I was once at a wedding reception and had to introduce myself to the men on both sides of me at the table. Unbelievable as it may seem, on my left was an astrophysicist; on my right a neurosurgeon. The poor duo then had to face endless, tedious jokes all the way through the wedding breakfast – anyone else’s work or tasks were dismissed as ‘It’s not rocket science’ and ‘It’s not brain surgery’.
This is the classic putdown, as Theodore H. Schwartz says in his new book – but do we ever really think about what being a brain surgeon actually entails?
Gray Matters – part memoir, part history, part scientific explanation – is an attempt to delve deep into this relatively new science, and the extraordinary things that Schwartz and his peers have found about the workings of the brain.
First, a warning. If, like me, you are the squeamish type, Schwartz goes into detail of how brain surgery operates – there’s lots of details of the cutting, drilling and slicing necessary (I have to admit, I read those parts fairly quickly). Schwartz himself is a skull base surgeon – one who operates on parts of the brain so deep that he compares them to the Mariana Trench. In particular, he concentrates on the third ventricle, which is right at the centre of the brain. The cerebrospinal fluid, which surrounds and protects the brain and spinal cord, flows through this part. He can operate through the eyebrow or even the eyelid to remove a tumour. For the would-be surgeon or scientist amongst your family and friends, this part of the book is ideal.
Some of the most fascinating parts of the book are when Schwartz delves into real-life cases – analysing why Abraham Lincoln lived for nine hours after being shot, but JFK died almost straight away
But Schwartz hasn’t merely written a pop-textbook on surgery. He also brings in historical development of this science and analysis of famous cases, and he explains why he spends the better part of his waking hours with his hands inside someone else’s skull. His discussion of his mother’s stroke is intriguing – had the stress she faced as a Jewish refugee hiding from the Nazis made her more susceptible? And his father’s death after suffering Broca’s aphasia – brain damage that affects the part that controls language – is very moving.
Neurosurgery itself is a relatively young field – around 120 years old – and the early mavericks who ventured into the skull were as courageous as world explorers. Schwartz mentions pioneers such as Dr Harvey Cushing, born in 1869, in whose hands rates of death in operations went from 50 per cent to less than 10 per cent thanks to his precision. One of his biographers wrote that watching Cushing operate was like watching Freud analyse a patient or the Pope saying mass.
Other names include Walter Dandy, Cushing’s great rival, who figured out how cerebrospinal fluid flowed through the brain; Wilder Penfield, who pioneered brain mapping; and Mahmut Gazi Yasargil, who developed modern microneurosurgery.
In the operating theatre, they were amazing men – and in the main they still are men. Schwartz notes that only nine per cent of US neurosurgeons are women and only 3.8 per cent are black. But you might think twice about spending time with any of them. Cushing worked 16-hour days, six days a week. The day his 23-year-old son died suddenly, he was just about to start surgery. Instead of collapsing in grief, he carried on with his day’s work.
Gray Matters – part memoir, part history, part scientific explanation – is an attempt to delve deep into this relatively new science, and the extraordinary things that Schwartz and his peers have found about the workings of the brain
Some of the most fascinating parts of the book are when Schwartz delves into real-life cases – analysing why Abraham Lincoln lived for nine hours after being shot, but JFK died almost straight away (it’s to do with the velocity of the bullet – Schwartz estimates Kennedy’s brain received 40 times as much force). Lincoln, Schwartz thinks, could have survived if he’d had access to present-day brain surgery techniques – although he would never have had the mental ability to deliver another Gettysburg speech. Robert Kennedy, JFK’s brother, could have survived his brain injuries if treated quicker. Shockingly, Schwartz says that Argentinian First Lady Eva Peron had a lobotomy to cure crippling cancer pain and that her husband Juan may have ordered the doctor to practise the technique on prisoners in Buenos Aires to ensure it was safe.
He discusses how the Nobel prize winner and activist Malala Yousafzai – who was shot by the Taliban for her support of girls’ education – survived because of an operation called hemicraniectomy, in which part of her skull was removed to ease swelling of the brain. The removed piece of bone was then placed inside her abdomen for safekeeping, to be replaced later. (In the end, a prosthetic was used instead.)
Schwartz also thinks Natasha Richardson – who died after hitting her head on a ski slope while with one of the sons she had with husband Liam Neeson – could have been saved had she had a scan to identify the brain haemorrhage and been airlifted to hospital. Her case was complicated because she did not begin to show symptoms until several hours after the initial impact.
Schwartz’s way with words is as skilful as his wielding of microscissors. I enjoyed his description of brain surgery as like burglary: get in and get out, try not to disturb anything and leave no clues you were there. And while anatomy textbooks may give surgeons a road map, he neatly describes actual brain operations as more akin to using the Waze app, with which you’re constantly adjusting to real-life situations.
In 2021, the British Medical Journal carried out research into who was smarter, neurosurgeons or rocket scientists – and also, how much cleverer are they than the rest of us? Neither scored higher than the general public in a range of intelligence tests. But, says Schwartz, this is asking the wrong question. Those who take on the role, though they may not necessarily be more intelligent than the average person, undergo extremely challenging training and work, and sacrifice time and personal lives to dedicate themselves to their patients. He’s certainly written a book that supports this.
