‘Do No Harm’ is a startlingly honest autobiography by the brain surgeon, Henry Marsh. He writes not only about the exciting, successful operations he has carried out, but also about the nightmarish failures and mistakes he has made. From this, you might misinterpret ‘Do No Harm’ as being an especially factual book about various successful and unsuccessful operations. But the truth is that Marsh brilliantly talks about hope, luck, risk and love, as his job so frequently deals with all of these intense emotions.

“I wonder… at the way we cling so tightly to life and how there would be so much less suffering if we did not. Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all” pg. 132

Ethical dilemmas are a prominent feature of the book and they are particularly dramatic because neurosurgery stands on such a fine line between life and death, as problems with the brain are so serious. Marsh talks about factors that determine whether a patient is operated on- such as risks of death during an operation, quality of life after surgery, how much extra time it will give a terminally ill patient and what the wishes of the patient’s family are. One particular case that stood out for me was of a patient who suffered severe head injuries from a cycling accident. On one page the surgeons discuss whether or not to operate to try and save what is left of his life. If they operate “…he’ll be left hopelessly disabled, without language and probably with horrible personality change as well…”pg. 131. Then on the next page, Marsh finds the remnants of the man’s corpse after a delighted transplant team had taken all of his vital organs. It was so shocking how on one page the cyclist was a man with the dignity of life and on the next, there was an empty shell, with its value found only in the way it could be put to use for organ donation. Marsh enlightens you and prompts you to think about your views on life, the phenomenon of pain, consciousness and our sense of ‘self’. I found the most moving part of the book was the description of his mother’s death, during which he explains his views on our sense of ‘self’, with such beauty and clarity.

“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.”pg. 200

And so I understand Marsh to be a supporter of physicalism, the view that everything, including our minds, is entirely physical. The term physical including not only matter, but energy, forces, processes and everything explained in physics. So one might just as well mean ‘brain’ when one says ‘mind’. In a more accurate sense it means that everything supervenes on the physical; mental states (thoughts and emotions) exist only as the physical electrochemistry of our brains. I’ve covered the mind/brain debate a little at A-level as well as during my first year of University and I find it a heartfelt topic with dramatically opposing views. On the opposite side to physicalism, dualists believe that there is more to us than just our brain and this ‘something extra’ is a completely different essence. You can think of consciousness and our spiritual nature as something supernatural. Therefore for anyone who believes in life after death, there has to be this non-physical, supernatural essence to us that survives the breakdown of the body. The physicalism view has been propelled by the advances in our understanding of the brain- by being able to understand how so many different tiny parts of the brain affect our behaviour, health and personality… affecting who we are.

“Many people deeply resent [the  physicalism] view of things, which not only deprives us of life after death but also seems to downgrade thought to mere electrochemistry and reduces us to mere automata, to machines. Such people are profoundly mistaken since what it really does is upgrade matter into something infinitely mysterious that we do not understand… There are one hundred billion nerve cells in our brains. Does each one have a fragment of consciousness within it?” pg. 200

You can read a brief explanation about physicalism of the mind here: https://www.princeton.edu/~achaney/tmve/wiki100k/docs/Physicalism.html or for a much more in depth article have a look at the Stanford Encyclopaedia entry: http://plato.stanford.edu/entries/physicalism 

‘Do No Harm’ was given to me by my Dad who absolutely loved reading it. In fact, on the second page in, he highlighted the quotation:

“…and then there is both good luck and bad luck, and as I became more and more experienced it seems that luck becomes ever more important.”

Some might think this is luck is fate, but I think our choices and our evironment affect our lives and fate is our projection onto the world. So I found this quotation quite confusing. I’m not too sure what to take from Marsh’s description of good and back luck, is it emphasising the fact that we cannot be in control of everything? As my Dad said, the book deals with so many aspects of life. (Since reading my review he has also told me that he can at some point, as a surgeon himself, explain to me what this luck is…)

I do have a few criticisms about ‘Do No Harm’ and its ending. The last chapter jumps across several different cases in less depth and I felt it was a fizzling rush to finish the book. Due to the fact that the book is so intense and thoughtprovoking, I thought the ending didn’t really do it justice. And more, the book is dedicated to Marsh’s wife yet she is barely mentioned at all. As nosy as it seems, I would have loved to hear a little about this personal side to Marsh. Especially as he mentions in the beginning of the book how being a brainsurgion was a major factor in the breakdown of his first marriage. However, the overall structure of the book is impressive. The chapter names are a lovely touch. They are a combination of specific neuroscience terms mixed with more literary terms. Both of which relate to the chapters’ stories; aneurysm… glioblastoma…hubris… ‘angor animi’. I also like that the book isn’t chronological, instead the chapters follow on from each other by the themes that are discussed. Each chapter is a different case or point in Marshes’ life. From when he was at Oxford University studying PPE, to when he was a geriatric nurse, to surgery in Ukraine and his time at St George’s Hospital, London. It’s a book that you can pick up now and then and savour a few chapters at a time.

Throughout the book Marsh gives detailed accounts of conversations and the emotions running between patients, doctors and the patients’ family. He recounts when he was a part of the latter group, at a time when his son was seriously ill with a brain tumour:

“It was a useful lesson for me… to know how much my patients’ families suffer… Doctors, I tell my trainees with a laugh, can’t suffer enough.”

It is here that I wish to draw attention to the Jake McCarthy foundation. A friend of mine lost her 24-year-old cousin to a brain tumour in December 2012. Please have a look at their website and fundraising page. The foundation aims to raise awareness of the symptoms of brain tumours, in order to instigate early diagnosis.

I fully recommend giving ‘Do No Harm’ a read, you can buy it here.

Thanks for reading my review, if you like you can follow me on Instagram and Twitter: @hattiebottom.


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