Retired neurosurgeon Henry Marsh doesn’t want to die. But then, as he rightly points out, who does it?
Marsh has prostate cancer and, after a long career of trying to prevent the deaths of others, is considering And finally – a successor to his memoirs Do no harm (2014) and Admissions (2017) – on what matters most in life through forced clarity of terminal illness.
As a medical student, Marsh remembers going through a brief period of fear that he had had all kinds of life-threatening illnesses until he decided, no doubt out of self-preservation instinct, that only patients – not doctors – had diseases.
Marsh’s own cancer diagnosis naturally came as a surprise. He blames himself for not seeing a doctor sooner, despite the obvious warning signs. Yet Marsh simply did what many of us do knowing deep down that something is wrong: he ignored the symptoms.
The journey between operating on patients and becoming one is not easy. Admitting vanity as a “self-important surgeon”, Marsh is his harshest critic, dismissing his younger self as impulsive, tactless and inconsiderate.
He’s also brutally honest about his reactions to the cancer diagnosis, condition and treatment – whether it’s tears, incontinence due to an enlarged prostate or chemical castration through starvation. androgens. Hormonal treatment leaves this passionate runner with the “plump and beardless body of a eunuch”.
The former surgeon’s relationship with hospitals is also changing. Where once they gave him status, now they make him understand that he is part of the patient “underclass”. More familiar with operative scrubs, he experiences the indignity of wearing a gown with an absurd gap exposing the bottom and is sometimes ignored or discussed by medical personnel.
Marsh uses these experiences to question the way he has treated some of his patients in the past and reconsiders the truths and half-truths that surgeons use in the consulting room, as well as their flexible working relationship with hope, apparently. a powerful medical tool. But instead of celebrating saving lives, Marsh torments himself by remembering patients with incurable tumors, like the botanist in the Ecuadorian rainforest he couldn’t save.
Advice is offered on how physicians and surgeons should avoid his mistakes, particularly with regard to communication and empathy, which he considers, like exercise, to be hard work. But the book is much more than a “how-to” manual. It’s a beautifully written collection of memories, thoughts and life lessons encompassing marriage and breakups, a fear of dementia and climate change, an obsession with woodworking and a compulsion to make things, despite building roofs that always leak.
Marsh also shares the joy of imagining fairy tales for her three granddaughters, who are named in the book’s dedication. He considers the ethical dangers of euthanasia alongside the compassionate use of assisted death and the more inconvenient and unofficial practice of ‘terminal sedation’ in the UK.
This is where medical staff give lethal doses of opiate painkillers to patients under the guise of relieving pain and distress. Coming to terms with this act as a young doctor, which he still believes is the right thing to do, he now realizes that unless previously discussed with relatives or loved ones, this is euthanasia without consent.
All of his thoughts linger after the reading: whether it’s the importance of death and personal choice; dismay at being scammed by a builder; or the pride of making dollhouses with bedroom floors in burl elm, ash and ebony. He looks back on operations in the UK, Nepal and Ukraine, where he worked for almost 30 years until shortly before the pandemic, and whose current situation leaves him desperate.
Among these memories are often brilliant descriptions of how certain parts of the brain function. He explains the standard model of consciousness and its relationship to the brainstem by comparing consciousness to the brightness of light glowing at the ends of hundreds of strands in a fiber optic lamp. Cut off the electricity (brain stem) and there will be darkness. If the brainstem remains intact and connected, even if some fibers are damaged, there will still be light. That’s why surgeons, including Marsh, have encountered patients with seemingly serious head injuries – like a chisel driven into their brains – but who are still conscious.
Although he has faced death for his entire career, it is only after Marsh faces his own impending demise that he understands more about his life. By sharing their discoveries, And finally will undoubtedly inspire others to reflect on their own existence and, more importantly, to recognize what is truly worth living.
And finally: Matters of life and death by Henry Marsh, Cape Jonathan £16.99, 240 pages
Join our online book group on Facebook at FT Books Coffee