Getting inside their heads: Conveying brain surgeons' experiences

by Melissa Olson-Petrie

The dramatic focus of The Healing Blade is a procedure called the standstill, developed for neurosurgery [in the late 1980s]. For a patient, what is "standing still"–at zero on every meter–is each measure of life known to medical science. A person undergoing a standstill has no breath, no heartbeat, no blood flow, no viable temperature, and most important, no brainwaves or other brain activity that clinically define being alive. The standstill is fascinating in its implications at a time when theologians, cosmologists and many of the rest of us wonder aloud if something human survives death and if there is an individual spirit that can transcend time and place and molecular substance, since whether something actually does so or not appears beyond resolution. The standstill does not answer the question, but it offers a fascinating place to look. Patients are taken down to death itself and brought back again. That much is certain...

From The Healing Blade (Beck Press, revised edition 1997) by Edward J. Sylvester

Professor Edward J. Sylvester of the Walter Cronkite School of Journalism and Mass Communication has said that he doesn't understand why all science writers aren't writing about the brain. "It's so fascinating to me," he says. "When you are talking about the brain, you are talking about the self–whatever it is, there it is."

The brain, specifically the ways doctors treat brain injuries, is the subject of his two most recent books, Back from the Brink (2004) and The Healing Blade (1993, revised edition 1997). At the "molecular level," these books link in some ways to his two earlier books The Gene Age (1983, revised edition 1987, written with Lynn Klotz) and Target Cancer (1986). Both books were nominated by publisher Charles Scribner Jr. for Pulitzer Prizes.

Sylvester is a former Los Angeles Times reporter. He comes at his books as a journalist first and a student of science second. He credits Klotz, a molecular biologist, with helping him to appreciate the difficulty and responsibility inherent in trying to preserve fine-mesh scientific detail in ordinary language.

"What to a journalist looks ‘as good as' in terms of the science isn't even close," Sylvester says. "When you are trying to explain it, you have to understand what the important details are and why they are important." For example, in writing Back from the Brink Sylvester had to understand the science; he had to know what causes damage in the brain. But, in the end, his role was to convey everything in ordinary language.

To achieve this level of understanding, Sylvester became a round-the-clock observer in the neurological intensive care unit at Johns Hopkins Medical Centers in Baltimore, primarily during summer 2001. He focused his attention on the unit's neurointensivists, neurologists who assume control of a patient's total care for brain and body.

With his digital recorder, Sylvester captured 40 hours of patient rounds, conferences, and conversations, as well as follow-up interviews. He used these recordings to reconstruct events from the months he followed specific doctors, nurses, brain-injured patients, and their families.

"I always like to have multiple interviews," Sylvester says. For example, he recorded morning rounds while doctors, residents, and other medical professionals discussed each patient's treatment and status. During follow-up interviews, Sylvester asked individual doctors to clarify what was said during rounds. "It really sets you up to ask good questions," Sylvester says. "For one thing, you've heard people asking questions also."

The neurointensivists whom Sylvester repeatedly interviewed were accustomed to answering medical questions about what was happening with their patients and why. However, they were not used to being asked about background phenomena, such as whether a patient came in by helicopter or ambulance, whom they called for assistance when, or what was going on in their minds.

"Eventually they begin to understand that you are setting a scene," Sylvester says. "You try to let them know that you'll need more from them than the hard, cold medicine of the story."

All this questioning and attention to detail–including background noises and asides captured on his recorder–helps Sylvester write in a manner that, at its best, allows his readers to share the doctors' experiences. In Back from the Brink, for example, readers might see how a neurointensivist observes a patient who is dying, or responds in the middle of a surgery when something goes wrong, or finally solves a vexing problem.

"Now and then you actually get inside somebody's head," Sylvester says. "You not only experience something they experience, but let other people do it too. It's more than just providing information. You get a sense that something deeper has happened here that you hope you conveyed in the writing."

However, none of this would work without the human side of the story.

"The stories are always focused on people," Sylvester says. "It's never for me just about what's going on at the molecular level. It's how it plays out in terms of humans."

For example, Back from the Brink not only follows the doctors at work, but it also shows some of their struggles to balance long hours at the hospital with their research, as well as the needs of their children and aging parents. The stories of patients and their families were equally important.

As he writes, Sylvester weaves together the science, the place, and the people involved, ultimately finding the explanatory aspects or scientific details of his books easier to write.

"You can re-do and re-do that until you get it right," he says. "You can wake up in the middle of the night with a great idea and go do it. The people part of it is always… You never really know if you got it right or not. That's where there is no final answer."

Read the other articles in this series on science writing at ASU:

John Alcock: Preaching about biodiversity...without being too obvious
Stephen J. Pyne: Lending a voice to fire, ice, canyons, forests

For more information, contact Edward J. Sylvester, Walter Cronkite School of Journalism and Mass Communication, 480.965.4210. Send e-mail to ed.sylvester@asu.edu