Volume 16, Number 3
ESSENCE OF NCCU:
An Outsider Captures the Inside
Back from the Brink
by Edward Sylvester,
Dana Press,
New York, 2004
For almost two decades, I've covered Hopkins neurology/neurosurgery as a science writer, insider enough to know that Satan runs the Meyer elevators and that you can't flim-flam nurse administrator Ski Lower. So when I opened Back from the Brink, Ed Sylvester's book about the culture of neuro-critical care units (NCCUs), I mostly expected the satisfaction of seeing names I knew. Because Sylvester -- a journalism professor at Arizona State -- was "embedded" here at Hopkins the summer of 2001 and at intervals afterward, the names are there: Long, Hanley, Geocadin, Lower, Hillis, Williams, Tamargo, Rigamonti, Olivi and more.
Sylvester gives all their due while showing an NCCU's daily workings. They fit into his device of following patients who come to the unit with tumors, status epilepticus and hair-trigger aneurysms. But it's Sylvester's perspective that kept me reading. Hopkins was picked, he says, because it is a cradle of neurointensivism, the speciality that "manages the whole of the patient admitted to the NCCU." Such a concept counters long tradition in which surgeons or other physicians admitting patients to critical care took charge.
Sylvester writes of the personality and persistence it takes to will such a unit into being and then, further, to make it "closed." And he doesn't skimp on edgy issues: balancing research and clinical work, when to give up on a patient, skirting turf wars, bed scarcity -- they're all there.
In shadowing neurocritical care directors Marek Mirski and Anish Bhardwaj, the author pleads neurointensivism's case. He echoes Mirski's message: At an NCCU run by a trained neurointensivist, you have a better chance of living, of leaving critical care sooner and of having it cost less. Of that, when you finish the book, you've no doubt.
-MC