‘I often have to cut into the brain, and it is something I hate doing.‘
Henry Marsh’s memoir about his life as a neurosurgeon is a remarkable read, albeit one that requires a certain steadiness of gut. Be advised: whilst delivered in Marsh’s cool, precise prose, the descriptions of surgery – what Marsh calls ‘controlled and altruistic violence‘ – are extremely graphic. But behind the blood there’s an uncommon level of humanity on display here, unusual not only in the world of autobiography but also fiction.
The most striking of the book’s many attributes is Marsh’s honesty. Having been in the profession for close to 30 years, his age and experience mean that he is readily able to face up to the limits of surgery, and the doctors which perform it. Marsh’s position means that he is used to treating people who are very seriously ill, and for whom little can be done, the miracles of modern medicine not withstanding. Most fascinatingly, over the course of his career Marsh has come to realise that the most difficult decisions are not made on the operating table, but rather before it; and whether complex (and expensive) surgery will actually bring any additional value to the patient’s life.
‘Most neurosurgeons become increasingly conservative as they get older… I certainly have – but not just because I am more experienced than in the past and more realistic about the limitations of surgery. It is also because I have become more willing to accept that it can be better to let somebody die rather than to operate where there is only a very small chance of the person returning to an independent life… The problem, of course, is that so often I do not know just how small the chance of a good recovery might be because the future is always uncertain. It is much easier just to operate on every case and turn one’s face away from the fact that such unquestioning treatment will result in many people surviving with terrible brain damage.‘ (p.124)
This passage – and, indeed, the whole book – throws up some thought-provoking questions about the limits of medical science, and just how far it should be employed to extend life. I’d agree with Marsh’s view – if I wasn’t able to live independently I’d much rather quit the stage quietly, leaving my family and friends with happier memories of the person I used to be. But then, it’s easy to say that – I’m not in that position, and if I were perhaps my view would change.
The book has a doctor’s typically robust view of death, even though Marsh acknowledges that in his current role it ‘has become sanitized and remote.’ With an unflinching gaze Marsh describes the deaths of some of his patients on the Intensive Care Unit, people who are admitted in a coma and remain in a coma, and who are only kept alive by a ventilator. ‘Death comes simply and quietly when they are diagnosed to be brain dead,’ he writes. ‘The ventilator is switched off. There are no dying words or last breaths.‘
This wasn’t always the case. Marsh describes his years as a junior doctor, when he was frequently called to certify the death of someone in hospital. And as a casualty officer, Marsh saw death in its more dramatic and violent forms – whether gunshot wounds, heart attacks, electrocution or a dozen other causes. But it is the small details that are the most moving – there are the ‘BIDs’, people brought in dead having collapsed in the street:
‘On these occasions I would find the corpse fully dressed on a trolley, and having to undo their clothing to place my stethoscope on their heart was a profoundly different experience from certifying death in the hospital inpatients in their anonymous white gowns. I felt that I was assaulting them, and I wanted to apologise to them as I unbuttoned their clothes, even though they were dead. It is remarkable how much difference clothing makes.’
Reading Do No Harm gave me a new perspective on the medical profession, and a new respect for the work that they do, it all its forms. If I’m ever unfortunate enough to have to go under the knife – for whatever reason – I hope my surgeon is as humane and honest as Henry Marsh.