Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh Book Review

Henry Marsh's Do No Harm is a refreshingly honest and personal account of the world of surgery and medicine that is often so hard to portray in a truthful and really representative fashion of the world of the NHS. The book's chapters each trace a different case that Dr Marsh has met during his time as a Medical Student, Junior Doctor and Consultant and each one is simultaneously intriguing from a medical standpoint and touching in a uniquely human manner. Throughout the book it may almost seem self destructive that Dr Marsh includes so many of his own faults, mistakes and lapses in error  but it is from these experiences that the reader can begin to gauge that the seemingly faultless and mechanical system we perceive to be healthcare is often in fact a touch-and-go race between Doctors and life's closing window.

As gripping and tense as an action thriller and painfully honest 'Do No Harm' perfectly illustrates the delicate and difficult skillset required by Surgeons and how devastatingly things can go fatally wrong even when everything is done right. The book will leave the reader with a profound respect for the work done by Neurosurgeons and an immense sense of the underappreciation this job must entail. Darkly witty and elegantly written 'Do No Harm' is compelling and sensational in it's ability to draw a readers interest into each case and event, bringing them right into the depth of the operating theatre.

Dissecting a Pig's Head with Adam Rutherford

It almost seems like an insult that the animals we commonly associate with human traits of ugliness, laziness and greed are in fact the best models for studying our own anatomy. Yet it's true that humans and pigs are very closely related mammals and pigs have all the same thoracic and abdominal organs as humans making them an excellent subject for studying our own major organs and organ systems.

Our own 'resident scientist'- a slightly contrived title for my school's attempt to integrate more science into school life- Dr Rutherford has brought an excitingly infectious passion to the biology side of school life and as a part of his attempt to bring more life to science set up a pig's head dissection for the school's budding biologists to get stuck in with- a rare and thrilling opportunity.

Before the day of the dissection I considered how it's every aspiring medic's fear that they will have an undiscovered fear of blood and gore that will make the life they've toiled and slaved for as a doctor an existence they find a cataclysmic black hole of terror. But I was delighted to find that my fear of having such a fear was utterly ridiculous. Sawing through a fleshy pigs skin and fat to the bone of its skull is far from a repulsive experience. In fact it's exhilarating in the sense that you're about to unravel the secrets that lie behind those folds of skin. What's unveiled is a wondrous anatomy just below the surface that rules every action we take and yet's strangely it's beauty is never appreciated. Studying structures in a-level biology is certainly a reason to be impressed by the complexity of the systems that rule us but you can't truly appreciate this complexity and beauty without seeing it literally 'in the flesh'. It's also really nice to appreciate the interest that this dissection draws- for all the right reasons. Students didn't turn up on that Friday lunch to see how 'gross' this could be but because they had that curiosity to discover it seems so many scientists share.

Google some statistics briefly and it's easy enough to discover that according to a group of Cambridge scientists a pigs skull is around 30mm thick which compared to the comparatively thinner skulls of humans with mens' skulls 6.5mm and womens' 7.1mm, (I wonder why the traditionally more at risk from head injury men had thinner skulls..?- another time)  is astoundingly thick. Adapted so for the constant trauma to the head a pig will experience from fighting and defence using head-butting. It certainly took some effort to saw through the skull as what began as a diligent and structured approach quickly disintegrated into an assault from the top of the pigs head inward with students hammering away and sawing through this impossibly thick bone. Once the top of the skull was finally popped off (splattering a bit of pigs brain on a certain someone in the process..) the brain was revealed in all its glory. A little injured by the brutal attempt to reach it, the brain was surprisingly small and the folds were far larger than that of what you'll have seen of human brain diagrams. Even so it was quite exciting to have before us perhaps the most complex system in the universe. A vast network of neurones and synapses that controls our function.

Moving on we managed to remove the snout revealing the fleshy and boneless interior of the pigs nose as well as then moving on to dissect both eyeballs. The eyeball dissection was certainly the most diligent part of the whole procedure as we  had to peel back the iris and ciliary body to reach the lens- a satisfyingly clear and cylindrical structure that controls the focal point of our vision.

The entire process was certainly a thrilling way to bring to life the brief overview of anatomy we have covered in a-level biology and it gives me an expectant excitement for all the anatomy learning and dissection I have yet to come in medical school; it certainly brings me one step closer to finding the idea of dissecting a cadaver less strange.

Alleyn's Medical Society: Professor Bainbridge on Promoting Sight by Regenerative Medicine

Ophthalmology, the study of the eye, is a discipline leading the frontier in regenerative medicine. Indeed the eye is one of only a few organs on the crest of a wave of revolutionary stem cell and gene therapy research. The progress seen over the past few years has been phenomenal with recent developments in a branch of new cell-based therapies that promote healing by inserting new cells into diseased tissue or reactivating stem cells that proliferated during the eye’s development.

Professor James Bainbridge is Chair of Retinal Studies at UCL and worked on the first gene therapy for inherited blindness ever in 2007. Professor Bainbridge has been at the very epi-centre of developments within Opthamology, in 2011 he worked alongside the American bio-tech company Advanced Cell Technology (ACT) to apply regenerative medicine to 12 patients with Stargardt’s Macular Dystrophy- which causes progressive loss of sight. The trial has been seen as a ‘milestone’ in working towards curing forms of inherited blindness using regenerative medicine.

Professor Bainbridge first gave Alleyn’s Medical Society an overview of the ‘facts and figures’ when it comes to Ophthalmology: 39million people in the world are blind, blindness has been rated the greatest medical fear even over cancer and other chronic diseases and ophthalmology surprisingly represents 20% of surgeries in America. What at first may appear to be a minor aspect of medicine in actual fact makes up quite a large proportion of our healthcare service. Even so whilst Professor Bainbridge’s research centres around Macular Dystrophy he discussed how on a day to day basis the majority of cases he comes into contact with are for cataracts- clouding of the lens inside the eye which leads to a decrease in vision. Cataract surgery is only done under local anaesthetic rather than general meaning most surgeries are done whilst the patient is awake- he stated that whilst that may seem a little daunting in reality most patients aren’t frightened by the scalpel coming towards them and during surgery can have an intense and abstract viewpoint due to the work done on the back of their retina.

Professor Bainbridge went on to explain that whilst the recent develop he’s seen and been a part of are amazing from a scientific perspective the greatest reward is the fulfilment of patients and families he’s seen as the work has been successful- after it all Medicine is about people not just science.
 
-Izzie

Alleyn's Medical Society: Dr Malik Ramadhan on what it mean's to be an A&E consultant

Emergency Medicine is the fast paced frontier of healthcare and the only thing really that all patients have in common is the severity of their conditions. Aside from that each new case that comes in has the potential to be absolutely anything within the gigantic spectrum that is medical conditions. Doctors working in acute medicine must be calm mannered and confident, skillful and certain with their differential diagnosis of a condition and quick to spot mistakes. If not errors can lead to potentially life altering effects for patients.

Dr Malik Ramadhan works as clinical director of A&E and acute medicine for the Bart's Health Trust, the biggest NHS Trust in the country with a workforce of 15,000. Dr Ramadhan visit was certainly a reminder that Doctor's roles aren't restricted to that only of a care provider but also as an educator and communicator, as he kept the audience on their toes by posing questions and initiating discussion. Dr Ramadhan began by discussing his work and how the geography of his catchment area affects the number of different kinds of cases he sees day to day. Working in a catchment area which is the most deprived in all of England Dr Ramadhan commented on the high number cases of diseases such as Tuberculosis, Pneumonia and also drug related conditions, in addition he commented on how he had recently even come across scurvy and leprosy, diseases we rarely associate with modern British healthcare. 

Dr Ramadhan stated that the main affect of the geography of this catchment area is the high level of stabbing injuries. Stabbing injuries are associated with knife crime which is high in north-eastern parts of London. Dr Ramadhan then went on to explain the physiology behind the body's response to being stabbed and how wounds are treated. Our blood pressure is controlled by the enzyme Renin in our kidneys, and steroids formed from cholesterol we ingest. Dr Ramadhan highlighted how whilst learning all about the biochemistry of these molecules may seem unhelpful and unnecessary during medical school he's now aware more than ever of the importance of a sound anatomical and biological understanding of how the body works in applying this knowledge in his work diagnosing patients. 

Dr Ramadhan progressed on to discuss the dangers of bacterial infections in a stabbing wound, demonstrating quite graphically the effect this can have on the body. Dr Ramadhan highlighted the reality of emergency medicine, it's severe and unforgiving to mistakes and often doesn't end in the 'happy endings' we might expect, yet even so it's rewarding and a profession that provides something absolutely fundamental to our society, literally saving lives every day.

-Izzie

Alleyn's Medical Society: Prof Matthew Hotopf on why there's no health without mental health

Mental health has a distorted appearance to the outside world, for some it doesn't even identify as a discipline. Too abstract in its treatments to fit in alongside the NHS powerhouses yet too institutional to make up a part of 'alternative healthcare' mental health, like its patients, can feel a bit isolated from the rest of us. Yet it's key to remember that WHO (the World Health Organisation) defines Health as a complete state of physical, social and mental well-being not merely the absence of disease or infirmity, our mental happiness is just as important as our physical well-being.

Professor Matthew Hotopf works at the local Maudsley Institute apcae with King's College Hospital on Denmark Hill. He has undertaken research into epidemiology (the science that studies the patterns, causes and effects of health in populations), pallative care and mortality all within mental health. Speaking to Alleyn's Medical Society this Tuesday he wanted to spread the awareness of mental health as a serious issue and the problems which have arisen from oppressive and unethical treatments such as electro-convulsive therapy and lobotomy in the past and its segregation from the rest of the healthcare system.

Historically there has been a geographic split between mental health and health. During the 18th and early 19th century the large teaching Hospitals of London were all very centrally located, with a ring of mental institutes formed around this area and the treatments available were either extremely experimental in nature or non-existent. During this time the care of mental health was extremely institutionalised, in the majority of cases the institutes which housed these patients sought not to cure them but to divide them from normal society. However our knowledge of psychiatry has developed hugely in the last 50 years and words such as 'retard' and 'imbecile' are no longer used to describe those with mental disorders or learning disabilities. The publishing of the white paper 'Valuing People' in 2001 saw one of the greatest steps forward in the government supporting people with mental health and is a mark of the progress made within the NHS.

Prof Hotopf talked about how mental health was involved with other aspects of healthcare and his job; a large number of A&E patients suffer from PTSD and depression. This means Prof Hotopf is often involved with working alongside colleges in other departments, he noted how this kind of work has made headlines recently as the women who took her own life and that of her newborn child's was suffering from a major perinatal disorder, something he has often come across.

To finish Prof Hotopf considerig how mental health can affect life expectancy and showed us how people with mental diseases are 3-5 times more likely to suffer depressive related conditions and have life expectancies up to 20 years shorter. He stressed that these statistics highlighted the importance of our mental health and of how it affects our health as a whole, in other words there is no health without mental health.


For further reference about mental health see 'The Man Who Mistook His Wife for a Hat' By Oliver Sacks

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/250877/5086.pdf
-'Valuing People' the White Paper published 2001

See the 2010 BBC 4 documentary 'Mental: A History of the Madhouse' for information about the Victorian psychiatry treatments.

-Izzie

Alleyn's Medical Society: Mr Ahmed on 'Through the Google Glass'

A seemingly tradition and disciplined medical profession surgery is perhaps one of the most fast paced and constant in terms of change of all medical disciplines. Alternative and innovative methods constantly come into practise each year and can help to improve the rates of success immensely. New techniques such as key hole surgery and gastric bypasses have seen revolutionary changes in the profession and it is this evolution of proficiency and ability which makes the career so exciting.

Mr Ahmed works as a consultant colorectal surgeon, working mainly to remove cancerous lumps from the rectal areas. He is also the first ever surgeon to broadcast surgery live to 14,000 students using a 'google glass'. The basis for this avant-garde idea comes from a lack of first hand experience of surgery amongst medical students. The extortionate costs of medical school seem wildly disproportionate when you learn how difficult it is for students to catch a glimpse of the action going on in surgeries at the cutting forefront of medicine. Based on this problem Mr Ahmed has given students the perfect view, directly transmitting his own line of site during surgery worldwide. This allows students to access a view they would normally never have the opportunity to and allows them to become more experienced and educated. The project labelled as 'Virtual Surgeons' has been hugely successful worldwide, with the most viewers coming in from more isolated countries where students lack access to surgery. The first surgical procedure received attraction from 300 newspapers in 30 different languages and even gained a segment on ITV news at ten, in addition #googleglass trended on twitter and 'Virtual Surgeons' became the 4th reason why London is the tech capital of the world according to the magazine 'Entertainment Weekly'.

The idea has been taken even further than just simply transmitting information though as students can text questions to the surgeon during procedures and receive feedback. The project is also now being integrated into some curricula including Queen Mary's University's medical programme.

The project has potential yet and could lead on to further developments to do with broadcasting medical practise. There are however some issues being provoked by this idea as some professionals are questioning the privacy issues and pressure for a surgeon that could be invoked by broadcasting surgery. It is also key to remember that lives are saved by doctors and not just technology; overreliance on this miraculous idea could have potentially devastating consequences. Yet this beautifully simple idea, elegantly executed has proven the amazing potential technology has within surgery and healthcare.

-Izzie

Alleyn's Medical Society: Mrs Heimann on Childcare and Development

Compassion and skill go hand in hand when it comes running a children's ward and the skills required to treat children vary hugely from their adult counterparts. The age of patients makes childcare a particularly sensitive and often emotional job for those who work there and nurses on a children's ward will come face-to-face with a variety of new challenges each day.

Mrs Heimann trained as a nurse at the Royal College of Nursing, Manchester University. She specialised in Child Health Nursing, has been involved in the production of  a number of papers on childcare and has worked on children's wards at a number of locations including our local Guy's and Thomas' Hospital. She now works as a course director at the London South Bank University.

Mrs Heimann began by discussing the key differences between treating children and adults. By nature children are far more vulnerable. Not only do they have a greater surface area and so are at a greater risk of dehydration and hypothermia due to loss of heat and fluids but their organ systems are immature and exposed to the foreign pathogens we as adults have built up some resistance to. Mentally children are also underdeveloped and so it can pose a serious challenge for nurses to communicate with children and gain an understanding of their basic needs. Parents and carers are often essential sources of information for a healthcare worker to build up a picture of how a child is acting differently and gain a diagnosis, instruments like pictured pain scales can also be used to estimate the amount of pain a child is experiencing.

Mrs Heimann then went on to speak about the difference between stages of development in children using the Piaget Cognitive Theory as a crude outline for her explanations. Piaget was the first psychologist to make a systematic study of cognitive child development using simple but ingenious tests to reveal different cognitive abilities. This theory helped to eradicate the common assumption that children are just less competent thinkers than adults and is now used in both healthcare and education to utilise resources more efficiently for a child's needs, Mrs Heimann did however note that this system is far from perfect and whilst approaching a situation, common sense and intuition are just as important in handling complications to do with children.

After describing her experience working on a children's mental health ward Mrs Heimann noted how many children only require simply yet providable measures such as a set routine, care. attention and cleanliness to recover from conditions such as persistent bed wetting and depression. Mrs Heinmann poignantly went on to describe how young babies suffering from depression can often after a period of crying fall silent, not mistakenly out of exhaustion or relief, but as they have completely lost hope a parent will return to them. It is these everyday emotional experiences that can often make childcare a very difficult speciality and one where a boundary should remain between patient and nurse. Not only to respect a parents role but to allow childcare workers some relief from emotional attachment and its often distressing consequences.

-Izzie