At its surface, When the Air Hits Your Brain details Dr. Frank Vertosick’s journey from a fledgling medical student to a fully-trained neurosurgeon after a seven-year residency.
Vertosick chronicles his career as a physician by focusing on key patients that were not only challenges to treat but who also taught him important lessons about life, empathy and the importance of taking risks.
He hides nothing about the pitfalls of medicine, surgical treatment and the medical field in general from his readers. Throughout his book, Vertosick describes biological processes in ways that are not only easy for laypeople to visualize and imagine but are also frankly quite beautiful and compelling.
When introducing one of his patients with Down syndrome, he writes, “The blueprint for a human body resides in its chromosomes, our molecular heirlooms... as the human egg and sperm are formed, chromosomes are shuffled like poker cards as nature tries to deal the best hand to our offspring. In Andy’s case, the shuffled DNA deck dealt him a loser.”
This kind of description sets his writing apart from the nonfiction genre because it gives his book a tinge of fictional elements, despite being comprised of true stories and experiences that balance out the more heavy-handed descriptions of surgical procedures.
Towards the beginning of the novel, Vertosick introduces the idea of surgical psychopathy, the stony mask that surgeons must put on in order to get through their work, without letting the deaths of patients destroy them emotionally.
He describes the transformation of Gary, one of his friends and the chief resident of the hospital, into such a psychopath while they were treating Andy (from the quote above). During an operation to clip an aneurysm in Andy’s brain, Gary’s hand slips and he causes massive bleeding that ultimately lands Andy in the ICU, where he slowly deteriorates for the next few months.
According to Vertosick, Gary “never spoke about the case again,” knowing it was useless to dwell on a patient’s death and decided to put aside his personal grief. Vertosick even wonders if patients even want compassion from surgeons in the first place, because they seek mainly doctors who can just get the job done.
However, Vertosick tries to demonstrate that compassion is not only necessary for those in the healthcare field but for laypeople as well.
Arguably, the most heartbreaking patient Vertosick encountered as a neurosurgeon is a baby girl named Rebecca, who has been born with an aggressive brain tumor and probably won’t live for more than a few months.
Even though Rebecca is terminally ill, Vertosick visits her — even when the nurses rotate taking care of her to avoid becoming too close to her, even when her own parents give up and stop coming.
Rebecca’s death leaves Vertosick’s “façade of surgical psychopathy cracking to pieces,” as he realizes that compassion is a fundamental human trait and that surgery and sympathy are not mutually exclusive states.
Although the author neither dispels the myth of the surgical psychopath nor subscribes to it, he does comment that doctors may inevitably use it as a form of self-protection against their career’s stresses. But he notes that it is not good to weed out all emotion entirely.
Another thing I love about this book is the author’s honesty. He realizes that neurosurgery, and medicine itself, is neither a perfect nor pleasurable profession.
He confesses that he does not always chase after his career with the utmost passion, instead saying that sometimes he thinks of neurosurgery’s “hundreds of tiny motions and [he doesn’t] feel like doing any goddamned one of them.”
In the medical narrative genre, I think that honesty about how the medical profession is not always as idealistic or as glamorous as it is portrayed on TV, for example, is one of the most important ideas a doctor can choose to convey.
As a young doctor about to enter into his neurosurgery residency, Vertosick heard the words, “You ain’t never the same when the air hits your brain.” This can be thought of as one of the book’s main themes. It applies to patients. Once a patient undergoes brain surgery, there is a very high risk of complications that will result in a patient literally never being the same again. But it also applies to physicians themselves.
Vertosick admits at the very beginning that “neurosurgery is an arrogant occupation,” and it takes years of being exposed to the grim reality of medicine along with countless inevitable deaths and failures for doctors to become humbled and for them to realize when the healing power of medical intervention falls short and when human sympathy and compassion take over. It’s to make a mistake that can change a human life forever.
When the Air Hits Your Brain is truly an eye-opening book. From describing his depression after permanently paralyzing an otherwise healthy man after making a mistake during surgery, to detailing his time spent treating a young mother who is forced to choose between receiving chemotherapy for her brain tumor and keeping her unborn child, Vertosick encapsulates the highest and lowest points of his career in his painfully eloquent and emotional writing.
