Back from the Brink: How Crises Spur Doctors to New Discoveries about the Brain

by Edward J. Sylvester

Just a few short years ago, the outcome of a life-threatening brain injury lay in the hands of the victim's god. Neurologists had a self-mocking term for their role in "Diagnose and adios." While doctors knew more about why and how a brain might die or be permanently impaired, they rarely intervened in brain trauma cases, believing there was little they could do. Today, though, a brave new world of brain rescue is opening up. A handful of hospitals around the country have begun to develop neurological intensive care centers where aggressive new treatments are pulling brain-injured patients back from the brink.

Acclaimed science journalist Edward J. Sylvester here takes us to one of the first of these facilities to develop neurointensive care, The Johns Hopkins Medical Centers in Baltimore. Sylvester introduces us to Marek Mirski, the pioneering neurologist who leads the neurointensive team, and follows Mirski into the very center of the brain trauma storm through five dramatic and very different cases. Sylvester also takes us on a whirlwind side trip to New York's Columbia Presbyterian Hospital, where Mirksi's compatriot Dr. Stephan Mayer—the founding neurointensivist—struggles for the life of yet another patient. A vivid, elegant writer, Sylvester has filled his book with unforgettable and fascinating events. His descriptions of the maelstrom in the traumatized brain are some of the most powerful ever put to paper, and the human faces in his cast of characters are almost clear enough to touch. Back from the Brink combines the best of medical journalism with the drama of ER as it covers some of the most innovative developments and exotic territory in modern medicine.

296 pages, Hardcover

First published January 15, 2004

Reviews

[Kristin · Rating 3 out of 5]

A decent book, but I found the title a bit misleading, as the focus seemed split between the development of the neurointensivist subspecialty at Johns Hopkins and Columbia hospitals, and the work of those specialized doctors to advance the treatment of patients in neurological crisis. Clearly the doctors who championed for having neuro ICUs staffed with neurointensivists were on the right track, as the specialists were trained to care for the whole patient and treat what is wrong in the brain without sacrificing the function of the rest of the body. Plus, these doctors care for the patients the entire time they are in the ICU and are better able to observe the minor, but significant, day to day changes that could be missed in patients who have a different doctor in a rotation examining them every day.
What I enjoyed most were the patient stories, as the author elaborated on what landed them in the ICU in the first place and how the doctors were able to apply their specialized knowledge to restoring the patients to as close to their normal selves as possible. Of course, not everyone survives, as it would be too unrealistic a portrayal to have 100% of the critically ill patients return to absolute normal, but most of them do OK. I would have liked more case studies and less trumpeting of the doctors' research projects, as those portions seemed a bit technical and certainly less engaging than reading about how those ideas and conclusions were put to good use in patients who may not have survived had they been afflicted 10, 5, or even 1 year sooner.

[Munzareen · Rating 5 out of 5]

Very interesting account and amazing to see how doctors work with the brain.