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.