The Pequod Review:
Do No Harm is an honest and highly intelligent memoir describing what it is really like to be a brain surgeon. Henry Marsh, who until 2015 was a full-time neurosurgeon at St. George’s Hospital in London, begins his story with this gripping passage:
I often have to cut into the brain. And it is something I hate doing. With a pair of diathermy forceps, I coagulate the beautiful and intricate red blood vessels that lie on the brain's shining surface. I cut into it with a small scalpel and make a hole through which I push with a fine sucker. As the brain has the consistency of jelly, the sucker is the brain surgeon's principal tool.
I look down my operating microscope, feeling my way downwards through the soft, white substance of the brain, searching for the tumor. 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. All I can see in front of me is matter. Yet I know that if I stray into the wrong area, into what neurosurgeons call eloquent brain, I'll be faced by a damaged and disabled patient when I go around to the recovery ward after the operation to see what I've achieved.
Throughout the book, he also has candid and intimate accounts of what can go wrong and how it impacts him:
Early the next morning, I lay in bed thinking about the young woman I had operated on the previous week. She had had a tumour in her spinal cord, between the sixth and seventh cervical vertebrae – although I did not know why, since the operation had seemed to proceed uneventfully – she awoke from the operation paralysed down the right side of her body. I had probably tried to take too much of the tumour out. I had probably strayed too deeply into her brain. I must have been too self-confident. I had been insufficiently fearful. I longed for this next operation, the operation on the pineal tumour, to go well – that there should be a happy ending, that everybody would live happily ever after, and that I could feel at peace with myself once again.
But I knew that however bitter my regret, and however well the pineal operation went, there was nothing that I could do to undo the damage I had done to the young woman. I also knew that any unhappiness on my part was nothing compared to what she and her family were going through. I knew too that there was no reason why the next operation should go well just because I hoped so desperately that it would, or because the previous operation had gone so badly. The outcome of the pineal operation – whether the tumour was malignant or not, whether I could remove the tumour or whether it was hopelessly stuck to the brain and everything went horribly wrong – was largely outside my control. I also knew, however, that as time went by the grief I felt at what I had done to the young woman would fade. The memory of her lying in her hospital bed, her mother sitting beside her with her daughter’s newborn baby on her lap, would become a scar rather than a painful wound. She would be added to the list of my disasters – another headstone in that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.
As soon as an operation begins, however, the surgeon usually finds that any morbid fear disappears…
Marsh also has rich insights into human behavior and motivations more generally:
We have achieved most as surgeons when our patients recover completely and forget us completely. All patients are immensely grateful at first after a successful operation but if the gratitude persists it usually means that they have not been cured of the underlying problem and that they fear that they may need us in the future. They feel that they must placate us, as though we were angry gods or at least the agents of an unpredictable fate.
Healthy people, I have concluded, including myself, do not understand how everything changes once you have been diagnosed with a fatal illness. How you cling to hope, however false, however slight, and how reluctant most doctors are to deprive patients of that fragile beam of light in so much darkness. Indeed, many people develop what psychiatrists call ‘dissociation’ and a doctor can find himself talking to two people – they know that they are dying and yet still hope that they will live. I had noticed the same phenomenon with my mother during the last few days of her life. When faced by people who are dying you are no longer dealing with the rational consumers assumed by economic model-builders, if they ever existed in the first place.
The book continues in this vein throughout, with interesting passages on nearly every page. Highly recommended.