What is it like to be a brain surgeon? How does it feel to hold someone’s life in your hands, to cut into the stuff that creates thought, feeling, and reason? How do you live with the consequences of performing a potentially life saving operation when it all goes wrong?

Essential Book Information

Henry Marsh is a world-renowned neurosurgeon who had been working as a consultant for the NHS for almost thirty years at the time that the book was written. Do No Harm gives a fascinating insight into neurosurgery itself as well as the changes that have occurred in British healthcare over that time. 

Basic Plot Summary 

Despite all of the gloom and doom, there’s an education to be had in this book. You can learn a lot about the brain’s function and effects on other parts of the body. All pain is signaled by the brain. Hemispheres matter. Location and size of tumours matter. Some tumours are “sticky” and become problematic because they adhere too much to the brain. Others, more luckily, almost “pop” out with a little coaxing. One never knows until one goes into the brain, which on more than one occasion sounds as much like the “last frontier” in outer space, especially when reading Marsh’s graphic descriptions of the “landscape” in there.

Neurosurgeons are often accused (by other doctors) of behaving as if they were God, and being immensely condescending to others – but here in Do No Harm, you get to see the other side of the coin – knowing you can operate but having to decide if you should, having to go and see a patient you have rendered paralysed, or at least, failed to cure, having to cope with the huge expectations, and huge anger and disappointment of relatives, and so on.

Review 

Dr. Marsh comes across as having a hot temper, exhibiting extreme frustration with NHS bureaucracy. At the same time, he gets very emotional over his patients declining and dying and experiences profound guilt over operations that go wrong or were ultimately unnecessary. He realises the God-like power he holds over people’s quality of life: “We (surgeons) sit there, alive and well and happy in our work, and with sardonic amusement and Olympian detachment we examine these abstract cases on which to operate.”

The book’s chapters are devoted to examining the divide between patients and surgeons and the walls that surgeons put up. I never really realised the dehumanisation that patients go through when entering the hospital. All sorts of emotions sprang up when Dr. Marsh explained how surgeons early on need to learn to view patients as something other than them; a different race. This way, they can get their job done and not suffer a mental breakdown. The strong points of this book definitely were the examinations of difficult topics.

In my favourite passages, Dr. Marsh reflects on the mind-blowing fact that the few pounds of tissue stored in our heads could be the site of our consciousness, our creativity, our personhood – everything we traditionally count as the soul:

“I am looking directly into the centre of the brain, a secret and mysterious area where all the most vital functions that keep us conscious and alive are to be found. Above me, like the great arches of a cathedral roof, are the deep veins of the brain – the Internal Cerebral Veins and beyond them the basal veins of Rosenthal and then in the midline the Great Vein of Galen, dark blue and glittering in the light of the microscope. This is anatomy that inspires awe in neurosurgeons.

Are the thoughts that I am thinking as I look at this solid lump of fatty protein covered in blood vessels really made out of the same stuff? And the answer always comes back – they are – and the thought itself is too crazy, too incomprehensible, and I get on with the operation.”

It makes me doubt being a surgeon, a little. But it also makes me think about the importance of good surgeons – not just technically good, but surgeons who try to do good; who may make mistakes, but admit to them, and try to redress the damage. I want to be one of them, for sure.

Is there anything more frightening than the thought of being diagnosed with a brain tumour? In the vast world of illness and disease, it is perhaps the singular worst thing any patient can begin to comprehend. Dr. Marsh has made a career out of performing complex surgical procedures on such patients, and not always with a positive result.

But the best thing about Do No Harm is that it breaks down the invisible wall between patients and doctors and shows surgeons as they really are: anxious, fallible, and human. Dr. Marsh describes his surgical mistakes (many of which have utterly devastating consequences) as well as his triumphs.

The type of neurosurgeon you could put your faith in? I should say so. An education not only on the brain but on dying? That, too. The doctors know what’s going down, and you will, too, once you read all of these cases. Sometimes no operation is the answer. Sometimes hope is your enemy – bound only to prolong your suffering when palliative measures would be so much more humane.

Recommendation

Above all, this was a very thought-provoking, interesting read, and a fascinating insight into the difficult and (I found) often distressing work of neurosurgery.

It’s a book like nothing I’ve ever read and would recommend it to pretty much everyone.

Rating

5/5

Overall, a compelling book. With moments of humour, dark and not, Do No Harm rails against bureaucracy and government, and offers countless snapshots of people like you and me, always hoping for the best from life, sometimes receiving the worst from it. In a word: fate.

It is this kind of honesty that makes Henry Marsh’s memoirs so compelling, overriding the initial concern that I might be reading the book solely out of a kind of ghoulish voyeurism. Henry Marsh was clearly drawn to this field by the challenge and element of danger, akin to what drives people to climb mountains. He describes with great clarity and insight the sense of shame when what should be a straightforward operation goes wrong, perhaps through a moment of hubris or distraction, but it could also be because one has given a more junior colleague the practice he needs in order to improve, or just bad luck, a sudden haemorrhage for no obvious reason. On the other hand, inexperience – or memories of a recent disaster- may make a surgeon over-cautious as regards something as simple as trying to adjust the clip on an aneurysm.

Review compiled by Habab A. Iraqi, Sudan, 2021 Executive Committee: Admin