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

by Henry Marsh

when I visit American hospitals and see the extremes to which treatment can sometimes be pushed, I wonder whether the doctors and patients there have yet to understand that the famous dictum that in America death is optional, was meant as a joke.

Our vulnerability and fear of death when we are patients know no national boundaries, and the need for honesty and kindness from doctors—and the difficulty at times in giving these—is equally universal.

The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.

as a surgeon you learn at an early stage of your career to accept intense anxiety as a normal part of the day’s work and to carry on despite it.

When you approach a patient you have damaged it feels as though there is a force-field pushing against you, resisting your attempts to open the door behind which the patient is lying, the handle of which feels as though it were made of lead, pushing you away from the patient’s bed, resisting your attempts to raise a hesitant smile. It is hard to know what role to play. The surgeon is now a villain and perpetrator, or at best incompetent, no longer heroic and all-powerful. It is much easier to hurry past the patient without saying anything.

Sometimes, if the dissection is particularly difficult and intense, or dangerous, I will pause for a while, rest my hands on the arm-rests, and look at the brain I am operating on. 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.

One quarter of the blood pumped every minute by the heart, after all, goes to the brain. Thought is an energy-intensive process.

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.

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.

Hope is beyond price and the pharmaceutical companies, which are run by businessmen not altruists, price their products accordingly.