Ryan Devlin
Book Review:
Do No Harm by Henry Marsh
This autobiographical work by Henry Marsh is written as he nears his retirement, and being that these are the memoirs of a neurosurgeon, one could argue that this is the wrong magazine to review this in. Yet, the setting of neurosurgery is not the book’s focus; it is instead a profound and honest look at medicine, and of having someone’s life in your hands. The messages and morals conveyed by this eminent surgeon should be heard to everyone at medical school, or looking to apply, regardless of their interests or specialty. The book can be utterly dark, bitterly depressing, yet it is also the reason that I set my mind on studying medicine.
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As Marsh details important junctures in his life, from the exhilaration of early victories, to his supporting of neurosurgeons in Ukraine, he also speaks frankly about the “disasters”; “catastrophic” mistakes that have left patients dead, paralyzed, and in catatonic states. He states that such casualties, miserably, are the consequence of becoming a master in a field where the margin between saving a life and crippling it forever is 5mm to the left. At one point Marsh comes face to face with his mistakes, sometimes finding patients in care due to his errors made years before, stating that each one is a gravestone in the cemetery that all surgeons carry in their hearts.
It was those such dramatic and sometimes immediate consequences of success and failure, that for me hammered home the responsibility of being a doctor. U.S. Surgeon Atul Gawande, in his book “Better”, another thoroughly recommended read, states that by becoming doctors, by accepting the job, we have already signed up for its responsibilities. It is then not a question of whether we accept this life of responsibility, it is a question of, having accepted it, how we do our work well. Mistakes, of course, are not just consigned to the sterilised air of an operating room. What if I don’t catch those early signs of cancer? The red flags? What if I don’t ask the right questions? Part of that responsibility is to have the confidence to say when you are right, when you are wrong, and whether or not a risk is too great. And what of the patient? The heart of our care? The doctor/patient relationship has evolved to become a team, combatting maladies together, and yet I know, as Marsh states, that regardless of how much I learn the hardest part will sometimes be the conversations that I have with patients: I cannot even begin to comprehend telling someone that they have cancer.
So why did a book that fired off so many potentially doubtful questions, draw me into medicine? It is because this is far more than the confessions of a retiring surgeon. Marsh is brutally candid and the
Henry Thomas Marsh is a leading English neurosurgeon, and a pioneer of neurosurgical advances in Ukraine. His widely acclaimed memoir Do No Harm: Stories of Life, Death and Brain Surgery was published in 2014
mistakes and accompanying guilt are a part of that honesty, but also within this book, aside from an interesting look at the ever frustrating bureaucracy of the NHS, and a view of being a patient himself, are the victories. Victories (both explicit and implied by a career as esteemed as the UK best neurosurgeon) of someone who still wants nothing more than the best for his patients. Victories of someone who doesn’t want to play God, who doesn’t want to win – Just wants to do what’s right. It made me think that with sufficient training, the doubts may not evaporate, but I should be confident, and capable enough to tackle them. At the end of the day, we are not infallible beings, we are just trying to do a job to the best of our ability.
Of course, this book is but the insight of one person, and is unlikely to reflect the views of everyone when they finally enter a ward as an FY1. You may even interpret Marsh’s words differently, as I am sure my view of his words will change. Yet “Do No Harm”, its very title offering a challenging quandary after turning the final page, by being unpatronizing and frank, challenges the reader. Its musings on life, death and the human condition may not reach the heights of Gawande in “Being Mortal” (anything written by Gawande is a must read), but it is still an incredible glimpse into the life, mind and workings of a surgeon and an insight into the NHS. The focus of this book may not be oncology. Yet, anyone with an interest in oncology, and beyond, should read it.
This and other books feature on our additional resource list on the EUOS https://edinburghoncology.wixsite.com/euos
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