CBSN

Brain surgeon tells of triumphs, failures in bestselling memoir

A day in the life of NHS neurosurgeon Henry Marsh

BBC Newsnight

Henry Marsh is disgusted and fascinated by the brain. The 65-year-old is one of the top neurosurgeons in the UK and author of the bestselling book, "Do No Harm: Stories of Life, Death and Brain Surgery," a candid memoir about his career operating on the body's most complex organ.

With compassion and oftentimes cringeworthy detail, Marsh writes about his triumphs in the operating room and also his failures, like a young woman he operated on for a tumor in her spinal cord who awoke from surgery paralyzed on the right side of her body. "I had probably tried to take out too much of the tumour. I must have been too sure of myself," he writes. "The memory of her lying in the hospital bed, with a paralysed arm and leg, would become a scar rather than a painful wound. She would be added to that list of my disasters - another headstone in that cemetery which the French surgeon Leriche once said all surgeons carry within themselves.''

donoharm-book-cover.jpg

In chapters titled after brain abnormalities like "Astrocytoma," "Meningioma," and "Pineocytoma," Marsh also details the process of cutting into patients' heads and drilling through the bone of the skull, never quite knowing what he will find.

"Each brain tumour is different," he writes. "Some are as hard as rock, some as soft as jelly. Some are completely dry, some pour with blood - sometimes to such an extent that the patient can bleed to death during the operation. You can never know for certain from a brain scan exactly how a tumour will behave until you start to remove it."

Marsh spoke with CBS News about his book and his work as a neurosurgeon.

What prompted you to share your life's work in a book?

The way I see it now, there is so much discussion about medicine and health care in media and in politics that is deeply unrealistic and I wanted to write a book that shows what it is really like, at least from a doctor's point of view. It's often a very imprecise business and doctors are not rational computers. A lot of people don't realize just how uncertain medicine is and how difficult many of the decisions are.

What has the response to your book been like?

I was worried that some doctors wouldn't like it, but I got a lot of positive responses from other doctors. Also from some colleagues in America, which surprised me in some ways. I thought this was very blunt so a critical approach would not be well received, but I've got some very nice letters from American doctors and neurosurgeons saying that they liked it. My impression is, from what doctors have written, is that I've said openly what everyone thinks and feels, but would rather not dare to say until now.

How did you condense a career that lasted for more than 35 years into one book?

I've kept a diary all my life. It was a form of therapy and I've always liked writing. And in recent years the diary became longer and longer, describing my day at work.

I always knew I have a very interesting life, a very interesting job and I didn't want all of that to disappear. I see such extraordinary and wonderful and terrible things at work. It'd be rather a shame if it all just sort of vanished. I wanted to somehow preserve it at least for myself by writing about it.

My second wife, the anthropologist Kate Fox, is a very good writer and I used to read bits of it to her. She said, "Hey you can make that into a book." That was 10 years ago and that's how the book started, really.

What is it like to work with brain?

There is of course something very extraordinary about the brain and the fact that basically everything you think and feel is actually a physical process dependent on the physical integrity of our brains. We can't even begin to understand how it works despite all the massive amounts of neuroscience research going on. And neurosurgery is actually very crude. Brain surgery is not that special in terms of the operating. It is special in terms of the decision-making, in terms of the human problems you face, the patients you face. In terms of the actual technicalities of operating, it's a bit subtler than orthopedic surgery. But eye surgery for instance, and some of the inner ear surgery, is more microscopic and more delicate. What's peculiar about brain surgery is that it's very dangerous because the brain is so complex and so packed. One or two millimeters of damage in the brain can leave you catastrophically disabled.

What is the most difficult part about your work?

When an operation has gone badly and you've damaged somebody and you're going to have to go and see them afterwards and then you feel responsible for that and that's terribly painful. Although you would have told the patients and the family there were risks, it's still terribly painful. And yet it comes with the territory so you have to accept that, and if you're going to be a decent doctor you mustn't run away from it.

If you have so much anxiety about performing surgery and dread and guilt when things go wrong, why have you done it for so long?

My feelings about it now at the end of my career are different from when I started. When I was younger the great concern was to master the technical challenges of the operating, my inner cemetery was not that large at that stage. Also when you're younger you're a bit more callous, a bit more detached from patients and you don't really understand what they're going through until you become older yourself. You develop a blindfold that separates you away from what patients have to know and what families have to put up with. And it would be very difficult to do the work if you spend the whole time being terribly compassionate and empathetic. But on the other, most operations go well and you have many very grateful patients and that is deeply rewarding. I try to share both those aspects in the book. A great surgical triumph isn't triumphant if it couldn't go wrong.

Have you ever had your brain operated on?

Good God, no! I'm trying to avoid that.

Are you disgusted by brain surgery?

Like everything in life, it's two sided. Its something I find miraculous that thought is a physical process and we don't understand it. I'm not a mystic. I don't believe in an afterlife. I think I am my thoughts and my death consists of electrochemistry. We can't even begin to explain where or how consciousness is created by our brains and I find that rather wonderful and moving. It's a bit like looking at the stars at night and thinking about the universe. On the other hand, when I see people with some particularly horrible, destructive cancer growing in the brain, then it's disgusting and very distressing.

How have your ideas of brain surgery and the medical field changed over the course of your career?

I've done a fair amount of operating but the sense of glorious triumph wears off after many years. Instead, if an operation goes well I just feel a sense of relief. Whereas when I was younger and still trying to metaphorically climb Mount Everest, there was tremendous exhilaration if an operation went well. But that faded as years went by. I've come to realize I make mistakes. The best way of avoiding mistakes is to have good colleagues who are better at seeing my mistakes than I am at seeing my own. Having good colleagues is a hugely important part of safe medicine.