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Life on a Knife’s Edge: A Brain Surgeon’s Reflections on Life, Loss and Survival
How do you carry on when things go deadly wrong?
When Dr Rahul Jandial operated on Karina, an eleven-year-old girl whose spinal cord was splitting in two, he had to make an impossible decision. He followed his head over his gut and Karina was left permanently paralysed, altering both patient and surgeon's lives for ever. This decision would haunt Rahul for decades, a constant reminder of the fine line between saving and damaging a life.
As one of the world's leading brain surgeons, Rahul is the last hope for patients with extreme forms of cancer. In treating them, he has observed humanity at its most raw and most robust. He has journeyed to unimaginable extremes with them, guiding them through the darkest moments of their lives.
Life on a Knife's Edge is Rahul's beautifully written account of the resilience, courage and belief he has witnessed in his patients, and the lessons about human nature he has learned from them. It is about the impossible choices he has to make, and the fateful consequences he is forced to live with.
From challenging the ethics of surgical practices, to helping a patient with locked-in syndrome communicate her dying wish to her family, Rahul shares his extraordinary experiences, revealing the depths of a surgeon's psyche that is continuously pushed to its limits.
When Dr Rahul Jandial operated on Karina, an eleven-year-old girl whose spinal cord was splitting in two, he had to make an impossible decision. He followed his head over his gut and Karina was left permanently paralysed, altering both patient and surgeon's lives for ever. This decision would haunt Rahul for decades, a constant reminder of the fine line between saving and damaging a life.
As one of the world's leading brain surgeons, Rahul is the last hope for patients with extreme forms of cancer. In treating them, he has observed humanity at its most raw and most robust. He has journeyed to unimaginable extremes with them, guiding them through the darkest moments of their lives.
Life on a Knife's Edge is Rahul's beautifully written account of the resilience, courage and belief he has witnessed in his patients, and the lessons about human nature he has learned from them. It is about the impossible choices he has to make, and the fateful consequences he is forced to live with.
From challenging the ethics of surgical practices, to helping a patient with locked-in syndrome communicate her dying wish to her family, Rahul shares his extraordinary experiences, revealing the depths of a surgeon's psyche that is continuously pushed to its limits.
224 pages, Hardcover
Published June 3, 2021
56 people are currently reading
752 people want to read
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Displaying 1 - 30 of 31 reviews
January 18, 2022
That's three 'knife' books I've read recently. The first, The Knife’s Edge: The Heart and Mind of a Cardiac Surgeon is how to be a great heart surgeon if not a really attentive husband and father and was the best book. The second, The Knife Went In: Real-Life Murderers and Our Culture refers to murderers who won't take responsibility for their actions and is amusing cynical, and this one, how to be a really great brain surgeon despite personal failings that sound like boasts (he alway has to be the best, he has to achieve and innovate). Of the three books I liked this one least.
I had previously read Neurofitness: The Real Science of Peak Performance from a College Dropout Turned Brain Surgeon and dnf'd this selfhelp book by any other name, but this title appealed to me. It was a better book, imo. The good bits were the anecdotes although only one of the, the last one, a woman with locked-in syndrome who wants to die, was really personal.
The anecdotes, even the last one were related through the lens of the author's own personal development and whereas I would want him to be my surgeon should I end up in such an extreme state as the people he treats, I don't know if I'd want to go out for a drink with him.
The stories, and there weren't that many of them, I enjoyed or learned something from were the last one where the woman could hear, see and blink and that was it, and letter by letter she spelled out from a board that she wanted to die and donate her organs. This sounds reasonable in the circumstances, but the author had said that the personal satisfaction with life of people with locked-in syndrome was about the same as people with no disabilities! Unimaginable why they would think that, gratitude for being alive maybe?
Then there was the mea culpa one which directed the rest of his personal life. He made an error of judgement in fixing a little girl's spine. Unfixed she would have become paralysed, his error of judgement in fixing it meant she was paralysed from the waist down. His colleagues circled the wagon and his admitted 'error of judgement' became 'complications' after surgery. Which is why it trying to get a malpractice case to court can take years and years, if at all. Doctors want to protect their own, even if it means lying.
Because of this, when the author had another child in his operating theatre who would have died without being given blood, he gave her blood. No one else wanted to do it, her parents, strict Jehovah's Witnesses had forbidden it under any circumstances. It would damn her eternal soul, says their doctrine. But he did it anyway, and the little girl lived.
There were other stories, but none particularly compelling, although the description of the author helping harvest organs for the first time was pretty gripping if somewhat gory.
So, even though it is the 'knife' book I liked the least, it's still a 4 star, a very good book, with lots of introspection and a very good tip on calming oneself down and a clarification of concentration.
Concentration is being able to remove distractions from the mind. I hadn't thought of it that way, but of course it is. Calming oneself down one always reads is taking deep breaths and counting to ten. The author says no, it's breathing in and out 3 seconds each and practice first so when you need to do it, it will come naturally.
I had previously read Neurofitness: The Real Science of Peak Performance from a College Dropout Turned Brain Surgeon and dnf'd this selfhelp book by any other name, but this title appealed to me. It was a better book, imo. The good bits were the anecdotes although only one of the, the last one, a woman with locked-in syndrome who wants to die, was really personal.
The anecdotes, even the last one were related through the lens of the author's own personal development and whereas I would want him to be my surgeon should I end up in such an extreme state as the people he treats, I don't know if I'd want to go out for a drink with him.
The stories, and there weren't that many of them, I enjoyed or learned something from were the last one where the woman could hear, see and blink and that was it, and letter by letter she spelled out from a board that she wanted to die and donate her organs. This sounds reasonable in the circumstances, but the author had said that the personal satisfaction with life of people with locked-in syndrome was about the same as people with no disabilities! Unimaginable why they would think that, gratitude for being alive maybe?
Then there was the mea culpa one which directed the rest of his personal life. He made an error of judgement in fixing a little girl's spine. Unfixed she would have become paralysed, his error of judgement in fixing it meant she was paralysed from the waist down. His colleagues circled the wagon and his admitted 'error of judgement' became 'complications' after surgery. Which is why it trying to get a malpractice case to court can take years and years, if at all. Doctors want to protect their own, even if it means lying.
Because of this, when the author had another child in his operating theatre who would have died without being given blood, he gave her blood. No one else wanted to do it, her parents, strict Jehovah's Witnesses had forbidden it under any circumstances. It would damn her eternal soul, says their doctrine. But he did it anyway, and the little girl lived.
There were other stories, but none particularly compelling, although the description of the author helping harvest organs for the first time was pretty gripping if somewhat gory.
So, even though it is the 'knife' book I liked the least, it's still a 4 star, a very good book, with lots of introspection and a very good tip on calming oneself down and a clarification of concentration.
Concentration is being able to remove distractions from the mind. I hadn't thought of it that way, but of course it is. Calming oneself down one always reads is taking deep breaths and counting to ten. The author says no, it's breathing in and out 3 seconds each and practice first so when you need to do it, it will come naturally.
September 18, 2021
I absolutely love his entire ethos. Got a lot of joy reading about patients and brains too, having studied medical law that has always been interesting to me too. I feel like in terms of living better, this is probably one of the best books I’ve read. The perspective he has on mindset totally aligns with my values and he articulates them perfectly. To try summarise it, we are the main drivers of our life and we can decide how to respond to adversity, failures and every challenge we face in between. There is an opportunity for growth in pain, and suffering is largely choice. The whole concept is underpinned by resilience.
December 1, 2021
Not as good as the author's first book. This is a disjointed memoir style book that jumps between personal anecdotes, musings, what the author learned and felt, sprinkled with medical cases - a bit of a hodge-podge. Some of it was interesting (but I kept on wanting more detail), but a better narrative structure would have been more helpful.
August 4, 2021
Fascinating look into the life of a brain surgeon
4 1/2 STARS
Even though it's a non-fiction memoir, this book capitvated me more than many thrillers do. If it wasn't for my need for sufficient sleep, I would have finished it in one go.
The case histories Dr. Jandial writes about are spellbinding to say the least. He is a neurosurgeon who mainly treats fatal cancers. All his patients have a limited amount of time left; the best cases 10 years; the worst cases 10 days. How do you deal with these human dramas day in day out, I wonder. You will have to read the book to find out, but I can guarantee you it will leave you gasping for breath.
I also very much appreciated the fact that he not only writes about his successes, but also about his failures and the impact they had on him and the patients (especially Karina's story). Also the competition between surgeons to be 'top dog' and -unfortunately- the incompetence of some them are not hidden. The case of the professor is particularly poignant.
Despite the gruesome topic and despite the pain of his patients, I still enjoyed this book enormously and it left me with an optimistic feeling, because some top doctors still care about their patients more than about their reputation and bank account.
4 1/2 STARS
Even though it's a non-fiction memoir, this book capitvated me more than many thrillers do. If it wasn't for my need for sufficient sleep, I would have finished it in one go.
The case histories Dr. Jandial writes about are spellbinding to say the least. He is a neurosurgeon who mainly treats fatal cancers. All his patients have a limited amount of time left; the best cases 10 years; the worst cases 10 days. How do you deal with these human dramas day in day out, I wonder. You will have to read the book to find out, but I can guarantee you it will leave you gasping for breath.
I also very much appreciated the fact that he not only writes about his successes, but also about his failures and the impact they had on him and the patients (especially Karina's story). Also the competition between surgeons to be 'top dog' and -unfortunately- the incompetence of some them are not hidden. The case of the professor is particularly poignant.
Despite the gruesome topic and despite the pain of his patients, I still enjoyed this book enormously and it left me with an optimistic feeling, because some top doctors still care about their patients more than about their reputation and bank account.
February 6, 2022
As a novice reader of books on the medical
sciences and doctors, this book kept me captivated from the very first word, even though majority of the narrative is grim and heartbreaking. As a scientist, and more precisely, as a neurosurgeon treating patients with the most complicated and rarest forms of brain cancer, Dr Jandial lays threadbare his thoughts, fears and feelings, and the various emotional thrills and turmoils he has experienced in the OT and after. He is passionate and devoted to advancing his medical skills and surgical craft and in this book he shares the knowledge gained from the numerous cases and thousands of patients he has met, saved or prolonged lives starting from his days as a surgical trainee. While speaking of his successes, he is not shy to speak of his failures or regret stemming from incorrect surgical decisions that have led to irreparable consequences for his patients. The book also provides insights on the various challenges young surgeons experience on account of the fragile egos and incompetences of senior medical surgeons. The stories on the 4 year girl hit by an SUV, Carina’s surgery, and the silent conflict with his professor mid-surgery to avert a catastrophe for the patient on the operating table, left me deeply moved, disturbed and grateful.
To feed his devoted pursuit to understand the functionings of the brain and the various diseases that can form within, Dr. Jandial not only seeks the most complicated of cases but he also demonstrates many of the basic humane qualities towards his patients and those are of utmost trust, transparency, empathy, respect and a deep sense of gratitude.
Thank you sharing your experiences with us and in a narrative that was so easy to understand and follow!
sciences and doctors, this book kept me captivated from the very first word, even though majority of the narrative is grim and heartbreaking. As a scientist, and more precisely, as a neurosurgeon treating patients with the most complicated and rarest forms of brain cancer, Dr Jandial lays threadbare his thoughts, fears and feelings, and the various emotional thrills and turmoils he has experienced in the OT and after. He is passionate and devoted to advancing his medical skills and surgical craft and in this book he shares the knowledge gained from the numerous cases and thousands of patients he has met, saved or prolonged lives starting from his days as a surgical trainee. While speaking of his successes, he is not shy to speak of his failures or regret stemming from incorrect surgical decisions that have led to irreparable consequences for his patients. The book also provides insights on the various challenges young surgeons experience on account of the fragile egos and incompetences of senior medical surgeons. The stories on the 4 year girl hit by an SUV, Carina’s surgery, and the silent conflict with his professor mid-surgery to avert a catastrophe for the patient on the operating table, left me deeply moved, disturbed and grateful.
To feed his devoted pursuit to understand the functionings of the brain and the various diseases that can form within, Dr. Jandial not only seeks the most complicated of cases but he also demonstrates many of the basic humane qualities towards his patients and those are of utmost trust, transparency, empathy, respect and a deep sense of gratitude.
Thank you sharing your experiences with us and in a narrative that was so easy to understand and follow!
September 23, 2022
One of my coworkers recommended this book, and I listened to it compulsively over a weekend. It is filled with often horrifying stories about a brain surgeon growing in his craft, and the challenges and tragedies that are part of his life. The book opens up a lot about the real horrors in this world, the kind of suffering people go through. It's sometimes gut-wrenching to read. Things like an older woman whose neck is being eaten away by cancer and who wants a super risky surgery just to live long enough to see her son graduate. Or a little mistake that a surgeon can make, that Jandial makes, and which utterly destroys a young girl's life, paralyzing her and dooming her to an existence of what sounds anyway like profound and ever-increasing misery. Or the JWs who make surgeons promise not to administer blood to save their daughter's life if it comes to that in the course of a surgery, because consuming blood is a sin and could send one to hell. There are tiresome bits of the book. Jandial sometimes pratters on for a long time about his philosophy and thoughts which I think he thinks are more profound than they really are. Still, it's overall an interesting book.
January 26, 2023
bardzo przyjemna, spodziewałam się więcej typowo medycznych aspektów a ayyor niestety zajął się dogłębnym badaniem swojej psychiki, mimo tego polecam
July 31, 2021
Probably one of the best books I’ve read on the human side of being a neurosurgeon. Dr Jandial does not shy away from talking about his mistakes and how it’s helped him become a better surgeon and a better doctor. It’s not a literary masterpiece but it’s not meant to be one, it’s telling the true stories of a what a person goes through as they hold the lives of others in their hands …. literally.
January 6, 2025
beautiful musings on resilience, pride, and emotion and cognition as a balancing act
October 7, 2024
Very thought provoking. We always tend to think of surgeons as totally sure of their actions, forgetting that they are human, with all the frailties that come with that.
Mr Jandial (consultants in the UK are always called Mr) proved that he is only human, as he openly admitted to feeling that there were times he had failed his patients.
But as a neurosurgeon specialising in that most insidious of diseases - cancer - it proved that he was (and is) a human being. All too often a surgeon just sees the part that they are dealing with - the rest (aka the patient) is just a piece of meat. But Mr Jandal came across as the sort of surgeon that you would want to treat you - he saw the entire patient.
Mr Jandial (consultants in the UK are always called Mr) proved that he is only human, as he openly admitted to feeling that there were times he had failed his patients.
But as a neurosurgeon specialising in that most insidious of diseases - cancer - it proved that he was (and is) a human being. All too often a surgeon just sees the part that they are dealing with - the rest (aka the patient) is just a piece of meat. But Mr Jandal came across as the sort of surgeon that you would want to treat you - he saw the entire patient.
August 1, 2021
This book offers a fascinating insight into the experiences of a brain surgeon, who deals with the fine line between life and death on a daily basis, and whose profession gives him an enormous amount of responsibility in very high risk situations. There’s a lot of emotion that can be felt in the narration, a lot of heartbreak with mistakes made and the weight those mistakes carry. I listened to the audio book and enjoyed Dr Jandial’s narration and storytelling, though at times the intricate detail of the brain / body and the surgery lost my attention a little.
September 29, 2021
I did not like this book at all because I did not like this doctor one bit. He came across as an arrogant,narcissistic and extremely selfish individual. Contrast his philosophy and pompous writing with that of the wonderful brain surgeon Henry Marsh, a man so incredibly humble, compassionate with an enormous amount of humanity. Rahul Jandial has none of these traits and I would not want him operating on me or my family.
January 29, 2023
I enjoyed this author’s writing style with his mix of personal experience, technical explanations, and lessons learned. I learned more about the brain which is fascinating. I also can apply the lessons he learned to my own life. Some of the stories were graphic and brought me to tears which is most unusual for me in reading a book. This shows how real he described the experiences. I definitely recommend this book and I look forward to reading more of his work.
November 10, 2023
A revealing insight into the life and career of a top brain surgeon. Fascinating to hear about his interactions with patients facing overwhelming challenges and how they changed their outlook on life because of it.
May 26, 2024
Phew! This book is very intense give the nature of the subject, but it has profound insights throughout. I appreciated the poetic way he described biology in a way the average reader can understand. Each chapter examines a particular patient or encounter he had and his reflection on it.
October 26, 2025
2.5 sądząc po tytule książki i opisie można twierdzić że dostaniemy wiele historii o różnych przypadkach tego co dzieje się na stole operacyjnym neurochirurga . A jednak samych operacji jest naprawdę mało a ponad połowa książki opiera się na autora własnym ja i jego wyspie w mózgu
This entire review has been hidden because of spoilers.
January 23, 2022
Very practical and engaging short book or providing accessible insights into neurosurgery and brain health and evolving medical approaches. A good read.
February 18, 2022
Absolutely brilliant book, so thought provoking in parts and an incredible insight into the world of a brain surgeon. Looking at loss, grief and life.
April 9, 2023
"In your lifetime, it's likely you'll have to deal with a traumatic event... In the moment the trauma arrives, step one is to survive - simply survive... [but] we must revisit the trauma on our own terms and on our own timeline, never letting it sit idle."
August 28, 2023
If you are interested in biology this is the book for you!!!
October 25, 2023
Dr Jandial, provides some insight into some personal challenges he has had to face. He shares how the brain and its physiology is deeply rooted into what makes us human.
A decent read !
A decent read !
September 6, 2024
yeah who cares about hippa violations anyways
June 15, 2025
It has been a long time since i have read non-fiction that fast
April 12, 2022
I have mixed feelings about this one and I am trying to organise my thoughts so that my review reflects everything.
This was not a year-by-year, blow-by-blow chronology of the author's life and career but a sort of 'surgery greatest hits'. There were only a select few, but each of them had a huge impact on Dr Jandial. They were emotive, moving and full of tension. It seems wrong to say that I enjoyed these sections but I devoured the often graphic descriptions and the medical explanations behind the surgeries, the complications and the recoveries. Don't get me wrong, I had to concentrate during some of the medical descriptions but I felt that everything was well explained without being patronising or over-simplified.
The bits that I lost interest in a little were the more meandering musings between each case. They were a bit more theoretical and philosophical and to be honest I didn't want to try and understand the philosophy behind trauma or fight or flight. I just wanted the more explicit accounts of actual patients because those were the sections that impacted me emotionally.
I've rated down the middle for the simple reason that personally I was reading more for the experiences and not the medical musings and so my interest wavered like a brainwave at times.
This was not a year-by-year, blow-by-blow chronology of the author's life and career but a sort of 'surgery greatest hits'. There were only a select few, but each of them had a huge impact on Dr Jandial. They were emotive, moving and full of tension. It seems wrong to say that I enjoyed these sections but I devoured the often graphic descriptions and the medical explanations behind the surgeries, the complications and the recoveries. Don't get me wrong, I had to concentrate during some of the medical descriptions but I felt that everything was well explained without being patronising or over-simplified.
The bits that I lost interest in a little were the more meandering musings between each case. They were a bit more theoretical and philosophical and to be honest I didn't want to try and understand the philosophy behind trauma or fight or flight. I just wanted the more explicit accounts of actual patients because those were the sections that impacted me emotionally.
I've rated down the middle for the simple reason that personally I was reading more for the experiences and not the medical musings and so my interest wavered like a brainwave at times.
June 24, 2023
Dr Rahul Jandial is a brain surgeon and neuroscientist. I first read his book Lessons From a Brain Surgeon in August 2019 and it has stayed with me ever since, so when I saw this book I had to get it.
Dr Rahul writes so eloquently, succinctly and yet so deeply about what he learns from his patients, the impossible choices and the extraordinary experiences both he and his patients face, when dealing with the most aggressive and extreme forms of illness.
It is just such a fascinating book. Every page makes you reflect on life, loved ones, choices and even how we learn and grow from the most challenging circumstances. The book manages to achieve this, whilst detailing brutal surgery, illness, paralysis and sometimes death.
Dr Rahul doesn’t have all the answers. There are parts of the brain that we are still trying to understand deeply. I enjoyed the combination of real-life stories and medical explanations. If you find programmes like 24 hours in A&E intriguing and you are not squeamish, I expect you would enjoy this book.
Dr Rahul writes so eloquently, succinctly and yet so deeply about what he learns from his patients, the impossible choices and the extraordinary experiences both he and his patients face, when dealing with the most aggressive and extreme forms of illness.
It is just such a fascinating book. Every page makes you reflect on life, loved ones, choices and even how we learn and grow from the most challenging circumstances. The book manages to achieve this, whilst detailing brutal surgery, illness, paralysis and sometimes death.
Dr Rahul doesn’t have all the answers. There are parts of the brain that we are still trying to understand deeply. I enjoyed the combination of real-life stories and medical explanations. If you find programmes like 24 hours in A&E intriguing and you are not squeamish, I expect you would enjoy this book.
February 8, 2023
Three and a half really. There was rather too much medical explanation and philosophical meandering. Valuable for the author but not so interesting for a general reader. However the author is sensitive , empathetic and of course highly intelligent and skilled.
Displaying 1 - 30 of 31 reviews