Admissions: Life as a Brain Surgeon by Henry Marsh

Admissions: Life as a Brain Surgeon

Following the publication of Do No Harm, Dr. Henry Marsh retired from his position at a hospital in London. But his career continued, taking him to remote hospitals in places such as Nepal and Pakistan, where he offers his services as surgeon and teacher to those in need. Now, Marsh considers the challenges of working in those difficult conditions, alongside the challenges...

Title:Admissions: Life as a Brain Surgeon
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Edition Language:English

Admissions: Life as a Brain Surgeon Reviews

  • Canadian Reader

    It's been some time since I read Henry Marsh's wonderful and compelling memoir of his life in neurosurgery,

    . I had hoped to re-read it prior to starting his new one,

    , but I didn't manage it. I'd ordered the book from Britain-- as it won't appear in Canada until the fall of 2017, and I didn't want to wait. I started it almost immediately. Given the passage of time, I do not know if my recollections of the first book are to be fully trusted, but this new book feels very diffe

    It's been some time since I read Henry Marsh's wonderful and compelling memoir of his life in neurosurgery,

    . I had hoped to re-read it prior to starting his new one,

    , but I didn't manage it. I'd ordered the book from Britain-- as it won't appear in Canada until the fall of 2017, and I didn't want to wait. I started it almost immediately. Given the passage of time, I do not know if my recollections of the first book are to be fully trusted, but this new book feels very different. Marsh still (quite harshly and unforgivingly) represents himself as an impatient, irascible, sometimes arrogant surgeon. There is still the rigorous, unflinching honesty, particularly about himself and the medical errors and miscalculations he has made. However, his failings and regrets as a person, particularly as a son, a husband, a father, and as a human being are also sharply scrutinized. I don't recall quite so much of this in the first book. I'm also aware that I am a different reader from the one I was a few years back. Maybe that's the difference.

    As this second memoir opens, Marsh is on the brink of retirement, eager to be done, and more keenly aware than ever of the anxiety that he has long experienced just before he is about to operate. He feels that perhaps he is losing his nerve--the fearlessness, the boldness, the confidence that seem requisite for cutting into and manipulating the physical substrate of consciousness.

    Marsh fears retirement. What is to be done with all that time? He will need to be doing something. Woodworking and building things have long been hobbies, so he decides on a big project, perhaps an impossible one: he purchases a dilapidated cottage along a canal outside Oxford, not far from his idyllic childhood home, with a view to restoring it. Almost all the work he does here, though, is thwarted. Vandals break his beautifully crafted windows. The weeds grow back in almost obscene luxuriance. Still, he continues.

    Large sections of

    are dedicated to describing Marsh's experiences in Nepal, an astonishingly corrupt, almost lawless country, where he assists his specialist physician friend. In Kathmandu, Dev, who did his neurosurgical training in London years before, now almost singlehandedly runs a private hospital devoted to brain and spinal surgery. A homegrown celebrity of sorts, he has required a bodyguard since thugs invaded his home, kidnapped his daughter, and held her for ransom a few years back.

    While Marsh is charmed by the people and beauty of Nepal, and is able to do some surgical work there, he is profoundly frustrated by the language barrier. Both in Nepal and Kiev (where he has long worked with a Ukrainian physician, Igor), he questions the appropriateness of a surgeon (himself) operating on a patient he cannot speak to, cannot appropriately assess (especially cognitively) and "know". Ultimately, he appears to regard his personal project of assisting and sharing knowledge with neurosurgeons in another country as a kind of folly, perhaps even a form of hubris.

    is an aptly nuanced title for this medical memoir. Having performed work that has driven home just how much the intangible (thought and consciousness) depend on the physical (the brain), having seen how a person's very identity can be decimated by pathology, Marsh does not believe in God or an afterlife. Interestingly, though, his book has the feel of a spiritual biography of sorts. It is certainly a book of confessions, of admissions of error, and an account of the terrible human misery he has seen. Perhaps it is even an act of expiation and a request for forgiveness--if not divine, then at least human. Given what the author has seen, it is not surprising that he should fear his own death and spend some pages toward the end advocating for euthanasia. I found it hard to disagree with him.

    I learned a tremendous amount from Henry Marsh's book. I respect his knowledge, honesty, and integrity.

    gives a fairly rare, painful glimpse into the life of a neurosurgeon and a deeply thoughtful human being, who is well aware of his limitations.

    A good little video clip:

  • Rebecca Foster

    Brain surgeon Henry Marsh’s first book,

    , was one of my favorite reads of 2015.

    serves as a sort of sequel, recording Marsh’s last few weeks at his London hospital and the projects that have driven him during his first years of retirement: woodworking, renovating a derelict lock-keeper’s cottage by the canal in Oxford, and yet more neurosurgery on medical missions to Nepal and the Ukraine. But he also ranges widely over his past, recalling cases from his early years in medic

    Brain surgeon Henry Marsh’s first book,

    , was one of my favorite reads of 2015.

    serves as a sort of sequel, recording Marsh’s last few weeks at his London hospital and the projects that have driven him during his first years of retirement: woodworking, renovating a derelict lock-keeper’s cottage by the canal in Oxford, and yet more neurosurgery on medical missions to Nepal and the Ukraine. But he also ranges widely over his past, recalling cases from his early years in medicine as well as from recent memory, and describing his schooling and his parents. If I were being unkind, I might say that this feels like a collection of leftover incidents from the previous book project.

    However, the life of a brain surgeon is so undeniably exciting that, even if these stories are the scraps, they are delicious ones. The title has a double meaning, of course, referring not only to the patients who are admitted to the hospital but also to a surgeon’s confessions. And there are certainly many cases Marsh regrets, including operating on the wrong side in a trapped nerve patient, failing to spot that a patient was on the verge of a diabetic coma before surgery, and a young woman going blind after an operation in the Ukraine. Often there is no clear right decision, though; operating or not operating could lead to equal damage.

    Once again I was struck by Marsh’s trenchant humor: he recognizes the absurdities as well as the injustices of life. In Houston he taught on a neurosurgery workshop in which students created and then treated aneurysms in live pigs. When asked “Professor, can you give us some surgical pearls?” he “thought a little apologetically of the swine in the nearby bay undergoing surgery.” A year or so later, discussing the case of a twenty-two-year-old with a fractured spine, he bitterly says, “Christopher Reeve was a millionaire and lived in America and he eventually died from complications, so what chance a poor peasant in Nepal?”

    Although some slightly odd structural decisions have gone into this book – the narrative keeps jumping back to Nepal and the Ukraine, and a late chapter called “Memory” is particularly scattered in focus – I still thoroughly enjoyed reading more of Marsh’s anecdotes. The final chapter is suitably melancholy, with its sense of winding down capturing not just the somewhat slower pace of his retired life but also his awareness of the inevitable approach of death. Recalling two particularly hideous deaths he observed in his first years as a doctor, he lends theoretical approval for euthanasia as a way of maintaining dignity until the end.

    What I most admire about Marsh’s writing is how he blends realism and wonder. “When my brain dies, ‘I’ will die. ‘I’ am a transient electrochemical dance, made of myriad bits of information,” he recognizes. But that doesn’t deter him from producing lyrical passages like this one: “The white corpus callosum came into view at the floor of the chasm, like a white beach between two cliffs. Running along it, like two rivers, were the anterior cerebral arteries, one on other side, bright red, pulsing gently with the heartbeat.” I highly recommend his work to readers of Atul Gawande and Paul Kalanithi.

    Originally published with images on my blog,

    .

  • Lindsay Seddon

    Should definitely be read as more of a biography than as a continuation of his first book, Do No Harm.

    I found the stories of various operations both in the UK and Ukraine really interesting, but found myself skipping over life in Nepal and the renovations to the house he decided to make-over.

  • Miriam Smith

    Won in Goodreads Giveaways - not read, passed on.

  • Bettie☯

    Description:

    Description:

  • Caroline

    I love autobiographies. Sometimes one identifies strongly with the writer, and the reading process feels quite seamless. Then there are other writers whose experiences of life and the world are very different to yours. This makes for a bumpy ride, with little identification, but these books are often the most fascinating. For me this autobiography fits the latter mould.

    Marsh starts the book by telling us that above everything, he values his suicide kit, which he plans to use if he gets dementia,

    I love autobiographies. Sometimes one identifies strongly with the writer, and the reading process feels quite seamless. Then there are other writers whose experiences of life and the world are very different to yours. This makes for a bumpy ride, with little identification, but these books are often the most fascinating. For me this autobiography fits the latter mould.

    Marsh starts the book by telling us that above everything, he values his suicide kit, which he plans to use if he gets dementia, or some horrible terminal illness. He ends the book in a similar fashion, discussing voluntary euthanasia. He approves of countries and states where this is legal, and points out that the fact it is available doesn't mean that everyone rushes up to take advantage of it, rather it acts as a cushion of reassurance - reassurance that if everything gets too bad, there is a kindly way out. He also mentions that 75 percent of medical costs are incurred in the last six months of our lives. This presumably means that 75 percent of sickness and medical crises occur within the last six months of our lives. I am always pleased when these issues get an airing.

    The book covers the time when Marsh retires from working as a neurosurgeon in Britain, although he still continues with the voluntary work that he has done in Nepal and the Ukraine for many years. I found the book heavily tainted with sadness and regret. By the end of it I wished that he hadn't become a neurosurgeon, but had rather chosen a genre of surgery with higher success rates. He is obviously passionate about brain surgery and talks about the 'intense joy' of operating, but I think the costs/risks are too high, and a couple of times Marsh voices similar views.

    The situation is even worse in Nepal and the Ukraine, where things like brain tumours are left undiagnosed until much later stages than in the UK. Plus families insist on operations when there is really no hope of a good outcome. Another issue is that most of the young surgeons that Marsh is training in Nepal just want to get their qualifications and then practice abroad. In the Ukraine, Marsh has issues with his main associate of many years - the head surgeon of the hospital where he goes to do voluntary work. Even though much of the operating theatre has been furnished with equipment that Marsh has brought over from the UK over the years... and in spite of putting in years of effort to train brain surgeons here. In this book he terminates his commitment to going to the Ukraine.

    On a completely different tack, we hear about an old run down cottage beside the Oxford Canal, which Marsh has bought in his retirement and is renovating. Marsh is obviously a skilled carpenter, but this cottage is massively decaying and decrepit. Nor does it have a road leading to it. All materials have to be delivered by path overland, or by boat. He wonders if he has taken on too much. The cottage is attacked by vandals, who break the glazing on the windows that Marsh has made himself....but he keeps going with his project.

    I think Marsh has huge determination and drive, and he is not turned off by massively challenging causes. His honesty and scrupulous self-appraisal are admirable. Whilst I feel sorry that his life does not have more happy endings, I nevertheless found this a gripping and fascinating read.

  • Karan

    Two and a half years back, I remember being left a little bewildered by the celebrated first book by ace surgeon Marsh which came packaged as a slice of life memoir-of-sorts which, to my consternation back then, alternated unannounced between his frustration with the current management styles in NHS hospitals, some scenes from difficult neurosurgical cases that took you right into the heart of his surgical practice and his brief, thwarted attempt to set up a neurosurgical mentorship and practice

    Two and a half years back, I remember being left a little bewildered by the celebrated first book by ace surgeon Marsh which came packaged as a slice of life memoir-of-sorts which, to my consternation back then, alternated unannounced between his frustration with the current management styles in NHS hospitals, some scenes from difficult neurosurgical cases that took you right into the heart of his surgical practice and his brief, thwarted attempt to set up a neurosurgical mentorship and practice in Ukraine. You briefly caught him cycling, but the real person behind that meticulous professional stayed off the page. Marsh was seen introducing his readers to his art, his skills and his tools, and understandably kept the anima behind the persona off the page.

    Admissions, his second outing, is the missing companion text to Do No Harm that introduces one to Henry Marsh the person behind the surgeon. I took right on to it after being struck by the introductory confessional where Marsh is seen contemplating about such morbid realities as suicide, euthanasia and what constitutes a good death. In his lonesome geriatric amble as he is considering a newly acquired retirement cottage as his next renovation project, he lets his nimble mind take his readers on various professional and personal trips down the memory lane, all tinged with a surprising dose of regret.

    With castigating candour he is seen drawing his personal equations, remembering the father whose memoir he wished he had written, the mother he wished he had spent more time with, the ex-partner he wished he had a better marriage with: Mr Marsh is practically unrecognizable as this doubtful old man.

    His sometimes uncomfortably intimate confessions in Admissions made me befriend Mr Marsh, an experience I enjoyed more than Do No Harm’s warranted but cold showboating from a pioneer in neurosurgery. Here, the counterpoints between the personal anxieties and the professional certitudes are stark. When a pioneer is seen dissecting a dedicated but narrow life with so much dejection and cynicism, I found myself privately cheering him on when he switched gears and busied himself in detailing a recollected neurosurgical case, However the binding theme here is that of despairing weariness as the retiring Marsh opens his eyes to the world outside neurosurgery and readies himself for retirement.

    He is seen dismantling all his achievements, unpacking all the uncertain moments in his illustrious career and is seen nervously groping for the Truth, wondering if there was a point to some, or any of it. What did all those trials, all that accumulation of knowledge, all those tremendous battles of will and action amount to? Did they have any significance outside the tight context of the healthcare system and institutions he tutored and practiced in? Arguably not, and this is terribly humbling, both for him and us. Seeing him mope about listless and unheard in an overpopulated, under-resourced, money-for-treatment outpatient clinic of a Nepalese hospital is a mind-state you didn’t expect Mr Marsh to find in, and there he is, open to Consider and Meditate.

    Being confronted with cultures, societies and problems completely foreign, he is seen re-evaluating the place of neurosurgery in the broader scheme of things; his righteous professional absolutism thawing into a more relativistic space and this makes for a remarkably more mature appraisal by him about his work’s Value (“As the human population continued to grow exponentially, and as I read it I wondered whether becoming a doctor, healing myself by healing others, might not be a little self-indulgent”).

    In this heightened philosophical state that he has worked himself in, the aphorisms from his pen acquire a new beauty, sieved as they are from the filters of contradictions and dualities that Mr Marsh is seen newly comfortable with. Especially here: “A good doctor will speak to both the dissonant selves of a dying patient – the part that knows that it is dying, and the part that hopes that it will yet live. A good doctor will neither lie nor deprive the patient of hope, even if the hope is only of life for a few more days. But it is not easy, and it takes time, with many long silences.” or “Many medical decisions – whether to treat, how much to investigate – are not clear-cut. We deal in probabilities, not certainties.”

    It is curious to observe that the same nervousness around senescence and dying that afflicts most of us also keeps this man awake: a man who has dexterously handled living tissue and cleaved dying tissue of other people, and has managed to wrestle in a good few months to years of thinking, breathing life for hundreds of patients “As I have got older, I have instead come to realize that we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling. This simple fact has filled me with an increasing sense of wonder, but I have also become troubled by the knowledge that my brain is an ageing organ, just like the organs of the rest of my body.”

    Sometimes, the heavy-handed existentialism gets a bit too indulgent and dysphoric or veers towards adolescent solipsism, but as we see him return to the elements: to the sights, smells and sounds of nature, he makes you smile. Its endearing to see him lose himself in the world of trees and tree surgery where he waxes eloquent about the smells of a freshly severed oak bark, and he makes for equally joyful company as he playfully searches for the Big Questions of Humanity by contemplating the brains, minds and inner lives of animals.

    By exposing his wounds so fearlessly, his subsequent rage at the litigious culture, and the exasperation at the dehumanizing, manager-driven NHS becomes a lament you want to lend an ear to. The questions he asks while articulating the woeful final moments where he has had to unceremoniously resign or is summoned to courts hits home with the young practicing clinician within me who is getting used to being part of the chaotic, failing-but-standing socialized healthcare.

  • Stewart Tame

    I won an ARC of this book in a Goodreads giveaway. It's apparently due to be published in October of 2017. A bookmark that came with it urges me to include #stmartinspress in my review, so consider it done.

    Yet another book where the title sums it up more succinctly than I ever could. Henry Marsh is indeed a brain surgeon (presumably retired by now), and this is actually his second volume of memoirs (Do No Harm was the first. ) The book was fascinating. Marsh writes well, with great candor, and a

    I won an ARC of this book in a Goodreads giveaway. It's apparently due to be published in October of 2017. A bookmark that came with it urges me to include #stmartinspress in my review, so consider it done.

    Yet another book where the title sums it up more succinctly than I ever could. Henry Marsh is indeed a brain surgeon (presumably retired by now), and this is actually his second volume of memoirs (Do No Harm was the first. ) The book was fascinating. Marsh writes well, with great candor, and an eye for detail. I have never been a surgeon of any description, but have a newfound respect for the profession. I had a vague idea, as do probably most of us, informed by various movies and TV shows and so on over the years. But, thanks to this book, I have a somewhat more realistic mental picture, of the decisions that must be made, and of the general complexities of the job.

    It's not all brain surgery. Marsh also writes about his off hours, his hopes and fears concerning his approaching retirement, his memories ... The book reminds me, in some ways, of James Herriot's work, All Creatures Great and Small and the rest. There's the same lovingly detailed descriptions of a life and career, a similar warmth and humanity. Herriot's work has perhaps more humor, but Marsh's has more insight and introspection. It's a book well worth your time, and I recommend it highly.

  • Inna

    Нашій медицині не вистачає генрі маршів.

    Нашій політиці.

    Нашій сфері послуг.

    Сфері продажів.

    Благодійності

    Військовій сфері.

    І просто нам.

    Нам не вистачає Генрі Марша в нас. Адже,як зазначено в післямові, правда – релігія Генрі Марша. А вміння визнавати власні помилки – одна з найменш притаманних нашому суспільству рис.

  • Marysya

    Я захоплююсь Генрі Маршем! Абсолютно щира, до болю чесна, але в той же час тепла, світла і неймовірно людяна книга надзвичайного Лікаря.

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