I loved this book! It's the second neurosurgeon memoir I've read in the last two months #noregrets. This book is quite different, in that the whole thing is about his career, whereas When Breath Becomes Air is half about the author's death from lung cancer.
Each chapter is named after a condition e.g. hemangioma or aneurysm or glioblastoma, and the chapter is mainly about that condition, while at the same time telling the story of his long training and career. The book is apparently based on a lecture he gave about his very worst mistakes -- messing up operations, misdiagnosing, deciding to operate when it was in the patient's best interest to let them die with dignity.
“The operating is the easy part, you know,’ he said. ‘By my age you realize that the difficulties are all to do with the decision-making.”
“But death is not always a bad outcome, you know, and a quick death can be better than a slow one.”
It's very gripping, which is impressive considering dozens of stories are told. Young fathers with brain tumours, whom he could treat the first time the tumour appeared but whose case became less and less hopeful with more relapses. Incorrect aneurysm repair causing fatal haemorrhage. A trainee cutting a spinal nerve, transforming a competitive cyclist's minor back problem into an injury that will prevent them ever walking on uneven ground again. But also recovering the sight of a heavily pregnant mother with a brain tumour.
Once, when he was a trainee, it was late and an old man called him over on the ward complaining about chest pain. He looked at his heartbeat, saw nothing unusual, told the man there was nothing to worry about and turned away. And the man died, alone, disbelieved.
"It used to be called angor animi – the anguish of the soul – the feeling that some people have, when they are having a heart attack, that they are about to die. Even now, more than thirty years later, I can see very clearly the dying man’s despairing expression as he looked at me as I turned away."
Something he seems to consider his main mistake is when he leaves patients in a fate worse than death, 'a grey man curled up on the bed' to paraphrase: PVS. PVS means Persistent Vegetative State, and a surgical slip can cut nerves that take away a patient's humanity, leaving them physically healthy but mentally empty, so that their family cannot say goodbye but must pay to look after them for decades, this empty shell of a relative.
There are stories of depressing days -- one particularly depressing day:
"None of us felt able to make our usual sardonic jokes at the morning meeting. The first case was a man who had died as a result of an entirely avoidable delay in his being transferred to our unit; another was a young woman who had become brain dead after a haemorrhage. We looked glumly at her brain scan.
'That's a dead brain,' one of my colleagues explained to the juniors. 'Brain looks like ground glass'
The last case was an eight-year-old who had tried to hang himself and had suffered hypoxic brain damage.
'Can we have some rather less depressing cases please?' someone asked, but there were none and the meeting came to an end."
He also spends a lot of time giving out about the struggling NHS and the damage it does to doctors and patients -- never enough beds so patients have to have their surgeries cancelled, for example, and an organisation so bureaucratic that he has to delay an appointment to run up and down through the hospital to find the new password to access scans, which it turns out has been set to Fuck Off 47 because you have to change the password every month and it's been 47 months since the policy was implemented. He talked about lots of personal experiences too, from participating in a group to decide whether the NHS should fund a drug for a rare disease (using quality-adjusted years of life added) to his mother's death to his child's benign brain condition.
He said a lot of anatomical terminology and it was cool -- I liked the precision of it. Henry Marsh himself seems like an unpleasant colleague to be around, but he's had an interesting life and writes it well.
Something that really struck me was how often he considered something a hopeless case, even if he didn't say it. He describes a glioblastoma, which is the aggressive brain tumour I made the sensor to detect (I was proud when he described the scan in two lines and I guessed correctly that it was a glioblastoma, although (a) this could've been in the other book (b) I probably would've guessed glioblastoma no matter what it was), and says it's highly unlikely to be cured by surgery, though he'll treat it with surgery to give them some extra life. He says it's sad how many of the brain tumours happen to young, otherwise healthy people who've just started families, how there's just so much death and so many diseases with poor prognoses. Again, I cried and thought fuck diseases it is not fair that a disease can just sneak up on you through no fault of your own I have to do something ... maybe I should do Molecular Medicine for my degree.
In short: a very good book full of interesting stories well woven together into a cohesive narrative -- and personally enjoyable too, because of my interest in medicine.