Do No Harm

 by Dr. Henry Marsh


Tech rating (out of 5):


Publication date: May 26, 2015
Category: medical memoir

Summary (from the publisher):

What is it like to be a brain surgeon? How does it feel to hold someone’s life in your hands, to cut into the stuff that creates thought, feeling, and reason? How do you live with the consequences of performing a potentially lifesaving operation when it all goes wrong?

In neurosurgery, more than in any other branch of medicine, the doctor’s oath to “do no harm” holds a bitter irony. Operations on the brain carry grave risks. Every day, leading neurosurgeon Henry Marsh must make agonizing decisions, often in the face of great urgency and uncertainty.

If you believe that brain surgery is a precise and exquisite craft, practiced by calm and detached doctors, this gripping, brutally honest account will make you think again. With astonishing compassion and candor, Marsh reveals the fierce joy of operating, the profoundly moving triumphs, the harrowing disasters, the haunting regrets, and the moments of black humor that characterize a brain surgeon’s life.

Do No Harm provides unforgettable insight into the countless human dramas that take place in a busy modern hospital. Above all, it is a lesson in the need for hope when faced with life’s most difficult decisions.

“Riveting. … [Marsh] gives us an extraordinarily intimate, compassionate and sometimes frightening understanding of his vocation.” – The New York Times

Winner of the PEN Ackerley Prize
Shortlisted for both the Guardian First Book Prize and the Costa Book Award
Longlisted for the Samuel Johnson Prize for Non-Fiction
A Finalist for the Pol Roger Duff Cooper Prize
A Finalist for the Wellcome Book Prize
A Financial Times Best Book of the Year
An Economist Best Book of the Year

ScienceThrillers review:

That’s a lot of hype. Do No Harm: Stories of Life, Death, and Brain Surgery
made the top 5 of the NYTimes bestseller list in Science this summer. People are loving this book.

Me, not as much.

Granted, I read the whole book and enjoyed doing so–evidence that this is good stuff, well written, intellectually engaging, even page-turning with suspense at times. The reason I didn’t fall in love, I think, is my personal reaction to the voice of the author, who represents a certain type of older male surgeon that I find less than endearing.

Henry Marsh is a British neurosurgeon who has been in the business for a long time. (Apparently he’s a bit of a media star in England.) In this memoir-ish book, Marsh tells eye-opening stories about patients he’s had, and cases he’s performed, including some that did not end well. A blurb on the book’s back cover praises Marsh for “rare and unflinching honesty,” and I agree. This book’s strength is Marsh’s confessional approach to telling his stories, revealing his inner frustrations, worries, and insecurities.

That a man who cuts open other people’s heads and mucks around with the insides suffers from doubts and insecurity should be no surprise, but in the psychologically strange world of surgery, it is shocking, in a way. For most of us, a mistake at work requires a broom or perhaps a delete key. For a neurosurgeon, even the tiniest lapse of judgment or concentration can mean lifelong paralysis, loss of speech, or death for the patient. No wonder that doubt creeps in. Yet on the outside, the surgeon must appear absolutely confident for the good of the patient, who can only cope with their situation by ascribing godlike properties to their doctor.

This odd mental arrangement is laid bare in Marsh’s book. He admits that to operate when you know that you are fallible requires extraordinary courage, coupled with some unhealthy defense mechanisms: a tendency to forget your mistakes, and to blame others.

Thus the arrogance of surgeons is legendary, and here we get into why I was put off by this narrator. While I give Marsh credit for his barefaced sincerity, and his desire to put the patient first, an arrogance runs through his stories that is not always sympathetic. Marsh has a particular disrespect for administration. Granted, his misadventures with the British National Health Service justify much of his scorn, but at the same time he represents an older generation of doctors who do not understand that medicine has changed. Surgeons are no longer boss of the world, not even in the OR. They can’t do whatever they want.

This spills over into their relationships with coworkers, in particular, I think, women in medicine. The good old days of male trainees being chained to the hospital for days on end, and then lingering to share a drink with the boys, are gone. Marsh relates an episode of frustration with scheduling a case because an anesthesiologist had to leave the hospital to pick up her child. While Marsh puts most of the blame on the bureaucracy and its newfangled rules restricting physicians’ working hours, I sensed a total lack of appreciation for why younger doctors, especially women, might have lives outside the hospital. (Marsh, like most older surgeons, is no longer married to his first wife.)

Do No Harm is primarily a loosely connected series of anecdotes, not a sustained narrative. Each chapter is named after a neurosurgical condition (Pineocytoma; Aneurysm) and includes a story about a patient with that. Many chapters have detailed descriptions of surgery, so they’re not for readers who are squeamish.

Marsh also touches a little on end of life issues, on the wisdom of doing nothing in some cases, and the tension between hope and futility. This is a theme I find fascinating but is far better explored in another physician’s book, Being Mortal by Atul Gawande which I highly recommend. (Click here for my review.)

If you like Do No Harm, you’ll love: Being Mortal by Atul Gawande; The Afflictions review by Vikram Paralkar; Working Stiff review by Judy Melinek and TJ Mitchell. (Click titles to read my reviews.)

FCC disclaimer: An advance reader copy of this book was given to me for review. As always, I made no guarantee that I would read the book or post a positive review.

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