaining balance. “It was very easy to kind of get sucked into just being focused on academics and streamlining my academic focus,” he says now. “I wish that I had taken some courses in anthropology and English and created a more well-rounded foundation for myself because you think at some point in life you’re going to have time to do that, but I still haven’t.”
Compassion for others is a prerequisite for the medical field, naturally, but there are practicalities to consider too. Most current-day physicians graduate with debt anywhere between $500,000 and $750,000, “so the days of going into a primary care field and being able to live comfortably are gone. There’s increasing pressure to be in a subspecialized discipline just to be able to pay off your student loans and live a comfortable life with your family.”
And while it may be rewarding, a doctor’s life is demanding. Most physicians put in more hours than the average worker, Chandler says, and they can be emotionally and physically taxing. On occasions, those efforts at a cliff-top rescue don’t succeed: “Every now and then, as you’re pulling them up and looking at them in their eyes, they slip through your fingers to their death, to the rocks below, and they’re looking at you as they go. And you have to process that and then go to the next person and do the right thing. It takes a little while to work that out in your mind and be able to be at your best despite tremendous loss.”
That sort of challenge may explain why patients sometimes encounter a doctor who seems short or insensitive. “What I would say is if you’re dealing in particular in my field with a lot of death, despair, tragedy, people complaining because they’re in pain or otherwise suffering, your way of dealing with it sometimes is to put up a little wall because otherwise you’ll just be decimated emotionally,” Chandlers says, “and that’s what people perceive as a doctor who seems cold and indifferent.”
Try to absorb everyone’s difficulties, and you become wounded, he adds, and patients can sense that. “The real challenge is to be somewhere in the middle.”
Improving access
How does Chandler cope with the extraordinary stresses of his demanding work? “The first and foremost thing that I do is I work on my spirit, and I maintain my spirit,” he says. “I do a lot of praying.” He has just come from performing surgery on a young woman with a problematic tumor in a deep part of her brain for this interview, he tells WayMaker Journal. “I was praying for a good 30 minutes that God would give me some guidance. I have found that prayer gives me peace, gives me understanding, gives me purpose.”
Traveling helps him decompress and reboot, too, as does the occasional cigar and time with friends and colleagues, “usually over a nice dinner.” Then there’s family time with his 5-year-old daughter: “She helps me to recharge as well.”
In addition to trying to encourage more young Black men, in particular, to consider a medical career, Chandler also does what he can to address inequalities in terms of access to health care. “The real onus is on us as health care providers to take measures to bring down costs,” he says. “Because right now the pharmaceutical companies, the various instrumentation companies are driving up bills.”
By way of illustration, Chandler recalls a recent “straightforward brain surgery” he performed for which the patient was in the hospital for two or three days—the total bill: $270,000. At a hospital in Eastern Europe, where one of his former residents is now based, the same operation would cost $7,000.
“The point is there’s a lot that we can do on the provider side to make health care more affordable to all patients,” he says, “and that’s something that we talk about, and we think about on a regular basis. My doors and many physicians’ doors are open to anybody, insured or uninsured. It’s just a matter of doing your research to figure out what health care facilities accept your particular coverage, even if it’s free coverage.”
That free coverage he refers to is what is now available under the Affordable Healthcare Act, which he says everyone needs to know about. “It ensures that anybody can secure some form of coverage. And the reality is most major hospital systems and academic medical centers will accept that form of insurance. And, in fact, even if you don’t have insurance, if you come in through an emergency room, every hospital has to treat you.”
DR. JAMES CHANDLER: MY WAYMAKERS
Without question, the first and foremost would be my father. Intellect is, in large part, genetic, and my intellect I garnered from my father primarily. My spirit, my faith, comes in large part from my mother. My parents had the utmost confidence in me; they were instrumental in my becoming who I am.
Then there is Dr. Charles Mosee, because despite the fact that I had that family foundation, it takes a while to build up the competence in yourself to achieve certain goals. Seeing this Black man doing these amazing surgical procedures, his level of dedication and reverence and respect… Seeing it, you’re like, Wow, maybe I can do this.
From an interview with Louis Carr
