British star surgeon writes about life and death – one of many new titles in Camera Obscura
Lately a great many new titles have been purchased for Camera Obscura and Laterna Magica, KIB’s special collections in the humanities. Among the newly acquired titles are The house of God by Samuel Shem, Anesthesia: the gift of oblivion and the mystery of consciousness by Kate Cole-Adams, and The novel cure by Ella Berthoud and Susan Elderkin to mention but a few.
Among all the interesting authors whose books have been purchased there is one that I want to highlight, the British neurosurgeon Henry Marsh. He has published two memoirs, Do no harm: stories of life, death and brain surgery (2014) (at the moment only available in Swedish with the title Liv, död och hjärnkirurgi : en neurokirurgs memoarer), and Admissions: a life in brain surgery (2017), which ought to be compulsory reading for all future doctors, regardless of specialty. Or indeed not only for them, but for all who are interested in the conditions of the medical profession and the patient’s vulnerability in health care. In the end, Marsh writs about the fragile thread between life and death, both in and outside the operating theater.
At the prospect of his upcoming retirement, Marsh is looking back at a long, successful life as a hailed neurosurgeon, but it is with a gaze that is ruthlessly sincere about his own shortcomings as well as bad conditions in the British health care system. In a very expressive language Marsh reflects on the inherent insecurity of the medical profession: ”Many medical decisions - whether to treat, how much to investigate – are not clear-cut. We deal in probabilities, not certainties.” … ”Sometimes, if you are to make the right decision, you have to accept that you might be wrong.“ And in spite of all the lives he has saved, and all the personalities he has restored, his failures keep haunting him.
When Marsh’s professional life now is coming to an end he feels great ambivalence before leaving the work that has been his life for 35 years. ”I lay on the red leather sofa in the neurosurgeons’ sitting room … longing to retire, to escape all the human misery that I have had to witness for so many years, and yet dreading my departure as well.” … ”Part of me longed to leave, to be free form anxiety, to be master of my own time, but another part of me saw retirement as a frightening void, little different from the death, preceded by the disability of old age and possibly dementia, with which it would conclude.” Marsh also reflects on his new status towards the patients he has treated: ”As a junior doctor you are pretty detached from the reality that faces so many of the older patients. But now I am losing my detachment from patients as I prepare to retire. I will become a member of the underclass of patients – as I was before I became a doctor, no longer one of the elect.”
About this “detachment” Marsh has many memorable things to say. It is often pointed out that future doctors have to acquire an empathetic approach, but Marsh develops this reasoning further. ”For most of us, when we become doctors, we have to suppress our natural empathy if we are to function effectively. Empathy is not something we have to learn – it is something we have to unlearn.” And furthermore he says: “The moral challenge is to treat patients as we would wish to be treated ourselves, to counterbalance with professional care and kindness the emotional detachment we require to get the work done. The problem is to find the correct balance between compassion and detachment. It is not easy.”
Other topics for the author’s thoughts are the insoluble band between medicine and money: ”Money and medicine have always gone together: what could be more precious than health?” he says with typical vigorousness. But despite the shortcomings of the public health care system he believes this to be preferable to the private health care sector: ”The faults of socialized health care are ultimately less than the extravagance, inequality, excessive treatment and dishonesty that so often come with competitive private health care.”
Death is constantly present in Marsh’s reflections, but there is also room for a liberating humour and self-irony. Highly amusing is the story of how Marsh, during one of his daily jogging tours along the Thames, crawls out along a steel beam that is projecting over the river to free a duck that was stuck in a fishing line: ”The duck promptly dived into the water without stopping to thank me. Nevertheless, I like to think that if one day I ever get into trouble when swimming, the grateful duck – as in the fairy stories – will come and rescue me.”
Reading Henry Marsh is taking part of a prominent and thoughtful professional’s closing of his career, and he does it with honesty, humour, and eloquence. Marsh is undoubtedly as skilful with his pen as with his scalpel.