Do No Harm – H. Marsh

“Every surgeon carries within himself a small cemetery.” (Rene Leriche)

Like anybody who ever watched Grey’s Anatomy, I have wondered whether or not I’d be cut out to be a surgeon.

After reading Henry Marsh’s semi-biography “Do No Harm”, one thing is clear – I could not be a neurosurgeon.

 

Image result for brain scan tumblr
You’ll need this.

 

Humans are remarkably resilient if you think about it. Broken leg? No worries. Amputation? Sucks, but we’ll deal. The only thing that we really cannot do without is a brain.

So poking inside someone else’s brain to remove cancerous growth is arguably the most high-risk thing you can do. And Henry Marsh does that for a living.

His book is best when it describes the insights of self-doubt and anxiety that he goes through before, during and after operations. He is painfully aware of the responsibility that has been placed in his hands by trusting patients. And, even more crucial, he is also aware of what can go wrong – and isn’t afraid to own up to it.

One thing he only touches upon, and I wish he’d speak more about, is known as the ‘binding problem ‘ – the disbelief that we as humans are nothing more than about three pounds worth of jelly. “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?”

Surely, we, who create works of art and poetry, sent people to the moon and brought them back safely, who eradicate illnesses and explore the universe – surely, we must be made of sterner stuff?

But instead of lingering on this thought, of wondering what that means, Marsh quickly turns to the next topic. And then the one after that. This book suffers from an acute lack of plot if you will – something that holds it together and makes it more than just a few random chapters bundled together.

Another example for this is the topic of informed consent. Marsh describes the antagonizing decision he forces upon his patients – Is it better to undergo surgery or leave it? Death, as Marsh says, is sometimes not the worst outcome.

Especially since Marsh knows how bad humans are at perceiving risk. Say, you had to decide whether or not to undergo surgery for that growth in your brain. The surgeon says there’s a 5% probability you will die. What do you do?

There’s no easy answer, of course. Humans are just inherently bad at understanding probabilities. 5% risk of death means 95% of the time, all goes well – but what if you are one of the 5%?

It’s a common enough phenomenon – not just for neurosurgery, but also for elections, for example. We suck at this, and surely, a potentially life-ending decision should be made on better information than that.

Marsh, however, tells us two questions you definitively should ask in case you ever find yourself facing this decision:

  • “How many operations of this sort have you performed?” It makes a wicked sort of sense – it is in your own best interest to get a surgeon that is as experienced as possible, after all. However, how would young surgeons ever learn if it were not for surgeries? It’s a bit of a Catch-22, which is not something you want to find yourself in.
  • “What would you do if it were you?” Hopefully, you will only be in this situation once in your life. Surgeons come across cases like yours on a daily basis. Ask them what they think, what they would do – and hope that they will give you an honest answer.

The above is Marsh at his best. His worst comes out when he turns into what I called ‘old-timey behavior.”

Marsh is at the end of his career, and it clearly shows. This book is woven with disgruntled anger at the change that hospitals went through.

He talks about the lack of beds and the reduction of funding. Marsh works in a big hospital in London, and by pure coincidence, so do I. A lot of his complaints are familiar and entirely justified.

However, some of his criticisms reek a bit of … elitism. He talks about the fact that he used to be able to do surgery after the shift ended, as he pleased. Nowadays, he complains, he cannot schedule late operations because his staff will want to go home.

He brings up this atrocious example of a nurse – she says she cannot assist during the surgery because she cannot find a babysitter on such short notice. Which, for me, seems entirely justified – for Marsh, however, this is a sign of how times have changed and how the downfall of the NHS is near.

As I said, old-timey behavior. Does Marsh ever stop to think that nurses had kids, too, back in the day, but that they were probably just too afraid to speak up to the surgeon? Times have changed, yes, but some of this change is actually really good.

(Just to be clear – the surgery in question wasn’t particularly time-sensitive. They did it the next day, without any detriment to the patient. It was just that Marsh wanted to do it on that particular day.)

 

Image result for old man yelling at cloud
Pictured above: Marsh yelling at a nurse for putting her kid before his surgery.

 

So to come back to my initial question – I don’t think neurosurgery is for me. The thought of poking in someone else’s brain – even if it’s for their best – is weird.

But I’m glad I read this book. Sometimes, finding out what you don’t want to do is as valuable as finding out what you could do.

(Fun Fact – Humans have been conducting brain surgery since essentially forever. A surgeon in Mesopotamia would get his hands cut off if their patient died during surgery.)

Next week – we’re going back to Vietnam, guys. I apologize in advance, but it’s the 50th anniversary of the Tet Offensive, so it’s worth a re-visit.

 

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