When the Air Hits Your Brain: Tales from Neurosurgery Read Online Free PDF Page B

it out now. He was transferred to the oncology service for radiation therapy. I never saw him again.
    Mr. Rathman’s case came back to me several months later, after I had left the neurosurgery service and was on my internal medicine rotation at the Veterans Hospital. I received a message that Dr. Abramowitz wanted to see me in his office.
    At the appointed time, I was escorted by a secretary into the boss’s lavish office. The walls were filled with diplomas, citations, awards, and autographed pictures of previous teachers and residents. He glared at me over reading glasses slung low over his long nose, his feet propped up on the broad desk.
    “Please sit down.”
    I complied, almost vanishing into a plush chair. The boss bolted up and continued.
    “I understand that you picked up a lung tumor in one of my staff men’s patients, a man who was headed for a discectomy the next morning?”
    “I just saw his Horner’s sign, that’s all. It was obvious because it was so dark…it could easily have been missed during the day, a fluke really.” I was nervous. Was this some sort of investigation of his attending surgeon?
    “Still, you saved him an operation. Listen, we need good men for this program. How would you like a job when you graduate?”
    “Doing what?”
    He laughed. “Doing this. Neurosurgery. Becoming one of us. It’s tough, but this is one of the best programs in the country, which means in the world.”
    I was stunned. “I’ll have to think about it, sir.”
    “Well, don’t think too long. Over one hundred people apply for the two spots we offer each year, and we like to pick them several years in advance.”
    Thanking him, I beat a hasty retreat. This was an honor, being offered a position in a premier program by an internationally renowned surgeon. But something bothered me: If this was such an honor, then why offer it to someone who got lucky on one patient? I remembered Groucho Marx’s comment about not wanting to belong to any country club foolish enough to take him as a member.
    And why several years in advance? I thought back to my grade school friend David, who committed to the seminary when he was only fourteen years old. Maybe surgical residency was like the priesthood: get ‘em early, before they know what’s happening.
    At least David wised up. He now has three children and sells insurance.

3
Thanks for Everything
    I was in the middle of my third-year rotation in medicine when the boss offered to make me “one of them.” The medicine rotation, or clerkship, was offered at the local Veterans Administration Hospital, more commonly known as the V.A. (Vee-Ay), the Vah, or, more sarcastically, the Vah-spa—although it was hardly spa-like. Nestled behind the university football stadium, the V.A. looked like any 1950s-era federal building: bland and boxy, with smooth, yellow-brick walls tinged with industrial soot.
    Our V.A. was one of the better veterans’ facilities in the country. Most of its employees tried hard to do a good job,but the unmistakable footprint of government bureaucracy was everywhere: nowhere to park (unless you were one of the administrators), oppressive paperwork, outdated equipment. Management teemed with career drones who knew they couldn’t be fired and acted accordingly. Surprisingly, the hospital’s many inefficiencies didn’t stem from a lack of money, since the V.A. was well funded. Regulations strangled the place, not poverty.
    The V.A. holds fond memories for me. For medical students and residents, that musty building was, for all of its problems, a fun house filled with discussions of medical esoterica over cold pizza at three in the morning. A place for poring through hospital charts that stood taller than the patients. A place where a baby-faced third-year student like myself could be introduced as “doctor” without being laughed at. The hours were long, the supervision scant, and the aggravations many; but the daily struggle to provide quality health