When the Air Hits Your Brain: Tales from Neurosurgery

272 Pages·2008·0.25 MB·English

by  Frank Vertosick Jr.

Table of Contents
Cover Page
Praise
Other Books by
Title Page
Copyright
Dedication
Epigraph
Introduction
Acknowledge
Half Title
1 The Rules of the Game
2 Slackers, Keeners, and Wild Cards
3 Thanks for Everything
4 A Night in the Street, a Night in the Chair
5 The Museum of Pain
6 Ailments Untreatable
7 Surgical Psychopaths
8 If It Was Easy, Everyone Would Do It
9 A Bit of Hard Cheese
10 Rebecca
11 Nightmares, Past and Future
12 The Wheel of Life
13 Belonging
Postscript
More praise for
WHEN THE AIR HITS YOUR BRAIN
“At a time when doctors have forgotten how to be teachers, and medical training
has become disease-oriented and depersonalizing, comes a book that can help
alter that view. When the Air Hits Your Brain lets you feel the pain, grief and joy
of practicing medicine. I know from experience that some physicians believe
their M.D. makes them Medical Dieties but I know for me it meant My Disease.
Read and understand the emotions and feelings physicians live with that they are
poorly prepared for by their disease-oriented training. Physicians know how to
think but not how to feel. Dr. Frank Vertosick is not a ‘normal’ doctor, thank
goodness. This book should be read by every medical student, doctor and present
or potential patient. In other words, by all of us.”
—Dr. Bernie Siegel, author of Love, Medicine and Miracles
“Dr. Frank Vertosick provides an amusing, insightful and honest inside view of
the training of the neurosurgeon. This highly readable account of daily life on
the wards shows all the humility, fortitude, and humanity that genuinely
underlies this sometimes not well-understood but genuinely wonderful
profession.”
—Dr. David W. Roberts, professor of surgery (neurosurgery), Dartmouth-
Hitchcock Medical Center
Also by Frank T. Vertosick, Jr., M.D.
The Genius Within
Why We Hurt
When the Air Hits Your Brain
Frank T. Vertosick, Jr., M.D.
Tales of Neurosurgery
Copyright © 2008, 1996 by Frank T. Vertosick, Jr., M.D.
All rights reserved
Printed in the United States of America First published as a Norton paperback 2008
For information about permission to reproduce selections from this book, write to Permissions, W. W.
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Manufacturing by Courier Westford
Book design by Beth Tondreau Design
Production manager: Devon Zahn
Library of Congress Cataloging-in-Publication Data
Vertosick, Frank T.
When the air hits your brain : tales of neurosurgery / by Frank T. Vertosick, Jr.
p. cm.
1. Nervous system—Surgery—Miscellanea. 2. Vertosick, Frank T.
3. Neurosurgeons—Miscellanea. I. Title RD593.V47 1996
617.4’8—dc20
95-9790
ISBN 0-393-03894-7
ISBN 978-0-393-33049-6 pbk.
W. W. Norton & Company, Inc., 500 Fifth Avenue, New York, N.Y. 10110 www.wwnorton.com
W. W. Norton & Company Ltd., Castle House, 75/76 Wells Street, London WIT 3QT
4 5 6 7 8 9 0
TO FRANK AND VERONICA,
who raised me to be whatever I wanted to be
Surgeons must be very careful
When they take their knife!
Underneath their fine incisions
Stirs the Culprit—Life!
—EMILY DICKINSON
Introduction
N
eurosurgery is an arrogant occupation. Astronomers study the stars but never
touch them. Particle physicists see God in the vapor trails of their great atom-
smashers, but cannot see the particles themselves, cannot reach into protons and
feel the quarks with their fingers. Molecular biologists sing the praises of the
double helix, but the gene is forever an abstraction, invisible to the naked eye.
These scientists must be content with the shadow nature casts upon their
instruments and photographic emulsions. But not the neurosurgeon, for whom
the greatest mystery of creation resides in a few pounds of greasy flesh and
blood. Only the neurosurgeon dares to improve upon five billion years of
evolution in a few hours.
The human brain. A trillion nerve cells storing electrical patterns more
numerous than the water molecules of the world’s oceans. The soul’s tapestry
lies woven in the brain’s nerve threads. Delicate, inviolate, the brain floats
serenely in a bone vault like the crown jewel of biology. What motivated the
vast leap in intellectual horsepower between chimp and man? Between tree
dweller and moon walker? Is the brain a gift from God, or simply the jackpot of
a trillion rolls of DNA dice?
The answers to these questions rest at the uncharted boundary between
theology and science. We do know one certain thing about the brain: it is not
unbreakable. When an unfortunate homo erectus plummeted from a cliff,
suffering the first hominid head injury, mankind learned of the exquisite
vulnerability of the pink goo between their ears. Surgeons of antiquity believed
the brain sacrosanct, beyond their healing skills. As late as the nineteenth
century’, when bold surgeons attempted anything—even the repair of a beating
heart—the nervous system was still considered off-limits. Although ancient
shamans trephined holes in the skull to allow evil demons to escape, they knew
that breaching the dura, the brain’s leathery covering, meant the patient’s sure
demise from infection, bleeding, coma.
Some mornings I awaken and wonder how I ended up a neurosurgeon. One
day I was a poor college student rummaging under my sofa cushions for a few
quarters to buy french fries; the next thing I knew I was wrist-deep in someone’s
skull. What happened in between remains a blur.
There is a misconception that surgeons flock to their profession at an early
age, drawn as if by a religious calling. Well, I didn’t grow up planning to be a
brain surgeon. I admit, as a child, I tried to build The Visible Head model—but I
threw away the macabre plastic replica,of a human noggin when the eyeballs fell
out and rolled off the kitchen table. I should have taken this as an evil omen, but
alas, I didn’t. So here I am.
What draws people into “glamorous” medical careers? For some, it’s
vindication for being a loser early in life: the grade school wimp beaten in the
playground, the high school geek who never had a date. For others, it’s the
secure (and large) income. As for me, I wandered too close to a dangerously
seductive profession and wound up stuck for good, a fly in the spider’s web. Had
I never seen a brain operation, I doubt that the thought of doing brain surgery
would have occurred to me. But once I viewed the living brain and was exposed
to the seductiveness of the profession’s arrogance in the flesh…I was hooked.
Brain surgeons have a well-cultivated public mystique, an aura of supreme
intellectual and technical competence created by the imperious and brilliant
Harvey Cushing, father of American neurosurgery and one of the first surgeons
to specialize in brain operations. Cushing descended from a long line of medical
men. Aristocratic and dashing, he drank his afternoon tea from fine china and
stored his cigarettes in a sterling-silver case. He also had a keen eye for the
media, fashioning himself into the medical superstar of the pre-television era—
he even made the cover of Time magazine. Cushing knew that the brain was
better PR than blocked colons and gangrenous legs. He endlessly exploited the
public’s fascination with his infant specialty.
But, in truth, the myth of the brain surgeon is largely that—a myth. While
one can’t be stupid and be a neurosurgeon, brain surgery isn’t the most
intellectually demanding occupation on earth. I can read a CT scan, but the
people who designed and built the scanner’s circuits tower over me in cognitive