Note to self: "do no harm" by Henry March

Notes to self is the place where I write about interesting stuff that I happen to read/watch/listen. It is less about writing a review and rather about recording my thoughts and considerations.

I just finished "do no harm: Stories of Life, Death, and Brain Surgery" by Henry March, a leading british neurosurgeon. The motivation of the book is the following: doctors (in particular surgeons, in particular neurosurgeons) are very reluctant to talk/discuss/admit their mistakes. Probably because their mistakes involve people dying or being left permanently disabled, doctors have a hard time facing them. Hence the goal of the book: putting the mistakes of the author out in the open with the hope of starting a conversation.

Actually, I somewhat disagree with the idea that the book is about mistakes. In my opinion, it is more in general about "the hidden side" of medicine and in particular neurosurgery - including its mistakes. The book is filled with the day-to-day life of a doctor, including the most mundane experiences and frustrations (such as the fights with the hospital management). It is about how decisions are made (surgery or no surgery?), the difficulties in handling patients, the human side of announcing a catastrophe to a relative. As the book often explains, patient have unrealistic expectations toward doctors, drugs, treatments and medicine - as a way to cope with difficult moments. The book feels like a counterbalance to that: everything you probably do not want to know as a patient, but nonetheless is the day to day of medicine.

It is extremely well written - all of it. I went through it as fast as I with thrillers. The most engaging parts are the descriptions of the surgeries. The list of brain structures, how they look under the microscope, what happen if the surgeon cuts few millimeters too much or too little - death, fatal bleeding, loss of speech, or a tumor that may regrow. Most of the surgeries described are successful, but many are not (otherwise, there would not be much suspense).

Final consideration. The book is full of dialogues between March and his colleagues about whether and how to treat a patient. In these dialogues, there are many sentences along the line of "I hope he dies - after what happened the only alternative is being almost brain dead" or "I don't think we should operate. The best we can do is to keep him alive but wreck his brain, better let him die". Now, these sentences did not shock me particularly - for the most part I agree with them. What struck me is how normal it is for doctor to say these things - they were not whispered but rather said openly in meetings. Final thought is: maybe there should be a broader discussion on what is better/worse than death - broader in the sense of involving the larger community rather that only doctors.