Brain and Spine Injury Lawyer & Attorney : Titolo Law Firm : Las Vegas, Nevada

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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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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