“IT was the operating,” Henry Marsh says, when I ask what propelled him towards neurosurgery.
“It was the excitement, the drama. Not exactly the blood, but the excitement and using one’s hands.
“I’d always liked using my hands and I thought surgery would be a way of using one’s hands and one’s brain. And you had social status with a good income. It ticked lots of boxes.”
Marsh, 67, may be relatively unknown in Ireland but he is neurosurgical gold across the water.
A pioneer of “awake” brain surgery — the skull is anaesthetised but the patient is awake — medicine was lucky to get him.
He could have been lost to philosophy, politics or economics (his first choice at Oxford University) but the unrequited love of an older woman — a family friend with whom he exchanged “a passionate kiss” — brought a halt to his studies and led to a half-hearted attempt to kill himself.
Fortunately, he did not succeed in shoving his hand through a pane of glass in his student digs.
During a hiatus from study and while working as an operating theatre porter in Newcastle, he found his true calling — medicine — inspired by the work of the surgeons he observed.
The move to neurosurgery came later. Marsh was drawn to the danger, a fascination with understanding the workings of the brain and a desire to treat the most serious illnesses.
I ask if the brain tumour his son William was diagnosed with as a baby had an impact on career choice?
“I think it probably did, I think I’d have been a very terrified anxious parent. I think it gave me some sympathy and understanding, more than what otherwise might have been the case when I dealt with patients,” he says.
Anxiety has been a feature of Marsh’s life — he ended up in a psychiatric hospital as a young man following a bout of mania and attended a psychiatrist after the break-up of his first marriage.
Anxiety is often a requirement for someone who traffics in life and death. Does it give a pre-op edge?
“I think so. Lots of actors get stage fright,” he says.
When he first started doing awake brain surgery, the anxiety was worse although he affected “a complete calm and confidence” for the patient’s sake.
In his memoir, he says he would ask patients if they wanted to see their brain. Some said yes. ‘You are now one of the few people in the history of the human race to have seen their own brain,’ he would say.
Given the often life-threatening nature of their illness, his patients presented frequent dilemmas: whether to treat or not to treat.
In his book, he writes you can ‘rarely predict with absolute certainty from a brain scan what sort of recovery the patient might make. But if we operate on everybody (as some surgeons do), without any regard to the probable outcome, we will create terrible suffering for some of the patients, and even more so for their families.’
He adds: “We are told that we must not act like gods, but sometimes we must if we believe that the doctor’s role is to reduce suffering and not just save life at any cost.”
Marsh doesn’t want his own life saved at any cost in an era “when most of us face the prospect of dying miserably, as in only a few countries is euthanasia — a good death — allowed”.
His mother, a political refugee from Nazi Germany, suffered the “final indignity” of double incontinence.
“I doubt if she would have wanted to bring her life to a quick end with a suitable pill if she had been given the choice. She strongly disapproved of suicide. But for myself, I see little merit or virtue in the physical indignity which so often accompanies our last few days or weeks of life.”
He writes that he has a suicide kit of drugs acquired over the years, but with a flash of typical black humour, says they came without a ‘use by’ date — setting him up for a possible failed suicide attempt.
I ask if the kit actually exists?
“Yes, that’s true. I mean it’s a joke, but it’s a serious joke. And the fact that the drugs — they come with a ‘use by’ or ‘best by’ date — is a sort of metaphor for life itself really isn’t it? We all tend to live a bit too long. It’s very hard to know when to stop,” he says.
The overriding impression from Marsh’s memoir is that he never stops.
In one chapter, he talks about planting a wood of 4,000 trees in Devon on land given him by his parents-in-law from his first marriage — sold off after the divorce, and now only visible to him on Google Earth.
In his retirement, as well as helping train and teach doctors in Nepal, Albania and Ukraine, he has set himself the backbreaking challenge of restoring a lock-keepers cottage near Oxford, with plans for a woodworking workshop.
Does he ever stop?
“I’m like a gyroscope. If I stop spinning I’m worried I’ll fall over. I get bored very easily. People who know me always comment on what some call my “energy”. I call it my restlessness.
“My late father (an Oxford don) said I showed this sort of restlessness from about the age of one year onwards.”
Marsh’s version of “slowing down” is not typical.
He still teaches in a London hospital, despite retiring from the NHS two years ago after a spat with a bureaucrat over dress code and following the threat of disciplinary action for not showing junior doctors “leadership”.
The latter involved reluctance to move from “exemplary” handwritten discharge summaries to a computerised version of “appallingly poor quality”. In fury, he wrote his resignation letter.
Still, he’s a passionate believer in socialised healthcare and believes deeply in the principles of the NHS.
“The problem is the NHS is under-resourced because politicians won’t admit to the public that they are going to have to pay more money if they want first class healthcare.”
I tell him it’s the same in this country.
“It’s a problem of all developed countries,” he says.
“We are all living longer and cancer is a disease of old age and the new therapies cost a lot of money. And medical technology is becoming more and more expensive.
“There should be some sort of public discussion about how to put more money into healthcare,” he says.
“But we seem to live in a society where it’s all about spin and PR and politicians coming up with instant solutions where the problem is a profoundly difficult one and the public aren’t fully informed.”
Marsh ends his memoir, appropriately, at the operating table, albeit in Nepal, where the registrars have opened a patient’s head. He scrubs up, anxious but proud that he still has the bottle to operate. He reflects that he is lucky “that I can still be useful, that there is still work to be done”.
One gets the sense that his work will never be done.
“William is a computer programmer. He has a very abstract intelligence. He works in IT. I can’t even begin to understand what he is doing.”
“My second daughter Katharine is an anthropologist. She’s just finished her doctorate in America. She’s sort of the scholar of the family.”
“My first daughter Sarah I think would have been very suited to medicine. She would have liked doing it, she’s very practical with her hands.
“But she is very deaf from birth, it’s a gene that runs in the family. So although she copes with it very well, at that time, I don’t think medical schools would have taken her on.”
“I always put my work first. I think I can claim to have a good relationship with my children now but I don’t think that I was a particularly good father or head of the household.”
“I think if you are honest, they are less likely to sue. The Irish are a lot keener on litigation than the English...but my feeling was if I felt I’d made a mistake and the patient suffered serious financial loss or serious harm, I would tell them they should sue me.”
“As Mark Twain said: “To a man with a hammer, everything looks like a nail”.
“No. There’s an awful lot of suffering and disability and bad results and a lot of hospital doctors wouldn’t want that.”