Published in Britain last year, Dr. Henry Marsh’s “Do No Harm: Stories of Life, Death, and Brain Surgery” comes to the United States laden with well-deserved critical praise: The book is as complex, evocative and cannily crafted as any “Masterpiece Theater” production. Dr. Marsh, 65, is an eminent London neurosurgeon who looks back on a long career, effortlessly layering the technical details of his work with resonant emotional overtones. (Read an excerpt.)

The surgery itself, Dr. Marsh writes, is the easy part of the job. After all these years, he has become a virtuoso with the saws and drills that take him through the skull, and with the microscope that helps him manipulate tiny instruments within the brain. Granted, one false move and he will damage his patient seriously and permanently, but those disasters are vanishingly rare, and for him the operating room is like a long stretch of flat turf for a racehorse — the place where, adrenalin-fueled, he hits his stride.

Far more difficult work awaits Dr. Marsh in cramped little clinic rooms before and after surgery, where he must decide what to do, or inspect what he has done. Incurable, inexorably progressive brain tumors are his stock in trade: “It is when I do not know for certain whether I can help or not, or should help or not, that things become so difficult.” Over and over again, he tries to predict whether taking patients to surgery is likely to make them more or less miserable than leaving them alone. This part of the work never gets easier.

Sometimes he makes the right choice, sometimes the wrong one. These days, health care quality experts might well pounce on the wrong decisions as examples of egregious medical error and call for corrective measures — retrain that old geezer and get him some evidence-based decision trees! But Dr. Marsh’s narrative makes clear, far clearer than almost any previous account of medical practice, how often hope will undermine rigid quality standards, and how difficult it can be to stand fast against hope’s dictates.