More on this book
Community
Kindle Notes & Highlights
by
Henry Marsh
‘If the patient’s going to be damaged I’d rather let God do the damage than do it myself’.
Illness is something that happens only to patients. This is an important lesson you learn early on as a medical student. You are suddenly exposed to a terrifying new world of illness and death, and you learn how terrible illnesses often start with quite trivial symptoms
Most medical students go through a brief period when they develop all manner of imaginary illnesses – I myself had leukaemia for at least four days – until they learn, as a matter of self-preservation, that illnesses happen to patients, not to doctors. This necessary detachment from patients becomes all the greater when you start working as a junior doctor and you have to do frightening and unpleasant things to patients. It starts with simple blood-taking and inserting drips, and progresses over time – if you train as a surgeon – to ever more radical procedures, cutting and slicing into
...more
So when doctors fall ill themselves they tend to dismiss their initial symptoms and find it hard to escape the doctor–patient relationship, to become mere patients themselves. It is said that they are often very slow to diagnose their own illnesses.
Surgeons can fall ill just like anybody else but it can be difficult to judge whether one is well enough to operate. You cannot cry off operating just because you are feeling a little out of sorts but nor would anybody want to be operated upon by a sick surgeon. I learned a long time ago that I can operate perfectly well despite being tired, as when I am operating I am in an intense state of arousal. Sleep deprivation research has shown that people make mistakes if moderately deprived of sleep when they are carrying out boring, monotonous tasks. Surgery – however trivial the operation – is
...more
with that wary sympathy all doctors develop, anxious to help but worried that patients will make difficult emotional demands of us.
it is both a compliment and a curse when your colleagues ask you to treat them. All surgeons feel anxious when treating colleagues. It is not a rational anxiety – their colleagues are much less likely to complain than other patients if things go badly, as they know all too well that doctors are fallible human beings and not entirely in control of what is going to happen. The surgeon treating a fellow surgeon feels anxious because the usual rules of detachment have broken down and he feels painfully exposed. He knows that his patient knows that he is fallible.
I asked if he had landed on his head or on his feet. If they hit the ground feet first they fracture their feet and spines and end up paralysed and if they hit their head first they usually die.
‘There are two great benefits to medicine as a career,’ I said to Rob. ‘One is that one acquires an endless fund of anecdotes, some funny, many terrible.’
We have both always been a little dismissive of the Health and Safety culture that increasingly dominates our risk-averse society
Although breaking one’s leg is indeed very painful it is surprisingly easy to tolerate – it is well known, after all, that soldiers in battle rarely feel great pain if they are seriously wounded – the pain comes later. You’re too busy working out how to save yourself to think much about the pain.
sooner or later. Just as it is irresistible to save a life, it is also very difficult to tell somebody that I cannot save them, especially if the patient is a sick child with desperate parents. The problem is made all the greater if I am not entirely certain. 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. It is easy enough to let somebody die if one knows beyond doubt that they cannot be saved – if one is a decent doctor one will be sympathetic, but the situation is
...more
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. Even
Healthy people, I have concluded, including myself, do not understand how everything changes once you have been diagnosed with a fatal illness. How you cling to hope, however false, however slight, and how reluctant most doctors are to deprive patients of that fragile beam of light in so much darkness. Indeed, many people develop what psychiatrists call ‘dissociation’ and a doctor can find himself talking to two people – they know that they are dying and yet still hope that they will live.
Hope is beyond price and the pharmaceutical companies, which are run by businessmen not altruists, price their products accordingly.
Doctors treat each other with a certain grim sympathy. The usual rules of professional detachment and superiority have broken down and painful truth cannot be disguised. When doctors become patients they know the colleagues treating them are fallible and they can have no illusions – if the disease is a deadly one – about what awaits them. They know that bad things happen and that miracles never occur.
slightly sardonic terms that surgeons often use when talking about alcoholics and drug addicts. This does not necessarily mean that we do not care for such patients, but because it is so easy to see them as being the agents of their own misfortune, we can escape the burden of feeling sympathy for them.
‘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,
There must be some secret place in the hospital where they can wheel the paralysed patients for a smoke. I was happy to know that common sense and kindness had not yet been completely beaten out of the nurses.
Recent neuroscientific research has shown that even within a few days of a limb being lost or immobilized the brain starts to re-wire itself, with other areas of the brain taking over the redundant area for the lost or immobilized limb. My slight feeling of estrangement from my leg was almost certainly an aspect of this phenomenon – the phenomenon of ‘neuroplasticity’, whereby the brain is constantly changing itself.
despair. I learned a long time ago in the outpatient clinic to make no distinction – as some condescending doctors still do – between ‘real’ or ‘psychological’ pain. All pain is produced in the brain, and the only way pain can vary, other than in its intensity, is how it is best treated, or more particularly in my clinic, whether surgery might help or not.
phantom limb pain, where amputees experience severe pain in an arm or leg which no longer exists as a limb in the outside world but which still exists as a pattern of nerve impulses in the brain. I
quiet and stoical manner was exactly what doctors like to find in their patients.
