What do you think?
Rate this book
Working in a Very Small Place: The Making of a Neurosurgeon
A look inside the world of Dr. Peter Jannetta--a pioneer in the world of neurosurgery--explores the techniques he has developed which were once received with scepticism and now are the standard world-wide
- GenresNonfictionBiography
315 pages, Paperback
First published July 5, 1989
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 6 of 6 reviews
April 7, 2023
This was an interesting non-fiction (hardback
edition). I gave this 3.5 stars.
The author showed us the making of a neurosurgeon.
Dr. Peter Jannetta served as chief of neurosurgery @
Presbyterian University Hospital in Pittsburgh, did
6 to 11 neurosurgeries total over 2 days each week.
He drank about 25 cups of coffee daily! & worked 6
days per week. Residents spent 7 yrs in this program.
Included in that time frame, Jannetta insisted each
resident do 1 year of research, on a topic of the
resident's choice.
Dr. Jannetta used a surgery microscope & had a video
monitor, during each of his surgeries. He often did 2
surgeries at once. He had an attending MD & resident
in each room & Dr. J alternated between the 2 rooms.
Dr. Jannetta developed a controversial procedure
microvascular decompression to treat trigeminal
neuralgia, a facial pain which patients described as
"a lightening bolt," "being burned with a hot wire,"
& "being tased in the face." This procedure also
had other applications IE disabling vertigo etc.
Dr. J insisted the patient's hearing be monitored
during the procedure, as he could lose hearing in
1 or both ears.
Twenty years prior a neurosurgeon discovered
aspects on resolving the problem above, but Dr. J
devised the solution. Dr. J taught this procedure to
other neurosurgeons in other states and countries.
They validated his success. Patients visited Dr. J
and neurosurgeons trained in this procedure.
The neurosurgeon residents walked a fine line, they
could not be too cocky, or too indecisive. Dr. J and
the attending doctors wanted residents to learn from
their mistakes & not repeat them. He preferred
inhalation anesthesia (IA) as patients were awake
sooner after the procedure & the neurosurgeon could
ask questions, to prevent an emergency.
The author observed surgeries and recorded what
happened. The anesthesiologist wasn't in the room
when Dr. J noted a patient seemed to be about
to awaken. There was a problem w/ the IA & Dr. J
wanted it fixed immediately.
They held a Neurosurgery Morbidity & Mortality Con-
ference, Saturdays, lead by Dr. J & attending docs for
benefit of the residents. Most comments were brutally
honest. Residents had to defend the choices they made.
30 years ago, as a social worker, I had a developmentally
disabled client, who was declared "brain dead." The author
here explained a xenon-enhanced CT might prove the
definitive test for "brain death." He added a MD who can
demonstrate that the patient has no blood flow within the
brain can conclude that a patient is dead & not deeply
comatose. (page 242).
Neurologists & Neurosurgeons connected to this
university collaborated rather than competed with
each other for patients. This book was published
in 1989. At that time MDs were required to have 100
hours of approved continuing education per yr. I am
unclear if this remains the same?
edition). I gave this 3.5 stars.
The author showed us the making of a neurosurgeon.
Dr. Peter Jannetta served as chief of neurosurgery @
Presbyterian University Hospital in Pittsburgh, did
6 to 11 neurosurgeries total over 2 days each week.
He drank about 25 cups of coffee daily! & worked 6
days per week. Residents spent 7 yrs in this program.
Included in that time frame, Jannetta insisted each
resident do 1 year of research, on a topic of the
resident's choice.
Dr. Jannetta used a surgery microscope & had a video
monitor, during each of his surgeries. He often did 2
surgeries at once. He had an attending MD & resident
in each room & Dr. J alternated between the 2 rooms.
Dr. Jannetta developed a controversial procedure
microvascular decompression to treat trigeminal
neuralgia, a facial pain which patients described as
"a lightening bolt," "being burned with a hot wire,"
& "being tased in the face." This procedure also
had other applications IE disabling vertigo etc.
Dr. J insisted the patient's hearing be monitored
during the procedure, as he could lose hearing in
1 or both ears.
Twenty years prior a neurosurgeon discovered
aspects on resolving the problem above, but Dr. J
devised the solution. Dr. J taught this procedure to
other neurosurgeons in other states and countries.
They validated his success. Patients visited Dr. J
and neurosurgeons trained in this procedure.
The neurosurgeon residents walked a fine line, they
could not be too cocky, or too indecisive. Dr. J and
the attending doctors wanted residents to learn from
their mistakes & not repeat them. He preferred
inhalation anesthesia (IA) as patients were awake
sooner after the procedure & the neurosurgeon could
ask questions, to prevent an emergency.
The author observed surgeries and recorded what
happened. The anesthesiologist wasn't in the room
when Dr. J noted a patient seemed to be about
to awaken. There was a problem w/ the IA & Dr. J
wanted it fixed immediately.
They held a Neurosurgery Morbidity & Mortality Con-
ference, Saturdays, lead by Dr. J & attending docs for
benefit of the residents. Most comments were brutally
honest. Residents had to defend the choices they made.
30 years ago, as a social worker, I had a developmentally
disabled client, who was declared "brain dead." The author
here explained a xenon-enhanced CT might prove the
definitive test for "brain death." He added a MD who can
demonstrate that the patient has no blood flow within the
brain can conclude that a patient is dead & not deeply
comatose. (page 242).
Neurologists & Neurosurgeons connected to this
university collaborated rather than competed with
each other for patients. This book was published
in 1989. At that time MDs were required to have 100
hours of approved continuing education per yr. I am
unclear if this remains the same?
July 23, 2017
While this an older book, written almost 30 years ago, it is never the less still an interesting book about Peter Jannetta, the neurosurgeon who perfected the microvascular decompression (MVD) surgery for Trigeminal Neuralgia and Hemifacial Spasm. Although he died in 2015 at the age of 81, Jannetta's research and papers are cited continually and many top neurosurgeon's resumes include being trained by him. As I am facing this surgery at some point, learning about Jannetta and the process in which this surgery became "the standard", despite much controversy, was fascinating.
March 14, 2017
In a galaxy far, far away I once dreamed of being a neurosurgeon. I read this and it was so inspiring. Alas, life had other plans...
September 18, 2018
A book set in the 1980's as Dr. Peter Janetta, a Pittsburgh neurosurgeon is making a name for himself in the field by treating patients afflicted with trigeminal neuralgia and similar conditions by placing a piece of medical grade felt in a very specific location to alleviate their symptoms. Shelton chronicles Janetta's rise to prominence and how it took many years of bucking trends for Janetta's methods to become accepted by most, such that at the time the book was written, Janetta's treatment was the gold standard for trigeminal neuralgia and further uses of the technique were being developed all the time.
Of course, there are critics, often older surgeons who aren't inclined to use an operating room microscope (a necessity for the procedure) or feel that the modest success of the procedures they learned in their day is sufficient and not prohibitive enough to make them want to learn something new and foreign. Based on the case studies Shelton presented in the book, obviously all Janetta successes, it was enough to convince me that Janetta knew what he was doing and his willingness to try a new approach was greatly beneficial to his patients. Prior to reading this book, my knowledge of cranial nerve disorders was minimal, so I can't say I had any incoming bias, as I couldn't even tell you what they do to treat trigeminal neuralgia today, 30 years after the book was written. Could be Janetta's approach, a modified/improved version thereof, or something completely different if this generation of neurosurgeons feel he was a quack or his theories were all wrong as it turns out. Certainly something I will research, but a good book to serve as an introduction. Had I been more versed, I may have found it dated, but other than some references to smoking and the notion that OR microscopes are a new technology and unlikely to be found in many hospitals, I could have easily believed this book was written within the last decade or so.
Of course, there are critics, often older surgeons who aren't inclined to use an operating room microscope (a necessity for the procedure) or feel that the modest success of the procedures they learned in their day is sufficient and not prohibitive enough to make them want to learn something new and foreign. Based on the case studies Shelton presented in the book, obviously all Janetta successes, it was enough to convince me that Janetta knew what he was doing and his willingness to try a new approach was greatly beneficial to his patients. Prior to reading this book, my knowledge of cranial nerve disorders was minimal, so I can't say I had any incoming bias, as I couldn't even tell you what they do to treat trigeminal neuralgia today, 30 years after the book was written. Could be Janetta's approach, a modified/improved version thereof, or something completely different if this generation of neurosurgeons feel he was a quack or his theories were all wrong as it turns out. Certainly something I will research, but a good book to serve as an introduction. Had I been more versed, I may have found it dated, but other than some references to smoking and the notion that OR microscopes are a new technology and unlikely to be found in many hospitals, I could have easily believed this book was written within the last decade or so.
November 24, 2008
Funny, wild, weird. Lori recommended this, not knowing that I've already read it and own it, having lived it.
I can't really review the book because I can't imagine how it would read as a detached reader. As someone seeking information before making a decision, I found parts of it over-simplified, but loved having Dr. Jannetta's story put into its historical context.
I can't really review the book because I can't imagine how it would read as a detached reader. As someone seeking information before making a decision, I found parts of it over-simplified, but loved having Dr. Jannetta's story put into its historical context.
Want to Read
October 16, 2009I have this book just need to read it.
Displaying 1 - 6 of 6 reviews