Now approaching retirement after working as a senior consultant at St George’s Hospital in London since 1987, ‘Do No Harm: Stories of Life, Death and Brain Surgery’ is Henry Marsh’s reflection on a long and distinguished career in neurosurgeon. Yet the first sentence of the opening chapter is rather disconcerting to say the least, especially coming from one of the most experienced neurosurgeons in the UK: “I often have to cut into the brain and it is something I hate doing.” Having encountered a significant number of highs and lows throughout his career, it is soon clear this isn’t something Marsh has ever taken for granted.
Marsh studied PPE at Oxford University before switching to medicine at the Royal Free Medical School in the days when relatively trivial matters like not having any science A Levels didn’t hold students back. Three years after becoming a junior doctor, he eventually decided to specialise in neurosurgery after he was asked to assist with a brain aneurysm operation. ‘Do No Harm’ is essentially a series of case studies with chapters organised around different types of brain tumours and head injuries he has operated on. Marsh’s harrowing accounts of surgical operations are edge of the seat stuff – some are life-saving successes while others are catastrophic disasters. He is unflinchingly honest about how he deals with the consequences of his errors, some of which are fatal and other complications which are life-changing and irreversible. The dilemma is that significant risks must be taken in a highly pressurised environment in order for medicine to advance and for surgeons to become better at what they do.
With such highs and lows to contend with, ‘Do No Harm’ is neither particularly depressing nor especially uplifting overall – just very honest and balanced. Marsh blends the medical aspects of neurosurgery and his personal reflections very well. Rather than a lengthy account of the technical complications of such operations, ‘Do No Harm’ is principally about empathy and decision-making. Marsh’s disillusionment and frustration with modern NHS bureaucracy is also well documented here along with his charitable work in Kiev where he has carried out many life-saving operations in a chaotic hospital which lacks basic equipment and waiting lists.
I think much of the book’s impact is down to the fact that it is about the brain rather than a different organ of the human body. I somehow doubt it would have had quite the same emotional force if Marsh had specialised in treating something like kidney failure or liver disease. As Marsh himself says, “The idea that [I] am moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.”
Along with ‘H is for Hawk‘ by Helen Macdonald, ‘Do No Harm’ is a worthy contender for the Costa Biography Award. It is a remarkable account of the philosophical dilemmas of modern medicine and the realities of working in an NHS hospital. Highly recommended.