Customer Reviews

Working in a Very Small Place: The Making of a Neurosurgeon

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Shelton writes as an outsider - albeit, as a science journalist, a very informed one - looking in on the world of neurosurgery. Specifically, he looks in on the world of neurosurgeon, Peter Jannetta.

Jannetta is a bold, charismatic man who has made his name despite detractors and carved out a subspeciality where others had failed to do so. Based on a few subtle observations, Jannetta revitalised a theory of microsurgical decompression for cranial nerve disorders such as trigeminal neuralgia, a condition of excruciating facial pain that drives some sufferers to suicide. Jannetta, against the tide of opinion, chose to go into tiger country at the cerebellopontine angle deep within the brain and lift tiny, sometimes microscopic, vessels away from the nerve and hold them away with small pieces of fluff. Established contemporary neurosurgeons were largely up in arms that a young upstart resident would perform potentially dangerous surgery when a safer alternative (of destroying the nerve distally) existed. Jannetta, with charm, stubbornness and unshakable self-belief held onto his view and over a period of years forced his procedure to be accepted. Sheldon documents his persistance with admiration and recognition of the historical context of this work.

In explaining this neurosurgeon's world, Sheldon explains to those on the outside the terminology, anatomy, clinical process and US referral system. Although his explaining these things in explicit detail slows the pace at times, it is probably better that he occasionally bores a few cognoscenti than baffles or alienates the lay reader.

In the best part and heart of the book, Sheldon has been invited into the inner circle and in his apparent shadowing of Jannetta, has built up a brilliant picture of a brain surgeon's daily work. Sheldon describes conferences, tutorials and closed-door morbidity and mortality meetings in an engaging and intriguing way. With the vitality of Jannetta central to the story, it is an entertaining coffee- and cigarette-fuelled rollercoaster ride. Sheldon has crammed a vivid personality, a packed daily schedule and the painful experiences and desperate histories of patients into a powerfully-told, brilliantly-painted portrait.

In the brain-book genre, this is most similar to A Scapel's Edge, describing another neurosurgeon (whom, I think, specialised in aneurysm surgery), rather than When the Air Hits the Brain, or the general surgery based Complications, which were written by surgeons themselves rather than journalist observers. Whilst probably not stealing the podium from my favourite brain-book, this is certainly an intriguing, enlightening, and most importantly, entertaining read.


dr_sasp

Mr. Shelton has written a well researched book. I find it specifically interesting in the fact that the doctor, Dr. Jannetta, allows the author a glimpse into the admitted as well as the often unadmitted; the surgical practice of "ghost surgery". (I no longer have the book so I may be wrong about page citiation but I believe it is approximately page 252.) The author relates an anecdote told by a resident about the time he wanted to operate on a woman with a brain tumor who had just given birth. Although Dr. Jannetta at first tells the resident not to operate because of the potential danger to the patient the resident persists and Dr. Jannetta relents. The author goes on to tell how the patient died and Dr. Jannetta, who had not been in either the O.R. or the hospital, comes in in the middle of the night to commiserate with his resident. It is not often, if ever, that a doctor admits publicly that he, by his actions, endorses 'ghost surgery'. This book gives the reader an entry into an often secretive and closed world. Neurosurgery seems to be the most highly regarded, feared and unknown of the medical specialties. For anyone curious about the life of a neurosurgeon, this is one of the books I would recommend.

This book hits the courageous and compassionate side of Dr. Jannetta spot-on. I had 2 of these surgeries with Dr. Jannetta, and Mark's book is factual, humorous, and intensely personal. This is a great read about the practice of neurosurgery, as well as about Peter Jannetta's work with the rare but very painful condition of trigeminal neuralgia. Tho published in 1989, its references and observations are still current, and would be informative to anyone considering the field of neurosurgery, or considering getting this procedure done.

I was diagnosed with HFS (hemi facial spasm) in approximately 2002. For over six years, I took botox injections, as the alternative brain surgery, did not seem pleasant. Over the years, I grew to disdain the quarterly botox injections, and started investigating the surgery, known as "microvascular decompression surgery", or MVD for short. After reading this book, I became convinced it was the better alternative to botox, so in June, 2006, I had a MVD. I remain free from spasms now, two years later, and I credit this book to a large extent in giving me the courage to undergo the brain stem surgery that has improved my quality of life significantly.

This is a book written for the layperson, not the medical doctor, and as such, is an easy read and will help prepare you for the necessary questions you should ask your surgeon. [...]

I read this book and found it interestinig in learning about the world of neurosurgery.
Another book, 1-4134-0609-2, A Pained Life, a chronic pain journey, tells about one patient's experience with the disorder Trigeminal Neuralgia. This is the pain problem that Dr. Jannetta's surgery is for. The author of Pained Life was operated on by Dr. Jannetta, along with other doctors, and tells of her personal encounter with him and others.