Brain Surgeon, A Doctor's Inspiring Encounters with Mortality and Miracles

之前读过英国神经外科医生 Henry Marsh 写的《Do Not Harm》。再来读下这本美国神经外科医生 Keith Black (俗称“黑医生”。美国著名神经外科专家、西达-赛奈医学中心(Cedars-Sinai Medical Center)神经外科研究所及脑肿瘤中心主任医师) 的回忆录。

FOREWORD By Forest Whitaker

Forest Whitaker. 福里斯特·史蒂芬·惠特克 美国黑人演员。

Chapter 1. Tiger Country

Chinese naturopath: 美国人对所谓“中医”的称呼。
naturopath /╵neitʃrəpæθ; ╵netʃərə╷pæθ/ 
n person who treats illness by suggesting changes of diet╷ exercise╷ etc and without using medicines 自然疗法家（通过改变饮食、锻炼等而不用药物治病者）.

glioblastoma 胶质母细胞瘤, aka glioblastoma multiforme (GBM, glioma)—the most malignant of all brain tumors. 在神经外科类型作品里出场率非常高。也是最常见的原发性脑肿瘤（占比>=50%)
在当时，这种肿瘤确诊后的中位生存期(Median survival)是 9-15个月。

Anything less than an image-complete resection, where no visible tumor can be seen on the post-operative MRI scan, usually does little to extend the life of the patient. As a surgeon, I know that I must get 99.9 percent of the tumor out in order to have a significant impact on my patient’s survival.必须做到影像学意义上的完全切除肿瘤才有手术指征。并且这种手术意义是延长生存期而非彻底治愈。

Over the years I’ve learned that my patients are people who
can live an entire lifetime in six months or a year. What they do with this time represents a much higher quality of life than that enjoyed by “normal” people who are caught up in the trivia of day-to-day, and not really focused on what is important. When you are given a year with the people you love, you don’t squander the gift. You don’t sit around playing video games or watching reruns—not if you have a young son or daughter with whom you need to build a relationship they will remember for the rest of their lives, or a spouse you might fall in love with all over again.

People often ask me, “How can you work with these patients, knowing that so many of them are going to die?” I cannot imagine better people to work with. I learn from them, as I watch them cherish every moment of their days. These people teach us all about the meaning of life well-lived. I

Chapter 2. A Love Affair with the brain

作者7岁时就能用手术工具麻醉并解剖青蛙、为被玩具枪击伤的小鸟做手术取出BB弹并清创伤口。

14岁(8年级)时能独立给狗做人工心脏瓣膜(heart valve)置换手术(当时的人工心脏瓣膜相当原始)，甚至还可以参与狗的心脏移植手术。在学校学高等数学(微积分)和德语。作者用当时刚刚出现的扫描隧道显微镜做实验时意外发现了开胸手术中使用的体外心肺机(heart bypass machines)导致红血球畸形的现象。畸形的红血球无法自由变形以通过直径较小的毛细血管，会导致毛细血管堵塞。如果这发生在大脑，将可能导致小型中风。这可以解释(当时)开胸手术后患者出现的记忆和认知障碍并发症。

17岁时作者把对上述研究写成论文发表并获奖。

本书中出现的美国俚语单词好多。

Phineas Gage. 费尼斯·盖吉（1823年－1860年5月21日），美国铁路工头。他在一场意外事故中，被一支长铁棍由左下脸颊刺入，穿越左眼后方，再由额头上方头顶处穿出脑壳。导致前额叶(frontal lobes)严重受损。他虽然奇迹似的生存下来，但自此性格大变。在他后来的12年中，经由治疗医师的长期研究，对人类大脑的机能探讨大有贡献。

读过的几乎所有医生的回忆录都写到了他们主刀的第一个手术对其职业生涯选择的决定性影响。那是一种神奇的满足感和成就感。


What an absolute joy! This was a level of gratification I could only imagine before. Working with my hands and my brain, I was able to restore this man’s language and his ability to move. It was an exhilaration I wanted to feel again and again。

Bible (Luke 12:48)： Of those to whom much is given, much is expected.
约翰肯尼迪曾引用过这段。

想起刚刚看完的《War doctor》后记里作者妻子的话：people of great strength doing remarkable things. 最能概括这种观念的句子是"With great power comes great responsibility" (大いなる力には、大いなる責任が伴う)(这个Wiki词条没有中文条目)。这句话因为《蜘蛛侠》作品而变得家喻户晓。这也是 Linux 里 (第一次)输入"sudo" 命令时出现的三条提示之一：

We trust you have received the usual lecture from the local System Administrator. 
It usually boils down to these three things:

    #1) Respect the privacy of others.
    #2) Think before you type.
    #3) With great power comes great responsibility.

Chapter 3. Risks and Rewards

clival chordoma 克利夫脊索瘤

Harvey Cushing 哈维·威廉斯·库兴（1869年4月8日－1939年10月7日）是美国的神经外科名医、美国陆军退役军医上校。他是脑外科学的先驱、最早提出库兴氏症候群的学者，后世称之“现代神经外科之父”。

There are two types of tumors: primary and metastatic. A primary originates in the
brain. A metastatic starts somewhere else. Of these two types, metastatic tumors are far more common.