Brain surgical treatment … a slip of the scalpel can cause appalling disability which, says Henry Marsh, can be worse than death. Photograph: Don McPhee
We go to doctors for aid and healing we don’t expect them to make us worse. Most people know the aphorism taught to medical college students, attributed to the ancient Greek Hippocrates but timeless in its quiet sanity: “First, do no harm.” But many medical therapies do trigger harm: understanding how to navigate the risks of drug therapies, as well as the catastrophic consequences of botched or inadvised surgical operations, is a big portion of why coaching medical professionals takes so long. Even the simplest of therapies carries the chance of creating things worse. Drugs this kind of as statins that decrease cholesterol may lessen your risk of stroke or heart attack, but they also stiffen your muscle tissues and inflame your liver. Medicines to thin your blood against clots run the chance of devastating haemorrhage. Operations to get rid of prostate cancer might depart you impotent and incontinent removing a gall bladder can damage your digestion. The most unsafe speciality is broadly deemed to be neurosurgery. When a surgeon meddles with your brain it’s not just incontinence or negative digestion you danger but coma, paralysis and death.
Brain surgeons such as Henry Marsh, the author of this startling and moving memoir, have to dwell, breathe, operate and make urgent choices in total awareness of a terrible dilemma: if they open the skull they may conserve the patient’s existence, but a slip of the scalpel can lead to appalling disability, which, as Marsh puts it, can be much worse than death. I worked as a junior neurosurgical trainee when, at the bottom of what he calls “the strict healthcare hierarchy”, and realised then that living with this kind of accountability is not just onerous, it utterly transforms the lives of those who bear it. It is understandable that it need to be demanding: most of us, if we have been to have our brains lower open, would choose it be accomplished by someone who prioritises their function over their personalized life. As a trainee I realised that I had too many other interests to be a great neurosurgeon, and quit for emergency medication – a tranquil backwater by comparison. Readers of this book, as effectively as the thousands of sufferers Marsh has treated above his occupation can be thankful that he did not.
He describes visiting a nursing property in the countryside outdoors London, run by Catholic nuns and devoted to the prolonged-phrase care of patients with catastrophic brain damage. Walking along the quiet, orderly corridors he recognised “at least five” of the names on the door plaques as those of former sufferers of his – the house is like a museum of his operative failures. Cut by reduce, chapter by chapter, he takes the reader through a lot of of these ”failures”, and the effectively appreciated risks he and his sufferers knew they were taking, as nicely as behind the closed doors of a effective malpractice suit created towards him. Passing a youthful colleague in the intensive care unit, just soon after going to a patient rendered comatose by way of surgical procedure, he remarks: “Terrible occupation, neurosurgery. Do not do it.” It’s this disarming candour that can make the book this kind of an enthralling read. Marsh is not interested in offering us a glossed picture of the brain surgeon as superman he needs to demonstrates us the dreadful pressures below which he has lived during his professional existence.
A pleasant orthopaedic surgeon, known as in to set Marsh’s broken leg, pities him for his option of occupation. “Neurosurgery,” he says, “is all doom and gloom.” But this is not a gloomy book, it is a testimony of wonder – the wonder Marsh has felt by way of currently being capable to operate on the brain. Many of the chapters describe his triumphs, and, in intricate and fascinating detail, his daily work. As a junior surgeon the 1st method he witnessed was to clip an aneurysm – a pathological weakening of a brain artery that, if it ruptures, can result in paralysis or death. The operation seemed to him charged with which means and set him off on his occupation. “What could be finer, I considered, than to be a neurosurgeon?” he writes. “The operation concerned the brain, the mysterious substrate of all considered and feeling, of all that was crucial in human life – a mystery, it appeared to me, as great as the stars at night and the universe close to us.” The wonder isn’t going to leave him: decades later, separating two lobes at the back of the brain, he reveals the pineal gland, which Descartes believed to be the seat of the soul. It is “a secret and mysterious location the place all the most crucial functions that hold us conscious and alive are to be identified. Above me, like the excellent arches of a cathedral roof, are the deep veins of the brain … this is anatomy that inspires awe in neurosurgeons.”
But if this book is about wonder, it is also about entitlement. Exhilarated soon after carrying out a productive and protracted lifestyle-saving operation one particular day, he confesses how irritating it was to have to stand in the queue at the supermarket: “‘What did you do these days?’ I felt like asking them, annoyed that an critical neurosurgeon like myself ought to be stored waiting.” This plea for unique remedy would come across as insufferably self-essential have been it not balanced by Marsh’s awareness of how pompous he can sound. We’re also provided to realize that by living so long underneath the seismic stress of such accountability, Marsh has earned himself some privileges.
It truly is the incremental stripping of these privileges that get up the final quarter of the guide his sense as he approaches retirement that he is expected to bow prior to the management newspeak, wellness and security directives and “clinical governance protocols” that are mind-boggling the contemporary NHS – initiatives that no one understands and that do practically nothing for patient care. He describes wards full of company employees who don’t know in which his patients are, or hours invested making an attempt to discover brain scans misplaced by the latest computer method. Government meddling has made his clinical career into a game of musical chairs, he says. The coalition has taken this a single phase additional: not content material just to pull away resources, it keeps on modifying the orchestra.
Marsh’s style is admirably clear, concise and precise, as you’d assume from a person accustomed to writing operation and clinic notes in a hurry. It is unexpectedly sincere on a assortment of controversial issues dealing with the modern day overall health service, even as Marsh expresses his relief that he is about to retire from it. It touches on the way greed prospects some surgeons to execute sick-recommended operations in private practice, as well as the corrupting influence of Big Pharma (Marsh’s charitable operate in Ukraine has shown him how drug trials are frequently fixed by corrupt and desperate doctors). There is no forcing of a narrative arc or a satisfied ending, just the quotidian frustrations, sorrows, regrets and successes of neurosurgical existence. “They call us heroes, and at times gods,” Marsh writes of his individuals. “Probably they in no way really realised just how harmful the operation had been and how fortunate they have been to have recovered so properly. Whereas the surgeon, for a while, has known heaven, having come very shut to hell.”
• Gavin Francis’s Empire Antarctica was shortlisted in the Costa guide awards. He is writing a book about medication and the entire body to be referred to as Adventures in Human Being.