Book Review: Do No Harm by Henry Marsh

This is the book I am shouting about from the roof tops at the moment.  Despite its subject matter it is a surprisingly warm and readable book.  I have to confess that I bought this book with a slight ulterior motive. Many years ago I worked as a neurology nurse at the hospital where Henry Marsh is a neurosurgeon.  Even then his reputation went before him and seeing him stride onto the ward could induce fear into any junior wide eyed nurse.

This book is a series of reflections on Mr Marsh’s life as a neurosurgeon.  The title of each chapter is the name given to some horrifying brain injury or disease, and is the stories of those he has treated.  The opening paragraph is one of the best I’ve read.

“I look down my operating microscope, feeling my way downwards through the soft white substance of the brain, searching for the tumour.  The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly is simply too strange to understand”

The book give a unique insight into the precarious life of a neurosurgeon and how quickly one can fall from hero to zero.  A tiny mistake in brain surgery can lead to devastating consequences for the patient.  Mr Marsh talks openly of the horror of having to face patients on a ward that have irreparable brain damage as a result of his surgery.  In describing the case of a young man he operated on to remove a tumor who suffered catastrophic bleeding and terrible damage to the brainstem he says:

“I will not describe the pain of seeing his unconscious form on the ITU for many weeks after the operation.  To be honest I cannot remember it well now, the memory has been overlain by other more recent tragedies, but I do remember many anguished conversations with the family as we all hoped against hope that he would wake up again”

He talks of the bond shared by neurosurgeons.  Only they can understand the true horror of what it means for surgery to fail.

“It is an experience unique to neurosurgeons……With other surgical specialities on the whole, the patients either die or recover and do not linger on the ward for months.  It is not something we discuss among ourselves, other than perhaps to sigh and nod your head when you hear such a case, but at least you know that somebody understands what you feel”

He also describes the ‘good times’ and the exhilaration he feels when operating.  Perhaps the phrase ‘your life in their hands’ is never truer than when under the care of a neurosurgeon.

“I take up the scalpel….and full, of surgical self-confidence, press it precisely through the patients scalp.  As blood arises from the wound, the thrill of the chase takes over and I feel in control of what is happening”

Henry Marsh is generous in the recollections he shares with the reader and also his observations on his own shortcomings as a doctor and as a man. Despite the potentially grizzly nature of the material, I would recommend this book to anyone.  It is a graphic but mostly sensitive  insight into a world that few of us will experience.