On the train yesterday I devoured [amazon_link id=”178022592X” target=”_blank” ]Do No Harm: Stories of Life, Death and Brain Surgery[/amazon_link] by Henry Marsh. I can’t recommend it highly enough. It is the author’s retrospective take on his career in neurosurgery, as he approaches retirement. From the start you share his sense of the strangeness of taking surgical instruments to people’s thoughts and emotions, memories and reason – as he puts it, too strange to think about really. He gets on with the delving into the jelly of the brain. This is a fascinating and utterly humane book.

[amazon_image id=”178022592X” link=”true” target=”_blank” size=”medium” ]Do No Harm: Stories of Life, Death and Brain Surgery[/amazon_image]

It does illustrate – as so many others have done – the strains on the NHS, due to demand growing faster than resources, but even more due to the madness of mediocre bureaucracy and constant reorganisation.

But the overwhelming message I took was the importance of the counterfactual in medicine. Marsh writes that as he grew more experienced as a surgeon, and older himself, the urge to operate always – because it’s what families and patients expect, and what surgeons do – began to ebb. Increasingly often, he concluded that the choice his patients often faced was between two different ways of dying, one of them involving painful and sometimes brutal surgery that gave false hope, a short extension of life at best. Given the strains on the NHS, the ageing population, the continuing advances in technology that make new interventions possible, this is going to be an important debate.

Anyway, as I get older too, getting the counterfactual right increasingly seems the key issue in any context. And one that it’s very hard for people to get to grips with, because seeing the realistic alternative course of events requires reason, experience, judgement and imagination.

On the medical theme, I’m also keen to read Atul Gawande’s [amazon_link id=”1846685818″ target=”_blank” ]Being Mortal: Illness, Medicine and What Matters in the End[/amazon_link]. I loved the other books by him I’ve read, [amazon_link id=”1846681324″ target=”_blank” ]Complications: A Surgeon’s Notes on an Imperfect Science[/amazon_link] and [amazon_link id=”1861976577″ target=”_blank” ]Better: A Surgeon’s Notes on Performance[/amazon_link].

[amazon_image id=”1846685818″ link=”true” target=”_blank” size=”medium” ]Being Mortal: Illness, Medicine and What Matters in the End[/amazon_image]