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

Hoda, Syed A. MD

doi: 10.1097/PAP.0000000000000087
Book Review

Weill Cornell Medical College New York, NY

The author has no funding or conflicts of interest to disclose.

  • Author: H. Marsh
  • Publishers: Thomas Dunne Books-St. Martin Press
  • Year/ISBN: 2015, 13: 978-1250065810
  • Organization: Hardbound
  • Price: $25.99
  • Pages: 277

Since the time of Hippocrates, physicians are advised to “First, do no harm.” Be that as it may, physicians do cause harm, albeit unwittingly. All specialists (including pathologists) have the potential to inflict damage—although neurosurgery is widely regarded as medicine’s most difficult art as the consequences of blunders in the brain can be catastrophic.

Henry Marsh, a British neurosurgeon nearing the end of a long career, has chronicled the triumphs and tragedies of his professional (and personal) life in Do No Harm. This is a surprisingly simple and extraordinarily intimate memoir that recollects some of the author’s cases in an elegantly petite book.

The starting point of each chapter is a real-life vignette. Patients with an array of tumors including glioblastoma, medulloblastoma, pineocytoma, and choroid plexus papilloma (in the author’s son!) are chronicled. The narratives are unadorned, yet illuminating and disarming. Many depict strains that can occasionally assume seismic proportions. Told here are tales of complex procedures that work, and of those that fail; of heroism (often of patients) and of heartache (often in surgeon as well as patients). Pathologists make rare cameos. The greed of the unscrupulous among us, the corrupting influences of “industry,” and the senseless inefficiencies of “management” are ensnared in this narrative. One can perceive the mellowing of Marsh over the years, from an arrogant youthful surgeon to a caring older guru—idealism yielding to pragmatism.

Marsh’s text is often lyrical—he writes of the brain as “the mysterious substrate of all thought and feeling, of all that was important in human life—a mystery, it seemed to me, as great as the stars at night and the universe around us.” Some may take issue with a few of Marsh’s opinions, particularly one that relates to the regulatory cutting of working hours to the extent that junior physicians do not gain sufficient experience during training (a movement apparently spreading beyond the United States). Marsh’s belief that some of the greatest advances in medicine are the result of cavalier risk-taking may offend conformists (even if the statement is broadly true). However, all will agree with Marsh that the surgeon’s ultimate goal is to operate on patients who “recover completely and forget us completely.”

Do No Harm will appeal to admirers of Atul Gawande, Jerome Groopman, and other physician-authors who write expressively on matters pertaining to our profession. Those who have felt the soaring highs and the shattering lows in their own lives will relate to the book. At heart, this is a book about wisdom acquired in the school of hard knocks, and about humility in a type of individual least expected to attain it—the neurosurgeon!

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Syed A. Hoda, MD

Weill Cornell Medical College, New York, NY

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.