Sunday Book: Henry Marsh - Admissions: A Life in Brain Surgery

Is it true that the blob of jelly resembling convoluted grey matter that we carry around in our skulls is really what we are? And how we are, and why? This is the profound question that is obliquely omnipresent in Henry Marsh’s second book on his life as a neurosurgeon as he describes his encounters with this physical part of us that seems to be, well, us.

As he pithily puts it in his last pages, he does not believe in an afterlife: “I am a neurosurgeon. I know that everything I think and feel, consciously or unconsciously, is the electrochemical activity of my billions of brain cells… When my brain dies, ‘I’ will die. ‘I’ am a transient electrochemical dance.”

Doctors, of course, have a long history of writing – think Keats, Chekhov, Arthur Conan Doyle, William Carlos Williams – and have now emerged writing about their own trades. Memoirs have recently become the purview of patients, and there has been a spate of revelatory, moving and compelling narratives, several from journalists and emerging from newspaper columns – John Diamond, Tom Lubbock, Marion Coutts. Now doctors writing about their own profession is big in America, perhaps initiated by the long articles under the rubric “Annals of Medicine” which are occasional and significant features in The New Yorker, before emerging as fully-fledged books, even influencing the course of medical training and practice. (Atul Gawande is a case in point: his Complications and Being Mortal are titles that speak for themselves.)

Startlingly he reveals that he has long kept a suicide kit at home 

Henry Marsh entered the field in 2014 with his own history, Do No Harm, its chapters titled by the names of the conditions on which he was operating. His descriptions of individual patients, their cases, the teams with whom he worked, the responses of all around him, and his own attitudes and feelings were mesmerising – and curiously informative.

He combined descriptions of his encounters with patients with specific conditions – and outcomes that ranged from triumphant to tragic – with a subtle history of the recent years of neurosurgery, as doctors moved from the wholly manual to engagement with computers and robots. His character appeared a fascinating combination of arrogance and self-deprecation, confident yet profoundly questioning. It was as much about the recent history of medicine in his field as about himself. But his biography was oblique.

Now having left the NHS, his new book, Admissions A Life in Brain Surgery, is more overtly autobiographical; it has also expanded its range geographically as Marsh goes on assignments to work in under-resourced countries like Nepal and Ukraine. Rather startlingly he reveals at the opening that he has long kept a suicide kit at home (although the medications may be well out of date). His description of his retirement from full-time NHS practice comes alongside a review of his decades as a surgeon; a candid description of his volatile childhood, and his breakdown as a student which led on to his discovery of medicine in general, and surgery in particular; and his coming to terms in some ways with the advent of old age (although he is still only in his late 60s).

These are all themes that underlie a varied range of memories: descriptions of specific trips abroad as a neurosurgeon; the finding, purchase and renovation of a derelict lock-keeper’s cottage on a canal in Oxford; the bitter chords still reverberating from the dissolution of his first marriage; his self-perceived failures as husband and father; and the happiness of his second marriage. Thus the narrative is an unusually candid journey of self-discovery, intertwined with broader themes about the role of the medical profession.

But these essays transcend his frank, even at times savage account of his own personality and character, as he describes in vivid prose his own personal achievements and disasters, and episodes in between, to reach for something more universal. He is quietly and pertinently almost transcendent with rage about what is happening to health systems around the world: commercialisation, competition, so-called market forces, corruption. There is a quietly terrifying chapter on visiting the Houston Medical Center, with its skyscraper hospitals on a vast site, and his criticisms of the “notorious extravagance” of the American system ring all too true. He is particularly distressed by what he regards as unnecessary procedures.

Medicine is here clearly presented as always the weighing of probabilities, summed up in his pithy quotation from Sir William Osler, “Medicine is a science of uncertainty, and an art of probability…” As well as admitting to his ignorance of the cultures and languages, he is distressed by the corruption and political mayhem of Ukraine and Mao-ist Nepal (where he unreservedly admires the great neurosurgeon Dev, with whom he had trained 30 years earlier, and who now has a private hospital in Kathmandu). He is outraged at the paucity of national medical services in such countries, but profound anger is reserved for what he sees as the political and managerial interferences in the NHS. This does not come across in any way as old fogey-ism, or anti-progress, but is rather an indictment of the perils of submitting to a medically ignorant bureaucracy in order to secure funding. Incident after incident, some of which he did not handle well, punctuate his narrative.

This is an enthralling book, unputdownable, although I would not have minded remaining a bit more ignorant of what may go wrong with that blob of jelly on which I depend. Admissions is a triple-edged title: the admission of patients, admission of unavoidable culpability and mistakes, and admission of the wonders of his field. It is highly personal and hugely relevant, and should be required reading for hospital managers, drug company executives and politicians. For the rest of us, it is an exhilarating, even thrilling read, a glimpse into a world we hope we may never have to enter. But if we do we will now be much better informed.

• Admissions: A Life in Brain Surgery by Henry Marsh (Weidenfeld & Nicolson, £16.99 hardback, £8.99 e-book)
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