posted on 24 Aug 2017

Admissions by Henry Marsh

I wrote highly about Henry Marsh’s first book, Do No Harm, when I reviewed it here, but I approached his second book, Admissions, with some trepidation, fearful that even the talented, driven Mr Marsh would be unable to pull off such a feat again. But my fears were misplaced. If these two medical memoirs are not already regarded as classics of the genre, they certainly will be in a few years time.

When Will Self reviewed Admissions for The New Statesmen, he said he read it thinking, “Ah, so that’s who you are,” as each of Marsh’s self-revelations illuminated more of the man’s character.

And certainly it is a more personally revealing book than the earlier Do No Harm. While the first memoir is not without Marsh’s characteristically self-lacerating doubt, it focuses primarily on the sometimes terrifying tradecraft of the brain surgeon and the frustrations and compromises inherent to life in the NHS. Admissions, which opens in the final months leading up to Marsh’s retirement, is far more autobiographical and Marsh reflects more widely on himself, his life in medicine and his deeply fearful anticipation of retirement and ageing.

In the first memoir, Marsh emerged as a driven, egotistical and somewhat fanatical man – qualities he doesn’t admire but seems to recognise have been indispensable to (and perhaps the cost of) a lifetime spent in the operating theatre. Nothing in Admissions would make one soften any of those judgements, but in this second book he emerges as an altogether odder and more human person – whether talking about his deepest fears (dementia, loss of dignity, needless and avoidable suffering), his own mental ill-health as a young man, or his passionate – and it seems often ill-advised – love affairs.

While it is clear that he is or has been a workaholic, it is also evident that this may be an attempt to hold at bay his own fears of the emptiness of retirement and the decay and diminishment he seems certain old age holds for him. What he cannot really contemplate is no longer being part of the priesthood of consulting surgeons – a relentless, all consuming vocation, a master-disciple relationship in which the best and brightest are groomed for succession and hard-won skills are passed on. He regrets the weakening and depersonalisation of this age-old apprenticeship model by bureaucratisation, the proliferation of non-clinical managers and shift-working. Increasingly he views himself as a creature from an earlier age and recognises that it is time for him to go.

And yet it doesn’t seem much of a retirement. His clinical qualifications must be re-validated so that he can continue his work in Ukraine and fulfil a long ambition to operate in Nepal. He is in the process of buying a derelict lock-keeper’s cottage, intent on restoring it as a place to live and as a woodworking studio. Before flying to Nepal he has to have a cancerous cyst removed from his forehead (he goes to a surgeon he knows and pays him with wine – a tradition amongst doctors who operate on each other, he says); and he must return sooner than planned from Nepal to attend a hearing – he is being sued. It seems as frenetic an existence as daily hospital life.

The cottage, Ukraine, Nepal – the curious thing is that none of these ‘projects’ turns out quite as anticipated. His initial – and hugely labour-intensive – work on the cottage is ruined by vandals. His relationships with the Ukraine and Nepalese surgeons – both old friends – begin to sour. (For one thing, both are used to working almost single-handedly in conditions of great impoverishment and corruption and now appear even more driven and relentless than Marsh himself. They also have apparently inexhaustible reserves of energy – something Marsh feels he is beginning to lack.) It is as if his retirement has also uncoupled him somehow from his previous obsessional behaviour. He is facing the future in a state of great personal uncertainty and unhappiness.

In a sense, the closing section of the book is his coming to terms with this. It is also the most gruelling. His self-doubt prompts him to re-examine three exceptionally awful cases he was involved in in the past. The precise purpose of recounting these utterly hopeless cases of great suffering seems to be to illustrate the La Rochefoucauld maxim which prefaces the book: “Neither the sun nor death can be looked at steadily.” Each has the quality of an admission that must be made – must be faced up to. Of one case he says: “It is difficult to talk of death to a dying patient, it takes time, and it is difficult if the rooms stinks of shit. And I know that I let this man down and was a coward.”

And from this he moves on to make a powerful case for the legalisation of euthanasia – for only then, he believes, will it be possible to consider the question “of how we can have a good death…with pointless suffering avoided”.

I know it is absurd to say of writers that you find them engaging and personable – that you could imagine some kind of friendship were you to know them – but I’m happy to admit that this is what I feel about Marsh. I find his voice utterly engaging. Admissions is a masterpiece and its clever, punning title entirely accurate: Marsh reveals himself as clearly – and as ruthlessly – as he does the interior of his patients’ skulls. The novelist Ian McEwan has said of Marsh that in him neurosurgery has met its Boswell. How right, how accurate – a grand, flawed, but hugely attractive figure, whose books have the hard gleam of lived experience and the chastened wisdom of someone who has pursued a vocation right to the very edge. Unmissable.

 

Alun Severn

August 2017