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When the Air Hits Your Brain - Tales from Neurosurgery (Anglais) Broché – 15 avril 2008

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When the Air Hits Your Brain Chronicles the author's evolution from naive and ambitious young houseman to world-class neurosurgeon. This book describes some of the challenges of the author's career, including a six-week-old infant with a tumour in her brain, a young man struck down in his prime by paraplegia and a clergyman with a.22-caliber bullet lodged in his skull. Full description

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July 1. Neurosurgery residency. Day one. Five A.M. A sickening wave of deja vu flooded over me as I looked at the automatic doors to the "porch," the neurosurgical step-down unit. Lire la première page
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Couverture | Copyright | Table des matières | Extrait | Quatrième de couverture
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Amazon.com: 185 commentaires
55 internautes sur 56 ont trouvé ce commentaire utile 
Vivid description of a neurosurgeon! 13 septembre 2005
Par CHEN SHANG CHI BRUCE - Publié sur Amazon.com
Format: Poche
I'm a neurosurgeon myself.I'm still so moved by the stories told by the author.They reflected the true life in my daily practice and circumstances.They seems funny but actually sad inside, filled with sorrow and tears of both the patients and doctors. I strongly recommend this book to those who would like to participate in this field of medical speciality and to those who would like to understand the real life of a neurosurgeon!
34 internautes sur 35 ont trouvé ce commentaire utile 
Fascinating, strange and touching 10 janvier 2006
Par C. Middleton - Publié sur Amazon.com
Format: Poche Achat vérifié
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.
57 internautes sur 62 ont trouvé ce commentaire utile 
You can always make a patient worse 26 juillet 2003
Par ealovitt - Publié sur Amazon.com
Format: Poche
This author has an edgy, sleep-deprived, wisecrack-a-minute style that makes me glad some states at least, have reduced the number of hours per week a medical resident must work, from one hundred to eighty. Neurosurgery is an unforgiving craft, and not all of the stories in this book have a happy ending. Neurosurgeons must tackle some pretty hopeless cases, and the human brain is a very unforgiving operating theatre.
Nevertheless, "When the Air Hits Your Brain" is an exhilarating read. I've been through it twice now---once through a night when I had pretty much given up on sleep. If you do intend to sleep, don't read it right before going to bed.
Here are the author's five rules for neurosurgery interns:
1. You "ain't never" the same when the air hits your brain.
2. The only minor operation is one that someone else is doing.
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 the nurse.
5. Operating on the wrong patient or doing the wrong side of the body makes for a very bad day--always ask the patient what side their pain is on, which leg hurts, which hand is numb.
Emotionally, Dr. Vertosick's worst rotation was to the local Children's Hospital. A child who was born with an inoperable brain tumor is the focus of the chapter entitled "Rebecca."
Read how the author strays into the 'inferno of overconfidence' as a chief resident, and comes "perilously close to emotional incineration." Follow him into the operating room as a patient's brain oozes through his fingers, where he is squirted in the eye by an AIDS patient's spinal fluid, and where he cures a woman who was misdiagnosed as an Alzheimer's patient when what she really had was a brain tumor.
Dr. Vertosick has written another, equally interesting book, "Why We Hurt," on the 'natural history' of pain.
18 internautes sur 18 ont trouvé ce commentaire utile 
"Neurosurgeons do things that cannot be undone." 6 avril 2008
Par E. Bukowsky - Publié sur Amazon.com
Format: Broché
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.
19 internautes sur 20 ont trouvé ce commentaire utile 
An engaging but disturbingly inaccurate read 29 novembre 2013
Par Kenneth Saladin - Publié sur Amazon.com
Format: Broché Achat vérifié
I bought this book to preview as a recommended reading for my premedical seminar students and as a source of ideas for clinical case studies that I write for a medical physiology course. I found it a very engaging read, hard to put down. Vertosick has an admirable flair for medical writing for a lay audience, and the book bears abundant fruit as a source of case studies to be read for general interest or to be fleshed out with thought questions for students. I will certainly recommend it to my students. For my premeds, it is a good companion to Ellen Rothman's "White Coat," which chronicles her four years of medical college, and Michael Collins's "Hot Lights, Cold Steel" on his four-year orthopedic surgery residency. Any high-school or college premedical student in need of a clearer vision of the path from there to independent-practice physician or surgeon would do well to read Rothman followed by Collins and/or Vertosick.

That said, I recommend it only with a caveat emptor, for I am astonished at Vertosick's egregious errors of human anatomy and evolutionary reasoning. He writes (p. 185) of surgery for a pituitary tumor, "The pituitary, an embryonic relic of the nasal passages, lies buried in the hard palate, just above the uvula." That's three major anatomical errors in one sentence! (1) The pituitary is in no way a relic of or derived from the nasal passages. About 2/3 of it arises in the embryo as an upward growth from the throat (pharynx) and 1/3 as a downgrowth from the floor of the brain. (2) The hard palate is not above the uvula, which is part of the SOFT palate posterior to the hard palate. (3) The pituitary is not even remotely embedded in the hard palate. The hard palate forms the FLOOR of the nasal cavity, and to get to the pituitary a surgeon has to go through the ROOF of the nasal cavity, then through an air space called the sphenoid sinus, and finally to the pituitary in a bony pit at the base of the brain. Another person with whom I shared this quote said he wouldn't want someone like Vertosick doing a vasectomy on him, because he would probably approach it through the navel! I would not accept Vertosick's version of perinasal anatomy even from a sophomore prenursing anatomy & physiology student.

Vertosick's evolutionary conjecture about the cancer (pp. 234-237) ("Cancer evolved for precisely this reason--to destroy the host.") is ludicrous on so many levels it would require a longer essay than a book review to explain it. Cancer cannot be explained as a natural, evolved mechanism for population control. Vertosick's thinking rests on completely fallacious reasoning about natural selection, with some resemblance to an old discredited "group selection" theory that evolutionary scientists dismissed many decades ago.

Yet another (p. 261): "Meningiomas...arise from the outer surface of the skull." Nonsense! A meningioma (tumor of the meninges) occurs in the membranes that lie between the brain and the skull, not between the skull and scalp on the outer surface of the skull.

I would still recommend the book as an engaging read for anyone and enlightening for premedical and other health-science students, but again, I find its scientific inaccuracies appalling and would forewarn my students accordingly.
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