BOOK REVIEW: Admissions – A Life in Brain Surgery by Henry Marsh

BOOK REVIEW: Admissions – A Life in Brain Surgery by Henry Marsh

Orion Publishing
April 2017
Softback, $27.99
Reviewed by Natalie Salvo

Non-Fiction/Biographies & True Stories/Science, Technology & Medicine Autobiographies

7.5/10

We all know that the only two certainties in life are death and taxes. This means that most things are complex and made of many shades of grey. One such example is brain surgery, something we often use as an example of a job that is at the pinnacle of things considered deeply challenging. Henry Marsh is a surgeon who has spent four decades working in this field. In his second memoir he follows-up his previous book, Do No Harm, by delivering some additional stories about his patients, as well as treating us to a more personal look at his life outside of the operating theatre. It is a mostly intriguing volume that is also a little disjointed in terms of its central focus at times.

A long time ago, I thought brain surgery was exquisite – that it represented the highest possible way of using both hand and brain, of combining art and science. I thought that brain surgeons – because they handle the brain, the miraculous basis of everything we think and feel – must be tremendously wise and understand the meaning of life… As I have got older, I have instead come to realise that we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling.

This work is not a chronological one. Instead, Marsh uses his memoir as more of a diary or an example of combined memories and reflections that jump around in describing his multi-faceted career operating and teaching, plus his own personal beliefs. This can make things a little difficult for the reader to comprehend because the subject matter is already quite challenging and because it can be difficult to understand where Marsh’s failures and successes (and there is a lot more discussion about the former than the latter) sit within the context of his career. This is a shame because the memoir was framed to look at the surgeon’s then-impending retirement and what awaits him in the next chapters of his life.

As I watched my sucker down the microscope, controlled by my invisible hands, working on the poor man’s brain, teasing and pulling out the tumour, I told myself that I wouldn’t have panicked in the past. I would just have shrugged and got on with it. But now that my surgical career was coming to an end, I could feel the defensive psychological armour that I had worn for so many years starting to fall away, leaving me as naked as my patients.

Brain surgery is a difficult area where surgeons have to deal with a series of probabilities rather than certainties and things can go catastrophically wrong. There are as many grey areas in deciding to operate as there is grey matter in the brain. Marsh admits this and is quite forthright in describing how surgeons approach their cases and how they are not immune to feelings of arrogance and competitiveness. The decision to operate is never an easy one and the decision has to be made by the medical practitioner as well as the patient and their families and sometimes this ends with dire consequences.

As the French surgeon René Leriche observed, we all carry cemeteries within ourselves. They are filled with the headstones of all the patients who have come to harm at our hands. We all have guilty secrets and silence them with self-description and exaggerated self-belief.

Marsh’s writing is quite detailed; his prose is clinical and detached when he is describing his patients but is also rather personal and conversational when he recounts his own hobbies and personal experiences. A lot of the book is dedicated to specific cases that Marsh has worked on in England, Nepal, and the Ukraine as both a surgeon and a teacher, as well as his views on the bureaucracy and inner workings of the UK’s National Health Service. There are also a few lessons for the reader in anatomy and brain function, which are always very well explained. A lot of what Marsh describes is fascinating, however his discussion about renovating a cottage seems rather pointless and adds little to the book, overall. It is more interesting to hear about Marsh and his reflections on things in the context of his work.

I have learnt that handling the brain tells you nothing about life – other than to be dismayed by its fragility. I will finish my career not exactly disillusioned but, in a way, disappointed. I have learnt much more about my own fallibility and the crudity of surgery (even though it is so often necessary), than about how the brain really works. But as I sat there, the back of my head resting against the cold, clean wall of the operating theatre, I wondered if these were just the tired thoughts of an old surgeon about to retire.

Admissions is ultimately an important book because it shows that brain surgeons are human too. The fact that Marsh is able to dig deep and reveal things with a brutal openness and honesty should be commended, even if some pages verge on self-indulgence as he describes his personal pursuits. This memoir is a highly readable book and a deeply personal reflection on Marsh’s brilliant career and is bursting at the seams with different admissions of one kind or another, though some seem not to have a real connection to the story at hand.

BOOK REVIEW: Admissions - A Life in Brain Surgery by Henry Marsh

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