As a young doctor just starting out, Henry Marsh watched a neurosurgeon operate on a woman’s brain, going after a dangerous aneurysm that could rupture and kill her.
This kind of surgery — taking place several inches inside the patient’s head — was perilous, and often compared, as he writes in his riveting new memoir, to bomb disposal work, “though the bravery required is of a different kind, as it is the patient’s life that is at risk and not the surgeon’s.”
There was “the chase,” as the surgeon stalked his prey deep within the brain, then “the climax as he caught the aneurysm, trapped it, and obliterated it with a glittering, spring-loaded titanium clip, saving the patient’s life.”
More than that, Marsh goes on, “the operation involved the brain, the mysterious substrate of all thought and feeling, of all that was important in human life — a mystery, it seemed to me, as great as the stars at night and the universe around us. The operation was elegant, delicate, dangerous and full of profound meaning. What could be finer, I thought, than to be a neurosurgeon?”
Marsh would become one of Britain’s foremost neurosurgeons, and in this unflinching book, “Do No Harm,” he gives us an extraordinarily intimate, compassionate and sometimes frightening understanding of his vocation. He writes with uncommon power and frankness.
Although his book may unsettle readers — so many things can go wrong with the brain, so many things can go awry in a hospital — it will at the same time leave them with a searing appreciation of the wonders of the human body, and gratitude that there are surgeons like Marsh using their hard-won expertise to save and repair lives.
When he was younger, Marsh recalls, he used to feel an “intense exhilaration” after a successful operation. He felt, he says, “like a conquering general,” having averted disaster and safely delivered his patient: “It was a deep and profound feeling which I suspect few people other than surgeons ever get to experience.”
Although he has made many patients very happy with successful operations, he says that there have also been “many terrible failures and most neurosurgeons’ lives are punctuated by periods of deep despair.”
Marsh candidly runs through a list of his “disasters” in this book. A woman left almost completely paralyzed because Marsh dismissed early signs of a postsurgical infection. A patient who came through surgery on his pituitary gland just fine but suffered a debilitating stroke days later that left him “utterly without language.”
Such stories underscore the role that bad luck and terrible mistakes can play in medicine, resulting in the dreaded word “complications”: A piece of surgical equipment can malfunction; a tumor can turn out to be stickily attached to the brain and impossible to completely remove; a poor decision (even whether to operate) can be made.
Amid the life-or-death dramas of neurosurgery in this book are some blackly comic scenes recounting the absurdities of hospital bureaucracy in the National Health Service: not just chronic bed shortages but also what Marsh calls a “loss of regimental spirit” and ridiculous meetings, like a slide presentation from “a young man with a background in catering telling me I should develop empathy, keep focused and stay calm.”
Marsh also writes about “surgical stage fright” and his distaste for seeing patients on the morning of their operations — “I prefer not to be reminded of their humanity and their fear, and I do not want them to suspect that I, too, am anxious.”
Once he is in the operating room and the patient — largely hidden behind monitoring equipment and anesthetic tubing — has metamorphosed “from person to object,” he says, his own state of mind undergoes a similar sort of change: “The dread has gone, and has been replaced by fierce and happy concentration.”
However much Marsh may talk about the detachment that doctors must learn, it’s clear from this book how much he cares for his patients. Many of the most difficult moments he recounts take place not in the operating room but in conversations before or after surgery — conversations in which Marsh tries to balance realism with patients’ need for hope (“that fragile beam of light in so much darkness”) and his own knowledge that “they are being stalked by death and I am trying to hide, or at least disguise, the dark figure that is slowly approaching them.”
“Do No Harm: Stories of Life, Death, and Brain Surgery,” by Henry Marsh (277 pages; Thomas Dunne Books/St. Martin’s Press; $25.99)