Peter Endicott reviews Brainspotting: Adventures in Neurology by A.J. Lees (Notting Hill Editions, 2022).
There’s a Mitchell and Webb sketch I was reminded of when reading A.J. Lees’ new book, Brainspotting: Adventures in Neurology. In the show, Robert Webb’s character arrives at a cocktail party with gelled back blonde hair, tall and looming in his grey turtleneck. Webb immediately introduces himself to the nearest couple as a brain surgeon. He asks the couple what they do, and tells the accountant and charity worker who respond that, while they hold laudable careers, it’s definitely not quite as impressive as being a brain surgeon. Eventually, inevitably, David Mitchell walks in and the host asks if he was kept late at the Space Centre. ‘Brain surgery?’ Mitchell says to Webb, when he is told of the latter’s career, ‘it’s not exactly rocket science, is it?’
There’s always a rocket scientist to meet, though maybe Lees hasn’t met one yet. In the opening of his book, he writes that although he is a neurologist, he is often mistaken for a brain surgeon after he tells people he meets that he can ‘make the blind see, the lame walk and can calm the shaking palsy’ (vii). Jesus is therefore in second place, having only managed the first two of these miracles.
Lees proceeds, in his introduction, to mention the thousands of patients he has seen, the thousands of ward rounds he has conducted, and the lectures he has given all over the world. He provides this information to contrast himself with Oliver Sacks who, when writing, did not have a salaried post as a neurologist. So, he trumps Sacks too.
This autohagiography seems meant to impress the reader, and prepare them for the following chapters of the book, which chart Lees’ career from medical school to his current work as a consultant neurologist. As a Parkinson’s Disease specialist, he has published widely on the pathophysiology of the disease, and advanced new and effective treatments for the condition.
First-hand accounts of medical practice written by middle-aged male doctors are common – Oliver Sacks is an example (as Lees notes), and so is Samuel Shem and Atul Gawande, as well as William Carlos Williams. Chekhov wrote about rural practice in his early stories. What feels like a new trend in publishing, however, is the volume of doctors talking so exclusively about themselves and their career paths. Most famous is Adam Kay’s This is Going to Hurt, but visit any bookshop and it is easy to find more – the pathologist Richard Shepherd, the anaesthetist Colin Black and Henry Marsh, a brain surgeon, all have recent titles out. These books, to a greater or lesser extent, do incorporate patients’ stories and acknowledge the support of colleagues within institutions. Still, as illustrative examples, these wider stories are used to reinforce the idea that medicine is a thing that is done by an individual, who is very brave and very clever.
The doctors listed above probably are brave and clever. The issue is when these stories seem to be the only stories that are published about medicine. When I was applying to medical school, students I met at interviews often talked about their favourite TV shows. House and Grey’s Anatomy were most commonly mentioned, though Scrubs was a close third. I’d shadowed a radiologist when I was thinking about applying, and she’d told me that she couldn’t stand the first two of these shows, where medicine was best practiced by individual medic savants, or conceptualised as a heady rush of catastrophes that can only be solved by beautiful doctors. She told me that Scrubs was by far the most accurate depiction of medical life where not just doctors, but also nurses and secretaries and janitors were shown as being vital to how a hospital works. Where patients, although still mostly acted upon, could become recurring characters who had agency within their story.
That healthcare is a group activity, where the act of looking after people is performed not just by a doctor in charge but by a range of different professions, by family members and friends and the patients themselves, seems self-evident. Reading Lees’ book wouldn’t suggest as much. Part of this could be explained by the stage that he is at in his career – Lees sees many patients one-on-one in a clinic setting – but the majority of the story presents Lees as a trainee in various teaching hospitals. Here, the supporting characters are his mentors: famous neurologists from the middle of the 20th century and Jean-Martin Charcot, who haunts the corridors of Salpêtrière University Hospital where Lees trains for a short time. With the introduction of Charcot, Lees’ book moves from giving a personal account of his medical training while ‘surrounded everywhere by the ghosts of distinguished physicians’ (113), to explaining neurology as being a timeline of great figures, and great men.
The historian Thomas Carlyle is cited as coming up with the ‘Great Man Theory’ of history.[1] In a series of lectures on heroism that would later be published, Carlyle states that ‘all things that we see standing accomplished in the world are properly the outer material result… of Thoughts that dwelt in the Great Men sent into the world: the soul of the whole world’s history, it may justly be considered, were the history of these.’[2] Lees wants to confirm that this is true for the history of neurology. That, rather than being dictated by politics or economics, by patient advocacy or by the teams that keep hospitals running, the story of neurology is a story of great men propounding great ideas, and teaching more great men to do the same.
Even when Lees has the opportunity to show that there may be a different interpretation of the history of neurology – and his own history – he reverts to this same line. He notes that ‘the location of The London Hospital [where he was a medical student] in the poorest part of the capital meant that there had always been a plentiful supply of unclaimed paupers and foreign seamen for its surgeons to cut up’ (17). Lees does not explore the fact that the foundational knowledge of neurology was based, in part, on collecting and experimenting on the bodies of the poor. Instead, he describes the layout of the college museum, and reflects on his ‘own eventual decomposition’ (17). Later he makes the important point that ‘diseases of the nervous system can humiliate in a way that cancer or heart disease can never do’ (70). Instead of thinking about how patient experience might have influenced the development of neurology as a speciality, he uses this statement to segue into a discussion on the conduct of different types of neurologists.
At other times the laser-focus on the power of individualism, of one man’s skill, can make you worried. Lees states that ‘despite their fallibility and lack of scientific scrutiny… ‘rules of thumb’, passed down from one generation of neurologists to the next, proved far more useful to me than retained textbook factual knowledge’ (62). One of these ‘rules of thumb’ is that women wearing sunglasses are likely to have psychogenic disorders. Later he states that ‘even if the neurological examination were to become one day redundant, I would still lay on hands during the medical consultation’ (67). ‘Even if I didn’t need to touch you, I would’, he seems to be saying.
The fondness for ‘rules of thumb’ comes from a nostalgia for a career that has clearly meant so much to Lees. There aren’t many other ways to explain how he can say of himself as a junior doctor that ‘my soul possessed a loving, reverberating energy that had the power to light up a room’ (73). Or that his self-named practice of ‘soulful neurology’ frees him ‘to believe in happy accidents, the possibility of miracles and the healing power of faith’ (78). Lees insists that his practice of soulful neurology ‘never lapses into sentimentality’ (77), but this description, this self-remembering, does exactly that.
Brainspotting doesn’t stand on its own as a sentimental account of a doctor’s education. It is part of a publishing trend, which suggests that the story of medicine is the story of heroic, mostly male, individuals. But different stories are needed to recognise the cooperative nature of healthcare, and the structures, be they political or economic, that inform how we are able to treat those who are unwell. When The Times can report a 5000% rise in patients waiting over a year for neurology appointments,[3] when 30,000 patients – including those suffering with symptoms of a stroke – waited over two hours for an ambulance to arrive,[4] we have to think beyond the white-coated doctor strutting in to save the day. The great men won’t be enough.
Peter Endicott is a doctor and writer working in London.
[1] See https://en.wikipedia.org/wiki/Great_man_theory
[2] Thomas Carlyle. 1841. “Lecture I: The Hero as Divinity. Odin. Paganism: Scandinavian Mythology.”. On Heroes, Hero-Worship, & the Heroic in History: Six Lectures. London: James Fraser. pp. 1–2.
[3] Andrew Gregory, “5,000% rise in neurology patients waiting for a year”, The Times, 18 July 2021.
[4] John Burn-Murdoch, “How to fix Britain’s chronically ill healthcare system”, Financial Times, 3 June 2022.
