Thursday, April 14, 2016

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

Sometimes . . . I will pause for a while, rest my hands on the arm-rests, and look at the brain I am operating on. Are the thoughts that I am thinking as I look at this lump of fatty protein covered in blood vessels really made out of the same stuff? And the answer always comes back—they are—and the thought itself is too crazy, too incomprehensible, and I get on with the operation. (p. 67–68)

With Oliver Sacks’s death in 2015, the world lost a brilliant neurologist and a highly skilled science writer. Sacks’s accessible case studies of people with neurological disorders in The Man Who Mistook His Wife for a Hat and several other bestselling books introduced me and millions of others to the fascinating mysteries of the brain. I never tire of reading neuroscience case studies, so I was happy to discover Dr. Henry Marsh’s recent contribution to the genre: Do No Harm: Stores of Life, Death and Brain Surgery.

Drawing from his decades of experience as a brain surgeon in London and in Ukraine, Marsh introduces readers to particular brain tumours or conditions—a different one in each chapter—and then goes on to detail his surgical interventions as well as his interactions with the patients he helps and the patients he cannot.

Marsh excels at describing the surgical approaches and tools he uses for each procedure, making readers feel as if they are in the operating theatre with him. I now understand, for example, how the tiny aneurysm clip works—or sometimes doesn’t—by gazing down the binocular operating microscope with Marsh and watching as he painstakingly clamps the six millimetre titanium life saver across an aneurysm’s fragile neck while wrestling with a faulty applicator.

While most of the stories in Do Not Harm end well, Marsh is frank about the ones that don’t. He discusses his mistakes and failures of judgment with candour, and challenges his patients and his readers to confront the uncertainty and risks inherent in any brain surgery. Marsh is honest about how he still agonizes over his choice of words when communicating with patients. He tries always to deliver just the right mix of optimism and realism for each situation, and he sometimes fails to do this well. 

It becomes clear throughout Do No Harm that Marsh has little patience for bureaucracy and inefficiency in the public health care system—England’s National Health Service, in his case. He is bitingly critical of his hospital’s bed management policies and surgery scheduling practices, and offers a particularly potent example of how digital health records can get in the way of timely patient care. While Marsh’s criticisms are coloured by bitterness and even a touch of arrogance at times, there is much value in seeing how public health care and hospital administration can look from a surgeon’s perspective. 

Whether or not you agree with Dr. Marsh’s premise that “neuroscience tells us it is highly improbable that we have souls” (p. 378), you will appreciate the expanded sense of wonder and mystery that Do No Harm will stimulate. As Marsh summarizes mid-way through his book:

Our sense of self, our feelings and our thoughts, our love for others, our hopes and ambitions, our hates and fears all die when our brains die. Many people deeply resent this view of things, which not only deprives us of life after death but also seems to downgrade thought to mere electrochemistry and reduces us to mere automata, to machines. Such people are profoundly mistaken, since what it really does is upgrade matter into something infinitely mysterious that we do not understand. There are one hundred billion nerve cells in our brains. Does each one have a fragment of consciousness within it? How many nerve cells do we require to be conscious or to feel pain? Or does consciousness and thought reside in the electrochemical impulses that join these billions of cells together? Is a snail aware? Does it feel pain when you crush it underfoot? Nobody knows. (p. 378)

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