I was once at a wedding reception and had to introduce myself to the man next to me at the table. Unbelievably, to my left was an astrophysicist; to my right a neurosurgeon. The poor duo then have to deal with endless and hilarious jokes during the party breakfast – other people’s jobs or tasks are dismissed as ‘It’s not rocket science’ and ‘It’s not brain surgery’.
This is a classic putdown, as Theodore H. Schwartz said in his new book – but we never really think about what being a brain surgeon actually entails?
Gray Matters – part memoir, part history, part scientific explanation – is an attempt to delve into this relatively new science, and the incredible things Schwartz and his colleagues have discovered about how the brain works.
First, the warning. If, like me, you’re the squeamish type, Schwartz explains how brain surgery works – there’s a lot of detail about the cutting, drilling and slicing involved (I have to admit, I read that part pretty quickly). Schwartz himself is a skull-base surgeon – someone who operates on parts of the brain so deep that he compares them to the Mariana Trench. In particular, they concentrate on the third ventricle, which is located in the center of the brain. Cerebrospinal fluid, which surrounds and protects the brain and spinal cord, flows through this section. He can operate through the eyebrow or even the eyelid to remove the tumor. For would-be surgeons or scientists among family and friends, this part of the book is ideal.
Some of the most fascinating parts of the book are when Schwartz investigates real cases – analyzing why Abraham Lincoln lived for nine hours after being shot, but JFK died almost immediately.
But Schwartz didn’t just write a pop book about surgery. He also brings in the development of the history of this science and the analysis of famous cases, and explains why he spends more than half of his waking hours with his hands in the skull of other people. The discussion about his mother’s stroke is fascinating – did the stress he faced as a Jewish refugee hiding from the Nazis make him more vulnerable? And his father died after suffering from Broca’s aphasia – brain damage that affects the part that controls language – very moving.
Neurosurgery itself is a relatively young field – about 120 years old – and the early mavericks who ventured into the skull were as brave as world explorers. Schwartz cites pioneers such as Dr. Harvey Cushing, born in 1869, in whose hands the death rate in surgery went from 50 percent to less than 10 percent because of precision. One biographer wrote that watching Cushing operate was like watching Freud analyze a patient or the Pope address a mass.
Other names include Walter Dandy, Cushing’s great rival, who understood how cerebrospinal fluid flows through the brain; Wilder Penfield, who pioneered brain mapping; and Mahmut Gazi Yasargil, who developed modern microneurosurgery.
In the operating theater, they are amazing people – and in the main they are still boys. Schwartz notes that only nine percent of US neurosurgeons are women and only 3.8 percent are black. But you might think twice about spending time with anyone. Cushing worked 16-hour days, six days a week. The day her 23-year-old son died suddenly, she was about to undergo surgery. Instead of collapsing in grief, he continued his day’s work.
Gray Matters – part memoir, part history, part scientific explanation – is an attempt to delve into this relatively new science, and the incredible things Schwartz and his colleagues have discovered about how the brain works.
Some of the most fascinating parts of the book are when Schwartz investigates a real case – analyzing why Abraham Lincoln lived for nine hours after being shot, but JFK died almost immediately (it has to do with the speed of the bullet – Schwartz estimates. Kennedy’s brain received 40 times more). Lincoln, Schwartz thought, might have survived if he had had access to today’s brain surgery techniques — even though he would never have had the mental capacity to deliver another Gettysburg speech. Robert Kennedy, JFK’s brother, could have survived his brain injury if he had been treated sooner. Shockingly, Schwartz said Argentina’s First Lady Eva Peron had a lobotomy to treat crippling cancer pain and her husband Juan may have ordered the doctor to practice the technique on prisoners in Buenos Aires to make sure it was safe.
He discussed how Nobel laureate and activist Malala Yousafzai – who was shot by the Taliban for supporting girls’ education – survived thanks to an operation called a hemicraniectomy, in which part of her skull was removed to reduce brain swelling. The bone that has been removed is then placed inside the abdomen to be stored, and then replaced. (Eventually, prosthetics were used.)
Schwartz also thinks Natasha Richardson – who died after hitting her head on a skiing slope while with one of her sons with husband Liam Neeson – could have been saved if she had had a scan to identify a brain haemorrhage and had been taken to hospital. Her case was complicated by the fact that she did not begin to show symptoms until several hours after the initial effects.
The way Schwartz uses words is like skillfully using microscissors. I like the description of brain surgery like a thief: go in and out, try not to disturb anything and have no clue that you are there. And while anatomy textbooks can provide a road map for surgeons, they neatly describe actual brain surgery more akin to using the Waze app, where you’re constantly adjusting to real-world conditions.
In 2021, the British Medical Journal conducted research into who is smarter, neurosurgeons or rocket scientists – and also, how much smarter are they than the rest of us? No one scores higher than the general public on some intelligence tests. But, says Schwartz, this is asking the wrong question. The people who take on these roles, although not necessarily smarter than the average person, go through very difficult training and work, and sacrifice their time and personal lives to serve their patients. He must have written a book supporting this.
