At the cutting edge of brain surgery

by Henry Marsh (W&N, £16.99)

HENRY Marsh is a man of simple needs: all he wants is to get on with restoring the lock-keeper’s cottage in Oxford which he has chosen for his retirement while occasionally taking time off to split people’s heads open and do what he can for their brains. For Marsh is a brain surgeon, recently retired from a lifetime’s work in the NHS, who still applies his skills helping former colleagues wherever he can be of use, mainly in Nepal or Ukraine.

The one-word title of his new book is cleverly chosen to reflect its two main elements: admission can refer either to the patients admitted to hospitals for surgery or to Marsh’s own admissions of errors or misjudgments in their treatment.

The book has its share of both varieties interspersed with Marsh’s thoughts on medicine, politics, religion, death, the NHS, Nepalese elephants and anything else that may affect the treatment of his patients. It all adds up to a fascinating memoir.

“Doctors deal with probabilities, not certainties,” he tells us with admirable frankness, and that remark must be true of brain surgery most of all. His accounts of the removal of brain tumours are not for the squeamish, particularly in cases pioneered by Marsh, in which the operation is conducted with the patient conscious.

In Nepal there is the added problem of the threat of assault from a patient’s family if things go wrong, which increases the stress on a surgeon deciding whether to operate and deciding whether to call a team of security men in case of a bad outcome.

Deciding whether to operate at all can be a major challenge when the most likely result will be to create more misery for all concerned:

“The moral challenge is to treat patients as we would wish to be treated ourselves, to counterbalance with professional care and kindness the emotional detachment we require to get the work done. The problem is to find the correct balance between compassion and detachment.”

Marsh also tells us: “It is estimated that there are 7,000 people in the UK in a ‘persistent vegetative or minimally conscious state’. They are hidden from view in long-term institutions or cared for at home 24 hours a day by their families. There is a great underworld of suffering away from which most of us turn our faces.”

“Does one good result justify all the suffering caused by many bad results?” Marsh asks, and he refers to some of these bad results as “headstones in my inner cemetery”.

WHETHER discussing his mistakes, or furious at politically inspired bureaucratic interference in what should be purely medical decisions from the UK to Ukraine via Nepal, Marsh paints a vivid picture of the pressures imposed on a surgeon who is quite literally at the cutting edge of modern medicine.

Only two things are missing: a chart of the parts of the brain for people like me who cannot tell our amygdala from our thalamus, and a glossary of acronyms. Even Marsh himself confesses to some bemusement when told that patient may be in a HONK coma following an AIR or SUI.