What is it like to be a brain surgeon? How does it feel to hold someone's life in your hands, to cut into the stuff that creates thought, feeling, and reason? How do you live with the consequences of performing a potentially lifesaving operation when it all goes wrong?
In neurosurgery, more than in any other branch of medicine, the doctor's oath to "do no harm" holds a bitter irony. Operations on the brain carry grave risks. Every day, leading neurosurgeon Henry Marsh must make agonizing decisions, often in the face of great urgency and uncertainty.
If you believe that brain surgery is a precise and exquisite craft, practiced by calm and detached doctors, this gripping, brutally honest account will make you think again. With astonishing compassion and candor, Marsh reveals the fierce joy of operating, the profoundly moving triumphs, the harrowing disasters, the haunting regrets, and the moments of black humor that characterize a brain surgeon's life.
Do No Harm provides unforgettable insight into the countless human dramas that take place in a busy modern hospital. Above all, it is a lesson in the need for hope when faced with life's most difficult decisions.
"Disarmingly frank storytelling...his reflections on death and dying equal those in Atul Gawande's excellent Being Mortal." —The Economist
Henry Marsh has spent a lifetime operating on the surgical frontline. There have been exhilarating highs and devastating lows, but his love for the practice of neurosurgery has never wavered.
Following the publication of his celebrated New York Times bestseller Do No Harm, Marsh retired from his full-time job in England to work pro bono in Ukraine and Nepal. In Admissions he describes the difficulties of working in these troubled, impoverished countries and the further insights it has given him into the practice of medicine.
Marsh also faces up to the burden of responsibility that can come with trying to reduce human suffering. Unearthing memories of his early days as a medical student, and the experiences that shaped him as a young surgeon, he explores the difficulties of a profession that deals in probabilities rather than certainties, and where the overwhelming urge to prolong life can come at a tragic cost for patients and those who love them.
Reflecting on what forty years of handling the human brain has taught him, Marsh finds a different purpose in life as he approaches the end of his professional career and a fresh understanding of what matters to us all in the end.
In Chapter 1 the fundamentals of imaging transplanted cells is discussed with emphasis on animal models as well as the horizon for clinical trials. Then, detailed methods on the culture of neural stem cells is reviewed as a foundation for approaching therapeutic goals. Chapter 3 presents the broad scope of animal models that serve as the foundation for developmental and pre-clinical investigation, with mention of recent genetically engineered mouse models that represent the best models for studying disease development and treatment. Chapter 4 provides background on the delivery techniques to animals and patients that are available, providing vital information on the subtleties of technique necessary for optimal cellular grafting. Chapters 5 and 6 discuss new and evolving information on the origins of brain tumors and the indelible role of stromal and microenvironmental influences on oncogenesis and tumor progression. Subsequently, the utility of neural stem cells as cellular vehicles to deliver chemotherapeutics to broad neuropathology is reviewed. In Chapter 8 the scope of treating brain tumors is expanded beyond stem cells, to present the best biological interventions to improve upon current treatment options for brain malignancy. The last two chapters present a comprehensive review on stem cell and gene therapy options for treating cerebrovascular and neurovascular pathology.
In amassing this collection, my intention has been to provide the reader with a broad introduction into molecular imaging, stem cell biology, cell therapy, animal models, central nervous system malignancies, stroke, and neurodegeneration. My hope is that Frontiers of Brain Repair will be the intellectual soil from which a deeply rooted and well-nourished vintage of neuroscience will arise.