Admissions by Henry Marsh

Reviewed by Rebecca Foster

Brain surgeon Henry Marsh’s first book, Do No Harm, was one of my favorite reads of 2015 [reviewed by Annabel here]. In short, enthrallingly detailed chapters named after conditions he had treated or observed, he reflected on life as a surgeon, expressing sorrow over botched operations and marveling at the God-like power he wields over people’s quality of life. That first memoir saw him approaching retirement age and nearing the end of his tether with NHS bureaucracy.

Admissions: A Life in Brain Surgery serves as a sort of sequel, recording Marsh’s last few weeks at his London hospital and the projects that have driven him during his first years of retirement: woodworking, renovating a derelict lock-keeper’s cottage by the canal in Oxford, and yet more neurosurgery on medical missions to Nepal and the Ukraine. But he also ranges widely over his past, recalling cases from his early years in medicine as well as from recent memory, and describing his schooling and his parents. If I were being unkind, I might say that this feels like a collection of leftover incidents from the previous book project.

However, the life of a brain surgeon is so undeniably exciting that, even if these stories are the scraps, they are delicious ones. The title has a double meaning, of course, referring not only to the patients who are admitted to the hospital but also to a surgeon’s confessions. And there are certainly many cases Marsh regrets, including operating on the wrong side in a trapped nerve patient, failing to spot that a patient was on the verge of a diabetic coma before surgery, and a young woman going blind after an operation in the Ukraine. Often there is no clear right decision, though; operating or not operating could lead to equal damage.

Once again I was struck by Marsh’s trenchant humor: he recognizes the absurdities as well as the injustices of life. In Houston he taught on a neurosurgery workshop in which students created and then treated aneurysms in live pigs. When asked “Professor, can you give us some surgical pearls?” he “thought a little apologetically of the swine in the nearby bay undergoing surgery.” A year or so later, discussing the case of a twenty-two-year-old with a fractured spine, he bitterly says, “Christopher Reeve was a millionaire and lived in America and he eventually died from complications, so what chance a poor peasant in Nepal?”

Although some slightly odd structural decisions have gone into this book – the narrative keeps jumping back to Nepal and the Ukraine, and a late chapter called “Memory” is particularly scattered in focus – I still thoroughly enjoyed reading more of Marsh’s anecdotes. The final chapter is suitably melancholy, with its sense of winding down capturing not just the somewhat slower pace of his retired life but also his awareness of the inevitable approach of death. Recalling two particularly hideous deaths he observed in his first years as a doctor, he lends theoretical approval for euthanasia as a way of maintaining dignity until the end.

What I most admire about Marsh’s writing is how he blends realism and wonder. “When my brain dies, ‘I’ will die. ‘I’ am a transient electrochemical dance, made of myriad bits of information,” he recognizes. But that doesn’t deter him from producing lyrical passages like this one: “The white corpus callosum came into view at the floor of the chasm, like a white beach between two cliffs. Running along it, like two rivers, were the anterior cerebral arteries, one on other side, bright red, pulsing gently with the heartbeat.” I highly recommend his work to readers of Atul Gawande and Paul Kalanithi.

An American transplant to England, Rebecca is a full-time freelance editor and writer. She reviews books for a number of print and online publications in the USA and UK, and blogs at Bookish Beck.

Henry Marsh, Admissions (Weidenfeld & Nicholson, 2017). 978-1474603867, 288 pp., hardback.

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