The promise of renowned neurosurgeon Charlie Teo
Luke Westaway was being woken by anaesthetists after another operation on a brain tumour. This awakening usually happens quickly, so medics can determine if any damage has occurred during surgery. There followed a series of questions, and Luke reassuringly answered the first few regarding his name, year and the number of fingers the medic was presenting. Then Luke was asked what kind of operation he had just undergone. There was a pause. “Penis enlargement,” he said. The nurses laughed. A part of his tumour remained, but so too his sense of humour.
Luke Westaway was a popular but fatally unlucky man. Nine years before that operation, he was first diagnosed with a brain tumour. Luke was 21, fit, handsome. He was working out at a gym one evening in late 2004 when he collapsed. Subsequent brain imaging was unclear. In March the following year, he collapsed again. Brain scans revealed a tumour. Yet over the next nine years – between multiple operations – he graduated with an education degree and began teaching at Hambledon State School in Cairns. “He was the guy at the party you’d always want to sit next to,” his mother, Angela, tells me. “Friends of his would joke that you wouldn’t want to go to the toilet, because you’d lose your seat.”
Luke would post updates on Facebook. There were good days, weeks, months. And there were bad ones. In 2013, Luke was told the tumour had spread – and that it was inoperable. His family had heard of the “miracle” work of the neurosurgeon Dr Charlie Teo, and sought a referral. Specialists declined. They eventually secured one through a general practitioner.
Dr Teo was famed for his minimally invasive surgery, maximal optimism and the scepticism of his peers. The Westaways had heard Teo would undertake operations that other surgeons deemed “inoperable”. But it would come at the cost of many tens of thousands of dollars. The family began fundraising. There were online appeals, clothes sales and community-organised car washes. There was no shortage of volunteers or donors. The value wasn’t only in the money raised, but the knowledge that their plight had inspired the generosity of strangers.
In 2014, Teo performed the final operation on Luke Westaway’s brain. The local newspaper published an article with the headline “Cairns man gets new lease of life thanks to surgeon Charlie Teo”. Unfortunately, the article was premature. Luke Westaway died three months later. Angela tells me that, prior to the operation, Luke’s prognosis was for only two weeks. “Dr Teo gave us three more months,” she says. “Three more months of smiles.” On hearing of Westaway’s death, Teo sent the family flowers. He called Angela, and they wept together. “He’s a decent human being – I can’t say one negative thing about him.”
Not long before his death, Luke Westaway was also diagnosed with testicular cancer, and a testicle was subsequently removed. Angela says it was unrelated to the brain tumour. It is a sorrowful tale, and it questioned the faith of his mother. “I’m still angry at God,” she tells me. “The pain never goes away – you just get used to it.”
Angela is insistent on one thing: the skill and humanity of Dr Charlie Teo. There are many families who feel similarly.
A fortnight ago, I received a letter from an Australian neurosurgeon. Something had been “gnawing” at the surgeon for some time, prompting the correspondence – the reputation of their famous peer Charlie Teo. The surgeon wrote that they knew of many patients who had used their life savings or sold family assets to undergo surgery with Teo that was of dubious value or could otherwise have been performed free in the public system. In some cases, bereaved, single parents were left destitute. “If you’re referred a patient with the comment ‘They’ve been to Charlie’,” the letter said, “this means they have lost all trust in the public system and have likely spent an enormous amount of money that had been set aside for something else on an operation that has left them so damaged that they have a very poor quality of life.”
Charlie Teo is blunt, talented and self-assured. He promotes himself and is popularly celebrated as an outsider in a rarefied field. His is the image of a bagpipe-playing, high-powered-motorbike-riding, Chinese-Australian neurosurgeon – an enemy of pomposity and received wisdom. As a boy, he modelled himself on John Wayne – a fact that amuses those peers who have called him a cowboy.
Teo is adored by the families of countless patients. He was a state finalist for Australian of the Year, founded the Cure Brain Cancer Foundation, and appears regularly on radio and television – often to condemn his peers for their rejection of him, which he has variously attributed to jealousy, snobbery and, more gravely, their guilt at having “sent people to their graves” by their cowardly reluctance to perform operations he embraces. Many specialists will decline referrals to Teo not because of any lack of skill – even his critics tell me of Teo’s “good hands and technique” – but because of what they describe as unjustified risks and cost. These, they say, can leave patients disabled and families impoverished. I am told by a number of neurosurgeons – all of whom wished to remain anonymous to avoid “public vilification” – that the vast majority of their colleagues feel this way. “But no one wants to shoot Bambi,” I am told ruefully.
It seems mandatory for journalists to describe Australia’s most famous living surgeon as “charismatic and controversial” – that specific phrase is ubiquitous – and while there’s plenty of evidence for the former, the controversies rarely receive examination. A neurosurgeon I spoke with believed the media was reluctant to properly consider criticism of Teo, instead favouring a narrative of the virtuosic rebel.
Are his peers simply jealous? The weight of media reporting favours this conclusion: there is much less coverage of his peers’ arguments. Teo has long suggested that he is more skilful, courageous and technically advanced than his peers – and that this causes them embarrassment. When he made statements to this effect on the 60 Minutes program in 2007, the Neurosurgical Society of Australasia placed an advertisement in The Australian newspaper in response. In part, it read: “Dr Teo stated in the interview that ‘no brain tumour is inoperable’ and while this may be true the term ‘inoperable’ is not used to describe whether a tumour can actually be removed. Whether a tumour is inoperable or not is a matter of opinion regarding the potential risks of brain injury, stroke or death weighted against the potential benefits of the surgery. Classifying a brain tumour as inoperable is not a sign of fear, incapability or lack of competence.”
Neurosurgeons, in consultation with specialists, will determine the risks of operating. This calculus will depend on the circumstance – is it an aneurysm or tumour? What type of tumour? Is it benign or malignant? What are the odds of death from the disease, and what are the odds of dying from the operation? What are the chances of profound damage resulting from surgery – and how can this be weighed against extending a patient’s life for six months?
This is a crude and arbitrary list of variables – a comprehensive one would comprise many thousands of words. “Often it is better to leave the patient’s disease to run its natural course and not to operate at all,” writes the British neurosurgeon Henry Marsh in his eloquent, confessional memoir Do No Harm.
But Teo poses the question “what if?” – what if he could save a life, and the patient wants him to try? “There was this little girl in Singapore,” Teo tells me. “Her tumour looked malignant. The mother was irate. I didn’t have my instruments. And I said to them that there was a 95 per cent chance that this operation was futile – or even the chance that she’s put on a ventilator. As it transpires, that little girl is saved. It wasn’t malignant.
“There was another man – I bought him 16 weeks of life. He wrote to me thanking me for those four months. In that time, he had bought a dog and named it after me. He got married. That’s worthwhile. I don’t want to judge them or tell them there’s better things to spend their money on. I personally would buy the chance for extra time with loved ones.”
In 2011, the District Court of Western Australian heard a case against two doctors – a neurosurgeon and oncologist. The plaintiffs were the parents of a young man, Daniel Jordan, who had been diagnosed with a brain tumour in the late 1990s. He was 11. The plaintiffs alleged that the doctors had negligently delayed potentially life-saving surgery – surgery that Charlie Teo would perform in 2000. Teo was called as an expert witness on behalf of the plaintiffs, but the case was dismissed by Judge Bruce Goetze. In his 2012 decision, Goetze said of Teo’s evidence: “Dr Teo is clearly passionate about the resection of brain tumours as providing the best chance of a cure. It seems, however, that, on this occasion, Dr Teo has allowed his passion and his subjective involvement in Daniel’s treatment to interfere with his objectivity and impartiality as an expert witness when writing his reports in that they are not balanced reports given his concessions in oral evidence. Further, his passion for the cause of resection and his involvement with Daniel has caused him to exaggerate Daniel’s neurological condition in 1996 with gross intracranial pressure, dying and being in extremis, so as to justify his call for resection from then onwards.”
When surgeons decline to refer patients to Dr Teo it is often because they believe he assumes too great a risk of injuring the patient – not because of any presumed incompetence, but simply because of the inherent risk of the operation. “Charlie gives the impression that only he can do [these types of operations],” one neurosurgeon tells me. “That’s not true. Appropriate treatment is available in the public system. What is ‘unique’ about Charlie is that he is prepared to do operations with a very high risk-to-benefit ratio. He is prepared to cause neurological deficits in patients on the grounds that there is hope that it might give them some benefit.”
To read about Charlie Teo is to see the man less as a skilled surgeon – which he is – and more as a broker of miracles. I wondered if his outsized stature, which he has assiduously cultivated and resembles mystique more than mere reputation, might exaggerate his patients’ faith in him. Reading articles on Teo, one encounters the word “miracle” with unsettling frequency – only to see corresponding obituaries weeks or months later. In October 2015, the local Lismore newspaper, The Northern Star, published an article titled “How we helped you save Jackson Byrnes”. Two months later, the paper published news of Byrnes’ death. In June 2011, Toowoomba newspaper The Chronicle ran a story with a headline that similarly mixed hope with self-congratulation – “Local generosity saved Peter’s life”. The man in question died less than a year later. October 30, 2015, Rockingham’s Weekend Courier writes: “Madison’s future looks brighter after brain tumour”. She died in May 2016. There are many more examples.
“Teo’s grandstanding detracts from the many neurosurgeons who have spent their lives committed to working hard in the public health system to provide the excellent care that is available in Australian public hospitals,” a neurosurgeon told me. “The publicity also creates a sense of: ‘If you haven’t seen Teo, you haven’t done everything possible’, so we have pensioners who fly to Sydney for a consultation they can’t afford.”
Routinely, I encountered articles that celebrated “life-saving” operations on people who were suffering terminal illness. The misleading optimism and sloppiness of this reporting is not Teo’s fault, but I asked him if these stories bothered him, and if he thought he needed to temper his reputation. “Some of the media reports [exaggerate],” Teo admits. “But I am honest with my patients. I tell all my patients that it has a 100 per cent mortality rate. They know – and I know – that tumours can come back again. There are some cases that are curable, but they are far and few between.”
This is a pattern with Teo – he can be disarmingly frank, as in the above quote, but just as easily say, “I’ve saved thousands of people”, as he told the ABC last year. “Patients say, ‘The doctor told me I was going to die but Charlie’s offered me hope,’ ” a neurosurgeon tells me. “Charlie says he tells them there’s 100 per cent mortality – which is the same as ‘you’re going to die’. What is the disconnect? Surely if the patient goes to the community to raise money for ‘life-saving surgery’ for a condition with 100 per cent mortality there has been a failure of communication. Shouldn’t he be conveying the message better?
“I’d say that it’s almost impossible for patients to give true consent because they’ve already been sold the dream. They are there because they don’t want to listen to the people who are telling the truth.”
But according to Teo, hope is hope. In 2015, he gave a TEDx talk in Sydney, titled “False hope? There’s no such thing.”
These expectations are arguably increased by Teo’s suggestions of his own superiority. His peers tell me that if his results really are markedly better, he should provide the evidence – and they offer Professor Michael Morgan as one neurosurgeon who publishes audits of his operations. It’s an argument echoed in the 2007 letter from the Neurosurgical Society of Australasia. “If a neurosurgeon considers that he or she has developed a treatment which provides superior results, they have an obligation to the community to disseminate the information to all practitioners. The usual method to do this is to present the technique and results at a scientific gathering of their colleagues so that the methods and results can be peer reviewed and confirmed.”
A neurosurgeon told me: “It is difficult to know if Charlie Teo’s results are any better than average because they are not published, but anecdotally they are not … In neurosurgery we all have disasters. In order to be sure you are providing benefit, you need to count the disasters and the successes and see if you end in a positive balance. Debate about [a suitable] ratio between disaster and success is appropriate and some people say you should never damage anyone even if by doing that you miss saving others, but everyone agrees you have to count both sides. Charlie seems to only count the wins. It’s like he’s a bowler who only counts wickets, without taking into consideration the overs or runs.”
Teo tells me he’s published plenty of papers – and medical literature databases confirm his authorship of many articles – but his critics say that, while publishing on technical matters, there is nothing to indicate that Teo’s survival outcomes are any better.
Teo speaks often about “patient autonomy” – after detailing the risks of an operation to a patient, he must respect their decision. Who is he to tell someone what an ideal quality of life might be – or to deny them the ability to make their own decisions? “One of the errors I made when I was younger was I projected my ideas of quality of life upon my patients,” Teo told me. “I now realise it’s wrong. My patients will ask me what I would do. That’s a hard question. I’m physically active, but patients tell me quality of life is different to mine. A life in a wheelchair might be acceptable. Patient autonomy is paramount. I don’t belittle evidence-based medicine or a surgeon’s autonomy, but patients come first.
“I spend an hour, hour-and-a-half, with my patients [during consultation]. I find common ground. Learn about their vocation. I get on their level. If they’re completely unrealistic, I’ll confront them. If their judgement is clouded, we’ll have a long conversation. What pisses me off is my critics don’t know I do this. But my registrars go away talking about my authenticity and they become my greatest followers.”
One neurosurgeon laughed bitterly at the notion of patient autonomy, and the implication that Teo’s critics don’t put their patients first. “Patient autonomy is nonsense,” they told me. What’s more, the neurosurgeon said, given a patient’s terror, desperation or denial, informed consent is simply impossible. It’s a sentiment found in Henry Marsh’s memoir: “ ‘Informed consent’ sounds so easy in principle – the surgeon explains the balance of risks and benefits, and the calm and rational patient decides what he or she wants – just like going to the supermarket and choosing from the vast array of toothbrushes on offer. The reality is very different. Patients are both terrified and ignorant.”
Another told me: “I have a moral objection to a doctor profiting financially from patients at a time when they are incredibly vulnerable and desperate.” Yet another said: “What’s really the worst thing, even worse than the false hope and the damage he does, is the amount of money he charges. Getting people to mortgage their house … so they don’t have the money for the important things that they need to do in their dying days.”
A common criticism of Charlie Teo regards his ego – he’s been described publicly, or privately to me, as narcissistic, “unsurpassably arrogant” and having “unbridled self-belief”. At some level, it seems churlish to scorn a neurosurgeon’s self-regard – they perform life-altering procedures on an organ of brilliant and partially mysterious complexity. Assuredness of one’s ability is crucial when performing brain surgery – an errant, submillimetre cut can erase memories, induce paralysis or provoke catastrophic bleeding. And Teo is assured. “I don’t blame you for writing the article,” he says. “I have, rightly or wrongly, created angst amongst my colleagues. But the truth is here in my office. Speak to my fellows. It’s terrible what’s happening [to me] – you can’t be a prophet in your own land. If I’m not doing something incredibly special and unique, why is Deakin University sending their fellows to learn from me? Or why am I being invited overseas to operate? There’s a disconnect. I’m not saying don’t write the article. But you can’t bullshit for 30 years. I’ve been in this game for 30 years – and never been sued.
“These arseholes who say I charge a lot of money – when I came back from the States those fuckers didn’t give me any operating time, no support, so of course I went private. It gives me the shits when they say I’m in it for the money. I do more pro bono work than anyone in the world that I know of. Singapore, for example. They give me a thousand dollars for each operation, which I donate. In India, it’s pro bono. I’m willing to do pro bono work in each state in Australia, if they’re willing to sponsor me.”
The suffering of the Westaways is intense, but is genuinely tempered by the additional three months provided them, they believe, by the skill of Dr Teo. This cannot be ignored. Similar testimony abounds. Angela is full of sincere faith and gratitude for the neurosurgeon – as well as for the other doctors who assisted Luke over the years. The neurosurgeons I spoke to were insistent that their criticism of Teo was not a criticism of the patients who chose him. “We do not decline further treatment lightly,” I was told by one surgeon. “None of us want to see these people die. If there’s surgery that would help, we would do it. These poor people are in a terrible position.”
The way we discuss dying in this country is strange. We apply metaphors of war and sport and, having transposed a patient into a soldier or Olympian, assume mortal illness to be an enemy that can be vanquished with courage and fortitude. One must always rage against the dying of the light, however futilely; to do otherwise is cowardly or perverse.
But surely acceptance can be graceful and courageous. When my father was diagnosed with what was likely terminal cancer, he declared no self-pity and knew he could still influence a future in which he wouldn’t feature. That future was his young children’s. He began ordering his finances, made phone calls to the tax office and his super fund. Sought appraisals on the value of our home – selling and moving to a smaller property would provide Mum with more funds for our care. The work was undertaken diligently. There was no theatre.
Perhaps there was an earlier rehearsal for this plain, self-effacing courage – my father lost his mother when he was nine, and only five years after his father had returned from three years in Changi. Dad absorbed early lessons of pain and injustice, but also of the importance of “getting on with things”. Told he would probably die, he was now getting on with securing basic financial stability for his kids. “I find it interesting to compare Georgia Blain’s acceptance of her mortality with Chris O’Brien’s Never Say Die,” a neurosurgeon tells me, referring to the late cancer specialist and brain tumour victim. “From Chris’s book, I get the impression that, until the end, he kept fighting to ‘beat’ the disease, something that was never going to happen. I would argue that his eyes weren’t really open; he was in denial. Denial is a valid coping mechanism, but I don’t think doctors should take money to support it.”
Acceptance is often harder for the people left behind by death. My mother, understandably, was distraught and insecure about her ability to raise us alone. It was Charlie Teo who told me the decision to undertake risky operations is sometimes the decision of “selfish” families who cannot bear the thought of loss – the patient themself is constructively resigned to their fate.
Happily, my father confounded doctors and survived. He found no great meaning in this, only relief. It wasn’t a triumph of the will, a miracle of hope – he just got lucky.
Postscript, from Juliette O'Brien:
I refer to an article published in last week’s paper as “Charlie’s sheen” by Martin McKenzie-Murray (April 22- 28). The article was not fair or balanced. It also misrepresented my late father, Chris O’Brien.
With regard to the case made against Dr Charlie Teo, every source was able to hide behind a shield of anonymity. Whether the justification for this (that each of them feared “public vilification”) was founded or not, the cumulative effect was akin to trolling. If only we could leave this kind of sniping to the realms of Australian politics and Twitter, where anonymity has unarguably contributed to a deterioration of respectful discourse. What’s more, it was unclear to the reader how many neurosurgeons held these opinions.
Second, by failing to present a range of opinions in support of Dr Teo, the article essentially forced him to defend himself against this cabal of nameless neurosurgeons. Only one patient or relative was interviewed despite the writer acknowledging that “Teo is adored by the families of countless patients.” Even if more patients and families were given a voice, their opinions would have been undermined by one neurosurgeon’s patronising dismissal of us as “terrified and ignorant”.
Dr Teo is quoted as imploring the journalist to “speak to [his] fellows”, saying “the truth is here in my office”. But no fellows are quoted. Were they given the opportunity to comment? I have met fellows of Dr Teo who worked long days with him for months on end. They are intimately familiar with his work, relationships with patients, the conversations in his office, and of course, the medical outcomes. And those I have met remain Dr Teo’s most ardent and loyal supporters.
But what I found galling on a personal level was to discover my father’s name buried in the final sentences in a context that was misrepresentative and disrespectful.
My dad died nearly eight years ago from brain cancer and Mr McKenzie-Murray seems to compare, or rather contrast, his decision to aggressively pursue treatments that would extend his life, with the “graceful and courageous” manner in which his own father accepted a diagnosis with “no theatre”. He quotes one of the unnamed neurosurgeons who suggests that my dad failed to accept his own mortality and, by espousing the attitude characterised in his book Never Say Die, “he was in denial”.
My dad is not here to defend himself or reflect on the entire course of his disease and how it played out to his death. That’s one reason why these statements are so distasteful. But perhaps I can speak for him.
My father was not in denial about whether the glioblastoma multiforme, a type of brain tumour that has one of the worst survival rates among all human cancers, would eventually kill him. But while he was alive, he had a choice: continue treatment that could be described as conservative and preserve quality of life, or pursue more aggressive treatment that would sacrifice quality of life in exchange for more time. My dad chose the latter.
He accepted his fate with equanimity, but he used his position to show patients and families the possibility and value of being your own advocate in the medical system. Are these mutually exclusive? Mr McKenzie-Murray seems to think so.
Dr Teo operated on my father’s brain four times. Despite being originally given six to 12 months to live, Dad survived two-and-a-half precious years. I have written about the suffering he endured. Yet we have no regrets. Our family’s only mistake was not being organised about the specifics and practicalities of when and how he would die – the palliative considerations. My mother and I have taken part in a campaign for better palliative care with Cancer Care NSW for this reason.
As to the question of false hope and whether Dr Teo peddles it, this article is altogether facile. As a general principle, surely hope can exist if the survival rate is anything above zero. I have spoken to Dr Teo about this and echoed our conversations in This Is Gail, a book about my mother’s journey while caring for her husband and after his death:
“Invariably, the medical literature about glioblastoma multiforme contains a terrifying graph that depicts patient survival rates. Along the y-axis is the number of patients still alive, and along the x-axis is time. As the curve moves from left to right, it plunges from high to low. It sweeps through milestones – three months since diagnosis, six months, one year, two years – falling towards the x-axis and illustrating fewer and fewer survivors. The curve falls to a place just above the straight black line. But it never quite reaches it. A small gap remains between the curve and the axis. This is where hope lives.”
Many unique circumstances will determine whether a patient could possibly find themselves in this tiny group. But this article sheds little light on the question of what Dr Teo promises, and what he does not. Citing local rags that run the most emotive headlines possible about lives being “saved” and “miracles” is of zero journalistic value. The only firsthand information on the matter is from Dr Teo himself, and even that is undercut by a condescending dismissal of patients’ capacities to absorb dire information.
While I do not represent other patients or families, I can say that my dad and our family got exactly what we were promised, if not more.
This article was first published in the print edition of The Saturday Paper on Apr 22, 2017 as "Charlie’s sheen". Subscribe here.