Henry Marsh Admissions A life in Brain Surgery


The first memoir by Henry Marsh , neurosurgeon, ( Do no Harm 2014) was received to high acclaim. His second book is a mixture of personal memoir, detailed description of the craft of neurosurgery with wider reflections on the practice of his speciality and thoughts on the NHS , to which he is passionately committed. He is also facing retirement, and his own ageing and mortality.

“I am starting all over again, but am running out of time “he writes.
He describes the internal cemetery surgeons have in their imagination, where they can revisit the patients who died, either because of surgical error or the wrong decision to proceed to operate at all.

The descriptions of micro brain surgery are fascinating –a tiny spatial misjudgement can result in catastrophe for the patient –but his reflections on the difficulty of making the decision to operate or not are just as powerful. The patient will die without an operation –but may be left with profound disability if operated on. He has difficult conversations with patients and their families and feels the burden of those decisions.

After retirement from the NHS he spends time operating in Nepal-language barriers means those conversations cannot be had, and because the patients are paying for the surgery, they insist on operations even when the outcomes will be disastrous. He describes the way a fee for service private system distorts clinical decision making. He is obviously devoted to his work, hardworking and sees his patients as people with their own lives.

However he is also arrogant, nostalgic for the days when junior doctors in training worked 80 hour weeks, resents moving from a smaller hospital( where he was left to get on as he liked,) into the large teaching hospital ,albeit with state of the art facilities. He is anti-management and scathing about systems of clinical governance. This has made him a heroic figure to some –to others, they can see that working relationships must have been very difficult. He describes a serious altercation with a nurse who refuses to go against protocol despite his instructions (luckily for him this happens just before his retirement -otherwise he almost certainly would have been disciplined.) It’s interesting that he is able to be honest about this, as the incident certainly does not show him in a good light.

He retires from the NHS angry that he is no longer completely” in charge “as the consultant. Retirement means continuing to operate in Nepal and the Ukraine, where he eventually (inevitably ?) falls out with his long standing colleague .He takes on a” retirement project”, renovating an old cottage –still being practical with his hands.

This is a mixture of a man –with a capacity for great arrogance and great humility. He has a refreshing ability for reflection –on his work, on his own impending mortality and the wider issues of euthanasia. As he describes himself with all his flaws, he does not come over as likeable. However, this is a fascinating account, well written and well worth reading.

Dr Linda Patterson Retired NHS consultant physician

Henry Marsh Admissions A life in Brain Surgery is published by Weidenfeld and Nicolson: 2017

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