Friday, December 2

And Finally by Henry Marsh review – from doctor to patient | Autobiography and memoir

A reader faced with the third installation of a famous neurosurgeon’s memoirs is entitled to a sinking feeling. They might be forgiven for the suspicion that such a book was conceived at a boozy party celebrating the sales of the previous two. Not only that, but memoirs by medics can feel anticlimactic. The daily proximity of life-and-death decisions makes them akin to war stories, but they lack the sweep of history, and there is the feeling that the work of one doctor, in contrast to that of war heroes, is much like that of any other.

All of this is to say that I was prepared to be bored by the subject and irritated by the author. I was wrong: given its subject – broadly, death and disease – the book is unexpectedly fun, and the author pretty much irresistibly likable. This is a very British book: in the US such a compendium of self-deprecation would doom any literary and elder-statesman ambitions. Ben Carson, also a neurosurgeon, wrote memoirs that are relentlessly edifying and self-congratulatory but he was, after all, running for president. Marsh is running for exercise, and in one of the many melancholy references to advancing age scattered through the book, he mentions being overtaken by a gazelle-like female runner with whom he exchanges a wry smile of incongruous fellowship. But lamenting incipient old age is only one of the threads in the book.

The other four are a resplendent talent for descriptions of nature, a naive and nerdy fondness for the arcana of quantum mechanics, an irrational faith in pop neuroscience, and a memorably dry-eyed take on events. This last manifests itself in tokens of honesty such as mentioning washing his bum thoroughly before going for a colonoscopy, or, more painfully, describing the hurt he feels when a much-loved colleague disappoints him at last by being nepotistic and ungenerous. I tend to trust someone who owns up to such things and protects neither their dignity nor their misjudgments. The cynic in me still wonders whether Marsh is a terrible boss and lousy relative, but he does come across as a fine figure of a man.

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The story is propelled by sombre news: Marsh is diagnosed with what eventually turns out to be incurable prostate cancer. His reactions from him to this, the sudden reversal of roles from omniscient and omnipotent doctor to humble patient, the ups and downs of tests, diagnoses and remissions are described with wonderful candour. His professional insight from him into how medicine works makes his observations unusually precious. He details the day-to-day ups and downs of living with the knowledge of possible, but not certain, imminent mortality with great humour, equanimity and courage. The book ends with him in remission, seemingly at peace with the world.

Marsh sometimes comes across as the sort of bloke who, in his enthusiasm, might wreck a silent, shared contemplation of a beautiful sunset by explaining that the red glow is in fact due to Rayleigh scattering by minute particles in the atmosphere. In a beautiful passage he tells of the eerie peace that came with lockdown: “The only sounds were of birds singing, children playing and the wind in the trees. […] Time had stopped.” And sure enough, Mr Know-it-all pipes up: “Cosmologists tell us that time really can stop, but at the event horizon of a black hole rather than in the back garden at the bottom of Wimbledon Hill.”

Neuroscience is more in his line of work, but even there he seems strangely possessed by a believe-it-or not imp. “A standard building brick is 65mm thick. One hundred and twenty-five trillion bricks (the number of synapses in our brains) stacked on top of each other would reach way beyond Pluto and the solar system.” This reminds me of the joke, “If all your blood vessels were lined up end to end you’d be dead.”

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Often it seems as if Marsh is afraid to bore the reader and feels compelled to digress from the main themes, which include the manifold anxieties and humiliations that come with being a patient and the moral issues involved in euthanasia. His discussion of end-of-life care and assisted dying is the best essay I have read on the subject. The constant jumping from topic to topic, from personal narrative to gee-whiz popular science, makes the book more light-hearted, but it remains an odd composite: clearly the product of an unusual and disarmingly hyperactive mind.

And Finally by Henry Marsh is published by Jonathan cape (£16.99). To support the Guardian and Observer, order your copy at Delivery charges may apply.

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