When you first get to know the English neurosurgeon in the first half of his memoir, in Henry Marsh’s “Do No Harm: Stories of Life, Death, and Brain Surgery”, he can seem a little standoffish, arrogant, and self-important (which he, at moments, concedes). In fact, it may feel like the stereotypical description of an established neurosurgeon who thinks too highly of himself, and less so of his subordinates and even of his patients. But in the second half of the book, as he talked about his failures and the ethical dilemmas of the medical profession. “Surgeons find it difficult to admit to making mistakes, to themselves as well as to others”, he reflected, and in the chapters which followed he documented cases of his overconfidence in the operating theatre, of his oversights, and of complications which followed successful operations.
“Knowing when not to operate is just as important as knowing how to operate”, and the limitations of surgery is a core ethical dilemma which Dr. Marsh constantly returns to. and is a more difficult skill to acquire. Another dilemma is the problem of true “informed consent”, when patients are terrified and ignorant and when the surgeon disproportionately benefits from the information asymmetry.
Unlike a traditional memoir, chronologically detailing events of one’s life, I liked how “Do No Harm” is organised. Each chapter focuses on a particular type of neurological disorder affecting the nervous system (the brain and the spinal cord, in particular), sharing stories of patients diagnosed with these disorders. And interwoven across the chapters are also broader themes related to his personal life (including the death of his mother and the end of his first marriage), his complaints about the National Health Service in the United Kingdom (UK) and the perceived inconveniences of bureaucracy, as well as his musings about changes to the healthcare system in the UK (“hospitals were different places, and all I had to do was ask the theatre staff and anaesthetists to stay on longer than usual”). Beyond the UK, he also wrote of his work with neurosurgeons in Ukraine, after the fall of the Soviet Union.
There is an honesty in this first-hand perspective – which perhaps explains the initial impression one might have of Dr. Marsh – and the unvarnished nature of this reflection is refreshing. The reader gets a peek of his everyday responsibilities, conducting meetings in the morning, going through difficult appointments with patients and their families, and doing surgeries and tending to patients, and through this journey there is greater empathy for the patient and the surgeon. Towards the end, in one of his conversations with a patient, he said, “If the operation goes wrong it’s a one hundred per cent disaster rate for the patient but still only five per cent for me”, which neatly summarised the difficult doctor-patient relationship. The conclusion, I thought, did not necessarily provide the best closure, but maybe the intent was to reiterate how routine his work is, amidst the difficulties and the failures and the dilemmas.