As I have got older, I have instead come to realize that we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling. Henry Marsh

Admissions is Henry Marsh’s second memoir of his life as a British neurosurgeon. It follows upon his earlier Do No Harm. Both describe why he turned to neurosurgery, the mistakes he has made and his anxieties about each new operation.

The operations require a steady hand, a range of technical equipment, skill in avoiding areas of the brain he doesn’t want to remove, hoping the patient will not be permanently disabled. Most of his operations entail removing a cancerous tumor.

In some cases, Marsh must decide whether it is better not to operate at all. The tumor is too large, the risk of operating is great, it may be better to let the patient live as long as possible, rather than ending it in a hospital hooked up to tubes for days on end. He writes:

But surgery, I told them, was almost impossibly difficult—at least, it was very difficult to operate without, at best, inflicting lifelong disability on the patient. So, what was better? To die within the next few years or face a longer life of awful disability?

He admits he has made mistakes that take a terrible toll on his patient’s lives, as well as troubling him for months. They are not confined to the operating room. He has had affairs, is divorced from his first wife, and now married again. He writes, “We always learn more from failure than from success. Success teaches us nothing.”

Yet he admits to a terrible temper, treating patients and physicians with condescension and deceiving some of his patients, “to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face.”

Several of the chapters in Admissions take place in Nepal and Ukraine, where Marsh has gone to help physicians who have trained with him in Britain. In Nepal, he assists his friend Dev in his private Kathmandu hospital. The country was recently ravaged by a civil war, is continuing to recover from its recent earthquake, where most patients have only a primitive understanding of modern medicine. If the surgery is not successful, the patient’s family is often furious, mounting protests and threatening both Dev and Marsh.

In Admissions, Marsh is facing his retirement. He worries he will succumb to dementia, as his father did and dreads dying in a hospital, cared for by unknown people trying to prolong his life as long as possible. He admits to having a suicide kit, hopes he will have the courage to use it if he wants. He concludes with a discussion of euthanasia.

…my concern is simply to achieve a good death. When the time comes, I want to get it over with. I do not want it to be some prolonged and unpleasant experience presided over by terminal-care professionals, who derive their own sense of meaning and purpose from my suffering. The only meaning of death is how I live my life now and what I will have to look back upon as I lie dying. If euthanasia is legalized, this question of how we can have a good death for those of us who want it, with pointless suffering avoided, can be openly discussed, and we can make our own choice, rather than having it imposed upon us.


Dom said...

Your blog discussion is very thought-provoking. Reading the blog discussion leads me to wonder:

1. Learning from success – Is it really true, as the author stated, that “Success teaches us nothing”? Doesn’t success provide us with some guidance in distinguishing between successful and unsuccessful ways of doing things? When we take a certain approach and it is successful that success “nudges” us to repeat that effort again in the future, rather than exploring alternative ways that may or may not lead to success?

2. Appropriate deceit – Under what circumstances, if any, is it justified or appropriate to do as the author did “to pretend to a greater level of competence and knowledge than we know to be the case, and try to shield our patients a little from the frightening reality they often face”?

Richard Katzev said...

Hi Dom:

I will take up your questions in order:

1. It depends on what you mean by learning. You don’t really learn anything if you are successful, other than what you did worked. On the other hand, you learn quite a bit when you are unsuccessful. You have to keep trying something different and that entails learning something NEW.

2. I really can’t answer that question without knowing the specific situation in which it is relevant. In medicine, some doctors refuse to mislead or deceive a patient, while others might think differently. It's a highly personal decision and depends a great deal on the patient, his or her knowledge of their condition, the nature of their disease and the uncertainty of the treatment.


Linda said...

Interesting discussion. I too am surprised that a brain surgeon would declare that "we always learn more from failure than success. Success teaches us nothing." I think there is some science that disputes that. Perhaps it depends on the activity or behaviour. I can remember mistakes I've made that were painful enough that I learned from them, but it seems to me that success might just as well illuminate some new knowledge or insight or sharpen a skill. I can remember those experiences as well.

No doubt though, for a brain surgeon with a terrible temper who treats patients and physicians with condescension, deceives some patients to pretend to a greater level of competence and knowledge, and who is "troubled for a few months" by his failure that took a terrible toll on the life of a patient, the belief that his failure makes him more learned than a successful outcome would have is, well, convenient for him. I rather sympathize with those Kathmandu families.

And the fact that he dreads dying slowly in a hospital at the mercy of "unknown people" (maybe people like himself?) and has stocked himself a handy suicide kit to avoid that (which most of us cannot do), is a supreme irony.

Thought-provoking, fascinating, stimulating as ever, Richard. I think I need to read this book.

(P.S.I am in a bit of a cynical and pessimistic mood today.)

Richard Katzev said...


Yes, you do seem out of sorts today.

The view that you learn more from failures than successes has a long and important philosophical foundation. See Karl Popper's views of Falsification. What do you learn from a success? To repeat what you already know. What do you learn from a failure? You have to learn a new approach. You have to try something different.

Henry Marsh is a very honest man. He doesn't always treat people with condescension and he rarely pretends to a knowing more than he does.

At times the book is rather technical but there's much to be learned from a highly regarded neurosurgeon.


Linda said...

OK . . . sigh. The Guardian agrees with you. https://www.theguardian.com/books/2017/may/13/admissions-by-henry-marsh-review

I over-reacted - will put the book on hold at my library.

Wonder if Marsh would sell me a suicide kit.

Richard Katzev said...

Glad to hear at least somebody agrees with me.