Fact into Fiction

Arjun Vivek Pendharkar, MD

Brian T. Andrews, MD, is chairman of the department of neuroscience at California Pacific Medical Center (CPMD) and an author of both fiction and non-fiction works. He authored Knife Under Fire (1993), a fictional murder mystery/thriller focusing on a neurosurgeon practicing in San Francisco, followed by The California Mille (1997), chronicling the same character as he navigates the famous west coast classic car race. His most recent book, Cherokee Neurosurgeon (2011), is a biography of his chairman and mentor at UCSF, the neurosurgical giant Charles B. Wilson. Born in British Columbia and raised in San Francisco, Dr. Andrews completed his medical school and neurosurgical training at the University of California San Francisco. I had the unique opportunity to interview Dr. Andrews through a series of phone interviews in which we discussed his personal life, academic interests in neurosurgery, and his literary works.

Congress Quarterly: Could you please tell us a little bit about your neurosurgical practice?

Dr. Brian T. Andrews: My initial practice was focused on neurotrauma. I was very interested in that as a senior and chief resident at SF General. After I finished my training I stayed on and did clinic, covered call, and neurotrauma. At the same time, I also built my private practice at Pacific Presbyterian (now CPMC) in San Francisco. I was not wedded to staying in academics for a few reasons: first, I didn’t like bench science, I liked clinical research and clinical work, and second, I had a fatal flaw—I didn’t like constantly mentoring residents in the operating room. I was not a fan of standing by while residents did the surgery. I was technically adept and able to do cases quickly and well, and was much happier doing cases myself. I also did something I highly recommend to residents—I got involved in the Joint Section on Neurotrauma and Critical Care. In fact, in 1996 after moving through leadership I became joint section chair, which lasted a year. The whole experience was enjoyable and kept me wired into the CNS and AANS and their executive committees. It also helped me foster relationships with publishers like Thieme because they were the ones that published the later books. I had a big interest in continuing my writing. I wrote a number of textbooks, mostly edited, and through my joint section contacts I could bring in some of the best people to write chapters on critical care. That was a lot of fun. My academic interests now are really focused on our program development with stroke and ancillary research on the stroke service.

CQ: Were you always a writer?

BA: I became interested in writing during college; I was a bio major at USC but was very interested in fiction writing at that time—Hemingway, Steinbeck, that sort of thing—and I was always a big-time reader of fiction. I did a number of creative writing classes but did not focus on it in any major way. When I went on to neurosurgical training I focused on academic writing. There was an editorial office where each resident was connected with an editor, and I had a young editor to work on my technical writing skills. That was extremely useful. Once I finished my residency I had a number of published works. I was really interested in neuro-intensive care so I embarked on writing a textbook titled Neuro-intensive Care, which was published in the early 1990s and was fairly popular around the country. So I wasn’t always a fiction writer, but I carried on with academic writing using the lessons I had learned through the editorial office at UCSF.

CQ: Let’s talk about your first novel, Knife Under Fire. What made you decide to take the leap from academic writing to fiction—and a mystery/thriller at that?

BA: As a young neurosurgeon I loved the books by Tom Clancy. Here is a guy who was an insurance broker from Maryland who got very interested in the CIA and nuclear submarine warfare and started writing books. I was very impressed that an insurance broker could become so facile at describing a technical field in a way that made it fascinating for the reader. That led me to thinking that maybe as a neurosurgeon I could take the technical parts of neurosurgery and do the same thing. I wrote Knife Under Fire, which came out in 1993 through a small publishing company in San Francisco. I didn’t really take any formal training on fiction writing. I just tried to engage the reader by describing what it’s like to do a craniotomy. In fact, the very first chapter opens with the character’s day, starting before dawn, then clipping an aneurysm which ruptures during the case—you can’t get more dramatic than that very real type of event. The reviews were mixed, but I enjoyed writing it, and the patients enjoyed reading it, too. I think they liked having a window through which to see me and experience my field.

CQ: So you decided to continue the story line with the same character in your second book, California Mille?

BA: The second book basically took the same main character and places him in this famous vintage car rally, a real event that occurs every year. My father and and I are enthusiastic about the Mille and rebuilt a 1954 Jaguar specifically for this event, which we participated in many times in the 1990s. I placed my character in the Jaguar and wove a mystery around his experience. And again I tried to include what it’s like to be a physician in the setting of this exclusive trip. It was tense and a bit lighthearted, and I really enjoyed writing it. Both my friends in the vintage car hobby and my patients seemed to enjoy it.

CQ: Was it difficult to transition from academic to fictional writing?

BA: I didn’t really think the transition to fiction writing was all that difficult after all the editorial advice I’d gotten in my science writing. I think that non-fiction and fictional writing are not difficult—but they require perseverance. My style was to get up early when I was in the middle of a project. I’d always be thinking about it throughout the day and get up early the next morning around 4:30 or 5:00 a.m. before OR or the clinical day to get the writing done when I was really fresh.

CQ: Next you wrote Cherokee Neurosurgeon, the biography of Charlie Wilson. Why did you decide to write a biography after two works of fiction?

BA: I was sitting in the front row when Charlie received the Cushing Medal in 2008. I was a former resident of his and began thinking that it would be fascinating to put together his life story, because he was such an interesting individual. Charlie was a guy who was absolutely devoted to his clinical practice, clinical neurosurgery, and developing brain tumor research, but he was extremely flawed when it came to conventional life. There were a couple of books I read about doing biographies, and I used a basic linear format for writing this work. I began by developing a series of questions, starting with Charlie’s childhood and his upbringing. His dad died when he was very young, and his mom was very influential— she is the Cherokee side of him (he is one quarter Cherokee). I ended up with about 15-20 interviews with him, which I transcribed long hand. Then I started to bring in other people, progressing through his life. I spent a lot of time on the phone doing these ancillary conversations and taking longhand notes. I used many of the stories and anecdotes from the people from his life and career and wove them into the story. Writing this biography was a way to bond with my mentor, and to this day we are extremely close. And it turns out that writing Charlie’s biography has become one of my favorite things I have ever done.

CQ: You mentioned that family life is very important to you. Could you tell us a bit about your own family?

BA: When I was on Charlie’s personal service—6 months of indentured servitude—I ran in at about the fourth month, excitedly telling him that my wife was pregnant. He looked at me and said, “Well, you obviously aren’t working hard enough,” and then I said, “But Dr. Wilson, I don’t remember it!” And so my daughter was born 30 years ago when I was a senior resident. And my son was born a year later. They grew up with me working hard but being around. Practicing neurosurgery takes you away, but you can often get home to sit at the dinner table or read a book to your kids before they fall asleep. We were blessed that our kids have grown up well. My daughter works in communications and works with us on our online presence with the practice and our medical center. My son is an engineer working at NASA on the robotics team. My wife and I are still together—another blessing—and planning to travel more in the future.

CQ: What advice do you have for young neurosurgeons?

BA: I think my advice to young neurosurgeons is that you often will get—coming out of Stanford/ UCSF academic programs—biased opinions that academic neurosurgery is the only game in town. And that is simply not true. There are absolutely fulfilling wonderful practices in this terrific career that are outside of teaching institutions, and there are lots of examples that terrific work can happen in other places and even smaller communities. Neurosurgery is so fulfilling because you have patients with true needs and you can be life changing in any practice setting.

CQ: What’s next as you look forward? Will you continue to practice? Will you write more books?

BA: I just turned 60, and I plan to work another decade. I think that neurosurgery will be hard to leave, but I’m honing it to do what I do really well at a volume that I like. And my writing practice will continue. I’ve got a couple of fictional things to work on and possibly another biography. I don’t think I’ll do any more academic writing, but to return to other types of writing will be really fun. I think that it’s something that will take over my interest and energies.