It has been estimated that the adult human brain contains about 125 trillion synapses—the space between the end of one nerve cell and the start of another. The recently retired English neurosurgeon Henry Marsh likes to think of these synapses as standard building bricks that, if stacked on top of each other, would reach way beyond Pluto. Such lofty considerations would induce vertigo in most of us, but Marsh has a playful way of writing about the human brain that is positively empowering.
And Finally: Matters of Life and Death is no exception. It is Marsh’s third, and seemingly final, memoir, after 2015’s best-selling Do No Harm: Stories of Life, Death, and Brain Surgery and 2017’s Admissions: Life as a Brain Surgeon. The major difference here is that Marsh, 72, has written it from the perspective of a patient as opposed to that of a surgeon.
In April of 2021, Marsh was diagnosed with advanced prostate cancer, which, though now in remission, could come back at any time. For several years, Marsh had suffered worsening symptoms of the disease, but could not bear the thought of asking for help.
“I thought I was being stoical when in reality I was being a coward,” he writes. “I simply couldn’t believe the diagnosis at first, so deeply ingrained was my denial.” Marsh suggests that this denial was rooted in a survival mechanism that leads doctors to believe that diseases happen only to patients and not to themselves.
As one of the world’s leading neurosurgeons, Marsh found that he could not do the job of cutting into a person’s brain if he was being truly empathic with what the patient was feeling. “You have to practice instead a limited form of compassion, without losing your humanity in the process,” he writes. But now, looking back, and as a patient himself desperate for information and empathy, he is not so sure.
“My former patients became reproachful ghosts who came to punish me,” he writes. “They were everywhere, lurking behind everyday thoughts and sights and sounds. I thought of how I would be a much better doctor if I could start all over again. How I would be full of the compassion and understanding that I lacked when I was younger.”
Just as aging pistoleros once hung up their guns, so newly retired surgeons are said to hang up their gloves. The comparison is an appropriate one for Marsh, who is nothing if not a straight shooter. In And Finally, he dwells as much on his failures as a surgeon—he once drilled out a nerve on the wrong side of a man’s spinal column—as he does on his successes, such as helping to implement groundbreaking neurological surgery in Ukraine, or creating a healing garden at Atkinson Morley’s hospital, in London.
His new book’s most compelling chapter tackles the issue of assisted dying, which he hopes will become legalized in Britain during his lifetime.
Marsh, who does not believe in any kind of afterlife, notes that “the most passionate opponents of abortion and assisted dying usually have religious faith, with a concomitant belief in life after death.”
He argues that in countries such as Switzerland and the Netherlands, where assisted dying has been legalized, safeguards successfully exist to protect “vulnerable” people from predatory behavior. He makes a withering assessment of the naysayers: “It seems a strange idea that banning assisted dying is a dam holding back callous societies and a flood of murderous carers.”
Marsh’s legacy as a neurosurgeon is by no means confined to Britain. His work training surgeons abroad, particularly in Ukraine, continues in spite of the difficulties he has faced working there. He writes about falling out with a Ukrainian surgeon colleague, who had been hiding bad results from him involving patients who had either died or come to serious harm: “The Soviet reflex of burying bad news was just too deeply ingrained in him.”
Marsh has always seen teaching the next generation of surgeons as one of the most integral parts of surgery. “Everything you do as a surgeon, even though it feels so intensely personal when you operate, is the culmination of the work of countless surgeons who went before you,” he writes.
His cancer has convinced him of the need to help trainee surgeons understand how great the distance is between themselves and their patients. By telling jokes and stories about himself, especially his past mistakes, he “helps junior [doctors] avoid making the mistakes you have made yourself.”
Most of all, Marsh tries to imbue his last years with a sense of purpose. Whether this be by creating fairy tales and crafting dollhouses out of wood for his beloved grandchildren or advising surgeons in Nepal, Ukraine, and Albania about best practices, he never loses sight of the moral imperative to communicate all that he has learned before his time finally runs out.
Tobias Grey is a Gloucestershire, U.K.–based writer and critic, focused on art, film, and books