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WHEN THE AIR HITS YOUR BRAIN

This is the book that every neurosurgeon would like to have written his or her version of,
but probably hadn't the time. It is the account of a neurosurgeon's training from medical
school to the end of residency, in this case in an American training programme in the
1970s and 80s. Although aimed at the public rather than at neurosurgeons, I could not put
it down. 
Of course, I am biased: I am probably much the same age as the author and shared many of
his experiences, or at least the British version of them. I recognise the same pressures
on junior staff, the same developments in our specialty, and the same types of character,
and I could tell as many tales. He even worked for a spell at the National Hospital for
Neurology and Neurosurgery, and, though they are disguised, I certainly recognised
several of the doctors described. 
In his excellent preface, the author sets out the raison d'etre for the book-to
desanctify neurosurgeons and to expose the random nature of their selection and the
dehumanising aspect of neurosurgical training which produces a standardised product. That
he fails in some of these objectives is not really a criticism. His bosses and
colleagues, as all surgeons, were not standardised but shared some common
characteristics. Despite the training process, he seems not to have been dehumanised, for
he writes about neurosurgical tragedies with sensitivity, even if he suggests that some
of his friends were. The random selection does not seem to have been too bad a thing
either; I am sure it leads to a more interesting group of trainees. 
For the author, and for me as well, training was a wonderful time, learning from a bunch
of real characters who central casting could not have dreamed up. It was extremely tiring
in those far off days of rotas of one in two and worse, but always exciting and totally
involving. Only after training the anguish begins, when the buck stops with the surgeon
at the top. 
Vertosick's story is admirably clear. It is enthralling my mother as I write, and she
says it all makes sense. Explaining neurological disease to your patients is difficult;
to do it effectively throughout a whole book is a real achievement. It is all there-the
ghastly experiences of severe brain injury, the macho world of subarachnoid haemorrhage
and aneurysms, the frustration of pain management, the tragedies of primary malignant
brain tumours, the sometimes unexpected triumphs of benign tumour surgery, and much more
besides.