And Finally: Matters of Life and Death by Henry Marsh 2022

Marsh, a 72 year old retired British neurosurgeon, has written a remarkable book.  Like his earlier book, Do No Harm, he comes across as a thoughtful, funny, and discerning individual.  I’ve known a lot of neurosurgeons in my career, and generally, they’re a weird lot. With a few exceptions, they’re a bit awkward and uncomfortable with people who are not anesthetized, but not Marsh.  He’s the person I would have wanted to operate on me had I needed a neurosurgeon some years ago.

This book was occasioned by Marsh’s diagnosis of advanced prostate cancer at the age of 70.  He had already begun to dwell upon fear and worry when an MRI scan of his brain which he had done as part of a research study showed changes consistent with advancing age and some minor strokes.  That scan plus his new diagnosis plunged him into a new world, that of patient, not doctor, and led him to a series of musings and in depth exploration of his feelings about disability, pain, and most of all dying and death.

He writes beautifully although the book would have benefited from tighter editing.  The scientific explanations of how an MRI works or the interactions between the hypothalamus, the pituitary, and the testes contributed little to the narrative and a rather long chapter about the storybook world he created for his granddaughters during COVID Facetimes could have been eliminated.  Nonetheless, his reflections on his illness brought some important insights.  Perhaps the most useful were his awareness of how the patient perceives the doctor and the doctor’s comments, attitudes, attention, or lack of it.  All of these observations, he notes, would have made him a better doctor when he was practicing.

There were so many comments Marsh makes about his early years of training and practicing that resonated with me especially his discussion of the need and the challenge of balancing empathy, caring, and compassion for each patient with the need to also maintain enough distance necessary for a surgeon to use a saw to cut open a skull and a scalpel to cut out brain tissue that was once needed for speech, sight, thoughts, etc.  Every physician, but especially surgeons, faces this conundrum, one that was also addressed in Michael Stein’s recent book ‘Accidental Kindness’.  In one of those interesting ‘coincidences’ both Stein and Marsh focus their exploration of this issue around the same surgical procedure, the removal of an acoustic neuroma which has the risk of leaving the patient with a disfiguring facial paralysis.  On a more banal topic, his recollection of being on call 24×7 in the days before cell phones and the need to find a pay phone and describe to a trainee how to do a medical procedure from a gas station or restaurant brought back clear memories.

The chapter on death with dignity and the need to expand its availability was spot on, and his chapter about his mother growing up in Nazi Germany was powerful.  A photo of his mother and her two siblings from the 1930’s led to the story of how his mother worked in the resistance and fled the Gestapo while her sister embraced Nazism and her brother flew for the Luftwaffe.  The presence of several photographs reminded me of W.G. Sebald’s use of them in his novels as well as Janet Malcolm’s recent book structured around old photographs.  The visual image as a prompt for memory is the common theme among these works.

Finally, as so often happens these days, the book enabled some surprising connections.  Marsh referred at one point to a patient of his who died from a brain cancer as a world famous sculptor in the Bernard Leach/Hamada tradition.  Phil Rogers’ work was exhibited at our favorite Boston gallery for many years and the Leach/Hamada tradition was the theme of a trip to Japan we made a few years ago with that gallery.

Marsh’s book will make for interesting reading for physicians and for those of us who are entering old age.  As an old physician, I found it to be excellent.