Reviewed by Dr Kathleen Huxley
As a follow on from his successful book Do No Harm Henry Marsh, the author of ADMISSIONS: a life in brain surgery weaves his wealth of experiences and roles as a doctor, neurosurgeon and colleague as well as son, husband and father into a series of fascinating snapshots into his life. Via memories and reflections of poignant occasions, overseas trips and personal details we are taken through detailed accounts of professional case histories intertwined with his personal and emotional journeys in an interesting and thought provoking narrative.
Initially, I interpreted the title of the book as a reference to admission of patients in his clinical role as a doctor but then realised he is also cleverly using it to refer to his own intimate admissions. Using the term in this revealing sense he is brutally honest in telling us about insights into his own personality and character and in particular, what he considers to be his shortcomings in the diverse roles he has been assigned or assumed in his life. Regarding his relationship with his parents he tells us ‘I was not a good son. I exploited their love, although their love was certainly the principal source of my feeling of self-importance, something which has been both a strength and a weakness throughout my life’.
Organising his thoughts and writing into twelve convenient chapters that tell a story in a compartmentalised way he approaches the end of his life and career as doctor in philosophical mode. As with many doctors he uses the experiences and lessons learnt from his former patients and jokes that his suicide kit is his most precious possession. As he contemplates his encroaching age he has no illusions about end of life choices but senses that hope of a future is something we all cling to even when dying. However, he feels the place where most of us will die – a busy hospital ward – is not necessarily conducive to conversations about hope.
Chapters which discuss his clinical work in the UK show a real frustration with how the NHS (National Health Service) is evolving and he cites several examples of rampant bureaucracy to illustrate his thoughts. In fact his exasperation with current NHS systems is given as the reason why he decides to resign from his London hospital post. He discusses and compares his work in a first world country with that he undertakes in two low income countries – Nepal and Ukraine. Different cultural norms and approaches in the field of medicine used in these countries are related using painful and often difficult case descriptions. The inherent difficulties and complications of practising brain surgery in any country make us reflect on the enormous talent and intricacy required of the job.
Alongside the love of his pioneering and professional role Henry describes himself as someone who greatly loves DIY and his ability to create, repair and build using his extensive collection of power tools to improve and renovate his homes. He describes the current restoration of his cottage, which he is doing himself, as a constant source of satisfaction.
At times harrowing, sombre and thought provoking this book explores a profession that many of us are fortunate enough not to have personally experienced or thought about. In the discussion of a multitude of medical cases in different countries, intertwined with more personal introspection, we realise that science has not yet solved many of the issues in the world of neurosurgery. Despite this we are given hope in the knowledge that there are teams of very hard working and dedicated professionals out there.
By Henry Marsh
Orion Publishing Group
UK: £16.99; 271pp