October 2019 Open Book Group – Do no Harm: Stories of Life, Death and Brain Surgery by Henry Marsh

Thank you to Kevin for moderating Do no Harm: Stories of Life, Death and Brain Surgery by Henry Marsh.

I’m sorry I was on holiday for this meeting. I enjoyed Marsh’s honest insights into his career as a brain surgeon.

Kevin summarised the meeting………next best thing to being there.

” Henry Marsh was born in 1950 to his parents, the distinguished law reformer Norman Stayner Marsh and bookshop owner Christiane “Christel” Christinnecke who, in 1939, had to leave Halle in Germany after she had been denounced to the authorities for “making anti-Nazi comments”. They married in London in the late summer of 1939.

His education was one of privilege with time spent at an Independent school in Oxford, followed by his senior education at Westminster School (a very notable Public School in London). As an aside, I think I’m right in saying that my previous moderated book author – Mark Colvin – also went to Westminster School.

Later he read Politics, Philosophy and Economics at University College, Oxford University, achieving First Class Honours, before graduating with Honours in Medicine from the Royal Free Medical School. He describes in the book how he was rather indecisive in where he wanted his education to take him, before he decided upon Medicine.

Marsh was until 2015 the senior consultant neurosurgeon at the Atkinson Morley Wing at St Georges Hospital, South London, one of the country’s largest specialist brain surgery units.

Since 1992, he has been working with neurosurgeons in Ukraine, and particularly with protégé neurosurgeon Igor Kurilets, and his work there was the subject of the BBC film The English Surgeon made in 2007.

He has a particular interest in the influence of hospital buildings their design and their impact on patient outcomes and staff morale; he has broadcast and lectured widely on this subject.

His second book published in 2017 – Admissions: Life as a Brain Surgeon seems to reflect this interest whereas this first book – Do No Harm focuses more on his learning and life experiences as a brain surgeon set against the frustrations of working within the ever under pressure National Health Service.

He either has two daughters, Sarah and Katharine, according to the Times, or 3 children according to the Financial Times (!) from his first marriage and is now married to social anthropologist Kate Fox, author of Watching the English.

And, just before we get to the actual book, it’s probably worth appraising what the title ‘Do No Harm’ refers to –

The Hippocratic Oath includes the promise “to abstain from doing harm”. Or to put it another way given an existing problem, it may be better not to do something, or even to do nothing, than to risk causing more harm than good. Marsh refers often to this policy or philosophy throughout the book.

So, to the book itself.

Marsh has talked of keeping a diary from a very young age. Unfortunately, in his words, in his very early 20s he burnt his first set of diaries that he had written from the age of 12. However, he again took up the keeping of a diary at a later time, particularly during what he describes a brutal divorce from his first wife.

(We know or learn nothing about his first wife, except a small reference that his hours and commitment to his work meant a successful marriage was all but impossible – we can make our own judgements as to the truth of this.)

It was his second wife, Kate Fox, who suggested he should try and put together a book using his diary as his source. Working with his wife and his editor, the book was structured in the interesting way of most chapters being headed up by a particular type of brain tumour, with a brief description.

His editor felt that this would make each chapter a bit of a thriller:

The patient and/or time in Marsh’s life as well as the specific brain tumour type, provides the object, subject and context of the upcoming surgery. The surgery itself is described in clinical detail, though quite easy to follow, and we, as readers, await the outcome be it successful or otherwise. Adding to the overall ‘drama’ is the questioning of the need and the possible known outcomes of the surgery. Marsh is able to convey that it is not only the complexity of the operation that needs to be considered, but also the ability of the patient to live a meaningful life following on from such surgery.

All surgeons can be seen as having almost god-like power but, perhaps, none more than those performing surgery on the brain and Marsh tries to emphasis this without exhibiting too much arrogance or hubris in doing so.

After the preface, the first chapter is titled Pineocytoma which is described as ‘an uncommon, slow-growing tumour of the pineal gland’.

In the first paragraph is, to me anyway, a quite brilliant sentence: The idea that my sucker is moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.

This is coming from a man who has spent his adult life opening up, cutting, moving, gently tugging away at the jelly-like tissue, dealing in millimetres but who still has a sense of wonderment about it all.

Although, his son’s brain-related illness obviously affected Marsh, it was not the main reason behind becoming a neurosurgeon – this took the observing of an aneurysm operation that lead to Marsh realising what he really wanted to do.

Throughout the book, there a number of passages that give the reader an idea as to what makes Marsh the man he is – his sons illness, his mistakes (seeing a poor ‘survivor’ of a failed operation many, many years after that operation) as well as the passing of his mother (chillingly, if that’s the right word, and very well written, in my opinion). Probably none of this life experience makes Marsh unique, but it is still interesting and important to help get some sort of insight into the mind of such a surgeon.

Mid way through the book, Marsh talks of his time getting involved in the Ukraine. Operating in almost primitive conditions seem to give Marsh a bit of a ‘second wind’ as well as a certain ‘celebrity’, which had both positive (an Emmy-winning film made in 2007 most likely helped stoked Marsh’s healthy ego) as well as negative (a patient, who had the most enormous tumour failed to survive multiple operations) as well as this was, perhaps, time when his first marriage was failing) outcomes.

Throughout the book, there is a sense that there is truth and trust in what is being written. There is also a sense of balance between a strong ego and a good dose of humility, which does seem to be reasonably genuine.

And, finally, there is a sense of frustration with how it was much easier when, as the senior surgeon, his word carried so much weight and things would get done as he wished, but, as he reached retirement, the overwhelming pressures of the ever-creaking NHS became almost too much for him. An example where such frustration takes place is when waiting for a bed to become available, and why sometimes there is such a wait, is almost laughable if it wasn’t so serious.

Indeed, and this is not covered in this book, one of his final acts as a surgeon was one of great frustration and some considerable public shame.

As Ian McEwen, author of Saturday which was based on a similar character who was actually a heart surgeon, is quoting as saying that Marsh is “Neurosurgery’s Boswell” – a frequent companion and life chronicler.

And, now to the group discussion:

With a room full of many who had had firsthand encounters with hospitals, surgery and the health services either here in Australia or in other countries, there was bound to be much discussion centred around the groups own experiences – good, bad and in-between.

Some felt that the book – seen as more of a memoir, than an auto-biography – did hold up Marsh as a strong-minded and, bordering on arrogant, senior surgeon.

This strong-minded experienced surgeon could certainly encounter much frustration in dealing with hospital managers and ‘the system’, however fair or reasonable hospital services management processes need to be in this modern world – certainly some felt that modern hospitals with their focus on money and numbers had lost the ‘personal touch’.

It was generally agreed that Marsh had maintained his personal touch.

It was also agreed that the format of the book was successful and that the book managed to keep up the interest for almost all of the group, although one did mention that it was impossible to eat AND read the book at the same time. Describing the brain as jelly probably didn’t help!

But, overall, the ‘thriller’ nature of each chapter allowed readers to keep going, although some would have preferred a more historical and linear structure – as in starting when he began his life/experience and finishing when he reached retirement.

There was some discussion around how Marsh managed those with a more religious belief system – as in is there a ‘soul’ and, if so, can it be within the brain? Marsh doesn’t share such beliefs although seemed to appreciate the efforts made by those who chose to care for those poor damaged ‘souls’ for their remaining years on earth. It’s unclear what Marsh does think is an appropriate course of action for such cases. Maybe that’s best left unsaid.

Certainly, the neurosurgeon in Marsh strengthens his views that having a soul is highly improbable.

The group agreed that the book was a truthful telling of his career with some examples of failure and weakness included. There was agreement that the insurance system in the NHS, under which Marsh practiced, probably provided him with a significant amount of personal protection, which would have allowed him to provide a quite candid review of his life’s work and achievements. This added to the feeling that the book was, indeed, a mostly true telling of his career.

(Marsh did have a private practice for many years but is generally not in favour. Of course, the recent case of the very high-profile Australian brain surgeon Charlie Teo added to the groups discussions)

A point that was very well made towards the end of the group meeting, was that his career has mirrored such changes within the NHS. This can be seen as being both positive (better equipment, knowledge, techniques etc) as well as negative (ageing population, cost pressures and lack of political will to fully address (and fund) many of the problems faced by those in the health systems around the world).

The group felt that the book was well written, which is not always the case with memoirs/autobiographies and were happy to continue including such (non-fiction) books in our lists of books chosen to be read each year.

Henry Marsh is a very public figure and is certainly not a shrinking violet. Therefore, there are several films, clips, readings and interviews that can be found online.

Here are a couple of links that some in the group might find interesting. The first one is a 11-minute film from the BBC Newsnight program which is well worth the time.

https://www.youtube.com/watch?v=iemljlI87GQ

Radio 4 Book Club https://www.bbc.co.uk/programmes/b05xcvb0

Richard Fidler Conversations https://www.abc.net.au/radio/programs/conversations/conversations-henry-marsh/8548808

BBC Desert Island Discs https://www.bbc.co.uk/programmes/b0bkqb2t

 

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