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New Brain Wave

Neurosurgeon turned author Katrina Firlik is having a ball exploring the right side of her brain for a change

Larry Merz

When Katrina Firlik was a youngster growing up outside of Cleveland, her father, a general surgeon, would share stories with the family about interesting clinical cases he had seen. Some of his examples helped explain a topic that was in the news or that the kids had otherwise heard about. Others served as cautionary tales to heed parental warnings.

So it was that katrina never forgot the tragedy, or the accompanying color slide, of the boy who foolishly ran with scissors, or the child who secretly snacked on clippings from the floor of his grandfather’s barbershop, or the accounts of other unfortunates — all of them anonymous in the telling — who unwittingly became living lessons.

Back then, the good doctor never suspected that his daughter might go on to become a surgeon herself and return home with anecdotes of her own. “When I told those stories, she was fascinated,” says Hal Schreiber, of Shaker Heights, Ohio, who retired last year. “Now she had turned the tables. Now when she came back from medical school or her residency, she was the one telling the gory stories about people who had their skulls eaten away by tumors and who had maggots in the brain. She’s managed to spoil a number of family meals.”

Katrina, who lives in New Canaan, has since taken her storytelling to a wider audience. Not long ago she wrote a well-received memoir, Another Day in the Frontal Lobe, which opens a window into the peculiar subculture of neurosurgery. She begins the volume by likening the texture of the brain to tofu, just the kind of remark that ver dinner would have members of the Schreiber clan reaching for their napkins. That is followed by a story about a workman who strolled into the emergency room with a barbed nail anchored in his skull after a mishap with a nail gun.

After completing her neurosurgery training in 2002, Katrina made her mark in a specialty awash in testosterone. She was considered skilled and poised in the operating room, whether performing emergency brain surgery or repairing a herniated disk. She was honored with the 2006 BRAVA Award from the Greenwich YWCA in recognition of achieving excellence in her profession. Her writing could be found in publications as varied as
the Journal of Neurosurgery and the Wall Street Journal. She even appeared as a neurosurgery expert on CNN.

That is why some people were surprised this summer when Katrina took the big step of leaving her busy practice with Greenwich Neurosurgery to follow her more creative impulses and explore what the twenty-first century holds for the human brain. “What drew me to neurosurgery in the first place is a fascination with the human brain and mind,” she says. “That’s what motivates me, intellectually speaking. And so my next phase is going to focus on that — what’s the latest research in brain technology and where do I see the future going.” Katrina is at work on a second book, a fictional medical thriller revolving around brain surgery’s coming role in elevating cognition and memory. (The smart money says trouble is in the offing.) She also has some ideas for inventions to enhance thinking, by noninvasive methods, that she wants to develop and bring to market. Her husband Andrew, a former neurosurgeon who is now a venture capitalist, helps fund early-stage medical devices and knows the ropes. Not to be overlooked is the couple’s two-year-old daughter, Annika, with whom Mom wants to spend more time.

Given Katrina’s extensive preparation to become a neurosurgeon in the first place — four years of medical school and seven years of residency — quitting was far from easy. Yet other voices were calling. “One of my main motivators is trying to express my creativity more,” she says. “I have this strong desire to go more creative in my career, but surgery is really not the way to express your creativity. People don’t want a creative surgeon. And they don’t want a part-time surgeon.

“Some people when they hear about my transition will say, ‘That’s a huge waste.’ And I do see that viewpoint, but at the same time I see it as a real positive that can bring all of my experiences into the next phase. They won’t be wasted. I’ll just be channeling them in a different direction.” Much of that channeling takes place in a sparsely furnished office. On this Friday morning, Katrina is seated on the couch across from her desk. Dressed in a black turtleneck and olive cargo pants, she has a certain graduate-student look. But it is not just her apparel that gives that effect. Her youthful face has prompted more than one patient to question whether she was indeed old enough to be opening skulls for a living.

Katrina possesses an inner calm, according to those who know her best, that served her well in a medical specialty that can be extraordinarily stressful. Fellow surgeons, in fact, can’t remember her ever lighting into anyone or slamming down a surgical instrument in frustration. And though she downplays being the first female in her residency program at the University of Pittsburgh Medical Center, it is a good bet that she ignored more instances of boys being boys — even if the boys were wearing white coats and stethoscopes — than she lets on.

At the same time, Katrina is not above black humor. Glancing outside, you ask what neurosurgeons think when they see someone cruising along on a motorcycle without wearing a helmet. “Donorcycle,” she says with a sheepish laugh. “That’s what we call them. But obviously I have a skewed view because I’m the person that would see the potential organ donors.”

Although Katrina finds satisfaction in the act of writing and connecting with readers, she is uncomfortable being the center of attention. When Random House was preparing to publish Another Day in the Frontal Lobe, the marketing department wanted to tweak her original subtitle, A Neurosurgeon Exposes Life on the Inside. The average person has no idea what a neurosurgeon is, they told her; you have to say “brain surgeon.” Katrina disagreed. People in her field would never use such a vernacular term. Plus, neurosurgeons do more than just brain surgery.

Eventually, the first-time author relented. She knew about medicine, she figured, but these folks knew about selling books. “I said, ‘Fine, we’ll do that as long as you don’t put my picture on the cover.’ And they said, ‘Well, we were also hoping to put you on the cover.’” At this, she laughs in resignation. Hardcover and paperback combined, her book had a printing of 100,000 copies, each one adorned with a cover photograph of Katrina decked out in blue scrubs.

Given her father’s career, it might seem natural that Katrina would one day wear a surgeon’s togs. The eldest of four children, she was born when Hal Schreiber was still in medical school. As a matter of fact, it was the dean of the Ohio State University medical school who delivered her. Despite such foreshadowing, her family never expected Katrina to become a physician. Her interest growing up was foreign cultures. She knew the capital of every nation, had pen pals in faraway lands, and even spent time in Japan through a student exchange program. At Cornell Katrina majored in cultural anthropology. Her focus began to change in sophomore year, when she met husband-to-be Andrew. Before long she was following his lead down a pre-medicine track.

Katrina attended medical school at Case Western Reserve University in Cleveland, where her father was on the faculty and proudly handed her the diploma on graduation day. Her residency in Pittsburgh, meanwhile, would become central to her book. (Andrew was in the neurosurgery program there, a couple of years ahead of her.)

Bombarded with information and experiences during their training years, every resident jots down personal reminders about patients and treatment protocols. But Katrina wanted to remember the bigger picture of her residency as well. So she started scribbling notes on three-by-five-inch cards about interesting people, conversations and curiosities that unfolded before her, then entered what she wrote in her journal.

Even as she was becoming indoctrinated into a world of perforator drills, bone dust, “brain guppies” and all the rest, Katrina remained an anthropologist at heart. “I was always fully entrenched in the training,” she says, “but at the same time always kind of observing it as an outsider and saying, this is a very interesting culture I’m becoming part of, both the good and the bad.”

By the time Katrina completed her training, her husband had already established himself in Fairfield County. When she interviewed for a job with Dr. Zoher Ghogawala of Greenwich Neurosurgery, she made a good impression. But the deal was clinched when he put in a call to the director of her residency program, who shared a story about Katrina’s calm manner during a particularly chaotic moment in the emergency room. “He said that there’s a Zen quality about her,” remembers Dr. Ghogawala, “that she’s unflappable.”

Since then he has witnessed on numerous occasions just what the man was talking about. Asked for an example, Dr. Ghogawala plucks one out of recent memory: A young woman had been brought to Greenwich Hospital in dire condition, suffering from a massive brain hemorrhage. Dr. Firlik’s charge was to open her skull, suture a critical vein and save the day. Simple enough to say. “To give you a sense of the magnitude of this: The patient was bleeding actively. The anesthesiologists were transfusing her with more blood. If she lost too much blood, she would die on the table.

“And the requirement was to put a stitch in an area of about one to two millimeters. If you got that stitch wrong, you basically could lose the patient. So it’s one of those very fine maneuvers that you have one chance at and if you don’t get it quite the way you want it, things could go very bad very quick. “Dr. Firlik called me into the room to give her some backup and assistance on this maneuver. As soon as I scrubbed in, she calmly picked up the stitch, no tremor, just put the stitch in perfectly and the bleeding stopped. It was classic Katrina.”

Five years ago Katrina got to thinking about all the material she had amassed in her journal. She decided to write an essay about some of her experiences and see if she could get it published in the New Yorker. When she was done writing, she sent it to some friends to get their reaction, including one who worked at the Wall Street Journal. Unbeknownst to Katrina, he passed it along to his literary agent, Alice Martell. Included in the essay was the story about the worker whose cranium had been violated by the barbed nail. “She ended this vignette with this one little sentence that said, ‘The frontal lobe is very forgiving.’” Martell says, “I read that and I said, ‘Boy, I know she can write.’ It was just this one little sentence, which was so elegant, so engaging and absolutely said it all. Her phrasing just totally won me over.”

Instead of an article, Martell saw the potential for a book. After preparing a proposal, Katrina made the rounds of the major publishing houses (“Editors across the city fell in love with this project,” raves Martell) and ultimately chose Random House. The book’s working title was Brain Matters. And though that was good enough for her British publisher, who acquired the book at the same time, her American editors wanted something different.

In toying with possibilities, Katrina got to thinking about one chief resident who said before he went into surgery that if anybody was looking for him he would be in the pons, at the base of the brain. She played with that idea for a bit and, after everybody put their thoughts in, came up with the catchy title, Another Day in the Frontal Lobe.

Her book was praised in the New York Times, among other publications. In addition to England, foreign rights have been sold to Taiwan, South Korea and Brazil. And though nothing has materialized yet, Katrina was also approached about possibly hosting a television series about the brain.

What’s more, Another Day in the Frontal Lobe gave birth to Katrina’s offbeat website, katrinafirlik.com. The site provides quotes about the brain, fun facts and brain-related photos. It also offers a gallery of illustrations by Katrina of different parts of the brain (and one of the spine) as well as of varied neurosurgery tools. And there is a link to a related site, cafepress.com/katrinafirlik, where folks can buy T-shirts, boxer shorts, mugs, among other items, all adorned with Katrina’s drawings.

She originally penned the pictures for inclusion in the book, but her publisher thought them unnecessary. Rather than leave them in a drawer someplace, Katrina found a company that could transfer the images onto souvenir-type items and take sales orders from the public. As one might guess, the market for "neurosurgery-inspired items” is limited. Katrina suspects that the people who do buy them have some involvement in working with the brain, be they medical students, doctors, nurses or researchers.

“I just get a big kick out of knowing that somebody in Texas is wearing a Circle of Willis barbecue apron,” Katrina says. “It just makes me laugh. For that reason alone, it was worth it.”

The best outcome, though, has been the public response to her writing. The reviews on amazon.com have been plentiful and largely positive. Through her website she has received countless e-mails from readers. Some thank her for helping them understand what a loved one went through during brain surgery. Young people have written to say she inspired them to consider going into neurosurgery. And others, quite frankly, have told her they hated her book.

Katrina remembers one doctor who launched an irate e-mail saying how turned off he had been by how much she wrote about herself. But he went through the roof, he said, when he visited her website and saw her drawings and the items for sale. This is absolutely ridiculous, he complained. “He probably didn’t think I’d write him back,” Katrina says. “But I wrote him and said, ‘Thank you for your comments, I appreciate your sharing your thoughts with me.’ Well, he wrote again and said, ‘I’m so happy you wrote back. I think my rage was simply because I’m jealous. I’m a colon surgeon, and I’ve always wanted to write a book. But no one wants to read about another day in the colon.’”