Do No Harm – Henry Marsh
After a considerable hiatus, we reconvened to discuss this autobiographical account of neurosurgeon Henry Marsh’s career. The book is essentially a series of episodes spanning several decades of practise, and the most immediately disconcerting thing about a fairly unsettling book all round is Marsh’s tone. He veers between brutal honesty, peevish rebellion and didactic pomposity, and everywhere in between. The idea of an egotistical surgeon is as entrenched as our acknowledgement of the job as fairly technical and demanding: on Radio 4 on 30th June, he described himself as “jolly clever”, whilst at the same time being keen to debunk the idea of the surgeon as a solo “Michelangelo genius”.
He partially dispels the latter notion with his description of his entrance into the medical profession, which would be impossible now. He is quick to describe himself as middle class, but the story of him meeting one old boy and discussing fly fishing in order to gain a place at medical school (despite only two science GCSEs) suggests he is rather grander than that.
However, there are moments when he confirms every assumption surrounding the medical profession I have ever had, especially regarding his personal relationships, about which to be fair he is very discreet. I felt deeply sorry for his first wife – about whom he respectfully mentions very little besides the fact that his work contributed to the breakdown of the marriage – but his few explosions of temper/ego in the book are all compared to his younger episodes and found paltry by comparison, so he must have been a terror in the 90s. He refers to the nervous breakdown he had as a young man – necessitating a year out from Oxford – as silly. He glossed over it on the radio as he does on family matters in his book – as long as he is calling the shots on which episodes of his life to expose he is far more detailed, just very selective, as is his right.
Marsh claims the idea of surgeons needing to have steady hands is a myth, but the idea of an inexperienced wobbler operating on you or a loved one is not going to inspire many with confidence. Everyone is keen on training new doctors but no one wants to be the one experimented on, as it were, especially his story of a man being paralysed when a normally able, confident trainee snipped a vital nerve in his spine. The description of that white thread flopping where it is not meant to be is utterly desolate. It is one of the reasons Marsh hates training junior doctors.
He is not sentimental about his patients: he is gleeful when an outpatient has recovered sufficiently to say to him: “I hope I never see you again.” There is no Grey’s Anatomy schmaltz here. He claimed on the radio never to have had his mind changed by a patient – occasionally he has advised against operating in order to prevent spinning someone’s painful life out and has clearly expressed his views on avoiding a painful end for patients and families. He would, however, encourage patients to get second opinions on riskier surgeries – this is the culture elsewhere and he claims that in this country there is too much of a tendency to defer to a medical opinion rather than question it.
He has experienced surgery in Iran and Ukraine on several occasions and so is qualified to make some comparison. One reader questioned his motives for going to Ukraine to perform surgeries: was it because these extreme, neglected cases were interesting to him, and a coup if he pulled them off (he is much less accountable there if he doesn’t) rather than doing something genuinely altruistic? Another quibble was his account of bringing second hand medical equipment from England to perform these surgeries, as if everything provided for Ukrainians was second best. The ‘better than nothing argument’ is never sexy. He bought said kit with his own money. The patients he saw would certainly have suffered more without him, so on balance it seems to have been a good thing. The same sceptic questioned whether he should go back to Ukraine having retired to operate. Again, less than ideal to know an elderly gent is operating, but I would choose one of the most accomplished brain surgeons in the UK over none at all, personally.
His parting, reedy comment regarding his expertise on Radio 4 was that he finds neurosurgery crude. It is particularly interesting that he compares it to butchery when the practise is comared to the complexity of the brain, which no one completely understands. The book opens with his painfully vivid description of an exposed brain, with its jelly-like surface encased in silvery strands like a spider’s web. Brain surgery is only every chopping bits out of the brain – he is especially good at describing tumours: soft, uckable-out ones and hard ones that have to be collapsed in on themselves. Herein may lie the tension inherent in the profession at which he is so clearly proficient: he likes making things and admiring in them in their entirety, yet for thirty years he has had to remove and break things, never adding to the whole of the brain. Perhaps as a result, his retirement plans are to make things: furniture and houses while taking care of his own health. At the age of 65 he claims: “I am taking nothing for granted”. Except perhaps the publishing world, as he is planning a second book.