Brain Injury Law Blog : Head Injury : Coma : Personal Injury : Las Vegas Nevada Lawyer & Attorney Tim Titolo

 I recently completed a book written by Dr. Antonio Damasio entitled Self Comes to Mind, Constructing the Conscious Brain published in 2010. You may have heard of Dr. Damasio’s previous books Descartes’ Error and  The Feeling of What Happens. He is the author of a number of books, including Self Comes to Mind: Constructing the Conscious Brain," published in November, 2010.

               

Dr. Antonio Damasio is a renowned neuroscientist who directs the USC Brain and Creativity Institute. He was previously the Head of Neurology at the University of Iowa Hospitals and Clinics. His research focuses on the neurobiology of mind and behavior, emphasizing emotion, decision-making, memory, communication, and creativity. Dr. Damasio’s research helps describe the neurological origins of emotions and shows how emotions affect cognition and decision-making. Dr. Damasio is the 2010 winner of the Honda Prize, one of the most important international awards for scientific achievement.

In my continuing study of the brain, I left Self Comes to Mind refreshed with an intricate sense of biological treatment and yet deeply humanizing--real people with serious problems spring to life in the pages, but they are never reduced to their deficits. I found a thorough examination of interior life through lenses of research, medical cases, philosophical analysis, and unashamed introspection.

Publishers Weekly had this to say:

As he has done previously, USC neuroscientist Damasio (Descartes' Error) explores the process that leads to consciousness. And as he has also done previously, he alternates between some exquisite passages that represent the best popular science has to offer and some technical verbiage that few will be able to follow. He draws meaningful distinctions among points on the continuum from brain to mind, consciousness to self, constantly attempting to understand the evolutionary reasons why each arose and attempting to tie each to an underlying physical reality. Damasio goes to great lengths to explain that many species, such as social insects, have minds, but humans are distinguished by the "autobiographical self," which adds flexibility and creativity, and has led to the development of culture, a "radical novelty" in natural history. Damasio ends with a speculative chapter on the evolutionary process by which mind developed and then gave rise to self. In the Pleistocene, he suggests, humans developed emotive responses to shapes and sounds that helped lead to the development of the arts. Readers fascinated from both a philosophical and scientific perspective with the question of the relationships among brain, mind, and self will be rewarded for making the effort to follow Damasio's arguments.

Several interviews with Dr. Damasio can be viewed.  Several topics are available including:

How Memory Works

“Consciousness” is How We Know We Exist

How Our Brains Build Our Autobiographies

How Our Brains Feel Emotion

…and others.

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 The Tell Tale Brain

I completed The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human by V.S. Ramachandran.   The preeminent neuroscientist V.S. Ramachandran has, without a doubt, raised the bar in this, his newest book, The Tell-Tale Brain. He states in the preface, "Readers who have assiduously followed my whole oeuvre over the years will recognize some of the case histories that I presented in my previous books, Phantoms in the Brain: Probing the Mysteries of the Human Mind and A Brief Tour of Human Consciousness: From Impostor Poodles to Purple Numbers. These same readers will be pleased to see that I have new things to say about even my earlier findings and observations. Brain science has advanced at an astonishing pace over the past fifteen years, lending fresh perspectives on - well, just about everything. After decades of floundering in the shadow of the "hard" sciences, the age of neuroscience has truly dawned, and this rapid progress has directed and enriched my own work." And what an enriching book this is!

     Ramachandran describes several neurological case studies that illustrate how people see, speak, conceive beauty and perceive themselves and their bodies in 3-D space. He explains the phenomenon of Phantom Limb Pain. He approaches the issues from evolutionary, philosophical, anatomical, psychological, and neurological perspectives.

Watch and hear Dr. Ramachadran describe how mirror neurons formed the foundation of civilization.

 

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 I recently posted about a book entitled Blood Work by Holly Tucker on my Wordpress Blog and on GoodReads.

This is a non-fiction book about the travails of blood transfusion in the mid-1600s. The epilogue put the topic into perspective: how science and its discovery is historically taboo based on religion and other inhibitions of society and then, many times, transformed into well accepted practice.

In Catholic France transfusion experiments were shunned while in Protestant England experimentation was acceptable.  The times however were well before blood circulation or blood types were known.  Known science considered blood something akin to todays oil.  Science still considered the four humors, black bile, yellow bile, blood, and phlegm as determinative of a person's health and disposition.

The first transfusions were done with animals and then animal to human.  The cultural world views played a significant role in the toleration of medical research.  The French feared animal to human transfusions would create dog-headed men and the like.

In 2006 President George Bush in his State of the Union address warned against the travails of unrestrained medical research that could create atrocious creatures of animal and human substance.  However by 2006 medical science was using pig valves in humans.  The point is that the same fears and religious world views still influence the highest reaches of leadership that affect acceptable medical research.

I want to direct any one who is remotely interested in the cultural aspects of medical research hundreds of years ago and today to read this book.  I also want to direct anyone so interested to listen to my friend, Dr. Ginger Campbell, in her podcast interview of the author Holly Tucker.  This one hour interview expounds on the issues raised in the book and was a serious compliment.

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 The Brain On Trial

Is Criminal behavior regulated by “free will?” Is free will something that is actually free at all? Neuroscientist, David Eagleman[1], recently published an article in The Atlantic, July/August 2011, The Brain on Trial.[2] He describes how the foundations of our criminal-justice system are beginning to crumble, and proposes a new way forward for law and order.

My interest in theological, philosophical, psychological and biological explanations ranging from the reason for suffering in this world and free will versus fate/destiny was discussed in my blog a few years back.

Can I freely choose to not eat chocolate cake? Can I freely invoke my long term understanding of the cake’s short term benefits versus its long term costs to overpower my short term understanding of my desire to eat it? Clearly the obesity crisis in our country and others would say ‘sometimes, but not most.’ Certainly eating chocolate cake is not a crime. But let’s apply the same ideas to crime and recidivism.

Neuroscientist, Wolf Singer argued that crime itself should be taken as evidence of brain abnormality, even if no abnormality can be found, and criminals treated as incapable of having acted otherwise.[3]

Conversely, at an Ethics and Public Policy Conference on Neuroscience and the Human Spirit,[4]  the question was asked: "Do . . . scientific advances challenge the first principles that the majority of our citizens believe provide the very foundation upon which our civilization rests—free will and the capacity to make moral choices? . . . Does [the] growing understanding of genetic and environmental influences on human behavior leave any room for free will?"

The conclusion advanced “accepting a compatibilist, naturalistic view of freedom and morality will unify our self-understanding. Since moral mechanisms have a clear social function that science can help us to understand and improve, no longer will morality have to seek shelter from science. We may not be free in the exceptional, ultimate sense we once supposed, but we are more than compensated by the pragmatic benefits that flow from recognizing our complete inclusion in the causal order. The "human spirit"—our dignity, freedom, and power—is not threatened by science, only shown its true home in the natural world.”

In his lengthy article, David Eagleman sets out court dramas of those recently brought to trial. Judges and juries compare, as they instruct and are instructed, to weigh their analysis against a “reasonable person” standard. Many times, we all engage in the blame game by asserting, “Well I would not have done that.” However that may be missing the point according to Eagleman. “Changes in the balance of brain chemistry, even small ones, can also cause large and unexpected changes in behavior [:]” Addictive personalities and gambling; Pedophiles and the desire to look at children. Also included are not just unacceptable behaviors but, as mentioned earlier, compulsive eating, excessive alcohol consumption, and hypersexuality, to name a few.

“The lesson from all these stories is the same: human behavior cannot be separated from human biology….Perhaps not everyone is equally “free” to make socially appropriate choices.” Do we really have free will to choose or is that really an illusion? Eagleman states “Many of us like to believe that all adults possess the same capacity to make sound choices. It’s a charitable idea, but demonstrably wrong. People’s brains are vastly different.”

Starting at birth we are the product of our parent’s genes. “When it comes to nature and nurture, the important point is that we choose neither one. We are each constructed from a genetic blueprint, and then born into a world of circumstance that we cannot control in our most-formative years….The unique patterns of neurobiology inside each of our heads cannot qualify as choices; these are the cards we are dealt.”

Turing to the legal system and courts, the standard applied assumes we are ‘practical reasoners’ which, in turn, presumes beings with free will. Eagleman uses the example of those inflicted with Tourette’s syndrome, who suffer from doing things they do not will to do: sticking out her tongue, voicing inappropriate language and others. The point is that a Tourette’s patient’s free will cannot over ride her sense of “free won’t.” Similarly, high-level behaviors can take place in the absence of free will.

“Historically, clinicians and lawyers have agreed on an intuitive distinction between neurological disorders (“brain problems”) and psychiatric disorders (“mind problems”). The two ends of the spectrum have been those whose brain injuries (e.g. Parkinson’s) who cannot help some of their behavior, while most others are simply thought of as freely choosing actors.

Therefore, prisons have, according to Eagleman, become de-facto mental-health-care institutions. Incarceration does little to rehabilitate those with mental illness and increases cases of recidivism.   Courts around the country and in Nevada have begun mental-health courts and drug courts based on better understanding of the problems of recidivism. 

Eagleman proposes a new approach. He posits the understanding that the brain “operates like a team of rivals, with different neural populations competing to control the single output channel of behavior.” Something he terms the ‘prefontal-workout.’ Essentially he is trying to defeat the short term brain circuits to overcome bad behavior. It is similar to bio-feedback of the 1970s. So when we see that delicious piece of chocolate cake, we can overcome the choice to eat it, which is essentially against our will. More importantly when one is faced with a socially unacceptable behavior, can he invoke a system to squelch the urge and make a better choice?

Eagleman concludes by saying that “neuroscience is beginning to touch on questions that were once only in the domain of philosophers and psychologists, questions about how people make decisions and the degree to which those decisions are truly ‘free.’ These are not idle questions. Ultimately, they will shape the future of legal theory and create a more biologically informed jurisprudence.”

David Eagleman’s article is available on The Atlantic's site and in print.

 

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Gary Prowe of Gainesville, Florida has published a book entitled Successfully Surviving a Brain Injury: A Family Guidebook, From the Emergency Room to Selecting a Rehabilitation Facility.

Susan H. Connors, the president of the Brain Injury Association of America has written the foreword to this easy-to-read guidebook, which is intended for families in the first days, weeks, and months after a brain injury. The book covers the wide range of medical, financial, legal, insurance, family, and personal issues caregivers encounter following a brain injury.

Survivors of a brain injury learn much from this book and develop a greater appreciation of what their families went through in the early days of their recovery. You can read more about Successfully Surviving a Brain Injury: A Family Guidebook at www.BrainInjurySuccess.org.  You can also purchase a copy of the book at Amazon.

Info@BrainInjurySuccess.org

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I found a great podcast from my ITunes store called Brain Science Podcast.  Creator, Dr. Ginger Campbell, is an Emergency Room Physician.  She has created a great resource for general interest audiences in topics related to Brain Science.  She also has a blog on Books and Ideas.

The topics covered in Brain Science Podcast vary and are very interesting.  Personally. I love to catch up by listening while on my elliptical machine in the morning.  There are over 4 years of podcasts sure to keep even the most ambitious listener busy for quite some time.

 I recently wrote to Dr. Campbell, conversation below, and sadly discovered that she is considering discontinuing the podcast after her summer break.  In other words she may or may not restart the podcast in September 2010.  Granted it is a large committment and amount of work.

I propose that anyone who enjoys learning about the brain write to Dr. Campbell by leaving a comment on the Brain Science Podcast.  Personally, I always appreciate comments to my posts and the back and forth discussion that follows.  I think hearing from interested listeners might prompt Dr. Campbell back to the mission she has been up to these past 4 years: educating folks.

I especially reach out to my clients to leave Dr. Campbell a comment after visiting her site.  Alternatively, if you are more comfortable with Facebook, leave a note at her Facebook site.

Here is the discussion I recently had with Dr. Campbell:

Tim,

Thank you so much for taking the time to write.

 

One topic that I have not yet had a chance to cover on the Brain Science Podcast is Head Trauma. This does not reflect a lack of interest on my part, but it is a result of two things. One is that since I have created the podcast for a general audience I only talk  specifically about medical issues once or twice a year. Secondly, I generally base episodes on books that are accessible to general audiences and I have yet to find a good book on Brain Trauma. This may reflect the fact that our scientific understanding is still fairly poor. Until a few decades ago patients with significant brain trauma (and spinal cord injury) usually died, so the field is relatively young.

 

After you have made it through the first year of episodes you will have a clearer idea of what I have in mind. Maybe then you might have some book suggestions.

 

Right now I am leaning toward continuing only my other podcast Books and Ideas, which would leave me the flexibility to consider brain-related topics whenever I want. But it is too early to make that decision.

 

Thank you so much for sharing my podcast with others. Even if I quit producing new shows after September, there will still be 70 episodes available, and I intend to leave these on-line as long as they remain accurate and relevant.

 

You mention that you disagree with my position on evolution and I am glad that this is not an obstacle to your enjoying the Brain Science Podcast. One current cultural trend that disturbs me is the idea people ought to agree about everything, and never listen to opposing viewpoints (let alone ideas from their opponents).

 

Since you are a lawyer, I am curious! Have you read John Stuart Mills book On LIberty?

 

Ginger

_____________________________

 

 

Dr. Campbell

 

Thank you for taking the time to respond. No I have not read the book On Liberty. I will look for it at the bookstore.

I understand your audience and desire to speak about the brain to a general audience. To a lesser extent, I occasionally post about human brain subjects that have nothing to do with TBI. Like I said, I am really fascinated with how the brain makes us who we are. I’ll explore neurophilosphy, religion and psychiatry, fiction (Crichton’s Terminal Man), Movies (The Lookout, The Soloist), Neuropsychology, Cognitive Neuroscience, Neuroeducation, http://brainandspine.titololawoffice.com/2008/06/articles/brainy-reviews/how-doctors-can-think-better/ .

 

I agree that healthy disagreement and the flow of ideas is vital. I look forward to working my way through the podcasts. There is no way I could get through reading all the books and I appreciate how you cover the content and describe the author.

 

 I posted on an interesting book entitled Another Day inThe Frontal Lobes, by Katrina Firlik. I was trying to review each chapter. Here is an example: http://brainandspine.titololawoffice.com/2007/11/articles/brainy-reviews/the-frontal-lobe-11/ If you link to my blog http://brainandspine.titololawoffice.com and click on Another Day inThe Frontal Lobes Reviews by Tim Titolo I have some other books I reviewed. I expect I will find some in your podcasts.

 

If it is OK, I intend to link to your site and podcast from my own blog. I really like the information. I had hoped we could list each other blogs on our sites. Yours is on mine. Check the right hand side of my blog (scroll down) to Links.

 

I am subscribed to your books and ideas blog/podcast although I have not visited it yet but will very soon. I love books. You are right about that blog giving you more freedom to explore brain books when they come up while still having the ability to explore multiple other areas of interest.

 

I see you are an emergency physician. Here is a problem worth considering. The care received in ERs for Brain injury or suspected brain injury is very poor. That is why, through the North American Brain Injury Society NABIS, we are advocating biomechanical professionals to be involved in ER care. Too often folks are sent home with complaints of headache or overwhelming pain from obvious injuries like fracture and lesions, and the brain injury (mild and moderate) diagnosis does not come for weeks and months. By then, the powers that be involved in damage control, defendants and insurance companies, deny causation etc. I simple CT or even more involved MRI routinely miss microscopic cellular injury, focal and diffuse.

 

I look forward to exploring the rest of the Brain Science Podcast and the Books and Ideas blog. Here is a link to books published by NABIS. http://www.braininjurybooks.com/  

Be Well and have a relaxing summer. (I love your dogs!)

 

Tim Titolo

 

Support the Brain Science Podcast.

 

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Pediatric traumatic brain injury (TBI) is a major public health concern and challenge to critical care practitioners. The prevention of secondary injury is key to improving morbidity and mortality outcomes. Interventions are targeted at maintaining adequate cerebral blood flow and minimizing oxygen consumption by the brain. The anticipation and prevention of systemic complications are also of vital importance.

A new book focuses on evaluating what is currently known about childhood TBI and the challenges faced by researchers and clinicians in this arena. The book is entitled "Pediatric Traumatic Brain Injury: New Frontiers in Clinical and Translational Research," edited by Vicki Anderson and Keith Owen Yeates and published by Cambridge University Press. 

The following is an Introduction I ran across:

Traumatic brain injury (TBI) is a major public health problem among children and
adolescents. Surveillance data reveal that 1 in every 20 emergency department presentations at pediatric hospitals is for a TBI, making TBI more common than burns or
poisonings. For children, such injuries represent a common interruption to normal
development, with population estimates ranging from 200 to over 500 per 100 000 a year,
and with well-established variations across age and gender (Crowe et al., in press; Langlois et al., 2006).

The majority of TBI in children and adolescents are mild, typically with few
long-term consequences; however, a significant proportion of children will suffer more
serious injuries and will experience a range of residual physical, cognitive, educational,
functional, and social and emotional consequences, requiring the lifelong involvement of
health professionals across a range of disciplines and leading to a significant social
and economic burden for the children’s families and for the community more broadly
(Cassidy et al., 2004).

This book, New Frontiers in Pediatric Traumatic Brain Injury, aims to evaluate what we
have learned about TBI in childhood to date and, perhaps more importantly, to articulate
the challenges we face and how we should go forward in the future. Over the past two or
three decades, researchers and clinicians working with children with TBI have become
aware that injuries to the developing brain cannot be understood or treated in exactly the
same manner as those occurring in adulthood. Although we may be guided by science and
practice in adult TBI, unique developmental and contextual issues need to be taken into
account at all stages of recovery and treatment in children. Thus, a separate knowledge base is needed for pediatric TBI. As a consequence, until recently our understanding of recovery and outcomes in pediatric TBI has lagged behind that for adults. This is changing. Research in pediatric TBI now has more solid foundations. A number of principles have been established, some consistent with the adult literature, such as the predictive value of injury severity (Anderson et al., 2004; Taylor et al., 2008).

Others are specific to early brain injury, such as the unique mechanics and characteristic pathology of inflicted injury in children (Coats & Margulies, 2006; Prange & Margulies, 2002), or reflect the importance of developmental and contextual factors, such as the age at injury, developmental stage of brain development, and functional maturation (Anderson et al., 2005; Taylor & Alden, 1997), the key role of the family, and implications of life tasks specific to children (Yeates et al., 1997). 

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As a back and neck injury lawyer in Las Vegas, Nevada, I encounter untreated or undiagnosed spine injury often.  Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years.

Experts say that back pain is associated with the way our bones, muscles and ligaments in our backs work together.  

There are several diagnostic tests to assist physicians in detecting and treating back and neck conditions.

An interesting review entitled "Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain" (Van der Windt DAWM, et al. Cochrane Database of Systematic Reviews 2010) reveals that diagnosing back pain is not a simple matter. I read the findings.

 

While lower back pain ranks as a common cause of disability in the United States, determining what causes a person's back pain is often challenging. A new review on diagnosing back pain finds that no single diagnostic test is good at discriminating between patients who have a herniated disc and patients who do not.

 

Lawrence Kurz M.D., an orthopedic spinal surgeon at Beaumont Hospital in Royal Oak, Mich., agreed with the results of this review: No one test is specific and sensitive enough to be used as the sole guide for making an accurate diagnosis of disc herniation as the cause of sciatica.

Healthy discs are spongy cushions of cartilage that fill the spaces between vertebrae in the spine. They act as shock absorbers for the spine and allow flexibility. A herniated disc can occur when a disc incurs damage because of trauma or stress and bulges outside of its normal position to press on a nerve. This can result in pain that radiates down to the lower leg - also called sciatica.
 

In other conditions, including osteoporosis and similar aging disorders, bony structures could press on nerves, causing pain.

 

Representing injured people with back and neck pain complaints requries diverse diagnositic testing.  Insurance company representative all too often point to one test to either deny or rule out a condition.

 

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There are several reasons the damages in brain injury cases remain high, attorneys say.

One is the skyrocketing costs of medical care. In fact, Harper said, the legal system’s method of awarding damages cannot keep up with the cost of lifelong medical care because jurors are instructed to reduce the verdict to a present value amount. But medical costs don’t “reduce,” Harper said.

Neither do the costs of caring for the injured person in the home. “My goal is always to bring the client home. That is a cost that should be borne by the (party found to have committed the tort),” said Anoka attorney Fred Soucie.

Another reason is that brain injury cases are readily demonstrable, both by medical evidence and through changes in the plaintiff’s behavior and moods. A traumatic brain injury will affect the person’s personality, judgment and concentration — which in turn affect the person’s ability to earn a living.

When the injury is catastrophic, the damages usually are self-evident. “I have had jaded insurance company lawyers say that the person has no pain and suffering because they are [so injured that they are] oblivious. That’s immoral and tactically stupid,” Soucie said. If jurors feel that the injured person is aware and suffering, they will punish the defense lawyer who appears callous in the extreme, he explained.

But even a “mild” injury can be proven, Soucie continued.  In fact, calling the injury “mild” can be a misnomer. Technically, the term “mild” is defined by the period of post-injury amnesia or loss of consciousness but the effects can be severe. The person may change dramatically, and friends, family and co-workers can explain the difference, he said.

Emotional value for juries

Additionally, the injuries are very compelling to jurors, Soucie said. “There’s always some juror skepticism but their hearts and minds are easily wrapped around these injuries,” he said.

The injuries are also capable of medical demonstration, said Minneapolis attorney Peter Riley, who recently settled a $3.4 million case involving multiple skull fractures among other injuries. Often the injury will show up as a bleed on a CAT scan or on an MRI, he said. “The defense [then] has a hard time saying the injury is due to something else,” Riley said.

Additionally, neuropsychometric testing can test for memory and brain functioning, showing exactly where the brain is damaged, and the test results can be matched to the patient’s symptoms, Riley said.

The neuropsychometric testing also can reveal any compensatory measures the brain has taken to make up for the injury, Riley said. In those cases, the jury has to be educated about the test results. If his recent case had called for it, Riley said he would have “backloaded” the plaintiff’s testimony by educating the jury beforehand so they would not have an opportunity to form an inaccurate opinion about the brain damage.

Not all head injuries are the result of trauma that reveals itself physically. Bloomington attorney Richard Ruohonen recently received a $128,000 verdict for a man who received an electric shock. The defendant, the city of Glencoe, had offered $50,000. The man was injured when he touched a pole the city had installed in his yard, but which was connected to a power line. He received five to 10 seconds of electric shock.

An electrical injury is more diffuse than an injury to a lobe of the brain, explained Ruohonen. His client’s injuries included loss of attention and concentration, memory impairment, pain and headaches. He also had a sleep disorder caused by injury to the brain stem, Ruohonen said.

This was a case of a skeptical insurance company. “They basically were saying it was all in his head,” Ruohonen said.

Actually, the case would have been more valuable but the client had a subsequent workers’ compensation injury to his neck. “That was the day the city got lucky,” Ruohonen said. The case might have been worth as much as $250,000 without the second injury, he explained. However, he is pleased with the result.

It would be speculating to say that the economy played role in the size of the verdict, Ruohonen said. It could also be that people in rural communicates are more conservative or that there were a lot of younger jurors (under age 35), he said.

The personal injury business can actually pick up during a recession, Ruohonen said. He noted that he is getting more calls from people whose injuries are two or three years old, and thinks perhaps they are now more hesitant to pursue their own claims. Besides, he added, “people down on their luck can be more sympathetic plaintiffs.”

And jurors don’t have a lot of sympathy for corporate or commercial defendants right now, he added.

“You’ve got a lot better chance if you’re going against corporations or insurance companies because people are upset with them. Those are great cases to try right now,” Ruohonen said.
 

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In a new book titled "Religion and Psychiatry: Beyond Boundaries," the author considers why and how, when and where religion (and spirituality) are at stake in the life of psychiatric patients.  The interface between psychiatry and religion is explored at different levels, varying from daily clinical practice to conceptual fieldwork.

Religion is one subject that many people around the world feel extremely passionate about, either feeling strongly in their belief of a certain religion, or being against religions generally or specifically. Other people do not engage with religion at all. These choices represent a part of who we are, and as such it is essential for psychiatrists to understand and be able to relate to their patients' decisions and beliefs in this area.

Religion and Psychiatry is recommended reading for residents in psychiatry, postgraduates in theology, psychology and psychology of religion, researchers in psychiatric epidemiology and trans-cultural psychiatry, as well as professionals in theology, psychiatry and psychology of religion.

Religion (and spirituality) is very much alive and shapes the cultural values and aspirations of psychiatrist and patient alike, as does the choice of not identifying with a particular faith.  Patients bring their beliefs and convictions into the doctor-patient relationship.  The challenge for mental health professionals, whatever their own world view, is to develop and refine their vocabularies such that they truly understand what is communicated to them by their patients.

"The boundary between religious belief and the practice of psychiatry is becoming increasingly porous," say the editors in the Preface to Religion and Psychiatry: Beyond Boundaries. "No longer can psychiatrists in a multi-faith, multi-cultural globalized world hide behind the dismissal of religious belief as pathological, or behind a biomedical scientism, as they are more frequently confronted by distressed patients for whom religious belief may determine their choice of symptoms and their compliance with treatment."

Published on behalf of the World Psychiatric Association, Religion and Psychiatry: Beyond Boundaries, addresses the impact that religion and spirituality have on shaping cultural values, as well as the choice of not identifying with a particular faith. With this book, Peter Verhagen and colleagues provide a framework to understand the importance of these factors in mental well-being, and how to develop and refine their vocabularies to ensure they truly understand what their patients are telling them.

This is the first time that so many psychiatrists, psychologists, and theologians from all parts of the world and from so many different religious and spiritual backgrounds have worked together to produce a book addressing these important issues.

The book discusses what religious traditions can learn from each other to assist the patient, as well as the neurological basis of religious experiences. It describes training programmes that successfully incorporate aspects of religion and demonstrates how different religious and spiritual traditions can be brought together to improve psychiatric training and daily practice.

In the Foreword to Religion and Psychiatry Mario Maj, President of the World Psychiatric Association, states "The WPA welcomes this comprehensive and multifaceted volume, produced by one of its most active Scientific Sectors, hoping that the effort will continue to clarify the issue and stimulate further reflection and research."
 

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The Dana Foundation released Neuroeducation: Learning, Arts, and the Brain, its newest free education resource. The book, the culmination of a summit sponsored by The Johns Hopkins University School of Education's Neuro-Education Initiative, focuses on the convergence of neuroscientific research and teaching and learning, with an emphasis on the arts.
 

 Education and brain experts discuss their experiences, challenges, and potential next steps to allow for the crossover from classroom to lab and lab to classroom. The concerns and hopes of those working in the field are presented in a summary of the roundtable discussions that served as the centerpiece of the summit.

Neuroeducation: Learning, Arts, and the Brain is available free by written request on institutional letterhead. Please make certain your request contains a complete telephone number-including area code-and a full street address. Requests should be mailed or faxed to:

Johanna Goldberg
Dana Foundation
745 Fifth Avenue, Suite 900
New York, NY 10151
Fax: (212) 317-8721

You may also e-mail your request to: jgoldberg@dana.org. Please include your institutional and mailing information.

The book is available online at http://www.dana.org/news/publications/publication.aspx?id=23964.
 

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Here are more highlights of fellow spine and brain injury law bloggers:

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The injury lawyers at Auger Hollingsworth attended the third annual Fund Raising Benefit Dinner for the Brain Injury Association of the Ottawa Valley on October 5, 2009. Ottawa Personal Injury lawyer: Spinal Cord Injury ... fibromyalgia and how to claim compensation for those injuries. Teens Die in Navan Pickup Truck Accident. Three teens died, and one was seriously injured, after a single truck roll over near Navan, Ontario. Visit our Blog Index to check out more posts! ...
Personal Injury Ottawa - Blog - http://www.personalinjuryottawa.ca/

NYC Medical Malpractice: Woman Sues After Brain Surgery Delay ... By dlever@lsinjurylaw.com; hstolzenberg@lsinjuryla... She was being treated for Chiari malformation, in which part of the lower brain falls into the spinal canal. The hospital involved in the case said that although there was a mix-up concerning her operation, Ronca was not injured by ... Attorney Blog - http://www.lsinjurylaw.com/blog/

Fewer Trauma Injuries at Children's Hospital Thanks to ThinkFirst ... By Howell and Christmas, LLC Fewer Trauma Injuries at Children's Hospital Thanks to ThinkFirst Program :: South Carolina Injury Lawyer Blog. ... The national program, ThinkFirst, is a brain and spinal cord injury prevention program. It is a school-based program that goes to elementary, middle, and high schools to talk to children about ways to prevent brain and spinal cord injuries. The program covers topics such as motor vehicle safety, bike safety, water safety and pedestrian safety to avoid ... South Carolina Injury Lawyer Blog - http://www.southcarolinainjurylawyerblog.com/

Montana state senator faces 3 felonies in boat crash that injured ...
By Matt Gouras
Denny Rehberg suffered a broken ankle and other injuries in the Flathead Lake crash, while Rehberg's state director, Dustin Frost, spent 10 days in a coma and has a severe brain injury. Barkus broke his pelvis and ribs and two ... A second alcohol test, taken four hours after the crash by state law enforcement officials investigating the crash, showed that Barkus was still legally drunk with a blood-alcohol level of .12, authorities said. A waitress reported giving Barkus ...
Breaking News - http://blog.taragana.com/n/

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Hre are some highlights from fellow bloggers on Brain and Spine Injury Law:

Motorcycle Accidents in Maryland: Avoiding Fatalities and Reducing ... By Lebowitz & Mzhen Motorcycle Accidents in Maryland: Avoiding Fatalities and Reducing Injuries from Car-Bike Crashes :: Maryland Motorcycle Accident Lawyer Blog. ... As a result, many motorcycle accidents have an especially high rate of injuries, including broken bones, spinal cord injuries, traumatic brain injuries, and other permanent injuries. Sadly, fatalities are very common when it comes to motorcycle accidents. Wearing a helmet is one of the best things a rider ... Search this Blog ... Maryland Motorcycle Accident Lawyer Blog - http://www.marylandmotorcycleaccidentlawyerblog.com/

SPINAL CORD INJURIES FROM CAR ACCIDENT « Haire Law Firm Blog By admin Below the point of injury, the spinal cord cannot send messages to the brain to control the operation of the body. Accidental spinal cord injuries result primarily from motor vehicle accidents all kinds, but can also occur in accidents ... Haire Law Firm Blog - http://hrj-law.com/blog/

Chris Davis Child Accident Lawyer Autistic Child Fatality By Auger Hollingsworth The teenager received a fetanyl pain patch, allegedly by mistake and despite FDA warnings to the contrary. Top Seattle child injury and malpractice lawyer Chris Davis, filed a lawsuit after mediation with the hospital failed. ... a traumatic brain injury after an accident, you may need the assistance of a neuropsychologist. Pedestrian Injury on Bronson Avenue. Ottawa: On September 21, 2009 an injury on Bronson Avenue leaves a pedestrian with head and spinal injuries. ... Personal Injury Ottawa - Blog - http://www.personalinjuryottawa.ca/

Recent Train Accident Devastates Southern California | Chicago ... By admin From January 2008 to March 2008, 4875 railroad accidents were reported, resulting in 309 fatalities and 3223 injuries. Â. The most common injuries stemming from train accidents include: · Brain trauma. · Spinal cord injuries. · Concussions ... It is important to consult an experienced personal injury lawyer if you have been involved in a train accident. Hiring a lawyer will ensure that your rights are protected and that you receive a fair settlement for your injuries. ... Chicago Injury Law Blog - http://www.chicago-injury-law-blog.com/

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Here is a book worth checking out on Mild Brain Injury http://www.learningstore.org/we1181.html

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SAGE, the world's fifth largest publisher of academic journals, is pleased to announce the January 2010 launch of a new quarterly journal, Social Psychological and Personality Science (SPPS).

SPPS will publish cutting-edge, short reports of single studies, or very succinct reports of multiple studies. The journal's brief, to-the-point research articles will be of broad interest to both professional and lay audiences and will be written in a format accessible to a wide range of readers, including science writers for the popular press. It will feature a speedy review and publication process to allow groundbreaking research to be published quickly.

Source:
Jim Gilden
SAGE Publications
 

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The National Alliance on Mental Illness (NAMI) has launched a new Web site, http://www.nami.org/soloist, as part of a social action campaign with Participant Media surrounding the release (April 24) of "The Soloist," starring Jamie Foxx and Robert Downey, Jr.

Schizophrenia is a serious and challenging medical illness, an illness that affects well over 2 million American adults, which is about 1 percent of the population age 18 and older.

Although it is often feared and misunderstood, schizophrenia is a treatable medical condition.

Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different from the brains of people without the illness.

Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development.
Read More Here.     

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The BIAA is having its annual conference in Las Vegas at the end of the month.  One of the featured speakers is Nathan Zasler.  Dr. Zasler just finished and book entitled The Neurology of Consciousness: Cognitive Neuroscience and Neuropathology.

This is a very welcome addition to the field of neuroscience literature and should be read by anyone involved in the care of persons with disorders of consciousness. The book starts with a thoughtful Preface by the editors, Dr. Laureys and Dr. Tononi, which is followed by yet another introspective commentary by Dr. Allan Hobson of Harvard Medical School in the form of a Prologue. The contributors to this text include some quickly recognizable names, including Drs. James Bernat, Antonio Damasio, Joseph Fins, Michael Gazzaniga, Adrian Owen, Joseph Giacino, Nicholas Schiff and Adam Zeman, among others.

 

Read the full review here.

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Dr. Robert Melillo is an internationally known lecturer, author, researcher and clinician in the areas of neurology, rehabilitation, neuropsychology and neurobehavioral disorders in children. Dr. Melillo's Hemispheric Integration Therapy (H.I.T.) forms the foundation of The BrainBalance Program(R), a multi-modal approach to the remediation of ADHD, Dyslexia, Autism, Asperger's, Tourette's, learning disabilities and processing disorders along with other neurobehavioral disabilities found in children. Brain Balance(TM) Centers do not rely on drugs, medical procedures or psychotherapy.

The new book, Disconnected Kids: The Groundbreaking Brain Balance Program(TM) for Children with Autism, AD/HD, Dyslexia and Other Neurological Disorders, (Amazon.com: Disconnected Kids: The Groundbreaking Brain Balance ...) shows parents how to use this drug-free approach at home, with customizable exercises for physical, sensory, and academic performance, behavior modification strategies, information on foods to avoid, and a follow up program for lasting results.

 

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Richard Restak, The Naked Brain: How the Emerging Neurosociety is Changing How We Live, Work, and Love. New York: Harmony Books, 2006.

Reviewed by Lloyd deMause

The revolution in neuroimaging techniques in the past two decades has produced such a new understanding of the effects of early experiences on the brain and the disorders from attachment deficiencies that are their result that psychologists-including psychotherapists and psychohistorians-simply cannot fully understand what the developmental causes of child abuse unless they keep up to date on what neuroscience has been discovering. If, for instance, you write about racism-from the Holocaust to Islamic terrorism-you cannot really understand what is happening unless you know early developmental problems affect the prefrontal cortex and later produce disabled medula (mirror neurons that enable one to empathize with others). Similarly, when you study group-fantasies of growing irrational fears of being attacked by other nations (who often have no designs at all on your nation), you really must understand how these fears (say, of Mother England about to pounce on you) were originally implanted in the amygdala, and unless you understand how kinds of experiences are making whole nations switch into these early amygdalan fear modules.

Restak provides an excellent summary of the basic advances in understanding neuropathology. I particularly learned a lot about what makes people-even groups-create in-group and out-group minds and feelings, which happens particularly before wars. That groups (tribes, states, ethnic groups, nations) carry over the fears they imprint from their parents to their later social lives is evident, particularly if their early attachments are insecure and they generate fears of being controlled by "enemies" (external and internal) should they try anything new and experience too much freedom in their adult lives. Studies are cited that scan the brains of hundreds of mothers interacting with their infants that show that the mothers who are postpartum depressed or otherwise were not adept at reading their infant's needs produce older children who have crippled prefrontal lobes and therefore are behind others in language and play skills by age two. It simply helps one to think this way about political events: "You remember quite vividly where you were on September 11, 2001, because the horrific events of that day aroused your emotions and activated your amygdala." And charts showing wars occurring during a nations' most fearful, most reactionary periods are actually amygdalan activation periods. Eliminating wars therefore must somehow affect this brain state.
 

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How Doctors Think is striking a chord with doctors.  Doctors' thinking processes, in particular, need attention, according to Jerome Groopman, MD, hematologist and oncologist. Groopman's 2007 book, How Doctors Think (Houghton Mifflin), called "a mix of science and soul" by New York Times reviewer William Grimes, has struck a chord with physicians, insurers, and others concerned about why so many medical errors occur and how to prevent them.

I find the latest advances in legal thinking and the use of heuristics is also cutting edge thinking in medicine. 

The following is an interview printed in Medical Economics by Leslie Kane MACC of Dr. Groopman:

Kane: You described three heuristics that doctors typically use—"the three As," as you call them. What are they?

Groopman: The first is anchoring. We quickly latch onto what we think the diagnosis is, and selectively accept or ignore information that corresponds with what we expect to find. This influences the questions we choose to ask, and how we ask them. That, in turn, tends to focus patients' answers. So we're more likely to find what we've already decided we're looking for.

The second heuristic is availability. That's the tendency to judge the likelihood of a diagnosis based on how readily relevant examples come to mind. During a flu epidemic, for instance, if you see 15 people with the flu, when the 16th person comes in saying he feels clammy and has a bit of fever, you automatically assume it's the flu. But it might be something else entirely.

Or if you've had a very dramatic case—which all doctors do—it imprints on your mind. When you see patients with similar physical findings, you superimpose that prior dramatic case on the one in front of you.

The third heuristic is attribution. We all hold stereotypes in our mind and are very quick to attribute complaints to a larger stereotype. If a patient is slovenly, hasn't shaved, has rum on his breath, and has an enlarged liver, he becomes alcoholic cirrhosis even if he says he doesn't drink much.

Kane: Doesn't everyone use heuristics to get through life? That's how people learn by experience, and make it through the day without having to evaluate every occurrence from scratch. How are doctors supposed to turn off these very human thinking mechanisms?

Groopman: You're correct. These kinds of mental shortcuts are wired in our brains. Physicians in particular invoke heuristics because we're working under conditions of time pressure and uncertainty, with limited data.

Kane: Given that heuristics are hard-wired, how can doctors overcome them?

Groopman: We need to remember that the three heuristics I mentioned are all traps. So you need to do metacognition—think about your thinking. To do that, ask yourself some simple questions when evaluating patients: "What else could it be?" Or "Am I being too quick to lump it all together?" Or "Can two things be going on at once?" Because maybe the person does drink, but that doesn't mean there can't be another problem that accounts for his enlarged liver.

These are the kinds of questions that when we were residents, we asked our attendings or the attending physicians asked us. But now that we're in practice, it becomes harder to ask these questions because we're working within our own heads.

Kane: With today's shorter patient visits, pay for performance, and evidence-based medicine, doctors are encouraged to use algorithms and decision trees to diagnose. The system doesn't encourage doctors to take more time for open-ended thinking. How can doctors find the time to think more and still make a good living?

Groopman: The system has gone headlong into checking off the boxes and following all the outcomes and decision trees. I believe medicine is still something that requires an understanding of the individual.

I've spent years in research for evidence-based medicine, and I'm very aware of the limits and deficiencies of how those data are used. They reflect a very, very cherry-picked group of patients. They use patients who aren't on seven medications, and they come up with statistical averages. How closely does the patient in your office correspond with the data-based medicine? Are you supposed to say to your patient, "Please leave my office, you don't fit the data"?

Kane: It sounds like there isn't really an answer to the situation. Hearing from doctors who are struggling with diminished reimbursements, I get the impression that the public expects doctors to be more altruistic than other human beings and not care about the financial end.

Groopman: I think this is a caring profession; it still attracts people who want to do good and people who are altruistic and dedicated. But that doesn't mean you shouldn't make a living. Being a doctor doesn't mean you're required to be a monk and give up the world. Physicians are being pushed to work ever harder, while at the same time the system is changing in ways that prevent profit from going to the people who do the work.

Kane: Any other wisdom or advice you'd give doctors?

Groopman: Learning how doctors think has helped me give better care, and has prevented me from making the kinds of mistakes I made in the past. I feel it has restored to me some degree of control because I know my mind better. And that control enables me to more effectively buck the system.

Groopman brings up important information about tuning into your own thinking. Doing so takes some attention and practice; and because thinking short-cuts are so human, it may be a challenge. But doctors have never been ones to take the easy path, especially when an activity can sharpen their expertise and enhance their patients' lives.

Groopman holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is Chief of Experimental Medicine at the Beth Israel Deaconess Medical Center. His earlier books include The Measure of Our Days (1997), which explores the spiritual lives of patients with serious illness; Second Opinions: Stories of Intuition and Choice in the Changing World of Medicine (2000); and The Anatomy of Hope: How People Prevail in the Face of Illness (2005). He is also a staff writer at The New Yorker.

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New Brain Injury Book To Be Featured on NPR
National Public Radio's Diane Rehm Show to Feature New Brain Injury Book

On Tuesday, May 27, at 11 am EDT, nationally-recognized talk show host Diane Rehm will interview Susan Connors, Brain Injury Association of America president/CEO, and Michael Mason, author of Head Cases, the compelling compilation of individual stories of brain injury and its aftermath.

Tune your radio to the National Public Radio Station in your area. When the show starts, call 1-800-433-8850 or send an email to participate.

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Book Title: Change Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves

Author: Sharon Begley

Contrary to what the title may suggest, this is not a training manual for the brain. The book is a fascinating and convincing account of recent discoveries in brain neuroplasticity (i.e. its `pliability') even into old age, and the amazing implications of such discoveries. Sharon Begley states, "Yes, the brain can change, and that means we can change." For those looking for a magic bullet, she adds that it is not easy. "Neuroplasticity is impossible without attention and mental effort."

Those who have worked in fields such as psychology, education, gerontology and various social services will no doubt have observed unexplained and seemingly miraculous events with their clients and students. This book gives answers to their questions. For example, working as an occupational therapist in gerontology a number of years ago, I was stunned when an elderly (and chronic) stroke victim suddenly raised her paralysed arm to bat a balloon in a lighter version of volley ball. There was an "aha" moment when I read the chapter "New neurons for old brains."

This book also gives credence to the Superlearning trend of a decade ago, which met with a great deal of scepticism at the time. There were those, like myself, who used it anyway, purely on instinct, and met with amazing outcomes we could not explain. Anecdotal, of course, but Begley's book gives the following example some weight: While in my sixties, I decided to test out on myself what I had successfully used on the children. I undertook papers at university after forty years break from education, but reducing the study time by two thirds (using the Superlearning protocol.) It worked far better than I had dared hope; the 'grandmother' amongst students a third her age achieving the 90th percentile. (I later helped 'learning disabled' adults achieve the same percentile.) I couldn't say how it worked; just that it did. Now Begley gives scientific reasons why.

I am sure that other readers will find similar places of déja vu in this book and be assured that they can repeat, again and again, what they previously thought was mere chance. Whether you are a parent seeking hope for a dyslexic child, or an older adult who does not want to end up in mental decline like your parents did, there is solid evidence that "we can change what we choose to change."

Intertwined in Begley's reports of neuroplasticity research (cataloguing the unbelievable intransigence of the 'hardwired brain' traditionalists) is the story of an interaction that has developed over the years between the Dalai Llama and a group of enlightened Western scientists. This is a beautiful account of an interrelationship that has, without doubt, benefited the world, albeit with little media attention.

My only surprise is that, although Begley refers repeatedly to the scientists' rejection of mind-brain dualism, she does not answer this with any of the impeccable research available on non-local mind - such as that of William Braud (whose research is documented meticulously in "Distant Mental Influence.") However, Begley's "Train Your Mind, Change YOur Brain" was published in the same week as Lynne McTaggart's "The Intention Experiment," to create what is essentially a dyad in consciousness literature: while McTaggart shows how we can influence our outer world, Begley shows how we can influence our inner world. One way or another, we can be empowered.

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Trial lawyers, civil litigators and criminal defense attorneys will find Dr. Robert Heilbronner’s latest book, “Neuropsychology in the Courtroom: Expert Analysis of Reports and Testimony” (Guilford Press, 2008), to be an informative legal guide for the evaluation of neuropsychological impairments in civil and criminal litigation.

Edited by Robert L. Heilbronner, this 2008 publication contains contributions from several authors including Erin Bigler, PhD, Ida Sue Baron, PhD, Brian Brooks, PhD, David Bush, PhD, Shane Bush, PhD, Jacobus Donders, PhD, Kevin Greve, PhD, James Holdnack, PhD, Grant Iverson, PhD, Michael McCrea, PhD, Wiley Mittenburg, PhD, Joel Morgan, PhD, Howard Oakes, PsyD, Wilfred van Gorp PhD, Karen Wills PhD.

The Preface identifies that the publication is directed primarily at neuropsychologists.  Obviously those in related professions are an anticipated audience as well.

The book is divided into 3 parts.  The first contains 7 contributions relating to Case Analysis. Part 2 is entitled "Forensic Analysis from Opposing Perspectives."  This portion gave me a illustration of how two neuropsychologists looking at the same case can hold very different opinions.  This is important in my representation of Brain Injured clients as well as those with suspected brain injury.

The third part contains 5 special topics.  Fixed versus Flexed Battery Approach by Dr. Bigler.  Pediatric Issues by Dr. Wills.  Issues about testimony and cross examination.  And finally Misdiagnosis issues.

This is definitely a book worth adding to your TBI literature library.  It is not cost restrictive and can me ordered through Amazon.

 Robert L. Heilbronner, Ph.D., ABPP-CN, is a board-certified neuropsychologist with over 20 years of professional experience. In addition to maintaining a private clinical practice, Dr. Heilbronner is a court-approved forensic expert who consults with plaintiff and defense attorneys in regard to the impact of brain injuries and various neurological disorders on civil and criminal cases.

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Trial lawyers, civil litigators and criminal defense attorneys will find Dr. Robert Heilbronner's latest book, "Neuropsychology in the Courtroom: Expert Analysis of Reports and Testimony" (Guilford Press, 2008), to be an informative legal guide for the evaluation of neuropsychological impairments in civil and criminal litigation.

"Neuropsychology in the Courtroom" is Dr. Heilbronner's most recent text in a series of books on litigation-related neuropsychology topics. Earlier books edited or co-edited by Dr. Heilbronner include "Forensic Neuropsychology Casebook" (Guilford Press, 2005) and "The Practice of Clinical Neuropsychology" (Swets & Zeitlinger, 2003).

This new 268-page hardcover book can be ordered from the publisher online at www.guilford.com, toll-free at 1-800-365-7006 or via fax to 1-212-966-6708. The ISBN is 978-1-59385-634-2.

Also released: Research and Markets (http://www.researchandmarkets.com/reports/c81056) has announced the addition of "Neuropsychology for Occupational Therapists: Cognition in Occupational Performance, 3rd Edition" to their offering

The third edition of this successful textbook is written primarily for undergraduate students of occupational therapy, and for practitioners working in the field of cognitive rehabilitation.

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While driving with his head lights off down a country highway, Chris Pratt (Joseph Gordon-Levitt), his girlfriend Kelly (Laura Vandervoort) and two friends crash into a stalled combine on the road, which results in Chris' brain damage affecting his short-term memory, and death of the two friends.

Four years later, Chris has to write things down to remember them. Chris works at the Noel State Bank & Trust as the night janitor. He aspires to work as a teller, but the bank manager, Mr. Tuttle (David Huband), does not think that Chris is capable. While cleaning the bank, Chris is watched by four men: Gary Spargo (Matthew Goode), Marty (Morgan Kelly), Cork (Aaron Berg), and Bone (Greg Dunham). Also, every time after his shift, a police officer Ted (Sergio Di Zio) comes by to chat with Chris and brings donuts. At home, Lewis (Jeff Daniels), Chris' blind best friend, makes Chris tell the story of Goldilocks and the Three Bears backwards to help him with his sequencing problems, and Chris writes down "start from the end." Later, as Chris is sitting alone at a bar, Gary walks in and introduces himself.

 Chris and Lewis go to visit Chris’ wealthy family for Thanksgiving. Lewis tells Chris' parents, Barbara Pratt (Alberta Watson) and Robert Pratt (Bruce McGill) about a gas station that he and Chris want to turn into a restaurant.

 The next time Chris is at the bar, Gary and two girls walk in, and one of them, Luvlee (Isla Fisher), starts talking to Chris. The four leave together to Luvlee’s apartment, where Chris ends up sleeping with her. Afterwards, Gary invites Chris to a farm to have a late Thanksgiving dinner. At home, Chris tells Lewis about his recent experience with Luvlee and Gary, which makes Lewis suspicious.

Chris goes to the farm, where Gary introduces Chris to his gang. In the basement, Chris notices a board, which Gary says is a plan still in progress. Chris sees pictures and notes of banks and Gary says he needs his help because he is going to rob the bank Chris works at. Gary tries to convince Chris that he is still dependent on his family and others, which Chris does not acknowledge initially. Gary tells Chris that he can have his old life back and reinforces this with the phrase "Whoever has the money has the power." Chris starts noticing that he is dependent and agrees to take part in the robbery. Chris is told that he is the lookout and has to call Gary when money arrives at the bank.

In Chris' apartment, Luvlee talks to Lewis, who tells her that he used to cook meth, which blinded him. Lewis makes it clear that he had known plenty of "Luvlees" and "Garys", and knows that they are going to hurt Chris. Chris hears the entire conversation, and when Chris and Lewis go to a restaurant to eat, Chris loses his temper and says that he’s going to move out. Chris also tells Ted to stop checking on him. The next day, Luvlee packs up and leaves despite seeing Chris coming to her house.

On the night of robbery, Mr. Tuttle tells Chris that he noticed his improvement, and that he will try him as a teller. Subsequently, Chris tells Gary and his team that he does not want to take part in the robbery and will not tell anyone about it. However, Gary attacks Chris and tells him to do his job. After the safe is opened, Gary makes Chris retrieve the money because of the cameras. When Ted comes, he notices a suspicious activity, and a gun fight breaks out. Ted kills Marty and shoots Cork and Gary as well. However, Bone shoots Ted. Chris runs out leaving in the getaway car with the money.

Chris drives to his apartment, where Gary and Bone are holding Lewis hostage, so he goes to his family’s house and comes up with a plan. He puts a shotgun into one of the duffel bags, calls Gary and arranges a meeting at the ice rink to exchange the money for Lewis. Chris then drives to where his car accident was and buries the money. At the ice rink, Chris says that he buried the money but forgot where. Gary, who is bleeding to death, finds the place in Chris' notebook and tell him to dig it up. Chris hands Bone one of the bags, and just before Bone shoots Lewis, Chris shoots him. Gary then dies on the ground.

Chris is cleared of all charges because he returns the money, confesses, and the camera footage shows that Gary forced Chris to participate. Chris and Lewis open their planned restaurant, although Chris' impairments make giving change difficult. Chris starts to ice skate again. Although he knows that his life is still limited, he has accepted it and is willing to move forward.

To get a closer look click here

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Chapter 11 entitled "Disturbing Deviations" takes the reader through Dr. Firlik's experience and observations of Pediatric Neurology. As a resident and a practicing surgeon, Dr. Firlik grapples with clinical detachment, reality and horror of being unable to change the "randomness of nature."

In a case of "hydrancephaly," Dr. Firlik was forced to decide whether doing surgery to slow the abnormal growth of an infant's head was justified given the condition. Hydrancephaly occurs when the brain does not develop its cerebral portion and, instead, fills the void in the skull with cerebrospinal fluid. If the cerebrospinal fluid does not absorb properly the head will expand creating a weight the infant neck cannot support. Evacuating the fluid may decrease the head size but the lack of brain will not make the infant any more likely to survive.

Other pediatric conditions include schizencephaly, pachygyria, holoprosencephaly, and tuberous sclerosis.  Apert syndrome is a congenital condition including multiple craniofacial abnormalities and syndacity (fusion of the fingers). Holoprosencephaly, also known as arhinencephaly, is a developmental defect of the midline brain structures which causes midline facial abnormalities.

All these rare pediatric conditions create disturbing features for the infant and their parents.

So if the brain makes it through the initial stages of life, Dr. Firlik comments, it is still amazing that it goes on to develop "normally." And is "normalcy" measured by IQ?

For centuries researchers have attempted to correlate brain volume and intelligence. Nevertheless, that simplistic general rule is peppered with exceptions. For instance, Einstein was said to have a below average sized brain.

Other research describes the correlation between gray matter and intelligence. Still, better technology points to the function of the brain as the best indicator of intelligence. Dr. Firlik observes,

"Clearly, in order for the fragmented community of brain injury specialists to come to any meaningful conclusions about the physical brain and intelligence, much more needs to happen: existing studies need to repeated or otherwise validated, the major questions need to be approached from multiple angles, and there needs to be communication across disciplines (the hard part)."

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I recently read the 2007 book called The Nine, by Jeffrey Toobin.  The author gives us glimpses into the people appointed by Presidents Clinton and Bush with some 1960s and 1970s appointments that made up the liberal court.  Surprises abound as Republican appointed Justices created a new kind of conservative court.

Two political ironies underscore Jeffrey Toobin's interesting new account of how personnel changes have changed the Supreme Court over the past two decades.

One is that, at the very time the Republican Party's four-decade ascendancy shows signs of abating, President Bush's appointments of Justices John Roberts and Samuel Alito have enabled conservatives to achieve their long-sought goal of a firm court majority.

Secondly, for all the GOP's advocacy of judicial restraint and its criticism of judges who legislate from the bench, the Republican-appointed majority represents what the author terms "a new kind of judicial activism" that threatens long-established rulings in crucial areas such as abortion and affirmative action.

O'Connor and Kennedy have maintained the swing vote on the court.  And, as Toobin points out, it all about how many votes you can muster that makes your opinion count.

As the Renquist court became the Roberts court the issues of abortion, Roe v Wade, still dominate the agenda.  With the most likely Justices to retire, Liberal Souter, Stevens and Ginsburg, the new conservative court will be an interesting observation in the coming years.

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Dr. Firlik confides in the tenth chapter that she is not immune from Emotion.

While reporting to a man who just had a brain tumor that was "not benign," and his wife and daughter, she broke down and cried. Nice to know that neurosurgeons have feelings.

Her comments remind me how physicians are able to block the misery of death and dying. Wouldn't be much good if they couldn't. Kind of like not being able to deal with the sight of blood.

When speaking with undergraduate students about the brain, Dr. Firlik remembers the absolute visceral reaction. The whole business of neurosurgery was too depressing to consider as a career.

What price had she paid to "not cry over every patient?" What had she gained? For her, it is an appreciation of the everydayness of life that her patients lose. She will one day lose it but that is what dealing with death has given her.

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In this chapter Dr. Firlik takes us through perceptions of Risk. Both from the neurosurgeon’s view and the patient.

She recalls a "warm hand-holding" surgeon who would “pepper” his remarks about the risks of brain surgery, while holding out the consent forms, with "religious-speak" like "We'll get you through this with God's grace."

On the other end are surgeons who personally remind me of Dr. Greg House. The ones who are "blunt" and say "You could have a stroke. (Pause) You could have permanent brain damage. (Pause) You could become a vegetable. (Pause) You could die. (Pause)"

Surgeons typically like dealing with their patients under anesthesia. Not weeping and asking a list of questions with other family members in their office. Unfortunately, this is where many doctors make mistakes. Appropriately, Dr. Firlik comments on the issue of malpractice and lawyers.

It is sad that many lawyers approach any bad outcome with the cynicism of a malpractice lawsuit. It is also sad that too many doctors get annoyed when their obligations to their patients interfere with their golf tee times.

I personally believe that it is hard being a doctor and a surgeon. I believe that sometimes the body responds differently than hoped or expected. I sympathize with a lot of what doctors fear from malpractice lawsuits. However, even those worrisome physicians should appreciate that some doctors are mis-motivated and simply practice bad medicine. Hence, the real need for lawyers, courts, and jury verdicts.

Dr. Firlik states she has never been sued although she expects to at some point. I hope that it will be the result of a mis-motivated lawyer and patient and she will be vindicated professionally and monetarily. That could well depend on the motivation of the insurance company underwriting her and the lawyers it chooses to defend her.

Good luck Dr. Firlik with that.

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I am reading Another Day in the Frontal Lobe by Katrina Firlik. Dr. Firlik is a neurosurgeon. She was the first woman admitted to the neurosurgery residency program at the University of Pittsburg Medical Center; the largest and one the most prestigious neurosurgery programs in the country. She currently teaches at Yale University and lives in Connecticut.

Dr. Firlik’s book, published in 2006, is 20 chapters of her neurosurgical observations offered to non-neurosurgeons. 20 chapters and glimpses into the mundane an d exciting drama of the operating room and brain surgery.

 
As a neurolawyer, I have a keen interest in the neurosciences. Although neurosurgery is not always present in the cases I handle, I find it very interesting to hear a neurosurgeon’s thoughts on everything from medical school anxiety to the fear doctor’s have of being sued for malpractice. With obligatory forays into operating room procedure, detailed descriptions of what drilling into the skull feels like, and other amazing insider information, I find this book a quick read. Maybe not for everyone, I am enjoying this book.

 
I want to share some of my thoughts about the chapters here. This will be an ongoing effort and I will post more as I go through the book.

 
I am at chapter 8 entitled, “Tools.” Here we find that neurosurgeons harbor great affection for the instruments they use in the acts of surgery. And they actually ascribe nicknames to these items. So “Adson forceps” are referred to as “bunnies.” The scrub nurse had better know the particular nomenclature for the particular surgeon or suffer his or her wrath when she fails to place the right instrument into his hand.

 
One surgeon asked his scrub nurse for “my little nipper,” his particular nickname for a tool properly called a “rongeur.” This tool is used to bite off pieces of bone. Fortunately of all the surgical tools before her, she was able to quickly deduce which one looked like one that nips.

 
The “sound of surgery,” I learned, is the sound of the neurosurgeons most commonly used tool – the suction device. Similar to the suction device used by dental hygienists, brain and spine surgeons use it throughout surgery to remove fluids that accumulate; namely blood and cerebrospinal fluid. Sometimes suction is interrupted due to pieces of tissue or clotted blood clogging the tube. A similar interruption occurs when an observing medical student unknowingly has her foot on the tubing. A mistake she will make only once.

Every intern’s rite of passage is to claim to have placed the first “bur hole” into a patient’s skull. Neurosurgeons use drills to carve out skull bone to expose the brain. These technologically advanced drills automatically stop once the bone is drilled through preventing further drilling into the brain. This was previously done manually and drills sometimes went too far! Interestingly, one cannot stop drilling half way into the skull and stop. If one does, the drill will not restart. I personally cannot imagine bearing down on a drill as it drives its way through a skull trusting it will stop once the bone is cut.

 
Finally “bone dust” from what I have gleaned does not smell very good. And you apparently get it on you when doing brain surgery!

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“We have at present no basis for a scientific explanation of the brain-mind relationship. We can only continue to study the brain without philosophical prejudice. And if the day should ever dawn when scientific analysis of body and brain solves the “mystery,” all men who have sought the truth in all sincerity will rejoice alike: the professing materialist and the dualist, the scientist and the philosopher, the agnostic and the convinced worshipper. Surely none need fear the truth.” (Wilder Penfield, Speech and Brain Mechanisms, 1959)

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