34 internautes sur 35 ont trouvé ce commentaire utile
- Publié sur Amazon.com
The history of neurosurgery is a fascinating one, however, even more interesting is to see how it has developed over the last century since, for example, the legendary Dr. Harvey Cushing forged the techniques of brain surgery over seventy years ago. `When the Air Hits Your Brain - Tales of Neurosurgery' is a compelling collection of tales written with erudition and sensitivity with at times gruesome detail of brain operations that sometimes were successful and other times not. As Dr. Vertosick proposes in his introduction, that, for the most part, a surgeon learns more from the failures than the successes; therefore most of the stories within are tragedies - failures that paved the way to future successes. For those interested in the world of neurosurgery, this book should more than satisfy as it covers a vast array of different cases as well as the general ambience and culture of this very specialized profession.
The author begins his tale as a burgeoning medical student, internship, ending with his last year as Chief Resident. Interestingly, his last year, from his perspective was his worst. He explains that being a Chief Resident is a precarious position, because you have to continue to cow tow to the attending staff and the junior residents continue to look upon you as just another taskmaster, a kind of in-house bully, ensuring the skills required are learned. Vertosick explains the position as "straddling two worlds, "...a sergeant in the surgical military, friend to neither enlisted man nor officer, endowed with great responsibilities but given little true authority." (P.254)
There are many miraculous and downright bizarre cases chronicled throughout the text. One of the strange cases was the woman who had been shot between the eyes by her drunken and irate boyfriend. Dr. Vertosick arrived hurriedly from home to the ER to find the woman in the waiting room, her head wrapped in a bloody towel, watching the television with a police officer by her side. Taking her into the examination room, the woman had indeed been shot directly between the eyes, and the exist wound, at the top of the back of her skull. The bullet, upon examining the exit wound dropped to the floor, where the police officer quickly retrieved it and left the room. Fortunately for the woman, the bullet had hit the skull, ricochet upward and bouncing, more so, rattling, between her brain and the top of her skull, lodging without damage. What truly amazed Vertosick, was the woman's attitude, because she continued to make excuses for her boyfriend, claiming he didn't really mean to shoot her in the head, he was just a little angry with her. She didn't realize how close to death she actually came.
There are many other strange and touching stories, the most heart wrenching being infants and young children born with brain related illnesses which the staff could not treat. What I admired in this text was Dr. Vertosick's honesty and his efforts to steel himself from becoming too close to his patients - he called it becoming a psychopathic doctor, however, in the end, he discovers a middle way.
Frank Vertosick is a very good writer and I hope he finds the time in the future to write another book about the profession.
18 internautes sur 18 ont trouvé ce commentaire utile
- Publié sur Amazon.com
Originally published in 1996, "When the Air Hits Your Brain," by Dr. Frank Vertosick, is a mesmerizing insider's look at "an arrogant occupation" whose practitioners operate on the spinal cord and the human brain ("a trillion nerve cells storing electrical patterns more numerous than the water molecules of the world's oceans"). A neurosurgeon must be supremely confident in his ability to get the job done; if he were to dwell on everything that could possibly go wrong during a procedure, he would be too terrified to operate. Because of the high potential for missteps, neurosurgical training is an arduous seven years of hell. Before he starts treating "brain cancers, spinal cord injuries, head trauma, [and] lethal hemorrhages," a trainee must endure a grueling regimen of study which includes repeated humiliation at the hands of verbally abusive mentors. This is not a profession for the faint-hearted, for when neurosurgery is unsuccessful, the results can be catastrophic. Even if the patient survives, his cognition, speech, movement, and vision may be forever compromised. In the words of Gary Stancik, a sardonic chief resident, the brain is like a '66 Cadillac: "It was built for performance, not for easy servicing."
Vertosick fell into neurosurgery by happenstance. He spent some time as a steelworker, majored in theoretical physics, and wound up choosing medicine by default. In the years to come, he would have to adjust to impossibly long hours, inadequate sleep, and hit-or-miss meals. He would become adept at performing quickly and efficiently under pressure. However, none of his earlier experiences would fully prepare him for the emotional roller-coaster that lay ahead. He was destined to endure a trial by fire when faced with such cases as a six-week old infant born with a malignant tumor, a twenty-two year old woman with devastating multiple injuries resulting from an auto accident, a Vietnam veteran with an intracranial aneurysm, and a twenty-eight year old pregnant woman with a lump of cancerous cells in her brain. Fortunately, Dr. Vertosick enjoyed some notable successes; he was instrumental in helping a number of gravely ill patients resume normal lives.
Although it is vital to care about and communicate with each patient, Vertosick argues that it is a mistake to become too personally invested in each outcome. Hardest of all, one must accept the unpleasant fact that even brain surgeons can commit colossal blunders. On one occasion, Vertosick sank into despair when one of his patients died because of what he perceived to be his incompetence. He could have given in to his torment and self-loathing and abandoned his career, but he ultimately decided to "stop moping over one postoperative death." In the words of the aforementioned Gary, "Yeah, it's a nightmare, but that's neurosurgery. Land of nightmares."
"When the Air Hits Your Brain" is impeccably and stylishly written, with fascinating asides about the complexities of medicine and the human body. Vertosick's wry and irreverent black humor serves as a welcome respite from the book's often grim subject matter. In his postscript, which was written in 2007, the author provides updates on the changes that have occurred in the last decade: by law, residents are not allowed to work more than eighty hours a week, aneurysms may now be treated without resorting to invasive surgery, and new technologies such as deep brain stimulation and "frameless stereotaxis (a kind of GPS system for navigating the brain)" are revolutionizing the field. This is an intelligent, moving, and enlightening book and one of the most powerful and intimate accounts that I have ever read on the making of a surgeon.