Sunday, February 28, 2010

Another Day in the Frontal Lobe: Katrina Firlik

How does one make their job seem accessible to the average reader when what they do is (literally) brain surgery? How does one write a popular book on one of the most sophisticated and niche disciplines in modern medicine? How, I ask you, does one enter our minds by telling us how they open brains?

Katrina Firlik does two things right to get her started. First, she chooses a great title for her book - Another Day in the Frontal Lobe. It is the kind of title that makes me look a book up even if I have never heard of it before. Then, she opens with one of the more arresting first lines in non-fiction that I have come across recently. Here are the first lines of Another Day in the Frontal Lobe -

The brain is soft. Some of my colleagues compare it to toothpaste, but that's not quite right. It doesn't spread like toothpaste. It doesn't adhere to your fingers the way toothpaste does. Tofu - the soft variety, if you know tofu - may be a more accurate comparison. If you cut out a sizable cube of brain it retains its shape, more or less, although not quite as well as tofu.
OK then. You can scratch tofu off my lunch menu for the next few days, thank you very much.

Firlik does one other thing right. She sets our expectation pretty early on that brain surgery, for all its glamorous reputation, isn't all science. Neurosurgeons, she tell us, have an intimate, manual relationship with the brain. They do deal with some really complicated issues of the brain, but the tools of their trade, their approach to surgery, their basic rules of thumb, have little to do with the higher order functions of the brain - language, emotions, skills. Their profession is based instead on some simple mechanical principles. Principles like - (a) room within the skull is limited and fixed; (b) this room is occupied by the brain, blood and cerebrospinal fluid; (c) when the brain starts swelling, there isn't much room for it to go without causing increased pressure from the fluids, unlike say a swollen eye that can swell indefinitely outwards because there is nothing constraining it. So one of the fundamental jobs of a neurosurgeon is to internalize these basic principles, and make sure this mechanical system keeps chugging along. If the brain starts swelling, either find a way to get the swelling down, or get some of the blood or cerebrospinal fluid out, or (extreme case) cut out a 'less important' part of the brain. But keep the pressure down! As Firlik memorable states about her kind - "we are part scientist, part mechanic."

This last is one of the unambitious yet evocative verbal flourishes that Firlik offers occasionally in the book. Another one I quite liked - talking about the 'why me' question that patients often ask when faced with strange quirks in their brain, Firlik quotes a senior surgeon as saying - "bad genes, bad habits, or bad luck". I thought that was quite neat.

There are ways in which Firlik the author isn't quite as accomplished as Firlik the neurosurgeon. (Random fact: Did you know that there are only about 200 women neurosurgeons in the entire United States?) It starts with what seems like a rookie error to me - if the subject of your book is a cliche or a gag line, confront it, joke about it, get it out of the way! What Firlik does is brain surgery. It is difficult to avoid the cheap joke ("This isn't exactly brain surgery ... wait, it is!"). but Firlik ties herself up in knots trying to avoid the obvious line, trying to make her work seem everyday. "Not quite the stuff of rocket science, but critical nevertheless" she says in a stilted and awkward attempt.

The awkwardness continues along the book where somewhere along the line Firlik seems to lose the distinction between a popular book and a lecture series. Her politically correct, corporate etiquette language starts to get a bit thick and annoying after a while. Her husband is a neurosurgeon-turned-Venture Capitalist (next stop - the White House). Introducing him for the first time, Firlik says "He is also a neurosurgeon but, because of his passion for innovation and entrepreneurship, pursued a career in venture capital." Seriously? 'Passion for innovation and entrepreneurship'? What is this, a job interview? Talking about her childhood when her father took the family to rural fairs, she says "We visited these rural fairs to gain an appreciation of a different scenery and culture". Boy! Is there a less interesting way to talk about that, anyone?

Finally, there is the telling of the story as a chronological memoir. This might be tolerable if the subject were a super-celebrity whose story is powerful enough to not need any narrative tricks. But Katrina Firlik, all her protestations aside, has had a pretty uneventful and - dare I say it? - easy life. So the straight telling of the story is just not compelling.

In the final analysis, Another Day in the Frontal Lobe is a book starring the most mysterious of human organs, that somehow manages to peel away the mystique without adequately replacing it with understanding. "I am not just a mechanic, after all," says Firlik, "and the brain is not just Tofu." Reading this book though, you might not quite see how.

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