Henry Marsh – a life in brain surgery

 

 

Admissions – A life in Brain Surgery is a second offering by Henry Marsh, following his critically acclaimed “Do No Harm”, about his work as a neuro-surgeon.  It does not claim to be a follow-up or sequel, so presumably it should be read on its own, but it is not an autobiography, as the sub-title would suggest.  It is more a series of reflections, those of a grumpy old man, and the title, suggested by his wife, is most apt.

Something of his life can be assembled by the end of the book from the fragments with which it is interspersed.  He was born in 1950 to a German mother and a father who was an academic lawyer at Oxford.  After an idyllic childhood in countryside outside Oxford (long since buried under the bypass) the family moved to Clapham and he was sent to a posh boys’ school, Westminster, for a while as a boarder.  He was clearly academically successful, going to Oxford to study PPE, a qualification that has launched so many of the stellar careers of our political leaders.  However, the baggage that came with such an educational background, and its social implications, was excessively burdensome, and left psychological issues, resulting in suicidal contemplation, a spell as a voluntary patient, and taking a year from his studies to work as a porter in a northern hospital.  He seems to have returned to finish his degree, then became a doctor and surgeon the hard way, though the how any why are not explained.

He touchingly expresses gratitude to his parents for their influence in forming his character and one is left wondering where he believes his difficulties arose.

 

Finding his vocation he then had a long, 24 year, marriage, which ended in an unhappy divorce, and a son and daughter.  At an early age his son required surgery, which he tells us lead to his specialising in neuro-surgery.  He is now retired, married again, and quite an eccentric.  He does the things that doctors say are good for us, cycling to work, running and taking cold showers, which he endures for the pleasurable feeling when they are over and done with.  Carpentry is his hobby, and he restores an abandoned lock keeper’s cottage that is not quite remote enough from North Oxford to escape the attention of vandals on his lengthy absences, but rural enough to be overwhelmed by weeds at the same time.

The main substance of the book is ruminations on his life work in surgery.  After leaving his post in a London Hospital, he says under a cloud, avoiding a disciplinary hearing for pulling a junior colleague’s nose in front of a patient, he goes to help an old colleague who now runs a private clinic in Kathmandu.  His description of the bustling third world city with its crowded roadways, pollution and massive expansion will be familiar to those who have visited the sub-continent.  Marsh takes us further into a society with markedly different expectations to our own.  If a child is sick, one can ask the parents if they are going to have others.  On the other hand, families will often insist on surgery for older relatives, even if the doctor can see no hope of a good outcome.  The message is one of optimism, despite the vast array of obstacles in contemporary Nepal.

We are then taken to Ukraine, where Marsh spent some time years before, helping a surgeon in Kiev.  Again the local doctor has gone private, and is no longer attached to a public hospital.  We get a portrait here of a man dedicated to his work but with much to learn, whose judgment is clouded by an authoritarian streak.  Marsh regrets not intervening in an operation that leaves the patient blinded.  When they part, it does not seem to be on good terms.  During his stay in Ukraine Marsh gives a lecture to young doctors on medical and ethical accountability, which he says some of his audience described as life changing.

The reflections then shift to mortality, out of the rarefied world of neurosurgery, and we are back in the mundane debate over of euthanasia, where we all have opinions, more or less informed by our own experience.  Marsh makes a fair case for euthanasia, I think, but has a full understanding on the difficulty we all have with death, and towards the finish of the book there is an unexpected flicker of black humour relating doctors’ jargon for facial recognition of progression in terminally ill patients that I will not forget.

 

This book review is submitted by one of my friends.