Medicine in memoir and fiction

I’ve been staying up late to read Do No Harm – a compilation of clinical case histories,  interspersed with personal memoir, by British neurosurgeon Henry Marsh. It gives a riveting, though sometimes gruelling, account of the challenges involved in operating – or deciding not to operate – on patients with life-threatening conditions such as brain tumours, brain injuries, and strokes.

Henry Marsh writes with honesty, thoughtfulness and compassion and his book would seem equally accessible to healthcare professionals and general readers, though it is not for the squeamish. I would strongly recommend it to anyone considering a career in neurosurgery, for it can be difficult to find authentic accounts of what working in this or any other medical specialty is really like. Although my own ambition to become a doctor was partly inspired by the library books I read as an impressionable teenager – The Healing Knife by George Sava was one, and another was about a leper colony in Africa – they were already out of date, and I suspect conveyed a romanticised picture. When I got to medical school and was confronted with the reality it became clear that I had little interest or ability in either surgery or tropical diseases, and chose quite a different career path.

Why don’t more doctors write books along the lines of Do No Harm? One reason must be the risk of breaching confidentiality and causing distress to patients themselves or to their relatives. The books by the late neurologist Oliver Sacks – for example The Man who Mistook his Wife for a Hat – are among the best-known examples of the genre, and won wide acclaim from many sources, but have been criticised in some quarters for exploiting vulnerable people.

Another consideration is that any realistic and balanced account is bound to expose the limitations of medicine, and the vulnerability of its practitioners. Perhaps this is not so important now that doctors and hospitals are no longer regarded with unquestioning trust and respect. Henry Marsh makes no attempt to gloss over the fact that some of his cases had a bad outcome, whether because the prognosis was hopeless to begin with or because he or his colleagues made mistakes. He clearly feels these failures keenly, agonising over them even if they were not his fault, giving parts of the text a confessional quality. He is also remarkably outspoken about his frustration with hospital management and the ways that modern NHS bureaucracy can hamper patient care. His frankness about these negative aspects is refreshing, although if I had the misfortune to be needing neurosurgery I think I might regret having read this book and realising how much can go wrong.

I have no intention of writing a factual account of my own medical career, partly for the reasons given above, partly because I don’t remember the details well enough. But writing is therapeutic and when channeling my work experiences into fiction I often find myself emphasising the darker side of my former profession. Readers may find my books unduly cynical unless they appreciate the role of black humour in defusing the stresses of working in medicine.