At the cutting edge

6 May 2017

9:00 AM

6 May 2017

9:00 AM

There’s a graveyard inside Henry Marsh’s head, though you’d never guess it to look at him. There he sits in his elegant flat in a small castle on a small island in the Oxford Thames: 67, attractive, restless. There he sits with the world all around him: Persian rugs, French tapestries, Japanese prints and his beautiful blonde wife (the anthropologist Kate Fox) in a separate flat below. But the ghosts of past patients are never far away.

Henry Marsh is a brain surgeon, celebrated for his skill in operating on patients under just local anaesthetic. He’s famous also for his astonishing memoir Do No Harm, to which he’s now written an equally remarkable sequel, Admissions. Both books are confessional, as clear-eyed and self-critical as Karl Ove Knausgaard — ‘Karl? He’s a friend! He’s really a very nice bloke,’ says Marsh — but unlike Karl, Henry’s subject isn’t just himself, it’s humanity.

Where Knausgaard navel-gazes, Marsh peers into the human cranium, and to read his books is to poke around with him inside the weird, wet architecture of the brain and to look over his shoulder as he excises parasitical tumours. It is also to face death with him, and to face being the cause of death. Marsh saves lives but occasionally, inevitably, he destroys them, and one of the most unexpected things about him, in print and in person, is how much this affects him.

‘I operated on a child in Ukraine last visit,’ he says, ‘and I made some bad decisions. It was a cyst, something called a colloid cyst, and she’d already had a failed operation in the hospital in Lviv — something had to be done. I tried to do the operation the way I would do it in England, but without the proper equipment. It was a disaster. She survived, but with very severe memory problems.’ I’m sure it wasn’t your fault, I say, as you do. ‘No, it was.’ Marsh looks determined. ‘It was direct surgical trauma from me poking around. I saw her last week and the parents were pathetically, painfully grateful because they know no better, and my Ukrainian colleagues think it’s a triumph because she’s alive.’ He holds his head. ‘For a few days afterwards I really felt like killing myself. I wasn’t going to kill myself, but I felt absolutely terrible about it.’

It seems odd in this mollycoddling day and age, but Marsh thinks it’s vital that doctors, particularly brain surgeons, feel the tragedy of their mistakes — at least for a while.

‘It’s important to feel grief, because it’s through these failures that we learn. Success teaches one very little, I think. And it’s so tempting for us to avoid confronting failure. We look for excuses. We say: “Oh the operation was a success but the patient died…”.’

Mankind cannot bear very much reality; not doctors, nor their patients. Several times in his work in the UK, and especially in Ukraine and Nepal where tumours grow to enormous sizes before they are diagnosed, Marsh has had to face patients with inoperable cancer, destined to die soon, demented or blind.

‘You should never blurt the truth to them brutally,’ he says, ‘That is absolutely wrong. Most people, many people, develop hyster-ical cognitive dissonance. Part of them knows they’re dying, part of them thinks they are going to go on living — so you end up giving people two sets of information. You say this tumour will be fatal but I don’t know how long it will take. There are a few long-term survivors. So you muddle it a bit, leave it up to them. If you are a decent doctor, which most of us aren’t, you’ll sit down and take your time. Of course, hospitals are largely designed to prevent us taking our time these days. Particularly those NHS bays behind curtains where you are supposed to have these profound conversations with everybody listening in.’ Marsh raises his eyebrows, shakes his head in disbelief. I say: I suppose there’s nowhere for a doctor to sit in there anyway, is there? ‘Exactly,’ he says. ‘The relationship has a whole different, more patronising dynamic if you are standing up. That’s why the balcony garden I created [after endless rows with the bureaucrats at his hospital] is great. In good weather you can actually take the patients out there and sit down and talk.’

Is that still there?

‘Oh yes, it’s flourishing. That’s what I’m proudest of, actually, in my career. What’s so sad is all hospitals ought to have environmental enhancements like that built in at the start. Hospitals now have “healing” gardens but they are usually miles from the wards and the patients just aren’t going to traipse all the way there, dragging their urine bags on stands, in their nighties. You have to go directly from the ward to the garden. I think all wards should have access to the outside world and green space not far away. Most of the rooms ought to be single rooms, but the NHS made this historic mistake of continuing with bays.’

Marsh’s first memoir made him a hero for all of us who find ourselves in a despairing fury at nitpicking management. Both books detail his many run-ins with the authorities, especially over the unevidenced ban on ties, which Marsh likes to wear to show respect. ‘There are bugs on ties but there are bugs on all of us! There was no scientific reason for the ban. It was a class thing. A weapon.’

But for all his frustrations with NHS managers, Marsh thinks it’s private practice that is most dangerous. It’s here that doctors can become monsters. ‘I practised privately myself for many years, but in general I don’t like private healthcare. It’s always more expensive and there is a vast amount of unnecessary treatment. As soon as you have a headache you have a brain scan. I’m afraid an awful lot of doctors get corrupted by how easy it is to make money that way. Medicine is not a business because patients are not normal consumers — they’re terribly vulnerable.’

One of Marsh’s great strengths as a writer and physician is a keen awareness of his own tendency towards narcissism — ‘I often think I became a brain-surgeon to justify my own sense of self-importance.’ It’s for fear of egomania that doctors shouldn’t work in isolation. ‘Look at Shipman or that ghastly surgeon, just the other day, Paterson, who was doing unnecessary mastectomies. People working on their own get out of touch and it corrupts you… it’s hubris isn’t it? The funny thing about medical hubris is that nemesis is visited on the patients rather than the surgeon.’

So doctors need institutions and critical colleagues, but even so, the NHS clearly needs to change. It’s in crisis. Doctors are leaving in droves. Why?

Henry blames money, but also the culture. ‘You no longer feel you are doing something special or belonging, I think. When I was a junior doctor, you had the firm system so you were part of a little family. If your consultant was a shit then you were unhappy, but most of them weren’t. You worked very long hours and you had status. We have senior house officers at neurosurgery in our department but now a lot of them work only a 50-hour, 48-hour week — there are about ten of them. They are often doing the job for only two or three months so never get to know the staff. The nurses regard them all as a waste of space. Junior doctors now, I feel very sorry for them! They just feel like little cogs in a rather dysfunctional machine.’

It’s not hard to imagine the young houseman Marsh working through the night. Even in his late sixties he seems limitlessly energetic. He’s just back from the Ukraine and a series of gruelling operations, but there’s nothing tired about him. He leaps up to show me photos: of his granddaughter, and of a young Ukrainian girl whose life he saved last Wednesday. In the photo she’s in bed with a wrapped head and a toy rabbit. Marsh shows her photo with all the pride of a new parent.

He shows me photos of the lock-keeper’s cottage on the canal that he’s renovating himself, and he really does mean himself, carving intricate window frames, clearing decades of rubble. In the final chapter of Admissions, Henry, writing from dusty Nepal, looks forward longingly to working on his cottage: ‘There will be much to do when I return. There will be things to make or repair…’

I think the endless work the cottage needs is its real point. I don’t think he fears death so much as not being busy — feeling useless.

Henry Marsh is an atheist. No surprise, you might say, after all the horrific deaths he’s seen. But it’s not the suffering that makes him an unbeliever so much as his understanding that the human personality — humour, character — is identical with grey matter. There’s nothing transcendent about a self. ‘And that’s just a fact with a capital F,’ he says. ‘Everything we think and feel is electrochemical.’ Nonetheless, life is still a mystery for Marsh, which is reassuring.

‘I don’t want to be all reductionist about it, saying it’s all just chemicals. The thing is, we still don’t know what elevates matter in this way. We can’t explain the single most interesting thing in the world, which is our own consciousness, and I find that quite consoling.’

He pauses for a second as he paces about: ‘It’s my own cloud of unknowing.’

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