Do No Harm is the memoir of Henry Marsh (1969, PPE), a leading neurosurgeon who worked more than 40 years in medicine. In his book, he shares his experiences, revealing the highs and lows of his career. Having already decided I wanted to study medicine but also having an interest in neuroscience, I came across Do No Harm in a bookshop during my first year of college. Neurosurgery is a fascinating and developing specialty, offering the chance to “hold someone’s life in your hands”, as Marsh puts it.

I mentioned this book in my personal statement, as I felt it helped me gain a better understanding of the responsibility doctors have along with the potential consequences, preparing me for my university interviews. Coincidentally, Do No Harm was one of the suggested books to read from Univ tutors, and Marsh attended Univ (though he didn’t study medicine here!).

While there are some medical terms mentioned, including the nearly unpronounceable names of brain structures, the book is easy to read, engaging and at times moving. One part I found interesting was the story of the work Marsh has done in Ukraine, performing neurosurgery on the patients there since 1992. It brought into perspective how the standard of healthcare varies between countries, and the injustice of this. I’ve read Do No Harm again since, and Marsh’s other book Admissions: A Life in Brain Surgery. I’d recommend Do No Harm to anyone interested in a career in medicine. It provides an honest insight into the reality of a doctor’s life.

Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh ISBN-10: 178022592X ISBN-13: 978-1780225920

Try checking the availability of this book at your school or local library or explore second hand bookshops and websites. You may also wish to purchase from either Amazon or Blackwell’s.

Henry Marsh, a renowned British neurosurgeon, provides a thoughtful, gripping rendition of his life on the front lines in a medical specialty that is filled with risk and imminent death. He speaks of the highs and the lows, the ups and the downs, and the difficult decisions that change lives forever. There are moments of celebration and gratification when complex operations go well. Yet, there are so many more undesirable outcomes and slips of the hand that result in devastating consequences, leaving patients suffering and doctors guilt-ridden. Beginning each chapter with an arcane medical terminology for a neurological condition, Marsh then seeks to uncover the human stories behind each one. His respect for his patients and his unending endeavour for excellence is interspersed with humour and honesty about his fallibility.

Reflections

To me, this was a thrilling and captivating read, perhaps due to my personal preference for reading books written by doctors and my admiration for their audacity, willpower and strength of character. The distinctively satisfying thing about this book is that Marsh breathes life into his writing. He characterises himself so well that I can imagine him, in my mind’s eye, cycling to work every day and striding through the long corridors of his hospital. The frustration, exasperation and even fury are presented bluntly, without being toned down. He doesn’t attempt to hide his sincere opinions about paperwork, the Government and the NHS. From his writing, his undying love for his work rises to the surface, through all those long and gruelling years on the front lines of one of the most devastating specialties in medicine.

A salient aspect of a neurosurgeon’s work that pervades every chapter is the necessity of breaking bad news and having difficult conversations with patients. Brain tumours can often be fatal, and while surgery provides reason for hope, there are inherent risks involved. It is the doctor’s job to not only help patients understand their condition, but also to provide assurance and comfort in distressing moments.

Operations can easily go awry. Mistakes can shatter the confidence that one has painstakingly built up over the years. As a doctor, especially a surgeon, learning how to deal with failure is of pivotal importance. If they allow themselves to be overcome with guilt and shame, it can compromise their ability and performance. After the writer operated on a young woman with a tumour in her spinal cord, the right side of her body became permanently paralysed, though with no identifiable reason from the operation itself. The writer admitted that he “had probably tried to take out too much of the tumour” and was left with only bitter regret. This was what he brooded over on the morning of the next operation. Fortunately, once the operation began, the fear receded, replaced by focus and adrenaline. Surgeons must be honest and open about their mistakes, with the humility to admit that they can do better. At the same time, they should not allow guilt to consume them as dwelling on past mistakes will only hinder them from moving forward.

In delivering a diagnosis to the patient, it can sometimes be exceedingly difficult to find the right diction, degree and intensity. Do you tell patients they have a malignant tumour growing in their brain with little hope of living more than a few months when they are on the verge of tears? Should you give them a specific prognosis, or should you use vaguer terms in the faint wish that they may be statistical outliers? As doctors, the way you talk—your words, tone, facial expression and body language—can have an immeasurable impact on the patient’s view of their disease. As a neurosurgeon, Marsh also visits his patients on the night before their operation to provide reassurance. Yet, it can also feel like hypocrisy when you instil too much confidence in your patient to assuage their fears, but the operation ends up in failure, as was the case when Marsh left his registrar to do a low-risk operation that led to a severed nerve root.

Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope. It can be very difficult to find the balance between optimism and realism. Henry Marsh, Do No Harm: Stories of Life, Death and Brain Surgery

Through reading this book, I also realised that patients’ family members and loved ones bear the brunt of emotional agony. While individual faces tend to fade over time in the memory of doctors as they are inundated with new cases, to the patients’ closest kin, the damage is irreversible, and the emotional baggage remains forever. This can sometimes result in intense emotional breakdowns, angry outbursts and even accusations directed at the doctor for failing to save the patient’s life. As a doctor, it is easy to get swept up amidst such unhappiness and grief, which is where compassion and calmness must both come into play. Doctors are treating not just diseases, but also unique human beings.

The inescapable truth in medicine is that one only gets better with practice, which means many rounds of shaky hands and flawed operations before one can rise to a position of confidence and competence. This is demonstrated in the hospital hierarchy, which consists of house officers at the bottom all the way to senior consultants at the top. In Marsh’s clinic, morning meetings are a daily ritual. It is a way of bringing all the doctors together to provide updates on the latest admissions, but more importantly, it is also a time for camaraderie and to start the day with high morale. They would “shout and argue and laugh” while analysing brain scans and debating various plans of action. Marsh would sometimes pick on the younger doctors to provide a diagnosis and their perspective on treatment, which not only trains them to think, but also provides an impetus to further the discussion.

For instance, when an elderly patient is admitted with a malignant and deadly tumour, the older doctors are usually more inclined to leave them in peace and to leave them to enjoy their final days, while the younger doctors are more eager to operate in spite of the potential risks and limited time that can be bought for the patient. The differing viewpoints reflect the shifts in perception as one pursues a career in medicine and ventures further along this arduous path. In medicine, there are often no right or wrong answers. We always act based on our belief and judgement of what is best for the patients, while taking their personal values and priorities into account. Neurosurgeons do not make decisions that are based solely on brain scans; instead, they begin by taking medical history, which helps them to understand the patient’s past and present, as well as how the disease is affecting their lives.

Moreover, the more intimate setting of these meetings allows doctors to know their colleagues and break down some of the barriers that tend to exist between seniors and juniors. In medicine, teamwork is omnipresent. Not only did Marsh establish a robust and enduring working relationship with his secretary, Gail Thompson, but he also collaborate closely with the rest of his medical team to ensure continuity of care for his patients.

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Most Interesting Part of the Book

When we are in positions of stability, security and influence, we often feel inclined to be a little selfish and just continue living our lives the way it is—earning more money, buying a new car, moving into a grander house. However, Marsh was not one to take material comforts too seriously. From his devotion to his work, you can see that his patients were at the centre of everything he did.

After first visiting the newly independent Ukraine in response to an odd request from an English businessman hoping to sell medical equipment, Marsh became deeply involved in the advancement of neurosurgical practices in the country. A far cry from his home country, Ukraine lacked the technical expertise of British hospitals and their surgical operations for brain tumours were appallingly primitive. Over the years, Marsh became more deeply involved in his Ukrainian friend’s neurosurgical practice, sometimes bringing patients to back to his hospital in London.

An especially moving case involved a Ukrainian girl, Tanya, who had an enormous tumour growing at the base of her brain. Marsh describes the uncertainty he felt about whether he should operate, for he was not sure if he could save her and he “had not tried to operate on such a large tumour in a child her age before”. Ultimately, his decision to go ahead was made out of compassion, for he could not bear to do nothing and leave her to die. As humans, we tend to hold on to every last vestige of hope, even when it is frighteningly tenuous.

Doctors often console each other, when things have gone badly, that it is easy to be wise in retrospect. Henry Marsh, Do No Harm: Stories of Life, Death and Brain Surgery

Sadly, after undergoing surgery and suffering a severe stroke, Tanya had to stay in the hospital for six months before she could return home to Ukraine, and even then, her life would never be the same again. She was “mute and disfigured”, confined to a wheelchair. Modern neurosurgery could not save her. It is the only point in the book where Marsh actually cried, when sending Tanya and her mother off at the airport; with other patients, he had hidden or swallowed his tears. To me, it is one of the most beautifully written chapters of the book, for it captures the writer’s emotional anguish and the grief he would always associate with having failed to save a child’s life.

Who would I recommend this book to?

There is so much wisdom contained in this book that can only arise from years of practising surgery and constant reflection. This is a book for patients, for doctors and for anyone who is looking for a little wisdom.

Our vulnerability and fear of death when we are patients know no national boundaries, and the need for honesty and kindness from doctors—and the difficulty at times in giving these—is equally universal. Henry Marsh, Do No Harm: Stories of Life, Death and Brain Surgery (Preface)

While his focus is on neurosurgery, Marsh also explores medicine from the perspective of a patient, when he himself becomes vulnerable, with his fate in the hands of his colleagues. Though he witnesses others battling on the verge of death every day, he admits that there is still much he does not understand about the actual experience of pain and clinging on to false hope. It is most excruciating to tell someone you cannot save them when you were their last hope.

This is a heartfelt book about striving, and also about failure. No matter how hard one tries, there are still tumours we cannot eradicate and diseases we cannot conquer. For one person, death comes knocking at the door; for others, life goes on.

Is Do No Harm a memoir?

Do No Harm is the memoir of Henry Marsh (1969, PPE), a leading neurosurgeon who worked more than 40 years in medicine. In his book, he shares his experiences, revealing the highs and lows of his career.

What is the story of and finally Henry Marsh?

Retired brain surgeon Henry Marsh thought he understood illness, but he was unprepared for the impact of his diagnosis of advanced cancer. And Finally explores what happens when someone who has spent a lifetime on the frontline of life and death finds himself contemplating what might be his own death sentence.

What is the memoir of the neurosurgeon Mr Henry Marsh?

He is the author of the New York Times bestselling memoir Do No Harm and NBCC finalist Admissions, and has been the subject of two documentary films, Your Life in Their Hands, which won the Royal Television Society Gold Medal, and The English Surgeon, which won an Emmy.