Brain Matters, by Katrina S Firlik

For anyone who has ever wanted to get inside the head of a brain surgeon
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The Independent Culture

As Katrina Firlik embarked on a seven-year hospital apprenticeship, her seniors warned her to think carefully: "Don't go into neurosurgery unless there's absolutely nothing else you could ever see yourself doing." Unfortunately for Firlik, she didn't heed their advice: she can imagine other, happier careers. And no one reminded her that she would be 33 when she finally emerged from "the tunnel".

Brain Matters: Adventures of a Brain Surgeon is an entertaining yet strangely disturbing autobiography of a woman still in her thirties. It is as if her life is already over, and she is trapped "doing the same things, over and over".

The bulk of the text focuses on Firlik's years as a resident in neurosurgery, working exhausting hours at a teaching hospital in the States. Gruesome tales abound: the time she saw maggots crawling inside a man's brain; or the carpenter with a roofing nail power-hammered through his skull. Tumours and strokes are her bread and butter. Surgeons debate the pros and cons of interventions, and check their patients' insurance coverage.

As a lone female among macho colleagues, she jokes that she could have written a book called "Gorillas in My Midst". Yet she prides herself on being one of the team, and just as competitive. Throughout, her tone is cool, rational, matter-of-fact. The brain is often likened to toothpaste, she says, but it doesn't stick to your fingers. It's more like tofu, "the soft variety, if you know tofu".

Indeed, Japanese food is her favourite, reflecting a childhood fascination with foreign lands. Aged 12, she memorised the capital of every nation. At university, she began learning Japanese, intent on becoming an anthropologist, but then "started to fixate on more practical concerns, like making a good living and maintaining a stable career". Her then-boyfriend Andy (now husband) was set on becoming a neurosurgeon, and she switched to the "premed" track. Once on the treadmill, she clung on.

Today, Firlik no longer works at the front line. She combines a teaching post at Yale with a lucrative private practice, mostly treating patients with bad backs seeking spinal surgery. It's where most neurosurgeons end up; the pay is good and so are the hours. She has never been sued, but like all her colleagues, she expects to be. Her malpractice insurance costs $106,000 a year.

Read this book if only as a warning of what may lie in store for the NHS. "Medicine is a business, after all," she says.

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