Book Review: Another Day in the Frontal Lobe

Another Day in the Frontal Lobe
Katrina S. Firlik
288 pages – $14.95

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Dr. Katrina Firlik, who describes herself as “part scientist, part mechanic”, is in a minority: with 4,500 neurosurgeons in the US, or about one for every 65,000 people, only 5 percent of them are women. Recounting how she came to be a neurosurgeon, and the life of a neurosurgeon in a hospital environment, Dr. Firlik gives a stark and realistic overview of the work involved in this profession, and how she got there.

“Surgery is usually a last resort,” Dr. Firlik writes. “Neurosurgeons complain that neurologists wait too long and try too many medications before sending patients over. Neurologists complain that neurosurgeons are too aggressive in recommending surgery.” Yet contrary to popular belief, neurosurgeons are not really brain surgeons; at least not exclusively. They spend much more time operating on spines and spinal injuries than brains. The brain is quite a solid box; the spine is much weaker. When it’s car vs. car, the spine loses out much more often. Nevertheless, Dr. Firlik only mentions spine surgery in passing; the focus of this book is on the brain, perhaps because it is more impressive to lay people.She then briefly explains how she came to choose neurosurgery during medical school, the rigors of the training required to specialize as a neurosurgeon after four years of medical school, and the quirks of her internship and residency, the period during which, “residents evolve from lowly interns to fully fledged neurosurgeons.”

Dr. Firlik points out how some people may choose which surgeon they want for their operation. Discussing how some neurosurgeons spend most of their time in the operating room, and others try to get as many hours in the lab as possible, she points out that, “a lay person might assume that the surgeon with his name on the greatest number of papers . . . is the guy to go to for a certain type of surgery. While this may be the case, . . . the reality could also be that this is the guy who spends far more time in the lab than in the OR. A great mind for science and great hands do not necessarily go together.”

Firlik discusses the different types of neurosurgeons. There are those who specialize in such things as aneurysms, who are usually called in at night or on holidays to operate in emergency conditions. Then there are the spinal specialists, who perform well-paid spine fusions working nine-to-five hours. Then there are the radiosurgeons, the kind who work with radiation such as the gamma knife; they, says Firlik, are “often the smartest ones around, because they have time to read.”

Firlik tells one story about a patient with an AVM (arterio-venous malformation) who died after surgery, and another who chose to live with an especially large AVM and its uncertainty. She then asked the questions that many of this review’s readers will ask themselves: “It’s clear that the brain can accommodate quite nicely to the overbearing presence of a malformation, but can the mind be trained to accommodate just as well? When inaction is the best action, how do you prevent fear itself from becoming an illness? Does the fear simply wear out, or does it have to be forced out?” She then says, “I have found that handling a patient’s anxiety can be more complicated, and sometimes even more time-consuming, than the surgery itself.”

Dr. Firlik is an esthete; she likes the way the brain looks, and she occasionally tosses in statements about how much she marvels at the way the human body works, how the brain leads to the mind, or waxes philosophical about everyday life. She explains, at one point, how she broke down and cried when telling a patient that his brain tumor was fatal, and manages to express a deep understanding of the human condition.

This book can be gruesome at times, as Dr. Firlik describes some of the more bizarre cases she has dealt with, and may not be for the squeamish. Some of the stories have sad endings, and others end happily. In the end, they probably all add up to the complex life of a neurosurgeon: dealing with one of the most eloquent parts of the human body is fraught with both great risk and great possibilities to heal.

Visit Dr. Katrina Firlik’s web site to find out more about her book, learn about the brain, and see her intriguing drawings of parts of the brain and some of the tools of her trade.