Lessons in life and death from a rock star of medicine
Brain surgeon Henry Marsh is a rock star of medicine, a description which will not i imagine dismay him.
He is not short of vanity, as he admits, and after all, you have to be pretty ballsy to be prepared to cut people’s heads open for a living, to quite literally hold someone’s life in your hands.
His earlier book Do no Harm, an enthralling and very frank account of his storied career in neurosurgery around the world, was an international bestseller.
now the scalpel, so to speak, has changed hands and Marsh, who has retired, finds himself on the receiving end after a cancer diagnosis.
But that is only the jumping-off point for this remarkable book: it is admittedly a patchwork covering a rich tapestry of topics from woodworking, trekking in the Himalayas, the etchings of the 16thcentury German artist albrecht Durer, the Covid lockdown, the working habits of Ukrainian snipers, roof scammers who plague elderly homeowners, the bewildering structure of the brain, sleep and the nature of dreams, the joys of pottery, hospital decorations, quantum physics, the actions of an Mri scanner . . . and of course mortality.
it’s a wildly discursive (perhaps too much for some tastes) though hugely entertaining book, just over 220 generously printed pages: i have read it twice but feel i have just skimmed the surface.
above all, perhaps, this is a book about getting old. it opens with Marsh volunteering to take part in a study of brain scans of healthy people, something he had always advised patients and friends to avoid. You might not like what you see, he tells them.
However, he is confident: he has good balance and coordination, is pretty clever (you’re telling me), ran several miles a week and lifted weights. He assumes that he will be one of the small number of older people whose brains show little sign of ageing.
But that’s not how it works out. ‘when i eventually looked at my brain scan,’ he writes, ‘all this effort looked like King Canute trying to stop the rising tide of the sea.’ His then 70-year-old brain is ‘shrunken and withered, a worn and sad version of what it must once have been’.
Though it isn’t known how much of the shrinking is due to loss of the ‘white matter’ that connects nerve cells and how much due to the death of the nerve cells themselves, the so-called grey matter, it was a deadline, the writing on the wall. and it certainly puts you off having a brain scan yourself.
Marsh can console himself with the thought that size doesn’t necessarily matter: in its first 18 months, a baby has many more synapses in its brain than an adult. Development from then on is about removing synapses: the brain is sculpted by experience, cutting away connections that aren’t being used.
Marsh muses on the nature of the brain, which was, after all his workplace, and the incomprehensible numbers involved. Human beings start life as a single cell, but end up as creatures of 30 trillion cells. Marsh’s being, his soul if you like, as with all members of the human race, is made up of the 86 billion nerve cells of our brains.
More than half a million kilometres of wiring connects the nerve cells together at junctions called synapses. it’s estimated there are about 125 trillion synapses in the adult human brain.
These numbers are so colossal it is impossible to envisage them. Sometimes there are metaphors to help: a standard building brick is 65mm thick. if 125 trillion bricks (the number of synapses in our brains) were stacked on top of each other, they would reach beyond planet Pluto and the outer limit of our solar system.
The truth is we are quite helpless when trying to imagine what goes on in our brains.
But, as Marsh writes, out of this unimaginably complex dance of nerve cells comes colour and sound, pain and pleasure, thought and feeling.
artificial intelligence ( ai) is much trumpeted as being the shape of our future. But as he points out, the ‘intelligence’ of an ai system is totally different to a child’s intelligence. a child only needs to see a cat once before being able to identify all cats in future, whereas ais need to ‘see’ millions of pictures of cats before they can identify them.
Take that, Zuckerberg. Like many doctors, Marsh doesn’t believe he can become ill. For years he has overlooked the symptoms of prostate problems, which afflict more or less all men of a certain age. and beyond.
eventually he agrees to take a PSa blood test: PSa stands for prostate specific antigen and most men will be familiar with those initials.
The test reveals a PSa of 127, a number that will make any man over 50 or so turn white. it is effectively a death sentence.
ANORMAL PSa is less than one. it means Marsh has prostate cancer. at first he believes the number is so high because he has cycled in for the test. in fact, he is told, he would have to cycle 100 miles on a very bumpy road to raise it by one.
Prostate cancer thrives on the male hormone testosterone, so chemical castration — or suppressing testosterone — is an important part of Marsh’s treatment, though he cannot stand the side- effects (exercise becomes more of an effort, and there are certain unpleasant physical changes, as he becomes plump and hairless).
But it works, the cancer hasn’t spread, and after a few months he can, happily, start radiotherapy. in the meantime this allows him to take a typically vigorous and vivid cruise around the arguments over assisted dying.
Marsh is an advocate of a change in the law, and points out tellingly that the main argument against a change — that family members, doctors and relatives will try to pressure vulnerable elderly people to kill themselves — is absolute nonsense.
There is no evidence that anything like that happens in countries where assisted dying is allowed. or are British healthcare workers and families especially callous?
Marsh has worked for years in Ukraine, a place he considers his second home.
in one extraordinary episode, he meets a Ukrainian sniper — this is long before the current conflict, after the initial Soviet invasion of the Donbas — and asks about his work.
‘is post-traumatic stress disorder a problem?’
‘i don’t think it’s a problem for Ukrainians,’ he replied.
‘ Do you aim for the head?’ i asked.
‘not necessarily. it depends on what you want to do. Sometimes you want to injure the man so he lies in front of his comrades, crying out to them, but you stop them reaching him.’
‘a very dirty war,’ i said.
it is hard to imagine a more vivid illustration of the savagery of the conflict going on in europe.
and every page of this wonderful, discursive book is enriched by Marsh’s humanity and wisdom, wherever his mind decides to alight. it is nothing more or less than a beautifully written exploration of the nature of humanity, and the mysteries of science and the brain.