Henry Marsh describes how he came to love operating on patients’ brains
ILLNESS, wrote Susan Sontag, is “the night-side of life”. In his bestselling 2014 memoir, “Do No Harm”, Henry Marsh, a neurosurgeon, gave an elegant account of his role as a gatekeeper of this night-side, an “underworld of suffering”. In “Admissions” he returns to the same territory, but also covers his life before and after the heart of his career.
The book starts at the ignominious end of Mr Marsh’s time in Britain’s National Health Service (NHS). Ground down, as he tells it, by bureaucrats and needless regulations, Mr Marsh sends his resignation letter. His final operation is tricky, but a success. The next day he finds his patient has had an unnecessary nasogastric tube inserted. He asks the nurse to remove it but, without the paperwork, the nurse refuses. Mr Marsh snaps. He tweaks the nurse’s nose, shouts “I hate your guts!”, and storms off. He later, sheepishly, returns to apologise. The telling episode shows both Mr Marsh’s disarmingly frank storytelling and his querulous, warty sort of heroism. He is, in spite of himself, hugely likeable.
After 40 years in the NHS, Mr Marsh fears falling idle and useless. So he keeps busy, and he writes. In Nepal and Ukraine he helps former colleagues in their clinics. Every day people appear with tumours bigger than any he had ever seen in Britain. The suffering is overwhelming, the surgery almost pointless. Here his reflections on death and dying equal those in Atul Gawande’s excellent “Being Mortal”. And every few chapters he returns to Oxford, where he has begun renovating a lock-keeper’s cottage near his childhood home. This brings him back to his youth, from swimming lessons to first loves, his time at Oxford University, and a brief stay as a patient in a psychiatric hospital. The effect is of a rather wayward Bildungsroman of his path to becoming a neurosurgeon.
It was the privileged insights into neurosurgery which made “Do No Harm” such a remarkable book. “Admissions”, to some extent, offers more of the same. Mr Marsh describes neurosurgeons as a tribe, isolated by the terrible responsibility of their job. There is the decision of whether to operate, which involves great uncertainty. And there is the risk of neurosurgery itself, where the smallest mistake can blind, paralyse or kill someone. But Mr Marsh describes it as a sort of addiction, where the huge responsibility is part of the thrill. “Like all surgeons all I want to do is operate.” As soon as he makes the first incision, he finds a “fierce and happy concentration”. His writing is at its vivid best in the “muted drama of the theatre”, with “the bleeping of the anaesthetic monitors, the sighing of the ventilator” and “the sucker slurping obscenely” as he removes a tumour from someone’s brain.
There are, though, fewer such moments in Mr Marsh’s new book. Those expecting a second “Do No Harm” will be surprised, but not disappointed. “Admissions” is more about the man than the surgeon, but it is excellent in its own right.
For information about financial planning or advice for surgeons, please visit our Whole Wealth Medical Page.
This article was published and provided by the Economist.