Into the Magic Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart

“‘I’m Jim,’ I said. Until that moment I was called Bob. My middle name is Robert. I can’t remember why I was called Bob. But for whatever reason, when she asked I replied, ‘Jim.’ And this was the name I would go by for the rest of my life.”

Although he likely doesn’t know it at the time, Doty’s decision to introduce himself as “Jim” is emblematic of the way in which meeting Ruth will change his life. It is not simply that Doty will become a new person as a result of the encounter, but rather that Ruth’s lessons will allow him to decide for himself who he wants to be, rather than letting those around him define his identity and worth. The above moment foreshadows this, with Doty choosing the name he wants to go by.

“I like being able to practice at something and get really good at it. I like that I am in control. Whether the trick works or it doesn’t work is only up to me. It doesn’t matter what anyone else says or does or thinks.”

When Ruth asks Doty why he likes practicing magic tricks, his answer is telling. Doty’s circumstances in life have conspired to make him feel powerless; the factors that make his life so turbulent—his family’s poverty, his parents’ struggles with mental illness and substance abuse—are entirely out of his hands. He’s drawn to magic precisely because it’s a way of exercising some control, and his words anticipate what will also be a key tenet of the “magic” he learns from Ruth: that by learning to control his own thoughts and feelings, he can take charge of his life, independent of “what anyone else says or does or thinks.” 

“Today when I go into an operating room, I can slow down my breathing, regulate my blood pressure, and keep my heart rate low. When I am looking through a microscope and operating within the most delicate parts of the brain, my hands are steady and my body is relaxed because of what Ruth taught me in the magic shop.”

Although Ruth describes visualization in particular as the technique that will allow Doty to change his life, all of the practices she teaches him are in fact vital to his future success. As he explains in this passage, even the apparently simple ability to relax his body—a practice Doty finds tedious at the time he’s attempting to learn it—ends up helping him realize his goal of becoming a neurosurgeon; before and during his residency, Doty earns praise for the “technical expertise” he brings to procedures that require extreme precision (186).

“The connection I had with Ruth and Neil was special and real. I’ve felt that connection with others throughout my life—sometimes it’s a random person in an elevator, where you look into each other’s eyes, and for reasons you can’t explain, there is a connection, not just simply eyes meeting, but some deeper knowing, an acknowledgment of each other’s humanity and the reality of being on the same path. And when that happens, it’s pretty magical if you really think about it.”

As helpful as Doty finds Ruth’s meditative techniques, much of the positive impact she has on his life stems simply from the care and attention she provides. Because Doty’s parents are so often preoccupied with their own problems, he spends much of his childhood feeling lonely and, as he puts it, “invisible” (27). For that reason, the mere knowledge that he has someone who will listen to and support him boosts his sense of self-worth and confidence. Doty’s “connection” to Ruth and Neil therefore offers an early example of the power of empathy and altruism, which Doty refers to here as its own kind of magic. This passage previews the way the idea of magic will evolve over the course of the book; a motif that initially evokes the power of visualization to “conjure” new realities ultimately serves to underscore the transformative effects of love.

“Today I know that the techniques Ruth was teaching me were in many ways age-old and had been part of Eastern traditions dating back thousands of years. Now science acknowledges that neuroplasticity is not only a reality but an inherent part of how the brain functions.”

One indirect lesson Doty draws from Ruth’s teachings is that science is not infallible. At the time Doty was learning from Ruth, few experts in neuroscience believed in neuroplasticity—the malleability of the brain throughout life. The idea itself was hardly a new one, however; as Doty notes in this passage, the meditative techniques Ruth taught him presuppose that an individual can in fact “rewire” their brain by focusing their attention in specific ways. Although this is now common knowledge in the scientific community, the fact that a blindspot existed around neuroplasticity for so long serves as a reminder of how much remains mysterious about the brain and its functioning.

“[T]his thinking about thinking—this ability of the brain to observe itself—is one of its great mysteries.”

At their core, the meditative techniques Ruth teaches to Doty rely on a feature of the brain that remains poorly understood: its awareness of itself. Although the brain sometimes changes in response to external influences, it can also think about and act on itself, and while this ability is clearly linked to the brain’s physical properties, it’s difficult to explain in these terms. Doty is an atheist and doesn’t go so far as to ascribe this phenomenon to a soul. He does, however, acknowledge the limitations of science in explaining consciousness, and he recounts experiences (e.g. an apparent after-death visitation from his father) that could be taken as evidence that consciousness is not a strictly physical process.

“When our hearts are wounded that’s when they’re open. We grow through pain. We grow through difficult situations. That’s why you have to embrace each and every difficult thing in your life. I feel sorry for people who have no problems.”

Ruth’s thoughts on the relationship between hardship and empathy are significant in light of the course that Doty’s life ends up taking. In many respects, Doty’s early experiences in life do condition him to be more compassionate. His interest in plastic surgery, for example, stems in large part from his identification with children with facial deformities; the fact that they have “wounds they [can’t] hide from the world” reminds Doty of the shame he felt surrounding his family’s poverty (177). On the other hand, it’s that same experience of poverty that drives Doty to spend decades prioritizing the pursuit of wealth over human relationships. This pursual suggests that it isn’t so much the experience of hardship but rather (as Ruth notes here) one’s response to it that matters. Instead of “embracing” his childhood suffering, Doty tries to escape it by becoming a multimillionaire. Ironically, however, this only reinforces his childhood anxiety about having “enough” money, and he remains as “alone, and scared, and lost” as he was as a boy (225).

“Rather than passively waiting for instructions from the brain, the heart not only thinks for itself but sends out signals to the rest of the body.”

Although it’s common practice to figuratively associate the heart with love and compassion, Doty makes the case that there is also literal truth to the idea. His point is not simply that emotions are often physical as well as mental, but that the heart in particular is a site of experience and intelligence; as he notes later on, “there are far more neural connections that go from the heart to the brain than the other way around” (230). Similarly, the practice of “opening one’s heart” actually correlates with changes in heart rate variability: “Feelings of love and compassion are associated with an increase in HRV, and when we feel insecurity, anger, or frustration, our HRV decreases” (96).

“[E]verything you put on your list, everything you feel in your heart, everything you think about and imagine with your mind, if you truly believe, if you work very hard, will happen. You have to see it and then you have to go after it. You can’t just wait in your room. You actually have to get good grades, and go to medical school, and learn how to be a doctor. But in some mysterious way you will also be drawing it to you, and you will become what you imagine.”

Ruth’s explanation of the way visualization works aligns with the book’s explanation. As Doty goes on to explain, much of visualization’s ability to influence reality stems from the effect it has on the practitioner’s brain; for instance, a person who imagines a particular goal over and over will be more likely to “go after it,” simply because of the brain’s preference for whatever is familiar. In other words, visualization works in large part because it changes the practitioner in ways that enhance their ability to change their external circumstances. With that said, both Ruth and Doty suggest that there is an element at play in visualization that eludes easy explanation; Ruth’s remark about “drawing” a particular future towards oneself anticipates Doty’s suggestion that visualization involves directing the “energy of the universe” to achieve particular results (150).

“‘You get what you expect’ can be a simple idea delegated to a New Age, feel-good thought or a powerful example of neuroscience and brain plasticity.”

As Doty explains here, the idea that meditation could have real-world effects is in many ways a scientific rather than (or in addition to) a spiritual one. Techniques like visualization rely heavily on the brain’s plasticity; the fact that the brain is malleable means that a person who intensely imagines a particular goal is wiring their brain in a way that facilitates their pursuit of that goal. To illustrate this point, Doty offers the example of an athlete visualizing “the perfect jump shot, the hole-in-one, a home run hit high past center field” (134); in doing so, the athlete “creat[es] neural patterns in their brain that actually enable their muscles to perform in new ways” (134).

“I think you have given us a perspective that too often we ignore. We forget it’s a human being who sits before us, not a file. While many have fulfilled all the criteria we require, in many ways, the criteria are arbitrary. It took nerve to come before us. It took passion and bravery to share what you shared.”

Doty’s successful effort to change the minds of the premed committee is important for reasons beyond the obvious impact on his career. For one, Doty likely wouldn’t have risked confronting the committee if he hadn’t become so used to imagining himself as a doctor. As he puts it, “The image of me in a white coat wasn’t imaginary; it felt as real to me as if I were looking at myself in a mirror” (163); in other words, visualization has made Doty’s goal so familiar to him that he’ll go to great lengths to secure it. The episode also highlights how much Doty’s self-image and self-esteem have changed in response to Ruth’s teachings; he’s no longer willing to simply accept others’ views of him, and in fact challenges the committee to see his academic struggles in the context of his broader life story. This speaks to what is perhaps most important about the interview: the reminder Doty provides that “it’s a human being who sits before [the committee], not a file.” In many ways, this passage anticipates Doty’s own eventual realization that everyone “[has] a backstory” (249), and that this basic commonality can be the basis for empathy. Whether he realizes it at the time or not, Doty is able to change the committee’s minds in large part by (as Ruth would put it) opening their hearts.

“Suddenly I woke up. I wasn’t sure what woke me up. I was just up and awake with my eyes wide-open. I looked around, and at the end of my bed was my father. He looked at me. He looked well. Better, in fact, than I had seen him for a long time. He was calm and had a look on his face that wasn’t a smile but a look of kindness and acceptance.”

The visit Doty’s father pays his son is one of several mysterious and potentially supernatural events in the book. The event likely occurs just as Doty’s father is dying, and while the timing may simply be coincidental, it allows for other interpretations: that Doty’s father’s spirit visits him to say goodbye, or that Doty—whether awake or dreaming—is somehow attuned to the moment his father passes away. The episode is therefore a possible instance of human consciousness behaving in ways science struggles to account for. Doty himself, at least, never tries to explain the incident, despite the powerful effect it has on him; his relationship with his father was fraught for much of his life, so this final exchange is an important reminder of his father’s love.

“Who was I? Was I the guy Oscar Wilde described, the one ‘who knew the cost of everything and the value of nothing’? I spent a good deal of my life trying to reconcile my inner Slick Goodlin and my inner Chuck Yeager.”

The line from Wilde that Doty includes in this passage is very much in keeping with the way money and value function more broadly in the book. Wilde’s quote draws a contrast between those who see the world primarily in terms of monetary value and those who see it in terms of figurative value (moral, aesthetic, etc.); it also suggests that the former are more inclined to negativity, thinking solely of what things will “cost” them. The reference to Slick Goodlin and Chuck Yeager—two pilots—further underscores the distinction; whereas Goodlin wanted to be paid a fortune to become the first man to break the sound barrier, Yeager agreed to do it simply “out of a quest for adventure and a spirit of discovery” (178). At this point in his life, Doty is torn between similar competing drives; he wants to become a plastic surgeon in part out of a desire to help those in need, but also because it’s a lucrative profession, and he’s still haunted by memories of his childhood poverty.

“I know now that my years of practicing what I learned in the magic shop had developed my brain so that I had the ability to memorize more easily than many of my fellow students. I could focus for much longer periods of time on my studies, and I never complained about my mind wandering off while I read medical textbooks.”

One of the major ways in which meditation changes Doty’s life is by improving his ability to focus—a skill that is essential not only in studying medicine, but in practicing it. The mindfulness techniques that Ruth teaches Doty—observing his breathing, repeating a mantra, or watching a candle flame—are in essence exercises in attention; they train the practitioner to notice when their mind is wandering and to continuously reorient their attention around a single sight, sound, or sensation. Although Ruth’s primary goal in teaching these exercises is to help Doty quiet his negative thoughts, the benefits are wide-ranging, and include improved performance in academic settings: “A 2013 study by researchers at the University of California, Santa Barbara, found that focused-attention meditation training improved memory, focus, and overall cognitive function in undergraduate students after just two weeks of practice” (180).

“There was something about going where no one had gone before, into the deepest recesses of what makes us human, that called to me.”

Doty’s description of his interest in neurosurgery is noteworthy for the way in which it echoes language surrounding meditation. Doty often draws on the idea of meditation as a journey inward—one that results in greater knowledge of oneself and one’s untapped potential. Similarly, a neurosurgeon explores the “deepest recesses” of the brain both on the operating table and in their research. With that said, it’s significant that Doty here identifies the brain as “what makes us human,” given how much emphasis Ruth placed on opening the heart. Ultimately, Doty will conclude that much of our humanity exists in the external world, and in our interpersonal relationships in particular; any journey inward needs to be paired with a journey outward if it aims to learn more about what it means to be human.

“It was like watching a play, and at the same time I could feel both the frustration and fear of the vice chairman, and the pride and certainty of the chairman. I could feel what everyone in the room was feeling.”

Although not as dramatic as the near death experience that follows, Doty’s out-of-body experience is significant for many of the same reasons. In retrospect, Doty suggests that his NDE might have been “a warning sign that [he] was straying too far away from what [Ruth] had been trying to teach [him]” (203); Doty not only sees Ruth during his NDE, but he also experiences an all-encompassing sense of love and oneness that is very much in keeping with her emphasis on opening the heart. Similarly, during his out-of-body experience, Doty’s sense of empathy is heightened; in the above passage, he describes being able to experience multiple people’s emotions all at the same time (a phenomenon that is also, like the NDE, difficult to explain scientifically).

“We spent the next two hours reviewing my stock and the charities I wanted to gift. By the end I felt important. Generous. And the lonely, hollow feeling I had woken up with was gone.”

The sense of satisfaction Doty feels after (he believes) putting his Accuray stocks in an irrevocable trust is an indication of where he has gone wrong in life. Particularly since exchanging medicine for investment, Doty has prioritized the pursuit of wealth; by the time he makes the above decision, he is a multimillionaire who owns homes all around the world. Nevertheless, he struggles with a nagging sense that something is missing. Just what that is becomes clearer in this passage, as Doty finds real happiness in the knowledge that he’s helping others. In the moment, however, Doty doesn’t seem to recognize the significance of this; it’s only when he loses his fortune that he comes to understand the human need to feel connected to one another.

“It seemed that all of my friends disappeared almost as quickly as the zeros in my bank account.”

In losing his wealth, Doty also loses most of the relationships he had managed to cultivate or hang onto during his rise to the top. Although this speaks in part to the opportunism of those around him, it’s also a reflection of Doty’s own priorities during that period of his life. As he notes earlier in the book, opening the heart leads to change “not only in how we see the world but in how the world sees us. And in how the world responds to us” (151). In other words, acting from a place of compassion is likely to be repaid in kind. An example of this occurs when Doty tells his parents—then in the midst of arguing with one another—that he loves them; his mother and father are so moved that they set aside their own preoccupations to reassure their son. At the height of his fortune, however, Doty is not acting primarily out of empathy or altruism, and the social connections he forges are correspondingly shallow.

“The grand finale of the magic that Ruth taught me was the ultimate insight that the only way to truly change and transform your life for the better is by transforming and changing the lives of others.”

The above passage sums up the major point Ruth and Doty make about the importance of opening the heart. It’s not simply that neglecting to do so risks hurting others, but rather that it inevitably hurts oneself; as much as a person might think they know what they want, they’re likely to be disappointed if they don’t factor in the innate human need for love and connection. In fact, relying heavily on cognitive “tricks” like visualization can actually exacerbate loneliness and self-absorption, given that “[t]he mind wants to divide and keep us separate” by “teach[ing] us to compare ourselves, to differentiate ourselves, to get what’s ours because there is only so much to go around” (229). For that reason, Doty argues that the ultimate “magic” is not actually the mind’s ability to change external reality through meditative techniques, but rather the way in which a compassionate and generous use of those techniques can change the mind.

“[U]ntil one is truly kind to oneself, giving love and kindness to others is often impossible.”

Like Ruth, Doty stresses that practicing compassion for others necessarily involves practicing compassion for oneself. On the face of it, this might seem strange; in fact, when Ruth tells Doty he’ll likely find caring for himself difficult, he finds it hard to believe. Self-compassion, however, is not the same as self-centeredness; on the contrary, Doty suggests that harsh self-criticism is often its own form of self-absorption. He describes, for instance, how insecurity can be a barrier to forming meaningful relationships with others: “We want to tell and show others how important we are. How much better we are than someone else. [...] We are searching for acknowledgment of worth outside of ourselves. Yet doing so separates us from others” (244). By contrast, the practice of extending empathy to oneself means acknowledging one’s faults but also forgiving them as fundamental part of the human experience. The resulting self-awareness, coupled with the acknowledgment of shared humanity, leaves one better positioned to extend the same empathy to others.

“I had begun to let go of the story that had defined my life. I had made an identity out of my poverty, and as long as I carried that identity with me, no matter how much wealth I accumulated, I would always be living in poverty.”

The idea that Doty ever “makes an identity out of his poverty” might seem counterintuitive, given how much of his life he spends pursuing wealth. However, this very pursuit is itself inseparable from the fear and shame he felt as a child growing up in poverty; he seeks money and success out of a desire to prove his worth to himself and others, as well as in the belief that he’s insulating himself against suffering. As a result, he continues to “live in poverty” both in the sense that his mindset remains unchanged, and in the sense that his need to distinguish himself from those around him cuts him off from what is actually valuable: his relationships with others.

“The more I talked to June, the more I saw her anxiety dissipate. She needed to tell her story and she needed to know that I heard her story and knew her as a person.”

Like most of the anecdotes Doty shares about his patients, this one serves a thematic purpose. June’s story is in some ways about the drawbacks of practicing empathy as a surgeon; when Doty is operating on June, he momentarily loses his composure as the weight of his friendship with, and responsibility to her, hit him. Nevertheless, it’s clear from the above passage that compassion plays an important role in medical settings; the mere knowledge that her doctor “knows her as a person” is enough to alleviate much of June’s fear about the surgery. In fact, social connectedness has a profound impact on mental but also physical well-being; Doty notes, for instance, that conversation is often a more effective way of treating his patients’ pain than actual painkillers.

“Many misinterpret Darwin by implying that survival of the fittest means the survival of the strongest and most ruthless, when in fact it is survival of the kindest and most cooperative that ensures the survival of a species in the long-term. We evolved to cooperate, to nurture and raise our dependent young, and to thrive together and for the benefit of all.”

After returning to Stanford, Doty makes it his mission to study the physiological underpinnings and effects of compassion and altruism. As it turns out, empathy has a strong neurological basis; areas of the brain associated with nurturing automatically activate in response to another person’s suffering, while those associated with pleasure light up when providing someone with help or comfort. Doty further suggests that this innate capacity for altruism is precisely what has given humans an evolutionary edge; humans have thrived not so much because of our strength or even our ability to outsmart competitors, but rather thanks to our tendency to help one another. The implication is that humans’ success continues to depend on empathy and altruism, and that societies that deny this fundamental reality will not survive.