Do No Harm: Stories of Life, Death, and Brain Surgery Paperback – June 7, 2016

In the age when medicine is becoming more and more guided by strict protocols and guidelines, surgery still depends now only on statistics, but on skill. This is even more true for neurosurgery, where any mistake could lead to irreversible brain damage and severe disability. So it's not surprising that neurosurgeons are much revered and there is an almost limitless belief in their abilities. In "Do No Harm", Henry Marsh, a well-known neurosurgeon with decades of practice shows the inside part of his profession, giving an account not only of success and cures, but of failures, mistakes and tragedies. Each chapter, usually named after a disease of the brain, contains stories of patients: the ones successfully cured, the ones who could not be treated and the ones wrecked by the complications of operations or mistakes of the doctor. Marsh is almost painfully honest, describing his “small cemetery” of patients, the "ghosts that watch him operate”, telling about his occasional anxiety before the operation, the shame he feels if the intervention didn't work, the decisions whether to operate at all, weighing the risks of operation against the not always large benefits (the difficult part, as he calls it). The operations themselves are beautifully and captivatingly described, and one could see that Marsh has a deep love with the brain and it's complicated structure, and feel a small part of the terrifying excitement of an operations which he compares to "bomb disposal". There is also some wry, grumpy English humour at the expense of the NHS and hospital administration. But the best part of this excellent book is Marsh's compassionate reflections about his patients and talks with them, the meditations the value of life and acceptance of death, things that we try to avoid, but with which he lives for many years. One could only hope to meet such a doctor in a critical moment.

4 stars for content, 3 stars for Impact...I have no doubt, since my almost 50 years of experience as a Surgical Practitioner in the USA, convinces me that Mr. Henry Marsh is a dedicated, honest and skilled Neurosurgeon who is trapped in the NHS along with his patients, trying to do excellent practice in this essential but dismal Specialty. The narrative is interesting and well presented with many of the situations and Government controlling imperatives and "red-tape" and coding and stratifications of care and cost containment efforts and absurd decisions paralleling those in the U.S. Aside from his own travails with retinal detachments and fractured leg, Mr. Marsh's projection of himself as the Quixotic defender of the tortured NHS regulars on occasion gets a little too whiney and blame diverting as fingers get pointed at Government Supervisors and Administrators and Managers who seem to control the patients' plight. Truth be told, that in the operating theater, Mr. Marsh is still in control and no matter how much the NHS seems to be in charge of outcomes, it is still the decisions made by the operative team which seem to be the "poor outcome culprit" in this scenario. To his credit, Henry Marsh stays true to his presented story lines and although the conclusions seem to put him at the center of the target, especially when he has allowed a less experienced member of the Registrar staff to "begin without him in the room" the only thing that takes a "hit" is his own "credability" as passionate defender of the public against the entire NHS quagmire of Medical Care.

I could not put this book down. One word of warning, though. Do not read it if you are scheduled for brain surgery. It may scare you too much, because the writer is relating mostly his failures, perhaps as a way of dealing with the corpses every neurology surgeon carries within.. That being said, it was a magnificent book that filled me with respect for the profession, for the author, and for the many brave neurosurgeons that sacrifice their families, their entire lives, even their emotional inner peace for the sake of helping others with the terrible diseases the brain can fall prey to. I realize now what a toll this profession takes on them, what a special person one has to be to deal with the patients and their families at the most vulnerable time of their lives, and how difficult it must be to give an honest diagnosis without killing any hope. Not only does the author describe - in more detail than I can understand - the intricacies of the brain and the delicate touch necessary to enter it with instruments of surgery, but he also covers the emotional interactions with patients, and the many things a doctor has to keep in mind as he/she deals with them with compassion and sensitivity. No wonder some neurosurgeons (i.e. Dr. Eben Alexander) have mystic experiences and find strength in the spiritual world. Dr. Marsh does not do this, though. He remains steadfast in his admiration for the wonders of the brain and the scientific view of the body. I suspect that, for this reason, the psychological burden of the profession may be greater on him. Thank you, Dr. Marsh, for your honesty, your strength, and your life-long commitment to your patients and to your demanding profession.