By MARTY LEVINE
“I think there's a story to tell,” says Lawrence Dade Lunsford, distinguished professor of neurosurgery after 50 years on the School of Medicine faculty, about his decision to write his new memoir, “Brain Surgeon Without a Scalpel.”
New physicians thinking about entering his field are one primary audience for the book, he says — particularly those aiming to be innovators, as was Lunsford, who pioneered image-guided and minimally invasive neurosurgical techniques in the first such operating room here in 1981. He also brought the first Gamma Knife radiosurgery theater to the U.S. in 1987, which delivers radiation treatments without incisions to battle brain tumors, vascular malformations, movement disorders and severe pain syndromes.
As he explains in the memoir: “My role was not as inventor. My role and that of many other collaborators here in Pittsburgh and elsewhere was to provide proof of sustaining value.”
“The field of medicine is always ripe for innovation,” Lunsford says. The memoir details such innovations, as well as “the impetus of mentors and eventually the importance of working as a mentor.”
There are chapters on Lunsford’s experiences as a faculty member and decade-long department head in a period of transition from independent teaching hospitals to our current mega-health systems — which, though jarring at times, can create advantages: “Successful medical centers ... can afford to take more risks in terms of innovation,” he says, plus they “have the opportunity to be much more effective in introducing technologies and building up their departments.”
This book covers the moments that inspired him and “a little about my concern about where the field of medicine has gone and where it might go further,” he adds.
The struggles Lunsford faced can be illuminating even to those outside of medicine, as are glimpses of the world in a different time — sometimes far from Pittsburgh.
He draws the distinction among mentors, fomenters and tormentors: “Fomenters are often people who recognize certain traits you may have and encourage you to use whatever gifts you were given. They push you to not waste those talents. Tormentors are those individuals whose negative behaviors are often obstructionist. They represent obstacles that are sometimes hard to escape.”
And he describes how his first innovation went from plan to fruition: “… the conversion of an existing operating room at Presbyterian Hospital into a dedicated stereotactic and image-guided minimally invasive surgical suite. … The impact of CT had become clear over the preceding five years. We could see things in the brain; we could target problems for biopsy or removal, or aid surgical removal. We could plan to do surgery in a dedicated CT scanner, but we still had to sell it to the hospital leadership.”
He recalls having to learn Swedish in three weeks during the fellowship in Stockholm that introduced him to Gamma Knife inventor Lars Leksell (after whom Lunsford’s professorship is named) — and finding out that the first syllable of his own surname was current Swedish slang for “klutz.”
And there was the memorable Christmastime train trip to Lillehammer, Norway, when the train stopped in the middle of nowhere — surrounded entirely by piles of winter white — when there appeared “a figure trudging through the snow with a big sack on his back. A Norwegian Santa’s helper … boarded the train and walked through every car,” distributing presents to the children, including Lunsford’s own young daughter.
He also writes about the travails of shipping the 20-ton Gamma Knife here (and eventually moving it across DeSoto street), securing funding, seeking FDA approval (as well as that of the Nuclear Regulatory Commission) and convincing some of his fellow neurosurgeons of its benefits.
He covers, too, the impact of the U.S. health insurance system on new technology as he became part of UPMC’s team evaluating tech, and what many decades of work had taught him: “We know that the difference between a good surgeon and a great surgeon is judgment. Judgment comes from both good and bad outcomes. From a purely technical perspective the recent graduate is likely at the height of their technical abilities fresh out of training, between the ages of 32 and 40 years. Judgment takes additional years.”
After 17 previous books and more than 1,300 published peer-reviewed articles, Lunsford also knows something about writing: “Medical writing has become very stylized in format and presentation, but compliance with the ‘rules’ can enhance the chances that an article will be accepted or will require minimal corrections. I have tried to teach many residents and medical students how to first define the issue they are writing about and then present it in a cogent fashion.
“When I review a paper from our group, I look at the paper as if I were a reviewer from a journal. Every paper must have a hook to get the reader’s or reviewer’s attention. What is the hook in your report? What did we know previously? How does this report expand, explain, amplify or improve knowledge about the problem studied?”
When reading others’ memoirs in preparation for his own effort, Lunsford found that it wasn’t always easy to tell what the writer had learned from each part of life. Through several drafts, he hopes in writing this book he has solved this conundrum, as well as the writing challenges of “how to hold back at times” and “how to bring out humor.” Certainly, it will improve knowledge about the problems he has studied.
Marty Levine is a staff writer for the University Times. Reach him at martyl@pitt.edu or 412-758-4859.
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