Author: Henry Marsh
Marsh, H. (2015). Do No Harm: Stories of Life, Death and Brain Surgery. Thomas Dunne Books, Macmillian; New York.
In Do No Harm, Dr. Henry Marsh, a well-known British neurosurgeon, takes readers on a behind the scenes look at the day-to-day life of a neurosurgeon. Neurosurgeons work specifically with diseases and injuries of the brain and spinal cord. Given the necessities of life involved with central nervous system function, precision and a deep understanding and brain and spinal cord structures and functions is essential for the work, because even a minor error can lead to paralysis or death. Dr. Marsh discusses the intricacies of brain surgery and the challenges such as freeing an aneurysm from the surrounding brain and blood vessels quickly before the patient has a stroke. All of this must occur while also trying to avoid hitting major arteries which would likely cause a quick death from loss of blood. Dr. Marsh also addresses technologies that allow surgeons to perform their job more easily and result in higher rates of success.
Most of the surgeries Dr. Marsh conducts involve tumors in the brain. One-quarter of all of the blood pumped by the heart goes to the brain, so any mistake in surgery can be lethal in a matter of a few seconds. Marsh details a different case study in each chapter in which he identifies the symptoms of the patient, the prognosis for recovery, the specifics of the procedure, and the outcome by reporting on whether or not each case was a success. Each of these cases demonstrates a different ailment of the brain and spinal cord, and he provides great detail regarding the challenges of each illness and the many unknown and potential complications of surgery. In some of the cases Dr. Marsh describes how his patients have recovered and are back to their normal lives fairly quickly, in others they may have paralysis and others still they may not have survived the surgery. Dr. Marsh feels that if neurosurgeons are open about their mistakes, other surgeons can learn from them and help more people, but in the litigious nature of the medical system, it is difficult for doctors to be upfront and honest about the mistakes they may have made during surgery. Marsh discusses his trials with patients who have sued the hospital over his perceived mistakes. The hospital administration takes the brunt of the case work, but all neurosurgeons must live with the mistake for the rest of their lives. Marsh recalls the details about the cases that did not work out in far more detail than those that were successful. As he reminds himself of these cases, he tries to be more successful with future cases, which may be similar. The families of the lost patients do not always blame the surgeon and in some cases in which patients are harmed or killed the neurosurgeon did everything right, but the patient may still not survive the invasive procedure. The pressure on neurosurgeons is enormous given the significance of each movement during a procedure.
Marsh also details the increasing bureaucracy of working in a public hospital. He must deal with a constant as lack of beds for patients and overwhelming paperwork when all he wants to do is care for his for patients. Even a powerful neurosurgeon like Marsh finds himself a victim of this bureaucracy because of a lack of operating space, brain scans that will not load on a new computer system, or wasted time spent searching the entire hospital for a patient who has been moved multiple times without any record of where they have been placed. At times it is difficult to like Dr. March as he berates younger surgeons or residents and hospital administrators while also recognizing that his skill as a neurosurgeon is highly sought after, and he is clearly very good at what he does. It is clear that Dr. Marsh loves neuroscience and neurosurgery and enjoys the challenging cases that other surgeons often bring to him looking for assistance and recommendations.
Dr. Marsh talks in great detail about some of the cases in which surgery will not help the patients live much longer or cases in which the risk of the surgery is greater than the benefit to the patient. Telling the family and the loved ones of the patient that the surgery will not “cure” or even help the patient is basically giving them a death sentence. Some neurosurgeons go through with unnecessary surgeries because they cannot bring themselves to have this discussion with the patient’s family. It is also possible on rare occasions that the patient overcomes all odds and lives far longer than anyone expected which may make the surgery viable. Even in a routine surgery, a surgeon must follow informed consent by telling the patient of the potential risks of the surgery so that they move forward with full knowledge of what will happen during the surgery and what may go wrong. Patients often put all of their trust in their surgeon even when the surgeon does not have much experience with the particular surgery they will be conducting. Many patients believe that if the surgeon is well known they must be good at all types of surgery and Marsh indicates that patients rarely question how much experience a surgeon has with cases similar to their own, even with extremely rare cases. Marsh can relate to the tension and anxiety family members face as his own son suffered from acute hydrocephalus as a toddler. In this case, Marsh was the nervous father pacing the hallways of the hospital wondering about his son’s prognosis.
Discussions with patient’s families must also take place immediately following long and strenuous surgeries. Medical school and years of experience still do not prepare one for telling someone that their wife, father, son, etc. has died in surgery or will not be the same after the surgery. Marsh claims that even after all of his years in practice, giving bad news to families is one of the most difficult parts of the job.
Marsh gets calls for advice while on holiday, in the middle of the night or when he has just left the hospital for the day. He discusses the many failed marriages of neurosurgeons because of the never-ending nature of their job. Marsh also cites the need to psychologically remove one’s self from the situation to preserve their own well-being and not to become too nervous about the surgery taking place. Initially, the psychological removal seems cruel, but Marsh insists that this is a necessity to continue with the job. Do No Harm reveals a very personal side of the life of a neurosurgeon and introduces the many challenges of the job but most importantly the happiness the surgeon, patient, and family feels when patients recover from brain trauma.
Other Related Resources
The New Yorker: Anatomy of an Error
NPR podcast: A Neurosurgeon Reflects on the “Awe and Mystery” of the Brain
Henry Marsh talks about Neurosurgery
Interview with Dr. Henry Marsh on “Do No Harm.”
The New Statesman: Life and Death at his fingertips: Watching a brain surgeon at work
Psychological Figures and Concepts
Phantom Limb Pain