Brain surgeon has to be up there with rocket scientist as one of the jobs which sounds like it’s the winner of the Most Impressive Job competition. You have to be very brainy, very skilled, and the stakes are as high as they get. The wonderful thing about this book – Do No Harm – is that Henry Marsh is such a relatable human.

Stories of Life, Death and Brain Surgery

Ostensibly a series of tales from the operating room, fascinating in itself for those who have some medical interest, it is his open and honest portrayal of himself which is really illuminating. He deletes emails from hospital management without reading them; he massages the truth to patients (because to be bluntly honest might be too upsetting); he smashes a kitchen chair up in a rage in front of his parents; he even has long, angry, internal monologues in which the F word is freely repeated. And, most relatable of all, he makes mistakes. But in his case, those mistakes might result in permanent, life changing disability, or even death.

A very busy man

Henry seems to live large parts of his life in a state of anxiety over imminent operations, but this is balanced by a powerful dose of self-importance. He amusingly and honestly paints a picture of himself waiting in a slow queue at a supermarket checkout after work. He admits to feeling impatient and frustrated – and looking at the other customers, thinking “And what did YOU do at work today?”. In his spare time he manages to keep bees, build his own loft, cycle to work and do an immense amount of voluntary work in Ukraine. There is a documentary about his work in Ukraine that you can find here on Youtube. It’s called “The English Surgeon”.

What are tumours actually like?

This book is beautifully written, even when illustrating such a viscerally unpleasant subject as tumours.

“Each brain tumour is different. Some are as hard as rock, some as soft as jelly. Some are completely dry, some pour with blood…Some shell out like peas from a pod, others are hopelessly stuck to the brain and its blood vessels”.

As you can see from this, there is a very real informative aspect to this book. The chapters have titles such as “Aneurysm”, “Astrocytoma” and “Choroid Plexus Papilloma”. We learn exactly what it’s like to do an operation, a high intensity activity in which tiredness disappears and Marsh seems to feel in-the-zone. Sure, confident, focussed. But there are relatives and patients to deal with too, and he seems to go through anxiety and self-doubt at a level I don’t think I could personally live with. I feel a bit uneasy of an evening if I think I might have done slightly too forceful soft tissue work on someone’s quads!

Failed Back Syndrome

The operating isn’t as difficult, he says, as deciding whether to operate or not. Of interest to us manual therapists, right towards the end of the book is a rather sad vignette of a lady with back pain who had undergone two “ill-advised” operations in the private sector – he refers disparagingly to “excavations and crude metal scaffolding” – but was still in pain and now despair. He could not help, and seems to think an operation was never the answer for her anyway. He seems to hold surgeons who operate on patients like this for money in some kind of disdain, and points out that the scans are often “normal”. Henry would probably align well with the Pain Science crowd. He doesn’t distinguish between “real” or “psychological” pain:

“All pain is produced in the brain…..I suspect that many of the patients …. would be best treated by some form of psychological treatment…..I will often ….spend longer talking to the patients with back pain than those with brain tumours”

I could choose dozens and dozens of quotes from this fascinating book. It gave me a glimpse into the very real, human work of neurosurgery, and a sense of relief that it’s people like Henry doing it. It has made me rather skeptical, though, about whether I’m getting the truth, the whole truth, and nothing but the truth if I happen to need surgery in the future.

A riveting book and I highly recommend it!

If you’re curious about neurosurgery and want to read the entire thing, you can buy it here, and I guarantee you will learn something new!