Having thoroughly enjoyed Henry Marsh’s first book, Do No Harm, and also quite enjoyed his second, Admissions, I was pleased to hear of the publication of his third book, And Finally. Marsh is a neurosurgeon, and his first two books provided many insights into the life and choices of a neurosurgeon and UK’s NHS within which he worked. His third book, however, is about how he is now a patient, on the receiving end, and also contemplating his own mortality. In this third book, the now retired Marsh tells us about his prostate cancer – which he did not attend to early enough, by his own admission – and the subsequent treatments (hormone therapy, radiotherapy, etc.) which he clearly did not enjoy, but which he finds have given him more empathy with patients. We also read of Marsh’s other interests and projects (wood working, building a huge dolls house for his grandchildren, working in other countries like Ukraine (before the war), and even how he has been scammed by conmen pretending to be roofers/builders, not once but twice, and how each time it happened when he was at low ebb, anxious and stressed, and therefore, gullible and susceptible.
Marsh, who still goes in work to teach or coach younger colleagues, reflects on doctor patient relationships:
The simplest way of limiting our empathy and compassion is to divide the human race (and all living creatures) into ‘Us and Them’.
p33
Having seen it from both sides, so to speak, as staff and as patient, he notes,
Much of what goes on in hospitals – the regimentation, the uniforms, the notices everywhere – is about emphasizing the gap between staff and patient, helping the staff to overcome their natural empathy. It’s not about helping patients. Hospitals always remind me of prisons.
p88
Although he testifies to the gentle and good treatment or handling he received as a patient, he nevertheless does indict the system as alienating patients, systemically.
He shows a fair understanding of how patients feel, when he was dealing with them:
It is so easy for doctors to forget how patients cling to every word, every nuance, of what we say to them.
p7
He explains how he is even over-optimistic in stating the case sometimes, because
Hope is one of the most precious drugs doctors have at their disposal.
p7
There is an interest section in the book where Marsh gives his views on assisted dying. He points out that given suicide is not illegal in UK, it is rather paradoxical that assisting someone to commit suicide is illegal. He does see the possible abuses of legalising assisted dying, but points out many countries have legalised it and there is no sudden flood of people being killed off as a result, and he says it is unlikely UK is a more callous society than others. It sounds, on balance, that he is in favour of assisted dying even though he makes clear he himself would not like to administer the lethal injection to patients, even if he wants it for himself, if he should become demented. He also adds that
I am very lucky that, as a doctor, I have the solace of access to an easier death than is permitted by the law in the UK if this is my eventual wish.
p189
Interesting as some of the content in this book is, it is the least well constructed of all his books. Much tighter editing would have created a more focused, more relevant read. It meanders in places, goes off at tangents, and sometimes lacks the clear plot line although it is never uninteresting. It has some little reflections on his own aging process and mortality, and it is a pity the book does not stick more closely to this in focus.
Why it is that only in old age, and close to death, I have come to understand so much more about myself and my past?
p220
It is interesting to see Marsh’s characterisation of himself, to see how he wants to portray himself to the reader, at any rate, and it is a rather attractive character which is depicted – one who has tried to do his best, who does not suffer fools, but who has many interests apart from medicine, but who has been a dedicated and high achieving practitioner, and who has no particular faith or belief, and is of the opinion there is nothing beyond death, no afterlife.
I do not know if this will be Marsh’s last book; I hope not. Even if not best constructed or edited, nevertheless, it is the product of an intelligent, inquiring, scientific mind, and full of interesting life experiences.
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