Ars Medendi reads: Do No Harm

The Book

Do No Harm – Stories of Life, Death and Brain Surgery

Henry Marsh

Weidenfeld & Nicolson, 2014

What it’s about: A Summary

I don’t want to spoil the book by giving too much away in this summary. I would simply say that, if you are looking into a career in the medical profession, this book is an excellent resource.

Simply, Do No Harm is the memoirs of a senior neurosurgeon, from the beginning to near the end of his career. It encompasses the good, the bad and the ugly of his field and medicine as a whole.

I would not say that Henry Marsh is a good role model for budding doctors. I would instead say that he acts as a reminder to all that doctors are as human as the rest of us.

On the Author:

Henry Marsh is one of the UK’s foremost neurosurgeons. It should be noted that, although I felt that only a cursory amount of attention is paid to his work in Ukraine in the book, the film The English Surgeon details this in far more detail. If you find this book to your tastes, it is worth giving the film a watch.

 

The Review:

“It is not surprising that we invest doctors with superhuman qualities as a way of overcoming our fears. If the operation succeeds the surgeon is a hero, but if it fails he is a villain.”

Henry Marsh is only human. In his memoirs he publishes truly honest, sometimes disturbingly honest, stories of his daily life and work. In it, he challenges the basis of the age-old Hippocratic oath “Do No Harm”, by reminding us that, in their humanity, doctors and even surgeons make mistakes more often than we care to admit. Even truly excellent ones! In fact, all fields of medicine and all treatments come with risks that cannot always be accounted for. Walking along the corridors of a nursing home, he recognises “at least five” of the residents as his own failures. And these failures are what populate the book from page 1. “The idea that neurosurgery is some kind of calm and rational appliance of science… is utter crap.”

In fact, Marsh provides a window into his world in a very honest sense. Neurosurgeons must, on a daily basis, make life-changing, or life-saving, decisions that could lead to immense success or utter failure. It is with this dilemma that Marsh presents us.

In the course of the book, we also can see the sacrifices made in the pursuit of becoming an excellent neurosurgeon. The career served to shape Marsh’s character, such that he feels a certain entitlement as a result of his importance at work. One particularly memorable example of this is the moment in the book where, after performing a protracted operation, he expresses frustration at the menial world outside the hospital by imagining asking the person in front of him in a supermarket queue “What did you do today?” It is this frank self-awareness of how pompous he sounds that makes Marsh somehow so relatable.

Marsh, conversely, approaches the subject of being treated as a patient by his colleagues, and seeing his close family treated as well. It is through this intense vulnerability that he understands the plight of his patients. Through the connection Marsh makes to his patients, we can see the powerful exhilaration in performing a successful procedure to save a life. It is the wonder that Marsh feels that we also feel, even starting as a trainee first working on the brain, “a mystery… as great as the stars at night and the universe around us.”

And yet, the book still feels like a cautionary tale of the old ways of medicine: strict hierarchies where the senior doctor’s word was law. The world Marsh trained in, whose values are so ingrained in his practice, is gradually fading away, turning him into an “impotent and angry victim of government targets”. And it is being replaced with fresh bureaucracy, new management structures, corporate training programmes and regulation of junior doctors’ working hours. We can all certainly relate to the bizarre frustration he feels at current juniors being free of the excessively-long hours he endured as a trainee, but he also describes with understandable anguish administrative staff brought in purely to police government policies and agency staff that do not know the whereabouts of their patients.

It is with these thoughts that the book ends. It is an appropriate finish to a book that encompasses the daily thoughts, successes and failures of a human being who is also a surgeon. And really that, in itself is poignant in this new era of personalised medicine: in the same way that doctors must view patients as human beings, we must acknowledge that doctors, too, are people with their own hopes, desires and full lives.

 

A note from the author: As my posts sometimes touch on emotive subjects, comments are disabled after 14 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.

Ars Medendi reads: The Man Who Mistook His Wife for a Hat

The Book

The Man Who Mistook His Wife for a Hat

Oliver Sacks

Picador, 1986

What it’s about: A Summary

Welcome to the world of a neurologist. Oliver Sacks compiles many case studies he has published in medical case journals. These serve both as incredibly insightful looks at particular neurological disorders.

This is the only one of Sacks’ books I have read, but it is the most iconic. And it is worth a read for anyone interested in the subject area. In fact, I would recommend it as a window into the personal nature medicine takes on especially in matters of the brain, our most misunderstood organ.

The Review:

“Constantly my patients drive me to question, and constantly my questions drive me to patients – thus in the stories or studies which follow there is a continual movement from one to the other.”

Throughout the book, Sacks refers to Luria’s neurological case work, and he uses his extensive knowledge to craft the cases, peppering them with appropriate quotations and scientific context. And yet throughout, the patients are depicted as profoundly human and deeply sympathetic. It is these patients that lie at the centre of the book, and at the centre of Sacks’ life.

Oliver Sacks’ book is varied by the different tales in it. Therefore it stands to reason that a review should look into each section separately.

Losses

This section of the book encompasses the deficits, or the “A”s – Aphasia, Ataxia, Agnosia etc. It is this section which includes the iconic “The Man Who Mistook His Wife for a Hat” – the true story of a man unable to visually process shapes and assign them with identify. It is for this reason that, during his interview with Sacks, he “took hold of his wife’s head and tried to put it on”. This section of the book explores the impact of memory disorders. Another story “The Lost Mariner” describes a man trapped in his past, unable to form new memories or understand his present.

Excesses

This section is perhaps the opposite to Losses, comprising of manias and hyper-activities of the brain such as Tourette’s. Striking is the story of one man plagued with the latter (“Witty, Ticcy Ray”), wherein the patient decides that he will only undergo treatment by Haldol for his condition on certain days of the week. It is in this way that we can understand how intrinsic the workings of the brain are to a person’s personality and creative ability; such that, perhaps, we cannot treat the former without affecting the latter to a degree.

Transports

This section is exactly as it sounds. Stories of patients transported elsewhere by their brains. “A Passage to India” is a story of an Indian girl with a malignant tumour that expanded to compress areas of her brain. It is at once a melancholic and beautiful tale. In a way, her visions of India were her salvation from an impossible prognosis, as understood fully only by her: “I like these dreams – they take me back home.”

The World of the Simple

It is this section that explores the world of the “autistic savant”: those dismissed due to their placement on the autistic spectrum, but who have intense creative or mathematical talents. “A Walking Grove” is the story of a man with severe developmental deficiencies able to ”retain an opera or an oratorio on a single hearing”. Is it through these abilities that he develops with relationship with his musical father, despite being unable to express himself through other means.

Bottom line: if any of these cases sounds interesting to you, I highly recommend picking up this book. It is truly extraordinary.

 

A note from the author: As my posts sometimes touch on emotive subjects, comments are disabled after 14 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.

Ars Medendi reads: The Noonday Demon

The Book

The Noonday Demon – An Atlas of Depression

Andrew Solomon

Scribner, 2003

What it’s about: A Summary

First of all, I have to say: the book is LONG. Very long. It took me maybe two months to read, but then I don’t have much time to read in the evenings after work. Despite it’s length, I highly recommend it.

As suggested in the title the book is an entire atlas of the disorder: providing insight into all relevant areas of context from a personal to a society-wide level. What the title doesn’t tell is how beautifully written it is.: “In depression, the meaninglessness of life itself, becomes self-evident. The only feeling left in this loveless state is insignificant”.

I would recommend a read for anyone suffering from depression, or interested in the disorder.

On the author

Andrew Solomon is a journalist, and this is evident from the sheer volume of research and detail going into the book. In the book, he often brings in his own experience into the writing, laying bear his vulnerabilities and the devastation depression has wrought to his life.

The Review:

“My depression has grown on me as that vine had conquered the oak; it had been a sucking thing that has wrapped around me, ugly and more alive than I. It had had a life of its own that bit by bit asphyxiated all of my life out of me.”

The strength and power of The Noonday Demon lies with the dozens of stories that feed into it. Each is the story of an individual, but they together give valuable insight into the understanding of one of the world’s most prevalent diseases.

Although the author admits he is not a scientific expert of any kind, his dedication to studying depression is shown through his detailed exploration of the disorder from its historical, cultural and political roots, to its chemical pathways and various treatments. And, as I mentioned before, the writing is at once compelling and stunning. The story of the author is interwoven with an exploration of all the aspects of our modern day (and historical context) that cause so many to suffer from depression.

In Breakdowns, the author explains the debilitating acute condition, and it is a powerful read. The author then goes on to describe talking therapies (those which come out of traditional psychoanalysis and are subscribed to by psychiatrists) and the physical interventions (from psychopharmacological therapies to harsher therapies such as electroshock therapy).

Both types rely on restoring a “normal” balance to the patient, both in encouraging positive thought and constructive action, and in restoring chemical balance. And both are personalised to the idiosyncratic patient’s needs, and must work together. In particular, antidepressants are chosen primarily based on their side-effects, something which is at once paradoxical and essential as many are incredibly unpleasant even now: “you take antidepressants like you take radiation for cancer.” Solomon also does not avoid discussing alternative medicines. This is particularly important due to the tendency to hail Prozac or nothing, despite the availability of alternative therapies of all types.

The next sections describe the various aspects of a person’s life experience that can lead to the depressive condition. It is in these sections that the stories of depressives truly shine and make the reader understand the importance of different cultural prejudices, addictions and poverty. He does not overdramatize or sweep these issues under the Prozac blanket as is so often tempting in the media. And yet he depicts the cycle of depression experienced by all too many people in our society.

Overall this is an honest, stark text depicting the often under-represented truths about depression as well as those we have heard often. Aptly, the final chapter is simply title Hope.

“Some people suffer mild depression and are totally disabled by it’ others suffer severe depression and make something of their lives anyway.” It is hope that makes the difference.

 

A note from the author: As my posts sometimes touch on emotive subjects, comments are disabled after 14 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.

Ars Medendi reads: The Man Who Couldn’t Stop

I have absolutely no illusions about this blog, and I am fully aware that the majority of the time I’m talking to myself. So I thought it would be worthwhile starting a new feature where I review books I have read. If you are reading this and have yourself read the book I am reviewing, I’d love to hear your thoughts!

 

The Book

The Man Who Couldn’t Stop

David Adam

Picador, 2014

 

What it’s about: A Summary

Broadly speaking, the book is the personal story of our author’s struggle with Obsessive Compulsive Disorder (OCD), interspersed with vital information on the historical, political and medical context of the disease. I adored this book.

It gives a slice of life into the struggles of an OCD sufferer, whilst educating you in an fascinating way that shows you it is more than just a “behavioural quirk”. The straightforward way in which the author reveals his deepest, darkest obsessions is both compelling and incredibly insightful for someone who has never truly understood the disorder before.

It is separated into different sections, each providing a different context for the development of the modern disease model and treatment. The writing style is also of note for its scientific and yet personal nature.

 

On the author

David Adam is a writer and editor of the journal Nature. That he was a correspondent for The Guardian whilst in the thralls of his disorder speaks volumes for his bravery.

 

The Review:

“An Ethiopian schoolgirl names Bira once ate a wall of her house… By the time she was 17 years old she had eaten eight square metres of the wall – more than half a tonne of mud bricks.”

It is hard to explain a mental disorder to one who has not studied medicine, and yet, from this book, I feel as though I have seen through the eyes of a person with OCD. At times hard to read and at others impossible to put down, I found that the take home message was simply that of enlightenment. Enlightening readers that no one is “a little bit OCD”; but that OCD is a serious condition that is frustratingly, and painfully, hard to treat (consider the famous “white bear” experiment referenced throughout this book).

In terms of historical context, the existence of OCD in the religious community, the animal world, and the difficulty of its treatment even up to the current day are explored. The grisly chapter on lobotomies is particularly striking, with almost unbelievable tales of “brains irreversibly damaged by cavalier surgeons armed with nothing more precise than knitting needles”.

These contextual sections at times descend into an Oliver Sacks-like description of patient cases, which is incredibly compelling (amongst the more well-known being Phineas Gage and the Collyer brothers). Also of note is the amusing use of paradoxical Freudian psychoanalyses, encouraging OCD sufferers to obsess more deeply into their intrusive thought, as a more “successful” early treatment.

The book also chronicles evolutions of diagnosis, and how it is essential that we consider such psychiatric disorders on a sliding scale rather than as black-or-white diagnoses. Also key to consider is the importance of personalised medicine, and further research into the use of behavioural therapies as well as drugs to treat patients where it is not possible to pinpoint something “physically” wrong.

I recommend this book to anyone curious about OCD or any psychiatric disorder.

 

A note from the author: As my posts sometimes touch on emotive subjects, comments are disabled after 14 days. This is because, at this stage, I feel that ongoing discussions tend to stagnate.