HA! Leisure reading, like anyone has even time for that. When I finished medschool and residency, I entered the world armed with the knowledge and skills and the unbridled confidence of a young doctor. And a healthy disdain for the written word. I used to be a voracious, almost indiscriminate reader in school and even through medschool, managed to get through the Lord of the Rings in 24 hours 3 days before exams, because that was the only way to not have it distract me from actual medical reading. And I think there were at least 5 more people who wanted to borrow that book after me. The Wheel of Time by Robert Jordan was also consumed, at least all of the books that were floating about the hostel at the time. On an aside, the week after I finished my neurosurgical residency I pulled out a dusty sony e reader, and loaded all of the 13 books and read them over a month. I did that again recently. It is good high fantasy. And possibly my favourite genre of fiction. But I was digging through some old pictures and I found a meme I had made of myself years ago. Here it is.
Please notice the Hudson brace.
This got me thinking about something I had read in a book that was recommended to me and then one thing led to another and I decided to write about a few books on neurology, and neurosurgery, and medicine in the non fiction/non academic space which have influenced my thinking, or just been a great read.
In no particular order, there’s When the Air Hits Your Brain: Tales from Neurosurgery by Frank T. Vertosick Jr. The book speaks of a neurosurgical residency and training and stories of patients that the author treated. What stuck with me were the rules of Neurosurgery that were imparted to him by his chief resident.
1 “You ain’t never the same when the air hits your brain.” The brain, like the Cadillac, was built for performance and not for easy servicing.
2 “The only minor operation is one that someone else is doing”
3 “If the patient isn’t dead, you can always make him(/her) worse if you try hard enough”
4 “One look at the patient is better than a thousand phone calls”
5 “Operating on the wrong patient or the wrong side makes for a very bad day – res ipsa loquitur in court.
6 “Additional rules of neurosurgical residency – Never stand when you can be sitting, never sit when you can be lying down, never use the stairs when there are elevators, never be awake if you can be asleep, and always eat and shit at the first available opportunity.”Gary, Chief resident, in When the Air hits your brain – frank T vertosick Jr
The last of course referenced in the meme.
Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh. The stories of life and learning and decision making and living with those decisions in a near dystopian healthcare service are both heart rending and heart warming. Dr (or Mr considering the Company of Surgeons and Barbers) Henry Marsh, has a gift of telling his stories and bringing an element of humanity into his narrative.
“There is no evidence that the complete head shaves we did in the past, which made the patients look like convicts, had any effect on infection rates, which had been the ostensible reason for doing them. I suspect the real – albeit unconscious – reason was that dehumanizing the patients made it easier for the surgeons to operate.”Henry Marsh
Something that I have personally stopped doing for over 10 years now. Much to the consternation of senior colleagues and surprise of the anesthetists.
Pretty much anything by Atul Gawande. Complications, his first book speaks of his time as a surgical resident, learning that complications are a part of surgery. And understanding why they happen and accepting them as a surgeon is the first step to being able to have honest discussions about them with our patients. Better, and his second, and Checklist Manifesto, his third book, look at improving surgical outcomes, personally and with organizational changes. How a surgical coach may improve surgeons, by impassionately looking at the performance and suggesting changes in posture, technique, not unlike professional sportspersons. How the implementation of checklists like in the aviation industry, even extremely simple ones can minimize the number of unforced errors in the operating room. Being Mortal is my favourite book of his and it addresses something that we don’t often discuss in training and with our patients. Care at the end of life and care of patients with terminal or potentially terminal illness. He speaks of his own experience with his father who had a tumor in the cervical spinal cord and also of the kindness and advice of Dr Ed Benzel, someone who I have the privilege of training under and remains a huge inspiration.
It’s All in Your Head by Susan O’ Sullivan. Too often have we dismissed complaints saying that it’s all in the patient’s head. But what if it actually is. What if that is something that can be addressed and treated. What if we spend more time dissecting non organic causes of a symptom or sign. House MD is great but no where near real life. Dr Susan speaks of patients with progressive weakness, seizures and a slew of neurological disorders with not a single diagnostic test confirming a diagnosis. On how sometimes these are the result of mind over matter, and not always with selfish ulterior motives. For someone who deals with patients in pain and very often with tests which are normal, for me, this book hints at looking at psychological causes or stressors that may lead to symptoms. It’s an area that is still growing in the amount of knowledge we have, and an area that needs a lot more research. There is a lot of flak that the book received though from patients of Chronic Fatigue Syndrome, who were unhappy with Dr Susan’s chapter on it. But it is still an eye-opening read.
When breath becomes air. By Paul Kalanithi. The story of a neurosurgeon who at the end of his training is diagnosed with Stage IV Lung cancer. This was recommended to me because Paul had almost finished his training to be a neurosurgeon, when he was diagnosed. I think what he was training to be, after reading the book, is not particularly relevant, though I have to be grateful that that was the reason I read this book, and I would recommend this book to anyone. It’s a poignant story of confronting one’s own mortality and finding answers to questions that plague us all. It’s hard to write more about this book without going back to thinking about it and consequently finding no words to describe the trains of thought that it generates.
The Emperor of All Maladies. By Siddhartha Mukherjee. I’ve long felt that cancer is our unsurrmountable mountain. We’ve come a long way since the first days of medicine and this book chronicles a journey of brilliant scientific and medical discovery. It does make it seem like we have the upper hand, but since doctors and surgeons measure time and effictiveness by failures and not successes, it sometimes feels like we’re fighting a losing battle. But thousands survive and live long lives after a dreaded diagnosis, and everyday we learn more and find newer therapies and targets, and there is still much hope.
I’d throw in anything by Oliver Sacks, simply because I’ve seem some really interesting patients that make us realise that we know nothing of how the brain works and Dr Sacks collection of neurological amazements is quite entertaining. Tale of the Dueling Neurosurgeons by Sam Kean is another fantastically written book on the evolution of our understanding of the brain. Brain, Vision, Memory and Hole in the Head by Charles G Gross are again accounts of the history of neuroscience. The last few books get slightly geeky but are still amazing reads.
Hope this helps you pick your next read, kindle download or audible credit.