Metaphor is a menace. Once a concept is employed as a metaphor, its literal meaning often gets lost, shoved so far back in the rhetorical closet that you need an ax and a spade and a trouble light to retrieve it.
Such a concept is “balance.” So relentlessly appropriated by yoga instructors and life coaches, so thoroughly swallowed up by the tenets of various self-help movements, by now its role in the human body — its actual, honest-to-goodness, non-metaphorical function — has become a mere afterthought. Balance, you could be excused for thinking nowadays, means learning how to juggle a career and a family. Or developing strategies to cope with this crazy world of ours.
Yet first and foremost, balance means being able to stand up straight and walk across the room without falling down — two things that, as Dr. Norman Doidge talks about it in his lucid and absolutely fascinating book, The Brain That Changes Itself, his patient could not do. The patient’s vestibular apparatus having been destroyed by a mistakenly prescribed antibiotic, she repeatedly stumbles and plummets. “Even when she has fallen,” Doidge writes, “she feels she is still falling, perpetually, into an infinite abyss.” And you feel sorry for yourself when Junior has the sniffles and you’ve got a big meeting at work?
Doidge’s book is about plasticity, a funny-sounding word that refers to the brain’s ability to continually remake itself. For a long time, Doidge notes, scientists thought the brain was a sealed black box; once its basic wiring was finished, which happens in childhood, it was over. That’s all she wrote. Brains, everyone thought, were hardwired, like computers. Brains don’t change.
Except that, as Doidge explains through a captivating series of real-life cases, they do. “Unlike a computer, the brain is constantly adapting itself,” he writes. “It doesn’t simply learn; it is always `learning how to learn.'” And because of that ability, there is hope for people such as Doidge’s patient, people with injured brains.
Doidge’s book joins a growing stack of works dealing with that most mysterious and essential of entities, the human brain. Indeed, brain books have become a bustling subset in an increasingly important literary genre: the medical narrative. Distinguished by the work of physician-authors such as Oliver Sacks, Richard Selzer, Jerome Groopman and Atul Gawande, the medical narrative is educational and riveting. It satisfies, in equal measure, the mind and the heart. The stories of the real-life physical traumas of real-life people, served up by engaging writers — no wonder the medical narrative is thriving.
The Brain That Changes Itself is an excellent addition to the category. So, in its own way, is Final Exam: A Surgeon’s Reflections on Mortality, a superb collection of essays by Dr. Pauline Chen, who graduated from Northwestern University Medical School.
Unfortunately the same is not true for two medical narratives published last year. Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside by Dr. Katrina Firlik, and The Three-Pound Enigma: The Human Brain and the Quest to Unlock Its Mysteries, by Shannon Moffett are bland and disappointing. The former is written with a flat-footed prose style that clashes with the dazzling immensity of its subject matter, and the latter is a strange and uninspiring cross between a textbook and a rambling personal journal.
Here, for instance, is how Firlik deals with the emotional detachment she believes necessary for physicians: “In thinking like a neurosurgeon, you also have to know how to make a decision in the face of tragedy and then just move on.” That sentence just lies there on the page, as coldly unappetizing as a lump of 12-day-old tuna salad on a cracked plate. When you turn to Chen’s essays on the same topic — the surgeon’s private emotions — you’re struck by the passion and acumen of a genuine craftswoman.
Perhaps because brain science is so inherently interesting, some authors believe if they simply pick it as a topic, they’re home free. They don’t have to do anything else. Just unspool a series of tales about the body and its odd ways of getting out of whack, and there you go.
The difference between the Firlik and Moffett books, and the Doidge and Chen ones, however, demonstrates the great truth about medical narratives: Having an important story to tell is only part of the challenge. After that it’s all up to the writer.
If you’re Doidge, you are able to explain current research in neuroscience with clarity and thoroughness. You can present the ordeals of the patients about whom you write — people born with parts of their brains missing, people with learning disabilities, people recovering from strokes — with grace and vividness. If you’re Chen, you can craft beautiful, luminous essays about life and death, about sitting down beside a beloved patient who has just died:
“The room remained dark and so silent that I could hear my own breathing. Frank’s eyes were closed. His body, already pale, was perfectly still; his lips were slightly parted and pale blue; and his cheeks were sunken and unmoving, weighing down against those glorious arches of bone.”
Led by Sacks, the grand old man of the medical narrative, these new physician-writers present science on a human scale, telling stories that don’t always have happy endings but that are infinitely hopeful nonetheless. They show healers and patients pushing back against what we don’t know. The true enemy, we learn, isn’t the cancer cell or the ruptured blood vessel or the broken bone, but ignorance. And sometimes cowardice.
In Letters to a Young Doctor (1982), Selzer, author of classic reflections on what physicians do and what their work means, wrote, “The flesh is the spirit thickened.” In the best medical narratives — and the works of Doidge and Chen join that fraternity — the narrow bridge between body and soul is traversed with courage and eloquence. And despite the fact that all lives are doomed and fragile, we can almost believe, for the flicker of a sentence, that we will live forever.