23 Mar 2014

Moving through thought – why I hate cutting into the brain’

Brain surgeon Henry Marsh tells Katie Razzall about some of the life-or-death decisions he has had to make, and explains that if an operation has gone well he tells the patient: “I enjoyed that!”

Warning: some viewers may find this video distressing

“I often have to cut into the brain and it’s something I hate doing.”

That’s not a sentence you often hear. But for neurosurgeon Henry Marsh, cutting into the brain comes with the job.

Mr Marsh has written a book, Do No Harm, about his experience of saving lives – and sometimes failing. It’s packed with descriptions of the life-and-death decisions he’s had to make in conjunction with patients during more than three decades of brain surgery. He gave his first TV interview about the book to Channel 4 News.

Surgeons and psychopaths

I met him in the south London hospital where he’s reaching the end of his NHS career. He told me: “There are some terrible moments. Doctors don’t like talking about it much. But you’d have to be a psychopath not to be deeply distressed by things going wrong. Surgeons have moments of black despair.”

In fact, a few years ago a magazine listed the 10 careers with the most psychopaths in them – and surgeons were number five. Shallow emotions, lack of empathy, cold-heartedness, lack of guilt, egocentricity and being manipulative were characteristics shared by both groups, it said.

There are some terrible moments. Doctors don’t like talking about it much. Henry Marsh, neurosurgeon

But in his book, Mr Marsh is full of guilt and empathy about the operations that have gone wrong. He told me: “In stressful operations, I start remembering them.”

These “ghosts of the past” guide him about what the right thing to do is – how much tumour to remove, for example.

Incredible experience

As I learnt in the operating theatre, though, a surgeon needs some distance or they couldn’t do the job. And once the patient is covered in blue fabric so only a portion of the top of their head is exposed, you do begin to forget there’s somebody under all that cloth.

We filmed Mr Marsh and his team carrying out an operation on a woman in her seventies with a malignant brain tumour.

Scientists don’t even really known what a thought consists of, but here were surgeons removing a tumour from an organ containing 100 billion cells.

I was warned that if I felt sick I should leave the operating theatre. In the end, it was an incredible experience. To watch doctors delve into someone’s brain, the most complex part of what makes us human, is a privilege. Scientists don’t even really know what a thought consists of, but here were surgeons removing a tumour from an organ with 100 billion cells contained within it.

The operation went well. The team had prolonged the life of a woman who otherwise would have been dead in months.

How she reacted to the joke Mr Marsh tries out after all his successful operations isn’t recorded.

“If it’s gone well,” he told me, “I say I enjoyed it. And the patient is usually offended. But I say to them, the last thing you want is to be operated on by a surgeon who doesn’t love doing it.”