On a recent Friday evening, it struck me: I needed to speak to a neurosurgeon.
I was watching someone root around in actor Adam Scott’s head on an episode from the second season of “Severance” on Apple TV+. (Note: This post and podcast episode contain spoilers for “Severance.” You’ve been warned.) I needed to know: How realistic is the brain surgery that gives the show its name and premise?
I quickly found the exact person I had to talk to: Vijay Agarwal, the neurosurgeon who consults on “Severance.” His day job is chief of the Division of Skull Base and Minimally Invasive Surgery at Montefiore Medical Center.
On this episode of the “First Opinion Podcast,” I talked to him about the neuroscience behind severance, how Hollywood approaches medicine, and his cameo appearance on the show as, naturally, the surgeon performing the titular procedure.
Agarwal was always interested in how TV and film depict medicine. So it was serendipitous when he was connected to the folks behind “Severance” when it was still just a concept. (As he recalled it, someone from hospital administration recommended him. “So hospital administration can make dreams come true sometimes?” I asked. “No comment,” he said.)
Soon, he found himself “sitting at this big table with [director] Ben [Stiller] and Dan [Erickson, creator and executive producer] and the show producers and a whiteboard and then just going through and almost lecturing,” he said, talking them through “brain anatomy, neurophysiology. It was absolutely wild.”
I had expected that the creators would want to take some liberties with the medicine to make the plot work, but Agarwal said that was far from the case. “One of the things about Ben Stiller, one of the things that really makes him a genius, is that he was so adherent to this concept of medical accuracy. So the show of course takes some allowances … but Ben really wanted it to be very accurate.” That accuracy goes all the way to the size of the hole drilled into someone’s head to implant the severance chip during the Season One scene in which Agarwal played a neurosurgeon.
“I joke with Ben that I’ve been training for that scene my whole life,” he said. While TV depictions of brain surgery often get little details wrong, Agarwal was able to make it realistic in a way that he thinks even the average viewer will pick up on. “I think it all comes down to little nuances, the pressure on the skull, the little give that comes after you drill through the skull into the dura mater, just really how the instruments are held, how the chip is picked up with the forceps or the tweezer type device, how things are implanted, the way you stand.”
Listen to the episode to learn more about how “Severance,” well, operates.
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