Book Review : Account of Neurologist’s Wins, Losses

Brain Matters: Stories of a Neurologist and His Patients by Bruce H. Dobkin MD (Crown: $17.95)

There is an endless debate among science writers over whether it is better to be a writer who learns science or a scientist who learns to write.

In general, scientists tend to write for other scientists, and they have difficulty conveying their material to the interested lay public. So for the most part, it is better to be a writer first.

But the very best science writers are scientists. Jeremy Bernstein, Lewis Thomas (a doctor), Freeman Dyson and Carl Sagan come immediately to mind. They and a few others have the knack of pegging their writing at just the right level and of imbuing it with a sense of the wonder of science. Rarely can a writer-turned-science-writer match their insider’s feel for what the scientific enterprise is all about.

L.A. Neurologist

In the last decade, several physicians have demonstrated that this is also true in the specialized field of medicine. Richard Selzer has written books that give an unparalleled description of what it means to be a surgeon, and Oliver Sacks has written of the illnesses of his patients (and himself) with a unique sense of the mystery of existence.

To this literature should be added “Brain Matters” by Bruce H. Dobkin, a Los Angeles neurologist who has filled his book with engrossing stories that clearly describe how medicine works, both from the patient’s and the doctor’s points of view.

The book is a searingly honest account of a doctor’s successes and failures. It displays a range of emotions, the most common of which is Dobkin’s frustration at medicine’s incomplete power of diagnosis and treatment. Dobkin lets us in on the thoughts that go through a doctor’s mind as he treats sick people, and he further tells us that sometimes all a doctor can do is touch his patient and hope for the best.

As a medical student, he treated a high-school senior with terminal cancer for whom nothing could be done. “It seemed impossible to me that doctors did not have something better,” he recalls in the book. “They were healers. But the science of medicine was almost useless here.” It was a lesson he is reminded of all the time.

He also knows that sometimes the most humane thing that can be done for a dying person is to turn off the machinery that is keeping him “alive.” Dobkin writes: “I am still a reluctant expert in the determination of brain death and in stopping support. Becoming the primary-care physician for the mechanically preserved who have little or no cerebral function is one of those negative fringe benefits you never know about until you’re already a trained physician.”

Full of High-Tech Medicine

Dobkin cares about his patients, but he also knows that the only way he can continue to deal rationally with illness and death is by being detached. His life is full of the high technology of modern medicine--CAT scans and PET scans and the like--and his days are filled with observing “the terrible things that can happen to ordinary people.”

“I sometimes could barely submerge my desire to avoid new, emotionally threatening encounters,” he writes.

As it happens, many of the patients in Dobkin’s book are doctors or close relatives of doctors, and they exhibit the same range of reactions to illness, treatment and death that the other patients and their families do.

There is a colleague whose wife, Cynthia, suffers a scuba-diving accident that leaves her brain irreversibly damaged. Her physician-husband refuses to accept that his wife will never regain consciousness, and for months he sits by her bed whispering to her though she can neither hear him nor respond.

There is an older physician, Larry Oubre, whose brain is mysteriously deteriorating. Dobkin and his colleagues treat him for a stroke. In fact, he has a brain tumor, which is not diagnosed until much later.

Dobkin recalls telling the doctor that he has brain cancer: “Larry lowered his head and whispered something I couldn’t make out. Tears wet his lashes. I squeezed his hand and once again repressed my impotence and grief. ‘I’ll do everything possible,’ I said. But he knew the prognosis.”

Oubre’s wife, Dobkin writes, “never blamed me for not making the tumor diagnosis sooner”--a chilling line. Dobkin blames himself.

There is a general practitioner from the Middle West who is suspected of having Alzheimer’s disease but who doesn’t. His wife’s calmness and good sense are a paradigm for all doctors and patients and their relatives.

And finally there is Dobkin’s father, Duke, who also develops brain disease. Thrust into being a patient’s relative, Dobkin learns about doctoring:

“My parents forced me to move from son to consultant,” he writes, “not because their doctors weren’t competent, but because they withheld the support the couple craved. I began to listen more closely to the minor symptoms of all my patients and asked how they and their families were coping with their neurologic disease. The nagging little symptoms of no real medical consequence, which I had tended in the past to ignore or play down, I now took the time to explain.”

Apportioned the Burden

When his father dies, Dobkin learns still more: “Before Duke’s death, I mostly avoided the pain and sadness that surrounds neurologic diseases by becoming caught up in an abstract cerebral landscape. I marveled at what my patients’ diseases taught me about the brain and apportioned the burdens of disease to the naturalness of bad health and death. That seemed to be the only sane way I could stare repeatedly into the face of tragedy. But Larry, Cynthia and Duke fused my detachment and compassion into a more natural alloy, and now I always feel Duke’s cold hand in mine when I try to comfort a patient or family.”

If you want to read a vivid account of doctoring and medicine, read “Brain Matters.” If in the future you need a neurologist, call Dr. Bruce H. Dobkin.