I have just been reading Do No Harm, the memoirs of Henry Marsh, a neurosurgeon. It would make a good Christmas present for someone connected to the medical world as it is an honest, humble (for a profession that, as its author suggests, attracts its fair share of egoists) and occasionally dramatic account of what it is like to do the supremely delicate surgery associated with opening up the skull and tampering with the complexities of the human brain.
I don’t know why we think of doctors as writers but I can think of three instantly: the great Chekhov, obviously, but also two decent “second division” authors, AJ Cronin and W Somerset Maugham. Perhaps we romanticise the profession as it deals so patently with human beings at their most vulnerable. Henry Marsh, a professor of neurosurgery at a leading London hospital and now nearing the end of his career, is not about to transfer his skills to novel-writing, but he comes across as a reflective and sensitive man, intensely involved in his work and clearly needing to think and write about the ethical aspects of what he does, as well as its purely surgical excitement.
He is not a religious man, so would not use the word “vocation” of his profession – though he does (to split hairs) describe it as a “calling.” He knew it was what he wanted to do when, as a young, newly-qualified doctor, he watched spellbound as a surgeon operated on an aneurysm. His book, all of whose chapter headings describe particular brain diseases and traumas, makes it clear that surgeons make mistakes. He himself is frank about his own failures amid the successes, the “headstone in that cemetery which all surgeons carry within themselves”. He also suggests that just because advances on medicine now make it possible to do many more operations than in the past, this does not mean that we should do them. Sometimes is it better to explain to patients that they are going to die and that intervention will only buy them a few more painful months, if that.
Knowing a fraction more about the brain than before I started to read this book, it does not give me confidence in brain surgery; so much can go wrong, despite the success rates and very low rates of failure for some more routine operations; so much of it requires luck as well as skill. A little learning is clearly a dangerous thing. Nonetheless, we all put ourselves into the hands of men like Henry Marsh when the occasion demands it. And it is good to know that surgeons are not just brilliant craftsmen; they loathe having to give bad news to patients or relatives and when something goes fatally wrong in the operating theatre through no fault of the surgical team, there is a united sense of sorrow and silence.
The book brought home to me that, among the desperately ill who need surgery to survive, the essential difference lies between those who have religious faith and those who don’t; Christians do not simply trust in surgical skill; they also put themselves in the hands of God.
There is one especially moving chapter in the book when Marsh describes his own mother’s dying and death from cancer. It was advanced and incurable and she chose not to have radio or chemotherapy. This hastened her death but also spared her and her family a protracted period of dying with all the side effects of these interventions. His mother believed in life after death; he doesn’t. He reflects, “As I sat by her bedside I had often thought of that – of how the millions upon millions of nerve cells and their near-infinite that formed her brain, her very self, were struggling and fading.” There is a time when “she” is still there, “and now all those brain cells are dead – and my mother – who in a sense was the complex electrochemical interaction of all those millions of neurons – is no more.”
Marsh comments, “In neuroscience it is called ‘the binding problem’ – the extraordinary fact, which nobody can even begin to explain, that mere brute matter can give rise to consciousness and sensation. I had such a strong sensation, as she lay dying, that some ‘deeper’ real person was still there behind the death mask.”
Marsh often alludes to this conundrum, probably because, of all the organs in the body, the brain is most critical for functioning; even hearts can now be replaced; brains can’t. He comments in another place, “The idea that [I] am moving through thought itself, through emotion and reason, that memories, dreams and reflections should consist of jelly, is simply too strange to understand.” Recalling another operation he asks, “Are the thoughts that I am thinking as I look at this solid lump of fatty protein covered in blood vessels really made out of the same stuff?…The thought itself is too crazy, too incomprehensible.”
As Christians we believe that “mind” is not the same as “matter”; that the “deeper real person”, to use Marsh’s own words, does not die with the death of the body; that our souls have been created directly by God and that they will, at Christ’s Second Coming, be finally reunited with our glorified bodies. Marsh, whose professional life has been concerned directly with the “material”, the body lying on the operating table, does have an intuitive sense the mystery of personhood: that “immaterial” reality which, although it is expressed through brain cells during our lives, is also a spiritual reality beyond all neurosurgical knowledge.
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