When the Air Hits Your Brain, by Frank Vertosick Jr., MD

Normally, arrogant surgeons and a cynical medical industry are not high on my list of interesting topics. Dr. Vertosick’s horror stories of his medical residency in this field held my attention, though. Routine 100 hour weeks, grueling schedules, and cruel instructors are the norm; a far cry from spending more time on the golf course than in the office! The subject did make this hard for me to read at times, however. A neurosurgeon saved my wife’s life in 1998, and this memoir brought back more than a few difficult memories.

Overall, my low opinions of a self-centered profession weren’t changed. “As I resuscitated a heart attack victim in the ER hallway one night, another patient came up to me, pointed to my expiring patient, and asked if I had tried intracardiac epinephrine yet. I curtly told him to mind his own business and sent him to his own ER cubicle, then promptly loaded up the intracardiac syringe and followed his advice. The patient lived.” This anecdote was presented as a bit of humor (it was bookended with what laymen can learn from television) but I just see a disturbing lack of humility. A second story, though, proved much, much worse.

The author is asked to watch over a baby girl just coming out of a touchy surgery, being told if she could live through the night she had a chance for recovery. He spends a sleepless night making impossible choices between drugs with terrible side effects, only to fall asleep before 5am. When awoken, he finds the baby gone and the surgeon standing over him.
     “Where’s the baby? Did she go back to the OR?”
     “No. I shut off her ventilator an hour ago. She’s in the morgue. Actually, her parents wanted her shut off last night before I left, but I forgot.”
Turns out the family already knew their child’s surgery had failed and the kid was going to die. This other doctor, though, ignored their wishes in order to teach a lesson to Vertosick about pressure. Never mind the extra pain and suffering the helpless baby experienced. I can only imagine the hospital charged the unfortunate family for the drugs, bed space, nurses, and anything else they could manage for the extra night. This reinforces virtually every negative opinion about the medical community I have. Meh.

That said, Vertosick seems to understand this negative stereotype and often counters by showing the more human side of medicine. Take the tale of a young woman involved in a serious car wreck and needing immediate neurosurgery; her parents appear in the trauma room. “To me, she was as much a bureaucratic nuisance as she was a patient. To them, she was a first step, a first word, a first bicycle, a first date.” While too many medical professionals seem to focus more on the nuisance than the emotional side, it is nice to see that at least they recognize there are multiple points of view to every situation. The story with the most impact detailed a patient who needed surgery to live, but the operation would require the termination of her pregnancy. The mother-to-be refused to trade her life for her unborn child’s; the narrative ends with the epitaph, “Sarah Clark. Loving Wife. Devoted Mother.” Hard to read that without thinking about how close I came to being a single father.

In When the Air Hits Your Brain, Vertosick demonstrates both the positive and negative aspects of how a neurosurgeon is trained, and humanizes an arrogant profession. While I am clearly not a cheerleader for our health care system, I am thankful each day that Dr. Gormley made it through his neurosurgical residency and was there when my family was in need.

First Sentence:

July 1. Neurosurgery residency.