Do No Harm by Henry Marsh

Impossible not to read this book at a canter. Each chapter is headed by a different kind of tumour or other trouble that the surgeon might have to deal with - including hubris!

Some of the chapters are about operations that go fairly well, and Marsh describes the miroscopic equipment he uses and how he uses it, but they are also about the patients and their expectations and the medical team and the relationship they have with the senior surgeon - the teaching Q and A. He describes the catastrophic results of a brain bleed or a careless cut. He describes risky operations that can only add a few weeks or months to patients lives, because brain tumours grow back.

In this book we understand that Marsh is highly skilled and has a good reputation, but he also tells us that he has wrecked people, who remain alive in a vegatative state. Knowing this must be terrible, and he prefers not to remember and yet he writes it. Which is brave and remarkable.

He is very critical of the modern NHS which is run by managers who are quite blind to the ridiculous things they do - like sending Henry Marsh on a course to learn what empathy means. (He also had to learn about fire extinguishers, which just might be important one day). A hospital protocol on dress instructs him to remove his watch and tie, although there is no evidence that wearing these items spreads infection. It is simply undressing those self-important doctors, isn't it, to make them kowtow to the management! Because doctors used to run hospitals, and that was probably better. Now they still have a load of paperwork but probably just an audit trail. Like teachers. 


(I met a teacher at a party the other day who complained about getting all the students to write what they had done in the lesson that day and date and sign it - the dreaded diary page. We had to stop the lesson early to do that.  This teacher (also in adult ed) said she had got her students to fill the whole thing in on day one. All twelve entries, pre-signed and dated, saving time to actually teach them in the lessons thereafter. She left adult education and set up privately as the whole thing was ridiculous.)

When the doctors and nurses ran the hospitals they knew the patients on their wards. Now, it seems, the surgeon simply doesn't know where his patients are and has to go from ward to ward tracking them down. The problem is the lack of beds but the truth is that we need a huge number of beds - almost an infinity of beds because every damn person is ill with something or other* and we are all going to die. Tackling the NHS is difficult - I would start reducing the number of operations and procedures carried out on old people and I know that's controversial, but hey, we need to do that. We also ought to allow assisted dying. I digress - these are my opinions not his.

Marsh also questions how greed drives some consultants to carry out unnecessary private operations. Yet the biggest questions he raises are whether we need to perform many treatments that keep people alive, especially when it is just for a few miserable months or with extreme brain damage. He shows operations can take place because doctors and families are afraid to confront reality or hold painful discussions, and says what may seem a “successful” operation can look more like “a human disaster” several years down the line.

Henry Marsh is horribly honest about his bad temper and nasty hissy fits. He almost dares us to like him. OK, I don't like him, but I can see why he has to be that way. What he does is extraordinary. 

And Marsh, at the apotheosis of his career, writes in Admissions: “Each time I scrub up, I am frightened. Why am I continuing to inflict this on myself, when I know I can abandon neurosurgery at any time? Part of me wants to run away, but I scrub up nonetheless … I sit on a stool and lean the back of my head against the wall. I keep my gloved hands in front of my chest with palms pressed together, as though I were praying – the pose of the surgeon, waiting to operate.” Despite the astonishing, near-unimaginable nature of their job, there is evidence from the books they are now writing that surgeons experience – as the glittering career progresses and the life-prolonging operations mount up – a growing sense of humility, a particular amalgam of wonder at what they do and modesty about their achievements.

There, it is hard and frightening but he does it. And he doesn't want to stop.

*I am not ill. However, today I realised that I have recently lost my sense of smell. I couldn't even smell the Jeyes fluid I used on the plant pots today. I could sense it in the back of my throat, only. I couldn't smell roses, lavender, mint or basil. Such lovely smells! Why has it gone?