When doing harm is unavoidable

This is my review of Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh.

"The idea that emotions and reason, that memories, dreams and reflections should consist of jelly is simply too strange to understand… Yet..if I stray into what neurosurgeons call eloquent brain, I will be faced with a damaged and disabled patient."

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 aneurism.

Marsh patiently explains various medical conditions, mainly tumours, in terms a layman can grasp. I found it hard to read more than about three chapters at a time, not because the book is depressing – Marsh manages to weave in a surprising amount of humour – but because the experiences of many of his patients seemed to demand a certain amount of respectful reflection before rushing on to the next trauma.

Marsh reserves his bile for hospital management and government targets or cuts. He may be a bit of a dinosaur in some respects, but makes his case very convincingly. The 48 hour Working Time Directive causes more frequent shift changes so that staff often do not know the condition of patients they are treating as well as they used to. Bureaucratic rules enforced by junior staff no longer so in awe of consultants and senior surgeons often mean that patients have to wait longer for operations, and suffer more often the stress of last minute postponements. He condemns Private Finance Initiative (PFI) schemes as a "very expensive way of building second rate public buildings" which "some would consider to be an economic crime, although nobody is to be held responsible for it."

If anything, this book has eroded my confidence in the NHS as a whole, but has made me more understanding of the surgeon's dilemma. Often, he really does not know whether on balance it is better to operate or not. As regards patient consent, the percentage risk of death from the operation may equal that of eventually dying from a tumour, but if one survives the former, there is the incalculable benefit of peace of mind. Even such an eminent surgeon as Marsh may have to face charges of indefensible error, say for delay in diagnosing an infection: "it was painfully clear, as I had always known – that the case could not be defended… The final bill…was for six million" to settle it. One is left thankful that there are people with the courage and motivation to persevere in this complex medical field.

⭐⭐⭐⭐⭐ 5 Stars

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