Outside the Box

When the media spotlight found Dale Swift ’80 in 2003, as he was helping to separate Egyptian twins joined at the skull, it introduced us to a pediatric neurosurgeon who’s not afraid to bypass conventional wisdom to do things better.

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Swift graduated from the Case Western Reserve University School of Medicine in 1984. "Medical school was great. There’s so much to learn. If I had won a million dollars and didn’t ever have to work, I would still have gone to medical school."

Likewise, neurosurgery was an easy choice.

"The brain is fascinating. But I don’t have the patience to sit around just thinking about it. I have to do something."

During his internship and residency at Columbia Presbyterian Hospital in New York City, Swift saw that most doctors shied away from pediatric neurosurgery. The risks with young patients are high, and you have to deal with frantic parents. Such a challenge appealed to Swift: "I decided it was an area where I could make a difference."

After a one-year fellowship in Pittsburgh, Swift joined Neurosurgeons for Children in 1992.

Debera Nwaeze has worked as Swift’s assistant for eleven years. She has motherly instincts – she protects his time, nags him about his workload, and wears her pride on her sleeve ("I keep e-mailing Oprah about him").

Nwaeze has seen Swift’s life evolve from the bachelor who often worked all night to a family man. Swift and his wife, Denice, have two boys: Kohl, seven, and Isaac, six. "I’ve been through the dating, the marriage, the babies, the dog. Now," Nwaeze rolls her eyes. "we’re renovating the house."

Not that much of Swift’s life mirrors the Cleavers. He and Denice have taken the boys, even as babies, as far as Peru and India for teaching stints and medical meetings. The family spends two weeks every summer in a cabin they built on a remote Alaskan island without electricity.

Being a brain surgeon affords him instant respect, but the glamour is largely lost on Swift. He drives an older Volvo with nearly 120,000 miles on it, the seats piled high with stuff and the dome light hanging, broken. Dressed in a stylish suit one morning to give a deposition for lawyers, he complains that he feels like a kid having to dress for church.

At dinner parties, "I try really hard not to say what I do. I say I work in a hospital, or something like that. Once I say I’m a neurosurgeon, the conversation just stops, and everybody wants to know about brain surgery."

Brain surgery suits Swift on many levels. There’s the mental puzzle of diagnosing a problem and deciding how to fix it. There’s the manual work of surgery, which he finds satisfying. And there’s the fulfillment of helping people.

"My work isn’t trivial," he acknowledges.

Those who work daily with Swift make fun of his manic energy but admire his enthusiasm. They know him as an inveterate teacher. Trish Williamson, one of three nurse practitioners in the practice, remembers how he once drilled her, as a nursing student, on the layers outside of the brain – while he was operating.

"We’ve got lots of egos here," Williamson says. "Doctors are like nurses, notorious for eating their young." But she has seen Swift swoop in and deflect criticism when another doctor starts belittling a resident. "It’s more conducive to learning when someone has a positive approach like his. He’s so willing – he’s always saying, ‘Come with me and see this.’"

Swift is teaching even when he meets with patients’ parents. His manner is kind but direct. By the time they see a neurosurgeon, most families feel numb or defeated. Swift believes in giving them plenty of information, in Spanish if necessary, to detail the procedures or options. "It’s often over their heads," says another nurse practitioner. "But he sees the highest risk patients, and those parents may need to hear something over and over."

At weekly meetings of the tumor board, a collection of some thirty radiologists, oncologists, and surgeons, Williamson has watched Swift sit back, listen to the discussion, then raise questions about the clinical rationale for certain decisions. "He must do a lot of continuing education, because he’s always citing research studies.

"He likes to think outside the box," she says. "We had a young boy in the hospital for weeks. The plan was that once his infection cleared up, we’d put a shunt in his brain (to drain fluid). Weeks one, two, and three went by with each doctor on call saying, ‘We’ll do the shunt as soon as he gets rid of the infection.’ Week four, Dr. Swift is on call. He says, ‘Why are we putting a shunt in?’ And the kid went home."

One of Swift’s newest challenges is to find the right balance between work and home. The job is winning; he wants to spend more time with his family.

Fatherhood has changed Swift’s perspective at work. "I was empathetic and sympathetic even when I didn’t have kids. But now little things get to me, like if it takes two tries instead of one to get an IV line in. That bothers me more now."

For the long-term, he hopes to pursue research in hydrocephalus, the so-called "water on the brain" condition of too much cerebrospinal fluid around the brain lobes. He has an idea for an alternative to implanting shunts. Such an accomplishment would be "what I’d like to be remembered for."

But research could never keep Swift out of the OR.

"I can’t not take care of patients. It’s too fun."

With that, Swift is up on his feet. Enough time sitting around philosophizing. He’s got three patients to see this afternoon, and he’s running a little behind.

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