Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh: a review

The first chapter of Henry Marsh’s Do No Harm is named after a pineocytom- ‘an uncommon, slow-growing tumour of the pineal gland’- and begins with Marsh cutting into his patient’s brain, ‘feeling my way downwards through the soft white substance […] , searching for the tumour’.

He introduces two themes which are to recur throughout the novel. With the risk of ‘facing a damaged and disabled patient’ after every operation comes the ability to move ‘through thought itself, through emotion and reason’ to look ‘directly into the centre of the brain’. Brain surgery inspires both fear and awe.

Henry Marsh began his academic life studying English Literature. His writing shows it. He writes clearly and concisely, elegantly explaining dense anatomy and complicated illnesses of the brain with ease that belies the difficulty in treating them. Marsh switched from English to PPE before studying medicine. He only caught one glimpse of neurosurgery during his education and thought that it looked like ‘a scene from a horror film’. However, later he gets the chance to watch an aneurysm clipping. ‘The operation was elegant, delicate, dangerous and full of profound meaning. What could be finer […] than to be a neurosurgeon?’.

However Marsh is clear about the other side to his ‘obsession with neurosurgery’. The novel is far from being a love-letter to his work. Instead it reads as more of a confessional. Marsh details the grim realities of being a neurosurgeon in a manner that is frank enough to emphasise that ‘doctors are human, just like the rest of us’. For example, the operation described in the opening lines of the memoir is a success, but Marsh notes his nerves throughout due to a ‘feeling of profound failure about an operation I had carried out a week earlier’. This operation had left the patient ‘paralysed down the right side of her body’. Following the story of the aneurysm clipping which inspired his career is one which nearly ends in the disaster of a rupture.

Marsh chooses to emphasise the role of luck in his line of work: ‘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’.

The line of uncertainty often is due to the variable nature of a tumour. Whether it is hard and stuck to the brain or slides off easily is often the difference between life or death for the patient.

Along the same lines, Marsh’s descriptions of his daily meetings with colleagues emphasise their humanity. These meetings often feature disagreements and uncertainty over the right thing to do. After all, ‘knowing when not to operate is just as important as knowing how to operate, and is a more difficult skill to acquire.’ They make some decisions, such as the choice to operate on a terminally ill girl who’s family cannot give up hope, with intense anxiety. However, deciding not to operate is just as difficult. At one point Marsh sobs in his car after telling a patient he’s known for twelve years that an operation will not save him.

The reasons for the turmoil felt over these decisions becomes clear when Marsh visits a home run by Catholic nuns for those suffering from ‘catastrophic brain damage’. To his ‘dismay’ he recognises ‘at least five of the names as former patients’. He wouldn’t recognise one ‘grey curled-up body’ but for the ‘enamelled plaque with his name by the door’. Marsh states that his ‘hubris’ caused the man’s condition. Trying to get too much of a tumour out resulted in a tear of the basilar artery. Marsh describes this as the ‘catastrophe’ lead to him being ‘curled into a sad ball, on a bed in the nursing home’. A sobering lesson learnt is that after a mistake death is often the preferable outcome. Living with the results of these mistakes is intensely difficult for the surgeon as well as the patient.

Outside of these struggles of neurosurgery is another foe which Marsh describes doing battle with, often to extremely comic effect: Management.

Marsh chooses to close his memoir with his being unable to find notes on a patient’s operation. He can, however, easily discover ones on her bowel movements; ‘the Trust management clearly considered it a matter of deep importance’. It is not too difficult to discern from this what Marsh thinks of new methods of hospital management. Certainly, it is a bittersweet, funny end to a novel which one suspects mimic’s Marsh’s thoughts about the end of his career.

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