There are two sides to every disease story — a lot more if you count the patient and the doctor, the patient's relatives and the doctor's relatives, the nurses, the therapists and the insurer. What a shame that the only time we ever get to hear all of them is in court. Otherwise, it is pretty much all monologue out there in the literature of health lost and regained, with all the usual problems of perspective and turf.
Someday, perhaps, a multi-author volume will do justice to the whole elephant. In the meantime we are left with makeshift composites, like the dialogue provided by two new books on the triumphs and failures of neurosurgery.
This is the realm of bad headaches — headaches that thrive on ibuprofen and just get worse, headaches that may eventually bring patients to doctors like Keith Black, scans in hand. A neurosurgeon at Cedars-Sinai in Los Angeles, Dr. Black is one of a few dozen in the country specializing in brain tumor surgery (most neurosurgeons work on the brain's blood vessels, or in the spinal cord). Among the patients he recalls in his fascinating, if somewhat stilted, memoir are a hip-hop artist with a benign tumor destroying her hearing and balance, a California pastor with nodules of melanoma in the brain, and a Hong Kong tycoon with a glioblastoma multiforme — the most feared of all brain tumors — extending its tentacles through the right temporal lobe.
No music is allowed in Dr. Black's operating room. It requires superhuman patience and concentration to peer into a microscope for hours, peeling apart gauzy layers of tissue to remove all these invaders. He likens the work to that of a cat burglar, his aim to get in and out of the brain without leaving a trace. One false move and the patient may never see, hear, smell again — or may never wake up at all.
Out of the operating room, with a concentration no less intense, Dr. Black does a lot of mental bargaining. In exchange for torturous surgery — one unlucky man is essentially cut in half to remove a tumor — patients with malignancies may get months to years of remission, while those with benign tumors may be fixed forever.
But how much grisly recuperation is fair payment for how much subsequent health? When should Dr. Black stand back and let nature take its course? Despite all the shades of gray, he has to make a decision in each instance, and so his world is an orderly progression of decision, action and result. And if there is the constant background thrum of other people's bad headaches, it is a chorus he has learned by now to accept.
For Lynne Greenberg, a Brooklyn Heights resident, mother of two and scholar of 17th-century English literature, the headache is the only thing, really, the metronome by which she has lived out the last three years. It struck in 2006 while she was sitting in a London library making her way through a stack of ancient documents: "Any movement or physical activity at all sent shock waves through the center of my head." It has never gone away.
More than two decades ago, when Ms. Greenberg was 19, a car accident catapulted her over an embankment to a 30-foot fall. She broke her neck but miraculously escaped all neurologic injury, and after a few months of neck immobilization she was declared cured.
After the headache appeared, a series of scans showed that Ms. Greenberg's old fracture had rebroken — or perhaps it had never healed at all. Was this the cause of the headache? Was it a coincidental finding? Did she need emergency surgery to stabilize her spine? Or was she a neurotic narcotic-seeking depressive reaping secondary gain from her alleged pain? Every doctor rendered a different opinion, leaving her increasingly frantic, confused, in a tangle of medications and pain.
Ms. Greenberg nails whole portions of the health care elephant in her compulsively readable book: the doctor shopping, the postop misery, the unhappy effects of chronic illness on marriage and small children, the looking-glass world of detox and rehab. The chorus in this book — other than the array of doctors, some good and some bad — are the poets Ms. Greenberg lives among, most prominently the blind John Milton, whose "Paradise Lost" chronicled a similarly cataclysmic fall.
Literate, fraught and unsettling, Ms. Greenberg's book has no resolution — none of the easy wrap-up Dr. Black offers us. He cured the hip-hop artist and put the pastor into a miraculously long-term remission; the Hong Kong tycoon fought a good fight but ultimately succumbed. Dr. Black's own story wraps up happily as well: an African-American kid from segregated Alabama, he was a science prodigy whose parents refused to limit his horizons, and he has soared high.
But it is Ms. Greenberg's epic journey through a gray landscape of pain, with a few rest stops along the way but no resolution in sight, that forms the more memorable narrative.