A Bomb in the Brain.

A Bomb in the Brain. – book reviews

Marjory Roberts

PEOPLE WHO TREAT PEOPLE

THE UNFORTUNATE LINK between man and medicine is often disease. Ironically, the sick put their lives in the hands of strangers who use equally strange means to treat them. When a blood vessel burst in journalist Steve Fishman’s brain, he decided to explore the relationship between “personhood” and “patienthood,” and in A Bomb in the Brain (Charles Scribner’s Sons, $19.95), he poignantly narrates his odyssey through illness. Fishman expertly conveys a healthy man’s experience of disease, framing with his own tale the stories of medical pioneers and modern-day doctors who put humanity into medicine.

When Fishman’s head explodes in excruciating pain, for example, he introduces the neurologists and psychologists who mapped out the experience of pain. The reader meets H.K. Beecher, who found that World War II soldiers severely injured in battle needed only a fraction of the painkiller that surgical patients required. Later theorists reasoned that perception affects sensation; for the servicemen, the wound signified an end to their fighting days, while surgical aches may have been associated with disease and death in the minds of the hospitalized people.

As Fishman goes through a battery of neurological tests, he describes Wilhelm Conrad Roentgen’s serendipitous discovery of the X ray and the daring chances one neurological pioneer took in devising a way to navigate the brain’s blood vessels, a test known as the angiogram. Fishman interrupts history long enough to relay, vividly and philosophically, his experience of the procedure. “I expect to … receive some signal that everything is going horribly wrong,” he says, “that the plastic rope has knotted and hangs like a noose around my heart, which I, too, through the magic of TV, can watch on the overhead monitor.”

Fishman also tells of the physicist and the engineer who unintentionally revolutionized man’s understanding of the brain with the invention of the CAT scan. But long before doctors could observe the brain, neurologist John Hughlings Jackson realized the value of simply observing the patient closely. As Fishman walks, hops and smiles for his doctor, he marvels at the exam’s simplicity: “It is an incredible idea that this nice man in a plaid suit can test my brain by watching me jump in place.”

The testing reveals that Fishman was born with a small vessel abnormality in his brain that inexplicably ruptured and caused minor damage. To prevent another hemorrhage, he elects to have brain surgery to remove the patch of malformed vessels. Before his operation, the reader stands amused and horrified with Fishman looking at his bald reflection. “I am two people,” he writes. “One of us has a white bulb of a head, an onion head, and one of us, still unconvinced, shadowboxes with the mirror and thinks a sequence of thoughts like `ugly…ugly…ugly.'” When he describes his first semi-conscious moments after surgery, the reader rouses with him: “My eyes crack. Like a photograph, no one moves… `Why am I so tired?,’ I manage to say, and am filled with a sense of danger… `Sorry I’m no fun,’ I say, feeling bellied up and embarrassed. My eyelids fall like broken shades.”

Sandwiched between these experiences is the most radical piece of medical history in the book — the development of neurosurgery. Turn-of-the-century surgeon Harvey Cushing excised brain tumors more successfully than did his predecessors, but guesswork seemed as much a part of his technique as skill. Even today, good brain surgeons bring a little bit of art to their science. When Fishman observes his surgeon, Eugene Flamm, perform an operation similar to his, the patient’s brain begins to bleed uncontrollably — an age-old complication of brain surgery. Flamm cuts off the major source of blood to one portion of the brain, giving himself about five minutes to hunt down the source and stop the bleeding before the patient suffers a stroke. A period of violence ensues; Flamm stomps, swears and cries, “What the hell am I missing here?” Just in time, he discovers and repairs the problem without harming the patient.

Modern medicine’s fallibilities, however, don’t strike Fishman personally until almost a year after his operation. He develops epilepsy, a chronic brain disorder. Medical advancement has less to offer him now. The drug that controls his seizures cannot stop them nor can it reduce the stigma the disorder carries.

Again, the reader feels Fishman’s terror as epilepsy induces “neural mutiny” during his first grand mal seizure: “My mouth is half open,” he writes, “and respiration comes in short, sweaty bursts; it’s as if phone books are piled on my chest…It feels as if I’m about to tip over, although this can’t be true, not here on this bed with its four planted legs. Or can it?”

Fishman is a wonderful writer with powerful insights. He is also a fine reporter, though at times his thorough accounts of doctors past and present threaten to crowd out his own tale. But the juxtaposition serves a purpose. In weaving his story with theirs, Fishman shows that it is the ultimate business of both doctor and patient to preserve life. And the worlds they inhabit seem less distant when we peer beyond the technology of medicine and into the lives of those who pioneer the inexact science of healing.

Marjory Roberts is an associate editor at Psychology Today.

COPYRIGHT 1988 Sussex Publishers, Inc.

COPYRIGHT 2004 Gale Group