Victor Horsley, one of the first surgeons to carry out a successful brain operation, was renowned for his arrogance towards peers and extraordinary sensitivity to patients. A junior doctor recalled that when conducting ward rounds, “he gave each patient the impression that he was his sole care in life and would arrange their pillows with a tender deftness”. In 1886, his operation on James B, an anonymous patient with intractable epilepsy, cured him of further seizures; it rendered James B a significant footnote in medical history and made Horsley a star.
That first brain surgery illuminates the symbiotic relationship of patient and physician, now explored often in this golden age of doctor-authors. In transcribing case histories as the source material for books, medics must wrestle with the dilemma, anticipated by the Hippocratic oath, which cautioned “whatsoever in the course of practice you see or hear that ought never to be published abroad, you will not divulge”. The neurologist Suzanne O’Sullivan is alert to Hippocrates and acknowledges the debt owed to patients in Brainstorm, the follow-up to her prizewinning It’s All in Your Head. The new book comes with the subtitle “Detective Stories from the World of Neurology”, but many of the mysterious cases to be solved here are those of patients visited by the “occasional, sudden, excessive, rapid and local discharge of grey matter” of the brain that characterises epilepsy.
Oliver Sacks’s exuberant essays, such as those in The Man Who Mistook His Wife for a Hat, are touchstones for many doctors following his literary path, but O’Sullivan favours spare, unvarnished writing (the kind of sensible language, notwithstanding medical jargon, you might overhear on a ward round). Wisely, she allows room for the patients’ own descriptions of their conditions. In an account reminiscent of Alice’s Adventures in Wonderland, a patient in the throes of a seizure notices: “things changing around me … they’re shrinking because they’re getting further away … although I can’t decide if I’m getting bigger or everything else is getting smaller”.
One of the enigmas of epilepsy is its stealth: patients are often unaware of the seizure’s arrival
Although two-thirds of people with epilepsy control their seizures with medication, that still leaves close to 200,000 people in the UK for whom the drugs don’t work. A number of these might be candidates for surgery, if the origin of their seizures can be located in the brain. Though technologies such as CT scans and fMRI offer enhanced powers of resolution, O’Sullivan confesses her reliance on more primitive tools such as video telemetry (video and EEG monitors). One of the enigmas of epilepsy is its stealth: patients are often unaware of the seizure’s arrival. During video telemetry, patients are kept under 24‑hour surveillance while electrodes attached to their scalps register any abnormal brainwaves. Some of the most dramatic passages in this book come when O’Sullivan, reviewing the recordings, resembles a detective poring over CCTV footage to spot the suspect, signalled by a tiny gesture from the patient – swallowing, or repetitive finger-tapping.
O’Sullivan often seems to be the neurologist whom colleagues turn to when all other avenues have been exhausted. Even so, she’s refreshingly candid about the limits of medical knowledge. Asking herself why spitting as an expression of a particular kind of epilepsy may be associated with one temporal lobe, she jokes: “I have no idea. The brain has a mind of its own.”
She also perhaps illustrates the numbing effect of a life spent in medicine when she admits she can’t fully fathom why some people with epilepsy don’t want to see the videos of their loss of bodily control. But then physicians, as Caroline Elton writes in Also Human (Heinemann), her insightful new book on “the inner lives of doctors”, are candidates for compassion as well. Many of O’Sullivan’s stories are powerfully life-affirming, but several are tragic. She is careful not to influence a patient’s decision to undergo surgery, citing the tale of a happily married, high-functioning businessman whose occasional seizures were, in the view of his supportive employer, trumped by his benefits to the company. He opted for brain surgery. The operation was successful, but afterwards he suffered severe depression and changes to his character that led to his getting the sack and divorced.
Brainstorm is testament to O’Sullivan’s unshowy clarity of thought and her continued marvelling at the mysteries of the brain. She doesn’t yearn for all the gaps in medical knowledge to be filled: “If we knew everything about how the brain functioned,” she writes, “what would we be then? Just sophisticated machines?” Some readers might be surprised to hear a neurologist echoing Keats’s criticism that Newton stripped nature of its poetry by reducing the rainbow to a prism. But if O’Sullivan was more clinical it’s doubtful she’d be such a fine writer.
• Colin Grant’s A Smell of Burning: A Memoir of Epilepsy is published by Vintage. Brainstorm is published by Chatto & Windus. To order a copy for £14.44 (RRP £16.99) go to guardianbookshop.com or call 0330 333 6846. Free UK p&p over £10, online orders only. Phone orders min p&p of £1.99.