Do No Harm

A few months ago, I was watching BBC’s Artsnight, a culture show fronted each week by a different guest host. On this particular episode, brain surgeon Henry Marsh was interviewing confessional author Karl Ove Knausgaard on the themes found within his work - primarily guilt, fear and loss. Mimicking the theatre of the surgery room, Knausgaard lies flat, his head locked in place, and goes under the inquisitor’s knife. Over the course of this psychological examination the doctor-patient dynamic changes though, as by the end Knausgaard is as interested in Marsh as Marsh is him.

Knausgaard, a worldwide publishing sensation, is treated as a celebrity wherever he goes: his six-volume autobiography distils the cerebrum onto the page by revealing his innermost pains and fears. It is a literary form of a brain surgery, where the author opens himself up for public examination. No surprise then that Knausgaard views Marsh with awe: for Marsh doesn’t play at putting life under a microscope, he lives it.

Knausgaard and Marsh.

Wanting to know more about Henry Marsh, I bought His book, Do No Harm. In it, Marsh writes openly – and most importantly accessibly – about the challenges of being a brain surgeon. Each chapter is headed by a medical term that anticipates the anecdote to come (Pineocytoma, Aneurysm, Angor Animi); then, over the course of the chapter we’re told the story of how Marsh treated the patient with the related condition. Technical terms litter the page but never in a way that proves alienating; like Macdonald’s H is for Hawk I reviewed last year, the esoteric is made relatable by highlighting the raw, human impact of the most technical of endeavours.

Despite the exalted position brain surgeons find themselves in, Marsh doesn’t see himself as a genius or an artist, but as a craftsman and technician. Later in the book, he speaks favourably about one of his patients, a plumber, recognising in their jobs a shared dexterity. Unlike a plumber though, Marsh deals with the labyrinthine piping of the brain. If he makes a wrong move with his instruments, the leak could prove fatal; the damage irreparable. These mistakes are documented very bravely in the book. There’s the time he leaves a woman paralysed, following a decision to remove too much of her tumour backfires. Another time, a Ukrainian girl dies following complications during her operation. Marsh in not incompetent; he is one of the country’s finest; it’s just that the smallest of mistakes can be fatal in his industry. Reflecting on one mistake with a female patient he explains the guilt that goes with being a brain surgeon: 

'She would be added to the list of disasters – another headstone in that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.’

It is a terrible weight that doctors carry when things go wrong, we’re lucky that their profound sense of vocation means they feel it’s worth enduring.'

Marsh’s story to becoming a surgeon is perhaps as remarkable as the surgery itself. Preferring the arts in school, he had no O Levels or A Levels in science. At university he studied Politics, Philosophy and Economics with the intention of going into the into the civil service. Heartbroken during his third year, he left his Oxbridge course and migrated north to mend his broken heart. Here, he worked as a hospital porter and an interest in medicine was born. Eventually, he retuned to uni and finished his degree. Aware his three years of study were no longer in line with his career aspirations, he sought enrolment on a medical course. Given his scientific naivety, no institution would have him. Fortunately, the admission’s officer was retiring from the Royal Free Hospital and, perhaps feeling unburdened by consequence, gave Marsh a place. A textbook lesson in how the best laid schemes of mice and men can go awry for good reasons.

Finding the career he always wanted, Marsh has sacrificed his life to the profession. Hearing how he takes calls from colleagues whilst at the check-out and the garden centre made me aware how there is no escaping his job. In a way, Marsh doesn’t want to escape his job though. He describes it as an addiction, how when you’re operated all your worries subside as you’re anaesthetised under the magic of surgery. His love for medicine has taken him back and forth to Ukraine, where he was initially invited many years ago to advise the country on how best to modernise their practice. The results of this can be found in the film The English Surgeon, which I would like to get my hands on. In Do No Harm, Marsh talks about the country’s health care system in stark terms: for all the bureaucracy of the NHS, other countries are mired in far worse predicaments.

In writing this book then, Marsh has not just bared the brain, but his soul too. It is a startling achievement and one I recommend.