Not too long ago, after having read his book "Surgery, the ultimate placebo", I wrote about Ian Harris, an Australian traumatologist. I remember that Harris defends the rigor in the surgical indications after having observed that more than half of the surgery that is practiced does not have enough support of consistent scientific evidence. Now I have finished the book "Do no harm", by Henry Marsh, an English neurosurgeon at the lintel of retirement, and I am inevitably immersed in the comparison between the two texts: first, Harris's, is written by someone who loves surgery and believes that too often is practiced with little rigor, while the second, Marsh’s, is a biography of great literary level, elaborated from the notes that the surgeon has been taking throughout his career, not in vain has he received several recognitions. Marsh, like Harris, is passionate about his work, but his literary contribution comes not from scientific exaltation but from the knowledge he has accumulated from his own mistakes. The veteran English neurosurgeon has not published any revealing research nor has he led any innovative discovery. His honesty and his hands are his strength.
According to Marsh, each surgeon has his own skeleton in the cupboard, and this is where he looks for the lessons to keep improving: What happened? Why did I bite off more than I could chew if I felt too tired? The neurosurgeon, after having intervened on more than 15,000 people, now demands more humility from his colleagues. In the book he takes the first step, recalling one by one, all the cases that did not go well, analyzing the reasons and drawing lessons, but what makes the reading more endearing is when the author goes beyond professional rhetoric and also remembers those people’s names, what they were like and how those disastrous clinical processes affected their lives and the lives of their families.
Shared clinical decisions
Marsh reflects on the relationships he maintains with patients. He believes that the emotional bond is necessary, in fact he would not know how to do it in any other way, he is a temperamental man, but -according to him- we have to know how to find a balance, which he has never stopped looking for. Patients must be treated with frankness, although - he admits - the difficulty appears when there is no hope and the patient wants to cling on to the last straw. According to Marsh, knowing how to convey the deep sadness intrinsic in not being able to help enough is one of the biggest difficulties that any doctor faces.
Quantity or Quality of life
When the prognosis is bad, many people feel disconcerted. Sometimes operating, despite the obvious risks, opens up excessive expectations and most believe that the worst that can happen is for others; while the decision not to operate is a less attractive option, although, they imagine, it is objectively the most advisable, because everyone, including the surgeon, if nothing is done, have the feeling that they have thrown in the towel too early. In an interview with Carles Capdevila, Henry Marsh says that at this point people should consider why it’s worth living, but that many don’t want, or can not do so, they just want to listen to therapeutic options that promise them more life, despite the inherent risks of such treatments. These are situations of great uncertainty in which, often, the surgeon finds himself facing the unbearable pressure of having to decide on how the last days of the patients should be spent.
"The English surgeon"
Henry Marsh, during the Communist dictatorship, was invited to Kiev to give lectures. He was impressed by the sordidness of the Ukrainian hospitals and met Igor Kurilets, a young neurosurgeon who was repressed by the regime for his too-bold proposals about the practice of medicine. Igor and Henry became friends and, since then, the British surgeon has established a London-Kiev bridge, which gave way to an intense professional relationship, including donations of surgical equipment, so that, at least once a year, Marsh stays in the hospital of his Ukrainian friend where he visits the most serious cases, operates on some and, above all, teaches an honest and endearing way to practice medicine.
In 2007 the Odyssey channel recorded "The English surgeon“. This multi-award winning documentary is based on the activities of Henry Marsh in the Ukraine.
The documentary is sensational, it could not be otherwise in the case of Henry Marsh, and in it I have seen two things that could have been impossible to capture in a book. The first is to see Marsh visiting the hospital in Kiev, where I was struck by his genuine emotions when faced with cases where there was nothing to be done and second, is to see how he treats the case of Tania, a girl with a cerebral tumour that he operated on in London in a clinical process that went wrong. Well, in the documentary we can see Henry and Igor going to visit Katia, Tania’s mother, they went to the girl’s grave and then they accept the invitation to lunch with the family. Moving!