Do No Harm by Henry Marsh

Do No Harm is a memoir written by Henry Marsh that details his career as a neurosurgeon. I’m still tinkering around my future in the medical field, and this book gave me an intimate understanding of life as a neurosurgeon.

I highly recommend this book for anyone aspiring to be a doctor, as it entails truths about the dilemmas doctors face.

The author also has another book, Admissions: A Life in Brain Surgery.

Take-Home Message

Despite their long hours of training and expansive medical knowledge, neurosurgeons are still humans. There are two things one often encounters in this field; mistakes and ethical dilemmas.

My Highlights

‘First, do no harm . . .’
‘Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.’
It is easier to carry out difficult operations if you have told the patient beforehand that the operation is terribly dangerous and quite likely to go wrong
as a surgeon you learn at an early stage of your career to accept intense anxiety as a normal part of the day’s work and to carry on despite it.
When you approach a patient you have damaged it feels as though there is a force-field pushing against you,
It is a hundred times more difficult and nerve-wracking to train a junior surgeon than it is to operate oneself.
A famous English surgeon once remarked that a surgeon has to have nerves of steel, the heart of a lion and the hands of a woman.
‘The best is the enemy of the good,’
Inexperienced surgeons are too cautious – only with endless practice do you learn that you can often get away with things that at first seemed far too frightening and difficult.
Psychological research has shown that the most reliable route to personal happiness is to make others happy.
All patients are immensely grateful at first after a successful operation but if the gratitude persists it usually means that they have not been cured of the underlying problem and that they fear that they may need us in the future.
It is frightening to think that your surgeon might not be up to scratch and it is much easier just to trust him.
It is not surprising that all surgeons hate operating on surgeons.
As with all operating, it is a question of balancing risks, sophisticated technology, experience and skill, and of luck.
But I then thought of how the value of my work as a doctor is measured solely in the value of other people’s lives, and that included the people in front of me in the check-out queue.
I think patients need to be congratulated for their surviving just as much as the surgeons should be congratulated for doing their job well.
The eyes are said by poets to be the windows to the soul
‘But death is not always a bad outcome, you know, and a quick death can be better than a slow one.’
it was best to see medicine as a form of craft, neither art nor science
There was a slightly grim, exhilarating intensity to the work and I quickly lost the simple altruism I had had as a medical student.
It had been easy then to feel sympathy for patients because I was not responsible for what happened to them. But with responsibility comes fear of failure, and patients become a source of anxiety and stress as well as occasional pride in success.
I became hardened in the way that doctors have to become hardened and came to see patients as an entirely separate race from all-important, invulnerable young doctors like myself. Now that I am reaching the end of my career this detachment has started to fade. I am less frightened by failure
‘The operating is the easy part, you know,’ he said. ‘By my age you realize that the difficulties are all to do with the decision-making.’
I looked at him and irritably told him that the simple, everyday problems were often the most important ones.
It was a useful lesson for me, when I became a fully trained surgeon myself, to know how much my patients’ families suffer when I am operating.
Anxious and angry relatives are a burden all doctors must bear, but having been one myself was an important part of my medical education. Doctors, I tell my trainees with a laugh, can’t suffer enough.
one of the unwritten rules of English medicine is that one never openly criticizes or overrules a colleague of equal seniority,
Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.
when the bad news is being broken so suddenly, all doctors know that patients will only take in a small part of what they are told.
When I have had to break bad news I never know whether I have done it well or not. The patients aren’t going to ring me up afterwards and say ‘Mr Marsh, I really liked the way you told me that I was going to die,’ or ‘Mr Marsh, you were crap’. You can only hope that you haven’t made too much of a mess of it.
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.
But it is so very difficult to tell your patient that there is nothing more that can be done, that there is no hope left, that it is time to die. And then there is always the fear that you might be wrong, that maybe the patient is right to hope against hope, to hope for a miracle, and maybe you should operate just one more time. It can become a sort of folie à deux, where both doctor and patient cannot bear reality.
I have learned over the years that when ‘breaking bad news’ as it is called, it is probably best to speak as little as possible. These conversations, by their very nature, are slow and painful and I must overcome my urge to talk and talk to fill the sad silence.
I found it consoling, when thinking about some of the mistakes I have made in my career, to learn that errors of judgement and the propensity to make mistakes are, so to speak, built in to the human brain.
Doctors need to be held accountable, since power corrupts. There must be complaints procedures and litigation, commissions of enquiry, punishment and compensation. At the same time if you do not hide or deny any mistakes when things go wrong, and if your patients and their families know that you are distressed by whatever happened, you might, if you are lucky, receive the precious gift of forgiveness.
It’s one of the painful truths about neurosurgery that you only get good at doing the really difficult cases if you get lots of practice, but that means making lots of mistakes at first and leaving a trail of injured patients behind you.
One was not to do an operation that a more experienced surgeon than me did not want to do; the other was to treat some of the keynote lectures at conferences with a degree of scepticism.
it is both a compliment and a curse when your colleagues ask you to treat them.
doctors are fallible human beings and not entirely in control of what is going to happen.
what could be worse than having a brain tumour? What right did I have to complain when others must suffer so much more?
Just as it is irresistible to save a life, it is also very difficult to tell somebody that I cannot save them, especially if the patient is a sick child with desperate parents.
what tortures doctors most is uncertainty, rather than the fact they often deal with people who are suffering or who are about to die.
It is easy enough to let somebody die if one knows beyond doubt that they cannot be saved – if one is a decent doctor one will be sympathetic, but the situation is clear. This is life, and we all have to die sooner or later. It is when I do not know for certain whether I can help or not, or should help or not, that things become so difficult.
Healthy people, I have concluded, including myself, do not understand how everything changes once you have been diagnosed with a fatal illness. How you cling to hope, however false, however slight, and how reluctant most doctors are to deprive patients of that fragile beam of light in so much darkness. Indeed, many people develop what psychiatrists call ‘dissociation’ and a doctor can find himself talking to two people – they know that they are dying and yet still hope that they will live.
When doctors become patients they know the colleagues treating them are fallible and they can have no illusions – if the disease is a deadly one – about what awaits them. They know that bad things happen and that miracles never occur.
the trouble with brain surgery is that even if little things go wrong the consequences can be catastrophic. If the operation goes wrong it’s a one hundred per cent disaster rate for the patient but still only five per cent for me.
I thought of the trivial nature of any problems that I might have compared to my patients’ and felt ashamed and disappointed that I still worry about them nevertheless. You might expect that seeing so much pain and suffering might help you keep your own difficulties in perspective but, alas, it does not.
When we are ill our suffering is our own and our family’s, but for the doctors caring for us it is only one among many similar stories.

Get the Book

Get the book as print or Kindle here.