As a reader, I have eclectic tastes. At Fowey book festival, Henry Marsh’s book on neurosurgery, Do No Harm, was a recommended read, so I tried it. At first sight, tales of brain surgery may not seem terribly inspiring, but the surgeon, Henry, who at times had a difficult relationship with his brilliant father (who later developed dementia) is wonderfully, refreshingly honest.
It is difficult to talk of death to a dying patient, it takes time, and it is difficult if the room stinks of shit. And I know that I let this man down and was a coward.
Marsh’s honesty alerts us to his sincerity. He admits his flaws, his disasters usually described as catastrophic. There is no attempt to shift blame but plenty of criticism of the way the NHS is funded, managed and led. We may think of surgeons as gods, but they cannot always play the role to perfection. Henry admits he has left people in a terrible state, where death might well be the kinder option. In real life, the words catastrophic brain damage were used in my late brother’s diagnosis, caused by no surgeon but by his disease Multiple System Atrophy, and the lack of oxygen caused by his heart attack. However, it is consultant brain surgeons who deliver the news of brain death.
The books are beautifully written, part of their appeal. Henry Marsh is obviously a clinician able to fully detail brains and operations upon them, but there remains a tenderness for his patients which only really good doctors have. This reminds me of the birth of my first daughter and the ensuing suturing of my devastated gynaecology. An episiotomy had extended and torn the length of my vagina. The doctor trying to do the repair (I flinched, reader) hastened the consultant whose words, post-forceps-delivery was music to my ears: my dear, on humanitarian grounds, I am going to repair you under general anaesthetic. He made a good job of it, too.
Marsh has a similar sense of deep humanitarianism, probably what inspires someone to surgery and keeps them there. The vignette patient tales remind us there are people and families attached to these brains he works on. He has the hands of a craftsman working on the most precious part of the human body.
The BMJ mentions (astonishingly) that medical students are often still not admitted into neurosurgery consulting rooms, so these books grant insight even to those studying the subject. In Admissions, the tone changes, for there is a strong focus on death – of patients, and the morbid thoughts brought on by retirement.
Do No Harm is less personal. In Admissions, we find that the surgeon has a ‘suicide kit’ of lethal drugs at home. He also cannot quite retire yet in this book, so goes to work in Nepal, frustrated by the corruption and medical ineptitude he finds there. Curiously, it seems that Henry cannot quite work out what to do with the rest of his life, which is no surprise for someone forty years at the sharp end.
I recommend reading these books in order (there are some wonderfully descriptive passages, both medical and geographical). They could have been called Confessions of a Brain Surgeon but the titles he chose are so much better.
As a GP once said to me: we all make mistakes, so you can only hope as a doctor that you do no harm. Then, do you admit it?