A few years ago, Henry Marsh cheerfully agreed to have his own brain scanned. As a neurosurgeon fascinated with neuroscience, why wouldn’t he? “Although I had retired I was still thinking like a doctor – that diseases only happened to patients.” He was, he admits, being vain but at 70 he ran, did “manly press-ups” and was still clever, with a good memory.
When the scans arrived he was able to interpret them himself, as he had done with those of many a patient. To his horror he saw a brain shrunken and withered, poxed with ischaemic damage. “My brain is starting to rot,” he says. It was all natural, time marching on, but still it filled him with helplessness and despair.
Furthermore, Marsh also found himself with advanced prostate cancer. Treatment was available but not a cure. So he began what cancer patients are encouraged to call a “journey”, and this book is a surprisingly entertaining, informative report on what happens when an eminent neurosurgeon suddenly becomes the frightened patient.
[see also: Henry Marsh on the mysteries of the brain]
To access treatment, he would cycle along the towpath to his own hospital, but rather than entering the staff hub, ready to make decisions and plans for others, he was obliged to suffer the patients’ waiting rooms; a different perspective entirely. He felt the wild oscillations between acceptance and fear familiar to everyone given an unwelcome diagnosis, the desperate hope, the same as his patients had. “Despite the evidence… the wish to go on living remains as intense as ever.” This hoping in the face of evidence seems to be a trait which evolution has created in humanity. Likewise, he says, is the short-termism that may yet be our undoing, as we fail to act to prevent imminent crises.
If, however, the wish to go on living is exhausted and disease becomes too much to bear, and a person sincerely wishes for death, then Marsh argues cogently and emphatically that assisted dying should be legalised in the UK, as it is in several other countries. He writes: “to help somebody to a peaceful and dignified death that they have chosen for themselves is an act of care and love”. He considers those who argue against assisted dying to be responsible for much suffering. His own disease has caused Marsh to remember certain patients he treated years ago, some of whom could not be saved, and he candidly admits that his recent experience as a cancer patient has taught him more about communication than he knew then.
Retirement means he can devote time to the grandfatherly hobbies he now enjoys – making a dolls’ house, for example, and his less-than-expert building projects. A whole chapter is devoted to the fairy stories he made up for his granddaughters, delivered by iPhone over lockdown. Disarmingly, he recounts how, despite his eminence and cleverness, he was conned by cowboy roofers. These can seem like amiable digressions but he has a knack of bringing them round to illustrate his central topics. The conmen’s charm, for example, which sucked him in until he felt he couldn’t withdraw, is analogous to a misdiagnosis in medicine. A doctor can find it hard to retreat from a mistake; it is easier to press on than to stop and reappraise. And so the tale of the cowboys who deliberately damaged his healthy roof leads to a discussion about how and why we trust doctors, and the inevitability, even the necessity, of their occasional failure.
[see also: The Great War’s miracle worker]
This is a valuable book from the front line of ageing. It may be called And Finally – that slightly droll tone is typical – and it may suggest a closing down, but its gift is open-handedness, a wise and Janus-like looking forward and back. At the time of its writing Marsh had undergone a year of cancer treatment and the disease is stalled, not cured – he hopes to finish the dolls’ house. The years ahead, however, will be troubled by world events. He knows Ukraine well, having taught and practised there for several decades. He phones friends in Ukraine often, sometimes air-raid sirens are audible in the background. His own mother fled Nazi Germany, and he fears for the world his grand-daughters will inherit, especially the multiple crises climate change will bring. But despite that and the inevitability of our own personal declines and deaths, “we have a duty to be optimistic. If we are not, and we give up, then evil will certainly triumph.”
And Finally: Matters of Life and Death
Jonathan Cape, 240pp, £16.99
This article appears in the 07 Sep 2022 issue of the New Statesman, Liz Truss Unchained