Do No Harm: Stories of Life, Death and Brain Surgery - as seen on 'life-changing' BBC documentary Confessions of a Brain Surgeon

by Henry Marsh

As I walked round the wards after an operating list with my assistants beside me and received my patients’ heart-felt gratitude and that of their families, I felt like a conquering general after a great battle. There have been too many disasters and unexpected tragedies over the years, and I have made too many mistakes for me to experience such feelings now, but I still felt pleased with the way the operation had gone. I had avoided disaster and the patient was well. It was a deep and profound feeling which I suspect few people other than surgeons ever get to experience.

This is not as much of a problem for me now that I have been operating on brain tumours for many years, but it can be a moral dilemma for a younger surgeon. If they do not take on difficult cases, how will they ever get any better?

I dislike telling patients that their operation has been cancelled at the last moment just as much as I dislike telling people that they have cancer and are going to die. I resent having to say sorry for something that is not my fault and yet the poor patients cannot very well be sent away without somebody saying something.

And I felt shame, not at my failure to save his life – his treatment had been as good as it could be – but at my loss of professional detachment and what felt like the vulgarity of my distress compared to his composure and his family’s suffering, to which I could only bear impotent witness.

As with all NHS chief executives in my experience (I have now got through eight) they do the rounds of the hospital departments when they are appointed and then one never sees them again, unless one is in trouble, that is. This is called Management, I believe. ‘I’m giving you advance warning of a meeting you are to have with me in the New Year,’ he announced. ‘But what’s it about?’ I asked, immediately anxious. ‘That will have to wait until the meeting.’ ‘For Christ’s sake – why are you ringing me up now then?’ ‘To give you advance warning.’

Doctors need to be held accountable, since power corrupts. There must be complaints procedures and litigation, commissions of enquiry, punishment and compensation. At the same time if you do not hide or deny any mistakes when things go wrong, and if your patients and their families know that you are distressed by whatever happened, you might, if you are lucky, receive the precious gift of forgiveness.

Few people outside medicine realize that what tortures doctors most is uncertainty, rather than the fact they often deal with people who are suffering or who are about to die.

Tanya died eighteen months after her return home. She would have been just twelve years old. Instead of a single, brilliant operation she ended up having to undergo many operations and there were serious complications – ‘complications’ being the all-encompassing medical euphemism for things going wrong. Instead of a few weeks she had ended up spending six months in my hospital, six horrible months. Although she did eventually get home she returned more disabled than when she had left it.

For the first few months after the operations her face had been completely paralysed. This had left her at first not just unable to talk but also with a face like a mask, so that it seemed she had no feelings at all – even the most intense emotions were hidden, unless sometimes a tear rolled down her expressionless cheek. It is sad how easy it is to dismiss people with damaged or disfigured faces, to forget that the feelings behind their mask-like faces are no less intense than our own.

‘Well, I’m ninety per cent certain. But we . . .’ I said, lapsing into the plural form so loved by policemen and bureaucrats and doctors which absolves us from personal responsibility and relieves us of the awful burden of the first person singular, ‘we might be able to help with an operation.’ He cried and cried. ‘Have you got any family?’ I asked, although I already knew the answer. ‘I’m all alone,’ he replied, through his tears. ‘Any children?’ ‘Yes.’ ‘Don’t they want to come and see you – even now when you’re ill?’ I asked and, once again, immediately regretted it. ‘No.’ He burst into floods of tears again. I waited for him to stop and we sat together in silence for a while. ‘So you’re all alone?’ I said. ‘Yes,’ he said. ‘I used to work in a hospital, you know. I’m going to die there aren’t I? All the piss and shit . . . All I want is a cigarette. You’ve just told me I’m going to die. I want a cigarette.’ As he said this he desperately mimed smoking a cigarette with his one good hand, as though his life depended on it.