Brain surgeon gives us a piece of his mind . . .
We say of easy things: ‘ I t’s not brain surgery!’ It’s a fitting expression because, as Henry Marsh’s extraordinary memoir of neurosurgery reminds us, this dangerous wave of medical science drifts us towards many unanswerable philosophical questions.
Brain surgery contains riddles and speculations far beyond the technicalities of lobes and fibres.
What are we? are we more than chemical factories? What is consciousness? What is personality? What is thought itself when we know that visible changes and damagethings irrevocably?to the brain can alter all of these
Marsh’s life-work, skill, fascination and sometimes torment lie in this craft of workingfragile, on with the brain, instrumentsso soft andof immense delicacy.
His first book, Do No Harm, was received as an instant classic. One of those rare moments when someone at the summit of medical science speaks to us clearly, emotionally and wisely about the glory, mystery and tragedy of the extraordinary bodies we live in.
This one takes him into his own ageing, with a degree of disillusion and anxiety about the state of hospital organisation, and his decision to retire. a spell working in Nepal follows, and all of it lies interwoven with memories of his childhood, training, family difficulties and many, many patients. He does not spare himself regrets and personal misjudgements.
He, as we all do, has to make sense of it, even as he sees ‘the age-wrinkled skin of my hands . . . through the rubber of my surgical gloves’ and wonders if he will miss the ‘ strange, unnatural place’ that is an operating theatre.
Near retirement, infuriated at a nurse who is ignoring his instructions to remove a nasogastric tube, he actually tweaks the nurse’s nose and shouts — later apologising also to the man in the bed with a rueful: ‘I’m not supposed to attack the nurses in front of patients.’
as I say, he spares himself little: we are offered the whole human being, not just the revered expert. He begins, startlingly, by admitting that among his most treasured possessions is a suicide kit, in case of a malignant brain tumour — too familiar to him — or dementia.
endearingly, though, he doesn’t know if he’d ever have the nerve to we suicideHe use ever talksit, reallyhe andof a once reflectswantgirl, an tended.death.on attempted whether‘ We becametwo days friendsthat sheof a kindwas on for the the ward.’ and although he never knew what happened to her, it is one of many moments of involved empathy with patients. In Nepal, he hated operating on people he was not able to talk to beforehand — ‘like a vet’. But there are costs to this human feeling. He notes, as many older doctors
do, that you can lose your professional detachment as you age, and sorrow too much for the losses and disablements you see. Buying a derelict lock-keeper’s cottage, which he renovates with his own, precious surgeon’s hands, he finds himself looking at old men in wards and wondering about the one who must have died in his cottage. Real streaks of pain run through his distress at children who will never see or speak again, tumours whose outcome will be grim and personalities that are altered as the brain changes from a bleed or tumour, but also, he reflects, with ageing. Including his own. ‘How can I know if I am the same person I was yesterday? This fragile, conscious self writing these words that seems to sail so uncertainly on the surface of an unfathomable electrochemical sea is the product of countless millions of years of evolution — as great a mystery as the universe itself.’ To sail on that strange sea with Marsh and his memories, to share his pities and indignations at bureaucratic heartlessness and disease itself is both exhilarating and alarming. some of the technical detail I had to force myself not to skim over; some was so fascinating it drew me on.
There are moments of charm, not least when, 25 years after he finished school, he sees the brain scan of his sadistic former Pe teacher and a colleague says that maybe it’s the tumour that makes the patient so unpleasant. Marsh says: ‘ It’s not’ and decides that he is not the man to do the biopsy.
The Nepal work is harrowing but, again, fascinating. Relatives will take a ‘ braindead’ patient home, using a hand-squeezed air bag to keep them breathing, so they can die in peace.
and the patients meet his immense respect ( I like the 65-year- old man complaining that he has ‘ difficulty climbing trees and milking buffalo, sir’.)
He notes the local stigma against psychiatry and regretfully allows a woman an MRI scan even though ‘ it won’t show anything, but she hopes it will make her unhappiness real’.
Back home he inveighs against the ‘ whiplash’ industry, and snaps: ‘ Never, ever operate on the spine of somebody involved in compensation litigation. They never, ever get better.’
He is, he says, denied the comfort of believing in an afterlife. But there is a gentle conclusion; Marsh stands by his river, ready for the retired life in his lock-keeper’s cottage and one day the dissolution of his physical atoms.
‘When my brain dies, I will die... I am a transient, electrochemical dance.’
Maybe. But it is a privilege to dance it with him through these engrossing, revealing pages.
100,000 The number of miles of blood vessels in the human brain