Think again. Katrina Firlik, a neurosurgeon practicing in Connecticut, deflates that myth right off the bat in "Another Day in the Frontal Lobe," her engaging tour of human brains and the doctors who cut into them. It's neurologists or psychiatrists who are more likely to ponder the deep questions of mind and consciousness. Neurosurgeons, whom Dr. Firlik describes as "part scientist, part mechanic," do manual labor, the hands-on work of opening the skull and cutting out tumors or cysts. Sometimes the work calls for exquisite delicacy. Other times, they're reaching for a mallet and chisel.
Good neurosurgeons (who, by the way, spend more time operating on spines than they do on brains) like to keep things simple. Case No. 1 in Dr. Firlik's file is a construction worker who has been shot in the head with a nail gun by his partner and has a two-inch nail in his frontal lobe. The victim is alert and mentally sharp. He feels no pain.
In the operating room Dr. Firlik, rolling up her sleeves, drills a circular hole in the skull around the nail head and gently pulls it out along with the nail. After pounding the nail out, she fastens the disc of bone back to his head with titanium plates and screws. Within 24 hours the patient is sent on his way. No harm done.
Mr. Nailhead makes a good demonstration model. Dr. Firlik uses his case, and others from her long years of medical training, to explain how neurosurgeons think, how they develop their skills and what they encounter from day to day. It is a report on the profession, and an autobiography as well. She describes her childhood in a Cleveland suburb, where her father was a doctor, the influences that led her to choose neurosurgery as a profession (a neat freak, she once dreamed of becoming a cleaning woman) and the long, slow slog through medical school.
Dr. Firlik is not always sure which book she is writing, and readers keen to get to the next case study may fret as the author discusses, say, her philosophy about the afterlife or the artwork of Andy Goldsworthy, introduced because it deals with the way nature fragments over time, just as the brain does. Dr. Firlik is a bit obsessive about her career, and in her more self-indulgent moments she puts it on display, like an art object, for general admiration.
Fortunately she has a sharp sense of humor, and a lively sense of the small absurdities of her profession. She looks on with amusement at the brain squeeze toys that medical manufacturers like to give away, and at the book "Gifted Hands," which a neurosurgeon writes about himself. On occasion, as one might expect, the humor is black. "If the patient isn't crying by the time you're done going over the consent for surgery, then you haven't done your job," she writes.
As a guide to the winding hallways of a hospital, and the terrifying mysteries of the operating room, Dr. Firlik excels. She starts with the brain itself and what it feels like, which is tofu, "the soft variety, if you know tofu." Because it is soft, the brain, it turns out, is a forgiving, flexible organ. In the large frontal lobes, tumors can grow to "impressive citrus fruit proportions" before patients even notice something amiss.
Who operates on what, and what with, turns out to be fascinating. Some neurosurgeons specialize in aneurysms, others in movement disorders like Parkinson's. Skull-base neurosurgeons, who deal with tumors at the base of the brain, are known for operations that can take so long they work in teams, one replacing the other at the end of a shift.
The equipment can be as simple as a drill, or as complex as a three-dimensional image guidance system, bearing the brand name Stealth or BrainLab, which allows surgeons to pinpoint the contours of a tumor in the brain. But even drilling has its subtleties. Neurosurgeons learn early to recognize the sound that a drill makes as it passes through each layer of the skull. And it is reassuring to know that doctors can overrule computers. In one of the book's highlights, a senior neurologist, ignoring the ambiguous information coming from a computer guidance system in the operating room, locates a tumor by running his finger over the surface of the baby patient's brain.
As the tofu comparison suggests, Dr. Firlik likes vivid examples, and she has a gift for translating medical issues into everyday terms, like the near-impossibility of cutting out glioblastoma multiforme, the worst kind of brain tumor.
Imagine quickly ripping open a bag of unpopped popcorn in the kitchen, Dr. Firlik suggests. Most of the kernels land in a pile nearby, but over the next few days stray kernels keep turning up, some as far off as the living room. "That's what a glioblastoma is like," she writes. "You can clean up the focused mess, but you know there are cells you can't see at first, far removed from the obvious focus."
Neurosurgeons solve problems, which makes their profession a lot less depressing than it might seem, but some of the cases Dr. Firlik deals with are grim. One in particular, is worth the price of the book.
Without going into detail, suffice it to say that if you see a small growth on your face, you really should have a doctor look at it as soon as possible.