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Do No Harm: Stories of Life, Death, and Brain Surgery

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What is it like to be a brain surgeon? How does it feel to hold someone's life in your hands, to cut into the stuff that creates thought, feeling, and reason? How do you live with the consequences of performing a potentially lifesaving operation when it all goes wrong?

In neurosurgery, more than in any other branch of medicine, the doctor's oath to "do no harm" holds a bitter irony. Operations on the brain carry grave risks. Every day, leading neurosurgeon Henry Marsh must make agonizing decisions, often in the face of great urgency and uncertainty.

289 pages, Kindle Edition

First published March 13, 2014

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About the author

Henry Marsh

23 books597 followers
Henry Marsh read Politics, Philosophy and Economics at Oxford University before studying medicine at the Royal Free Hospital in London. He became a Fellow of the Royal College of Surgeons in 1984 and was appointed Consultant Neurosurgeon at Atkinson Morley's/St George's Hospital in London in 1987, where he still works full time.

He has been the subject of two major documentary films, YOUR LIFE IN THEIR HANDS, which won the ROYAL TELEVISION SOCIETY GOLD MEDAL, and THE ENGLISH SURGEON, featuring his work in the Ukraine, which won an EMMY award. He was made a CBE in 2010. He is married to the anthropologist and writer Kate Fox.

His latest book is And Finally, coming after Admissions and Do No Harm.

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Displaying 1 - 30 of 2,731 reviews
30 reviews8 followers
January 18, 2015
I read this book because Mr Marsh operated on a friend of mine who had a brain tumour - she sadly died, but 5 years after her surgery. Some throwaway lines such as "I like to wash my female patients' hair" rang true - she had wonderful long hair and she found it very moving that her surgeon made her hair beautiful again after the mess that accompanies brain surgery.
As a fellow doctor , I both liked his honesty but also realised he must be impossible to work with. Other asides which are very revealing - " I think most of my colleagues dislike me" and the story of him throwing out fellow surgeons from "his" neurosurgery restroom reveals a lot of insight into how he is viewed at work. Other statements such as " I do not allow junior doctors or medical students in my clinic" - are just exasperating - how do they learn then? How did Henry Marsh himself learn?? ie from watching others.
However, although he is known to all at St Georges as quite a maverick, he also brilliantly explores the human side of having to make potentially earth-shattering decisions every day - in my job, I can usually phone the patient back, or see them again, if I am not 100% perfect on the day. In neurosurgery, a tiny lapse of concentration or just sheer bad luck, renders the patient potentially paralysed or dead, or worse - he does explain what is worse.....
Neurosurgeons are often accused ( by other doctors) of behaving as if they were God, and being immensely condescending to others - but here you get to see the other side of the coin - knowing you CAN operate but having to decide if you SHOULD, having to go and see a patient you have rendered paralysed, or at least, failed to cure, having to cope with the huge expectations, and huge anger and disappointment of relatives, and so on.

In highlighting so many cases where things have gone wrong, perhaps Henry Marsh does himself a disservice - after all, to many of his patients, including my friend, he is viewed as wonderfully kind, reassurring, capable - everything one would wish for if you have to undergo such a frightening procedure. As well as these cases where often he shows things not turning out well, he has performed hundreds of operations that have been huge successes.
And there is the interesting part of this book - you start out feeling irritated/bored with some of the medical descriptions, and exasperated by his "I am God" behaviour - but by the end you see him (and other surgeons like him) as normal human beings, bravely doing what most of us couldn't cope with, and somehow still retaining his humanity and care.
A very interesting book
Profile Image for MISS Petra to you!  Say yes ma'am.
2,383 reviews33.9k followers
January 2, 2016
This was a bit of a surprise after reading several of the late Oliver Sacks books on neurology , concentrating on the symptoms, psychology and behaviour of a person with a brain with a physical disorder. This book is on the nitty gritty scalpels in the brain, blood spurting out and deflating tumours from within. Not what I expected at all. But good, very good.

It's my bedtime book. What does that say about me? LOL
Profile Image for Caroline.
497 reviews555 followers
February 13, 2016
An intensely readable book about Henry Marsh's experiences as a neurosurgeon, working for St George's Hospital, under the British National Health Service. It also describes the charity work he does at a hospital in the Ukraine, working in incredibly difficult conditions.

He's funny......and pompous yet humble..... and a brilliant yet vulnerable man, who is not above throwing the occasional wobbly when one of the ghastly NHS computers behaves badly. His other great bête noir is a hatred of administration generally (of which there is an endless amount in hospitals), and in particular the myriad health and safety rules which intrude upon his life as a doctor. But he has a kinder view towards people - especially towards his patients.

Until reading this book I hadn't really taken on board the full implications of what can happen if brain surgery goes wrong. You can be left unable to speak, or paralysed down one side, or even in a completely vegetative state for the rest of your life. And if the stories in this book are anything to go by - the risks are quite high. Even if the risk is seemingly fairly low - say 5% - I personally would prefer not to be operated upon. If the outcome of the operation going wrong was death, that would be an okay alternative (for me), but given that the outcome can be life, but a grossly diminished life? For me then the cost would be too high. The brain is an incredibly difficult thing to operate on. There are risks. And when things go wrong they can go horribly wrong. Even for experienced surgeons, the challenges are often enormous.

On the other hand, experience shows that when faced with the prospect of death, we often cling on to life with desperation. Marsh has seen this time and time again, as people beg to be operated upon, and then later, to be operated on again, to squeeze just a few more months out of life. "(I) wondered, yet again, as I walked away down the dark hospital corridor, at the way we cling so tightly to life and how there would be so much less suffering if we did not. Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all." I hope deeply that should I find myself in this position, I would be able to let go....

I will end on a happier note, albeit one peppered with expletives. It illustrates the frustration that hospital staff experience in the day-to-day care that they try and give their patients. It is a long extract, but it made me laugh.

I thought this book was a marvellous, un-put-downable read, and would recommend it to anyone.

A review from The Guardian


A BBC film about Marsh's work in the Ukraine.


Profile Image for Erika.
75 reviews125 followers
February 6, 2017
4.5 stars.

The Goodread’s description of Do No Harm talks about the books’ “astonishing compassion and candor” and says it’s “it is a lesson in the need for hope when faced with life's most difficult decisions.”

I’m thinking whoever wrote that only read half the book.

English neurosurgeon Henry Marsh does write beautifully about brain surgery. There certainly is great compassion and candor, and he’s fascinating on the topic of the human brain—how it works and what can go wrong with it. There are engaging narratives here, and Marsh has a way of dropping a story and picking it up again that kept me eagerly waiting to find out what would happen to each of the patients he depicts

But, Do No Harm is not “a lesson in the need for hope.” Hope doesn’t even factor into it. Instead, this is part medical memoir and part impassioned rant against England’s National Health Service. Again and again, Marsh provides examples, sometimes hilarious, sometimes depressing, of the way technology and a dysfunctional corporate culture impedes his ability to help patients.

Toward the end of the book, we meet a man and his parents who come to Marsh’s office for a diagnosis of the man’s brain tumor. They are terrified and ready to hear the worst as they sit and wait for his verdict. But Marsh is unable to access the brain scans. There’s been a mix up in the hospital system's network, so he leaves the scared family in his office, and walks over to the imaging department, which is far away, but they’re not answering the phone.
“Where is Caroline?” I asked as I arrived at the x-ray reception desk, a little out of breath.
“Well, she’s about somewhere,” came the reply.
So I headed off round the department and eventually I found her and explained the problem.
“Have you tried your password?”
“Yes, I bloody well have!”
“Well, try Mr. Johnsons. That usually works. Fuckoff45. He hates computers.”
“Why 45?”
“It’s the 45th month since we signed on to that hospital system and one has to change the password every month,” Caroline replied.
So I ran down the corridor and down the stairs and past the waiting patients back to the consultation room.”
Fuckoff45 doesn’t work and neither does any other permeation Marsh tries. He runs back to the imaging department and convinces Caroline to accompany him back to the consultation room. FuckOff47 finally does the job. By then, the patients are almost vibrating with anxiety, his clinic is running 45 minutes late, and it’s not even 10:00 yet.

And on it goes.

I listed to the audio version of this book read by British actor Jim Barclay who perfectly captures Marsh’s brilliance, passion and wit. I did subtract half a star because portions of Do No Harm read like a bad Yelp review and while no doubt Marsh is correct in his indictment of the NHS, I don’t need to be taken that deeply into the weeds. That said, this is a small detail in an otherwise wonderful book.
Profile Image for Valliya Rennell.
339 reviews230 followers
May 20, 2020
3.25 stars

“Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.”

In this book, Mr. Marsh tries to show the reader what it is like to be a neurosurgeon. Also serving as his memoir, this book shows the stress, the triumphs and failures of working in a hospital, specifically in neurosurgery. Personally, I thought it was very interesting and touching, but I had some problems just with the way it was written. If you are interested in medicine, give this a go.

I really enjoyed that he doesn't develop God-complex when he writes. Marsh is fully aware of his failures and some of my favorite parts of the novel were when he has to deal with failing and ultimately destroying someone's life. The guilt and the constant thinking over what could have been done better/differently was heartbreaking to read about but also enthralling. Throughout this book you get a better idea of what goes on behind the scenes in a hospital. As someone who was in the hospital recently and kept experiencing delays, I think I can now understand a bit more what was happening. I have often wondered how doctors live with the stress of holding other people's fates in their hands, once again this is an area in which Mr. Marsh excels. Chapters are devoted to examining the divide between patients and doctors and the walls that doctors put up. I never really realised the dehumanisation that patients go through when entering the hospital. All sorts of emotions sprang up when Marsh explained how doctors early on need to learn to view patients as something other than them; a different race. This way, they can get their job done and not suffer a mental breakdown. The strong points of this book definitely were the examinations of difficult topics.

What I didn't enjoy as much was the formula. Unlike many memoirs/autobiographies, Do No Harm isn't chronological. The names of the chapters aren't dates either, so you end up jumping around in the time line which is very disorientating. Sometimes I was trying to wrap my head around what was going on and at what state he was in his life to understand where he was coming from in that moment. Similarly, I liked the chapter titles (names of diseases for the most part) in the beginning. Later though, they stopped being disease names and sometimes, it would be disease name that isn't really covered. Again, this was kind of disorientating. At times the book was also quite formulaic, especially towards the beginning, but as we got into the last 1/3 this went away.

Overall, this was a very thought-provoking, interesting read.
Profile Image for Rebecca.
3,508 reviews2,506 followers
October 9, 2015
“Terrible job, neurosurgery. Don’t do it.” Lucky for us, Henry Marsh reports back from the frontlines of brain surgery so we don’t have to. He’s nearing retirement age after a career divided between a London hospital and medical missions to Ukraine. The punchy chapters are named after conditions he has treated or observed. Rarely, he has been a patient himself (detached retinas, a broken leg), or observed a family member’s illness – his son’s brain tumor, his second wife’s epilepsy, and his mother’s terminal cancer.

Marsh comes across as having a hot temper, exhibiting extreme frustration with NHS bureaucracy. At the same time, he gets very emotional over his patients declining and dying, and experiences profound guilt over operations that go wrong or were ultimately unnecessary. He realizes the God-like power he holds over people’s quality of life: “We [surgeons] sit there, alive and well and happy in our work, and with sardonic amusement and Olympian detachment we examine these abstract cases on which to operate.”

It was particularly interesting for me to see the view from the other side of the operating table because two chapters have personal significance for me: “Oligodendroglioma” was my late brother-in-law’s diagnosis, and the account of a near-disastrous clipping surgery in “Aneurysm” showed me why my mother has been so reluctant to have it performed.

In my favorite passages, Marsh reflects on the mind-blowing fact that the few pounds of tissue stored in our heads could be the site of our consciousness, our creativity, our personhood – everything we traditionally count as the soul:

I am looking directly into the center of the brain, a secret and mysterious area where all the most vital functions that keep us conscious and alive are to be found. Above me, like the great arches of a cathedral roof, are the deep veins of the brain – the Internal Cerebral Veins and beyond them the basal veins of Rosenthal and the in the midline the Great Vein of Galen, dark blue and glittering in the light of the microscope. This is anatomy that inspires awe in neurosurgeons.

Are the thoughts that I am thinking as I look at this solid lump of fatty protein covered in blood vessels really made out of the same stuff? And the answer always comes back – they are – and the thought itself is too crazy, too incomprehensible, and I get on with the operation.

This book might not be for you if you are squeamish about surgical details, but if you can get past that I submit to you that, like Atul Gawande’s Being Mortal, this is one that everyone should read.
Profile Image for Nicky.
4,138 reviews1,003 followers
January 26, 2015
If you’re really squeamish about blood and body parts and squishy bits, this isn’t the book for you. Marsh talks a lot about the practicality of operating on the brain, as well as about interacting with patients, decision making, dealing with outcomes, training new surgeons, etc. He’s very frank about all of it. If, like me, you’re planning to become a doctor, you might want to read it just to get a frank, unvarnished view of what it’s like to work in the NHS, what it’s like to have people’s lives in your hands, and how to (and sometimes how not to) interact with patients and coworkers. He has the humility to admit that he’s not perfect, without false modesty. He’s a brain surgeon, and he’s bloody good at it: if he weren’t, a lot more people would be dead. But he does make mistakes, and he owns up to them — both the avoidable and the unavoidable ones.

Some parts of this book feel painfully real, too. I’ve been the family member being told by a doctor that someone isn’t going to make it; seeing it from the doctor’s perspective is no easier. I really appreciated Marsh’s humanity about these things: he wasn’t afraid to admit that he didn’t want to meet bereaved family members, but he did meet them all the same, and confess to his mistakes where he’d made them.

On another level, of course, the book is fascinating just because it’s about the brain. Neurology or genetics are tentatively my interests right now, and while I’m not going within a football field’s length of neurosurgery, this still had a lot of fascinating insights.

As a volunteer for a charity for the blind, I heard about a patient my age who had brain surgery. She was fine before, aside from the tumour on her pituitary gland which was just starting to cause problems. She came out of it totally blind; in removing the tumour on her pituitary gland, the surgeon also irreparably damaged her optic chiasm (where the optic nerves cross). Mostly, I’ve thought about this from her perspective — now I find myself wondering about that surgeon. Did he think it went perfectly, until after? The damage might not have been apparent until she woke up from anaesthesia. He did well, otherwise; got the whole tumour, as near as damn it. And yet the course of that young woman’s life is completely changed all the same. A lot of the things she wanted to do aren’t possible anymore. I bet it felt just a little bit like failure, even if he saved her life.

It makes me doubt being a doctor, a little. But it also makes me think about the importance of good doctors — not just technically good, but doctors who try to do good; who may make mistakes, but admit to them, and try to redress the damage. I want to be one of them, for sure.
Profile Image for Melissa.
59 reviews4 followers
May 13, 2019
Read this for a bookclub. Not my usual style which is why I'm always reluctant to joining bookclubs- I'm 30 years old now, I know what sort of books I enjoy. Life's too short to read books you're not interested in.

It started off okay but for me quickly descended into just an outlet for an angry, arrogant old man's egotistical musings. I still can't quite figure out what he was trying to achieve by writing this book, other than to rant about 'management', technology, and tell us 50 times that hospitals don't have enough beds.


I think a lot of my dislike of this book comes specifically from the arrogance of the author, and his obviously false humility. There was a moment in his book where he had been forced to go to a kind of health & safety course (like all us mere mortals who are 'useless and don't save lives' do) and when the instructor tried to hand him the work folder he refused to take it because he thought he was above this nonsense, so the guy had to put it on the floor next to him. He also on numerous occasions expressed how irritated he was if for example, a nurse who worked in a completely different ward didn't recognise HIM, in HIS OWN HOSPITAL. Like, are you child? Grow the eff up. I can't even count the amount of times I found myself exclaiming 'ugh what an asshole!' while reading this

I guess I just wanted more stories of the people he has operated on, more of a study on human behaviour. He tantalizes us with hints of how a person can go through a 'horrible personality change' caused by tumours or surgery but then doesn't give any examples. Instead we just have ramblings of a old man dotted with recounts of some of his surgeries, both with good outcomes and bad.

It was okay, but I wouldn't recommend this book.
Profile Image for Laura.
179 reviews144 followers
January 17, 2015
This book should be compulsory reading for:

- Anyone who has ever been treated by the NHS
- Anyone who will ever conceivably be treated by the NHS
- Anyone who has, or ever will, undergo serious surgery of any kind

Henry Marsh is a world-renowned neurosurgeon who had been working as a consultant for the NHS for almost thirty years at the time that the book was written. It gives a fascinating insight into neurosurgery itself as well as the changes that have occurred in British healthcare over that time. While some of these changes are undoubtedly for the better (when Marsh started out working in hospitals, there was a bar in which doctors drank and smoked for hours while on call); many of them are negative. The reader sees through Marsh's eyes the devastation wrought by ever-changing and unrealistic government targets, unreliable technology and the increasingly labyrinthine bureaucracy that all NHS workers need to wade through each day.

But the best thing about Do No Harm is that it breaks down the invisible wall between patients and doctor and shows surgeons as they really are: anxious, fallible and human. Marsh describes his surgical mistakes (many of which have utterly devastating consequences) as well as his triumphs.

It's a book like nothing I've ever read and would recommend it to pretty much everyone apart from the incurably squeamish.
Profile Image for Ammar.
441 reviews217 followers
April 9, 2017
In 25 chapters, each built around a neurosurgical operation (infections and strokes but mostly tumors), the author provides vivid accounts of patients before and after surgery as well as encounters with Britain’s National Health Service.

Far more than the average doctor-memoirist, Marsh does not conceal his feelings, whether dealing with patients, colleagues, assistants, or superiors, and he spares no one when matters turn out badly.

Beautifully written , candid, and honest about the advantages and misgivings during his career, Dr Marsh, lays it down on paper as it is.
Profile Image for Laura.
675 reviews98 followers
August 22, 2016
Is there anything more frightening than the thought of being diagnosed with a brain tumour? In the vast world of illness and disease, it is perhaps the singular worst thing any patient can begin to comprehend. Dr Marsh has made a career out of performing complex surgical procedures on such patients, and not always with a positive result.

The brain is a fascinating yet often poorly understood organ. As a registered nurse, I have cared for patients afflicted by hundreds - if not thousands - of different ailments, however disease of the brain is perhaps one of the most overwhelming. It controls every part of our being; our thought processes, our emotions, behaviours, desires and so much more. Dr Marsh writes a gripping memoir dedicated to his many years of operating on some of the sickest patients in the country.

I enjoyed much of the book, and as a fellow NHS worker, could highly empathise with Dr Marsh's frustrations on the red tape that interferes with the care we give. From difficult staff parking to the ever changing government and management enforced regulations, none of the complications that mounted pressure on an already stressful job came as a surprise to me.

Dr Marsh is not afraid of admitting his weaknesses, both personally and professionally. At times he is pompous, arrogant and self important. Although I do not wish to tar all surgeons with the same brush, in my experience the surgical brand of senior doctors do tend to behave in a particular way! Some of the writing is very much tongue-in-cheek (example: referring to an overweight patient as "a small whale".)
It could be argued Dr Marsh appears unsympathetic towards his patients, although I could understand to an extent that a degree of emotional detachment is required.

I was impressed of Dr Marsh not coming from a traditional medical background. Although privately taught, he worked as both a porter and a nurses assistant before his medical training - something I wish could be made mandatory for modern would be doctors. I would have liked to have seen more emphasis on the role of nurses in neurosurgery, both the operation itself and its long aftercare. Otherwise, I fully enjoyed this memoir and only wished it were a little longer. Deserving of its place on the Costa Coffee book club short list.
Profile Image for Adam Dalva.
Author 7 books1,479 followers
July 5, 2022
Addictive, short chapters filled with the horrors and wonders of the physical brain - impossible to put down, if slightly repetitive. Knausgaard's great NYTimes article got me into this, and it was a happy morning of reading.
Profile Image for Inna.
597 reviews117 followers
May 19, 2020
Я ніколи не думала, що мені так легко буде читати книжку про нейрохірургію. Можливо це завдяки постійному перегляду серіалу Grey's Anatomy, після якого тебе не тільки медична лексика не лякає, та навіть описані операції ти собі спокійно уявляєш і це тебе не шокує.
Описане в книзі вкотре підтвердило мені, що невизнання власних помилок – жахлива риса, але якщо ти лікар – це ще й жахливий злочин. Маємо пам’ятати , що лікарі стають професіоналами, залишаючи за собою довгий перелік огріхів, що покалічили чиїсь життя та долі. Хтось має страждати, хтось – померти, аби хтось інший вижив. Ця жорстока правда життя пульсувала в кожній історії лікаря Марша.
Я ніколи не думала, що мені так легко буде читати книжку про нейрохірургію. Можливо тому, що вона про людину таку ж недосконалу, як і ми з вами.
Profile Image for K.J. Charles.
Author 58 books7,643 followers
November 30, 2020
Autobiography of a brain surgeon. Fascinating and genuinely horrible, to the point where you vaguely wonder if people emerge from this sort of career with PTSD. The author spends a lot of the book sort of edging round the question of how you cut into someone's brain knowing that your actions can kill or 'wreck' them ie cause permanent life changing damage, but when failure to operate might also lead to death. Not edging as in avoiding, but it's clearly a pretty impossible question to answer, though he does at one point speculate that a lot of his peers are psychopaths. Also very honest about his own ego, bad temper, and high-handedness etc.

It's compelling in an 'oh Jesus this is my worst nightmare' sort of way. The rage against management seems of variable justification (yes, you have to take off your goddamn wristwatch for a bare forearms policy, grow up), but that against the NHS's slow death by a thousand cuts and PFI and bodged IT is something we can all get behind, preferably while overthrowing the government.
Profile Image for Sara Dahaabović .
242 reviews91 followers
December 30, 2017
Was supposed to be a buddy-read with Ammar but I put it on hold for almost two months because I was studying a lot of medical cases at the time and the last thing I needed was to read another "textbook" (yeah that's how it felt sometimes)

Honestly, it wasn't like what I expected, I was a bit disappointed and I almost rated it with two stars, some cases felt just okay (everyday cases, nothing major, nothing interesting). Was Marsh just trying to fill the pages of his book? I really don't know. I thought he would only mention the rarest and most interesting cases that he came across during his long career or stories of patients that changed something in him.

But all in all, he is such a good author and doctor and I liked following his career progress and to see how he dealt differently with his patients over time.

"If the operation succeeds the surgeon is a hero, but if it fails he is a villain"

I also really enjoyed reading the perspective of a neurosurgeon; someone in my family had a brain surgery a while ago and we really consider the surgeon a hero/angel/life-saver but what if something went wrong? would we still appreciate his efforts? I doubt it :(

"Perhaps they never quite realized just how dangerous the operation had been and how lucky they were to have recovered so well. Whereas the surgeon, for a while, has known heaven, having come very close to hell"

All respect to all surgeons who save lives every day!
314 reviews2 followers
October 20, 2014
I'm never sure about reading books that are related to my profession but Mr Marsh is highly regarded and I thought it would be very interesting to hear about his thoughts and experiences. It really is a lovely book. A good mixture of surgical, medical and personal experiences that's really wonderfully written. I think having a certain amount of medical knowledge made it a much more relaxing and easier read for me but am sure it would appeal to other non medical people too. I would warn people though that they might be shocked or surprised by some of Mr Marsh's honestly but I find that extremely comforting, reassuring and bold of him to be so very honest especially with regards to changes that have happened in the NHS over his career. A number of times I actually found myself laughing as he described 'run ins' with bureaucracy and management. I feel humble that I am part of the same profession of Mr Marsh with all his wisdom, experience, excellence, humanity and honesty.
Profile Image for Ken.
Author 3 books885 followers
March 12, 2015
If you're a hypochondriac, steer clear. Otherwise, steel yourself and have a look-see at surgery from the other side (assuming you're not a neurosurgeon reading this). Henry Marsh is a British brain surgeon and a writer with a clear, straightforward style -- not only his diction, but his personality.

With each chapter named after a different (and terrible) thing that can go wrong with these miracle devices we call our brains and our bodies, he delivers anecdote after anecdote of actual cases he's experienced over the years, some ending happily, many not. What's refreshing is his human voice. Being seen as savior or demon (often depending on outcome of surgery) is no easy way to make a living, as readers will see.

Still, Marsh is not one to hide behind his vaunted profession and overly-romanticize it. In fact, he admits that errors happen. Things go wrong, even during routine operations. In one frightening case, he let a junior surgeon begin a rather straightforward procedure and an error causing permanent disablement occurred.

Rather than falsify records as many doctors do (and easily can, considering the patient is out and you're only surrounded by members of your team, the medical brethren), Marsh owned up to it. In his view, hospitals deserved to be sued in some cases -- a man like this should at least win a settlement to help with the obvious ordeal lying ahead. Still, settlements or not, mistakes don't stop guilt from hounding doctors. At least doctors who care.

Despite all of the gloom and doom, there's an education to be had in this book. You can learn a lot about the brain's function and effects on other parts of the body. All pain is signaled by the brain. Hemispheres matter. Location and size of tumors matter. Some tumors are "sticky" and become problematic because they adhere too much to the brain. Others, more luckily, almost "pop" out with little coaxing -- like Teflon, even. One never knows until one goes into the brain, which on more than one occasion sounds as much the "last frontier" as outer space, especially when reading Marsh's graphic descriptions of the "landscape" in there.

Here's an excerpt showing Marsh's typical tone and overall humanity: "My outpatient clinic is an odd combination of the trivial and the deadly serious. It is here that I see patients weeks or months after I have operated on them, new referrals or long-term follow-ups. They are wearing their own clothes and I meet them as equals. They are not yet in-patients who have to submit to the depersonalizing rituals of being admitted to the hospital, to be tagged like captive birds or criminals and to be put into bed like children in hospital gowns. I refuse to have anybody else in the room -- no students, no junior doctors or nurses -- only the patients and their families."

The type of doctor you could put your faith in? I should say so. An education not only on the brain but on dying? That, too. The doctors know what's going down, and you will, too, once you read all of these cases. Sometimes no operation is the answer. Sometimes hope is your enemy -- bound only to prolong your suffering when palliative measures would be so much more humane.

Overall, a compelling document. With moments of humor, dark and not, Do No Harm rails against bureaucracy and government, and offers countless snapshots of people like you and me... always hoping the best from life, sometimes receiving the worst from it. In a word: fate.
Profile Image for Lauren .
1,680 reviews2,290 followers
June 13, 2019
Marsh is a complete breath of fresh air - full of compassion, knowledge, and empathy. This book was a profound look at life and death through the perspective of neurosurgery.
Profile Image for Stefan Mitev.
142 reviews667 followers
April 19, 2022
Хенри Марш е известен английски неврохирург, който описва най-трудните моменти от кариерата си в мемоарната книга "На първо място, не вреди". Разликата между него и българските лекари е огромна. Основният фокус на разказите му е върху допуснатите грешки и неволно причинената вреда. Няма да намерите самохвални истории за неговото величие, умения и знания. Точно обратното, описанията на парализирани пациенти след оперативни усложнения са болезнени за четене. Със смирение и безсилие Хенри Марш признава, че понякога оставя хората в по-лошо състояние - с овладяно заболяване, но с трайни неврологични последици, които никога няма да се подобрят или възстановят. Прокрадва се темата за живота на всяка цена - струва ли си да спасиш човека от мозъчен тумор, ако след това ще живее парализиран и изцяло зависим от околните? Книгата задава сложни философски въпроси, но не предлага лесни отговори. През цялото време авторът се обвинява, че не е постигнал най-добрия възможен резултат, дори когато не зависи пряко от него. Стремежът към перфекционизъм на всяка цена е почти невъзможен за откриване в родната българска обстановка.

Книгата не е за всеки - тя не предлага героични истории с щастлив край, а болезнени признания за трудностите и ограниченията на медицината.
Profile Image for Iryna Khomchuk.
446 reviews58 followers
March 30, 2018
Десь на курсі третьому я зрозуміла, що помилилася з вибором професії і замість філології воліла б вивчати... медицину. Однак це була одна з тих помилок, які не так легко виправити. Згодом мене все-таки закинуло близько до медицини (маю на увазі мою сьогоднішню роботу у спеціалізованому медичному виданні)))), але це радше така собі компенсація долі за нездійснену мрію...

А от Генрі Марш, полишивши політологію й зайнявшись вивченням медицини, спромігся кардинально змінити своє життя. І не лише своє, а й тисяч пацієнтів, котрим допоміг як один із найвідоміших у світі нейрохірургів. До цієї когорти врятованих ним належать і багато українців, бо ж Генрі Марш уже 25 років регулярно приїздить до України й допомагає нашим громадянам.

Про це він, поміж іншого, також розповідає у своїй книзі — одній із кілької, майстерно написаних цією різнобічно обдарованою і талановитою людиною. Українська медицина його очима — це, насамперед, бюрократія, котра тримається на авторитеті професорів та керівників медзакладів, а не система, ��окликана якнайліпше допомагати хворим. Однак приємно визнавати й те, що вона, як і ми, потрошку, повільно, але все-таки змінюється.

Бюрократії, втім, вистачає і в одній з лондонських державних клінік, де працює Генрі Марш. Ущент заповнені палати очікування, довгі списки пацієнтів, ще довші списки правил, почасти непотрібних і недолугих, за дотриманням яких слідкує масивна менеджерська машина, — це те, з чим Генрі Марш не може змиритсия й у своїй країні. Так само, як і в нас, ті, хто хоче отримати комфортну медичну допомогу, надають перевагу приватним клінікам. Однак це, втім, аж ніяк не означає, що поміч лікарів із державного сектора медицини буде менш професійною.

Кожен розділ книги має назву недуги й у кожному розповідається про один із тисяч випадків, із якими мають справу медики. Здебільшого, це — різноманітні пухлини, що вражають головний чи спинний мозок, часто — смертельні, тому й говорити авторові доводиться і про те, як це важливо — мати можливість гідно помирати. Однак у медичній термінології не прийдеться плутатися навіть непідготовленому читачеві, бо не вона тут основна. Головне, про що говорить Генрі Марш, — це людяність і чесність. Чесність передусім перед самим собою. Бо лише так, зізнавшись собі, що ти помилився, що вчинив неправильно, можна виправити ситуацію. Якщо вона, звичайно, піддається виправленню. А це важливо не лише для хірургів, а й для кожного з нас...
Profile Image for Kate.
606 reviews517 followers
May 10, 2017
I’ve had Do No Harm on my kindle for 3 years, yes, YEARS! After reading Fragile Lives earlier this year, I figured I’d give this one a go as instead of a cardiac surgery this book centres on neurosurgery. I have a morbid fascination with medical things like that so I was looking forward to it.

Henry Marsh has written a very interesting book. He’s no Derek Shepherd in terms of drama and excitement, but he is dealing with the everyday lives of his patients. Do No Harm gives the reader an interesting glimpse into what it’s like to be a neurosurgeon and the things they go through inside and outside of the surgical theatre.

I don’t know what I was expecting when I picked it up but what I found was an honest memoir. It had case studies in every chapter, as well as a glimpse into Marsh’s own life outside of surgery, and how it impacted his home life.

It’s an easy read in terms of pace and writing, but it’s all too easy to forget you are reading about patients. Any one of us could end up on an operating theatre table needing help from a man like this.

The irony of Do No Harm, for me, was that my eldest child ended up in A&E on the day I read this book. He fell after deciding spinning around to make himself dizzy was a good idea and proceeded to hit his head!!! He is completely fine, but this book couldn’t have been read at a worse time!

Do No Harm is definitely a book to read if you like true life medical stories! Interesting, graphic but always honest!

Profile Image for Milly Cohen.
1,023 reviews268 followers
May 29, 2016
(si les interesa la confesión humana, realista, dolorosa, humilde y valiente de un neurocirujano, léanlo!)
Profile Image for Repix.
2,129 reviews389 followers
November 2, 2018
No he podido dejar de emocionarme durante todo el libro y soltar lagrimones. Es muy ameno y humano.
December 15, 2017
Quite honestly, this book was really unlike anything I've ever read before. This book should be read by anybody that has ever received treatment on the NHS, is awaiting treatment, or is going in for any kind of major surgery at any point.
This book is written by an extremely well known neurosurgeon, called Henry Marsh. His writing gives an incredible insight into neurosurgery, and the many changes the health care system has gone through for the last thirty years. Many of these changes have been rather negative, but there are also some positives.

What I like about Marsh, is the way he tells it like it really is. He doesn't sugarcoat things, and he explains why it needs to be this way, with some empathy, in order to maintain a healthy doctor patient relationship.
He quickly admits that things do in fact go wrong, even in apparently simple routine operations. Marsh describes his surgical mistakes as well as sharing his huge triumphs. This book remarkably reminds us that health care staff are human too, and they too, can make mistakes.
What is terribly shocking is the totally unreasonable and unrealistic Government targets, and the way these reflect on the staff, therefore it has a domino effect on the patients. Having the duty of bed management in a hospital is an extremely stressful job. I should know. I cannot imagine how frustrating it is as a surgeon to have serious, life threatening surgery cancelled, due to a lack of beds. It's truly horrendous.
This book is wonderfully educational and I found it fascinating, learning about neurosurgery, from an actual neurosurgeon, who really, is an inspiration.
Profile Image for Mbgirl.
235 reviews8 followers
July 4, 2017
What an amazing life Dr Marsh has lived. From geriatric psych nurse to renown in neurosurgery, his authentic thoughts and revisitation of heartbreaking and interesting cases and patients reminds us all, life is most definitely precious. Marveling at the details of the various classes of tumors, benign and neoplastic, I was very intrigued to read it all. As well, his risk in undertaking a mentor role, taking Ukrainian neurosurgeons under his tutelage...bravo. A real, human, honest account from the POV of a veteran expert. will try hard to take away some of his attitudes the next time I may get a ribbing from our own super talented Chinese peds neurosurgeon: hero to so many locally.
Profile Image for Mia.
329 reviews202 followers
November 26, 2015
"Every surgeon carries within himself a small cemetery, where from time to time he goes to pray- a place of bitterness and regret, where he must look for an explanation for his failures."

-René Leriche, La philosophie de la chirurgie, 1951

I loved this book, and I can say with confidence that it's the best nonfiction book I have ever read. (Before you get too excited, bear in mind that I don't have extensive experience in the nonfic realm.) But, honestly, if you're even slightly interested in neuroscience or surgery and want to read an intelligently written, frank account of modern medicine, this is the book for you. If, however, you're the squeamish sort who shrieks at the mention of blood or is simply not down with pretty graphic descriptions of surgery, perhaps you should stay away from this one. I feel I should say, though, that I found the descriptions of neurosurgical procedures incredibly fascinating and beautifully written.

Henry Marsh's voice is clear in every page of this book. He's tough, brutally honest, and I found his outlook on life, death, and brain surgery refreshing. Marsh, like most every surgeon, struggles with professional objectivity, with giving hope to patients and sometimes having to take it away, with the high stakes of his practise and the looming fact that he can't save every patient who passes into the ward. It's a hard, gruelling, yet rewarding career, and being able to see a typical day (and some atypical ones) in the life of Dr Marsh was not only interesting but his musings on hope, medicine, when to give up, and death in the modern age were thought-provoking as well.

I left them in the little room, their knees squeezed together as the four of them sat on the small sofa and wondered, yet again, as I walked away down the dark hospital corridor, at the way we cling so tightly to life and how there would be so much less suffering if we did not. Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.

Like any career, neurosurgery has its highs and lows, and we see both in Do No Harm. There are good days:
I went down the stairs to my office to see if there was any more paperwork to be done but just for once Gail had left my office empty. It had been a good day. I had not lost my temper. I had finished the list. The patients were well. The pathology had been benign. I had been able to cancel the two spines at the beginning of the list rather than at the end. There were no major problems with the patients on the wards. What more could a surgeon want?

And, inevitably, there are bad ones:
None of us felt able to make our usual sardonic jokes at the morning meeting. The first case was a man who had died as a result of an entirely avoidable delay in his being transferred to our unit; another was a young woman who had become brain dead after a haemorrhage. We looked glumly at her brain scan.

'That's a dead brain,' one of my colleagues explained to the juniors. 'Brain looks like ground glass.'

The last case was an eight-year-old who had tried to hang himself and had suffered hypoxic brain damage.

'Can we have some rather less depressing cases please?' someone asked, but there were none and the meeting came to an end.

Some things mentioned here weren't entirely clear to me, mostly the parts where Marsh describes the Trust or what he thinks of the NHS or how NHS hospitals differ from others, or how he could afford private insurance but now cannot. This is because I live in the U.S., where we have a commercial healthcare system, and so some of the gripes the author has with how things are run in the U.K. went over my head. That doesn't mean, though, that I didn't appreciate Marsh's dislike of useless authority, or his hatred of hospital bureaucracy and pointless lectures. I especially loved his occasional refusal to adhere to meaningless rules, and his frustration at when delays and problems are caused due to unnecessary restrictions and regulations imposed by the management. My favourite was when he was having his time wasted by being forced to attend a mandatory lecture by a man who didn't know what he was talking about:
How strange it is, I thought as I listened to him talking, that after thirty years of struggling with death, disaster and countless crises and catastrophes, having watched patients bleed to death in my hands, having had furious arguments with colleagues, terrible meetings with relatives, moments of utter despair and of profound exhilaration- in short, a typical neurosurgical career- how strange it is that I should now be listening to a young man with a background in catering telling me that I should develop empathy, keep focused and stay calm. As soon as the signing-out register had been passed around, and I had signed it, thus confirming that the Trust could now state that I had been trained in Empathy and Self-control, and the classification of Abuse and of Fire Extinguishers, in addition to many other things I had already forgotten, I charged out of the room despite Chris' protests that he had not yet finished.

Click the spoiler for an amazing close-up of the tiny arteries and veins on the surface of the brain! (Don't click it if you're squeamish, obviously.)

4 reviews
October 28, 2015
As a veterinary technician and someone who has been in the medical field for 11 years, I was really, really excited to read this book. I got a few chapters in and couldn't stand how incredibly egotistical he is.

There are a lot of parts in the book that I can relate to but most of it is just about how much he is above other doctors in the hospital (as well as staff and the general public) because he is a neurosurgeon. I got halfway through the book and had to stop reading because he is just such an ass to the other staff and clinicians at his hospital, I couldn't take it any more! He is the stereotypical surgeon that I cannot STAND working with- throwing things, yelling, believing he is god's gift to the earth. I could see why a lot of people like the book for the stories of each patient he tells, but I couldn't look past his immense ego.

Very disappointing read, interesting description of the cases but his ego puts a dark storm cloud over the entire book to me.
401 reviews7 followers
April 20, 2014
"The idea that emotions and reason, that memories, dreams and reflections should consist of jelly is simply too strange to understand... Yet..if I stray into what neurosurgeons call eloquent brain, I will be faced with a damaged and disabled patient."

It is this kind of honesty that makes Henry Marsh's memoirs so compelling, overriding the initial concern that I might be reading the book solely out of a kind of ghoulish voyeurism. Henry Marsh was clearly drawn to this field by the challenge and element of danger, akin to what drives people to climb mountains. He describes with great clarity and insight the sense of shame when what should be a straightforward operation goes wrong, perhaps through a moment of hubris or distraction, but it could also be because one has given a more junior colleague the practice he needs in order to improve, or just bad luck, a sudden haemorrhage for no obvious reason. On the other hand, inexperience - or memories of a recent disaster- may make a surgeon over-cautious as regards something as simple as trying to adjust the clip on an aneurism.

Marsh patiently explains various medical conditions, mainly tumours, in terms a layman can grasp. I found it hard to read more than about three chapters at a time, not because the book is depressing - Marsh manages to weave in a surprising amount of humour - but because the experiences of many of his patients seemed to demand a certain amount of respectful reflection before rushing on to the next trauma.

Marsh reserves his bile for hospital management and government targets or cuts. He may be a bit of a dinosaur in some respects, but makes his case very convincingly. The 48 hour Working Time Directive causes more frequent shift changes so that staff often do not know the condition of patients they are treating as well as they used to. Bureaucratic rules enforced by junior staff no longer so in awe of consultants and senior surgeons often mean that patients have to wait longer for operations, and suffer more often the stress of last minute postponements. He condemns Private Finance Initiative (PFI) schemes as a "very expensive way of building second rate public buildings" which "some would consider to be an economic crime, although nobody is to be held responsible for it."

If anything, this book has eroded my confidence in the NHS as a whole, but has made me more understanding of the surgeon's dilemma. Often, he really does not know whether on balance it is better to operate or not. As regards patient consent, the percentage risk of death from the operation may equal that of eventually dying from a tumour, but if one survives the former, there is the incalculable benefit of peace of mind. Even such an eminent surgeon as Marsh may have to face charges of indefensible error, say for delay in diagnosing an infection: "it was painfully clear, as I had always known - that the case could not be defended... The final bill...was for six million" to settle it. One is left thankful that there are people with the courage and motivation to persevere in this complex medical field.
Profile Image for Elizabeth.
660 reviews50 followers
January 9, 2015
It takes a particular kind of person to want to be a surgeon, especially a neurosurgeon. Reading this book has left me in awe of the work of Henry Marsh, and all other surgeons. I know I couldn't have done it.

He writes with extreme candour, not shying away from the times when he has operated on a patient and it has not been a success. He tells of many incidences of failure in his book. Neurosurgery is obviously, by its nature, one which is fraught with huge risk of failure - leaving a patient disabled, or dead is quite possible. He admits he doesn't always know when to operate and when merely to allow nature to take its course. He has made mistakes which have led to the NHS Trust, for whom he works, being sued. He has caused catastrophic life-altering injuries to patients on the operating table. He admits this. Surgeons are human, they are prone to error and when it goes wrong it can be disastrous for everyone concerned.

This book covers many types of cases he has come across throughout his working life, the successes, the failures, the frustrations of working within the NHS, bound by government guidelines and working practices, the difficulties of training new surgeons and so on.

I got the impression that he felt his most rewarding work has been that done in Ukraine, helping people who felt he was their only chance. I watched the documentary The English Surgeon part way through reading this book, and it helped me to visualise that work and also to see some of the people mentioned in this book.

We often imbue surgeons, and doctors, with superhuman powers - believing that they can cure everyone and everything, that they are miracle-workers. This book, sometimes brutally, debunks that myth. They can only do what is possible.

If I had to have a criticism of this book, it is that it is quite heavy on the failures "this operation went wrong and the patient died or was left in a severely disabled state". I understand that neurosurgery is dangerous and that many people who come to the operating table are beyond help or are just being patched up temporarily, but one or two more successes to balance it out might have made it a little less despairing at times. That's not to say that all the cases were without hope - he wrote of his own son's successful treatment at just a few months old and I found that particularly moving.

It is, above all, a fascinating insight into the difficult and (I found) often distressing work of neurosurgery.
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