dr. tiffany Perry
When does natural talent turn into a calling? Dr. Tiffany Perry discovered that being good with your hands can really take you places—that’s how she switched from a career as a professional pianist to one of Cedars-Sinai’s most sought-after neurosurgeons. Besides nimble fingers, all it took was an open mind and some serious dedication.
Do you remember your first week in LA?
Yeah. The first week my daughter and I moved, we were actually living in a hotel. We were closing the deal on the house the following week. We stayed in Santa Clarita for that time and I just commuted back and forth from downtown. There were dinners and receptions that I had to go to, but it was interesting. It was fun.
What brought you here?
Originally I’m from North Carolina, and I was living in Cleveland for my second spine surgery fellowship at the Cleveland Clinic. I stayed on the faculty there for a couple of years. I was just ready for a change… ready to get out of the cold and into the sunshine.
I interviewed at a few different places: Duke in North Carolina, MCV in Virginia, Scripps in La Jolla, and UNC Chapel Hill in North Carolina. I declined all of them because they weren’t the right job.
Ironically, I interviewed for a residency out here, and I'll never forget calling my mom from my rental car while I was driving back to the airport. I said, “You never have to worry. I will never, ever, ever move to Los Angeles.” [Laughs] It was just bumper-to-bumper traffic. It was like a parking lot. I missed my flight. It was awful experience.
So when an opportunity came up in LA, I thought I would never take it. It was suggested that I talk with Dr. Black at Cedars-Sinai. He’s very particular about who he brings on, so there was a chance he may not even like me.
We talked over the phone and I really liked him and he said, "I want you to come out for an interview." I came out for two interviews and they offered me a place on the spine faculty. On the spine faculty, I am the only neurosurgeon and, ironically, the first female—I was shocked. It's just kind of interesting.
Is that your first experience being the only female on staff?
You know, yes, because even at the Cleveland clinic, there was one other female. So this was new to me. And in LA, of all places.
Why do you think that is?
I don't know.
Was school a pretty even split between men and women?
No, not for neurosurgery. I think neurosurgery is around seven percent female. And spine is less than that.
Did it feel like a “boys club”?
Yeah, but it was fine. Everybody has been so supportive. I honestly think that being female is a positive. I'm one of the busiest surgeons at Cedars-Sinai. Today was my sixth day operating in a row.
I assume there’s no such thing as a “typical” week, so what was this past week like for you?
I started the week on Monday morning. I was on call last weekend, so I actually had an emergency case that I did on Monday morning. And then, I had clinic in the afternoon, which means I saw patients.
On Tuesday, I operated all day. Most of what I do is around spinal deformity. So in the past two weeks, I think I had two spine tumors. I do a lot of what we call “front backs,” which is where I put in the hardware from the front to try to straighten up the spine or release the disc, release the deformity, and then I turn the patient over and I put in a lot of screws in the back. On Tuesday, one of my three cases had something like 30 screws to insert. It went really well. The patient is super happy and she went home this morning.
Wednesday, I operated in the morning. I saw patients in the afternoon. Had a dinner that night with one of my reps from Cleveland. We went to Spago. I got to meet Wolfgang Puck. So, that was the big day.
On Thursday, I operated on three cases in the morning and saw patients in the afternoon. Friday, I operated. Then, my daughter hurt her hand on Tuesday. She's fine but I had to see the orthopedic surgeon yesterday.
Wow, that's intense. How do you deal with the pressure of operating on someone and knowing that their life is in your hands?
I think that's what the years of training are for. When you look back at your residencies, you think, "Oh my gosh, I'm never going to make it through this. Why do we go through this torture?” But it really does train your mind to be able to compartmentalize.
When you’re dealing with a young patient you have to get out of “mommy” mode and think, “This is clinical. He needs emergency surgery.” So you operate and try to save his life and then afterwards you try to deal with those effects. It can be hard.
An older gentleman came in with the worst trauma I had ever seen. He severed his spinal cord in a car accident. It was awful. This happened at 4am last Tuesday morning. I was on call from the Monday night and I was thinking, “It’s Monday night. It’ll probably be pretty quiet.” I ended up having two emergency cases come in that night.
So at 5am I get him into the operating room. His spine was completely disconnected. Like, imagine having a fracture in your arm and the bone is kind of sticking out—that's sort of what it was like. And so, what an orthopedic surgeon would do is align the bone and put a cast on.
I realigned him, put a plate in, locked it in and flipped him over, putting 20 screws or so from the back and locked them down. He unfortunately ended up passing away, not from the spinal surgery but from respiratory issues. Frequently, patients have difficulty breathing after such trauma. He regained arm function, though, which was huge.
That was hard. That's the first patient I've ever… I mean, patients have passed before, but that was the first patient with trauma that bad. You’re sweating like crazy, fighting for six hours to save their life, at least save some sense of spinal function.
How do you disconnect from that?
I run, which is good for me. I practice yoga. I play the piano, as well.
What about when you're in the middle of the surgery, operating for six hours—when do you eat or go to the bathroom?
You don't. I didn’t go the whole day. I finished operating on him and then I went into a second room to start operating on my next patient, because I had my normal 12 hours of surgery scheduled for the day. It's a different way of life.
Let’s take it way back and talk about how you got into neurosurgery.
I was not one of those people who’s like, “I want to go to medical school and I want to be a doctor.”
I was a classically trained pianist and I wanted to go into piano performance. I really wanted to have my own studio and teach and then perform on the side, but it's difficult to make a full-time living off of that.
I did a double major in piano performance and biology. I loved science. I loved labs. It felt very natural for me. I took botany and studied the anatomy of vertebrates.
In my junior year, I spent the spring semester in London and studied art theatre. I would go see performances in the West End. I was surrounded by all these extremely talented people, but I could see they were struggling to “make it.”
I emailed my advisor, who was also my piano instructor, and said that I didn't think I had what it took to be successful. I didn’t think I was good enough. I already had my own studio and I was teaching. So I had my own students and I loved it, but I just thought, “I can't do this.”
Was that moment heartbreaking for you?
It was very difficult. It was all that I had pictured myself doing. Like going to a conservatory, getting a masters or a doctorate. I just didn't really see myself doing anything else. My advisor argued with me. She said, “You're going to be just fine. You're very dedicated. You're hard working.” I worried, “What if I have a kid? What if I had a family and I'm not able to provide?”
So, I called my biology advisor from London. He asked if I’d ever considered pursuing medicine, because I’m really good at biology. I had no interest in being a doctor, but he suggested I take the MCAT as a backup plan. So I took a train from London to Brighton, England, to take the exam.
Back in London, I got my scores and passed. When I flew home at the end of May, I interviewed for medical school and got accepted at UNC Chapel Hill.
Then, getting into neurosurgery was totally random. After I got into medicine, I became very interested in psychiatry. The first year, you kind of study everything. And I loved psychiatry. I love the neurosciences and neuroanatomy. I was very good at it. So I thought, “I'm going to go into psychiatry.”
The summer in between your first and second year, you choose what you want to do. They encourage you to shadow somebody if you think you know what you're interested in. I wanted to shadow a psychiatrist. But I hated it.
Because it’s so depressing?
Yes. I grew up thinking that if something is broken, then fix it and be done with it, you know? If my daughter is crying, let's fix the problem. I realize it's not always about fixing things, but it is to me.
So I was so discouraged. After that summer, I'll never forget calling my parents and telling them that I was going to quit. I had decided that medical school was not for me. I hated psychiatry and I thought it was the one thing I wanted to do.
My parents are very supportive and at the time they said, "We understand the first year is difficult, but the second year is supposed to be more focused. Why don’t you give it one more year? If you hate it, you can quit.” I said, "Okay."
My neurosciences instructor asked if I’d ever thought about neurosurgery because I’m very good with my hands. I said I hadn’t. He suggested I set up a couple of weeks of shadowing experience with a female neurosurgeon, Dr. Ritter, at Chapel Hill. He thought we’d get along. So I met with Dr. Ritter and she became my first mentor.
It was love from the first time I was in the operating room. I just knew that this was what I wanted to do. So, from that summer, I went from wanting to quit to starting research projects in neurosurgery. I finished out my four years and then went into my residency.
Do you feel like there was something in you that was always searching for what you were supposed to be doing?
Yeah. I tell my daughter this, too. When you find that one thing that you’re supposed to do. The thing that, when you wake up—no matter how tired you are, no matter how little sleep you have—you know that you love it and you can’t wait to do it again. You can't wait to start your day again. That’s what you need to do.
That’s amazing. Is that how you feel every day?
Yeah. Every day.
Do you ever have a moment when you’re like, “Ugh, I don’t want to do that surgery. Boring!”
I don’t. My patients tell me that the moment I start explaining the surgery, going through the risks, benefits, ad nauseam, they’re like, “This is amazing. You know, I’ve seen three other surgeons, but they haven’t gone into this much detail.” I’m like, “It’s your back! I can help you fix it, but you need to understand what you need to have done.”
Did you ever worry that you’d want to have a family and that might affect your work or vice versa?
I think you always think about that. I ended up having my daughter in residency. I mean, there’s never a great time to have a kid. I took five and a half weeks off and then continued my research. She went to the lab with me. You just learn to deal with it. It becomes a way of life. And she—I have an amazing daughter.
What do you think about neurosurgeons’ reputation for having big egos?
I think it’s because there is this rite of passage. It’s hard. Seven years of school, four years of college, four years of med school, seven years of residency, fellowships on top of it.
You’re operating on the most delicate parts of the body. You can get a heart transplant, right? You can get a kidney transplant. All the other organs can be replaced. The brain and the spine can’t be. So, if you mess up, it’s a big deal. There’s no going back. And the anatomy’s very difficult. We’re still learning so much about the brain and the pathways. We know how the heart functions, and if we can’t figure it out we can put in a new one. The brain doesn’t work that way.
Have there been a lot of advancements in the field since you were at medical school?
Absolutely. We’re using intraoperative CT scans for navigation now, sort of like a GPS system. Before, we were only able to use x-rays to do that. A lot of things are now minimally invasive through smaller incisions that we weren’t able to do before. There are so many new things that are happening every day.
How do you learn about them?
I mean, it’s kind of up to you. Recently, I went up to San Francisco to do a training course for a new technique that I wasn’t certain I was going to use. I’m not one of these people that adopt every new thing that comes out. I’m a creature of habit, so I like to be good at what I know how to do. But I thought, “Well, maybe this could be something.” It’s a new approach in lateral spine surgery called OLIF [Oblique Lateral Interbody Fusion]. I may end up using the technique. I think that I would feel comfortable enough to use it.
As far as other things, we’re currently looking at Lou Gehrig's disease or ALS. I’m not one of the principal investigators but kind of got involved in the product review. It originated at Emory University and a couple of institutions across the country are involved, Cedars being one of them. They’re looking into doing focally directed stem-cell therapy in the spinal cord with 10 injections on both sides, to see if stem cells implanted in the spinal cord can possibly reduce the symptoms or the morbidity of Lou Gehrig's disease.
I don’t have a particular vested interested in ALS, but it’s phenomenal and fascinating. My hope would be that it could then be translated somehow to another spinal-cord injury.
Do you remember the first time you performed surgery without supervision?
Oh my gosh! I remember my first patient and his name.
How old were you?
Let’s see… I was 33. I was young because I did my schooling straight through. I will never forget the first surgery and thinking, “Oh my gosh! If anything messes up, this is all on me.” It was very nerve-racking. I don’t feel that nervousness anymore. But with every single case, no matter how small or big, I feel like I take it just as seriously.
A lot of patients will say, “Is this a serious surgery?” I’m like, “I consider every surgery seriously.”
Do patients ever think you’re too young?
They’re like, “You don’t have any grey hair!” But my answer is always, “You’re more than welcome to get other opinions. I encourage you to get other opinions. And if you decide I’m the right surgeon, you can call me.”
That’s my answer. I did 19 cases in the last two weeks. I do not need to look for cases. I’m very busy. So, if they want me, they’ll come back. The last thing that you want to do is convince a patient that you’re the surgeon for them, because if something goes wrong…. That’s not a good practice.
Have you been in a situation where something did go wrong that wasn’t necessarily your fault?
I think that the hardest thing that I deal with isn’t really operative outcomes. My patients are great and I’m very careful. I’m extremely careful during the pre-op to make sure that my indications for surgery are solid and that the patient understands that this is their decision.
I think the most difficult people I deal with are chronic pain patients. Patients who come to a clinic visit and get angry because I won’t prescribe pain narcotics for them. I don’t prescribe unless I cut you. And I tell them, “I didn’t train in chronic pain. I didn’t train to write narcotic prescriptions. If I cut you when I operate on you, I will write prescriptions for three months post-op. It’s a hard-and-fast rule. At three months, if you still require pain meds, you’ve got to go see a pain specialist.”
So, those are my hard families and hard patients. They will lambast you, and they get very angry and aggressive. If they escalate, I get our clinic manager. And my clinic manager knows my rules. It’s very simple. That’s the biggest thing you have to worry about, especially now that the AMA [American Medical Association] is really trying to crack down on opiate use, narcotic use for chronic pain. I will never—knock on wood—be found guilty of that.
Before the interview you mentioned that you’re on call at tomorrow’s Rams game. What does that mean exactly?
Yeah, I’m there at the sideline. Cedars is considered an “unaffiliated opinion” at the NFL games. It’s fun. I love football.
It’s fun, until something happens…
Right. Thank heavens nothing really serious has happened. It’s more like concussions and deciding whether the player is fit to return to the game or not. Each team has their own doctor, but by being unaffiliated we can make a better call on the player’s health because we don’t have any vested interest in a particular team winning.
Hopefully things go well and you can just watch the game.
Yes. That’s what I hope.
Your job is so diverse.
It is. I work a lot and it’s never repetitive, but it also means I never get out. Wednesday night was the first time I went to dinner since I moved out here a year ago, which is really sad. But when I’m not working, I’m a full-time mom.
Do you ever see yourself ever being like, “You know what? I’m done with this. I’m going to go paint.”
That’s so funny, because I actually do paint watercolor and I volunteer at my daughter’s school. The Halloween before last, the school was doing this huge haunted house for the kids in the theme of Hotel Transylvania and I painted all the characters for it. Last year, they did Tim Burton’s Nightmare Before Christmas and I painted all the characters, too.
But, yes, I do think that eventually I’ll do something else. Spine surgery is very hard on your body, on your joints.
Because you’re standing the whole time?
Standing and inserting all the screws—it’s exhausting. I think that it’s harder on women’s joints because they’re smaller. They custom-made handles on the instruments for me to make them smaller.
One of our surgeons at the hospital is 77. I think that’s just awesome. But I know I wouldn’t be able to do it for that long, so I bought my LSAT book to look into getting my JD.
A Juris Doctor. To become a lawyer and go into medical legal ethics. So, we’ll see, maybe I’ll start my JD program when my daughter starts high school. We’ll see.
What’s the best piece of advice you could give?
Two things come to mind. One I told you, and I told my daughter already: Find the thing that you love, that you’re passionate about. Put everything—your heart, your body, your soul, your mind— into it, and if you follow that dream, and follow your heart, you will be happy. You’ll have peace. You will have peace with yourself. I really, firmly believe that.
The second thing is to stay true to yourself. Every day, every morning, every night before you go to bed, you look at yourself in the mirror. If you can’t look at yourself in the mirror then you know that you didn’t stay true to yourself that day, and something needs to change. You’re really the only person that you need to answer to. No one else. I think that’s really important to recognize.
What does your work mean to you?
I think my job is actually a part of me. It’s not who I am, but it’s so much a part of who I am. I think it allows me to express what I’m about and what I stand for and I believe in. I have no regrets. I would go back and do all the same things all over again. I think that’s a pretty good thing to be able to say.
What does LA mean to you?
LA definitely has brought so much diversity in my life. Even though I don’t feel like I get out much, my patients really are my life. I mean, they email me, they call me, they text me, they come from all over. I’ve operated on people from Afghanistan, Iraq, Iran, China, Miami… Patients come from all of over, not for me, but for Cedars-Sinai. And they’re like an extended family for me. I mean, I just I love them.
Photography by Magdalena Wielopolski ©