Thursday, February 22, 2018
Book Review: In “Do No Harm,” the Grim Work of a Neurosurgeon

(DPI Book Review) June 3 – I’ve always believed the best interviews – and the most honest sources – were the recently retired professionals,those still with their wits yet unshackled from the self-promotion and axe-grinding so common in most of us.

Henry Marsh is a recently retired British neurosurgeon, and he fits the bill. In the recently published “Do No Harm: Stories of Life, Death & Brain Surgery” Marsh brings a searing, almost painful honesty as he recounts tales of his career as a surgeon.

It’s true Dr. Marsh is not your typical neurosurgeon, if there is such a thing. In the last decade he achieved some celebrity as the subject of popular documentaries. He’s not Dr. Oz, but he clearly is comfortable in the spotlight and he comes across as a person who enjoys being heard.

Still, Dr. Marsh, with the help of his wife, anthropologist Kate Fox, has produced a simply and elegantly written memoir of the first order. It is at turns wrenching and provocative and amusing – and a bit depressing.

In 275 lithe pages Dr. Marsh describes the spot he occupied for three decades: The harried traffic cop at the intersection of life and death for his unfortunate patients – those with brain tumors or major head trauma. Do We Operate? Chances of survival if we don’t? Quality of life if we do?  Potential complications? Dreadful stuff.  All of that, every day he came to work.

You will be struck by Dr. Marsh’s bitingly critical voice, not least of which is criticism of himself as a surgeon. While he says he was a “good surgeon, not a great one,” he confesses medical mistakes that litigation-threatened American surgeons would be loathe to admit.  He devotes a chapter to being sued.

His stories, housed in chapters titled mostly with words ending in “-blastoma,”  are harrowing affairs. For some patients, dying – as a practical option, at least — comes off quite well.  And families, he writes, are frequently the last to arrive at that conclusion. After reading this book you will be hard-pressed to disagree.

There are other themes, too. Marsh’s career-long frustration with Britain’s National Health Service, and its attempts to reform itself, is a rich source for biting narrative.   And his ongoing alienation from the coldly institutional world of modern medicine in general sets a certain tone as well.

Marsh is proud of the British instinct for amateur achievement and disdain for authority – all a contrast to the credential-obsessed, hype-fueled, death-is-not-an-option American medical culture we all know so well. It’s from that wry British persona that Marsh’s wonderful clarity and humanity springs.

Dr. Marsh is the product of a classically British aristocratic family and he arrived in medicine after some wandering. It seems he was spared the meat-grinder that most medical students go through, and that may explain how a man as sensitive and reflective as Marsh could have possibly become a surgeon, much less a neurosurgeon. Even though I’m sure he was a fine at what he did, I came away feeling he had the wrong temperament for his life’s work.

Like all physicians Marsh liked, and grew more attached to, some patients more than others. When people get sick and come into a doctor’s care, many are simply too passive, too uninformed, too blindly trusting – Marsh doesn’t explicitly say this, but if there’s a takeaway from this book it’s that sick people need to take a more active role in their survival. And being liked by your doctor seems to count for something.

It takes a certain self-awareness to write a memoir as powerfully wrought  as “Do No Harm” – Henry Marsh in that respect is not your usual doctor and surgeon, who almost by necessity are clinical and remote.  But he’s written something worth reading. It’s a personal achievement, though not quite on the level of saving a patient’s life on the operating table.

–Stephen E. Clark


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