Layering up …


… an apologia wrapped in a neurology primer inside an autobiography enveloped in a case series, written in the direct, vigorous prose of a man who is willing to call a spade a bloody shovel.

Do No Harm, by Henry Marsh, is in fact a bit more complicated than that: nestedThe descriptions of neurosurgery are extraordinary, allowing us to glimpse an experience we can never know.  The case studies ratchet up the suspense:  which of these people will be destroyed by their well-meaning neurosurgeon in the next two pages?  Will Marsh have to gather all his moral courage, look the patient in the eye and explain why she is now paralysed, or tell parents why their child died on the table?  Or will he be able to see his patient restored to life and happiness?

And then there are the health systems.  The underfunded and neglected system in the Ukraine is held up against the prodigal yet hamstrung NHS, and two neurosurgeons fight their patients’ battles in the midst.  Marsh loves his discipline but hates hospitals, and both loathes and fears the senior management team.  He reacts like a prima donna to rules, but gradually the reader sees that while he is solely accountable for anything which goes wrong, he cannot fully control the fine details of time and process which might allow him to deliver his top performance, or cause him to destroy a life and a family.

What begins as biography and popular neurosurgery develops into an analysis of failure and the ethical dilemmas of surgery or medicine.  Guilt, obsession, exhilaration, empathy, arrogance and rage simmer between the lines, emerging to be pinned to the page like specimens by the steely self-awareness of the author.

I understand that Henry Marsh recently retired because he couldn’t stand the endemic NHS finger-wagging ANY MORE.  Perhaps writing this was the only way he could avoid actually biting the fingers off.

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