Exploring the techniques of surgeons and the passions of innovators.

Sunday, August 27, 2006; BW13

Bad Choice, Worse Choice

Brain surgeons are rarely faced with good and bad choices or granted the luxury of time to ponder them. Usually, they must make quick decisions about bad and worse choices -- and hope they've made the right one.

In Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside (Random House, $24.95), an uneven, overlong but often thoughtful account of a neurosurgeon's seven-year residency, Katrina Firlik recounts some of her more wrenching cases. In the process, she demonstrates unusual empathy -- sometimes a rarity in her specialty, one of medicine's toughest and most remunerative.

"The brain is my business," declares Firlik, who describes how a single wrong move can turn an Albert Einstein into a Forrest Gump. Neurosurgeons must be part mechanic and part scientist, she writes, balancing fearlessness with caution as they scoop out brain tumors, stabilize spines and try to repair the devastation wrought by a stroke or a car accident.

Firlik is adept at describing complex procedures and introduces readers to some of the jargon favored in her specialty: "Walkie talkies" are patients who can still do both after an operation, while a "handshake AVM" describes arteriovenous malformation, an inoperable, fatal tangle of blood vessels; a handshake is all the neurosurgeon has to offer such a patient.

Firlik's lengthy account has one omission. She was the first woman admitted to the University of Pittsburgh's prestigious neurosurgery residency (in 1996). But she skates over this only to digress about irrelevancies such as her mother's view of doctors who don't wear white coats (dim), the author's philosophy of home decorating (eclectic) and the condition of her husband's college dorm room (neat). Readers would probably find her observations about being a pioneer far more interesting.

-- Sandra G. Boodman

O Pioneers

In Donald McRae's Every Second Counts: The Race to Transplant the First Human Heart (Putnam, $25.95), the famed South African cardiac surgeon Christiaan Barnard shares roughly equal billing with three Americans: Norman Shumway, Richard Lower and Adrian Kantrowitz. Who are they? That is a central point of McRae's fascinating account of the events surrounding the historic surgery performed by Barnard in Cape Town on Dec. 3, 1967.

The heart transplant that made Barnard famous cast a shadow over the pioneering research and experimentation done by the Americans, particularly Shumway and Lower, which by late 1967 brought them all to the point where any of them might have been first. Barnard's advantage was that he was more daring, confronted less red tape and got a proper donor heart.

McRae has an interesting perspective on these events: As a 6-year-old boy growing up in South Africa at the time, he first knew of Barnard as a national hero, exalted by the apartheid government as proof that South Africa could produce geniuses on a par with those from the United States or Europe. As he recounts the painstaking work of the Americans, he conveys both a sense of injustice that it has gone largely unrecognized and a sense that, for them, being first was never about being famous.

The author's legwork is impressive. He did extensive interviews with all of the surviving principals -- including Shumway, who died earlier this year -- and many of the secondary players, including Barnard's brother and medical colleague, Maurius, who said he'd planned to call his autobiography "The Chris I Have to Bear."

-- Gregory Mott

Only Connect

Born in 1847, raised in Edinburgh and London, hauled off to Canada to escape the tuberculosis that had killed his two brothers, Alexander Graham Bell made history before age 30 by inventing the telephone. Reluctant Genius (Arcade, $29.95) is a puzzling name for Charlotte Gray's biography. The man she depicts tortures himself when in love, clashes with his parents about his career and suffers over his shortcomings as a husband, but he positively revels in his role as genius. Nothing seemed to suit him better than to pursue -- with as few distractions and interruptions as possible -- his obsessive inspirations.

Gray pays ample attention to Bell's long residence in Washington, D.C. She covers his hosting of weekly soirees with the local intelligentsia, his deep ties to the National Geographic Society, his feud with Edward Gallaudet over how to educate the deaf, even his effort to invent a device to find the assassin's bullet buried inside the dying President James Garfield.

Gray may have tried too hard to make Bell a hero. As did his wife, Mabel -- who was deaf, as was his mother -- Gray harps on Bell's lack of interest in maximizing the profits from his inventions. Not only did he lack strong business instincts (unlike his profit-driven rival, Thomas Edison), Bell also battled chronic physical and emotional ailments. Gray seems reluctant to accept these ordinary human traits in a person she's keen on viewing as much more than ordinary.

-- Tom Graham

I Want a New Drug

The Body Hunters: Testing New Drugs on the World's Poorest Patients (New Press, $24.95; forthcoming in September) has two serious flaws: The author, Sonia Shah, stuffs too many big issues into one small volume, and the book reveals little that people interested in the topic do not already know.

Nonetheless, The Body Hunters does sound an alarm that ought to be heeded. The same bell was rung by The Constant Gardener and the recent film based on that John le Carré novel. Indeed, le Carré praises Shah in the foreword as a crusader who "has struck a blow for all who dream of . . . curtailing the greed that drives [the] worst practices" of the pharmaceutical industry.

As a writer, Sonia Shah is no John le Carré. She tries to cover too much historical and geographical ground in too little space. She rails against globalization. She dwells unnecessarily on some despicable American medical research in the mid-20th century: infecting prisoners with malaria, feeding children radioactive substances, the Tuskegee syphilis study. What Shah doesn't do is delve deep into the moral thickets of today's medical research -- ethical issues that have generated considerable media coverage, as her many footnotes prove.

Is it justifiable, for example, to study HIV infection among Cambodian prostitutes without giving them the same care that research volunteers in the United States would receive? Should one set of research standards apply to lifesaving drugs and another to lifestyle drugs that will benefit only the well-to-do?

Such questions will continue to demand our attention. Shah's book doesn't break new ground, but, like le Carré's, it will bring new participants into the debates, and that's bound to be good.

-- Tom Graham

The reviewers are editors and reporters who cover health and science news for The Washington Post.

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