tirsdag den 16. august 2016

Gør ikke skade af Henry Marsh



Gør ikke skade af Henry Marsh. 4/6 stjerner

Henry Marsh er hjernekirurg, og han åbner i Gør ikke skade op for en verden fyldt af etiske dilemmaer, dødelige valg og umulige situationer i det engelske hospitalsvæsen. 

Bogen er bygget op omkring enkeltstående tidligere patienter, hvis operationer Marsh beskriver detaljeret. Fælles for dem alle er, at de har ladet Marsh bore, save og skære sig ind i deres hjerne. Der er noget helt og aldeles magisk over hele foretagendet at åbne et menneskes hoved og bevæge sig rundt i den bløde hjernemasse, hvor al personlighed og tankevirksomhed består, og Marsh beskriver netop dette med en næsten glødende begejstring. Mens han bevæger sig længere og længere ind i hovedet på en patient, får man selv en følelse af at glide ind i et glinsende virvar af nerver, arterier og et maskineri, der endnu i høj grad er et mysterie for mennesket. 

Hjernerygmarvsvæsken, blandt læger kendt som CSF, er lige så klar som flydende krystal og løber rundt igennem trådene i arachnoidea hvor den i lyset fra mikroskopet glimter og glitrer som sølv. Derigennem kan jeg se selve hjernens glatte gule overflade, gennemtrængt af bittesmå røde blodkar - arterioler - der danner smukke grene ligesom når man ude fra rummet ser en flod med dens bifloder. Glinsende, mørklilla vener løber ind imellem de to lapper og fører ned til den midterste hjernearterie og videre hen til det sted hvor jeg agter at finde aneurismet.

I begyndelsen var det beskrivelserne af hjernen og bevægelsen ind i hjernen, der fangede min interesse, men langsomt skifter fokus i takt med, at Marsh inddrager fortællinger fra sin vej til at blive hjernekirurg. Han beretter om de fejl, han har begået og om de konsekvenser, det har haft for andre menneskers liv og samtidig får hans eget liv betydning. Han beklager sig over kollegaers manglende ærlighed omkring deres fejl, og han virker fast besluttet på at lade dette værk bestå af ærlighed. En ærlighed der til tider forfærdede mig og i øjeblikke fik mig til at foragte ham. Han forsøger ikke at forsvare sine handlinger, men udlægger dem blot til læserens skue. Men mens jeg var fyldt med foragt for mandens valg, blev jeg konfronteret med de samme dilemmaer, og jeg måtte spørge mig selv, hvad jeg ville have gjort i samme situation. Jeg priser mig lykkelig for, at jeg ikke skal tage stilling til etiske problemstillinger af samme karakter, at jeg ikke bærer så meget ansvar på mine skuldre, og foragten er siden erstattet med medlidenhed og respekt. Det er hårde beslutninger, man må tage som hjernekirurg, beslutninger om andre menneskers liv og død, og selv hjernekirurger er blot mennesker.

Alle accepterer at vi begår fejl og at vi lærer af dem. Problemet er at når læger som jeg selv begår fejl, kan det få katastrofale konsekvenser for vores patienter.  

En bitterhed vælter frem overalt, og især hospitalsvæsnets mange moderniseringsprocesser får smidt forbandelser efter sig. Marsh er uddannet af et andet system end det, der hersker i dag, og han føler sig konstant undermineret og frustreret over besværligheden ved nye systemer, der gang på gang fejler og gør hans job umuligt. Bogen bliver dermed samtidig også en kritik af hele sundhedsvæsnets modernisering og en lidt gammelmandsagtig tilbedelse af det gamle, manuelle system. 

Gør ikke skade er en utrolig interessant bog om noget, jeg indtil nu vidste absolut intet om. Den har rykket ved min opfattelse af hjernekirurgi, etik og ansvar. 

Jeg har læst værket i den danske oversættelse og det var desværre en fejl. Bogen er fyldt med fejl - både sjuskefejl, stavefejl, grammatiske fejl og kommafejl. Det var svært at abstrahere fra, og det spiller også ind i min endelige vurdering af bogen, selvom forfatteren selvfølgelig på ingen måde kan stilles til ansvar for, hvordan hans bog er oversat. Læs den på engelsk, er vist alt jeg kan sige. 





ENGLISH BELOW

____________________

Henry Marsh is a neurosurgeon and in his book Do no harm he talks about the world as he knows it; about ethical dilemmas, deadly choices and impossible situations in the medical practise in British hospitals. 

The book's foundation consists of the stories of previous patients of his and he describes the operations in extreme detail. All patients have let Marsh drill and cut into their brains and there is something incredibly magical about the whole business of opening up into somebody's soft brain tissue, where the personality of another human being is being kept. Marsh describes this with an exhilarated eagerness and while he slowly moves further and further down into his patients brains you almost feel yourself slipping further into the glistering network of nerves, arteries and machinery, that is yet mostly a mystery to the human. 

To begin with it was the descriptions of the brain and the movement into the brain that caught my interest, but slowly the focus changes while Marsh reveals stories about how he came to be a neurosurgeon. He talks about his mistakes and the consequences they have had on other people's lives. He complains about his colleagues' lacking honesty about their mistakes and he seems very focused on letting this particular work be one of honesty. And it is an honesty that at times horrified me and in certain moments made me despise him and his choices. He doesn't try to defend his actions, but - instead - simply tells about them. But while I was filled with despise for his choices I was confronted with the same dilemmas and I had to ask myself what I would have done in the same situation. I consider myself lucky to not have to make the choices and act on them in such situations and that I don't carry the same kind of responsibility upon my shoulders. My despise then turned into pity and respect. It is without doubt very tough decisions you have to make as a neurosurgeon, decisions that will have influence on other people's life and death - and even brain surgeons are only human beings.

A bitterness is seeping out everywhere and he especially condemns the medical practise and all the new and advanced systems that are replacing the old. Marsh is educated in another system than the one dominating today and he constantly feels undermined and frustrated because the new systems makes it impossible for him to do his job. The book becomes a critique of the whole medical practise and Marsh praises the old, manual systems in a way where you can't help but think of him as an old and angry man.

Do no harm is an incredibly interesting book about something I know absolutely nothing about. It has certainly changed my views on brain surgery, ethics and responsibility. 

I've read the book in a danish translation and it was just horrible. That's partly why I've only given the book 4 stars, so all I can say is that you should definitely read it in English. 

3 kommentarer:

  1. Hello Ida,
    what a good review. I feel you are really moved by this book. You show emotions and your language is authentic. You gave the book 4 stars. It is very convincing and good advertising for the book. I think I should also read it sometime. The book is also translated into German ("Um Leben und Tod") . But the English edition is 50 % cheaper. Reading it in English is a little bit more tricky, of course. What do you mean? Nowadays we are faced with a lot of problems in medical care, f.e. the Patient Decree (living wills) is put in doubt (a new German law), active euthanasia for incurables is criminalised, there are many not necessary medical treatments, more important persons are put in first places to an organ transplant and not so important have to wait (some incidents in Germany) and so on. The latter reminds me of Ninni Holmquist's novel "The Unit".
    Best regards
    Wolfgang
    PS: I've finished the 2nd volume of Knausgard's "My Struggle" Tomorrow I'll start wird the 3rd.

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    Svar
    1. Hello Wolfgang! :-)

      Thank you! I'm glad you liked my review. I did find it very interesting! Despite it being technical at times it really impressed me. I definitely think you should read it in English. Maybe the German translation is better than the Danish one, so you might be luckier than me. However, I feel like there might be that charming british vibe in the English edition. I think Marsh language is very warm and even witty at times in that special way only Englishmen can be - and I think that will be more obvious in the english edition because it is close to impossible to translate. But of course I could be wrong.

      I can see on your second comment that you ended up getting the German edition - have you read it since you left the comment and in that case, did you like it?
      Yes, I think it's a pretty interesting link between Marsh and Knausgård, but they do share the extreme honesty about themselves and their deepest thoughts - even the not-so-pretty ones.

      I think it is terrible that some people can be put in first places to organ transplants just because they are more "important". All lives are equally important. But it isn't something that has happened a lot in Germany is it?

      Best regards
      Ida

      Slet
  2. Hello Ida,
    how do you do? I have a second remark.
    Henry Marsh's book is published also in German. I have borrowed it from my library. It is interesting that Knausgard had read the book too. He is very impressed by that book.
    Now I have to read two books(Marsh/Knausgard 3rd volume) in parallel. To do that I reserved two time slots in my timetable. :-). If I read Marsh's book, I'll tell you my opinion.
    By the way,I must correct an error in my first statement. There is no new law to the Patient Decree,but a new Court ruling is putting the Patient Decree in doubt. But that doesn't make it better. The question is what purpose is behind it?
    Kind regards
    Wolfgang


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