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

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? But what if they have a colleague who is more experienced?

Anxious and angry relatives are a burden all doctors must bear, but having been one myself was an important part of my medical education. Doctors, I tell my trainees with a laugh, can’t suffer enough.

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

Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope. It can be very difficult to find the balance between optimism and realism. There are degrees of malignancy with tumours and you never know what will happen to the individual patient in front of you – there are always a few long-term survivors – not miracles but statistical outliers.

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.

Neuroscience tells us that it is highly improbable that we have souls, as everything we think and feel is no more or no less than the electrochemical chatter of our nerve cells. Our sense of self, our feelings and our thoughts, our love for others, our hopes and ambitions, our hates and fears all die when our brains die.

The original plans for this wing of the hospital – built ten years ago – had been for a bigger building than the one which was eventually built. It was built under the Private Finance Initiative favoured by the government of the time and as with most PFI schemes the design of the building was dull and unoriginal. Nor was it cheap, since PFI has proved to be a very expensive way of building second-rate public buildings. Some would consider PFI to be an economic crime, although nobody is to be held responsible for it. It is clear now that PFI was part of the same debt-crazed culture that gave us Collateralized Debt Obligations and Credit Default Swaps and all those other dishonest acronyms and financial derivatives that have brought us (though not the bankers) to the edge of ruin.

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.