Henry Marsh (2)Rezensionen

This book focuses on how the doctor becomes a patient himself with advanced stage prostate cancer. In general, most medical professionals make the worst patients and I can make this declaration as a medical professional myself. There always a struggle with the vulnerability of being the patient after years of helping others. It's easier to see the struggles in others probably more so to avoid acknowledging our own issues.

I understand Dr Marsh's mindset of thinking like a doctor after retirement and then as a patient. It's not just an occupation but a part of your identity. I don't think it necessary for me to read his other books to understand that this one is deeply reflective on his unique and unexpected position in life as a cancer patient. There are many advances in medicine over the years and being a patient allows a perspective that one might not otherwise imagine. Denial is a powerful coping mechanism which ultimately fails us in the end. Although, I found his writing to be overanalytical I respect his dedication and need to share his life experience. I have read many books about the transformation that can occur when a doctor, particularly a surgeon, becomes a cancer patient. There is a tremendous amount of humility knowing that we all share the same destiny.

I know my review is rather critical but I did say that medical professionals make the worst patients as well as critical thinkers.

Thanks to NetGalley and St Martin's Press for allowing me access to this digital book for review. I provide an honest and unbiased review. All opinions are expressly my own.

An odd book describing in detail brain surgery operations with risky outcomes, and the experience of the surgeon behind the work. The person, author, is by far a perfect human but is forced to act in a role that is beyond the everyday, and expect to be responsible for all sorts of trouble for his patients as alternative to death. You get something strange from this book, a sense of big themes of life, how culture handles them, the humanity of disease and the strange machine that wraps around the medical profession.

I found Marsh's book captivating, though sometimes hard to read. Not just because the stories he tells deal with the harsh reality of life-threatening conditions but because witnessing his flawed actions is, frankly, off-putting. We all want to think of doctors, and surgeons in particular, as being infallible paragons of virtue and perfect decision-making. Yet, recognizing they're as human and flawed as the rest of us is terrifying.

My favourite chapter was the last one, where Marsh described his views on death, end-of-life care, and what it really means to die "a good death." I also appreciated his take on practicing medicine in Nepal. The parts set in Ukraine were more challenging to read - perhaps because I was born in Romania, and some of the descriptions hit a little too close to home.

Overall, I found this a complex, interesting, thought-provoking book, one I'm glad to have read.

A candid and well-written memoir about a surgeon's confrontation with his own mortality through his own cancer diagnosis and treatment. This would be a good book for anyone going through a recent cancer diagnosis. Uplifting and down to earth. Totally immersive.

Somewhat interesting, but way too much about his carpentry.

Henry Marsh’s books are compulsively readable for me; I tend to tear through them in a few hours. This book is no exception. Covering mainly the COVID-19 era but with threads throughout Marsh’s life, this book is about his diagnosis of prostate cancer, becoming a patient as a doctor, and coming to grips with mortality. It made for interesting reading immediately after What Doctors Feel, because Marsh is a retired neurosurgeon and is able to reflect on his whole career and discover a new perspective on medicine. I was touched that he found teaching the next generation more rewarding than being a surgeon himself.½

More like a 3.5 but I don't see the option. This is a rather weird, disjointed ramble through the mind of a retired British surgeon who has been diagnosed with advanced prostate cancer. This puts him in the position of patient rather than doctor, so on the other side of the table, and it has him reassessing his career and his approach to patient consultations of the past. It certainly has value but he wanders off into pathways and other areas of London that I have no clue about, and his reconstructing a doll house for his granddaughters - wonderful things as stand-alone experiences, but kinda left this reader wondering. Still, lots of inside info on the medical profession and the limits and capabilities of medical science, especially the prostate cancer issues. Just be prepared for a bit of meandering.

The case studies within this book give a fascinating insight into working on the surgical front line in the UK. Henry Marsh (Author), has certainly dedicated his entire working life to help and save others however for me I feel as though he came across as very arrogant and as though he has a God complex. I noticed from early on that the book was more about his own journey and less about the people that he had helped and saved. This ruined it for me as I would have liked to know more about his patients and less about what he does/plans on doing with his retirement which is the majority of this memoir.

Henry discusses his collegues, patients, junior doctors, and his own responsibilities as an attending surgeon with a lot of bitterness and complained throughout about regulations and changes within his role that he did not agree with as to me he was stuck in the past having done the job for over four decades. Hi frequent complaints about the NHS and also his work within other countries left me feeling as though he saw himself as better than everyone else within the field.

Despite this, way in which Henry talks through the cases that are included is truly captivating, although maybe not for the faint hearted. As someone with little to no medical knowledge, the cases were described fantastically and I was able to follow along with ease which some authors within an area of expertise fail at with too much terminology the everyday person would not understand. The variety of cases discussed was fascinating to me as there were some fairly common cases but also rarer cases that you do not come across everyday.

The chronology of the writing could have been a lot better as often there would be jumps of time both forwards and backwards which left me often a little puzzled and difficult to follow the timeline.

Overall I did enjoy this book and the insight it gave me, however due to the God complex I feel that Henry Marsh has and his constant complaining has led me to not wish to read another of his books and ultimately I give 2 stars.

A doctor facing, or trying to deny, death; resulting in a somewhat rambling, a little too philosophical and discursive (and I could have done without the fairy tale he told to his granddaughters). I guess his departure from the personal reflects his attempts to deny what eventually happens to all of us.

Interesting look at neurosurgery.

Henry Marsh started out as a student of philosophy at Oxford, but “fled to the more practical world of medicine,” partly (perhaps) because he feared he was “not clever enough to understand philosophy.” For the next forty years he was a neurosurgeon, but modestly explains that he is not a scientist - to claim so would be to “like saying that all plumbers are metallurgists.” He became a man of practical action: he cuts open people’s heads and brains; he is a devoted woodworker and builder of things by hand (even though his roofs may leak). He runs. He bicycles. He hikes across mountain ranges. He keeps bees. He also keeps a journal, and - as his previous books (Admissions: A life in brain surgery and Do No Harm: Stories of Life, Death, and Brain Surgery) suggest - ponders questions personal, intellectual, and philosophical about his life and career.

Which is, apparently, coming to a close. After retiring from medicine, he volunteers for a study of brain scans in healthy people. He assumes his scan will be a fine example of a 70-year-old brain kept lively, supple, and unchanged from his long regimen of activity. But when he receives the copy of the scan, he is afraid to look at it. When he finally does, it shows him a shrunken brain speckled with “white-matter hyperintensities,” typical of aging. “…My brain is starting to rot. I am starting to rot. It is the writing on the wall, a deadline,” he says. But he feels fine, lives normally, so learns to shelve the distress.

As he does with some other symptoms, which he ignores or minimizes for years, choosing to think they indicated common older-man benign prostatic hypertrophy. When he at long last seeks medical attention, he initially wants to attribute his sky-high prostate-specific-antigen to pressure on the prostate from his bicycle seat as he rode to his appointment. However, what it really is is advanced prostate cancer. Strangely mixed with his dismay at this dire diagnosis is relief that he has likely been released from a greater fear of dementia, triggered by his father’s decade-long suffering and the ominous “pox” on his brain scan.

George Eliot’s magnificent novel Middlemarch describes a moment when the rigid, lonely, self-absorbed, and bitterly disappointed old scholar Casaubon has been diagnosed with an incurable heart ailment. “Here was a man who now for the first time found himself looking into the eyes of death—who was passing through one of those rare moments of experience when we feel the truth of a commonplace, which is as different from what we call knowing it, as the vision of waters upon the earth is different from the delirious vision of the water which cannot be had to cool the burning tongue. When the commonplace “We must all die” transforms itself suddenly into the acute consciousness “I must die—and soon,” then death grapples us, and his fingers are cruel…” Henry Marsh movingly explores that moment and the months that follow.

At this point, And Finally morphs into a more or less typical health-professional-gets-sick memoir. Theresa Brown’s recent Healing: When a nurse becomes a patient is one such - an expert oncology nurse is diagnosed with breast cancer, and discovers that being at the other end of the radiation beams is a revelation: all the things she never noticed or understood about what her patients actually felt or thought or experienced as she briskly gave treatments and managed complications while tut-tutting “Hey, we saved her life!” if they complained. Similarly, Marsh undergoes uncomfortable, embarrassing, and frightening procedures. Like many other patients, he frantically googles for information on survival rates, treatment options, complications. He, of course, is well equipped to understand the technicalities and statistical probabilities… and he still freaks out at times. Will he die of his disease, or with it? Will he see his granddaughters grow up? (Probably not, he concludes.) He cries. And he looks back on patients he realizes now he did not serve as well as he could have. He recalls a patient (an actor) whose delicate and difficult surgery left her with a permanently damaged face. He meets her again some years later, and she tells him: “I could see that you were so upset when you saw me after the operation, that I forgave you.” He muses on the difference between telling a patient he has a 5% chance of surviving versus a 95% chance - regardless of the actual number used, if there is any chance at all, they will take hope from it. He endures the indignities and depersonalization of the modern healthcare system: his anthropologist wife remarks that hospital patients ask each other the exact same question prisoners do when they meet: “What are you in for?” Information and instructions are provided in the form of generic printed handouts rather than conversation. Hospital balconies with lovely views are locked and off-limits to patients. Radiation departments are often deep in the lower levels, but those who have managed to place a sunlit window or even a mural of a beautiful landscape bolster their patients’ morale. (He got funding for and oversaw the creation of a garden for the use of neurosurgical patients at his hospital, and considers it one of the prime accomplishments of his career.)

This is a smallish book, but Marsh packs a lot into it. His voice is serious, clear, and steers well away from any sort of “inspirational” revelations or triumphant acceptance of his cancer as any sort of “gift.” There are detailed technical explanations of prostate cancer radiation treatments and brachytherapy, which may overwhelm a patient seeking a layperson’s understanding. Marsh’s personal beliefs do not include any sort of afterlife, and his discussion of the life-extension movement is bitterly critical. Even as he so longs to live, he pleads passionately in support of accessible, compassionate assisted-dying services. This is personal and powerful. A reminiscence about the elaborate doll houses he built for his beloved granddaughters is touching; a very long description of fairy tales he has written for them, overstuffed with dragons and unicorns and magical objects of all kinds, is less so. The book rambles and swerves at times, jumping back and forth from memory to contemplation of the future, from former patients to current doctors, from woodworking to brain surgery, from medical journals to children’s stories, from London to Ukraine (where he volunteered for many years, and his heart aches for that country’s woes now), from hope to terror and back again.

In a lovely passage, Marsh muses over his hoard of exotic woods with beautiful names he has collected - burr elm, spalted beechwood, cocobolo, sandalwood - and the places they came from, and what he planned to make with them. What will become of all of it? For “I am constantly having new ideas of things to make with all this wood – but the fact of the matter is, whatever happens, I will not live long enough to use even a fraction of it. I would look at my hoarded wood with deep pleasure, but as old age and decline approach, this pleasure is starting to fade and instead is replaced by a feeling of futility, and even of doom – of the future suggested by my brain scan. Besides, anything I now make will outlive me, and I should only make things that deserve to survive in their own right. I no longer have the excuse of the craftsman – who sees all the faults, often invisible to others, in what he has made – that I will do better next time.”

As it happens, Marsh’s cancer responds well to his therapies. He likely has more time ahead of him than he feared - but perhaps no more books. This rambling, effusive, thoughtful exploration of the mind of a man facing down the “commonplace” that he must die, and soon, is useful and moving.

** Thanks to NetGalley for an advance copy in exchange for an honest review. **

Al estilo de Oliver Sacks. No querés dejar de leer. Emotivo.

A really engaging book that manages to makes its complex subject matter (brain surgery) accessible and fascinating. Marsh throws in a fair amount of commentary on the state of the modern NHS but his writing is never preachy and the book overall is satisfying and thought provoking. His meditations on death and the question of whether we should avoid it at all costs are especially interesting.

一開始當作（又一本）神外故事會看，但中段開始基調逐漸改變，作者開心見誠地談論自己的失敗，剖析自己遇到無法救治的病人或者手術失敗的病例時的所思所想，還反覆吐槽NHS管理得如何官僚死板，讓普通人一窺醫生這一職業背後的壓力和煩惱。 印象比較深刻的章節，一是作者自述其公學牛津drop out gap完回校再轉行的游刃有餘白人中產人生（……），二是官僚制度無論在蘇聯解體後的烏克蘭還是在倫敦都死死把控住治病救人的醫院，三是作者反思自己年輕時因自大而手術失敗、使病人成爲植物人，印象最爲深刻的四則是作者照料臨終母親、以及散見於各章節的對死亡的思考。看完很强烈的一個感受是，in Cantonese，人命真係好化學……

Atul Gawande's Being Mortal is a more thoughtful examination of life and death on those growing older. His manner is more comforting and his writing style more comfortable. That said, Henry Marsh is grumpy, a little crotchety, and, refreshingly, he allows those manners to come through in his writing, taking to task his friends and patients and families and even episodes from his own personal life.

I made a number of passage notes, but these two excerpts come from the final chapter, which was my favorite for their summing up:

Life by its very nature is reluctant to end. It is as though we are hardwired for hope, to always feel that we have a future. (264)

We have to choose between probabilities, not certainties, and that is difficult. How probable is it that we will gain how many extra years of life, and what might the quality of those years be, if we bust ourselves to the pain and unpleasantness of treatment? And what is the probability that the treatment will cause severe side effects that outweigh any possible benefits? … And yet it has been estimated that in the developed world, 75% of our lifetime medical costs are incurred in the last six months of our lives. This is the price of hope, hope which, by the laws of probability, is so often unrealistic. And thus we often end up inflicting both great suffering on ourselves and unsustainable expense on society. (265-266)

Written by a neurosurgeon who works in the NHS- so a lot of details about the system and management were a bit different than what I’m used to, but all the same in a way- frustrations caused by things out of his control, for example. Like sending away for a test while the patient is waiting for their operation and something happens so the test never comes so the procedure gets delayed to the next day- resulting in a very upset patient of course. The surgeon was usually kind and apologetic, but at the same time he often came across as arrogant or dismissive, as when he waved aside someone’s concerns that they woke up from surgery with huge bruises on the face (doctor knew it would go away quickly, patient was very alarmed). The book is full of individual stories about different cancers and injuries he treated- sometimes with descriptive details on how the procedures are performed, other times with more about the patients as people, or the circumstances surrounding the surgery, or how the surgeon felt himself about it all. The tricky balance he had to keep between caution and confidence, to do such delicate and dangerous things inside people’s heads. Some of the stories have good endings, some are terribly tragic, and occasionally there’s one where he never hears of the patient again. As many of the people seeking treatment (or their families) were elderly suffering from brain tumors, there’s also things about end-of-life care and decisions- brought to mind Being Mortal. And purely from the descriptions of the physical art and skill, I was reminded of Mortal Lessons. I also had in mind the few Oliver Sacks books I’ve read- when Marsh explained how specific damage to the brain would affect certain parts of the body or abilities. I think what struck me most about this account, is how acutely honest the surgeon was about his mistakes. It’s rather terrifying to think that if you need brain surgery done, it is, after all, another human performing the operation.

from the Dogear Diary

This was impossible to put down — lots of detailed stories about both neurosurgery and the author’s life and career as a consultant neurosurgeon in the NHS, volunteer in Ukraine, and patient.

Elche - 2017

There is an aura around the words "Heart Surgery" and "Brain Surgery". Henry Marsh takes us inside the field of Neurosurgery and gives us the story of doctor and patient. An excellent and well written book.

Compared to Do No Harm, this book doesn't dwell on brain surgeries that much. Marsh focuses more on his experiences in Nepal and Ukraine and dwells on subjects such as death and religion. More than once, he explained why he doesn't think there is life after death. I am not sure why this is such a preoccupation with him but at least he wasn't dogmatic. And of course, expect the bashing of NHS. Nevertheless, still a good read as Marsh writes of his fragility, again throwing off the cloak of invincibility of doctors.

Indeholder "Forord", "1. Slusevogterhytten", "2. Opbrud fra London", "3. Nepal", "4. Amerika", "5. Vågen kraniotomi", "6. Sind eller hjerne", "7. En ridetur på en elefant", "8. Advokater", "9. Håndværk", "10. Knuste vinduer", "11. Minder", "12. Ukraine", "13. Undskyld", "14. Opbrud fra Ukraine", "15. Hverken solen eller døden", "Tak".

Bogen starter med tanker om døden. Vil man vælge døden, hvis demens eller en ondartet hjernetumor banker på en dag? Eller vil man hele tiden vente til næste dag? Han køber en lille hytte i Oxford tæt ved sit barndomshjem. Og tænker at han vil bruge den som værksted, når han går på pension efter fyrre år som læge og neurokirurg. Han er grundigt træt af bureaukrati. Som noget af det sidste opererer han på en patient med en invaderende form for frontallapstumor. Formentlig lidt livsforlængende, men om det er en god ting?
Han er gift med Kate Fox og får den ide at han kan tage til Nepal og hjælpe Dev, som er Nepals absolut førende neurokirug (og hedder professor Upendra Devkota). Hans sidste patient i London får stoppet en nasogastrisk sonde ned i halsen og Marsh tænder af på en sygeplejerske, der ikke vil fjerne den. Fantastisk måde at forlade sit job på efter fyrre år?
Nepal er noget helt andet og han er forelsket i landet med smukke, høflige mennesker og knusende fattigdom og skyer af udstødningsrøg og bjerge af skrald. Mange af neuropatienterne er ofre for motorcykeluheld. Marsh taler ikke sproget og han forstår heller ikke kulturen, så han føler sig som en dyrlæge. Et års tid tidligere var han i USA i Houston til en workshop. De opererer på grise og afskårne menneskehoveder for at øve sig i at afhjælpe aneurismer. Marsh bemærker de slående forskelle på hundedyre hospitaler og hjemløse der sover i byens parker.
Han tænker meget over om det egentlig er en fordel for patienter at blive opereret eller om det var bedre at lade dem dø en værdig død. I Nepal er der mange fremskredne tumorsygdomme, fordi det tager længere tid at få en diagnose. Til gengæld insisterer mange så på en dyr MR-skanning, selv om resultatet er givet på forhånd. Han dyrker motion, løber og tager koldt styrtebad, men hader det meste af det.
Inden rejsen til Nepal fik han fjernet en knop i panden. Det var hudkræft, men havde ikke bredt sig. Pyh! En tur på elefantryg giver også anledning til at se et par piger fra Tyskland, der sidder og ruller riskugler til elefanterne. Han kan ikke finde ud af hvad han skal mene om at se disse børn af det velhavende Vesten lege bønder. Han tænker over elefanters store hjerner og hvalers store hjerner og hvordan bevidsthed og smertesans skal tolkes. Vel tilbage på hospitalet hjælper han med en operation på en dreng. Han overlever men er blevet helt blind. Under en senere tur til Nepal får han besøg af sin søn William og går ud på en vandretur i bjergene. En kilometerlang stentrappe tager pippet noget fra Marsh. Udkantsnepal er ved at blive affolket, for folk her tager til Pokhara. Flere stentrapper føles som en opstigning til helvede i stedet for den traditionelle nedstigning. Og patienter, der dør, udløser tit vrede fra familien. Det er lidt hårdt at være forhadt, når man bare passer sit arbejde.
Tilbage i London er han sagsøgt. Det er et vilkår ved arbejdet, men han er ikke begejstret for sagsøgerne eller deres advokater.
I stedet nyder han at arbejde med træ. En kollega havde overraskende nok et helt professionelt savværk og hele stammer af træ liggende, så han har fået sig nogle egeplanker at lege med. Han funderer en del over hvor mange ting, man kan rage til sig gennem et langt liv.
Han køber slusevogterhytten (takket være et lån i Londonlejligheden, hvor han selv havde renoveret noget af den uden lige at følge byggeregulativet). Men mens han er i Nepal er der indbrud og hærværk. Desuden er der sækkevis af affald fra den tidligere beboer. Marsh er ved at køre lidt sur i hytten, men der er pramme, der sejler på floden og han slipper af med to pramladninger affald på den vis!

Der er nogle gode tilbageblik over forældrenes liv og hans egen opvækst. Og steder han har boet. Og hans første ægteskab, som ikke endte godt.

Han tager til Ukraine, hvor han side 1992 har kendt Igor, men Ukraine er et barsk og mishandlet land. Og Igor laver fejl og har svært ved at indrømme dem. Marsh føler at han bare skulle have nægtet at hjælpe Igor med at operere hjernetumorer.

En patient med sukkersyge dør, fordi hendes blodsukker ikke bliver kontrolleret. Ren sjusk. Men Marsh siger undskyld til familien og de lader være med at sagsøge hospitalet, selv om han opfordrer dem til det. Han er grundigt træt af bureaukrati.

Hans samarbejde med Igor går ikke godt og han ender med at tage hjem til London og leve med brexit-afstemningen og andet lort fordi han kan slås fysisk med ukrudt og knuste ruder i sin hytte.

Superpersonlig bog, hvor forfatteren delagtiggør læseren i sine tanker om livet og døden. Og døden har han haft som fast følgesvend gennem hele lægegerningen.½

Once again, a highly readable memoir of being a neurosurgeon and also a visiting neurosurgeon in both Nepal and Ukraine. Unflinchingly frank and honest, this is a book that deals with marriage breakdown, depression, regret and also ambition and drive. It looks at a great surgeon, a humanist and also a villain, all of which Henry Marsh is, through the prism of his memory and experiences. Recommended.

Honestly this didn't captivate me. I found it quite repetitive and didn't like his 'voice'. It improved when he discussed his own experiences with his mother dying from cancer at home, but a lot of the book is about how hard it is to relate to patients, which... is hard to relate to. I'm sure he's a perfectly competent doctor, but this book didn't endear him to me as a person, and I thought it needed some serious editing.

Marsh's honesty is endearing. He breaks the cloak of invincibility that you think doctors have. They can be vulnerable too, and they make mistakes. But Marsh also doesn't hide that he enjoys the authority he has as the senior doctor and his pride at his superior skills as a neurosurgeon.

Sehr interessant.

Ich dachte immer, die Anspannung bei einem Hirnchirurgen sei, dass der Patient während oder kurz nach der Operation verstirbt. Das eigentliche Problem sind aber die Patienten, die überleben - obwohl die Operation nicht glückt.

Tragische Schicksale.

Ich hätte gerne mehr über seinen Sohn erfahren - hat dieser Angst vor einer Remission?

Gut, dass ich nicht in England krank bin. Das Gesundheitssystem scheint schlechter als das deutsche System zu sein.