Do No Harm: Stories of Life, Death and Brain Surgery

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

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Authors: Henry Marsh
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started, I was called in the early hours to see a middle-aged man on the ward who had become breathless, a common enough problem on a busy emergency medical ward. I got out of bed and pulled on my white coat (I slept with my clothes on since one rarely got more than an hour or two of sleep without being called to Casualty or the wards). I walked onto the long and darkened Nightingale ward with its twenty beds on either side facing each other. Restless, snoring, shifting shapes lay in them. Two nurses sat at a desk in the middle of the room, a little pool of light in the darkness, doing paperwork. They pointed to the patient they wanted me to see.
    ‘He came in yesterday with a query MI ,’ one them said, ‘MI’ being short for a myocardial infarct, or heart attack.
    The man was sitting upright in his bed. He looked terrified. His pulse was fast and he was breathing quickly. I put my stethoscope to his chest and listened to his heart and breath sounds. I ran an ECG – an electro-cardiogram which shows the heart’s rhythm. It seemed normal enough to me so I reassured him and told him that there was nothing seriously wrong with his heart
    ‘There’s something the matter Doc,’ he said, ‘I know there is.’
    ‘Everything’s all right, you’re just anxious,’ I said a little impatiently, keen to get back to bed. He looked despairingly at me as I turned away. I can still hear his laboured breathing now, the sound following me like an accusation, as I walked away between the rows of beds with their huddled, restless shapes. I can still hear the way in which, as I reached the doors to the ward, his breathing abruptly stopped, and the ward was suddenly silent. I raced back to the bed, panic-struck, to find him slumped in his bed.
    ‘Put out a crash call!’ I shouted to the nurses as I started to pound his chest. After a few minutes my colleagues tumbled bleary-eyed onto the ward and we spent half an hour failing to get his heart going again. My registrar looked at the earlier ECG trace.
    ‘Looks like there were runs of V-Tach,’ he said disapprovingly. ‘Didn’t you notice that? You should have rung me.’ I said nothing in reply.
    It used to be called angor animi – the anguish of the soul – the feeling that some people have, when they are having a heart attack, that they are about to die. Even now, more than thirty years later, I can see very clearly the dying man’s despairing expression as he looked at me as I turned away.
     
    There was a slightly grim, exhilarating intensity to the work and I quickly lost the simple altruism I had had as a medical student. It had been easy then to feel sympathy for patients because I was not responsible for what happened to them. But with responsibility comes fear of failure, and patients become a source of anxiety and stress as well as occasional pride in success. I dealt with death on a daily basis, often in the form of attempted resuscitation and sometimes with patients bleeding to death from internal haemorrhage. The reality of cardio-pulmonary resuscitation is very different from what is shown on TV . Most attempts are miserable, violent affairs, and can involve breaking the ribs of elderly patients who would be better left to die in peace.
    So I became hardened in the way that doctors have to become hardened and came to see patients as an entirely separate race from all-important, invulnerable young doctors like myself. Now that I am reaching the end of my career this detachment has started to fade. I am less frightened by failure – I have come to accept it and feel less threatened by it and hopefully have learned from the mistakes I made in the past. I can dare to be a little less detached. Besides, with advancing age I can no longer deny that I am made of the same flesh and blood as my patients and that I am equally vulnerable. So I now feel a deeper pity for them than in the past – I know that I too, sooner or later, will be stuck like them in a bed in a

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