Henry Marsh (2014) Do No Harm – Stories of Life, Death and Brain Surgery. London: Orion Books Ltd.

Front cover

Front cover

Back cover

Back cover

I found this book a great read and the draw of “just another chapter” hard to resist. Inevitably there is some terminology but always well explained.

Henry Marsh’s medical career had an unconventional start by today’s standards. He describes how, as a young doctor, he became hardened and detached from his patients seeing them as a separate race from the all-important, invincible young doctors. Earlier in his career he describes himself as having felt threatened by and fearful of failure.  Approaching the end of his career he now feels less detached from his patients and more aware of his own vulnerability.

He talks about the reality of informed consent and how as patients awaiting surgery we tend to invest doctors with superhuman qualities.

Discussing the risks in the outpatients’ clinic he acknowledges that the patient’s choice to go ahead with surgery or not depends on how he explains the risks of operating compared with the risks of not operating. He is committed to making sure that relatives are also aware of the risks “It can be difficult to find the balance between optimism and realism.” Most patients and families research their disease on line. “…the paternalistic white lies of the past will no longer be believed.”

“You [the surgeon] must learn to be objective about what you see, and yet not lose your humanity in the process.” “Knowing when not to operate is just as important as knowing how to operate, and is a more difficult skill to acquire.” Excellent communication skills are key, although he observes that in some situations it is tempting to operate where the patient may survive but be hopelessly disabled, in order to avoid a painful conversation with a family and being honest about the likely outcome. He states that death is not always a bad outcome and a quick death can be better than a slow one. Unquestioning treatment, operating on every case, will result in many people surviving with terrible brain damage. Most neurosurgeons get increasingly conservative with age. The patient leaving the hospital alive he says is not the definition of success, if the result is a human disaster.

In his routine of visiting patients on a Sunday evening before surgery, presumably now a thing of the past with patients now admitted only on the day of surgery, he describes how the confidence that his patients’ have in him is contagious and how he disliked talking to patients on the morning of their operation saying “I prefer not to be reminded of their humanity and their fear, and I do not want them to suspect that I, too, am anxious.”

He describes with touching candour the sense of responsibility when things go wrong as the result of surgery and the experience of having to face a patient “you have damaged it feels as though there is a force field pushing against you, resisting your attempts to raise a hesitant smile… It is much easier to hurry past the patient without saying anything.”

His honesty and self-awareness are particularly reassuring. Whilst envying the generation of surgeons who trained him “who could rage and roar to relieve their frustration and intense stress without fear of being had up for bullying or harassment” he notes that years ago, faced with a delay to the start of surgery (caused by a new computer programme), he would have stormed off in a rage, demanding that something be done, his anger has now come to be replaced with fatalistic despair.

This book was a finalist in the Wellcome Trust book prize 2015, short listed for a Guardian first book award and the Costa Book Awards 2014.

This book was lent to me by a very kind friend, a retired GP, who had himself been involved in training medics. Knowing that I had had a bruising incident with a consultant whilst sitting in on her consultations, his recommendation of this book was probably not a coincidence and I found some of Henry Marsh’s observations extremely helpful, in particular that “Surgeons find it difficult to admit to making mistakes, to themselves as well as others, and there are all manner of ways in which they disguise their errors and try to put the blame elsewhere.” The sense of “self-importance” which Henry Marsh recognized in himself earlier in his career has clearly given way to compassion and an ability to come alongside his patients.

Inspired by this I have read “The Other Side” Kate Granger and can’t wait to start her second book “The Bright Side”.

Atul Gawande’s “Complications” & “Better” are also in my book stack.

 

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