Book Review

Judith's Pavilion: The haunting memories of a neurosurgeon

N Engl J Med 1997; 336:1331-1332May 1, 1997

Article

Judith's Pavilion: The haunting memories of a neurosurgeon
By Marc Flitter. 221 pp. South Royalton, Vt., Steerforth Press, 1997. $24. ISBN: 1-883642-31-0

All the time, physicians hear patients tell their stories, the particulars of suffering or newly worrisome lives. In return, the ailing or alarmed man or woman hopes (sometimes hopes against hope) for a responsive medical story: an account of what has happened, an explanation of things as they are, and a speculation about what may happen. This talking by someone in trouble, this listening by someone in the know — a human encounter wherein the stakes are high — makes for considerable drama, as the physician-poet William Carlos Williams more than implied when he told a medical student about the mix of inspiration and obligation he often felt as both a doctor and a writer:

I'll be sitting there, trying to figure out what's wrong with someone and suddenly I realize how close to the edge this work brings you everyday with no letup: death is often around the corner, so life expands in meaning, for the one who is sick, for the one trained to fight sickness. A big responsibility, of course, but a privilege: you get fired up, you've got to do your best. If you win, someone else wins, too — a life has been spared, and smiles lift you high; if you lose, cries fill your ears, the church bells ring, you can feel your body sag.

I thought of those words (and I thought of Dr. Williams's “doctor stories,” his effort to render in fiction the heart and soul of his medical experience) as I read this memoir by Marc Flitter, a Pennsylvania neurosurgeon who has drawn on 20 years of clinical work to give us a compelling (at times touching, at times unnerving) account of what he has seen and heard and tried to accomplish, and also what he has constantly kept in mind (or rather, all too often, has not been able to get out of his mind). We are taken, as it were, from one room to another in this “pavilion,” which is a metaphor for all the pain and hurt and suffering Dr. Flitter has encountered in his many years of neurosurgical training and practice. Put differently, his writer's imagination has enabled him to find a way to bring together coherently and suggestively the “haunting memories” to which he refers in the subtitle of his book. It is as if we were on rounds with him, walking the corridors of his medical (and introspective) life, visiting the vulnerable men and women who come to him in fear and who, often enough, learn from him of their grim prospects.

Though Dr. Flitter's remembered roster of patients is his own, we soon realize that he has in mind for us something more than a series of stirring or melancholy medical tales — descriptions of the persons whose destinies he literally held in his skilled hands. These “casualties of fate and technology,” as he puts it, become for him moral companions; they have a lot to teach us about the medical profession, its possibilities but also its downside. We encounter doctors who work exceedingly hard and do the best they can against high odds, but we also meet doctors who are all too vain, callous, and wrong-headed. Nor is this writing doctor anxious to point his finger at his colleagues so that he himself can be let off the hook. Many pages in this book are given to honest self-scrutiny, even confessional acknowledgment of errors made — an authorial voice anxious to level with the reader, and also a voice that is convincing, affecting, original, and eloquent. In a chapter unashamedly titled “Failure,” he tells us of a “hockey-stick incision” he made, and then this: “The scalpel traced upward through her skin like a flare at sea, lighting her scalp with its trail of blood.” A bit further on we read, “After having broken through the equivalent of a vault, what would be required of me now was the delicacy of repairing a watch or inscribing the Lord's Prayer on a grain of rice.”

No question, Marc Flitter chose a career in a subspecialty that is especially demanding, one shadowed by tragedy. In this book we meet patients struggling with brain tumors and strokes and severe epilepsy. But even though these men and women are often destined to die before our eyes, the teller of the story of their intractable or fatal illnesses is so gentle and thoughtful, writing of these people with such skill, compassion, and tenderness, that we mourn them less than we meet them as our fellow human beings. They stand tall as our teachers, their tragedies redeemed by a physician through these brief encounters, these lively, engaging riffs on neurosurgery — a writing doctor's brilliant, promising first appearance, with more surely to come.

Robert Coles, M.D.
Harvard University Health Services, Cambridge, MA 02138