Resenhas - Do No Harm

fergarciafleury 18/05/2020

Henry Marsh é um exemplo de ser humano. Ser humano não no sentido de ter ideais humanistários, mas sim no sentido de errar, reconhecer pensamentos impróprios e seus erros, saber se redimir e pedir perdão. Marsh teve uma coragem em reconhecer sua arrogância, seu temperamento e principalmente o quanto suas ações mudaram a vida dos seus pacientes (muitas vezes para pior). É louvável sua iniciativa de mea culpa e deveria ser um comportamento mais disseminado entre os médicos.

Ara 23/02/2018

Livro incrível. Não nutro muita admiração pela classe médica, devo confessar, mas ler o relato desse homem a respeito dos seus medos, sucessos e principalmente fracassos foi realmente tocante. Relatos muito interessantes sobre o cemitério particular de Henry Marsh. "É preciso três meses para aprender a fazer uma cirurgia, três anos para saber quando é preciso fazê-la e 30 anos para saber quando não se deve fazer uma operação".

nenos 17/04/2024

"Life without hope is hopelessly difficult, but in the end, hope can so easily make fools of us all."
The more I read about the inner workings of the human brain and neuroscience, the clearer my understanding becomes of why I do the things I do. Memory, thoughts, behaviors, feelings, occasional wisdom—our capacity to modulate and self-regulate give us an illusion of being in control and of an integrated system, commonly referred to as a sense of self. It is strange to think that the source of our consciousness, ideas, suffering, love, hopes, ambition, hates, and fears comes from an electrochemical chatter of one hundred billion nerve cells in our brains, but I can come to grips with the idea of all this dying when the brain dies.
Thanks to neuroscience, we know more today about mental processes. We know these processes aren’t sentient, and there isn’t a head circuit or specialized circuit for conscience, only different sparse modules of brute matter provoking a generalized activation of the cerebral cortex. We know so little, yet we have become the paragon of animals. One of the pinnacles of human science might be neurosurgeons, who think and operate while being the same "solid lump of fatty protein covered in blood vessels" as us. This work is about Dr. Henry Marsh, a reflective, precise, realistic, experienced, and, in my humble opinion, a very wise neurosurgeon.
I don’t mean to misrefer, but I believe it was Einstein or E.F. Schumacher who said: “Any intelligent fool can make things bigger and more complex. It takes a touch of genius - and a lot of courage – to move in the opposite direction”. That’s one of my takes on this work. Dr. Henry Marsh, along with his wife, agent, editors, and several friends, turns such a complex subject, with intricate details of a complex machinery, into a reading for mere mortals filled with Mr. Marsh’s motives, fights, honesty, misadventures, paths, strategies, successes, regrets, choices made along his decades-long career.
Each chapter bears a different story, mainly focused on a specific brain disease. With over three decades in neurosurgery, Dr. Marsh doesn’t brag about his accomplishments at all. Instead, he encourages us to reflect upon the difference between impression and involvement with his objective writing, moral dilemmas, and applied professionalism. A typical neurosurgical career involves moments of utter despair and profound exhilaration, with anxiety as a normal part of the day’s work. It involves knowing the limitations of surgery, knowing when to operate or not, balancing between optimism and realism, seeing death in more dramatic and violent forms, and sometimes engaging in a folie à deux.
Brain diseases and surgery seem to inhabit another scale, multiple orders of magnitude higher, overwhelming both doctors and patients. It is very disconcerting to only read about the situations told in the book, an amalgam of vulnerability and amazement. Tumors, for example, have a peculiar nature. In Mr. Marsh’s own words: “Some are hard as rock, some as soft as jelly. Some are completely dry; some pour with blood - sometimes to such an extent that the patient can bleed to death during the operation. Some shell out like peas from a pod, others are hopelessly stuck to the brain and its blood vessels. You can never know for certain from a brain scan exactly how a tumor will behave until you start to remove it”.
Surgery itself has a very frightening nature, but it can be somewhat relieved by the precious virtue of honest communication, telling the truth without depriving hope, explaining the why's of procedures if needed. I can’t imagine the emotional burden of engaging in painful conversations with patients about the acute risks of surgery, like a catastrophic stroke by rupturing an aneurysm, various types of infections, the risk of a rapidly rising whirlpool of angry, swirling red blood by operating in between innumerable blood vessels, operating in a space only a few millimeters next to vital nerves and arteries, and many other rapid life-or-death decisions on the spot.
The narrative becomes almost like something visual. Very strong words with distinctive checkpoints of his past and present applied lessons and wisdom are the cherry on top. His message throughout the book becomes very clear: Endless practice is a double-edged sword. On one side, there’s prestige, heartfelt gratitude from families, personal happiness, and experiencing the greatness of human spirit (Camus). On the other side, unexpected tragedies, utter failures, a deep sense of shame from seeing the trail of injured patients behind, clinging to hope against fatal illnesses, and lastly, letting nature take its course.
There’s something very humane about health professionals, dealing with flesh and blood almost always without quality of life, bearing reality, dealing with people suffering horribly, and looking right into their eyes with the fear of death, dissociated by so much darkness, sometimes without showing a drop of awareness or responsiveness to the outside world.
“Dying is rarely easy, whatever we might wish to think. Our bodies will not let us off the hook of life without a struggle. You don’t just speak a few meaningful last words to your tearful family and then breathe your last. If you don’t die violently, choking or coughing, or in a coma, you must gradually be worn away, the flesh shriveling off your bones, the heart starts dying starved of oxygen, your skin and eyes turning deep yellow if your liver is failing, your voice weakening, until, near the end, you haven’t even the strength to open your eyes, and you lie motionless on your death bed, the only movement your gasping breath. Gradually you become unrecognizable – at least you lose all the details that made your face characteristically your own, and the contours of your face are worn away down to the anonymous outlines of your underlying skull.” -Henry Marsh

Alas, there's nothing to be done.

Link to my highlights: