I always find accounts of lives worked in medicine absolutely fascinating, especially those of surgeons, who live on the cutting edge (sorry!) of medical science. It takes a special kind of person to become a surgeon, and then those who choose pathways into more specialised areas require more training and experience still.
Henry Marsh is one of the UK’s top neurosurgeons – a brain-surgeon if you will, although neurosurgery extends to the spinal cord and nervous system as well. Unusually for a doctor, he first read PPE (Politics, Philosophy and Economics) at university before deciding to train in medicine. He has been Consultant Neurosurgeon in one of London’s largest teaching hospitals since the late 1980s and is now in his mid-60s approaching retirement.
In the preface, Marsh sets out his stall – and, perhaps surprisingly, one of the first things he says is:
Knowing when not to operate is just as important as knowing how to operate, and is a more difficult skill to acquire.
A brain surgeon’s life is never boring and can be profoundly rewarding but it comes at a price. You will inevitably make mistakes and you must learn to live with the occasionally awful consequences. You must learn to be objective about what you see, and yet not lose your humanity in the process. The stories in this book are about my attempts, and occasional failures, to find a balance between the necessary detachment and compassion that a surgical career requires, a balance between hope and realism.
The twenty-five chapters that follow are each titled after the main medical condition requiring surgery that features within and, being in Latin, are helpfully defined and explained briefly underneath.
We start off with a type of brain tumour (Pineocytoma in this case – ‘an uncommon, slow growing tumour of the pineal gland’). Marsh explains how brain tumours are all different: hard, soft, dry, bloody, stuck to the brain, or like peas in a pod. This particular one was very rare and ‘cooperative’ – it went well. But after finishing the operation, Marsh went to visit a young mother he had left paralysed a week earlier. Yes, you need to do a double-take, for at the end of the first chapter, in an almost throwaway manner, Marsh tells us about one of his failures. A brave move so early in the book perhaps, but it clearly demonstrates how challenging neurosurgery is.
We move on to aneurysms, which if burst can cause a fatal haemorrhage. These little balloons full of arterial blood need to be clipped off – it’s a very delicate thing – imagine doing one of your first and getting a batch of dodgy clips, as Marsh’s registrar does. Eventually, between them, they get it sorted, but Marsh had to take over for the hardest part this time. The registrar may be sad that he didn’t get to do the clip itself, but it was still very valuable training.
You sometimes forget that behind the surgeon is a whole team of staff in theatre including registrars, nurses and the anaesthetist, not to mention those outside like the bed manager, which sounds like a thankless task to me. The modern era NHS is a very different animal to that of old, in which operating lists often ran very late and everyone had to stay until it was done. He describes momentary exasperation when his locum anaesthetist refuses to start an operation at 4pm because she has no childcare that evening. He admits:
I envy the way in which the generation who trained me could relieve the intense stress of their work by losing their temper, at times quite outrageously, without fear of being had up for bullying and harassment.
A recurring feature of Marsh’s career are his trips to the Ukraine. He developed a strong link with a hospital there and has gone back periodically to teach and operate, at first in very difficult conditions with a severe lack of modern equipment. It seems to have been rewarding work for him and gives him time off from the bureaucracy of the NHS. His work there was featured in an Emmy award-winning documentary, which I’m sure I remember seeing, as well as his episode of the occasional series about surgery Your Life in Their Hands which was about brain surgery under local anaesthetic, which is just amazing.
Each different operation demonstrates the challenges to the neurosurgeon in and out of theatre. Marsh tells it to us straight, but with compassion and often a streak of black humour. This insightful book helps to demystify the world of brain surgery, but also the mind-set of the surgeon himself. They are viewed as godlike when it all goes right but we know they are human and sometimes fallible, it is a courageous man that shares this with us. Surgeons’ abilities to learn from their mistakes and to constantly develop their skills and techniques though are very reassuring and I have a profound respect for them.
Direct Red by Gabriel Weston, an account of a young woman doctor starting her career in surgery, may have set the bar in recent years amongst medical memoirs, but Do No Harm, which has been recently been shortlisted for the Costa Biography Award, the Guardian First Book Award and longlisted for the Samuel Johnson Prize for Non-Fiction, has raised it higher still.
Henry Marsh, Do No Harm (Orion Books, London, 2014) 978-1780225920, paperback, 288 pages.
Annabel is one of the Shiny New Books editors and a big fan of TV medical dramas.