When The Air Hits Your Brain Essay

, Research Paper

This is the book that every neurosurgeon would like to have written his or her version of, but probably hadn’t the time. It is the account of a neurosurgeon’s training from medical school to the end of residency, in this case in an American training programme in the 1970s and 80s. Although aimed at the public rather than at neurosurgeons, I could not put it down.

Of course, I am biased: I am probably much the same age as the author and shared many of his experiences, or at least the British version of them. I recognise the same pressures on junior staff, the same developments in our specialty, and the same types of character, and I could tell as many tales. He even worked for a spell at the National Hospital for Neurology and Neurosurgery, and, though they are disguised, I certainly recognised several of the doctors described.

In his excellent preface, the author sets out the raison d’?tre for the book?to desanctify neurosurgeons and to expose the random nature of their selection and the dehumanising aspect of neurosurgical training which produces a standardised product. That he fails in some of these objectives is not really a criticism. His bosses and colleagues, as all surgeons, were not standardised but shared some common characteristics. Despite the training process, he seems not to have been dehumanised, for he writes about neurosurgical tragedies with sensitivity, even if he suggests that some of his friends were. The random selection does not seem to have been too bad a thing either; I am sure it leads to a more interesting group of trainees.

For the author, and for me as well, training was a wonderful time, learning from a bunch of real characters who central casting could not have dreamed up. It was extremely tiring in those far off days of rotas of one in two and worse, but always exciting and totally involving. Only after training the anguish begins, when the buck stops with the surgeon at the top.

Vertosick’s story is admirably clear. It is enthralling my mother as I write, and she says it all makes sense. Explaining neurological disease to your patients is difficult; to do it effectively throughout a whole book is a real achievement. It is all there?the ghastly experiences of severe brain injury, the macho world of subarachnoid haemorrhage and aneurysms, the frustration of pain management, the tragedies of primary malignant brain tumours, the sometimes unexpected triumphs of benign tumour surgery, and much more besides.