This second selective collection of reminiscences by the noted British neurosurgeon details his adventures as he approaches and enters full retirement. As I read both of his books, I conjured up various adjective to describe the complex persona of the author-as he portrays himself. Here, brilliant, skilled, articulate, pioneering, kind, athletic, adventurous, altruistic, sensitive, sentimental; there, short-tempered, cynical, agnostic, impetuous, curmudgeonly, introspective, insecure, adulterous, guilt-ridden.
He chose to continue with limited practice and teaching in Nepal, Ukraine, and Sudan after retiring from British academia. His keen observations of medical practices in Nepal include a fine discussion of the unrealistic family expectations and demands with threats of litigation, combining with practitioners’ pecuniary motives and competition all leading to rampant over-investigation and futile treatments including widespread use of decompression craniectomies (removal of much of the skull to allow the brain to swell) for hopeless stroke victims, and is spot on. When the practitioners’ hubris and reluctance to bear bad news to relatives is thrown into the mix, the result is bad and needlessly expensive health care. His description of the polite but impoverished Nepalese with volatile dispositions and unique customs and culture is a great introduction to a country that was entirely foreign to me.
The title seems to refer equally to the patients admitted to the neurosurgery ward and to his own often fatal errors practising in that rarified field. He refers to one patient as “one of the larger headstones in my inner cemetery.”
Chapter titles seem to have been chosen almost at random and often have little to do with their subject matter. For example, only eight of 31 pages in a chapter titled “An Elephant Ride” even mention elephants. The “Mind-Brain Problem” chapter is mainly a discourse on swimming and exercise. The “Memory” chapter is a combination of his family history and his experiences in a remote Tibetan general medicine clinic. But his plea for wider availability of medical assistance in dying in the last “Neither Sun Nor Death” is eloquent and compelling.
One further quote that I can’t resist passing on: “The best way to deceive others…is to deceive yourself.”
Like him, I chose to retire at age 65, but, unlike him I never continued any practice in a foreign impoverished country. I knew I would not miss the almost daily decisions I had to make that often determined the future of others, but like him, I felt lost for a while. He expresses this feeling superbly as facing “a frightening void, little different from the death preceded by the disability of old age and possibly dementia with which it would conclude.” At this remove, an admission of my own is in order. I can now relate that I became depressed. It was not that I had no hobbies to keep me busy but rather, having spent years growing and nurturing the possibly delusional belief that my work over 40 years was important and beneficial to others, I felt entirely useless and irrelevant. But pigheaded independence ensured that I would never seek help.
Recently, out for breakfast with friends, all of us ranted about our personal experiences with the inefficiencies, absurdities, waste, and inane rules and regulations promulgated by government and hospital bureaucrats and overseers hobnailing the real providers in our health care system. But none of us could match the vehemence and eloquence of Henry Marsh in this task.
This chronicle, much of it about agonizing deaths from brain tumours, is realistic and informative but depressing and not for everyone, although written in easily understood plain English. I have watched two colleagues and my first secretary die slow painful deaths in their forties from brain tumours, and in spite of that, quite enjoyed reading it because of its raw reality.
Thanks,
Goodreads.
The Passionate Reader 