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28 May 2017

Admission: A Life in Brain Surgery by Henry Marsh – a handbook for giving up hope joyfully

Globetrotting brain surgeon's second memoir offers a frank asessment of man and medicine.

By Will Self

I confess: I haven’t read Henry Marsh’s first memoir, Do No Harm, nor was I aware of the praise it had garnered or the prizes it received, before I read this, his second memoir. I did, however, have an encounter with Marsh some years ago: flicking through television channels late one night, I chanced upon The English Surgeon, a documentary made in the early 2000s, about his work in Ukraine.

In this fly-on-the wall account of one of Marsh’s visits to Kyiv to perform neurosurgery – trips taken entirely at his own expense, to do unpaid work – he came across as rumpled, crumpled and indefatigable. Toting a suitcase full of second-hand surgical instruments, he approached the grim business of cutting open people’s heads and extracting tumours under less-than-ideal conditions with embattled intensity. Not for Marsh the moral posturing of the merely charitable; he evinced rather the true humanism of an Erasmus: alive to the self-inflicted follies of people quite as much as their suffering.

I’ve thought about that documentary many times over the years and wondered about its subject, which made the realisation – as I read Admissions – that I was lancing inside the mind of this fabled neurosurgeon curiously like a homecoming. “Oh,” I kept thinking to myself, as he shared some fact about his life, or vouchsafed another insight into the perilous state of modern medicine, “that’s who you are.”

Lady Bracknell might have viewed the writing of two memoirs as unfortunate – and there is certainly a sense of profound sadness and melancholy wreathing this text. Marsh takes for his subject specifically the year of his retirement from full-time medical practice, and the thoughts and memories that this gives rise to. But given that he’s a self-confessed workaholic, there is little by way of repose to be found here. Marsh remains hard at it, both flying out to Nepal to work with an old colleague who runs the only dedicated neurosurgical hospital in that country, as well as buying and then single-handedly renovating a derelict lock-keeper’s cottage on a canal in Oxford. In between these contemporary storylines, he takes us sailing around the windmills of his mind – reflecting on everything from the mind-body problem, to the mechanics of bed-blocking on the NHS, to his own sojourn in a mental hospital as a suicidal young man.

The portrait Marsh paints of himself in youth – deeply conflicted, subject to intense, almost metaphysical, epiphanies and unrequited romantic passions – is nothing but endearing. All the more so because he manages the rare feat of convincing his readers that the Marsh writing, and the serial Marshes he writes into being, are one and the same person. It’s a paradox, because he is also self-confessedly a radical sceptic: a materialist-monist who views his own thinking “I” as a very provisional construction indeed – a will-o’-the-wisp, conjured into being in the act of reflective self-consciousness, only to evaporate with unconsciousness and death, or be deformed by disease or its amelioration. And I think it is this philosophic position that makes his writing as engaging as it is – because it allows him to express his own fears and sense of failure with a candour free from some overarching ethical calculus, and tempered merely by his own compassion.

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Marsh writes about the actual business of neurosurgery – the sawing and the cutting, the stitching of blood vessels and sucking out of cancerous tissue – with forensic precision. As with so many of us in this wipeable world, my own experience of blood and guts (let alone exposed brains) is minimal; and it is this, surely, that makes us all so squeamish. But to read Marsh on the subject is to feel oneself well capable of taking a seat at the operating table (Marsh’s First Rule of Neurosurgery: get comfortable), taking up a scalpel and getting on with the job.

I particularly relished his descriptions of the anatomy of the brain itself, as well as his can-do accounts of freeing cancerous masses from their baroque architecture – but I enjoyed (if this is the correct word) still more his willingness to delve as fearlessly into his own, troubled being. There are plenty of admissions in Admissions: concerning mistakes he has made (and those made by others); accounts of highly undoctorly behaviour that nonetheless confirms Marsh as the man I would most like to have prying open my skull. And, as someone who is about to undergo surgery (a relatively minor operation), I paid particular attention to those passages concerning practitioners’ attitudes towards the patient etherised upon the table.

Not that Marsh tends in any way towards the Eliotic: his writing about the landscape and nature of Nepal, or Oxfordshire, is as plain-dealing as his accounts of the lives and deaths he witnesses. The Nepal passages (and one concerning a trip back to Kyiv) can be despairing: he often seems to see neuro­surgery as a luxury that poorer countries can ill afford. And yet, although there are particular problems where there is inadequate health-care provision, and where Western rationalism conflicts with traditional beliefs, the overall trajectory medicine that makes across our personal heavens (for most of us, the doctor is the only God in whom we trust) is, Marsh suggests, common to all societies – a Malthusian and unbridgeable gulf between our desire for the ever more sophisticated medical treatments available, and the unwillingness of governments to admit the extent of the tax increases that would be required if we were all to have them free and on demand.

Perhaps most disarming of all is Marsh’s frankness about his fears of growing older and dying. He writes in support of assisted dying – and opines that perhaps the reason so many of us hang on to the bitter end (and have vast resources uselessly expended on keeping us painfully alive), is that we cannot abandon hope. But I suspect it is the creeping normalcy of indigent old age that wrong-foots us: every day we swear to ourselves that if we feel this bad tomorrow, we will seek a way out – but each new day discovers us finding it just about bearable.

Admissions strikes me as the perfect handbook for those who are ready to abandon hope, but joyfully. Copies of it – together with Atul Gawande’s Being Mortal – should be distributed to every care home in Britain. 

Admission: a Life in Brain Surgery
Henry Marsh
Weidenfeld & Nicolson, 271pp, £16.99

Will Self’s latest novel, “Phone”, is newly published by Viking

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This article appears in the 24 May 2017 issue of the New Statesman, Why Islamic State targets Britain