“Another Day in the Frontal Lobe”

When I sat down last week to read Another Day in the Frontal Lobe – a memoir of medical residency I picked up for the obvious reason that it was written by a neurosurgeon, about her neurosurgical residency – I was hooked from the very first paragraph:

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. Damaged or swollen brain, on the other hand, is softer. Under pressure, it will readily express itself out of a hole in the skull made by a high-speed surgical drill. Perhaps the toothpaste analogy is more appropriate in these circumstances.

This prose is full of the promise of an intimate view of the brain. It is not merely the up-close and personal perspective of a self-described “mechanic” who has been literally hands-on in the brain; it is also written with style and vivid imagery that can get closer even than a documentary in giving a true feel for the physical nature of the brain. My own experience of the brain is highly academic; my memories of a neuroscience lab in high school are largely of the slightly disturbing similarity between a rabbit brain and a walnut, and all the brains we dealt with were fixed by formaldehyde, so sometimes I catch myself thinking of the brain as one of those color-coded textbook images. A dose of toothpaste and tofu in the mental imagery is just what the doctor ordered.

In addition to its beautiful form, the opening paragraph has a critical function: it serves as a gateway for who should read this book. If you find yourself squirming, uncomfortable, or especially nauseated by that paragraph, you are probably not going to enjoy this book. (And if you shudder at that scene of the cordyceps-infested ants from Planet Earth  I’ve mentioned before, you should probably do yourself a favor and not even read the rest of this blog entry. Trust me on this.) The cases Dr. Firlik reports encompasses the entire range you might expect of brain surgery, from suicide attempt to tumor removal, and regardless of how carefully or poetically they are written, eventually the mere facts of what’s going on will get to you. It takes a great deal to gross me out, but a week later I’m not sure how I feel about learning that a person can be semi-functional with maggots nesting in the frontal cortex.

The rest of the book does live up to that opening paragraph, so if it fascinates you more than it repels you I suggest picking up a copy for yourself. My own copy will be making a home on my office bookshelf, in the hopes that one day I will put together a popular-nonfiction based course (perhaps with its new neighbors, My Lobotomy and My Stroke of Insight) to introduce students to the brain. As long as we read that first paragraph on the first day of class, so they would know what they were getting into.


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