Do No Harm - Gawande

 

If you like stories about medicine, perhaps Atul Gawande's “Better”, or other tales of medicine from the ER or operating room, you will undoubtedly like the stories from the memory of Henry Marsh, straight out of the surgical theaters in Britain, and based on his 30+ years as a prominent neurosurgeon.  The book, “Do No Harm, Stories of Life, Death, and Brain Surgery”, was the subject of a review I read recently, which was recommended to me by my cousin, a neurosurgeon in New York State.  When he passed on the review to the family he said, “The most accurate description of what it feels like to be a neurosurgeon that I have read”.  I was compelled to buy the book and judge the full weight of the material...

Not to be taken lightly, brain surgery is serious business.  Neurosurgeons head into the profession with a rock solid belief that they are the best doctors and will do great things.  What’s not to like about having the encyclopedia knowledge of the human brain and nervous system as well as the tremendous motor skills of a top surgeon, who must perform while looking through a microscope,  to remove a tumor from a child's brain, thereby saving a young life and with it the hopes and dreams of the parents who stand nearby terrified of a bad outcome.  Well, as it turns out, as sad and unfortunate as these cases are when they turn up, they have turned up.  A brain tumor, whether it be malignant or not, is still a very grave condition.  Even the very very best in the business, do not stand much of a chance against the odds when the human brain turns against itself…  Add to an already dire prognosis, the absolute dangers of poking and cutting around in someone's brain, the final outcomes of any patient in need of brain surgery, perhaps the bad news can never be painted rosy.  A brain surgeon is not someone operating on an otherwise healthy patient who needs an appendix removed, having done so, returning said patient to 100% or better.  A brain surgeon is operating on a very sick patient, who will never fully recover, and can only get worse if a mistake is made.   Let me try this another way.  Any patient who undergoes any surgery is at risk, but more so from a mistake made by the doctor...the surgical procedure itself, can be expected to cure the patient completely and add the longevity of a person's life, after the recover.  If you happen to be unlucky enough to have a problem with your brain or spinal core, that requires surgery...very rarely if ever, should the patient expect a return to a normal life, and that is with perfect surgery.  Except with brain surgery, brain tissue is always removed...until such a time that brain tissue can be regenerated, spelled stem cell research, there is no 100% recovery.  Even then, if you regenerate brain tissue, any of what constitutes “Us” contained in said tissue, will be recovered.  Now, what if the surgeon makes a mistake, if a tiny tiny mistake?  The results are easily catastrophic for the patient.

Thus, a career of stories of life, death, and brain surgery pour forth from Henry Marsh.  Many times I felt I was reading his personal journal...a journal that should remain personal and perhaps private.  Yet, those in this business, need to communicate, if not with us, but with one another and of course with future doctors who wish to follow in this strange business of entering an human’s brain attempting to do good while at the same time attempting to do no harm.

I for one have a profound and newfound respect for the neurosurgeon...they are to be set apart from other surgeons...who can find great satisfaction in curing and healing patients...who become God like in their abilities to ease suffering.  The neurosurgeon, by contrast, lives under the dangling sword of Damocles...an ever present fear of doom that as doctors they will do more harm then good.  This produces within them the most humbling notion that they are,  all too human…hug a neurosurgeon today...they definitely need it…  Five Stars for Henry Marsh and the sharing of his candid and personal stories...and beyond the neurosurgery, the stories of medical care that confirms what we know already know about bureaucracy and the tension between running a business and saving lives.   Five stars also for the humans that go into this humbling profession…any young surgeon considering this tract has got to read this book first...