Henry Marsh’s first volume of memoir, Do No Harm, gave an unforgettably human voice to the most elevated and mysterious of medical callings: that of the neurosurgeon. Marsh had come to that vocation as a young man, not long after he had witnessed the miracle of his three-month-old son survive the complex removal of a brain tumour. He had studied philosophy at Oxford, but here was a path that appeared to offer a more hands-on route to everyday enlightenment. His first operation, to clip an aneurysm, not only saved a life but restored an individual to his self. “What could be finer, I thought, than to be a neurosurgeon. The operation involved the brain, the mysterious substrate of all thought and feeling, of all that was important in human life – a mystery, it seemed to me, as great as the stars at night and the universe around us.” And all of that, for better and worse, would be at his fingertips, every working day.
Nearly 40 years on, Marsh is looking at those mysteries from the other end of the telescope. He has reached the end of a distinguished career as one of Britain’s foremost brain surgeons, mostly working as the senior consultant in the Atkinson Morley wing at St George’s hospital in London. He retains elements of that former idealism – certainly a good deal of the wonder – but they are inevitably shadowed with the more disturbing imponderables of his chosen profession. For all of the lives he has saved, and all of the selves he has restored, he is haunted and troubled above all by his failures.
The precision of his scalpel inevitably comes up again and again against the greyer areas of mind and matter. “I have learnt that handling the brain tells you nothing about life – other than to be dismayed by its fragility.” Marsh’s vocation has taught him many things, but humility appears chief among them.
This second volume of memoirs sees him searching, in this life of uncertain outcomes, for a real sense of an ending. It opens with his retirement from the NHS imminent, and facing a new life in which he will have to find a surrogate for the intensity he has enjoyed. In time off from hospital and theatre, Marsh relaxed through carpentry: he built not only furniture but staircases and roof joists for his London home. His retirement will take him to Oxford, where he grew up, where his second wife feels at home, and where, in desperate search for a retirement project that will consume him, he has bought a derelict lock-keeper’s cottage to restore.
Admissions intermittently tracks the progress of that renovation, the cottage becoming a metaphor for Marsh’s sense of moving forward into a new life, but also of mortality as he relives the childhood he lived near here. He jokes in a preface here that his most precious possession is his suicide kit, a few drugs he has kept back over the years, perhaps long past their sell-by date. He has witnessed enough dementia and senility in his career to know he would like to avoid that fate for himself – or at least he thinks he knows; he has, too, seen euthanasia sympathisers converted to life at all costs when it comes to it.
In the meantime, he dreams not of dying with dignity, but of retiring with it. When he was a junior, a houseman, his own senior consultant’s career had ended triumphantly, he recalls, with the removal of a large tumour from a young female patient. A couple of days later, in her hospital gown and with her head still shaved, she had risen from her bed to present her saviour with a valedictory bouquet of flowers. There is no such “closure” for Marsh, much as he craves it. His final NHS operation is a success, but he ends his career in a bureaucratic row over new speech therapy guidelines that sees his patient being fed through an unnecessary nasal tube and him (literally) tweaking the nose of a male nurse in fury.
Marsh is, given his profession, a surprisingly emotional man, likably so. His account of his younger self that threads through this compulsive book is a Bildungsroman in itself. He is also a fine writer and storyteller, and a nuanced observer. Now that he is not practising full time in the NHS he writes frankly about some of its problems (even more so than in his previous book). He does his best not to be bitter, but he is certainly disillusioned. “The feeling that there was something special about being a doctor had disappeared,” he says of his final years.
He was spending less time with patients, more time in meetings, justifying his judgments, discussing the latest government targets and edicts. The hospital itself had become larger – his previous unit, in which everyone knew everyone – subsumed into a more anonymous and less accountable corporate structure. Over the years, and on an ongoing basis, Marsh has worked pro bono for friends and former colleagues in hospitals in Nepal and the Ukraine. Even these points of reference do not always show the British system in the best light. “Of course doctors need regulating, but they need to be trusted as well. It is a delicate balance and it is clear to me that in England the government have got it terribly wrong…” Sadly, he feels well out of it.
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