Do No Harm

Stories of Life, Death, and Brain Surgery

Henry Marsh

 2014, 2016

reviewed by Mira de Vries

What is it like to be a senior neurosurgeon?

Marsh allows us a peek into his soul, not through a microscope or MRI scan but through these fascinating memoirs. His description of bodily details which most of us would find gory makes them sound like exquisite art exhibits or magnificent scenes in nature. More harshly but no less poetically he describes his own emotions, particularly when matters go wrong. Throughout he alludes to but never quite puts his finger on the elusive bridge between cerebrum and psyche.

Usually before writing a review I refrain from reading others' reviews lest I be prejudiced by them. But as hundreds of fine reviews of this bestseller are already available on the Internet, I choose here to only highlight aspects of this book that seem to have escaped the attention of other reviewers.

Of the twenty-five chapters, the titles of twenty are names of neurological pathology followed by a brief definition. Three refer to emotional states. One title has a definition in both neurology and psychology. That adds up to twenty-four.

Only one carries the title of ostensibly a medical treatment: Leucotomy, or as it is called in the US, lobotomy. In this chapter Marsh reminisces about his brief job as a nursing assistant on a long-term psycho-geriatric ward while still a student. Not only the title contrasts this chapter to the others but also his attitude. While elsewhere he describes his patients with the utmost of respect even when they have been reduced to a pathetic state of helplessness, here he describes them as “babbling, demented incontinent old men” (sic) and his respect is reserved for the nurses who work with them. And while in the other chapters he blames himself for causing such damage, here he in no way acknowledges that the mess these men are in is iatrogenic, whether or not caused by Marsh. He describes how the operation is done but fails to condemn it. Instead he writes, “Fortunately it was rendered obsolete by the development of phenothiazine drugs such as Largactile.” Fortunate for whom? The phenothiazines were the first neuroleptics, later falsely relabeled antipsychotics, which indeed render lobotomy obsolete as with these drugs psychiatrists can reduce their patients to “babbling, demented incontinent old men” and women without soiling their hands. Marsh admits to having committed such operations but is happy to have abandoned them. “The psychiatrists told me that the operation really did work,” he cites doubtfully, then prematurely aborts his skepticism by skipping to a description of a person with mysophobia who, before treatment, is not too babbling, demented or incontinent “to sign the consent form that allowed me to burn a few holes in his brain.” Rather than relating the tragic results as he does in other chapters, he has his train of thought interrupted by a nurse, never to return to the subject again. (Perhaps he never did do lobotomies himself but only inserted them into the book for what he perceives as their entertainment or educational value?)

That kind of cop-out is not typical of this publication. Marsh is otherwise not wary of withering criticism of himself nor of the medical establishment:
  • I thought the word 'technology' would mean interesting things like microscopes and operating instruments but it turned out, to my dismay, to mean drugs.
  • Many of the hospitals are involved in trials for the big drug companies and I was told that the same patient might be put into several different trials since the doctors get paid for every patient they enter. If that is true … the results are therefore meaningless.
  • [In patient files] the recent relevant results have rarely been filed, and if they have been filed, have been filed in such a way that it is usually very difficult to find them. I can learn … about my patient's birth history, and perhaps gynaecological, dermatological or cardiological conditions, but rarely find information such as when I had operated on the patient, or the analysis of the tumour I removed. I have learnt that it is usually much quicker to ask the patient instead.
  • I thought of the presentations I had heard over the years at international conferences by the great names of neurology and the breathtaking results they claimed … although rarely, if ever, with a word about any bad results they might have had along the way.
In addition, this book contains some great quotable passages which deserve to become aphorisms that make Marsh immortal. Here are a few examples:
  • We invest doctors with superhuman qualities ... If the operation succeeds, the surgeon is a hero, but if it fails, he is a villain.
  • Doctors [are] reluctant to criticize each other in public [except if they] hate each other.
  • They do the rounds of the hospital departments when they are appointed and then one never sees them again, unless one is in trouble... This is called management.
  • Doctors need to be held accountable, since power corrupts.
  • The real utility of the drug is to give dying patients hope.
Though Marsh's surgery sometimes stumbles, his stories are a smashing success.

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