Welcome to Throwback Reviews, a monthly review about a science book that has been already available to the public, but its impact is still prevalent. In this installment we remember, Do No Harm: Stories of Life, Death, and Brain Surgery by Henry Marsh.
In the preview of the documentary The English Surgeon, a quote flashes that reads, “Imagine having almost God-like powers to heal, but failure means brain damage or death.” The quote in an instant leaves you breathless, it contains our deepest wishes and, at the same time, our worst fears. That statement not only describes the hard job that it’s neurosurgery, but it conceives the life of Dr. Henry Marsh.
Do No Harm by Henry Marsh
The Complications of Neurosurgery
British neurosurgeon Marsh wrote in 2014 what can be described as one of the best books on death, medicine, and beholding a life in this strange road. Do No Harm (Picador), Henry Marsh’s memoir, contains a volume of small pieces of writing that leaves the human soul searching through the unfortunate turns of life for what morality means, and the incredible decisions that sometimes doctors make on the daily basis.
In his 2016 preface, Marsh laid it all out, describing what this book means and the journey that awaits those who read it:
“If we are ill and in hospital, fearing for our life, awaiting terrifying surgery, we have to trust the doctors treating us – at least, life is very difficult if we don’t. It is not surprising that we invest doctors with superhuman qualities as a way of overcoming our fears. If the operation succeeds, the surgeon is a hero, but if it fails, he is a villain.
The reality, of course, is entirely different. Doctors are human, just like the rest of us. Much of what happens in hospitals is a matter of luck, both good and bad; success and failure are often out of the doctor’s control. Knowing when not to operate is just as important as knowing how to operate, and it is a more difficult skill to acquire.”
Out of luck; that’s the most hurtful reality that one encounters when reading Marsh’s tales. In every chapter, he puts up a medical diagnosis, like aneurysm, meningioma, and anesthesia dolorosa. He then goes on to describe his series of cases, which go from success in brain surgery to straight-up vegetative states of consciousness.
Tales on Death and Triumph
Marsh has distinct prose that keeps the reader on the edge of their seat while holding the book. One example of this is when Marsh describes an uneventful day doing a common procedure, removing an unruptured aneurysm. The patient had a five percent chance of the aneurysm bursting. But, as Marsh wisely knows, if the aneurysm did burst, a fifty percent chance of dying. Marsh quickly sets up the hard decisions on a daily basis that surgeons – especially those specializing in the brain – take. Later, with his dark-humored, yet detailed writing, Marsh describes a roller coaster of a ride, in which a simple operation turns into danger and complications. Luckily, the patient in this chapter has a positive outcome. Some in the others don’t.
Throughout the book, we discover the deep regrets, miseries, joys, and even fears that Marsh holds. He outbursts in of fits of anger when describing the National Health Service (NHS) and how medicine has changed in Britain. The neurosurgeon goes on to great lengths to expose the dangers of his operations and even the legal actions that he has faced over the years. There are some parts of Do No Harm that become dark and heartbreaking, but that, to some extent, is what makes it a wonderful account. Marsh doesn’t want to ease up the pain and suffering that he experiences every day when operating or seeing patients.
But still, not everything is grim and gray in Marsh’s picture. He opens up about his journeys to post-soviet Ukraine. Marsh describes his first steps through Kiev, discovering an outdated medical community; an outpost of patients with enlarged brain tumors and too little resources to take such gigantic operations. He describes his friendships with a rebel neurosurgeon in Ukraine, Igor, and the heartbreaking stories that many patients in Ukraine face when there are no medical resources to operate on them.
A Mortal Obligation
Marsh beautifully describes some of his successes, like his final chapter, when he was certain to leave a patient in a vegetative state. What makes Do No Harm a masterful book is the balance that doctor Marsh exploits, in the service of showing the two faces of his medical practice. His account gets better when complications and triumphs combine for a heartwarming celebration. But most importantly, the book triumphs because from the start, Marsh shows that he’s no God, but a mere mortal, trying to save some and in the process, facing failure.