Neurosurgeon George Chovanes, M.D., begins his writing career with an ambitious project involving science, neurosurgery, politics and mystery. The protagonist in The Sharp Edge of the Soul is chief neurosurgical resident, Dr. Alex Adams, who is suspect of the chief of neurosurgery, Dr. Victor Todd. Todd makes philosophical comments about the perennial neurosurgeon's preoccupation with the mind-brain dilemma --- he wishes to program the mind by altering the brain. Dr. Todd is researching this with monkeys. But is he also using humans?
How the brain thinks or controls emotions is not a new topic, but Chovanes capitalizes on the subject. Neuroscientists, John Chapin, Sanjiv Talwar and colleagues at the State University of New York in Brooklyn recently developed a "neural interface" that allows an animal to manipulate a robotic arm by simply thinking about it. Their latest experiment reported in Nature reversed the process and allows external commands to the somatosensory cortex to control the rats --- creating "roborats."
The story takes place in the 1990s when right and wrong intersect with human conscience and civilization in general. The skillful weaving of differences between the "gold standard" MRI diagnoses of the brain and clues missed on a CT, add to the intrigue in this medical mystery novel. Eventually the intrigue involves a brain MRI of the President of the United States, whom Alex feels has had problems in moral judgment. Alex is unaware that his chief had been a consultant for the president's physician.
Chovanes begins his story with a craniotomy on a small child. The operating room chatter introduces the reader to Dr. Todd, whose foul disposition causes nurses to scatter. They reminisce about the pleasantries of Dr. Henry, Todd's predecessor who accepted Alex into the program despite his "advanced age." Alex is 40 and finishing his fifth and final year. After Todd enters the operating theater, the child's bleeding aneurysm is clipped. The neurosurgeons feel powerful - they can enter the human brain where no other can. Beyond that, Dr. Todd feels they should be able to influence thinking by altering the brain. Perhaps even find the human soul.
After the operation, Alex sees Dr. Sutcliff, a retired neuro-anatomist, and inquires about Dr. Todd's statement regarding altering the brain. Sutcliff mentions that Dr. Todd had discussed this new science and shared his insight into its workings. Sutcliff then informally asked about specifics since Todd had an animal model --- no human data. Todd looked at Sutcliff strangely, ended the conversation, and left. Sutcliff continues to be haunted by Todd's odd facial expression.
The tour of neurosurgical grand rounds shows how "slicing" of a junior resident's presentation of cases is great sport for the chief and senior attending staff. Specialty jargon is interwoven throughout, e.g., the mental classification of people according to their head type (egg shaped, bullet head, rat head, melon head, a boulder) and its relationship to faces. The work load is graphically illustrated by describing how fatigued residents instantly fall asleep when immobile, no matter how stimulating the presentation. The interspersion of OR, ICU and general hospital gossip, and the description of the standard neurosurgery dress uniform, blue blazer and khaki, bring back memories and give authenticity to this medical thriller. (In my training hospital, the dress uniform for cardiologists and cardiac surgeons was also blue blazer and khaki.) The chief resident's advice to his underling is to "Wear long sleeve shirts. They're power shirts." However, Dahlia Laronge, the fourth year neurosurgery resident, disagrees and advises the junior residents to do opposite. Dahlia was a nurse when her husband died while under the care of Dr. Todd. She then went to medical school and was selected by Dr. Henry for the neurosurgery program. Thus Alex and Dahlia are the last two remnants of the previous chief. Do they both threaten Dr. Todd's research? Will they get too close to discovering his ultimate research goals?
The climax occurs at neurosurgical grand rounds, attended by the dean and the district attorney. Under strange circumstances, Alex has been removed from the program. Dahlia takes over grand rounds and presents several of Dr. Todd's former patients, including physicians who were strangely made aphasic by Todd's radiotherapy ablation technique.
The Sharp Edge of the Soul is a tour de force wherein the nearly absolute power of a chief of service, who brings in the most research dollars, essentially equals the power of the dean of a medical school. This is a well-constructed medical novel concerning a theme that will become increasingly important as we gradually approach a futuristic world of fetal stem cell research, human cloning, neural grafting and explore the deep recesses of the human mind.
Reviewed by Del Meyer, MD, Sacramento, CA
Dr. Meyer is a pulmonologist and a member of the Editorial Board of the Medical Sentinel. His e-mail is: delmeyer@HealthCareCom.net.
Originally published in the Medical Sentinel 2002;7(3):102. Copyright ©2002 Association of American Physicians and Surgeons (AAPS).
(The Sharp Edge of the Soul by George Chovanes, MD. (Xlibris Corporation, www.Xlibris.com, 2001, ISBN: 0-7688-6036-0, 290 pp., $28.79 [hardcover] or $18.69 [paperback].)