I have spent the past few days at the Edinburgh International Book Festival and on Monday, I went to a talk by Henry Marsh about his new book ‘Admissions: A Life in Brain Surgery’. I really enjoyed reading Do No Harm: Stories in Life, Death and Brain Surgery in 2014 in which he reflected on the successes and failures of his career as a consultant neurosurgeon and his frustrations with NHS hospital management with remarkable frankness. As the clever pun in the title suggests, his second book is similarly confessional and candid, perhaps even more so in some respects.
Having retired from full-time NHS work in 2015, Marsh reflects more on his family and personal life post-retirement in which his main efforts to keep busy and reduce the risk of developing dementia are focused on renovating a derelict lock-keeper’s cottage he bought in Oxfordshire close to where he grew up. However, Marsh continues to operate in Nepal, Ukraine and Albania and he addresses how certain experiences in his youth have influenced his career and his approach towards treating patients.
Overall, there is a little less focus on specific medical cases in ‘Admissions’ compared to ‘Do No Harm’ but there is a fascinating chapter about the “awake craniotomy” procedure for treating low-grade glioma tumours in which the patient is conscious and answers questions or performs simple tasks so that the surgeons can be assured that they are not damaging the brain during the operation. It means that patients even have the rare opportunity to see their own brain on a monitor, a situation on which Marsh reflects: “You feel there should be some philosophical equivalent of acoustic feedback when this happens, a metaphysical explosion, but there is nothing”.
During the event, Marsh said that surgical procedures are often not that difficult to carry out in terms of the level of manual dexterity involved. Instead, it is the difficult conversations with patients and their families which pose real challenges and moral dilemmas, particularly when having to explain that medicine is an inexact science, dealing with probabilities, risks and likelihoods rather than certainties or guarantees of a full recovery. This is especially notable in the chapters about his work in Nepal, where there are dramatically different attitudes towards managing the expectations of patients and their families, many of whom refuse to accept that some tumours are inoperable. As well as working with considerably fewer resources in the only neurosurgical hospital in the country, Marsh also had to adapt to different approaches towards teaching junior clinical staff who are often reluctant to admit mistakes or ask for help.
Marsh has been notably outspoken about increasing levels of bureaucracy and litigation in the NHS. He seemed a little more measured in tone during the event compared to his comments in his books but reaffirmed his belief that the government is in denial about the need to raise taxes in order to spend more money on healthcare in the NHS. There is also an eye-opening chapter about a legal case in which he was sued by a patient for negligence which eventually collapsed at the last minute.
‘Admissions’ is an excellent companion to ‘Do No Harm’ and Marsh is equally engaging and thoughtful as a writer and as a speaker, balancing some humour with more philosophical reflections. He said that he currently doesn’t have any plans to write a third book but given his obvious talent for writing, I hope he hasn’t put down his pen for good.