Gray Matters: A Biography of Brain Surgery
“I stare into the eyes of the patient sitting in front of me . . . contemplating both his future and the terrifying prospect of having the hands of a relative stranger rooting around in his skull.”
Join the author, a neurosurgeon, on his journey into the inside the brain as he wields the scalpel, bores a hole with a drill, and takes out a bullet that potentially means life or death.
Partly autobiographical, the author relates his own trials and tribulations during his training as a professional brain surgeon. Chapters detail surgeries on real people: celebrities, athletes, and politicians, many of whom are still here to tell their tale. “The public’s fascination with brain surgeons reflects the ongoing mystery about what it is we really do.’’
“On these pages, I want to tell the story of neurosurgery from its primitive beginnings, when it was mostly used to treat head trauma, to its current state as a computer-based discipline of meticulous precision.” From the founders of neurosurgery, Harvey Cushing and Wilder Penfield, to the research perform by today’s neurosurgeons, Theodore H. Schwartz asks how the early pioneers came to understand the human brain. Read on, reader, The answers lie in future chapters.
The author dispels the myths around neurosurgeons. They would have not tried it if they knew what they were in for. They are no women. Most neurosurgeons love their research and the power that gives them a chance to save a life. Many patients die from brain surgery. Today, women are prominent in the field. This field owes the early pioneers for their innovations to head trauma so most patients can live.
The chapter on political assassinations includes JFK and Lincoln. JFK’s bullet killed him because the doctors believed it struck the back of his head. Repairing a bullet wound to the brain is unpredictable. “The event haunts historians, who must deal with the enormous controversy surrounding the details of the shooting . . .” The stark black and white illustrations of Lincoln’s brain add to understanding the difficulties of repairing a victim’s brain trauma.
Operating on a person’s gray matter, the neurosurgeon must weigh the risks. It depends on the time and the doctor’s skill. Did the patient arrive as soon as the accident occurred the brain? Is the damage so severe to leave the patient paralyzed or mentally deficient? “Saving the life of a head trauma victim is one thing. Restoring function to a devastated brain is quite another.” An example is Natasha Richardson’s ski accident. She fell on her head and seemed fine. After she hemorrhaged it was too late to save her life. Had she been operated on immediately, she may have been alive today. A fall against a sharp piece of furniture or glass object can produce serious injuries. However, so many people live too far from a hospital to seek immediate treatment. “Access to neurological care is just another example of the unequal distribution of resources on our planet without an easy solution.”
Sports injuries such as concussions can become life-changing head traumas. Football is the leading sport, next girls’ soccer, followed by girls’ basketball. “Blows to the head can also damage blood vessels, which regulate blood flow, disrupt cell metabolism (the amount of energy consumed), create ingliosis, named after the glial cells, which nourish and clean up the excess waste and chemicals produced by the neurons.” Eventually, the National Football League was forced to require professional helmets for all players. Why do spectators enjoy a fight or a head-on-collision? “The reason sports are so engaging for the spectator is that the struggles and risks inherent in human conflict are amplified and focused into brief, intense moments that result in a clear outcome: victory or defeat.”
The author imagines himself as a patient waiting for surgical treatment of a brain tumor. Time stops and you become a diagnosis, the stranger’s hands will decide if you live or die. There is no time and all is chaos. “I stare into the eyes of the patient sitting in front of me . . . contemplating both his future and the terrifying prospect of having the hands of a relative stranger rooting around in his skull.”
The author specializes in brain tumors. He has to decide to choose surgery or radiation to treat a meningioma, a benign tumor. It depends on its size, age of the patient, or how fast or slow its growth and its location. These variables run through the neurosurgeon’s head, weighing the risks. But malignant tumors don’t care about your politics. “They don’t care if you’re wealthy, famous or powerful. They will grow and likely kill you all the same.”
Wilder Penfield and George Ojemann discovered brain mapping and brain stimulation. In addition, he taught his students about how the brain codes for language, so critical in removing brain tumors. The reader may be surprised to learn that the patient is awake while the surgeon stimulates each part of the brain to elicit a response. When he opens the cranium with a drill, the patient does not feel any pain. “Awake in the operating room, their brains exposed, the patients would name each object: ‘This is a key . . . this is a telephone . . .’ ‘’ It depends on the tumor’s location whether the patient will be awake or asleep during the surgery.
Chapter nine takes the reader on a journey to the center of the brain. “Like the peak of Mount Everest or the Mariana Trench, there are places on this planet so inhospitable and unwelcoming that it can seem humankind was never meant to explore them. Similarly, there are locations in the brain where tumors can lurk, deep in its innermost chambers, hidden from all but the most intrepid of adventurers.” These tumors are located at the bottom of the skull. Skull base surgery is long and full of danger. Reading the detailed descriptions with case studies and pictures, readers will feel as if they were watching an actual operation. Finally, the journey ends with the hope that neurosurgeons will find a way to prevent these tumors.
Today, neurosurgeons are trained in the use a computer-guided procedure to fix aneurisms and strokes, if they are caught on time. President Joe Biden survived this kind of surgery for two aneurisms. Schwartz believes that extreme stress may be one of the causes of these brain accidents.
In comparison to other books which describe the brain’s anatomical and functions (The Brain Book by Richard Restak), Schwartz is not afraid to expose hidden tumors and try to extract them. He shows that the gray matter beneath the skull matters to all neurosurgeons.
The rest of the book will peak the reader’s curiosity for lively discussions on the plasticity of the brain, philosophical questions about the self, the existence of free will and the dilemma of brain vs mind. Which is the executive director of the body, brain or mind?