Henry Marsh

DO NO HARM

Stories of Life, Death and Brain Surgery

Patients, Marsh says, invest their doctors with superhuman qualities as a way of overcoming their fears when undergoing surgery.

The reality, of course, is entirely different. Doctors are human 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 is a more difficult skill to acquire.

Drama attends many kinds of surgery but the drama of brain surgery is of a different order. Operations on other parts of the body may kill the patient if things go wrong but otherwise patients usually survive with their personalities intact. Brain operations may not only result in death but may leave patients paralysed, unable to speak or understand speech, or in a catatonic state where they are alive but without manifesting any sign of awareness. Sometimes such disasters are unforeseeable but they can also be due to mistakes by the surgeon, and Marsh describes catastrophes of this kind unflinchingly.

This is not to say, of course, that the book is a catalogue of disasters and failures, far from it. Marsh is clearly an excellent surgeon who cares deeply about his patients. Probably anyone needing a brain operation who chanced to read this book would want him as their surgeon. But there is no doubt that the general tone of the book is sombre. Lacking religious belief, Marsh is sure that everything that constitutes a human being is under his hands as he operates. Now that he is nearing retirement he is becoming ever more conscious of his own mortality. As a young doctor he thought of himself as belonging to a race apart from his patients, but now he knows what awaits him. He and his colleagues sometimes ask themselves what they would do if they were diagnosed with a fatal brain cancer. Suicide, Marsh says, although he is not sure that this is what he would do if the situation arose.

Many changes have taken place in hospital life since Marsh first became a consultant and they are not for the better. In earlier times the consultant's word was law and the interests of patients were paramount. If an operation needed to take many hours and go on long into the night, the team accepted this unquestioningly. Now an anaesthetist may refuse to work beyond five o'clock, the junior doctors work in shifts and so get less experience, and consultants are always liable to overrule by managers. Marsh has a delightfully comic account of being obliged to attend a MAST (Mandatory and Statutory Training) seminar on Customer Care. The purpose of this was to teach Empathy and Self-control. It was delivered by a lecturer from the catering department.

How strange, I thought, as I listened to him talking, that after thirty years of struggling with death, disaster and countless crises and catastrophes, having watched patients bleed to death in my hands, having had furious arguments with colleagues, terrible meetings with relatives. moments of utter despair and profound exhilaration—in short, a typical neurosurgical career—how strange it is that I should now be listening to a young man with a background in catering telling me that I should develop empathy, keep focused and stay calm.

See also Admissions: A Life in Brain Surgery (Marsh's sequel to this book).

25-03-2015