The burden and fear that precede surgery do not belong only to the patient and his family. Even the doctor, and with him all the staff involved, acts across the thin divide between fear and courage, between responsibility and fragility. This is where it comes from Awakethe autobiographical novel by Christian Brognainternationally renowned neurosurgeon, published by Rizzoli and written together with Claudia Zanellaactress and writer. A book that, even before arriving in the bookstore October 21stsold out in pre-order and reprint.
It is a story that for the first time overturns perspective, revealing the most intimate dimension of the surgeon: the fears, the concentration before an operation, the meditation, the physical and mental training, the need to keep the mind clear like a Formula 1 driver or a downhill skier on the track. Awake it is the story of a doctor who chooses to tell not only the fear of patients, but also his own. And how that fear can transform into awareness and care.
Doctor Brogna, you write that your goal is not just to remove a tumor, but to protect the person in his entirety. How has this vision changed your daily clinical practice?
Operating the brain means intervening on the seat of identity. It is there that memory, language, emotions, a sense of humor and the ability to love live. This is why I have always felt that my task could not just be technical: it is not enough to remove a lesion, it is necessary to protect what makes a person themselves.
This awareness transformed my approach to neurosurgery. There awake surgery — operating with the patient who is awake — was born precisely from this need: to enter into a relationship with whoever is in front of me, to understand their desires, their fears, what they cannot afford to lose. Often it is the patients themselves who show me the route: there are those who tell me “don’t take away my memory”, those who want to continue writing, painting, those who just ask to be able to continue recognizing their children. These requests guide my hands more than radiological images.
Awake surgery then becomes a constant dialogue: while I intervene, the patient speaks, draws, plays. Through his experience, I am able to orient myself.
And so, every intervention becomes not only a medical gesture, but an act of custody of the person in his entirety. I must and want to protect their identity.”
In Awake he also talks about the doctor’s fears, which are often overlooked. What was your greatest fear in the operating room and how did you turn it into strength.
We never talk about the fear of us doctors. As if everyone were entitled to have them – the patient, his family, his friends – but we are not. As if the white coat were armor that doesn’t scratch. But that’s not the case. I wish it were like that!
The great fear of us doctors in the operating room is that of making an irreversible mistake that could compromise the life of a patient and, consequently, that of his family. It is an enormous responsibility, which sometimes weighs like a boulder on the heart and mind.
Over time, however, (and also thanks to meditation) I have learned to transform this fear into a strength: even deeper attention, total concentration, authentic respect for those in front of me. It is not a paralyzing fear, but a guide that pushes me to be meticulous and present in every gesture and decision.
In the book she talks about the operation on Giorgio, a patient who played the saxophone while she operated. How much does it matter, in awake surgerythe creativity of patients in guiding it within the complexity of the brain?
The book takes shape around ten decisive hours: the intervention on Giorgio, a young saxophonist, who plays his inseparable sax while undergoing surgery. Giorgio’s surgery is one of the most emblematic examples of how fundamental the patient’s creativity is in awake surgery. When the patient plays the saxophone during the operation, it is not just a symbolic gesture: it becomes a living mapping tool. Asking him to play allowed me to monitor in real time the areas involved in his artistic, cognitive, motor, linguistic and mathematical abilities, helping me to avoid damage that could have compromised them.
In this sense, the patient’s creativity not only guides my hand, but becomes an active part of the treatment itself. It is a unique and lively dialogue, in which the patient is not a passive subject, but a travel companion, a precious collaborator on the healing journey.
After experiencing a coma due to meningitis, he experienced firsthand the fragility of the mind. How much has this experience changed your relationship with patients?
Three years ago I experienced firsthand the terror that comes with a serious illness, a terror that I could only imagine before, but had never really experienced.
Suddenly, on my birthday, due to bacterial meningitis, I was the one experiencing that fragility. I have always been very close to my patients, since my specialization days, but in that moment I understood what it means to live suspended between fear and hope. And this feeling, now, after my coma, is even clearer, and I carry it with me and in my relationship with my patient, in his treatment journey. Now I know what he really feels and I can listen to him even more authentically.
Awake it is written together with Claudia Zanella. Why did you choose to entrust your story to co-writing and what did this collaboration give you?
I am a doctor, Claudia a writer. We do profoundly different jobs.
Without her, this book would never have existed. Alone I could have written a scientific manual, similar to my publications. But Awake it’s something else: it’s a narrative essay that has the feel of a novel, even if it tells a true story. To bring it to life, a writer or a writer was needed.
Furthermore, Claudia is also an actress: she studied at the Academy and has the extraordinary ability to completely enter into characters. It’s strange to say this, but she managed to become me.
Every morning she came to the operating room, dressed as a doctor, stood next to me and listened to everything I told her. Then he returned home and transformed those fragments into pages full of emotions.
My story, his pen. And from this union he was born Awake.
What is the state of health of healthcare in Italy? What should be improved?
After graduating and specializing at the Sapienza University of Rome, I decided to leave and look for the “giants”, the best teachers from whom I could really learn. I worked in hospitals in France, Türkiye, Brazil and for seven years at King’s College Hospital in London. This path allowed me to closely compare different healthcare models, to see different approaches and mentalities.
Italian healthcare is supported every day by doctors, nurses and healthcare workers who work with love, dedication and a spirit of sacrifice, often in truly difficult conditions. We have extraordinary excellence, advanced technologies, highly trained professionals and medical universities among the best in the world. If I could go back I would go to Sapienza University again, without thinking twice! But it is undeniable that the system is under pressure. There is a lack of resources, a lack of doctors and nurses, a lack of long-term visions that fuel the motivation of healthcare workers. But above all there is no time. Time to listen, to create a relationship of trust, time to really take care of the person and not just their illness.
