As a young doctor just starting out, Henry Marsh watched a neurosurgeon operate on a woman’s brain, going after a dangerous aneurysm that could rupture and kill her. This kind of surgery — taking place several inches inside the patient’s head — was perilous, and often compared, as he writes in his riveting new memoir, to bomb disposal work, “though the bravery required is of a different kind as it is the patient’s life that is at risk and not the surgeon’s.”
There was “the chase,” as the surgeon stalked his prey deep within the brain, then “the climax as he caught the aneurysm, trapped it, and obliterated it with a glittering, spring-loaded titanium clip, saving the patient’s life.” More than that, Dr. Marsh goes on, “the operation involved the brain, the mysterious substrate of all thought and feeling, of all that was important in human life — a mystery, it seemed to me, as great as the stars at night and the universe around us. The operation was elegant, delicate, dangerous and full of profound meaning. What could be finer, I thought, than to be a neurosurgeon?”
Dr. Marsh would become one of Britain’s foremost neurosurgeons, and in this unflinching book, “Do No Harm,” he gives us an extraordinarily intimate, compassionate and sometimes frightening understanding of his vocation. He writes with uncommon power and frankness. And while his book may unsettle readers — so many things can go wrong with the brain, so many things can go awry in a hospital — it will at the same time leave them with a searing appreciation of the wonders of the human body, and gratitude that there are surgeons like Dr. Marsh using their hard-won expertise to save and repair lives.
When he was younger, Dr. Marsh recalls, he used to feel an “intense exhilaration” after a successful operation — he felt, he says, “like a conquering general,” having averted disaster and safely delivered his patient: “It was a deep and profound feeling which I suspect few people other than surgeons ever get to experience.” But while he’s made many patients very happy with successful operations, he says that there have also been “many terrible failures and most neurosurgeons’ lives are punctuated by periods of deep despair.”
Dr. Marsh candidly runs through a list of his “disasters” in this book — headstones in “that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.” A woman left almost completely paralyzed because Dr. Marsh dismissed early signs of a postsurgical infection. A patient who came through surgery on his pituitary gland just fine but suffered a debilitating stroke days later that left him “utterly without language.” An 11-year-old Ukrainian girl with a huge tumor at the base of her brain, who suffered a severe stroke after a second operation, returned home more disabled than when she had left it, and died 18 months later.
Such stories underscore the role that bad luck and terrible mistakes can play in medicine, resulting in the dreaded word “complications”: A piece of surgical equipment can malfunction; a tumor can turn out to be stickily attached to the brain and impossible to completely remove; a poor decision (even whether to operate or not) can be made; a vein can tear and flood the brain with blood, hiding everything and leaving the surgeon to operate by “blind reckoning, like a pilot lost in a cloud.” A trainee doctor, supervised by a veteran like Dr. Marsh, can also botch a routine procedure: “It’s one of the painful truths about neurosurgery that you only get good at doing the really difficult cases if you get lots of practice, but that means making lots of mistakes at first and leaving a trail of injured patients behind you.”
Amid the life-or-death dramas of neurosurgery in this book are some blackly comic scenes recounting the absurdities of hospital bureaucracy in the National Health Service: not just chronic bed shortages (which mean long waits and frantic juggling of surgery schedules), but also what Dr. Marsh calls a “loss of regimental spirit” and ridiculous meetings, like a slide presentation from “a young man with a background in catering telling me I should develop empathy, keep focused and stay calm.”
In these pages, Dr. Marsh provides a visceral account of the dread and anxiety he often experiences before a complicated surgery, and the guilt and shame he feels when things go wrong — “the hell of seeing the wrecked patient afterwards on the ward round” and feeling “responsible for the catastrophe.” He describes the complicated calculus of risk involved in making decisions — weighing the possibility of saving patients from slow deterioration or constant pain against the danger of making them worse; balancing skill and experience against the hazards of an operation that might fail to fix the underlying problem.
Dr. Marsh also writes about “surgical stage fright” and his distaste for seeing patients on the morning of their operations — “I prefer not to be reminded of their humanity and their fear, and I do not want them to suspect that I, too, am anxious.” Once he is in the operating room and the patient — largely hidden behind monitoring equipment and anesthetic tubing — has metamorphosed “from person to object,” he says, his own state of mind undergoes a similar sort of change: “The dread has gone, and has been replaced by fierce and happy concentration.”
However much Dr. Marsh may talk about the detachment that doctors must learn, it’s clear from this very book how much he cares for his patients. Many of the most difficult moments he recounts take place not in the operating room but in conversations before or after surgery — conversations in which Dr. Marsh tries to balance realism with patients’ need for hope (“that fragile beam of light in so much darkness”) and his own knowledge that “they are being stalked by death and I am trying to hide, or at least disguise, the dark figure that is slowly approaching them.”