Marsh, Henry: Do No Harm: Stories of Life, Death and Brain Surgery

There are very few books in which professionals speak frankly and honestly about their profession. It’s a bit like magicians. They never give away the secrets of their magic, they just get on and do it. But Henry Marsh has revealed the secrets of the Magic Circle of Neurosurgeons.

Who is this man? He’s pictured inside the back cover: a genial chap, a veteran now, wearing a pale blue surgeon’s gown. He has enormous hands, or is it the camera angle that makes it seem so?

He graduated from Oxford University with a degree in Politics, Philosophy and Economics, but later turned to medicine. Without a degree in science, the only medical school that would have him was the Royal Free Medical School, London. He is now a senior consultant neurosurgeon at St George’s Hospital in south London, specializing in brain surgery: a special style of brain surgery where the patient is merely under a local anesthetic.  That way, the surgeon or assistant can to ask his patient questions about how they feel, or find out if they can recite the alphabet. This crucial feedback is used to guide the surgeon’s knife as it seeks the right place within that most delicate of organs, the brain. Perhaps what I’ve just written is a simplification of the actual process but I’m trying to write in a simple and straightforward manner, just as the author does.

He demonstrated something of his method on TV back in 2004, for the BBC documentary Your Life in Their Hands. If I were operating on a human brain (God forbid) I think the presence of BBC camera crew would be a distraction. Apparently not in his case, as the patient survived and the programme won a prestigious gold medal.

Most chapters of the book describe a single operation to cure a particular condition, each being given its medical name and a plain English definition. There are many such conditions, and to read the book is to receive a brief medical education in this specialized area. One learns about the symptoms. The reader will doubtless wonder whether that headache he gets is caused by a tumor, and why could I not walk in a straight line after that night out? Actually, our book group didn’t discuss our personal symptoms – and in any case our medical member wasn’t present on this occasion to tell us ‘don’t worry’.

You may have often wondered how surgeons get started. Some poor soul has to be their first victim…er…I mean patient. Well, the book tells us how it’s done. Yes, it is just a little bit dodgy, and if I need surgery I’m going to plump for an older surgeon. There is also the issue of success rate. A bold and skilful surgeon will take on some of the more challenging cases, and so may have a lower success rate than a beginner, so the hapless patient should not expect to find useful data from which to judge the likely outcome of the operation.

The author recalls operations and family circumstances in great detail. Did he keep a diary like politicians do? Probably he just has a great memory, as most physicians do. Without it, they would fail all those MD and Royal College examinations. It is noteworthy that the surgeon must deal with the family as well as the patient: being a surgeon is not the same as being a technician, one has to talk to, and deal with, troubled people in their most vulnerable moments. Many of these situations are portrayed with a good deal of compassion. Sometimes it all goes wrong and the surgeon (or rather the hospital) must face a legal challenge. It’s clear that things do indeed go wrong. The author describes the shocked response of a lecture he gave on that very subject, called When Things Go Wrong.

His career has been unconventional. For example, he tells us of his time in the Ukraine. He visited the country often, helping the poorly funded Ukrainian colleagues to improve their neurosurgery. Conditions in the hospital were grim, and it was necessary to take second-hand equipment from the UK to supplement what little was available locally. He seems to have been able to move around rather freely in the Ukraine (in the 1990s), carrying out difficult operations under the most testing conditions.

He has much to say about the condition of British hospitals. A particular hobby-horse is the design of hospital buildings – he considers them often not fit-for-purpose.  Perhaps the buildings are improving, but not so the rest of the working environment. He repeatedly makes the point that the administration has become so heavy handed that his job is made harder than it was in the early part of his career. Nowadays, he sometimes has trouble finding his patient, as the sick are forever being moved from one ward to another to release beds.  Moreover, the number of operations that can be fitted into a day has decreased because of regulations on working hours, and unnecessary rules that force long breaks between operations whilst the theatre is cleaned and prepared. One of the most hilarious sections of the book is when he describes his attendance at a compulsory course given for all hospital staff on the subject of Customer Care.  It’s not Patient Care anymore. He secretly looks forward to a good sleep at the back of the room, but things do not turn out as expected. He concludes ‘how strange it is that I should be listening to a young man with a background in catering telling me that I should develop empathy..’.

Yes, surgeons are usually arrogant – they need to be self-assured – and aren’t they often charismatic? It goes with the territory. But this one is capable of laughing at his own misfortune when he himself becomes a patient and falls down the stairs, breaking a leg. Yes, it’s good to be able to chuckle at the mighty downfallen.

We were unanimous: we all loved the book. It was easy to read and fascinating. The drama of the work was totally absorbing, at least up to the last few chapters which might have been omitted – they seemed like more of the same.  We were full of admiration for our surgeon. It should be recommended reading for all young doctors. I hope he trained sufficient young doctors to carry on the good work.