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

Now here is a book I totally missed, despite universally favourable reviews from many a respected newspaper. Indeed, The Economist has described the author as neurosurgery’s Boswell! I do remember the account of his surgery in the Ukraine in the BBC film ‘The English Surgeon’ in 2007, but was unaware of this publication.

It came to me from a former trainee, who has inscribed within ‘I couldn’t stop thinking how much this guy thinks like you in certain circumstances. He reminded me so much of you that I had to send you the book’. Well obviously my attention was now well and truly caught! I read it with some trepidation, wondering what insight I might gain into my personality and finished it in a single reading. Several times last night I read passages out loud to the family, who were trying to watch television. Every reading was greeted with howls of laughter and cries of instant recognition. It seems my former trainee was on to something.

This is certainly a tale for surgeons of my generation. (Mr Marsh qualified, gained his Fellowship of the Royal College of Surgeons (‘FRCS’) and his consultant post, and had the sense to retire, all within a couple of years of my own experience.) He tells of what is so familiar to us all, even in ENT. The interminable waits for what is laughingly called ‘theatre turnaround time’. Of trying to get a patient onto a list, even if (heaven or pen-pushers forbid) the list might overrun. He walks out of corporate mandatory training, but gets his certification first. He wanders the hospital looking for outlying patients. He tries to seek the attention of those occupying the nurses’ station, who ignore him, assuming he is ‘just’ a member of the public. He must pronounce on scans, which modern information technology systems make totally inaccessible. He tells us of some (stress ‘some’, he is better than I am at leaving them to get on whilst he remains ‘hands off’) trainees who exhibit overconfident arrogance, and/or are totally deskilled by loss of training time and traditional ‘firm’ structure. So often, reading this, I found myself muttering ‘Oh yes…yes’ over and over again.

Each chapter is entitled with a neurosurgical diagnosis, and then carries a vignette of success, triumph, hubris or tragedy. He tells us of a transatlantic lecture, where he confessed to every major error he had made in his practice and what each had taught him. The response was stunned silence of course. This is that kind of book, an honest account of what it does mean to have ‘their life in your hands’, with the errors, the complications and the personality clashes we have all experienced.