"And Finally" by Henry Marsh: Life Lessons from a Surgeon

By: Sue Nelson / The Financial Times
Translation: Telegrafi.com

Retired neurosurgeon Henry Marsh doesn't want to die. But, in the end - as he rightly points out - who wants this?

Marsh has prostate cancer and, after a long career trying to prevent other people's deaths, he reflects on the work "And finally" - this is a continuation of memories "Do no harm" (2014) and "Admissions" (2017) – about what matters most in life, being clear about what is imposed by terminal illness.

As a medical student, Marshi recalls going through a brief period of fearing that he had all kinds of deadly diseases, until he decided, no doubt out of an instinct of self-preservation, that only patients—not doctors—have diseases.

If the hospitals used to give him status, now they let him know that he is one of the "low class" patients.

It is understood that the cancer diagnosis came as a surprise to Marsh. He blames himself for not seeing a doctor sooner, despite the obvious warning signs. However, Marshi simply did what many of us know deep down—that something is wrong: He ignored the symptoms.

The path from operating on patients to becoming one of them was not easy. Accepting "personal obedience to the important surgeon" as futile, Marshi is its harshest critic, dismissing his younger self as impulsive, tactless and inattentive.

He's also brutally honest about his own reactions to his diagnosis, condition and cancer treatment – ​​whether it's tears, incontinence from an enlarged prostate or chemical castration through androgen deprivation therapy. Hormonal treatment left this passionate runner with "the fat body of a hairless eunuch".

The former surgeon's relationship with hospitals also changed. Where once they gave him status, now they make him understand that he is a "low class" patient. Familiar with the surgical uniform, he finds it humiliating to wear a dress with an absurd gap that exposes the butt, and to be occasionally ignored or when talking to the medical staff.

Marsh uses these experiences to question how he treated some of his patients in the past, reconsiders the truths and half-truths that surgeons use in consulting rooms, and their flexible relationship between work and hope— apparently this powerful medical tool. But instead of glorifying saving lives, Marshi torments herself by recalling patients with incurable tumors, like the Ecuadorian rainforest botanist she couldn't save.

Advice is provided on how doctors and surgeons should avoid mistakes, particularly in relation to communication and empathy, which he believes are difficult, as is the task. But the book is much more than a "how to..." manual! It's a beautifully written collection of memories, musings and life lessons that span marriage and break-ups, fears of insanity and climate change, an obsession with woodworking and a compulsion to make things – despite building roofs that always leak.

Marsh also displays the joy of imagining fairy tales for the three granddaughters who are mentioned in the book's dedication. It assesses the ethical risks of euthanasia alongside the compassion of assisted dying and the more worrying – unofficial – practice of 'terminal sedation' in the UK.

Here, medical staff administer lethal doses of painkillers to patients under the pretext of relieving their pain and discomfort. Accepting this act as a young doctor, which he still believes was the right thing to do, he now understands that if there is no prior discussion with relatives or loved ones, it is euthanasia performed without consent.

All of his musings linger after reading: whether it's the importance of death and personal choice; the frustration of being cheated by a master; or the pride of making dollhouses with elm and ebony bedroom floors. He reflects on operations in the UK, Nepal and Ukraine, where he worked for nearly 30 years – until just before the pandemic, and the current state of affairs that left him depressed.

Among these memories are often brilliant descriptions of how parts of the brain work. He explains the standard model of consciousness and its relationship to the brainstem by comparing consciousness to the glow of light shining on the ends of hundreds of filaments of a fiber optic bulb. Turn off the electricity and there will be darkness. If the brainstem remains intact and connected, there will still be light – even if there is damage to some of the fibers. That's why surgeons, including Marsh, have encountered patients with seemingly drastic head injuries — such as chisels embedded in their brains — but who were still conscious.

Despite facing death throughout his career, it's only after Marsh faces his own near death that he understands more about his own life. Sharing his findings, works "And finally" it will definitely make others think about existence and, more importantly, understand what is really worth living for. /Telegraph/