The Weird and Wonderful World of Neurosurgery

Natalia Eugenia Birgisson, MD

Katrina Firlik, MD, is a neurosurgeon turned writer turned entrepreneur. Her witty and insightful memoir, Another Day in the Frontal Lobe: A Brain Surgeon Exposes Life on the Inside (2006), offers an engaging look into the profession. She enjoys conveying medical concepts to the public and has appeared on CNN, Fox, and MSNBC as a commentator on a variety of medical issues. She is also co-inventor of a brain stimulation device designed to enhance recovery after stroke. Dr. Firlik is co-founder and chief medical officer of HealthPrize Technologies, an Internet company with a novel solution for improving adherence to prescription medications. Previously, Katrina was a neurosurgeon in private practice at Greenwich Hospital in Greenwich, Connecticut, and on the clinical faculty at Yale University School of Medicine. She lives in Darien, Connecticut, with her husband, Andrew, a neurosurgeon-turnedventure capitalist, and their daughter, Annika.

Congress Quarterly: As a neurosurgeon, how did you get interested in writing?

Dr. Katrina Firlik: My interest started a lot earlier, when I was back in college really. That’s when I started reading a lot of well-known physician writers—Oliver Sacks, primarily, and also Richard Selzer, who was a surgeon. Their writing helped me become interested in medicine, and specifically in the brain, as a college student. My interest in physician writers continued as I went on through residency and beyond. But in terms of why I decided to write as a neurosurgeon, I realized that I had this privileged view of so many things that other people outside of neurosurgery would never have access to. I love explaining things as well, so it was a fun challenge to describe some of the experiences I had about the process of becoming a neurosurgeon. Also, crafting the perfect sentence and finding the right word to describe something is enjoyable for me, it doesn’t feel like work. It is very satisfying for me to write.

CQ: Did you take notes during residency?

KF: I did take notes. During my residency, I wasn’t planning to write a book. But I did have the foresight to realize that I was going to see a bunch of amazing things, and I decided that I was going to very loosely keep a journal. When I heard interesting conversations between residents and attendings or heard a touching quote from a patient, I wrote it down on a 3 x 5 index card and put it in the pocket of my white coat. It was a little messy because as you know residency is very challenging and there was very little time. But as the quotes collected in my white coat, I would transcribe them into my laptop about once a month. By the end of the seven years, I had a pretty good volume of interesting things I had collected that I would not have otherwise remembered in so much detail.

CQ: What was your writing process?

KF: I started by writing an essay. It was a childhood dream of mine to publish in the New Yorker, although I realized later this is nearly impossible to do. But I wrote an essay, regardless, and sent it around to some of my friends for their opinions. One of my friends who is a writer sent it to his agent without telling me. His agent immediately loved it and called me, suggesting that I write a book. She walked me through writing a proposal and interviewing at publishing houses. It was a fun, exciting experience to get to know the publishing world. Over two days we literally walked from publishing house to publishing house in New York City, pitching the book to editors. It was so different from my clinical world. Then one chapter at a time, I sent my writing to my editor at Random House. The editor would look at each chapter and make recommendations about how to change it. She gave me a lot of leeway and latitude, with broad scale suggestions, often about adding personal anecdotes here and there. 

CQ: What would you say is your most interesting writing quirk?

KF: I don’t know if I have any bizarre quirks. But I love reading about the quirks of other authors. For example I read once that Michael Crichton ate the same lunch every day for months as he was working on a book. I suppose I have to have everything organized before I can sit down to write. I’m kind of a neat freak, and if things are disorganized or if there is a pile of laundry, I have to tidy up before I can think.

CQ: What was one of the most surprising things you learned in creating your book?

KF: I always assumed that the author would have some say in the cover. And they don’t. I learned this when I went to my editor at Random House with recommendations for the cover, and she said gently that I should stick to the writing and they would take care of the marketing. The one thing I didn’t want was for me to be on the cover. I knew this would really embarrass me in front of my colleagues. Well, it turns out Random House wanted me to be on the front cover. I was much happier with the cover of the Chinese version of my book. It features a cartoon head with a wrench next to it.

CQ: Has this book impacted your neurosurgery practice or career goals?

KF: One thing that may not be obvious is that I’m currently not practicing. I practiced for several years and loved it, although what it made me realize about myself is that I also love taking on new challenges. While the routine with my practice was very satisfying on one level—I absolutely loved taking care of people one-on-one and making a difference in their lives—my mind kept straying to other pursuits. At first I thought that my ideal scenario would be to do neurosurgery and something else, be that starting a new company or writing another book or learning something new. I soon realized that my choice of neurosurgery was not very conducive to any sort of part-time work. What patient wants a part-time neurosurgeon! So I went through a long transition period and ended up starting a healthcare Internet company that hopefully, if successful, will allow me to help a lot of people. But it did, unfortunately, require that I give up my practice. So currently, I’m co-founder and chief medical officer of a company called HealthPrize. It’s very exciting. The reason that I loved residency so much is because it is such a steep learning curve; you are constantly learning new things every day. And that was very similar to the challenge of starting a new company.

CQ: Have your colleagues or patients commented on your book?

KF: Yes, although most colleagues didn’t say anything. But the ones who did were very positive. For example, one of my mentors, Dr. Dennis Spencer, wrote one of the formal reviews of the book initially. I did get great comments from the patients who read it. Probably the funniest was from another surgeon through my author website, a somewhat nasty email. He said that the stories were interesting but that this was all about me and my ego. I decided to take the high road and wrote back thanking him for reading my book and for taking the time to write. What was hilarious was that a few days later I got an email back from him apologizing, saying that he had been jealous because he was a colorectal surgeon who wanted to write a book, but Another Day in the Colon wouldn’t sell as well.

CQ: Do you think you will write another book?

KF: At the moment, I am finishing a proposal for my second book. Time slipped by after I published the first one, and I had to keep pushing back my second book. So now I’m working on it, which is not a memoir but is broadly about life-saving techniques. So it is medical and it is timely, with so many people worried about being at the scene of trauma. If anyone has stories they want to share with me on the topic, I would love to hear them.

CQ: Do you have any suggestions for other surgeons interested in writing?

KF: First, I think that any doctor has enough stories to write a book. The question is whether they want to go through the work of writing the book. Medicine is just perfect for stories. If they have an interest, I suggest taking notes along the way. I never could have written a book had I not taken notes during residency. Those notes were incredibly helpful when I sat down to write years later. Second, I would suggest reading a lot. Even if there isn’t time to read novels, reading essays and short stories will help inspire good writing. And third, I would caution that when we sit down to write for the general public, we almost have to unlearn what we learned for writing in academic publications. The style that is used for academic writing is often dry with convoluted jargon. Great writers often write fairly simply. Try to write so that you are understood.

CQ: What do you think makes a good story?

KF: Definitely some form of tension. One reason that neurosurgery was so perfect for a book was because there are often ethical quandaries with patients in dire scenarios, and there’s often differences of opinions between large personalities about who to take to surgery. And some kind of human angle that people can relate to is important. That’s why I loved borrowing from conversations I overheard. Something that I learned from my editor was that readers like to get to know the writer in nonfiction writing, so personal anecdotes really help.