Review: Do No Harm by Henry Marsh

Untitled-6In neurosurgery, often the most trying dilemma is whether to operate or not.
It’s counter-intuitive; human nature tends towards action rather than inaction, the feeling of doing something rather than nothing is something which can curb the powerful feeling of worry.


But brain surgery is not easily aligned with human nature. As Henry Marsh, one of the UK’s foremost neurosurgeons writes, the risks of brain surgery can often outweigh the sentence of living with the issue. In his early career, one of his seniors tells him:
“The operating is the easy part… by my age you realise that the difficulties are all to do with the decision-making.”
He frequently tries to explain to his patients that although the tumour or problem that they have is likely to eventually kill them, surgery could well result in a stroke, haemorrhage or death. He’s not infallible. Too much or not enough of the tumour could be removed, a major blood vessel could burst, a vital nerve could be accidentally severed. Tellingly, his patients nonetheless usually choose to proceed with the operation.


Do No Harm is Henry’s startling presentation of neurosurgery as he’s experienced it, the highs and lows of a life dedicated to the human brain, daily holding someone’s life in his hands. The curtain is pulled back on a field quite shrouded in mystery and awe. Each chapter revolves around a certain neurological issue- from various types of benign and malignant tumours, to nerve damage and traumas. He regales the stories of his patients (who we come to feel we know) and his procedures with startling and endearing honesty, and examines his own mistakes as he must live with the consequences of when it all goes wrong. Although Henry’s often hailed as a hero and a saviour, he’s resolute in pointing out that his patients perhaps never quite realise just how dangerous the operation had been and how lucky they were to recover. He conveys this recounting a dizzyingly tense procedure to “clip” an aneurysm, when the functionality of the surgical instruments themselves and alone decided the outcome. Luck is immeasurably and frustratingly important.


Needless to say there are many recounts of tragedy in the book but Henry’s musings on his patients, the adrenaline-fuelled drama of surgery and the testing times for a busy modern hospital struggling with government regulations are passionate and frank. Most interestingly, his disciplined medical career has not meant the stifling of a sense of mystery and fascination with the human brain. He, just like anyone else, is dumbfounded by the “binding problem”: the fact that brute matter can host consciousness and feeling. As he talks of his mother’s death he ponders “I had such a strong sensation, as she lay dying, that some deeper real person was still there…”


Henry’s reputation precedes him as a phenomenal neurosurgeon, but with Do No Harm he conveys remarkable humanity. The line he must tread between compassion for patients and detached medical professionalism is a constant factor, but he seems to do it so well. It’s a truly moving book offering unsurpassable insight and leaves us thinking about doctors, medicine and even human nature how we perhaps never would have done.