Brain surgeon who laughs in the face of death
Ithink we can call off the search for the World’s Most Calmly Imperturbable Man. The winner is the patient on whom Henry Marsh (above) once performed a bungled operation to release a trapped nerve. The next day, Marsh approached the bed and told the man, ‘I’m afraid I have some rather bad news -- I’ve operated on the wrong side of your neck.’ After a thoughtful silence, the patient replied: ‘Mr Marsh, I put in fitted kitchens for a living. I once put one in back to front. It’s easily done. Just promise me you’ll do the right side as soon as possible...’
Marsh is the English neurosurgeon whose bestselling 2014 memoir Do No Harm: Stories Of Life, Death And Brain Surgery kicked off the genre of Medical Memoir, which flourishes, eight years later, in works by Adam Kay, Rachel Clarke and Gavin Francis.
Marsh described, bluntly and breezily, how it feels to drill or saw into a human skull and forage in the spongy brain for some microscopic intruder that threatens a patient’s life. He also told shocking tales of NHS mismanagement – and of his own ineptitude that sometimes left his patients at least half-dead.
And Finally is a sequel of sorts – about what happens when a doctor, 40 years into his career, becomes a patient. It starts with a horrible shock, when Marsh volunteered to take part in a study of brain scans in healthy people. Expecting to see an organ of ageless perfection on the screen, he gazes instead at ‘ageing in action, in black and white pixels, death and dissolution foretold...my 70year-old brain was shrunken and withered… I am starting to rot’.
From this ghastly revelation, Marsh embarks on a journey towards surgery and recovery – but not on his brain. In Chapter 4, he reveals that he’s been diaghe nosed with advanced prostate cancer (he likes to volunteer such information casually and without drama, as when he quietly mentions that he’s had chemical castration) and the book follows his preparation for the ordeal.
His intention, though, is not to horrify the reader with pages of pain and mortality. He spends most of his time discussing everything else on his mind: his love of making furniture, keeping bees, hanging out with his granddaughters (he devotes a whole chapter to the fairy tales he tells them, about the Rain Witch who causes floods, and the unicorn with Droopy Horn Disease), recalling his trips to Ukraine, where he pioneered neurosurgical advances, and planning ways to make hospitals less grim and scary for patients.
Horrified by the spartan bleakness of a new hospital, he arranges for ‘neurosurgical gardens’ of cypresses and green plants to be installed on ward balconies. He removes gloomy paintings, pastiches of ‘the suicidal artist Mark Rothko’, from outpatient waitingrooms and replaces them with floor-to-ceiling photographs of the sun rising through trees.
Marsh’s seemingly formless jumping from subject to subject conceals his skill in writing about two things at once. You read the long description of his beloved London house, and the renovations brought to it over 20 years, and you know he’s talking about his own now-declining body. You read about the scrappy contents of his loft, its possessions (cameras, LPs, computers) made redundant by time, and you know he’s thinking about his fading brain and memory.
You can’t help but be startled, though, by this intellectual titan’s fondness for earthy jokes. The subject of prostate cancer is a rich seam of potty humour, of course, but Marsh revels in it. Early in the pandemic he reports, ‘Loo paper disappeared so I took to perching over the bathroom basin’ (an image I struggled to banish from my mind) and thereafter we get regular reports along the lines of ‘I’d washed my bottom in preparation for a rectal examination’.
The tone is raised by a brilliant line about ‘fiducials’ which are tiny specks of gold inserted by syringe into the prostate to guide X-ray beams.
Recalling that he’s also got three gold fillings in his teeth, Marsh says, ‘I could now modestly boast that both the entrance and exit to my gastro-intestinal tract were lined in gold.’
The book ends with good news on the prostate front, a new beginning for Marsh as a teacher of neurosurgeons, a decision to give up his beloved cottage on Oxford Canal to end his days in London, a serious and passionate argument in favour of assisted dying and – coming out of nowhere – a shocking revelation about his aunt and uncle’s enthusiastic participation in the Nazi war machine.
You close this tumbling, ruminative, magisterial, self-questioning, poignant, funny and slightly bonkers memoir as puzzled as ever by the complexity of the brain but entranced by the author’s pure enjoyment of what Philip Larkin called ‘the million-petalled flower of being here’.