Admissions: A Life in Brain Surgery by Henry Marsh Michael Barber

Henry Marsh believes there are fates worse than death. Regrettably, after thirty years at the sharp end of neurosurgery, he has been personally responsible for some of them.

As he once wrote, ‘The more I think of my past, the more mistakes rise to the surface, like poisonous methane stirred up from a stagnant pool.’ Such honesty is rare in public life, particularly among high achievers. So too are such arresting similes. But then Marsh came to medicine late, after a grounding in the humanities at Westminster School and Oxford, where he took a First in PPE. He also spent six months working as a hospital theatre porter, a therapeutic act of rebellion that serendipitously exposed him to what surgery had to offer: ‘I found its controlled and altruistic violence deeply appealing.’

Fast forward to the present and the satisfaction that surgery still affords him is tempered by his loathing for hospital administrators and the idiotic regulations they enforce. Unfortunately, when he finds a target for his anger, it’s not a manager but a nurse. Irate at the man’s refusal to bend the rules on behalf of a patient, he tweaks his nose, as grave a misdemeanour as an officer striking a private. But, as he’s retiring from St George’s in two weeks, his apology is accepted and the matter closed.

This assault is one of the ‘admissions’ referred to in Marsh’s title. Another is the need for doctors to dissemble: ‘There is nothing more frightening for a patient than a doctor, particularly a young doctor, who is lacking in confidence.’ Frank about his surgical mistakes, he is equally candid about his personal shortcomings and the consequences thereof. Work always came first, ahead of his first wife and their children. There were appalling scenes and a messy divorce. He was not a good son either, rarely visiting his widowed father who lived nearby, while acknowledging that the love and support he received from his parents were ‘the principal source of my feeling of self-importance, something which has been both a strength and weakness throughout my life’.

It’s not all bad. On the other side of the ledger are the hundreds of lives he’s saved, not just in Britain, but also in Ukraine and Nepal, where for many years he did pro bono surgery, often with secondhand equipment he’d provided himself. Nor should anyone doubt his ‘passionate’ commitment to the NHS: ‘The faults of socialised health care are ultimately less than the extravagance, inequality, excessive treatment and dishonesty that so often come with competitive, private health care.’ A corollary of this is his disdain for ‘the great industry of personal injury compensation, with its army of suave and accomplished lawyers and assured expert witnesses, rooting in a great trough of insurance premiums’.

Marsh does not believe in an afterlife. But neither does he wish to stay too long at the feast like his parents, one of whom became doubly incontinent and the other demented. In his preface, he reveals that he has a suicide kit of drugs he has acquired over the years. Assuming they still work, would he dare to use them if and when the need arose? Marsh addresses this dilemma again at the end of the book. Considered dispassionately, it’s a no-brainer. Who would not prefer a swift and painless end to a slow and miserable decline? And yet … As La Rochefoucauld observed, ‘Neither the sun nor death can be looked at steadily.’ Which of us, asks Marsh, can honestly say that we would choose death as an alternative to life, however excruciating our circumstances?

One solution, which he endorses, would be to legalise euthanasia for those who have the mental capacity to choose it. But, despite opinion polls that show a majority in favour of this, the political will is not yet there. Nor would euthanasia solve the ‘ever-growing problem of dementia’, since sufferers have lost their mental capacity. On the other hand, surely it’s unethical to penalise doctors if they prioritise the reduction of suffering over the need to prolong life at any cost? It would be a fitting rider to this humane and eloquent apologia if the law were to recognise this.