Dr. Joel Salinas grew up knowing he wasn't like other kids. During medical school, he finally figured out why. Hear how the unique way he perceives the world impacts his life and his work as a neurologist.
Dr. Joel Salinas grew up knowing he wasn't like other kids. During medical school, he finally figured out why. Hear how the unique way he perceives the world impacts his life and his work as a neurologist.
Vital Signs. Season 2, Episode 1.
Title: I Had To Will Myself to Breathe
Dr. Joel Salinas, guest
Rose Reid, narrator
Dr. Salinas: My first year, as a medical student, I'm doing my first rotation and suddenly out of nowhere, the code blue alarm goes off, which is the cardiac arrest alarm. It's already chaos. There are people in white coats, there's nurses in scrubs. And there's this man on the floor who's wearing gray sweats and he is just there, limp on the ground as people are beginning to cut with a pair of shears through his sweater to begin to do CPR and advanced life support. And as I'm seeing this happen, I feel as if I were him. I feel the sensation of my chest being pushed in with each compression and my chest recoiling. I feel the sensation of a breathing tube being slid down my throat. I feel my chest rising with each breath that they're pushing with the bag valve, and then just kind of releasing. And after about 30 minutes of this, they eventually call the code. And I just feel as though I have total silence in me. And I felt as if I had to will myself to breathe. I had to keep reminding myself that this is me. I didn't die.
I'm Dr. Joel Salinas. I'm a behavioral neurologist here at NYU Langone and the NYU Grossman School of Medicine.
Narrator: The brain is one of the final frontiers in medicine. We know what it does, but we don’t always understand why, or how. The brain is both separate from - and intricately connected to - the rest of the body. It’s responsible for regulating the many complicated systems that keep us alive, yet isolated inside our skulls, far away from the other vital organs. More than anything, though, our brains make us who we are - and who we aren’t. The human brain is what distinguishes us from every single other species on the planet. From the brain we derive every emotion, thought, sensation, and impulse - conscious or not - that we’ll have over the course of our entire lives. It’s nearly impossible to imagine that the way YOU experience the world is different from how anyone ELSE experiences it. Or at least, from the way MOST people experience it.
Dr. Salinas: One night there in this kind of compound where myself under the medical students who were volunteers there were were just kind of hanging out, and at some point, the topic of meditation comes up. And a friend of mine who had a background in neuroscience kind of chimes in and says, there's this group of people who have a really easy time getting into these really deep meditative states because they have this brain thing that makes them experience the world like they're having an acid trip all the time Where they experience color and sounds, and colors and letters, and tastes and sounds. And when he said this, I was struck by it. Not because I thought it was bizarre, but because it was so ordinary. Because to me, I thought everybody has that. And it was at that point that my world was just completely flipped upside down.
Narrator: From SiriusXM and NYU Langone Health, This is Vital Signs, where medicine is made personal. I’m your host, Rose Reid.
Music break
Narrator: That night, in the compound with his classmates, was not the first time that Dr. Joel Salinas suspected he might not be just like everybody else.
Dr. Salinas: Throughout my childhood, I can pretty safely say that I was definitely a very weird kid. I was very, very particular about a lot of things. That included when I would color letters, they had to be specific colors. Like letter A had to be colored red, B orange, C had to be black. D had to be light Brown, E had to be cobalt bluish, F had to be a light gray. G had to be green, H had to be a lighter orange. I had to be white and so on. And that was true of numbers as well. One had to be yellow, two red, three purple, four blue, five orange, six light green, seven more like a teal, eight is yellow, nine black. Um, and it was, it was very specific and I had to have like the right crayon, so be able to do it. Because if it wasn't that way, it was very uncomfortable. Like something was wrong.
Narrator: Dr. Salinas was drawn to television, as most kids are. The action on the screen consumed him. Somehow, he was more than just a passive audience member. And he loved it.
Dr. Salinas: I was just stuck on television. There was something about television that was kind of an escape for myself. Like I would sit, I mean, talk about screen time. I would just sit in front of the TV with VHS tapes that I would play of cartoons and other things. And there was always something just really immersive about television. Watching any kind of show where I felt that I was in the show. So if I were watching kind of like Looney Tunes and watching Bugs Bunny eating a carrot, it was like I was Bugs Bunny eating the carrot. I could feel the feeling, the physical feeling of the carrot in my mouth as he's chewing and the kind of crunchy kind of texture of the carrot on my molars. If it was like the Ninja Turtles that I was watching, I could feel the sensation of cloth around my eyes, like the kind of bandanas that they wear over their eyes. Um, so it was just kind of like, uh, like this really intense virtual reality. So what could be more fun than just being in all these different worlds, being all these different people?
Narrator: These intense experiences were not limited to television characters. Dr. Salinas started to react similarly to the real people in his life, particularly the adults.
Dr. Salinas: I really wasn't drawn to being around other kids. I really was drawn to being around adults from kind of a ridiculously young age to the point where it was kind of like people would mention there's something wrong with your kid. Being around adults, I would kind of sit and watch. There was something very rich, complex and deep about the movements that they had in their bodies, the emotional experiences that they had. And as I'd be there watching them, I felt like I was experiencing the world through their eyes, but in a very physical way. My father, he was a UPS truck driver for most of my childhood. And he would get dressed in his brown UPS uniform, do his UPS route in this like, just scorching, Florida heat, all day long, um, in these trucks that really heat up like an oven. And then after that, he'd come home just like so sweaty and tired. And I could feel the weight of this kind of exhaustion on my shoulders. Even though I was like three or four or five years old, I felt as if I had had this tremendous day of work. And at the same time, I had also a really equally tremendous sense of appreciation for my father, that he was making this physical sacrifice. When even as a very young kid, I began to realize if I saw like an aunt or uncle who was really upset or sad, or if I saw my mother crying, for example, if I could soothe them, if I could soothe them and make them feel better in some way, if I could fix the situation in some way, I could also feel better.
Narrator: There’s a term for these feelings. It’s called profound empathy. This type of empathy is often felt by people like Dr. Salinas, whose senses like sight and sound are in overdrive. It can be a burden to feel other people’s pain, sacrifice, despair - or even their joy - so intimately. It can also be a gift.
Dr. Salinas: I felt like these types of feelings were just very, very physical and made me kind of mature very, very quickly. And this same kind of feeling of connection to the physical experience of the people around me, I think was ultimately kind of a guiding light for me that led me towards medicine.
Narrator: Eventually Dr. Salinas found an outlet for these strong emotions. He applied to medical school, and entered a field well-suited for his strange talent. It’s also where he would ultimately figure out what, exactly, was going on.
Dr. Salinas: There was an opportunity earlier on to go on a medical trip to India to learn about how public health measures are done in Gujarat, India, in a place called Deesa. And one night there, in this kind of compound where myself under the medical students who were volunteers there, were were just kind of hanging out, having chai, having cookies and just getting to know each other. We were sweaty from the day while wearing the scrubs and probably smelling horribly. And at some point, the topic of meditation comes up and everyone is kind of doing this looks like a, like a Round Robin of like all of the health benefits of meditation. And a friend of mine who had a background in neuroscience chimes in and says, we're talking about meditation, but you do all know that there's this group of people who had the really easy time getting into these really deep meditative states because they have this brain thing that makes them experience the world like they're having an acid trip all the time. Where they experience color and sounds, and colors and letters and tastes and sounds. And when he said this, I was struck by it. Not because I thought it was bizarre, but because it was so ordinary. Because to me, I thought everybody has that. And it was only later that night where I just couldn't get rid of that thought, like why would he, why would he mention that, why would anybody bother mentioning that. I said, hey, you mentioned this thing about people who experience colors and sounds, and tastes and sounds - why would you mention that? Everybody has that. And he said, no, that's not normal. And it was at that point that my world was just completely flipped upside down, when I realized that maybe, just maybe, the way that I've experienced the world is completely different from how most people experience the world. And I had just had this assumption throughout my whole life, that everybody was seeing what I saw and tasting and hearing and just feeling the world the way that I did. And that's when he taught me about the word for it, which was synesthesia.
Narrator: Synesthesia is a neurological condition that causes sensory overlap. People with synesthesia will often “see” music and “hear” paintings , or “feel” certain tastes as shapes, like round or pointy. If it sounds confusing, that’s because it is - especially for the person living with it. The word’s origin is Greek... meaning “to perceive together”, and rarely do any two people with synesthesia report identical experiences. There are different types of synesthesia, and the limited research suggests perhaps two to four percent of the population lives with it. It is often inherited, more common in women, and in people who are left-handed. Individuals with synesthesia often report feeling isolated because they observe the world so distinctively, despite possessing an uncanny ability to relate, viscerally, to others. Finally putting a name to his lifelong sensations was jarring for Dr. Salinas.
Dr. Salinas: On the one hand, there was a relief in that I, I had a word that could articulate my experiences that I've had my whole life that made me very weird and bizarre. But there was a reason for it. There was this name for it. And at the same time, there was this tension of a combination of disbelief and also fear. The disbelief coming from myself as kind of the scientist-slash-skeptic, which is: This isn't real until I've proven it somehow. This fear also kind of came in, this kind of like low grade kind of constant anxiety of what if I really am different? What if people learn that I'm different? Would they think that there's something wrong with me? Would they trust me? Am I broken or flawed? Or if they don't think that I'm broken or flawed, would they think the opposite? Would they think that there's some kind of a gift here, and that me talking about it is some kind of like showing off, or trying to be superior. And that leading to some kind of resentment?
Narrator: As Dr. Salinas began to learn more about synesthesia, he also had a lot of questions.
Dr. Salinas: I kind of dug into kind of why, why does synesthesia exist? You know, how many people have synesthesia? It's about one in 25 people have at least one form of synesthesia. The most common one being this, uh, what's called grapheme-color synesthesia, or kind of letter number colors, synesthesia. Where every letter or number has a color tied to it. So if I were to see the word CAT written in black on a white sheet of paper, the letter C is black in my head and on the paper, but the letter A is red on top of the black of the ink. And the T is like a red orange color on top of the black. So there's just kind of multi-layer experience. And it's, it's very idiosyncratic. The way that our brain creates these connections seems to be kind of like how we learn language. But then there's also potentially something that's more ingrained at the level of genetics and how our brains develop as either kind of an artifact, or maybe there's some point behind it and evolution that lets us communicate to each other better, or maybe survive and find better mates. So in kind of embarking on this journey of trying to understand synesthesia, it ended up really blending with learning about the brain more because the more I learned about the brain, the more I learned about who I am, and why the world is the way that it is.
Narrator: There’s researching, and then there’s being researched. In his journey to understand synesthesia, Dr. Salinas quickly became the subject. He approached neuroscience researcher Dr. Vilayanur Ramashandran at the University of California in San Diego to try and find some answers.
Dr. Salinas: I'd never had that experience before where I had to kind of swallow my own pride and anxiety about being weird and different and really kind of put it all out there and say, yeah, I have this thing - is that weird? Does somebody else have that? Is that a thing? They would make me do all these little tasks. I mean, they had structured tests like, um, there's a common one for grapheme-color synesthesia, where you're presented with a letter on a screen, and then you have to pick a color on the color wheel that matches kind of your color association with it. It's a color wheel that has thousands and thousands of thousands of pixels of color that you can choose from. And the test is ultimately after how many times you select the color, can you accurately choose about the same color because only somebody who has a grapheme-color synesthesia with this association is by default where you really don't have to put a lot of thought into it. Where you just choose it. And it was very, very accurate. I was like, down to the pixel, I was picking the exact same color every single time. So that in a way was really validating to be like, okay, here's some like objective proof. It was evidence, right? It was, it was evidence that, uh, outside of my own opinion, that this was a thing that I was experiencing in my brain That people couldn't really challenge completely because scientifically people who had synesthesia have this effect. People that don't, don't have the effect.
Narrator: Even within the world of synesthetes - yes, that’s what they’re called - Dr. Salinas is a rarity. In another test linking sight with sound, his reaction time to a particular audio cue was three times faster than other people with synesthesia. Another of Dr. Ramachandran’s tests was even more revealing.
Dr. Salinas: He took a sheet of paper, writes the number two, three times in a row. Two, two, two, in black ink. And he holds it in front of me and he says, okay, what color do you see here? And for me, the number two is red. And there's like a little bit of like fuchsia in the corner. He’s like, okay, great, it's red. So I'm gonna rotate this, and I want you to keep telling me what color it is as I keep rotating. So as he's rotating very slowly I say, okay, it's red, it's red, it's red, it's red. And then I say, wait. At that moment, that color changed. It became a light brown. I thought that's really weird. Why did it suddenly go from red to light brown? And then I thought a little bit longer about it. And I said, Oh, wait. It's because the twos are now the letter N and my letter N is a light brown. And at that moment it was clear, okay, this is clearly below the level of consciousness. This is something that's, like, programmed and wired in my brain. And it just is what it is. What just felt so validating about that, was that it wasn't like I was willing myself to have this experience. It's like, there's this process going on in my brain just all the time, and that just is what it is.
Narrator: It can be hard for any of us to quiet our brains. They’re always on the go, these little engines continually processing, organizing and synthesizing information. Just being alive can be emotionally exhausting. For Dr. Salinas, this feeling is compounded by his synesthesia. As a result, he sometimes struggles to navigate the rich sensory world he perceives.
Dr. Salinas:People will say, how do you live your life? Like, how can you not be just distracted all the time? The way that I've learned from a very young age, cause I've just lived with it, is just to be in it, let it envelop me and kind of just pass, pass through the experiences. And it can be really fun to focus on, on something or something will call my attention and that's like the pretty kind of fractal kind of bizarre experience. In a way you develop this brain muscle that you're training throughout your life, to be able to redirect yourself, to be able to focus on one thing or another. Because if you don't, you will be very distracted, a lot of your life.
Narrator: The more he learned about synesthesia - and himself - the more Dr. Salinas realized just how much of his life has been guided by it. In addition to the melding of colors, numbers, sounds, and shapes, sometimes synesthesia also causes people to physically feel things they witness - but aren’t happening to them at all. It’s called mirror-touch synesthesia.
Dr. Salinas: So these parts of the brain that help us tell the difference between you and I is kind of essentially weaker in my brain compared to other people. And so it becomes harder to tell the difference between where I end and you begin, or where you end and I begin. In my brain, looking at you, I'm essentially looking at myself. I might as well be looking at my reflection of myself, I think hearing about mirror touch was another one of these kind of like aha moments where things just kind of clicked into place of validation. Oh yes. This makes a lot of sense. There have been many times where I've been totally overwhelmed by the experiences around me, where I just can't mentally suppress it. And that really came full on early in my medical training, even before I knew that I had synesthesia.
Dr. Salinas: So in my first year, as a medical student, I'm doing my first rotation. And then suddenly out of nowhere, the code blue alarm goes off, which is the cardiac arrest alarm. This is my first kind of cardiac arrest or emergency in the hospital. It's already chaos. There are, um, people in white coats, there's nurses in scrubs. And there's this man on the floor who's wearing gray sweats. And he is just there limp on the ground as people are beginning to cut with a pair of shears through his sweater to begin to do CPR and advanced life support. And as I'm seeing this happen, I feel as if I were him. I feel the linoleum on my back. I feel that sensation that the scissors grazing the skin on my chest as the shears are cutting his sweater. I feel that sensation of my chest being pushed in with each compression and my chest recoiling back out with each of those. I feel the sensation of a breathing tube being slid down my throat as he has a breathing tube slid down his throat. This kind of sharp kind of pointy feeling down my throat. I feel my chest rising with each breath that they're pushing with the back valve, and then just kind of releasing. And after about 30 minutes of this, they eventually call the code. And I just feel as though all of the sensory information, all of the touch, everything is suddenly just silent.
Dr. Salinas: And I felt as if I had to, will myself to breathe. And at that point, I had to leave the room. I went into the bathroom and I got on my knees and threw up in the toilet. And as I got up to the sink and was washing my face and splashing cold water in my face, and I was looking in the mirror, I had to keep reminding myself that this is me. I didn't die.
Narrator: If he was ever going to finish medical school, Dr. Salinas had to find a way to manage these intense feelings. Often, the only way out is through.
Dr. Salinas: That was the moment where I knew that if I was going to be the doctor that could be there for my patients, I had to figure out a way to manage this. That was the discomfort. That was the challenge. That was the big, scary thing that I had to run toward rather than away from. I think there's two kind of key ways that that has helped me with at least with caring with patients on the one hand, because of, I mean, just with all of the synesthesia, but with the mirror touch in particular, there's this heightened sensitivity around movements and sensations and emotional experiences that some people may not pick up on. But having this like very kind of extreme form of synesthesia may pick up on, my brain, may pick up on it and I just kind of hone in on it. And on the other hand, it's just being, being to be very present with people. So they feel like there's somebody else who has skin in the game, somebody else who's in there. And I think something, you know, and this is kind of like more non-scientist maybe woo-hoo, uh, but it is definitely a non scientist in me in that I think you can tell when somebody genuinely cares about you and is fully present and there with you. And it makes a world of a difference.
Narrator: Dr. Salinas was beginning to see the up side of his synesthesia, particularly when it came to medicine and patient care. It’s kind of like a superpower, allowing him to tap into people’s emotions and feelings in a way that most of us can’t. More than that, he realized what a critical role synesthesia played in his identity - even if he had only just learned its name. It had become precious, an essential part of him. But then… What if it was suddenly...gone?
Dr. Salinas: When I was in medical school, this is after I had learned about synesthesia, maybe like my second year, third year when I was helping to do medical trips to Haiti. While I was there, I started to develop this very intense head pain on the kind of top right part of my head and touching that area there was a divot, like a little kind of like groove in my head. And I thought, well, that's funny that probably shouldn't be there and it's painful.
Narrator: He asked a neurosurgeon who was with him in Haiti if what he was experiencing was normal.
Dr. Salinas: (01:52:31)
He kind of lowers his glasses down the bridge of his nose, and he says, it usually means you're going to die. It was clear that I wasn't kind of in the throes of about to die, but, um, there was a lot of concern.
Narrator: When they returned to Miami after the trip, Dr. Salinas underwent some routine testing.
Dr. Salinas: And when the results come back, he says, actually it looks a little more complicated. I'm going to refer you to a neurosurgeon, a friend of mine who specializes in this type of surgery. Because it looks like it's a tumor and it's unclear whether it's malignant. We think it'll be fine.
Narrator: They decided to watch the tumor for a few months. But the head pain Dr. Salinas was experiencing continued to get worse. At that point his neurosurgeon recommended a biopsy.
Dr. Salinas: So there's this moment as like a medical student and I've worried, okay, they're going to do this biopsy. Like what's going to happen to me. Will I still experience the world after this gets removed? Will I still have synesthesia afterward?
Narrator: The procedure to biopsy this particular tumor was complicated. His doctors had anticipated - correctly - that the tumor contained a lot of blood vessels, which would increase the risk for bleeding in his brain. When Dr. Salinas woke up from his surgery, his first inclination was to scan the walls for letters and numbers.
Dr. Salinas: And I was able to see the words “Post Anesthesia Care Unit” and P was purple, O was white, S was light orange T was whatever and I was like, Oh my goodness, thank goodness. My synesthesia is still there. And it hasn't changed.
Narrator: Luckily, the tumor was benign. But it may have played a major role in the development of his synesthesia.
Dr. Salinas: It was only later on that it, things began to really click in talking to one of my research mentors that maybe it was having this tumor over this part of my brain - this very specific part of my brain - which if this is really was a developmental tumor had been there as my brain was wiring and developing, that might've led to having this very extreme synesthesia. That in some way it was kind of this like, um, total chance alignment of genetics and biology and environment and throw in a random tumor in there that influenced the development part of my brain that relates to how all of our senses kind of merge together and get distributed and kind of our own bodily map of our body and where we are with space. That all of this came together to be, to be me and how I experience my world and my reality.
Narrator: When something makes us different, we might want to run from it. Looking in a mirror can be painful, and it’s not for everyone. Dr. Salinas knew he had to harness his synesthesia to help others, even if it meant delving deeper inside the brain itself. Not only did he become a neurologist, but the bulk of his research focuses on the brain, and how our social environments impact our cognitive health.
Dr. Salinas: This is kind of where my career is at now, is this earlier stage of being kind of a clinician investigator where not only am I linking the neurologic aspect of things, kind of this blending of the cognitive and the emotional and how we relate with the world. But also trying to understand how is it that we connect with each other? How does that change over time? And how can we use that to do something better for the world that has tremendous impact. And to me that manifests itself in brain health. The better you are at being able to perceive and experience the world, the more likely you'll be able to live that most fulfilling life that you want to live.
Narrator: Accepting who he is and what his brain can do has been powerful for Dr. Salinas. He doesn't just have synesthesia; he is a synesthete. And while this identity sets him apart from others in this very specific way - it begs the question: what doesn’t set him - and each of us - apart from others? We can only move through this world with our own brains, seeing and hearing and feeling things the way it allows. Your singular brain provides the context and texture of your life, informing your identity and all of your experiences - whether you have synesthesia or not. In this way, Dr. Salinas is no different from the rest of us. His quest to understand this extreme difference has, in a way, revealed our shared humanity - despite our unique identities.
Dr. Salinas: We're all living in these bodies and trying our best to explain these ambiguous feelings that we have, that really nobody else but us can feel. My synesthesia and the way that I experienced the world, this is all a part of me. This is part of my world. This is part of a combination of biology and environment that come together to form this brain that is this entity that comes together in some way through my senses for me to be able to call it Joel.
Narrator: Vital Signs is a co-production of NYU Langone Health and SiriusXM. The podcast is produced by Jim Bilodeau, Julie Kanfer, and Keith King, with sound design by Jim Bilodeau and writing from Julie Kanfer. SiriusXM’s executive producer is Beth Ameen, in partnership with Allison Clair and Jim Mandler of NYU Langone Health. Don’t miss a single episode of Vital Signs and subscribe for free wherever you listen to podcasts. To hear more from the world-renowned doctors of NYU Langone Health, tune
into Doctor Radio on SiriusXM channel 110. Or listen anytime on the SXM app. To get in touch with our production team, email VitalSigns@siriusxm.com. For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you more stories of medicine made personal.
For the Vital Signs podcast, I’m Rose Reid. Join us next time as we bring you the stories of medicine made personal.