When the Air Hits Your Brain - My Thoughts

When I was walking back to my car after one of my shifts this past summer at UC Davis Medical Center, I had brief small-talk with a surgery resident. He asked me what services I had been on and what I was interested in the most. When I mentioned neurosurgery, he suggested I look When the Air Hits Your Brain by Frank Vertosick, Jr., M.D. He was a surgeon, and I a lowly pre-med student, so of course I wrote down his advice as if he were God and I was Noah and the ran showers were starting. I started reading it a couple weeks ago, and finished within a few days. Here are my impressions.

Dr. Vertosick begins at the beginning of his medical career: medical school and how he became interested in neurosurgery. His reasoning was more than a little odd to me. Neursurgery was his first rotation in his third year of medical school. At the time he saw the specialty and the work involved in it as boring and tedious, and there was no strong consideration during to pursue it as a post-graduate option. Still, there are stories he remembers from the rotation, one of which had significant importance. One day he was doing a physical on a patient who had been admitted for the removal `of a herniated cervical disk in his neck. Frank noticed that the man's pupils were aymmetrical. That, coupled with some other key symptoms, led Frank to believe the patient didn't have a herniated disk at all, but a tumor. He reported his finding to the resident physician and was able to save the man from an unnecessary and potentially harmful procedure. Some months later, the director of neurosurgery called Frank the Med Student in for a meeting and offered him one of the two neurosurgery intern positions after graduation for his 'good eye.' Frank said he had to think about it. Later, while working in the immunology lab for a side research project, Frank was moving materials under a microscope, where the slight tremors in his hands were exacerbated. The lab technician teased him about it and flippantly commented 'I hope you aren't going in to neurosurgery.' Frank was so offended by the jab that he called the neurosurgery department that night and told him he accepted.

When I read this I literally took a second to scratch my head. Huh? He became a neurosurgeon to prove something to himself? It's certainly not a reason you would bring up in an interview (which it sounds like he didn't have to have). As a pre-med student, I'm starting to get various strings of advice, and some of them have to do with interviewing. We are constantly presented with the question: why do you want to be a doctor? There are the good reasons and then there are the not-so-good reasons. 'Because someone told me I can't' doesn't sound like it would impress anyone.

At the same time, the real world is different from what people say in interview settings. So while it bothered me a little why Frank originally went into neurosurgery, in the grand scheme of things, I don't think it mattered much. He was honest with us, and from the rest of the book it is clear that he cared for his patients and his profession at the level we would all hope from someone with such responsibility.

Dr. Vertosick goes into great detail on some of the surgical procedures he was apart of. Having recently observed a few neurosurgeries myself, I especially enjoyed these pieces. One of them I'd even seen in person. With just about all of the procedures he described, he also told the backstory of the patient. He used these as examples of the many lessons he learned throughout his residency, such as being a surgical psychopath, not being too confident, and that no matter how bad a patient is, you can always make him or her worse.

I really clicked with the commentary on surgical psychopathy. It's an aspect of being a physician I am both apprehensive and understanding of. On the one hand, I never want to become the type of person who is unaffected by death, or who looks at the patients as just numbers on a chart or another procedure. If I make a decision that ends a person's life, I don't want to be able to shrug it off, go have a beer, and forget about it the next day. On the other hand, I don't take death well (at all) and I realize it will be extremely taxing on me as an individual if I let each mortality hit home. Will I be able to strike a balance? Can I gain some of the psychopathy without crossing totally over to the other side?

From reading When the Air Hits Your Brain, it seems that Dr. Vertosick has walked the line and has ended up somewhere on the caring side. There was a particularly heart-wrenching case of a newborn with a brain tumor. They worked on the infant but the tumor was so deep that the damage done to remove it was seemingly irreversible. That, and the cancer would almost certainly remit. The advice to the parents was to say their goodbye's and not come back, move on with their lives as soon as they could, as there was nothing that could be done for the child and the longer they lingered, the longer it would take to try again in starting a family. But the baby ended up living longer than expected, and had more cognitive development than expected. She was soon able to laugh and play, and Frank visited her often. As predicted, however, the cancer came back to take her. Before it did, though, Frank spent nearly a whole day with her. He says he will always remember how, in those moments, he was the most important person in the world to her.

What more fulfillment could you get in a profession?

There were other stories just as thought-provoking, but I don't want to spoil it all here. I have a few areas of critique, as is inevitable with any public piece of work.

For one, the narrative seemed a little rushed at points. For example, I think he went from his first days as an intern to his third year of residency at the turn of the chapter. Or, at least, I was temporarily confused about the progression. All of a sudden he seemed very comfortable in his environment, and the story quickly migrated from telling of his personal transition to focusing on the patients. I was wondering where his confidence had come from, and at what point he went from feeling like a clueless med student/new physician to a surgeon who could challenge the knowledge of other people.

I must admit that I felt a little disappointed by the amount of detail left out concerning the lifestyle of a surgeon. When I picked this book up, I was hoping to come away with a better understanding of how residency is for someone who chooses this profession. I'm getting married in December, and one of my main apprehensions about surgery (and especially neuro) is the demanding lifestyle, and if I can be successful in both my career and my family at the same time. Dr. Vertosick mentioned his girlfriend/eventual wife only a few times, and those were in passing. I was wondering how he maintained the relationship during, or what arguments and hardships might have come out of the lifestyle he chose? When did he get married and how did that affect his career? How did he deal with the long hours of being a surgeon, and was he able to balance work with other aspects of his life? None of that was in there. I can see why the decision was made to keep the focus on the patients and the procedures, as that is more exciting for the average reader, but I came away feeling like I only got one side of the life of a resident: in the hospital.

Still, Dr. Vertosick writes with care, detail, and a poignant grasp of humanity. He is a person who rips people apart and puts them back together, sometimes with dire results, and he knows it. It really is amazing the types of things he has done, and for that I recommend this book to anyone who can read. Sure, it's about being a doctor, but it's about being human more than anything else. And who can't relate to that?