Do No Harm (Henry Marsh) – A Book Review

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You’re probably not a brain surgeon. Have you ever wondered what it might be like to be one? If so, this may be the book you need. In a meandering narrative, ranging from his early training up to the modern NHS, the author, eminent neurosurgeon Henry Marsh, paints a warts-and-all picture of himself and his profession.

There are highs – operations with immediate and spectacular results, like a pregnant lady whose sight is restored. Brain anatomy is described with admiration worthy of a great work of art, and the experience of a difficult operation going well is presented as an almost religious experience.

But if the highs make you want to become a neurosurgeon, the lows may dissuade you. The disasters are bad to an extent many of us could not begin to imagine in our professional life. In perhaps the most haunting passage in the book he visits a nursing home for those with persistent low levels of consciousness and finds he recognises several of the names on the doors – a human record and reminder of his past failures.

Of course, all doctors must live with the risk that their mistakes can be very costly. A physician who misses a crucial diagnosis, a psychiatrist who disregards a report of suicidal ideas, a junior doctor who prescribes the wrong dose of a medication; all can have disastrous or even fatal consequences. But there is something direct about brain surgery – a slip of the hand, a crucial blood vessel damaged, and the patient is immediately and irrevocably lost. Most medical errors can be attributed to a combination of factors, and responsibility can be shared; not so here. Marsh writes movingly of his regrets; his disasters are followed by long hospital stays where he has to see people injured by his mistakes, talk to the families, and then go on to the operating theatre to start again on a new patient.

There is more to this book than a catalogue of successes and failures. There is laudable humanitarian work in Ukraine. There is a brief account of Marsh’s own ill health. There is a stark contrast between his mother’s civilised and peaceful death at home and the deaths of his patients. There are countless complaints and moans about the current direction of the NHS, its abundance of paperwork, managers, and committees, which are less compelling.

As an account narrated by Marsh in the first person, the book exposes a lot of his character. Just as he doesn’t attempt to hide his mistakes in the operating theatre, he doesn’t attempt to hide his flaws as a person. His obsession with his work leads to the break-up of his marriage. He admits being rude and difficult with colleagues. In one rather bizarre passage, he describes his irritation at having to wait in a queue in a supermarket, behind people who are so much less important than him. At times it is hard for the reader to side with him. Crises of confidence never last long, and he is able to move on and operate on his next patient. He mentions a neurosurgeon of a previous generation who, asked about a patient whose surgery had gone disastrously wrong that morning, had already forgotten both the patient and his mistake. This ability to forget about mistakes is held up as something almost worthy of envy. But Marsh’s fascination with his mistakes shows a keenness to learn from them, and perhaps his ego helps him to confront them; he recounts how, as a visiting lecturer in the US, he gave a lecture titled “My greatest mistakes”. He finishes the lecture to stunned silence. Few doctors would choose to give a lecture on that topic.

On the face of it, this book is a collection of stories about brain surgery. At times it reads like an advert for the profession, at others like a cautionary tale. It is also a startlingly honest self-portrait of an interesting and flawed man, and his quest to make a difference. It is beautifully written – Marsh must surely be the only neurosurgeon around who obtained a degree in politics, philosophy and economics before converting to medicine.

The title, “Do no harm”, is part of the Hippocratic Oath. But this book illustrates in graphic detail how impossible this task is. Perhaps a better (but less catchy) title would be “Do more good than harm”. You get the impression that Marsh is still struggling to live with his mistakes.

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