REVIEW - “Do No Harm: Stories of Life, Death and Brain Surgery” by Henry Marsh

“Do no harm: Stories of Life, Death and Brain Surgery” is a captivating entanglement of surgical tales, written by NHS neurosurgeon Dr. Henry Marsh and published in 2016. The story steers readers through the ever-complex navigations of Dr. Marsh’s life as he navigates struggles between life and death on a daily basis. Marsh introduces us to a world where death is remarkably omnipresent, where a minute error could prove potentially fatal, and where one constantly battles a whirlwind of emotions - fear, intense anxiety, or relief and gratitude - related to patients’ and their families’ conditions.

Each chapter in this novel carries readers through a different story - of a specific patient or case, about Marsh’s own life, or about administrative concerns that understatedly comprises a large part of being a doctor. A chapter begins with a new neurosurgical word and its definition. This theme continues throughout the chapter, albeit it can manifest in more subtle ways. Marsh intricately describes the beginning, middle and end of neurosurgery in an unglorified, edited and raw manner. He brings to light the vital importance of co-ordination with junior doctors, registrars and anesthetists to ensure successful surgery. He details the uncertainty and decision-making required when deciding how to approach a patient and their family, such as in declaring their diagnosis or in suggesting surgery or not.

Many of these insights were surprising, and highly informative, to me. What was most unexpected, however, was the unbalanced ratio of successes to failures in his novel: Dr. Marsh listed many more losses than wins. Neurosurgery, I learned, is much unlike various other surgical professions - often one can end up seeing a patient for years, such as with a recurring tumour, and many times surgery simply prolongs a patient’s life instead of curing their illness. Unfortunately, progress in brain research and neurological disease has been limited, despite over 40 years of extensive investment into this field. This means that although treatments have become less invasive and new therapies are developed, there is no one-cure-for-all treatment for patients.

If I were to provide one advice before reading this book, it is to be warned: you must read this with a thick skin. Although Marsh’s writing furthered my motivations to help patients through research and practice, it was, admittedly, rather depressing. It was of no help that I fell ill while reading the novel - making my empathy for the hospital-ridden patients described much more profound. There were moments, more initially in the novel, where I could physically sense my heart rate rising as Marsh describes how he dissects cerebral anatomy to remove a tumor. I became habituated to his lifelike descriptions later on in the novel, but the exquisite beauty - and terror - of neurosurgery never leaves you behind.

Marsh’s imagery is incredible, which enables a detailed visualisation of each scene in the novel; this is both an asset and a danger. The underpinnings of neurosurgery come to life and, for once, you are put in the surgeon’s shoes. You learn to forgive yourself, to make mistakes (and learn from them), to cut self-blame, and to be empathising yet detached with patients’ lives and stories.

Ultimately, Marsh is a brilliant, poetic writer and clearly a skilled surgeon. However, more than that, he has the courage to admit that he is vulnerable, and moreover, to reveal his fallibility in a book. This is what make Dr. Marsh all the more likeable, because he is - to us - all the more human.