When the Air Hits Your Brain: Tales from Neurosurgery by Jr. Frank Vertosick

room to seek out the psychiatry resident. We found her watching TV in the lounge.
    “Well,” she said upon seeing us, “what did you think of Jake?”
    I related the story of the wolves and Tommy and Vietnam and the other observations I had hurriedly jotted down on his progress notes. “He’s a little scary,” I concluded.
    “Schizophrenics are like rattlesnakes,” she observed dryly. “They look scary, but they’re far too frightened of you to be really dangerous. Personality disorders are a whole lot scarier, trust me. Tommy is Jake’s brother, a systems analyst for CocaCola. Jake talks about him, although they haven’t spoken in years. Tommy was wounded in Vietnam while Jake was institutionalized. When Jake has an acute episode he usually says wolves are after him. Two years ago, it was a pack of dogs—the hallucination is being upgraded all the time. It’s hard to tell if he really is afraid of his hallucinations or whether he just wants a night away from his cardboard box. I think it’s the hallucinations—they can be frighteningly real to these people, like a waking nightmare. If he just wanted to be admitted for a few days, he could threaten violence or suicide and try to get a 302 that way—but he never has. Not yet, anyway.” A 302 is an involuntary commitment to a psychiatric hospital, which can be imposed on patients only if they are perceived as an immediate physical threat to themselves or others.
    The resident gave Jake his shot of Prolixin and returned him to the street. I watched him walk jerkily through the automated front doors, his gait bending under the weight of the brain-altering drugs, which had done little for him except make his movements as distorted as his thoughts. A wispy snow fell about him, dusting the walkways like confectioner’s sugar. Jake pulled his spring jacket around his neck and wandered off into the blackness to face his wolves alone.
    • • •
    I graduated from medical school in May and began my surgical internship that July. Like medical school, internships consist of different rotations, providing the broadest possible experience before our careers funnel into single, narrow specialties. My first assignment as a full-fledged M.D. was cardiac surgery. The chest team at last!
    Our cardiac service included both adults and children. A curious thing about illness: it strikes the very young and very old—but few in between. On the cardiac service, patients were either seventy years old and undergoing coronary artery bypass grafting (CABG, or “cabbages,” as the residents affectionately called them), or three days old and undergoing a repair of a congenital FUH (fucked-up heart).
    Interns did nothing of any consequence on the cardiac service. Not that we didn’t work hard; there was a massive amount of inconsequential nothingness to do. To be stuck in the hospital for two or three days at a time was not unheard of. Every year, the police ticketed at least one cardiac intern for falling asleep at a red light while driving home.
    Our purpose was to take night calls and to be human retractors in the operating room. During the day, I held quivering hearts upside down so that a vein graft could be sewn into their backsides. Immersed in iced saline during cardiopulmonary arrest, the hearts froze my fingers, and only hours after surgery did my frostbitten fingers regain their feeling.
    The nights on call terrified me. Cardiac patients destabilize in an instant, and my knowlege of cardiac surgery bordered on the nonexistent. Opportunities for sleep were rare—the few moments between beeper pages were spent searching for drug dosages in the pocket-sized Washington Manual. We might be called to administer drugs to a 300-pounder one minute, and to medicate a four-pound infant the next.
    I lived in constant fear of a patient “tamponade,” when a blood clot forms around the post-op heart and smothers the life from it. If left untreated, even for a few minutes, tamponade