67 year old and retired, neurosurgeon Henry Marsh is now committed to a second career: that of the writer. His book “Do No Harm: Stories of Life, Death, and Brain Surgery”, has been brought in Albanian by “Minerva” publishing house, while his last book has come out in the UK only three months ago.
What is the reason of this extraordinary success? Dr. Henry Marsh told Albanian Free Press that there’s a lot of interest by the public and doctors to learn the truth in relation to medicine on the doctor’s point of view. “It is not a scientific book, but a book on human stories. It’s a book that talks about patients, how they are treated and my feelings in relation to them”, the British doctor reveals.
Henry Marsh has constantly been a preoccupied with the issue of healthcare and the relations between the state and individual. He also issues another clear message: the state should pay for it on the ground of social equity
Interviewed for Albanian Free Press by Alket Aliu
Dr. Marsh, you have come to Tirana to present your new book. How was it received by readers?
As with any writer, I’m hopeful that people in Albania will find it interesting and will like reading it. The presentation this morning seemed to go well, there was a big audience and many people came up to me to sign the book afterwards. There have been over 30 translations of the book. For instance, I learned that recently, in Russia, the translation sold 70 thousand copies. So, I think there’s great interest in the public, in doctors to tell the truth about what medicine is like from the doctor’s perspective.
What’s the content of the book?
The book is a series of stories. I tell it in the style of a novel. It is not a book of science, but human stories. It is a book about patients and how patients are treated and my feelings about treating them. There are some stories of success when an operation is done very well. What is unusual and special about the book is that I talk a lot about failure, because in medicine, we often fail. It is not always successful. We all die eventually, we cannot live forever. Brain surgery is very dangerous. The operations are not always successful. In my book I talk more about the sad and unsuccessful side of the work, rather than the successful side. That is unusual. I think that my book is the first book written by a senior doctor, focusing on failure and not on success. But, in medicine and in all of life, triumphs or victories are considered as such, because they may have gone badly. If every operation was easy and always successful, there would be nothing special about it. It would be the same as drinking a cup of coffee. I think it is unusual for a doctor to write about failure, rather than about success. This is why the book has sold very well all over the world.
Why do you think such stories have had a bigger impact on the reader?
I don’t know. I wrote it, I don’t read it. I think, probably, the fact that, although as doctors we have to pretend and act that we are confident and certain that everything will go well, in reality we have to hide our feelings and often, if you are faced by a difficult operation or a patient who dies, because the operation has gone badly due to our mistakes, we suffer greatly. It’s very painful to be a doctor. Some doctors are psychopaths, but most are not. We have to hide, pretend and act like actors in a play. I think that it was interesting for patients, for readers who were not doctors, to realize that doctors are human beings.
Are the failures that you refer to part of the reasonable percentage of cases that result unsuccessful or are they a result of the greater risk that doctors take?
Every time you decide to operate, you’re making a prediction, you’re saying that the operation is not as dangerous as it would be if the patient didn’t undergo surgery. With these probabilities, we cannot tell the future with certainty and when we make predictions, there’s an uncertain future. We often make mistakes, we often are biased and our judgment is not good. But surgery is all about balance of risk.
You have also become known for a new method of operation or anesthesia when dealing with brain tumors. Have you mentioned this experience in this book?
Only little in my first book. In my new book which was published in England three months ago, I write more about operating upon people while they are awake. It is not exactly a new technique. I did not invent it, but using it for a certain brain tumor surgery was new. I was the first person in Europe to operate in this way.
Has this method been more successful than the traditional one?
It’s safer. It’s only for a particular sort of brain tumor. It is a safer way of operating, but we do not usually cure the patient. We usually help the patient to live for a few more years, but it is not a big revolutionary change or a breakthrough.
You’re a renowned surgeon. Do you think a good surgeon must also be a good psychologist?
To be a good surgeon means that there are many different ways to be a good surgeon. You need to be good with your hands, good with your decision making, good at talking to patients, good at getting on with colleagues, good at management and administration, good at scientific research. Nobody can be good at all those.
With this new technique that you’re applying, you continue to communicate even during surgery?
Yes, when you’re doing the operation, you’re talking to the patient while the operation goes on.
You have been in many countries. How do you see Albania in comparison to these countries in terms of the healthcare offered to patients?
I cannot speak for Albania, but the conditions in Prof. Petrela’s department are the same as in Europe or even America. There is no big difference. This is not a diplomatic reply, it’s just the simple truth. I think that there are problems in terms of what we call post-graduate training and what will happen in the future, I think there are possible problems.
How do you think costs should be distributed? Must people pay or the state pay for healthcare?
Ideally, the state should pay for it on the ground of social equity. If you have private healthcare, it means wealthy people could get better treatment than poor people. I do not want to live in a country where your healthcare depends upon how much money you have.
Does this mean that the state must assume more responsibilities or taxpayers should?
I think the state should. I think that there’s still problems with that, but it’s better than private healthcare. The problem with private healthcare is that doctors in hospitals become corrupted and they will do too many operations, too many investigations to make a profit. In an ideal world, medicine is a vocation, where we do our best for our patients. Not to make money for ourselves, but to do the best for our patients. In many countries I’ve worked in, where healthcare is mainly private, this leads to many problems. People do not like to pay tax to the government, therefore it’s a matter of educating the public. If you want good healthcare, you will have to pay more taxation. But if doctors in hospitals have a financial interest in how much work they do, how many x-rays they do, how many operations they do, I’m afraid they will do more and more and often unnecessary treatment.
Has the medical community made advancements in the fight against tumors and cancers in the last years?
Yes, people are living longer, but it’s also more expensive. Pharmaceutical companies are not altruists, they are businesses and they make a big profit from cancer.
Do you think this illness will ever be considered defeated?
Maybe, but then we will die from something else. Cancer is a disease of old age. By the age of 70, we have a one thousandth times greater risk of cancer than the age of 20. So, the longest people live, the more people get cancer and they undergo treatment. However, this treatment is expensive. The modern treatment for cancer usually does not cure the disease and this means that people live a little bit longer after hundreds of thousands of dollars worth of chemotherapy. This is a big problem and the other big problem is dementia. If we live to 80 years of age, we have a 30 to 50% risk of Alzheimer’s Disease. In Western Europe, there’s a growing population of old people who are losing their brain. All the Albanians go to look after them and make money. We cannot live forever and it is important to be realistic. That is also a lifestyle question. We know that 30% of the risk for Alzheimer has to do with lifestyle. If you exercise, if you don’t smoke, if you have good blood pressure control, you will reduce your risk of dementia, not by 100%, but by 30%. So, again, public health education is very important.
