There are
very few books in which professionals speak frankly and honestly about
their profession. It’s a bit like magicians. They never give away the
secrets of their magic, they just get on and do it. But Henry Marsh has
revealed the secrets of the Magic Circle of Neurosurgeons.
Who is this
man? He’s pictured inside the back cover: a genial chap, a veteran now,
wearing a pale blue surgeon’s gown. He has enormous hands, or is it the
camera angle that makes it seem so?
He graduated
from Oxford University with a degree in Politics, Philosophy and
Economics, but later turned to medicine. Without a degree in science,
the only medical school that would have him was the Royal Free Medical
School, London. He is now a senior consultant neurosurgeon at St
George’s Hospital in south London, specializing in brain surgery: a
special style of brain surgery where the patient is merely under a local
anesthetic. That way, the surgeon or assistant can to ask his patient
questions about how they feel, or find out if they can recite the
alphabet. This crucial feedback is used to guide the surgeon’s knife as
it seeks the right place within that most delicate of organs, the brain.
Perhaps what I’ve just written is a simplification of the actual
process but I’m trying to write in a simple and straightforward manner,
just as the author does.
He demonstrated something of his method on TV back in 2004, for the BBC documentary Your Life in Their Hands.
If I were operating on a human brain (God forbid) I think the presence
of BBC camera crew would be a distraction. Apparently not in his case,
as the patient survived and the programme won a prestigious gold medal.
Most
chapters of the book describe a single operation to cure a particular
condition, each being given its medical name and a plain English
definition. There are many such conditions, and to read the book is to
receive a brief medical education in this specialized area. One learns
about the symptoms. The reader will doubtless wonder whether that
headache he gets is caused by a tumor, and why could I not walk in a
straight line after that night out? Actually, our book group didn’t
discuss our personal symptoms – and in any case our medical member
wasn’t present on this occasion to tell us ‘don’t worry’.
You may have
often wondered how surgeons get started. Some poor soul has to be their
first victim…er…I mean patient. Well, the book tells us how it’s done.
Yes, it is just a little bit dodgy, and if I need surgery I’m going to
plump for an older surgeon. There is also the issue of success rate. A
bold and skilful surgeon will take on some of the more challenging
cases, and so may have a lower success rate than a beginner, so the
hapless patient should not expect to find useful data from which to
judge the likely outcome of the operation.
The author
recalls operations and family circumstances in great detail. Did he keep
a diary like politicians do? Probably he just has a great memory, as
most physicians do. Without it, they would fail all those MD and Royal
College examinations. It is noteworthy that the surgeon must deal with
the family as well as the patient: being a surgeon is not the same as
being a technician, one has to talk to, and deal with, troubled people
in their most vulnerable moments. Many of these situations are portrayed
with a good deal of compassion. Sometimes it all goes wrong and the
surgeon (or rather the hospital) must face a legal challenge. It’s clear
that things do indeed go wrong. The author describes the shocked
response of a lecture he gave on that very subject, called When Things
Go Wrong.
His career
has been unconventional. For example, he tells us of his time in the
Ukraine. He visited the country often, helping the poorly funded
Ukrainian colleagues to improve their neurosurgery. Conditions in the
hospital were grim, and it was necessary to take second-hand equipment
from the UK to supplement what little was available locally. He seems to
have been able to move around rather freely in the Ukraine (in the
1990s), carrying out difficult operations under the most testing
conditions.
He has much
to say about the condition of British hospitals. A particular
hobby-horse is the design of hospital buildings – he considers them
often not fit-for-purpose. Perhaps the buildings are improving, but not
so the rest of the working environment. He repeatedly makes the point
that the administration has become so heavy handed that his job is made
harder than it was in the early part of his career. Nowadays, he
sometimes has trouble finding his patient, as the sick are forever being
moved from one ward to another to release beds. Moreover, the number
of operations that can be fitted into a day has decreased because of
regulations on working hours, and unnecessary rules that force long
breaks between operations whilst the theatre is cleaned and prepared.
One of the most hilarious sections of the book is when he describes his
attendance at a compulsory course given for all hospital staff on the
subject of Customer Care. It’s not Patient Care anymore. He secretly
looks forward to a good sleep at the back of the room, but things do not
turn out as expected. He concludes ‘how strange it is that I should be
listening to a young man with a background in catering telling me that I
should develop empathy..’.
Yes,
surgeons are usually arrogant – they need to be self-assured – and
aren’t they often charismatic? It goes with the territory. But this one
is capable of laughing at his own misfortune when he himself becomes a
patient and falls down the stairs, breaking a leg. Yes, it’s good to be
able to chuckle at the mighty downfallen.
We were
unanimous: we all loved the book. It was easy to read and fascinating.
The drama of the work was totally absorbing, at least up to the last few
chapters which might have been omitted – they seemed like more of the
same. We were full of admiration for our surgeon. It should be
recommended reading for all young doctors. I hope he trained sufficient
young doctors to carry on the good work.
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