The answer, as Henry Marsh reminds us in his poignant and thought-provoking new memoir “And Final,” is sometimes yes.
A surgeon confesses his fears – and mistakes
When he learns of his diagnosis of advanced prostate cancer at the age of 71, Marsh, a neurosurgeon in London and the author of two previous memoirs – “Do No Harm” (2015) and “Admissions” (2017) – is shocked. One minute he’s crossed over to another world, patience (my term, not his). As he begins to accept this new status, Marsh is haunted by the faces and ghosts of former patients: “Now that I was so anxious and unhappy and feeling abandoned, I realized how anxious and unhappy so many of my patients must have been .”
Marsh’s honesty is disarming, and it redeems him when he offers an explanation for his shortcomings as a caretaker. “As a doctor,” he writes, “you couldn’t do the job if you were truly empathetic… you have to practice a limited form of compassion, without losing your humanity in the process. While I was still working I thought I had achieved it, but now, looking back, and as a patient myself, I was in doubt.”
It’s insights like this—examining his fallibility, his shortcomings, and even his complicity with an indifferent system—that make Marsh’s writing so powerful and allow him to transcend the usual pathography. Still, some of his observations about medicine feel like they shouldn’t be as much of a revelation to him as they appear to be: for example, his comment that “one of the worst parts of being a patient is waiting – waiting in boring outpatient waiting rooms , waiting for appointments, waiting for the results of tests and scans.”
Yet his book shows how illness unites us. Marsh, like everyone else, is plagued by fears and worries. “I am besieged by philosophical and scientific questions that suddenly seem very important — questions that I have taken for granted or ignored in the past,” he writes. His book is an attempt to understand the questions, if not to come up with answers. As in his earlier works, Marsh’s investigation is intimate, insightful, witty and deeply moving.
Marsh’s writing style is such that you feel like you’re following him like an acolyte in the operating room, or in his woodworking shop, or at his dining room table; you hear the musings of a scientist, a neuroscientist, a neurosurgeon, and the inner dialogue of a patient who feels his vulnerability. He weaves together science, philosophy, history and personal anecdotes as he tackles everything from the nature of consciousness to deciding when it’s time to pass on a difficult operation to a younger and perhaps more capable colleague. As it turns out, prior to his cancer diagnosis, Marsh struggled with a parallel problem: “As I approached 70, my cancer already present but undiagnosed, it had become increasingly difficult to deny that my body had passed its sell-by date. .” He had become more aware of his limitations, the accumulation of minor injuries. “I didn’t want to die, but who did? But neither, to put the obvious, do I not want to be old and decrepit.
“When Breath Becomes Air”: The Young Doctor’s Last Words of Wisdom, Hope
As a loving grandfather, Marsh worries about the future of our species. “The history of science is largely the history of the refutation of human exceptionalism – the Earth is not the center of the universe; people are animals. As the great zoologist JZ Young observed, we are resurrected apes, not fallen angels.” Marsh isn’t “very concerned with the idea of the human race coming to an end,” he explains. “In the very long term, this is unavoidable. … But I am shocked by the suffering that the decline and end of the human race is likely to bring, and I think of my granddaughters and their possible descendants, and climate change, and all that it will bring.”
For the reader seeking insight into how to face the end of life, Marsh relates that he has seen many people die, “some good and some bad”. Death can be slow, painless, agonizing, or, if you’re lucky, a peaceful ebb. “But rarely is dying easy, and most of us will now end our lives in the hospital…in the care of strangers, with little dignity and no autonomy. While scientific medicine has brought great and wonderful blessings, it has also brought a curse – dying has become a long-lasting experience for many of us.
Long before he was aware of his diagnosis, Marsh had put together a suicide kit consisting of a few legally obtained drugs that could end his life. But after his diagnosis, he’s worried: what if the sealant doesn’t do the job? In desperation, he calls a doctor friend, promising that the friend will bring about the desired end. “Isn’t this a bit premature?” asks his friend. “‘Yes…but I want to prepare myself for the worst.'” The friend promises, and Marsh’s anxiety subsides.
The book concludes with a meditation on a photograph of Marsh’s mother as a young girl in 1929, posing with her siblings. “Looking into my mother’s young eyes, as my own life may now be nearing its end, I felt as close to life in block time as possible – past, present and future all combined into one whole.” Fortunately, Marsh remains in the present, his cancer is now in remission, and with this book he has left readers of the future a work to enjoy and learn from.
Abraham Verghese is Professor and Vice Chairman, Department of Medicine, Stanford University. He is the author of ‘Cutting for Stone’. His new novel ‘The Covenant of Water’ will be released in May.
Matters of life and death
St Martin. 240 pages. $27.99.
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