Category Archives: Costa prize

Do No Harm by Henry Marsh

Do No HarmPeople who tend to be squeamish or prefer not to know about the internal workings of the human body, wouldn’t enjoy reading Do No Harm by Henry Marsh. It’s also probably best to avoid this book if you have a friend or relative who has been diagnosed with a neurological condition or is about to have surgery.

Marsh is a neurological surgeon with more than 30 years experience. In Do No Harm he offers insight into the joy and despair of a career dedicated to one of the most complex systems in the body. This is a candid account of how it feels to drill into someone’s skull, navigate through a myriad of nerves that control memory, reason, speech and imagination and suck out abnormal growths. If successful he can save someone’s life or extend their projected life span. But often he is millimetres away from catastrophe. One false move and the result could be death or paralysis.

Marsh frankly admits that in his career he has made mistakes. A few years ago, he prepared a lecture called “All My Worst Mistakes.” For months, he lay awake in the mornings, remembering the patients he had failed. “The more I thought about the past,” he recalls , “the more mistakes rose to the surface, like poisonous methane stirred up from a stagnant pond.”

On a visit to a nursing home for people with extensive brain damage he sees the result of some of those mistakes in the motionless forms of patients in their beds “To my dismay I recognised at least five of the names.” One of them is a schoolteacher in his fifties whose life he ‘wrecked’ (Marsh’s word) during a fifteen hour operation to remove a large tumour. In the final stages he tore part of the artery that keeps the brainstem, and thus the rest of the brain alive. The patient remained in a coma for the rest of his life. The experience haunted Marsh for years.

Yet without mistakes, he says, there would be no progress. And without the willingness of doctors to take risks, many of the greatest advances in his field would never have happened.

It’s one of the painful truths about neurosurgery that you only get good at doing the really difficult cases if you get lots of practice but act means making lots of mistakes at first and leaving a trail of injured patients behind you. I suspect that you’ve got to be a bit of a psychopath to carry on…

Henry MarshDoes that mean surgery is always the best course? This is a question discussed regularly in the daily case conferences Marsh holds with the junior doctors and radiographers who form his hospital team. Is it kinder to let someone die gradually than to undertake invasive surgery from which they may never recover or if they do, face life changing side effects? The team reach a clinical, unemotional conclusion but its down to Marsh to face the patient and explain the decision. It’s an encounter that requires a delicate balance of compassion and detachment.

Marsh suffers anxiety before such meetings, trying to resist the temptation to be overly optimistic about the likely outcome of any procedure. Often before surgery he is oppressed by “almost a feeling of doom’ and panic which only dissipates at the last moment when he sits in his operating chair and takes up his scalpel.

… full of surgical self-confidence, I press it precisely through the patients scalp. As the blood rises from the wound the thrill of the chase takes over and I feel in control of what is happening.

Marsh never set out to become a neurosurgeon. After completing his medical degree he caught a glimpse through a porthole of a patient “anaesthetized, her head completely shaven, sitting bolt upright on a special operating table.” The surgeon stood behind her, with a light fixed to his head, patting her bare scalp with dark brown iodine antiseptic. The image stayed in his mind, and struck him as “a scene from a horror film.”

But his second visit to a neurological theatre fascinated him. Unlike all the other operations he had witnessed which involved the handling of ‘warm and slippery body parts’, this was done with an operating microscope through a small opening in the side of the head using only a few microscopic instruments.

The brain continues to fascinate Marsh. He is awed by what he sees through his surgical microscope, which “leans out over the patient’s head like an inquisitive, thoughtful crane ” as the infra-red cameras in his GPS system shows he position of his instruments. The internal cerebral veins are like “the great arches of a cathedral roof” and beyond the Great Vein of Galen can be seen “dark blue and glittering in the light of the microscope.”

In Do No Harm he does a grand job of sharing that wonder with his readers and also the drama of the operating theatre. You don’t need extensive biological or medical knowledge to appreciate the level of difficulty involved in these procedures though a schematic showing what bits of the brain lie where would have been a useful addition to the book.

Every chapter is headed with the name of a type of tumour (who knew there were so many?) in which Marsh talks about some of the cases that involved those conditions. In between he shares his many battles with the bureaucracies and inefficiencies he encounters in the British National Health Service (NHS).

Surgeons kept waiting because of a decree that doctors can’t begin a new operation while another is in the final stages in an adjoining theatre. Or theatre staff forced to kick their heels because their next patient wasn’t allowed to change into their hospital gown while there were members of another gender in the same waiting room. The working hours of junior doctors changed without any consultation with the surgical leads. Computer systems that won’t co-operate when a bed is needed quickly. The causes of Marsh’s frustration range far and wide.

In one episode, which would be farcical in any other sector, he describes having to leave his clinic to repeatedly go up two flights of stairs to get a password so he can discuss an X-Ray result with his patient. “Try Mr Johnston’s,” he’s told. “That usually works. He hates computers. The password is ‘Fuck Off 45’.” It marks the forty-five months since the introduction of a highly-expensive computer system.

Back in his office, Marsh tries every possible combination of upper and lower case letters, adding spaces, taking them out, all without success. He runs up the two flights again. One staff member realises there’s been a miscalculation. The system has been in place two months longer than they recalled. So it turns out the password is now “Fuck Off 47.” All of this while the poor patient waits to hear if Marsh can save his life by operating to remove the cause of his elliptic fits.

His railings stem from a deep concern for his patients and a desire to want to do right by them (he even washes and dries the hair of his female patients before they leave the theatre). He tries not to let his feelings show but his mask slips regularly. Leaving the hospital one evening having told one man that an operation was not possible, he rails against the traffic as if it were the drivers’ fault

“ … that this good and noble man should die and leave his wife a widow and his young children fatherless. I shouted and cried and stupidly hit the steering wheel with my fists. And I felt shame, not at my failure to save his life — his treatment had been as good as it could be — but at my loss of professional detachment and what felt like the vulgarity of my distress compared to his composure and his family’s suffering, to which I could only bear impotent witness.

This is a book that I never expected to enjoy but it proved far more readable than I expected. I’m glad however that I didn’t read it before my friend had her own surgery to remove a brain tumour (from which she thankfully recovered). I appreciated there were risks involved, but never realised just how narrow the margin of error would be. Sometimes ignorance is a blessing.

Footnotes

About the Book: Do No Harm by Henry Marsh was published by Weidenfeld and Nicholson in 2014.  It was shortlisted for the Costa Biography Award, the Wellcome Book Prize and the Guardian First Book Prize. Marsh wrote a follow up in 2017. Admissions  was written as he prepared for his retirement.

About the Author: Henry Marsh worked as consultant neurosurgeon in London for about thirty years. In addition he travelled regularly to the Ukraine, donating his time to treat patients in extremely difficult situations and in the face of political opposition. H retired from full time work in the NHS in 2015 but continued to work in private practice until 2017.

Why I read this book: This was a book club choice. I probably wouldn’t have read the book otherwise. But I am so glad I did.

Snapshot November 2016

Another chapter in my reading year in which I try to capture a picture of what I’m reading, thinking about reading, buying on Nov 1, 2016.

Reading

Most of my reading at the moment is for the course on children’s literature that I foolishly decided to embark upon. It’s a level 3 (equivalent to third year university) delivered via the Open University. It’s my final module on a BA Honours Lit course I started about 12 years ago I think, persuaded by a friend who heard I had an idea for a non fiction book and recommended I sharpened up the academic research skills first. I tossed about the idea of history but got swayed by my other love of literature. It was meant for me to be ‘fun’ – I already have a lit degree so why would I need another one???  But now the end is in sight.

I finished Treasure Island by R. L Stevenson last week and now am ploughing through Little Women by L.M.Alcott and absolutely hating it. I know it’s considered a classic but it’s so full of saccharine I feel an urgent need to visit the dentist every time I read a chapter. And it’s so long! Little Women (which in America is marketed as part 1 with part 2 called Good Wives) comes in at 470 of densely typed pages. Give me strength while I grit my teeth.

wakinglionsBy way of an antidote I am also crawling my way through Waking Lions by the Israeli author Ayelet Gundar-Goshen. It’s not the fault of the book – just my lack of time.  It’s quite an intriguing story which looks at how the decisions we make on the spur of the moment can have long term repercussions. In this case, the decision is made by a surgeon who accidentally runs over a man on the road. Should he leave the injured man who is clearly on the path to death or should he summon help. He chooses the former. But then the victim’s widow turns up at the door intent on a very unusual form of blackmail.

Buying

lietreeRather a lot of new purchases recently. One by Sarah Crossan, a verse novel about conjoined twins which won the CILIP Carnegie Medal – an annual award for children’s fiction. Also purchased is another contender for the medal, The Lie Tree by Frances Hardinge which won the Costa Book of the Year 2015. It’s described as “deliciously creepy novel”. Both of these were bought all in the interests of research you understand for my children’s literature course (what do you mean you don’t believe me!). I succumbed to an offer at the bookshop and bought The Vegetarian by Han Kang, The Hungry Tide by Amitav Ghosh and The Glorious Heresies by Lisa Mcinnerney which won the  Baileys’ Women’s Prize for Fiction 2016.

Watching

The BBC did a short series with Andrew Marr looking at three different genres of books: detective fiction; fantasy epics and spy stories. I’m part way through the one on detective fiction where he argues that these follow a set of “rules”. See more about this series at the Open University web page

Listening

After my recent disappointment (described here) with my first experience of Marjorie Allingham’s detective fiction, Karen at kaggsysrambling recommended another of her titles – The Tiger in the Smoke. I’ve managed to get an audio version of this. Early days yet but the characterisation at least feels more authentic than in the other title I tried. I’m also enjoying the flavour it gives of post war Britain. Apparently J. K. Rowling has described this as her favorite crime novel

Brooklyn by Colm Toibin

BrooklynLast  year I made a comment in one blog post about how much I enjoyed Colm Toibin’s Norah Webster. More than a few people people responded by recommending his earlier novel Brooklyn. Some went as far as saying Brookyn was “even better”. I’ve now read it and while I enjoyed it, I wouldn’t rate it as highly.

Both Norah Webster and Brooklyn give center stage to a strong female character who have to confront life changing situations and find their own way through them. The recently widowed Norah Webster and the young woman Eilis Lacey,  heroine of Brooklyn are two brave and spirited Irish women whose predicaments are portrayed with warmth, sympathy and depth.

We first encounter Eilis looking out from her bedroom window in the village of Enniscorthy watching her glamorous older sister Rose make  her way down the street to an evening at the golf club. Eilis is clearly more an observer of life than a participant. Though  she is  intelligent and reasonably good looking there few prospects of a husband or a job in accountancy or book keeping that would enable her to fulfill her potential. The most she can get is a lowly job as a shop keepers assistant in the grocery. Rose spots a solution when a  priest vists from America and agrees to help find a job in Brooklyn for Ellis.

Within a few weeks, Rose, having survived a rough Atlantic crossing, is ensconced  in a boarding house for Irish girls in Brooklyn and selling nylons in an upmarket department store. Tóibín details her first reactions to her new home, the strangeness of the busy pedestrian traffic after the quietness of Irish village streets, the novelty of heated bedrooms and the availability of affordable fashionable clothes. Over time her homesickness dissipates, she embarks on a study program in book keeps and falls in love with Tony, a good looking American Italian plumber with ambitions to get into the property market. Just  as life seems to be going her way,  tragic news from home sends her back to Ireland  and  the tension between the obligations of her old life and the excitement of the new.

Where the early parts of the book that dealt with Eilis’ sense of isolation and then the opening up of new possibilities felt touchingly convincing,  the final section lacked  that same feeling of authenticity. The emotional dilemma encountered by Eilis didn’t seem to be fully explored and we never got the examination of her inner thoughts that would have made her final decision more understandable and credible. As a result I put the book down thinking I’d been short changed, that there was so much more that Toibin could have done to explore Eilis’ emotional quandry. Brooklyn was sweet and lovely for the most part, but ultimately disappointed right at the end.

Pure by Andrew Miller – Review

Pure by Andrew Miller is set in Paris in 1785. Jean-Baptiste Baratte, a young, ambitious engineer, arrives at the palace of Versailles hoping to get a Ministerial commission that will help him make a mark on the world. He “dreams of building utopias where the church and its superstitions will be replaced by schools run by men like himself.” Instead, the task he is handed is not one of construction but of demolition.

In the  Rue de Saint Innocents stands the oldest cemetery in Paris. More than 50,000 victims of bubonic plague were reputedly buried here in one day. The  subterranean wall separating the living from the dead has collapsed and the bones and decaying flesh have released a miasma which fouls the air,  taints the food and even the breath of those who live within its shadow.

It takes a year for Barratte and his team of miners to open the graves and clear away the past. It’s a job which almost costs Baratte his life as the cemetery becomes a kind of hell of burning fires and walls of bones and skulls. Few of those involved in the enterprise emerge unscathed physically or mentally. When they began they imagined they were engaged in a noble cause, building the foundations of a better future in which their endeavours would be marked for posterity.

“They will name squares after us ……..the men who purified Paris,” declares the foreman of works. But as the graves are emptied and the cemetery’s wild flowers wither, so the vitality drains out of the workers. Tobacco, alcohol, weekly visits by prostitutes – nothing can distract the team of miners from the sense of loss. ‘I had some good in me once’ one observes bleakly.

Baratte too undergoes a transformation. The naïve young man is easy prey when he first arrives in the city. It takes little to persuade him to exchange his sensible brown suit for one of pistachio green silk or to join a group of drunken vandals who move about the city under cover of night painting obscenities about Queen Marie Antoinette. But it is not long before he finds he cannot sleep without a sedative and his ideals and belief in the power of reason are destroyed.

The cleansing of the cemetery is an extended metaphor for the cleansing that we as readers know these citizens will experience shortly, although on a significantly bigger scale. Andrew Miller provides plenty of symbolic references to the French Revolution, including naming one of characters Dr Guillotin and including dialogue that can easily be read on two levels. Take this example, from Baratte’s first meeting with the Ministerial aide,  who gives him his commission:

It is poisoning the city. Left long enough, it may poison not just local shopkeepers but the king himself. The king and his ministers.

Yes, my lord.

It is to be removed.

Removed?

Destroyed. Church and cemetery. The place is to be made sweet again. Use fire, use brimstone. Use whatever you need to get rid of it.

Pure is Andrew Miller’s sixth novel and it won him the 2011 Costa Book of the Year award. The judges praised it as a “structurally and stylistically flawless historical novel.”  Miller deftly avoids some of the biggest failings I see in many historical novels – the author’s tendency to want to drown readers in period detail and factual information and then to make their characters speak in a kind of cod ‘period language’.

Not so for Miller. He’s clearly done his research but only uses it to bring the characters and location alive through snatches of information about clothes, food and daily domestic life . His descriptions of the stench that pervades the neighbourhood were so powerful I could almost smell it on the page I had in my hands.  (rather like my feeling on reading the Paris scenes early on in Patrick Sushkind’s Perfume).

In all, for me Pure was a gripping read.

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