Book review: Do No Harm

W&N: £6.29 paperback, 2014

Review by Jim Killgore, publications editor, MDDUS

THIS fascinating book by neurosurgeon Henry Marsh – familiar to many from the documentaries Your Life in Their Hands and The English Surgeon – is a memoir of sorts, though woven through a series of vignettes involving some of the patients he has operated on over the years.

Marsh writes with refreshing honesty and humility yet no false modesty. He is confident of his unique skill yet also painfully aware of the limitations of his role – which he calls more craft than art.

“Much of what happens in hospitals is a matter of luck, both good and bad; success and failure are often out of the doctor’s control,” he writes. “Knowing when not to operate is just as important as knowing how to operate, and is a more difficult skill to acquire.”

Many of the surgical challenges described in this book ultimately come down to plumbing, though at the most intricate extremes – removing tumours or clipping off aneurysms without compromising the rich blood supply to the brain where even minute haemorrhages can result in catastrophic blood loss. All done with fine precision using a binocular operating microscope: “I am deeply in love with the one I use, just as any good craftsman is with his tools,” he says.

The anatomy Marsh describes looking down his microscope is almost otherworldly. “I often have to cut into the brain and it is something I hate doing. With a pair of diathermy forceps I coagulate the beautiful and intricate blood vessels that lie on the brain’s shining surface. I cut into it with a small scalpel and make a hole through which I push with a fine sucker… The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.”

Surgical errors in such procedures are more often than not attended with devastating circumstances for the patient and Marsh provides frank insight on how neurosurgeons deal with this responsibility.

“You can’t stay pleased with yourself for long in neurosurgery,” says one colleague. “There’s always another disaster waiting round the corner.”

This book offers a rare view of what life is like in the premiere league of surgery – but it is also an artful and engrossing read.