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

Reviewed by Gerti

It is a popular misconception that the phrase "First do no harm" is a part of the Hippocratic Oath which doctor’s take. The phrase does not appear in the oath, but a similar phrase is found in “Epidemics”, Book I, of the Hippocratic school: "Practice two things in your dealings with disease: either help or do not harm the patient". The exact phrase is believed to have originated with 19th-century surgeon Thomas Inman, but it is used here as the ironic title of this memoir by neurosurgeon Henry Marsh. While “Do No Harm” tells the story of his career in brain surgery in England and elsewhere, I call the title ironic, because much of the book in fact involves the harm he does patients, whether they live or die.

For example, there is the time when he has an assistant start a surgery because it is an “easy” one with which the man is familiar, and after all, students need to learn. Dr. Marsh only comes in once it has been botched completely, and then realizes he should have been there to watch the procedure from the beginning. Nice realization for Marsh; death sentence for the patient.

Another time Marsh is visiting a long-term care facility for patients who are in comas or vegetable-like states and need constant care. These patients have ceramic name plates outside their doors (since they reside there for years) and Marsh notices with shame that at least 4 of the people housed there are former patients of his. He has “wrecked” them, to use the vernacular he says doctors use to describe a patient whose surgery has been left them debilitated.

The book is divided into sections, based on what type of tumor or symptoms the patient is having. Many are bleak with a poor prognosis, but there are some success stories as well. Marsh goes to the Ukraine to help doctors there with their neurological patients, and actually flies a few people to England to see their surgeries occur under the best conditions possible. This peek at medicine in the former Soviet state is both fascinating and frightening at the same time.

In short, much of the book is terrifying, as Marsh talks about how similar normal brain tissue is to diseased tissue, and explains the state of the NHS (National Healthcare System) in England, talking about a room with 20 patient beds in it, something we would never see here in modern US facilities. Enlightening also is how well Marsh himself is treated when he has a detached retina, since he has private insurance and can afford to go to a private healthcare facility. It made me understand why concierge medicine is so popular. The book “Do No Harm” is an inside look at brain surgery that I think few people will be able to stomach. Well written, but with bad outcome scenarios which are scary as hell.