Scott Webb (Host): Welcome to UK HealthCast, a podcast from UK HealthCare. I'm Scott Webb. And today, we're going to learn about Pediatric Neurosurgery at UK HealthCare from pediatric neurosurgeon, Dr. Randaline Barnett. She's a Kentucky native and one of only three pediatric neurosurgeons in the state.

Doctor, it's so nice to have you here today. I know you're the Director of Pediatric Neurosurgery. And when I think of pediatric and neurosurgery and I see those words together, it makes me a little frightened maybe because I'm a parent myself. I have two kids, they're a little bit older. And we're going to kind of get to all of what you do and how you do it and all that good stuff, but I just want to welcome you to the podcast.

Randaline Barnett: Thank you so much, Scott. I really appreciate being here today.

Host: Well, it's nice to have you here. And I feel like I'm going to learn a lot from you. I'm sure listeners will as well. But before we get to the teaching and learning part, maybe just tell us a little bit about yourself, your background, experiences, and so forth.

Randaline Barnett: So, I'm a native of Kentucky. I grew up in Eastern Kentucky in Breathitt county. My dad was a coal miner. My mom stayed at home with me and my sister. We had a big family that we all love each other and spent a lot of time together growing up. I'm the first physician in my family and definitely the first neurosurgeon in the family. And I always knew I wanted to be a doctor. I didn't quite think I would grow up and be a neurosurgeon, but I always wanted be a doctor. I really looked up to my Family Medicine doctor that took care of my sister and me growing up, and just saw how much of a staple he was in our community, and I wanted to be that person for our folks.

So later on, I went to undergrad and medical school both here at University of Kentucky. It was in medical school that I got really interested in the brain. And I just thought it was fascinating. I was always more procedurally oriented. So, I knew I wanted to do something in Surgery. And part of me thought am I crazy? Could someone like me be a neurosurgeon? And thankfully, I met some really amazing people. One of which is one of my partners here at UK, Dr. Justin Fraser, and he became a mentor for me and was so encouraging and really gave me the confidence that I needed to know that I could do this.

And so, I set my sight on doing Neurosurgery. I ended up going to residency at the University of North Carolina in Chapel Hill. So, I was there for seven years. And it was there that I decided that I wanted to do pediatric neurosurgery. We had two pediatric neurosurgeons there at that time, Dr. Scott Elton and Dr. Carolyn Quinsey, both of which were phenomenal surgeons and people that I really looked up to. But I realized that I loved caring for children and their families. I think kids are just so incredible. They're funny and they're smart and they're brave, and they're so inspiring. You know, watching them handle, you know, some of the things that we watch them go through with just such grace. I mean, it really can teach adults a lot about how to live our lives.

Host: Yeah.

Randaline Barnett: And then, I got so much joy in being able to help them. And then, later on, their parents would send me pictures of them, you know, even a couple years down the road, starting school or, you know, playing baseball. It was just amazing being able to watch them grow up and know that I played a part in that. And so, that was really special to me.

I decided to go into Peds. And for Pediatric Neurosurgery, we have to do a fellowship in that. And so, I went and did my fellowship in Memphis, Tennessee at Le Bonheur Children's Hospital and St. Jude's Children's Research Hospital. And so, I was there for a year prior to me joining the faculty here at UK. I loved, loved working there, but I knew my heart and my purpose was here in Kentucky. I always wanted to return home to take care of my people. I'd tell everybody that I would not be where I'm sitting today without the community that I had pushing me and was behind me every step of the way, even down to our Church groups who would pray for me. Every exam I've ever taken in my life, I mean, its really amazing how much people supported me, and I wanted to be able to pay that back for people back home. And so, I'm really happy to be here and able to grow our Pediatric Neurosurgery Program here.

Host: Yeah, that's great. I can't get the Loretta Lynn song out of my head. You said you're a coal miner's daughter.

Randaline Barnett: Yes.

Host: And so, it's playing in my head. So, the coal miner's daughter became a pediatric neurosurgeon. It's just such a cool story. And I guess I want to get a sense of like what exactly do you do, because I think there's a misconception about the difference between Neurology and Neurosurgery. So, maybe you can talk a little bit about how you work with Neurology and when someone might see you versus a neurologist.

Randaline Barnett: Yeah. I think that's a great question. It's actually something that I get asked not infrequently by both, you know, physicians and patients. As a neurosurgeon, you know, I have the privilege of working with a multitude of specialists that take care of our kids with us as a team. A lot of our children do have complex conditions that may need care outside of Neurosurgery. And so, I'm very used to working with other specialists and having that team approach, but neurologists in particular, and we have some really incredible pediatric neurologists here at UK.

I tell folks that they are the experts in the medical management of neurological conditions. And so, for instance, when we talk about seizure disorders, I am definitely not an expert in managing seizures medically. You know, I tell people that, as a neurosurgeon, I can look at an EEG and I know the basics of an EEG, but the neurologist is the expert and they're the ones that have been trying to read those studies and work on managing those conditions with medications. And then, as a neurosurgeon, I become involved in cases when there is a possible indication for surgical management of of a neurosurgical condition. And so, I will provide consultations on my opinion on whether or not something could be treated with surgery. And if so, then I recommend the type of surgery that I would perform and talk to our kids and their families about that.

Host: Yeah. I was just thinking about you know the brain-- not the way you think about the brain-- but, you know, the way a lay person would think about the brain. And thinking about kids being so much smaller than adults and wondering, you know, is a child's brain different than an adult-sized brain? And the reason I was thinking about all that, doctor, is I was trying to figure out like when would a parent or why would a parent seek out a pediatric-dedicated neurosurgeon. You know what I mean? Is it because it's so specialized and the brains are smaller, and you really need someone, you know, who's had the experiences you've had. Is that why someone would do that?

Randaline Barnett: You know, when we look at kids compared to adults, kids are very different physiologically. And theres different stages of development that someone who's not dedicated to Pediatrics may not know about as well as someone who's a dedicated pediatric neurosurgeon. I think, you know, as a pediatric neurosurgeon, I have to take that into consideration on how I would treat kids based on their age and their development. So, something that I may be able to offer to an older child, I may not be able to do that same surgery in an infant, for instance.

And so, you know, we have to think about that creatively to make sure that we're doing what's most appropriate for that kid at stage of their life. And I think another thing too that a lot of people don't think about is, you know, we always think about the physical part of Surgery and Medicine. And we don't think about the emotional and social aspects of it. And when kids are going through something that involves their brain, you know, that's really scary and it can be really isolating. You know, being the only kid in their class that's ever had a brain surgery. For someone like me, I really want to make sure that I am involving them in this entire process, and I'm hearing their concerns. And so, when kids find out they need surgery, usually, the first thing they ask is, "Well, do you have to shave my hair?"

Host: Sure

Randaline Barnett: You know, and that's a very question because they have to go back to school, and we all know that sometimes, you know, kids get curious and they may ask questions and not always be the nicest when they're asking their friends about things that have happened to them. And I really focus on lessening the emotional trauma of what they're going through. And so, you know, for instance, when I take out brain tumors, I will try to make sure I shave as little bit of hair as possible. I will part their hair in specific ways to we can hide it. And it's really incredible just knowing that I can do that for them and we thought about that. And their parents are so grateful for us also investing in that aspect. Because as a pediatric neurosurgeon, whatever I do to a child, they have to live with the ramifications of that for the rest of their life. And I want to make sure that they're growing, not only physically, but socially and emotionally. And that they feel safe and secure with that.

You know, I'm definitely not the first person to say this, but it's something that I tell everybody about Peds, is when you save a kid's life, you are not just saving their life, you're saving their lifetime. And so, it's really important to me to give them a lifetime of good memories. Pediatric neurosurgeons, in particular, we really focus on that a lot.

Host: Yeah. Yeah And this is, you know, I don't know that there's anything to back this up. When I think about the average adult neurosurgeon, I just feel like they're not spending time worried about your hair and where to shave your head, that it's more about, as you say, the physical part of it. And what you are doing there of really thinking about the kiddo and having to go back to school and "Is there a way for me to shave their head, still get to the tumor where they're going to be okay going to school where they don't have to wear a hat for however many months or whatever it is?" I just love that really truly like patient-centered care and putting the kiddo first. That's awesome.

Randaline Barnett: Thank you so much. Thank you.

Host: Yeah, it's great I want to get a sense of what your typical day is like, right? Because your typical day is going to be different from the rest of us, right? Because I don't take out brain tumors from, you know, children, right? So, my typical day is going to look a lot different than yours. But you just seem like such a happy, upbeat, sunny person, and I'm sure there are some tough days, but just take us through a typical day.

Randaline Barnett: I always think this question, it's interesting because I think as a surgeon, you know, I'll be honest, I don't think we have a typical day.

Host: Okay.

Randaline Barnett: And you go into this knowing that your days aren't going to be typical, and nothing is really going to be planned. But, you know, for the most part, Mondays are my clinic days. So, that's the set day of the week where you know I get to see my patients in the clinic. And you know I see my followups from surgery or I'm providing consultations for new patients who may need a surgery or a surgical opinion. Then on, Thursdays, that's my elective OR day. So, that's the day that I will plan to book surgeries from clinic or even from the hospital that you know aren't urgent and we have a couple days to get things sorted out. The rest the week though is just up to the day and what's going on. You know, I can come in on a Tuesday and think I'm going to have a chill administrative day where I just have some meetings and then end up needing to do an emergency surgery for a child. Each day can come with surprises.

But I think that's something that's really unique about our job. You know, being able to to be that person who can come in and fix these challenges and really just be there to help take care these kids at any moment in time. And so, you know, for the most part, you know, I'm either in clinic, in the operating room, or in meetings where we're trying to advance our pediatric care here in the children's hospital. There's a lot of work that I'm doing on building some comprehensive care program when it comes to pediatric brain tumors, spina bifida, spasticity, even when it comes to fetal neurosurgery. You know, we just formed a fetal multidisciplinary group here. We've been discussing cases. And hopefully, at some point in the future, we'll be able to offer fetal surgery for spina bifida. That's something that our university is currently working on, you know, getting the resource to be able to do that and offer that here in Kentucky so our patients don't have to travel. But that's usually what I'm working on during the day. Then, when I do go home, I have a daughter and a husband who I love dearly and I love spending time with them. And we have a little farm and we love getting out on the farm and, you know, growing our own food and, hopefully, we get some chicken soon. My daughter's excited about that. I think that's a good way for me to decompress from the stress here at work too.

Host: I'm sure.

Randaline Barnett: You know, having that to focus on outside of work.

Host: Do you have any baby goats? The reason I ask is because I watch videos, these reels, and I start skimming through. And it seems like so many people have these adorable baby goats. And it just makes me want one. And my wife insists there's no way we're bringing a baby goat into our home. But I love the idea of being on a farm and having these awesome little animals as pets, because we have the traditional. We have cats of course, right? Or dogs. But i don't know, you don't have any baby goats though, right?

Randaline Barnett: So, we currently don't have baby goats. I really want to have baby goats, and I'm currently trying to convince my husband that we need them.

Host: I'm in total agreement. They are just so funny and so adorable. And it does sound, Doctor, like you don't get to have a bad day like an off day, right? So like if I have an off day and I stumble over some words, ah, I can always fix it later, right? But if you have one of those days that you think you're going to be in the office and it's going to be, you know, mostly clerical and meetings and things, and then there's some sort of emergency surgery, you don't get to decline that, right? Like you have to be ready. So, I'm assuming you have to get to bed on time and, you know, take care of yourself and all of that, right?

Randaline Barnett: Yeah. That's exactly right. I do focus on my physical health as well. I make sure I'm getting enough sleep. I love to exercise. I love to run. That's another way for me to sometimes decompress from the stress at work. You know, I definitely try to to fill my cup back up emotionally so I can really be there for my patients.

Scott Webb: That's great. Yeah, I want to get an idea here. You know, you are the director obviously of Pediatric Neurosurgery. So, I'm sure you are unique because you are you and everything that you do there is unique because of you and everybody else and all the personalities and expertise and all of that. Just wondering, I guess, what is unique about your role at UK HealthCare that we just maybe wouldn't see at other hospitals?

Randaline Barnett: The most recent quote that I saw for pediatric neurosurgeons in the U.S. was there's a little over 400 of us practicing in the United states. And when you think about how many people live here in the U.S., you know, a little over 400 of us doesn't seem like a lot. And so, when you you think about it, there's not many of us and there's not many hospitals that have pediatric neuro surgeons. You know, you usually going to see us at the tertiary academic hospitals. So in Kentucky, in particular, you know, there's many here. And University of Louisville has a couple of pediatric neurosurgeons, and that's all we have in the state of Kentucky. I think that's unique in itself. I think, you know, with me in particular, I like to think that my role is unique in the fact that I'm a native of Kentucky, and I know the people here. I grew up in Eastern Kentucky. And I saw a lot of disparity that's present in healthcare. And not only healthcare, but when it comes to education and food insecurity and housing and just access to, you know, basic necessities. And, you know, I'm really well aware of the struggles that our people go through on a daily basis, let alone trying to get to a doctor or even a specialist, especially having to come hours to somewhere like Lexington in some cases.

And I think me being here and knowing that population so well and being one of them, it puts me in a unique position for me to advocate for them and to know how to meet them in a way that's going to benefit them in ways that I don't think all physicians would understand if they weren't from that background. And I really think that that's my like greater purpose here too. You know, I came back to serve my people and it's really exciting being able to do that.

Host: Yeah. We've talked a lot about here about you understandably and about the patients, you know, working together, communicating, considering the patients feelings, all that makes me wonder about the families of patients and how important family is in general, right? Especially in Kentucky. So, how do you involve the families in the process of diagnosing and treating their children?

Randaline Barnett: Yeah, I think that is incredibly important and something that I teach residents is in Pediatric Neurosurgery, yes, our main focus is the child and that's our patient. But really, our patient is the entire family. And when I'm treating a child, I focus on the entire family because the family dynamics are definitely going to play a role in the success and the outcomes that this child is going to have.

 When I talk to parents and these kids about their condition, you know, I want to make sure that we're all on the same page, that they have a good understanding of what's going on, and that I've presented options to them for how we can address it. And we work together as a team to choose what option is going to be best for their child and their family. You know, I never want to feel like I'm the one that's just saying we have to do this. I want parents to feel that they have some control in what is a terrible situation to begin with and, most of these situations, you feel like you've lost control. I want them to feel like, you know, they do have ownership, they do have control, and they do have an ability to be a part of their child's care. You know, I want to work together as a team and that's incredibly important to me, and I love for parents to be invested and engaged in that process. Because I think, you know, when you're treating a child, the family dynamic is so important in that child's ability to recover.

Host: Well, Doctor, not only are you just, you know, one of the most positive people I think I've ever met, like this has been really good my soul today. I could just feel the positivity, you know, emanating from my computer into my headphones. It's just been such a pleasure to speak with you today. And you're brilliant, of course, and considerate and just everything, as a parent, I would want in a pediatric neurosurgeon. So, I just want to give you a chance here at the end. What are you most hopeful for about the future of Pediatric Neurosurgery?

Randaline Barnett: You know, as a pediatric neurosurgeon and as a mom, i just continue to hope and pray for there to be better treatments and cures that come up for some of these really complex pediatric neurosurgical conditions. You know, I think having to watch what these kids and their families go through, it's definitely hard. And, you know, I give it to our families, they're amazing, and they're so strong. You know, sometimes they're facing conditions that are just unimaginable. I hope and pray that we continue to, you know, make this big advancements and be able to offer better treatments and care as we move forward. I hope that, you know, our society will invest more resources and funds into pediatric cancer research and other pediatric neurological conditions to help move that forward. I want all of our kids to be happy and healthy and, especially as a mom, you know, I would want that for every child.

Host: Sure. Yeah, you know, Doctor, when you said there were 400 roughly pediatric neurosurgeons, you know, if you just said there were a thousand, I would've thought that was too few, right? So, 400, you know, and just, what, three in the state of Kentucky? I don't want to speak for you. But I know you feel lucky to be you and to be where you are and get to do what you do. And I just feel like the folks in Kentucky are so lucky to have you. This was was really educational and heartwarming and good for the soul. Thank you so much.

Randaline Barnett: Thank you so much. I really appreciate you having me.

Host: And for more information, go to ukhealthcare.uky.edu. And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate, and review this podcast and all the other UK HealthCare podcasts. I'm Scott Webb. Stay well.