The pen is scarier than the scalpel
John O’Connell, a self-confessed hypochondriac, is darkly suspicious of doctors’ attempts to be approachable in print As little as a century ago, doctors were our friends. Summoned by messenger in the middle of the night, they would be welcomed into the home with open arms and plied with a generous snifter. Thus fortified, they would take the patient’s history; ask about eating, sleeping and bowel habits; feel the pulse and listen, without the benefit of a stethoscope, to the chest. And that, really, was that. Decorum prohibited any sort of detailed physical examination. Only after Queen Victoria’s death did her physician, Sir James Reid, discover that she had a ‘ventral hernia, and a prolapse of the uterus’.
Nowadays, not only is the ‘home visit’ a rarity, but the doctor-patient relationship has become tense and combative, thanks largely to the internet and the opportunities it affords for self-diagnosis. We want doctors to confirm that we are as ill as we think we are, and to be impressed by our selftaught medical expertise; but we also want them to assure us that nothing is wrong. These are ludicrous demands, impossible to satisfy. And so we have grown to resent doctors, and their lofty authority, and their calm, detached unknowability.
Thanks to a new publishing trend, however, doctors are currently more knowable than they have been for years. As if frustrated by how little the public understands them and their craft, growing numbers of medical professionals are writing bracingly revealing books whose appeal is a carefully calibrated mix of memoir, confession, philosophical rumination and — the icing on the cake — gory case studies. There is much flashing of multidisciplinary credentials. ‘Look!’ these books shout. ‘You might think doctors are unfeeling automata, but I’m not! I can quote Yeats and play the piano!’ The acknowledged classic of the genre is Boston-based surgeon Atul Gawande’s Complications, published in 2002. Complications gets the balance exactly right: it snags our attention on the puzzling tale of a shotgun victim with an entry wound in his buttock but a bullet lodged in his upper abdomen (and no major organs or vessels destroyed en route); breaks off to consider the issue of good doctors who, for a variety of reasons, go bad; then tells us what it’s like to operate on a woman whose leg has been destroyed by necrotising fasci itis, aka ‘flesh-eating bug’. Throughout it all, Gawande’s aura of fallibility humanises him. ‘Every day, surgeons are faced with uncertainties,’ he writes. ‘Information is inadequate; the science is ambiguous; one’s knowledge and abilities are never perfect.’ My favourite medical memoirs are by brain specialists, reflecting the fact that the brain has always been the focus of my hypochondriacal anxieties. I didn’t sleep for a week after finishing the neuropsychologist Paul Brok’s Into the Silent Land (2003); couldn’t stop thinking about Stuart, whose left frontal lobe was mashed when he was driving on a motorway and a bolt snapped off the vehicle in front: ‘He told the paramedics he was fine and had better get home now, but they saw the brain stuff gelling his hair and put him in the ambulance.’ Brok’s interest is in what can happen when the brain’s wiring goes even slightly awry, and his case studies are of obscure phenomena like Cotard’s syndrome, an especially chilling form of dementia whose victims cease to believe that they exist. (Though actually, I often feel like this at 5 p.m. on a Friday afternoon.) If you want to know what the brain actually feels like, though, it’s to a brand new book, Katrina Firlik’s Brain Matters, that you should turn. On the first page, Firlik tells us that the brain is more like tofu than toothpaste, and that under pressure it will ‘readily express itself out of a hole in the skull made by a high-speed surgical drill’. I don’t know about you, but I feel better for knowing this.
Firlik is a 37-year-old clinical assistant professor of neurosurgery at Yale, and Brain Matters is exactly the sort of book you would want a brain surgeon to write. The prose is neat and sterile, even prissy head-girl prose par excellence. (Typical sentence: ‘As a physician, I understand and respect the critical role of selective animal experimentation in advancing science and medicine.’) But it loosens up, and soon we’re privy to such ER high jinks as paging the on-call dermatology resident to see what happens — dermatology specialists and their stress-free lifestyles being something of an in-joke among knackered neurosurgeons.
In time we learn that Firlik’s favourite artist is Andy Goldsworthy and her favourite writer Raymond Carver. More importantly, we learn that surgeons call motorbikes ‘donorbikes’, say things like ‘This guy is toast’ while operating, and that it is no longer necessary to shave patients’ heads entirely before surgery. (Kirlik remembers seeing a photo of a bald Elizabeth Taylor after the actress had had a brain tumour removed and thinking, ‘Why did they shave her? That’s so old-school.’) It’s customary for books by doctors to contain at least one killer anecdote (as it were). Brok’s is an account of performing split-brain surgery on an epileptic — temporarily neutralising one of the hemispheres while the patient remains awake. Firlik’s, though, is even better. She once treated a schizophrenic man who had so neglected a cancerous growth on his head that it had eaten through his skull. Unfazed, he had taken to wrapping a towel around his head to stem the leakage of cerebrospinal fluid. It fell to Firlik to remove this towel, which she did by drenching it in saline and tugging at it with tweezers. As she pulled it off, a fly escaped into the room. Odd, she thought. But then she looked closer. ‘I continued to watch until it became clear what I was seeing: a fat white maggot emerging from the man’s frontal lobe.’ This is all very entertaining, to be sure. But what is the real point of these stories? Are they there to inform, or simply to make us squirm delightedly? If the former, then what am I learning, other than that the fate of many of these pseudonymous patients may eventually be mine?
There’s a good deal in Brain Matters about the body wearing out. At one stage Firlik invokes the Japanese term for the beauty of time-battered things, wabi-sabi, and muses on the difficulty we in the West have with ageing and its implications. Will I, at 60, find her tales of vascular degradation as fascinating as I do at 34? Will I be as impressed by the force and clarity of her atheism? Probably not. But then, it’s not really her job to impress and fascinate me. She’s not my friend; she’s a doctor.
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