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VanderArk, Gary MD

Book Review: Infobytes

Dr. VanderArk is Director of the Neurosurgery Residency Program at the University of Colorado Health Sciences Center in Denver.



When the resident literary genius on the planet writes a bestselling novel about a day in the life of a neurosurgeon, it gets your attention. After all, how could he possibly know enough about the highly technical field to write knowledgeably and accurately about the life of a brain surgeon?

It turns out that Ian McEwan spent two years observing Neil Kitchen, a consultant neurosurgeon and Associate Clinical Director at The National Hospital for Neurology and Neurosurgery in Queens Square, London. He gets it so right that he's able to say things like, “it's not possible to be an unassertive brain surgeon” and even master neurosurgical cynicisms with statements like, “In neurosurgery, he chose a safe and simple profession.”

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Saturday tells the story of a single day, February 15, 2003, in the life of Henry Perowne, a 48-year-old neurosurgeon, who lives on Fitzroy Square in London. This day proves to be a metaphor for life.

Perowne is a fortunate man living the good life. He has plenty of patients and a rewarding surgical practice that produces an upper-middle class privileged existence. He has two successful, talented children – 18-year-old Theo, a talented blues musician, and Daisy, a 23-year-old poet about to publish her first book. He is happily married to Rosalind, a successful attorney.

McEwan's incredible ability to put words together is illustrated early in the book. When Henry awakens prematurely at 3:30 a.m., he goes to the bedroom window and watches two nurses crossing the street on their way home from the evening shift “…in the lifeless cold, they pass through the night, hot little biological engines with bipedal skills suited to any terrain, endowed with innumerable branching neural networks sunk deep in a knob of bone casing, buried fibers, warm filaments with their invisible glow of consciousness – these engines devise their own tracks.”

Then Perowne sees something that shakes him. It is an airplane on fire streaking through the sky towards Heathrow Airport. This startling sight, which he expects to be a major disaster, casts a pall over the coming day.



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The backdrop for the story is the pending war with Iraq, which Prime Minister Tony Blair strongly supports. Perowne is a mildly ambivalent hawk compared to his vehemently dovish children. London, on this Saturday, is the site of a huge protest march. The parade forces a detour in his usual route to a morning squash match with his anesthesiologist. This results in a minor fender-bender.

His Mercedes 500 SL miraculously escapes major damage but a red BMW containing three thugs does need repair for which they demand immediate reparation.

The BMW driver has Huntington disease and it will seem like fiction to some neurologist readers that Perowne is able to diagnose it and temporarily distract his opponents with a discussion of possible treatments.

Following the incident, our hero busies himself with his squash match, grocery shopping, visiting his demented mother, attending his son's rehearsal, and preparing for a family dinner that will attempt to reconcile his daughter with her maternal grandfather. The reunion, however, is interrupted by the reappearance of two of the thugs who proceed to terrorize the family.

As you might expect, the neurosurgeon saves the day. He also saves his family and, most significantly and concretely, the thug with Huntington disease.

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This is a well-constructed tale with wonderful character development. McEwan's story is as complex as the surgery Perowne performs. He seems to understand the neurosurgeon's need to push the envelope and work to the maximum but not go beyond it.

As the tension builds and the plot thickens, pages fly by. You will find that this book considers themes with which we all struggle; the war in Iraq, family responsibilities in an over-committed life, literary naiveté in a world filled with science and, most of all, responsibility as physicians to patients who want to do bad things to themselves and to us.

Neurologists might also be shocked to discover what a wonderful, fulfilling, and active sex life our neurosurgeon hero enjoys. McEwan certainly makes a day in the life of a neurosurgeon fascinating.

I was particularly amused by and could identify most intimately with the banter between Perowne and his daughter over his literary innocence and her attempt to educate him with a reading list. At her behest, he has plowed through Anna Karenina and Madame Bovary. What does he gain from these literary masterpieces? That adultery is understandable, but wrong, and that 19th century women had a hard life. What would you expect? Neurosurgeons are pragmatists.

I also loved the description of Perowne's shopping stop at the market to buy ingredients for his bouillabaisse. In selecting his fish, he ponders the latest scientific research indicating that fish have a higher capacity for pain than previously assumed: “This is the growing complication of the modern condition, the expanding circle of moral sympathy. Not only distant people are our brothers and sisters, but foxes too, and the laboratory mice, and now the fish.”

Yes, read this book. Read it for McEwan's priceless prose and his quick pace. You don't need to read it to know how a neurosurgeon's mind works. You already know more about that than McEwan.

©2005 American Academy of Neurology