Do No Harm: Stories of Life, Death and Brain Surgery (Costa Biography Award shortlist)

Do No Harm is a memoir of medical cases and personal anecdotes by the neurosurgeon Henry Marsh, who was made a CBE in 2010. While it may seem unsurprising that someone who saves lives on a regular basis is honoured for his work, the failure rate also detailed in Do No Harm is staggering. One of the most important messages readers will take away is that doctors are not infallible. This also happens to be my only piece of criticism worth mentioning: Marsh repeatedly stresses that doctors are fallible. But because most people trust that doctors they know what they are doing, the above assertion might well be ignored. From a literary perspective it is however unnecessary. One of the features of this memoir is that it not only relates the professional experiences of Dr. Marsh the neurosurgeon, but also the life of Mr. Henry, who is divorced, who lost his mother to cancer and who broke a leg shortly after an eye operation. The private life thus provides a counterpoint to the case history. .

Intriguingly, technical jargon does not pose any problems. For the most part, specialised language is limited to the chapter names which, incidentally, are always followed by a definition in layman’s terms. Thus, “Olgigodendroglioma” is, put simply, a tumour of the central nervous system. The life scientific is rendered accessible as we are presented operations from the surgeon’s perspective, and some of the descriptions are absolutely beautiful: “Cerebro-spinal fluid, known to doctors as CSF, as clear as liquid crystal, circulating through the strands of the arachnoid, flashes and glistens like silver in the microscope’s light.” Marsh’s passion for his subject is evident and infectious. Humour is also important in this memoir; as one might expect, jokes are made at the expense of some patients or colleagues. The more outspoken jibes are however reserved for the interminable battle against disorganisation and excessive bureaucracy:

‘Ah!’I said, ‘Look. I may not be able to find the operating note, but I can tell you that you passed a type-4 turd on 23 April …’ […] She looked at the document with disbelief and burst out laughing.

The absurdity of the situation lies in the fact that the doctor cannot find the document he needs because he is swamped with paperwork that appears to be irrelevant to his job. The above is only one of many examples that illustrate the impracticality of some governmental practices, and shows how the doctors’ expertise is ignored in favour of adherence to legal ramifications.

Difference in opinion can spell life or death for patients. The wrong diagnosis or the wrong decision whether or not to operate is quite possibly more dangerous than the operations themselves. This is another point Marsh stresses repeatedly; in this case however, repetition is warranted because every case has its own peculiarities, whereas “doctors are fallible” is a universal truism. The dilemma of accurately judging what the lesser evil might be in any medical intervention sets the tone for the entire book. The tension between the scientific and intellectual, and the emotional is also a recurrent theme; on the one hand, neurosurgeons are supposed to be emotionally disinterested, yet they are required to be tactful when telling a patient they are about to die.

As genres that function as testaments to the world of who and how you were, memoirs are always prone to embellishment. Yet in Marsh’s text, this danger only appears in the title: Do No Harm. The hippocratic oath to respect human life and to do no harm may be impossible to achieve; Marsh’s memoir does not shy away from recounting his mistakes as well as his successes. The result is highly authentic and compelling narrative that offers remarkable insights into the world of neurosurgery.

Jérôme Cooper