Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh Page A

with in the lectures and textbooks. I enjoyed the feeling of power and importance the long hours gave me. In reality, I had little responsibility. The days and nights were spent clerking in patients, taking blood, filling up forms and chasing up missing X-rays. I usually got just enough sleep, and I became used to being disturbed at night. Occasionally I assisted in theatre, which meant long hours standing still, holding patients’ abdomens open with retractors while my seniors rummaged about. Looking back now, thirty years later, my sense of my own importance at that time seems quite laughable.
    Much as I liked being part of the small army of junior doctors in the hospital, as the months as a surgical houseman passed I became increasingly uncertain as to what I was going to do with my medical career. The reality of surgery had proved quite different from my superficial impressions of it when a theatre porter. Surgery seemed to involve unpleasant, smelly body parts, sphincters and bodily fluids that I found almost as unattractive as some of the surgeons dealing with them, although there were a few surgical teachers in the hospital without whose influence I would never have become a surgeon. It was their kindness to patients, as much as their technical skill, which I found inspiring. I saw no neurosurgery as a medical student or houseman. The neurosurgical operating theatre was out of bounds, and people spoke of it with awe, almost alarm.
    My next six months as a houseman were in a dilapidated old hospital in south London. The building had housed a workhouse in the nineteenth century and it was said it had not yet escaped its dismal previous reputation with the local population. It was the sort of hospital which made the British public’s devotion to the NHS quite incomprehensible, with the patients housed like cattle in the old workhouse rooms – large and ugly rooms with dozens of beds lined up on either side. The Casualty department was on the ground floor and the Intensive Care Unit on the first floor immediately above it, but there was only one lift in the hospital which was one quarter of a mile away down the main hospital corridor. If a patient had to be transferred urgently from Casualty to the ITU it was the task of the junior houseman on call, with the help of a porter, to push the patient’s bed all the way down the corridor from one end of the hospital to the other, take the lift, and then push the patient and bed all the way back again. I tried to do this as quickly as possible, pushing people in the corridor out of the way and commandeering the large and rattling old lift, creating a sense of drama and urgency. I doubt if it was clinically necessary but it was how it was done on TV and was good fun. Even though I got little sleep at night there was a doctors’ mess and bar run by a friendly Spanish lady who would cook me a meal at any time of night. There was even a lawn outside the main building where I would play croquet with my fellow junior doctors when we had the time.
    It was busy work with more responsibility than my first job as a house surgeon, and with much less supervision. I learnt a lot of practical medicine very quickly but they were not always enjoyable lessons. I was at the bottom of a little hierarchy in the ‘firm’. My job was to see all the patients – most of whom were admitted as emergencies through the Casualty department – when they arrived and to look after the ones already on the wards. I learnt very quickly that I did not ring up my seniors about a patient without having first seen the patient myself. I had done this on my first night on call, asking my registrar’s advice in advance of going to see a patient the nurses had called me about, and received a torrent of abuse in reply. So, anxious and inexperienced, I would see all the patients, try to decide what to do, and only dare to ring my seniors up if I was really very uncertain indeed.
    One night, shortly after I had