Introduction -- Lessons Learned from Four Decades of Neurosurgical Global Health Experience -- A Life in Global Health: Preserving What Is Noble in a Profession -- First Influences. Where Does All This Start? -- Second Influences: Appalachia -- Appalachian Patients -- Appalachian Clinics -- Seasons of the Year -- Guatemala -- Chicken Buses, Dugout Canoes, Pickup Trucks and Shoe Leather -- Applying Lessons Learned to a New Area of Neurosurgical Need -- Why Work So Hard? -- Hold Hope -- Picking a Site for Neurosurgical Service: Ecuador -- Family -- The Red Scrub Cap -- First Surgeries -- FIENS -- Africa -- Operating in a Strange Land -- Worldwide Partners in Global Neurosurgery: The Concept of Dyads -- OR Equipment and Establishing Neurosurgery in a New Region -- The Lancet Report 2015 -- Continuing Medical Education in the Global World -- Persistence -- Service Through Education -- The Corners of the Day -- Teaching is Doctoring, Doctoring is Teaching -- Why I Do Research -- Native American Health -- Children and Family in Global Health -- Danger -- Mistakes Made and Lessons Learned -- The Magic That Makes Us a Person -- What Did We Learn From COVID-19 -- On Death -- The Way Forward -- Epilogue.