Editor's Note: This episode of Bookclub is available to listen online or for download.
Henry Marsh’s Do No Harm is an unusual book - a doctor’s diary that explains the humanity involved in the practice of medicine, and the consequences of understanding that. Among them, that it is good to realise that there is frailty in a surgeon like anyone else, and that there are worse things than death. Marsh is a neurosurgeon, now 65, and his story - put together over many years and part personal history as well as a meditation on a hospital life - is given excitement by the way it describes the enthusiasm with which he’s always bored into the brain. When he was a medical student he found much surgery unappealing - ‘big smelly body parts’ - but found his calling one day when he watched an aneurysm operation. ‘It was an epiphany.’ This came after his own son had suffered a brain tumour and he had found himself succumbing to depression. Now he was set on his course.
The book takes us into the operating theatre and the consulting room, and more to the point, into the doctor’s head. How’s this for a straightforward picture of how a surgeon copes with the knowledge that he can’t always get it right. ‘You learn by mistakes. Success makes us complacent and less self-critical. The problem in medicine it’s that painful to admit to mistakes, and you learn early on in your career to pretend to patients you’re more knowledgeable and more competent than you are - because when you’re a young doctor, taking blood, you’re sweating and shaking and, yes, you could call in a more senior doctor to do it, but if you don't practice you don’t get better, and you end up deceiving yourself. That’s the best way of deceiving others, and then the problem is that if you’re deceiving yourself you’re less likely to admit you’ve made a mistake and you’re less likely to learn from it.’
This might seem scary, the kind of book you’d rather not pick up. That would be the wrong reaction. It’s reassuring on almost every page, even where Marsh is discussing things that have gone wrong (the cases are completely anonymised, of course). I suspect that even someone who is facing surgery would find this an absorbing story, because it rings true. We’re not dealing with super-humans, but with men and women who remain determined to do their best, every day. And even when you realise the speed at which decisions of life-and-death importance have to be made - quite often, he generates a feeling of suspense - the business seems heartening rather than frightening.
I suspect this is because he places medicine in the context of a rounded life. There is the practical business of the beauty of the well-wielded surgeon’s knife, which he loves, but more importantly a description of the precious relationship that develops between patient and doctor, even when it is brief, and particularly when it ends with death.
That is a considerable achievement. Marsh is a self-confident man, willing to talk about his feelings and his judgement about himself without embarrassment, and without those traits he couldn’t have written the book. He is the autobiographer who is not afraid of himself. That helps. The book has been extraordinarily successful - he told us there may be a television series in the pipeline - and, reading it for the first time, I understood why. He touches the fears that we all have of the operating table and the hospital bed, and demythologises the whole experience. He also makes a case for the doctor who has a touch of arrogance - a belief that although something can always go wrong, if you have the commitment and the dedication to work on your technique it is more likely to go right.
Our readers this month were won over. I think any of them who find themselves in hospital in the coming months will fare better as a result. Let me sum it up. I asked Henry Marsh if he thought he would like doctors to have more authority. The answer - ‘yes’.
I hope you enjoy Do No Harm.
Happy reading
Jim
