'Do No Harm' Book Review

Henry Marsh is well known as one of the best neurosurgeons in England. His book ‘Do No Harm' is a memoir of his life as a neurosurgeon, how he became one, the adversity he faced and how he balanced his personal life with one of the most demanding jobs in the world. His chosen title implicates one of the five pillars of medicine, non-maleficence, which involve ‘do[ing] no harm’ to any patient. Dr Marsh’s dedication and pious following of the Hippocratic oath that every doctor must take before graduating from med school is evident throughout his book. From the care he takes in respecting his patients wishes and appropriately informing them of their prognosis by balancing out optimism and realism; to the diligence and absolute calm yet focused approach he takes during surgery.

Right from the start, the reader is brought into the action, operating on a patient with a pineocytoma (a rare and slow-growing tumour in the pineal gland). This should be a relatively straightforward operation, Dr Marsh explains to the patient whilst also making him aware of the risks, which include death, a sudden seizure or that he may not be able to remove the tumour. It is very important that the patient fully understands his options when deciding whether or not to have surgery. Dr Marsh usually prefers to do this the day before the operation. The next day, he likes the patient to be anaesthetised and everything covered up apart from the small cranial area that he is operating on because this helps to dehumanise the patient and makes it easier for him to concentrate on the procedure.

Dr Marsh’s route to medicine was not conventional. He did not know he wanted to do medicine so didn’t take any science subjects for his A-levels, however this didn’t prove a problem because he was fortunate enough to get in with a 5 minute interview for 6 year med course which included a preliminary one-year course which was meant to cover everything you needed to go before going into the conventional course at med school.

Dr Marsh writes about the numerous consultations he has had over the 30 years he was a neurosurgeon. Towards the end he became the senior consultant at his hospital and gained a good reputation. However, on many occasions, Dr Marsh reminds the reader of the many mistakes that all surgeons have to make before they become ‘great’ surgeons, as such the most successful neurosurgeons have often left a trail of failed operations behind them which is mostly forgotten about. One misjudged move or miscalculated cut could result in paralysis, a severe seizure or death, which means 100% failure for the patient but only a fraction of that for surgeon who has done the same operation numerous times. Following the operation, the surgeon is reminded daily of his mistake by his patient in the ITU who appears to have picked up a further disability than when he came. Some of his patients he remembers very well, others he forgets quickly – mainly due to the time he spends with them. He concludes that the best neurosurgeons have poor memories.

By Alex Szczech 12Y2

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