Frank Vertosick's memoir When the Air Hits Your Brain: Tales of Neurosurgery is fast, funny, and fascinating—as well as gritty, gruesome, and gross. It's his story of learning to be a brain surgeon and some of the cases he saw during his residency years. From the first chapter ("The Rules of the Game"), the five rules that a senior resident told him when he began his assignment:

1. You ain't never the same when the air hits your brain. Yes, the good Lord bricked that sucker in pretty good, and for a reason. We're not supposed to play with it. The brain is sorta like a '66 Cadillac. You had to drop the engine in that thing just to change all eight spark plugs. It was built for performance, not for easy servicing. ...

2. The only minor operation is one that someone else is doing. If you're doing it, it's major. ...

3. If the patient isn't dead, you can always make him worse if you try hard enough. ...

4. One look at the patient is better than a thousand phone calls from a nurse when you're trying to figure out why someone is going to [expletive deleted]. ...

5. Operating on the wrong patient or doing the wrong side of the body makes for a very bad day ...

In between anecdotes of skulls sawed open and oozing brain tissue, Vertosick offers wise thoughts on how to handle stress and crisis. He describes how he emerged from depression after his first major failure, a delicate aneurysm operation that went sour. (Chapter 11, "Nightmares, Past and Future") It's a failure that killed a patient. But as his senior colleague tells him when he's thinking about quitting the profession:

You didn't make his aneurysm bleed ... his wife did. And his hypertension, years and years of hypertension—he was no doubt too [expletive deleted] busy to see a doctor about it, too. You didn't kill him; you were just asked to step in and prevent him from dying on his own ... and you couldn't. Yeah. Thor Sundt wasn't there, but Thor Sundt can't do every aneurysm in the country. And I'm sure Thor Sundt has torn a few aneurysms in his lifetime, great as he is—you think he came into this world with a clip applier in his right hand? There will always be people better than you and worse than you. If you worry about not being as good as someone else, why don't you just give up every case right now? Just set up a phone hot line and sit in an office and match people with the very best surgeons in the whole universe. No point in cursing humanity with your own sorry skills, is there? C'mon! Quit feeling sorry for yourself and do the best you can with those who ask for your help. ...

Vertosick is wrong, I think, in his discussion of evolution and death (Chapter 12, "The Wheel of Life"). But he's so right in so many other places that one can excuse his occasional literary license. Brain surgery is like trail running and child rearing and lots of other areas in real life. Messy stuff happens. As Vertosick's friend tells him, "Yeah, it's a nightmare, but that's neurosurgery. Land of nightmares. There are plenty more nightmares in your future. ... Clip the aneurysms and take what happens." Good advice.

(cf. MoveOn (2007-01-16), SolveTheProblem (2007-05-24), ...) - ^z - 2009-10-31