Quote of the book
“Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all”
5 key points
- Marsh sees medicine as a form of craft, not an art or a science, which took some years for him to realise.
- Marsh came to empathise with relatives who were angry or upset because he had been one himself, to his son who had a tumour.
- Marsh expresses his frustration with the healthcare system in the UK. Notably, he calls out government cuts and management bureaucracy which puts pressure on healthcare staff to be increasingly efficient with fewer resources, caring for more patients than there are beds.
- Breaking bad news is always hard and there’s no way to know if you’ve done it well or not.
- Marsh feels that the uncertainty of medicine is what is hardest for doctors, not the suffering and death.
This book is written by Henry Marsh who shares his unconventional journey into neurosurgery after studying medicine as a second degree. He studied Philosophy, Politics and Economics at Oxford University, went onto teach English literature abroad before starting his studies in medicine. The title of the book is a reference to the first hippocratic oath, which is the oath taken by medical physicians: “first do no harm”.
The book is littered with candid examples of his patients and his reflections, through his time in medical school to becoming a neurosurgeon. The book tries to address how to deal with the consequences if everything goes wrong, but this time in a life and death situation, crossing the fields of philosophy, ethics, and medicine. It is written with an intensity that takes you to the operating room where Marsh performs brain surgeries. What is it like to be a brain surgeon, operating on one of the most sensitive and core parts of the body – not just an organ, but the part which shapes what it means to be human?
Marsh writes with incredible honesty, littered with some humorous anecdotes. It immediately stood out to me, from comments that he does not allow junior doctors in his clinic, and his general tone of writing, that Marsh seems to be a very independently minded doctor who prefers to work alone. He also describes in detail the emotions and intensity that went through his mind as he operated on a patient to try and remove a brain aneurysm. This style of writing makes the reader remember that sometimes doctors feel nerves and tension upon operating on a patient, even if they try not to show this to their patients. He also candidly shares the pain of having to share bad news with a family after the death of their loved one, particularly when the loved one in question is a child. I thought this was a humble reminder that doctors are human too, which is sometimes forgotten about when in a life-or-death situation.
Marsh does not shy away from the bare, raw details of being a doctor. For example, one particularly moving story that Marsh shares is about a three year old child, who was the only child of their parents, diagnosed with a terminal brain tumour. Marsh realised it would be futile to operate further on the child when he realised the child was not going to get better. He let the family know, who decided to go elsewhere and ask another neurosurgeon to operate, before the child passed away. The pressure of the family trying to sue him was one reason why Marsh decided to leave paediatrics. In other sections, he will describe in detail how he would certify the death of a patient, which is chilling to read, as well as numerous cases of when he has needed to bring up a patient’s mortality to them.
Ultimately, this book shares what it is like to operate on such a fragile part of the human body, to confront death, the frustration with politics of the NHS, and his personal life with the death of his mother and his own hospital visits. Beyond the suffering, death, and extent of human vulnerability, Marsh leaves the reader with a feeling of hope.
Overall rating: ⭐⭐⭐⭐⭐