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

me how she had become confused and forgetful over the preceding weeks. I explained to them that her brain scan showed what was undoubtedly a malignant tumour.
    ‘My father died from a malignant brain tumour,’ she told me. ‘It was terrible to watch him deteriorate and die and I thought that if that happened to me I would not want to be treated.’
    ‘The trouble is,’ I said reluctantly, ‘it will happen to you anyway. If I treat you, with a bit of luck, you might have some years of reasonable life but if we do nothing you have only a few months left to live.’
    In reality this was probably optimistic. The scan showed a foul malignant tumour in her dominant temporal lobe – dominant meaning the half of the brain responsible for speech and language – that was already growing deep into her brain. It was unlikely that she had more than a few months left to live whatever I did, but there is always hope, and there are always a few patients – sadly only a small minority – who are statistical outliers and defy the averages to live for several years.
    We had agreed that we should operate. Patrik did most of it, and I assisted him. The operation went well enough though as soon as Patrik drilled open her head and cut through the meninges, we could see that the tumour was already spreading widely, more widely than in the brain scan done only two weeks earlier. We removed as much of the tumour as we safely could, tangled as it was with the distal branches of the left middle cerebral artery. I did not think we had done her any serious harm though nor had we done her much good.
    ‘What’s her prognosis, boss?’ Patrik asked me as he stitched the dura and I cut his stitches with a pair of scissors.
    ‘A few months, probably,’ I replied. I told him about her father and what she had said to me.
    ‘It’s difficult to do nothing,’ I said. ‘But death is not always a bad outcome, you know, and a quick death can be better than a slow one.’
    Patrik said nothing as he continued to close the woman’s meninges with his sutures. Sometimes I discuss with my neurosurgical colleagues what we would do if we – as neurosurgeons and without any illusions about how little treatment achieves – were diagnosed with a malignant brain tumour. I usually say that I hope that I would commit suicide but you never know for certain what you will decide until it happens.
    As we stitched her head up I did not expect any problems. Judith took her round on her trolley, pushed by one of the ODAs and nurses, to the ITU while I sat down and wrote an operating note. A few minutes later Judith put her head round the theatre door.
    ‘Henry, she’s not waking up and her left pupil is bigger than her right. What do you want to do?’
    I swore quietly and quickly walked the short distance to the Intensive Care Unit. In the corner of the room I could see Melanie, and a baby’s cot beside her bed, but I hurried past to look at the second patient. With one hand I gently opened her eyelids. The left pupil was large and black, as large as a saucer.
    ‘We’d better scan her,’ I said to Patrik who had come hurrying up when he had heard the news. Judith was already re-anaesthetizing the woman and putting a tube down into her lungs so as to put her back on a ventilator. I told Patrik to tell the staff in the scanner that we would be bringing her for a scan immediately and never mind what else they were doing. I wasn’t going to wait for a porter. Patrik went to the nurses’ desk and picked up the phone while Judith and the nurses disconnected the woman from all the monitoring equipment behind her and with my help wheeled her quickly out of the ITU to take her to the CT scanner. Together with the radiographer we quickly slid her into the machine. I walked back to the control room with its leaded, X-ray- proof window looking out into the room where the patient lay with her head in the scanner.
    Impatient and anxious I watched the transverse slices of