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When the Air Hits Your Brain: Tales of Neurosurgery

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"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

Rule One for the neurologist in residence: "You ain't never the same when the air hits your brain." In this fascinating book, Dr. Frank Vertosick brings that fact to life through intimate portraits of patients and unsparing yet gripping descriptions of brain surgery.

With insight, humor, and poignancy, Dr. Vertosick chronicles his remarkable evolution from naive young intern to world-class neurosurgeon, where he faced, among other challenges, a six week-old infant with a tumor in her brain, a young man struck down in his prime by paraplegia, and a minister with a .22 caliber bullet lodged in his skull. In candid detail, WHEN THE AIR HITS YOUR BRAIN illuminates both the mysteries of the mind and the realities of the operating room.

--Publishers Weekly

288 pages, Mass Market Paperback

First published January 1, 1996

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About the author

Frank T. Vertosick Jr.

4 books66 followers
Frank T. Vertosick, Jr. is a neurosurgeon and is the author of three books: Why We Hurt, When the Air Hits Your Brain and Mind: A Unified Theory of Life and Intelligence which was previously published as: The Genius Within: Discovering the Intelligence of Every Living Thing.

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5 stars
4,440 (51%)
4 stars
2,993 (34%)
3 stars
988 (11%)
2 stars
179 (2%)
1 star
65 (<1%)
Displaying 1 - 30 of 649 reviews
Profile Image for Petra X has her eye on the prize.
2,384 reviews33.9k followers
January 6, 2019
This is the sort of book you think of long after you've finished. Some tales won't leave me. The six-week old little girl born with a brain tumour. Her teenage, indigent parents were told to go away and have another child as this one wouldn't leave hospital and wouldn't live long. So they went and never saw her again. But she lived for 18 months developing into a sunny, golden-haired child albeit one tube fed, on oxygen and paralysed. At one point the author didn't see her for six months but then he did and she recognised him and smiled and wanted to hug him despite not having use of her arms. She had remembered one of her very few friends. Some months after her death her parents who had never been back to visit her sent a statue of a laughing girl to the hospital with a little plaque in memory of their daughter

The author wasn't concerned about too many of the technicalities of brain surgery although there is enough science to make it instructive, but about the effects on the patient, for better, or quite often for worse. There are two thing I got from this book:

1. Don't have any kind of surgery if you can avoid it, especially not brain surgery. There's always a risk.
2. Failure instructs better than success. See 1. above. It might be good for the doctor but for the patient, not so much.

Good book, not stellar, but a very enjoyable.
Profile Image for Elyse Walters.
3,851 reviews34.9k followers
June 28, 2017
Audiobook: memoir of a brain surgeon. Purchased as a 'daily special' ways back. I would have paid twice as much!!!!

We also are privy to the authors feelings, and moral concerns. The narrator's voice, Kirby Heyborne, felt so genuine. He was easy to be with -not an ounce of ego in his voice -- which allowed me to experience the greatness of Frank T. Vertosick Jr.

This story begins when Vertosick is a 3rd year medical resident. He didn't have this 'life-desire-or-goal' to become a brain surgeon. ---yet the tale of how that leap happens is interesting in itself.

The way we learn about this field of medicine- raw details- blending with superb storytelling--is what made listening to this audiobook so good. We begin to get an 'honest-to-goodness' overview into the culture of neurosurgery.

One woman was pregnant and had a brain tumor. -- It was gut wrenching story. A couple 'do' make your eyes water. Many of the patient cases were riveting. A couple of the 'inside' chats between doctors were frightening.

I learned about radio surgery--spine surgery- ( which are are growing in this country) - more specifics within the operating rooms - functional Nero surgery- electrical stimulating devices- recent advances - and new advances of surgery for Parkinson's disease.

NOTE: KGO - SF Bay Area radio host - Ron Owens - had brain surgery for Parkisons disease. They put an electrical stimulator inside his brain to help control symptoms such as shaking - and slowing down the progression of the disease itself. He shared with his viewers on the radio - before - during - and after his brain surgery. Great success story.

I WASN'T expecting the ending to this book. -- [the epilogue] -- oh my god....It was soooooo sad!!!!!

Profile Image for Scott.
1,677 reviews120 followers
June 17, 2022
4.5 stars

"[My book] is not about technology, it isn't even really about the medicine. It's about the human aspect of disease, the human dimension of those who suffer from it, and the human dimension of those neophytes, like me, who learn to treat it. And that dimension is timeless." -- the author, page 272

Although not quite obvious by the occasional details, Dr. Frank Vertosick apparently went through a neurosurgeon's schooling / training / career advancement in Pittsburgh, Pennsylvania of the 1980's - I lost count of how many times a patient, their visiting relative, or a medical professional lights up a cigarette in the hospital interior (!) - and he highlights a number of his cases and/or professional experiences in the concise but often involving medical memoir When the Air Hits Your Brain. The author comes across as an honest and self-deprecating straight-shooter type (although I would've guessed that he would've joked about his surname, which sounds like a vaguely Germanic term for flight nausea), and his many stories are culled from his various successive physician positions (intern, resident, attending, etc.) throughout the years 'on the job.' They run the gamut from the successes to the mistakes, from the heroic life-saving moments to the truly heartbreaking or tragic incidents. *I defy any reader not to burst into tears - because I sure as hell did - by the concluding pages of chapter 10's 'Rebecca,' about a very ailing six-week old infant that he oversaw during his required pediatric rotation.* Other than some medical terms or explanations being sometimes difficult to fully comprehend without diagrams or photographs, this was an insightful and affecting book.
1 review3 followers
May 1, 2010
I couldn't put this book down. It was a brillant and an unvarnished retrospective on the author's difficult five years in medical residency for neurosurgery. The story has both great humor and pathos and I haven't both cried and laughed in the same sitting like I did with this book in as long as I can remember.

His "rules of neurosurgery" are particularly enjoyable:

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.

A great book and one I will certainly read again.
Profile Image for India M. Clamp.
203 reviews
May 25, 2022
Vertosick reticulates his residency (3rd year) and the operating room becomes familiar---like our living room---yet it’s a place where expletives fly, ego is extinct and truth is conveyed emotionless. Surgeon saying “F-you cookie monster” brings little to no reaction.

-Surgery should be the last option
-Time is the panacea

Vertosick is an astute storyteller and one of his tiny patients is a cute golden-haired baby and he says “she did not long for death, developed dimples, and curly hair.” She was born with a brain tumor and (child of indigent parents) 6 months later she died. Her name was Rebecca.

Health concerns us all. When the Air Hits your Brain: Tales of Neurosurgery is required reading for anyone who has/was/could be a patient and requisite for anyone in medicine. Sad, erudite and death imparts knowledge--including surgeons' (Vertosick) wistful fate. Buy, read and say hello to the tears.
This entire review has been hidden because of spoilers.
Profile Image for دُعاء| Doaa.
51 reviews14 followers
May 30, 2021
Best medical memoir I’ve ever read.
I learned so much from his experiences and helped to overcome my fears. I know for a fact that I’ll re-read it again and again. I strongly encourage medical students to read it.
Profile Image for Sonja Arlow.
1,063 reviews7 followers
November 19, 2018
Failure instructs better than success

When does compassion stop being useful to a dying patient. When does morals and ethics get in the way of progress?

These are hard questions and the author does a brilliant job addressing this and showing the failures and triumphs of becoming a neurosurgeon.

He strikes the right balance between medicine and the human behind the mask.

It also shows the rivalry between different specialities in the medical profession. Why neurosurgeons look down their noses at internists and vice versa.

The case studies involving infant neurosurgery – specifically the story of Rebecca – and the story of Sarah the pregnant cancer patient was fascinating and utterly heart breaking at the same time

As a side note, I am pretty sure that the writers of Grey’s Anatomy liberally “borrowed” some of the stories in this book.

Recommended for anyone who has a love for medical memoirs. If you want to try a book like this but is daunted by the “medical speak” then I would recommend starting with The Real Doctor Will See You Shortly: A Physician's First Year
Profile Image for Ruthanne Johnston.
415 reviews34 followers
May 29, 2017
What an amazing story! Dr. Vertosick, a neurosurgeon, wrote this book in the late '90's, but please don't let that deter your interest in reading it. Times have changed, neurosurgery has changed, but the basics are still there because our brains and nervous systems remain the same.
It's a portrait of a young physician/surgeon as he develops his skills, makes errors, slowly but sadly adopts the attitude of many surgeons, that of surgical psychopath. That designation simply means that he removes himself so far from the personality of the patient and his fears and emotions, and concentrates solely on the mechanics and outcomes of each of his procedures.
There were moments in the book when, as a nurse, I flat out didn't like Dr. Vertosick. But as the book went on, I could understand better his point of view and felt such deep respect for his knowledge and capabilities in this, the most mystifying part of the body, the brain.
There are many graphic scenes of surgery so it may not be for the faint of heart or anyone who has lost a loved one to a brain tumor, an aneurysm or stroke.
The epilogue of the book caused me to cry. That is when I learned the ultimate fate of this talented physician. He bravely tells of his condition today and how he can no longer practice the skills that he developed so carefully over the years. Sad, oh so sad.
Profile Image for Sarah Milne.
119 reviews11 followers
September 11, 2010
I truly enjoyed this book. I liked the author's voice and style. I liked his narrative, and I liked his questioning. It's a great read, and an informative one.

Oh, and I really like his descriptions. Like this one:

“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?”
Profile Image for Mel.
116 reviews90 followers
June 4, 2017
Fascinating, but brief. Worth noting for current readers, this was first published in 1977. I don't know how much the science has progressed, but pretty sure, significantly. Still--this is one doctor's experience, and he tells his story with a respect for the patient and the profession. It was good to be reminded that there are doctors who regard their patients with compassion.
Profile Image for Nina.
701 reviews128 followers
March 21, 2022
What an emotional journey this was. I loved the stories Vertosick shared, and the way he described the people he met with warmth and empathy. He chose to focus mostly on his mistakes, and I find that honorable. He writes beautifully, with interesting metaphors and humor. I also learnt a lot, which is also a plus.
Profile Image for ahmad  afridi.
139 reviews141 followers
May 19, 2022
The thing I liked in this memoir from neurosurgery residency is that he didn’t used the prevalent formula of medical memoirs who use some rare disease or some very uncommon presentation of a common endemic disease of a small locality factionalized from textbooks to amuse readers . Here he discussed simple cases like aneurysm, subarachnoid bleed and laminectomy etc. without going into detailed technicalities of procedure, with minimal professional jargon and that too explained in laymen terms . He is more focused on presenting the human aspect of the procedure, with the ethical dilemmas he face while a patient is lying in front of him with his skull open. He is aware of the butterfly effect his actions will result in, while manipulating the minute and fine anatomy of brain and the quality of life the patient has to live with. The patient and their immediate relatives are not spared from the burdens of lifelong effecting decisions . Like when they are told that we will remove the tumor from your brain but it is located in that part of brain which control speech function and that will be lost. Surely none of these stories of interactions with patients and attendants about their disease, possible courses of treatment and the outcome in shape of limitations on daily activities are pleasant in any sense but it is what they have to live daily. These stories are introspective , witty at times , blunt in places and tips for Residents here and there.

Would strongly recommend to anyone related with healthcare provision . Those not related with healthcare can find it a bit depressing but nonetheless they can enjoy it too because of very little use of medical terminologies.
Profile Image for Marijan Šiško.
Author 1 book63 followers
February 13, 2017
'You don't have to be a brain surgeon', kaže anglo-saksonska poslovica, kad se govori o poslu koji ne zahtijeva značajne cerebralne sposobnosti. Ispostavlja se da je jedan od njih i posao neurokirurga. ne, ne traži se genijalnost, ali sigurna ruka, čelični živci i otporan želudac-definitivno. Autor nas u ovom djelu brutalno i bez imalo uljepšavanja provodi svojom specijalizacijom iz neurokirurgije, od samih početaka i gotovo slučajnog izbora sve do konačno teškos tečenog znanja neurokirurga. Kroz beznadežne slučajeve, i one druge. kroz suze, uspjehe i neuspjehe. ako ikog zanima kako medicinska profesija izgleda iznutra, knjigu svakako preporučujem.
Profile Image for Fatma Nur.
13 reviews1 follower
November 16, 2019
"Ben gerçekten de elimden gelenin en iyisini ortaya koymuştum; ama benim yapabileceğimin en iyisi maalesef yeterli olmamıştı. Geçmişin kabusunu kabullenip gelecektekileri beklemeye başladım."

Kitaptaki anıları bizzat yaşamışçasına etkilendim. Mesleğin gerçekleriyle bu kadar yüzleştirmesine rağmen beyin cerrahisini kesinlikle korkutmayan, soğutmayan bir şekilde anlatmış yazar.

Benim için başucu kitabı olacak.
Profile Image for Jana.
768 reviews87 followers
December 17, 2017
I’m both fascinated and disturbed by this subject. I guess it’s fascinatingly disturbing. But the stories in this memoir of the author’s early training as a neurosurgeon are compelling and memorable. And he comes off very likable and humble to me, which makes him all the more intelligent, right?

Audible version is excellent.
Profile Image for Scot Parker.
268 reviews49 followers
December 18, 2018
"You're never the same after the air hits your brain."

As the synopsis says, this book is a collection of stories from Dr. Vertosick's career as a neurosurgeon. If that sounds interesting to you, you'll like this book. The stories are engaging and fascinating, told in a compassionate, occasionally self-deprecating voice. I'm glad I read this.
Profile Image for Deb✨.
290 reviews3 followers
May 23, 2019
3.5 stars. This book covers some interesting subject matter. I think it would be an interesting read for people that are not in the medical field. The author does a good job of describing his experiences so that people can understand what he is talking about and be fascinated by what all is involved. There is some pretty emotional stuff in this book, and it takes a special kind of person to be a neurosurgeon, for sure! For people that are in the medical field and work in the hospital and see a lot of this stuff on a fairly regular basis this book might be just an okay read.
Profile Image for Justin.
356 reviews46 followers
April 22, 2017
This was yesterday's audible daily deal and I thought to myself "that sounds intersting" I am so glad I decided to buy it, this book was more than interesting, it was fucking amazing! I learned, I laughed, and I cried my fucking eyes out at work. This book is more than just a look at the life of a neurosurgion, it is a look at life itself. I am not in a medical profession and have never had any interest in medicine at all, but I can not recommend this book enough!
Profile Image for Holly.
109 reviews57 followers
September 2, 2015
A wonderfully interesting read about the life of a neurosurgeon, and the various cases he had.

It balances the human story and the science story perfectly, and I felt like I got a lot out of the book. Who knew cancerous cells basically reverted your cells back into the cells you had as a baby, before they matured?

I'll definitely look into more books about neurosurgery!
Profile Image for Ardon Pillay.
135 reviews16 followers
July 15, 2020
A no holds barred account of the life of a neurosurgical resident in the 70s. Vertosick went through a training programme which would now be called inhumane, spending more than a hundred hours at a time in the hospital without going home.

However, he reflects on everything good that came out of this. The very tactile nature of neurosurgery demands practice and practice demands time. The hard work that he put in clearly paid dividends, as he learnt not just how to perform some immensely complex and specialised surgeries on the nervous system, but also became very good at building a rapport with his patients.

Achieving these sort of results in medicine takes hard work of course - as Bob Kelso, the chief of Medicine in Scrubs put it, “nothing worth having comes easy.”
Profile Image for Karen.
832 reviews121 followers
March 4, 2015
Vertosick lets readers tag along as he moves from medical student to intern to resident and up the chain of command supervising others in a hospital setting. Yes, his book provides interesting case studies full of technical detail. It also lets us see how surgeons are all-too-human: skill isn't innate, it comes with practice; there's a bit of infighting between neurologists and neurosurgeons; everyone's sleep deprived; there are hazing rituals; most surgeons are arrogant; and nobody is perfect.

Nevertheless, I was very interested to get the nitty gritty detail on this profession.

Hidden in the last few pages of the book is a meditation on the fact that everybody dies. Vertosick describes the planned obsolescence of the human body, the evolutionary advantage for the species of winnowing out flawed design, and the absurdity of thinking nature could produce organisms that never corrupt. It's a harsh reality but one that everyone has to deal with at some point. As a surgeon, he's confronted with the reality of death every day.

And here is a "gee whiz" for fans of House M.D. This book was published almost a decade before House M.D. aired, and I swear it's an influence. There is a resident named Eric Foreman, and there is an arrogant doctor named Gary (close to Gregory) who has bad bedside manners, is full of insults for others, he makes bets and he even yells, "The game's afoot" to his interns. Hmmmmmm.
Profile Image for Sunflower.
940 reviews7 followers
September 22, 2012
"When the air hits your brain you ain't never the same". How did I get through medical training without hearing this gem? Slightly reminiscent of "The House of God" (his Rules are just as funny as those in that book) but actually true, Vertosick describes incidents and episodes from his neurosurgical training which helped to shape him. What he says is truly funny in places, but he also writes about his thoughts (on becoming a neurosurgical psychopath, for example) in an entertaining but serious way.
As the author himself says" This book is about the human aspects of disease, the human dimension of those who suffer from it, and the human dimension of those neophytes....who learn to treat it". Yes.
The rest of the "Rules"
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 on the wrong side of the body makes for a very bad day.
3 reviews1 follower
September 7, 2018
i'm not a expert with words.. so i cant find words to describe how great of a book this one was❤️❤️❤️
a must read book, not only for medical personnel but for all
thanks dr Vertosick for sharing your experience with us 😊😊
Profile Image for György.
121 reviews6 followers
March 16, 2019
The truth is, we don't appreciate enough the careless period of life when we have no health issues. But, perhaps that's the way life goes and we're trying to enjoy life as much as we can before the process of senescence starts peaking up. We like to think about our species as the top creation of the Nature, some even claim we're divine creatures. Yet, there're many them undecided between whether we are divine creatures, or only a thermonuclear waste. This duality of everything transcends our comprehending of us and generally everything. While listening this book, I've unwillingly recalled my memories about the book "Genome: the Autobiography of a Species in 23 Chapters" where first time in my life met genetic disorders I couldn't even imagine they exist! While reading the Genome, I thought I could make a fortune with them by making a movie for each 23 chromosomes. So, here is the point of this book that will move the reader, according to Mr. Cicero's criterion that every book has to satisfy "“Docere, Delectare, Movere,” or “To Teach, To Delight, To Move.” - to much deeply appreciate life, because despite we're made from elements that can only come to existence in supernovas and nebulas, there is nothing so fragile as a human.
Mr. Vertosick book gives us an insight how really fragile we are and something about all we do that comes out from our instinct for survival and our struggle to live forever.
All the stories from the life of a young medical student and the surgeon unit of the hospital are about our efforts to save and prolong life!
This book, despite intended for medical... people, I think it's very useful for those non-medical as well. Good job! Cheers!
Profile Image for  Sarah Lumos.
122 reviews112 followers
July 16, 2018
Who knew neurosurgeons could be so funny? I even texted some of the humorous bits to my best friend, and when I am fangirling that hard, it is never a bad sign. Dr. Frank T. Vertosick Jr. - which is such a badass name - does not act like your conventional doctor. I always picture doctors as cerebral, serious, and compassionate types. And there is nothing wrong with that, but Vertosick’s awkward and witty persona is like John Green’s, whom I adore. My only qualm is that Vertosick does not write textbooks. If he did, maybe I would be more inclined to learn the material and not just absent-mindedly memorize it during my library furloughs from humanity.

“Failure instructs better than success.”

So basically, Vertosick fell into neurosurgery by accident. He wanted to go into cardiac surgery but lacked the prerequisites. In my opinion, neurosurgery should not be something you go into by accident. Reading memoirs by neurosurgeons made me realize the strenuous and demanding nature of this medical speciality. For starters, the brain is not like any other organ. When you make a surgical error, there is no stitching it up and going back. Sometimes these mistakes are permanent, which is a lesson Vertosick learned the hard way. And yes, there were many times he regretted going into neurosurgery.

Neurological diseases are complicated, but fascinating to study. It is crazy how just one small malfunction in the brain can cause debilitating effects to the rest of the body. When Vertosick discussed his patients, I felt like I was right there in the surgical unit with them. In his own words, he never amounted to a surgical psychopath who was void of all empathy towards his patients. There was never a point a family’s devastation about losing their son stopped impacting him.

He believes just seeing a human as a brain is dehumanizing. It dilutes a body down to a corpse as opposed to a whole person. He tried to get to know his patients history, family, occupation, and background. This extra effort showed in his writing. I could tell he cared for his patients, each one of them, and I find it remarkable that an overexposure to death, violence, and trauma did not harden his heart.

I never wanted this book to stop. I could read it forever. No jokes. It was a fascinating read, but I think I went through it too quickly. I need to sit down sometime to re-read it and take notes because Vertosick also is great at describing neuroanatomy and neurophysiology concepts. I love his sense of humor and I look forward to reading his other works.
Profile Image for Anthony Ferner.
Author 12 books9 followers
December 29, 2016
Excellent account - for a lay reader - of what it's like to be a neurosurgeon in training. Not as elegantly written, perhaps, as Henry Marsh's Do No Harm, but equally illuminating if not more so. The detailed descriptions of operative procedures are stunningly good, and some of the case histories - e.g. the disaster of a ruptured aneurysm - read like nail-biting thrillers, often without happy outcomes. When things go wrong neurological disasters tend to be truly disastrous. One of the most interesting aspects of the book is the insights it gives into how surgeons deal with inevitable failures by turning into what he calls everyday 'surgical psychopaths'. This is in order that they can survive - and so we can too.
Profile Image for Nurgül Tekeli.
3 reviews2 followers
September 13, 2016
Hayatta en temel görevin şu olmalı, böyle yaşamalısın, şöyle bir insan olmalısın demeden okuyucuya birçok hayat görüşü ve ilham aşılayan çok güzel bir kitap. Bir doktorun asıl olarak keyif aldığı şeyleri ve rahatsız olduğu noktaları çok güzel ele almış. Doktor olmak yardımcı olmaktan keyif almaktır gözüyle değil anevrizmayı kıskaçlayabilmenin verdiği haz duygusundan bahsederken ki samimiyetle yazılmış. Okurken yazarın yaşadığı keyfi ve üzüntüleri okuyucuya yaşatacak kadar da iyi bir akışı var kitabın. Bir yandan sevdiğin işi bile yapsan bunalma hakkının olduğunu, ya da her gün aynı işi yapsan dahi ilk aklına gelmesi gereken şeyin dağ evine taşınmak, şehirden kaçmak değil de, o tekrarlar içindeki muhteşemliği ve keyfi görmen olduğunu söylüyor.
Profile Image for Christy.
111 reviews15 followers
May 24, 2020
I had deeply mixed feelings about this book.

Some of the stories were heart-wrenching - and I'm saying this as a person who has experienced a lot of loss and relishes gross, gritty, and emotional stories. Others were just plain interesting.

I'm not sure whether the author and his colleagues actually were insufferable, pompous assholes, or if he just wrote them that way. I almost abandoned this book half-finished because of their callousness, especially towards chronic pain patients. I realize that these stories occurred decades ago, but that doesn't make the callousness any easier to listen to.
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