Quick: what do Michael Crichton, Saint Luke, Anton
Chekhov, Copernicus, Ethan Canin, William Carlos Williams, Sir Arthur Conan
Doyle, Carl Jung and Rabelais all have in common? None of them are women? Okay, throw in Tess Gerritsen, Alison Sinclair
and Alice Weaver Flaherty. They are
doctors and writers. What is it about
the medical profession that along with the fragile art of healing comes the
ability to tell a story? Is it because
the illness of the patient is steeped in narrative? Is it that one cannot begin to heal what ails
a patient until he or she understands that unique backstory?
To that list of
physician-writers must be added British neurosurgeon Henry Marsh. His recently published memoir, Do No Harm: Stories of Life, Death, and Brain Surgery (Thomas Dunne Books, 2015)
is an insightful and poetic look inside the human mind. It is, at the same time, technical but
accessible, brilliant and beautiful. We
follow the surgeon’s microscope into the patient’s brain in the opening
pages: “I am looking directly into the
centre of the brain,” he writes, “a secret and mysterious area where all the
most vital functions that keep us conscious and alive are to be found. Above me, like the great arches of a
cathedral roof, are the deep veins of the brain—the Internal Cerebral Veins and
beyond them the basal veins of Rosenthal and then in the midline the Great Vein
of Galen, dark blue and glittering in the light of the microscope. This is the anatomy that inspires awe in
neurosurgeons.” It inspires awe in
readers as well.
The human brain, of
course, has its own disturbing poetry.
Marsh tells us of the “angor animi—the
anguish of the soul—the feeling that some people have, when they are having a
heart attack, that they are about to die.”
The same feeling haunts those who face the surgeon’s scalpel as it
slices through the brain. Most of the
pathologies that Marsh confronts are cancerous, and he names each chapter after
a particular tumor type or affliction.
These are stories about life and the living hidden in the grey
gelatinous structures of synapse and dopamine.
It is a brilliant ride, like venturing into space at light speed through
the streaking light of the stars.
In many ways, Marsh
critically examines his own arrogance.
He admits mistakes and blunders, patients he has ruined, left paralyzed,
incapacitated, brain dead. Still, here
in the 21st century, surgery on the brain is an inexact science,
which is the reason that Marsh operates on so many patients using only local
anesthesia. The brain itself does not
feel pain. Pain signals must resonate in
the brain as they are felt in the body and therefore, all the nerve fibers spread
throughout the body are connected back to the brain. A physician may heal himself, but a brain
cannot feel itself. When the patient’s
skull is opened while he or she is awake, Marsh and his surgical team can ask
questions and elicit responses from him or her as different areas of the brain
are touched and explored. He will know
immediately if something has gone wrong.
However, it is probably something most people would not want: to be awake during brain surgery.
Throughout, Marsh does
a lot of shouting at people. He shouts
in surgery to make himself heard over the controlled roar of the
machinery. He shouts at other people who
annoy him, even once saying, as he is shouting, that he feels like a “pompous
fool.” He does not shout when he must
deliver bad news, and this book is threaded through with these tragic scenes. He does not shy away from describing the moments. For instance:
“I left them in the little room, their knees squeezed together as the
four of them sat on the small sofa and wondered, yet again, as I walked away
down the dark hospital corridor, 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.”
Perhaps what makes
Marsh such a top surgeon in the United Kingdom is not just his skill in the
surgical suite. He has been touched by
brain disease in his own family. He must
witness his son’s medical intervention and recovery. The good doctor, himself, suffers a broken
leg and nearly loses his eyesight. So
when he faces the loved ones of others, he must strike a delicate balance. He has a duty to his patients from which he
cannot shrink. “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.”
In dealing with death
and the end of consciousness every day, Marsh does not escape thoughts of his
own end. “Will I be so brave and
dignified when my time comes?” he asks himself.
He walks out to his car in a lonely parking lot. “The snow was still falling and I thought yet
again of how I hate hospitals.” He must
remain detached and professional with his patients because if he does not, he
risks being overwhelmed by the power of emotion and the tragedy of their
plights. His job is to bear witness,
even if he is impotent to bring the patient back. “I must hope that I live my life now in such
a way that…I will be able to die without regret.” He remembers his mother on her death bed
saying, “It’s been a wonderful life. We
have said everything there is to say.”
We should all be so lucky.
Marsh believes that it
is unlikely we have souls, or that we continue to exist after the brain is dead. What we know as consciousness ends when the
brain depletes its oxygen supply and is destroyed. “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.” I do not want
to believe this, nor do I want to agree with him, but the passage stopped me in
my reading and I found myself staring off into the shadows of a hot summer
night immersed in silence and lost in contemplation. “There are one hundred billion nerve cells in
our brains,” he goes on. “Does each one
have a fragment of consciousness within it?”
That is what makes this book so relatable and moving for the
non-scientist: Marsh asks the questions
we want to ask. In his musings and
ruminations, he is not the superior surgeon with the highly trained surgical
skill set. He is just a human being
questioning the mystery of existence.
This is a beautiful
book, a life-affirming, human story of a man whose life intersects with so many
others in the frailty of disease and the search for healing. Henry Marsh is a philosopher at heart, the human
embodiment of a deep and feeling intellect composed of those millions of nerve
fibers. In an age where doctors seem
more worried about keeping drug companies happy and charging insurance
companies for another round of tests rather than healing the patient, Marsh
tries to live out the oath to do no harm.
But what we see in this book is that sometimes, despite the heroic
efforts of the surgeon, the patient is harmed.
That is the cost of business in medicine, especially in neurosurgery. Some patients cannot be made better. In this book, we see the frustrations, the
disappointments, the tragedies faced by this doctor, as well as the triumphs,
the miracles, the resilience of the human body fighting to stay alive. It is a rich and riveting story, one I could
not stop reading and which left me thinking long after I finished the final
chapter.