JANE SCHNEIDER

The whining drill bites into bone, sending a tendril of smoke into the air. Neurosurgeon Stephanie Einhaus, MD, bears down gently again on the crescent of skull bone exposed before her. The trick is to cut so bone is removed without harming the brain. After five minutes of delicate work, she frees a piece roughly the size of a pill box. Revealed through the window is the elegant labyrinth of the brain. The organ pulses with life.

Einhaus, one of only two female neurosurgeons in Memphis, is assisting midlevel resident Adam Oliver at Le Bonheur Children's Medical Center as they work in tandem on the brain of a 4-year-old child with epilepsy. The child's seizures have struck with such frequency that her brain shows evidence of scarring; a common occurrence when the body drops to the ground and the head repeatedly hits a hard surface.

The four-hour procedure, a corpus callosotomy, requires severing the large fiber bundle connecting the left and right hemispheres of the brain. This surgery decreases "drop" seizures by making it more difficult for the brain to send messages between the two hemispheres.

Einhaus specializes in treating pediatric epilepsy, as well as hydrocephalus and brain tumors. "We can determine if a kid has seizures, where they're coming from and how to treat them. Often we see kids who've exhausted medications and the doctors don't know where else to go with the patient," said Einhaus. Thanks to Einhaus' work, along with Frederick Boop, MD, and James Wheless, MD, Le Bonheur is gaining a national reputation as a pediatric epilepsy center.

Einhaus splits her time between treating children at Le Bonheur and adults at the Memphis VA Medical Center, where she is chief of neurosurgery. She is also a Semmes Murphey Neurologic and Spine Institute physician and an assistant professor of neurosurgery at the University of Tennessee.

Of the 5,005 board-certified neurosurgeons nationally, just 182 are women. Yet Einhaus downplays operating in such a testosterone-driven field. Yes, a few colleagues have been less than welcoming over the years, but she shrugs off such encounters with a knowing smile. Einhaus works alongside surgical residents at both hospitals; walking them through delicate procedures and sharing the nuances of surgery she has gained in 14 years of practice. The problem-solving components of her work still captivate; the complexities of neurosurgery, with its razor thin margins for error, she still finds challenging, satisfying.

"There can be a lot of stress, knowing you're a few millimeters away from something that could put someone to death or blind them. You get nervous knowing you're millimeters away from hurting that patient. If you clip an aneurism and it ruptures, (you could cause) the patient to bleed to death. (So) you have to focus on what you're doing and not let yourself become unnerved by the bad stuff."

Fifty years ago, practitioners didn't have the benefit of CT or MRI imaging, advances which help neurosurgeons today more effectively diagnose and treat patients. "We go to a scan and look anatomically. They figured it out by physical examination," a skill which made earlier practitioners "superb diagnosticians," said Einhaus. Imaging technology makes a world of difference when trying to identify brain disorders, yet young doctors can wind up relying too much on the technology if they're not careful. Instead, Einhaus said, she talks about developing gestalt, a trust of their inner voice.

"Learning the technical stuff takes a couple of years but having gestalt about what to do, to know and trust your judgment about whether to operate, or how much you can push a procedure; those things are harder to teach," said Einhaus.

The other piece of the puzzle for her is relying on faith to help families in times of crisis. "Many people in Memphis have a strong faith and to use my faith is an advantage. I'll pray with families and they appreciate that. People are going through huge tests and they get stressed out, particularly when it's a child. People are groping for answers, for hope. I think using my faith to help them is huge."

Her love affair with neurosurgery came about by accident. During med school rotations at the University of Florida, Einhaus discovered she enjoyed surgery because "it was hands-on and gave instant results. I wanted to do plastic surgery because I'd heard students could do a lot and I could show them how good I was," she said with a laugh. Instead, she wound up at the VA hospital, where students could scrub in and assist with neurosurgery. She was hooked. "I didn't think I was special, but I realized I had a knack for it. It calls for precision, we deal with life and death situations, and I work well under pressure."

She completed her residency at the University of Tennessee and graduated in 1989 as the medical school's first female neurosurgical resident.

Though her job is demanding, Einhaus structures her schedule so she can pick up her two young daughters from school and be involved with their activities. Her husband, a retired pilot with Northwest who now runs a photography business, also shares in their care. "I work hard not to let my career overshadow my family, or put them on hold. It's a constant struggle to find that balance though," she said. Down time is spent playing with the kids or cooking.

While Einhaus may know her way around the operating table, she can be self-effacing about those skills she has yet to master, like programming her Blackberry. "It's not brain surgery," joked the reporter. "I know," she laughed, "I know."