Top positive review
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An outstanding reflection on medicine, neuroscience and the human experience
on 17 March 2014
I graduated from St. George’s Hospital Medical School in 1991 and well remember doing a neurosurgical attachment at Atkinson Morley’s Hospital in Wimbledon, where Mr. Marsh was a consultant before the hospital moved to the St. George’s site. I found the experience horrifying and the visions of people lying in rows of beds on the old Nightingale wards, shattered psychologically, physically and neurologically, reminiscent of a field hospital at Sevastopol, has stayed with me. This outstanding book is somehow reassuring to me because it shows that the existential awfulness of neurosurgical illnesses and treatments is not lost on all neurosurgeons and Mr. Marsh gives us a page-turning series of vignettes which get to the heart of what it is to be a neurosurgeon (and by extension a doctor of any kind) dealing with these kinds of conditions.
Although they are experienced in sharpest relief day in and day out in neurosurgery, this book teases out the dilemmas facing all doctors who deal with life and death illnesses. It is clear that the author’s experience prior to medical school as a geriatric nurse, teacher in Africa and Oxford student of PPE has furnished him with the literary tools and perspective to be able to portray these impossible situations in an eloquent fashion and he brings us uncomfortably close to the anxiety, doubt and equivocation which must affect anyone doing this job who has an ounce of sensitivity.
Lest this sound too much like a hagiography, it must be stated that although he comes across as a man of great compassion and sensitivity, the book reveals Mr. Marsh to have more than a few elements of the old school, irascible, patrician consultant surgeon about him. These make for great anecdotes, of course, and he will no doubt be long remembered by his trainees for that, but it is not difficult to see why he is unpopular with some of the more junior surgical consultants who function as NHS apparatchiks, nor with their controllers, the ever burgeoning plethora of new-style NHS managers. Both these groups will be ecstatic to see him retire. Mr. Marsh’s contempt for the idiotic, self-serving bureaucracy, blithe and uncaring of patients’ needs, which the NHS has become is well-expressed and will be shared by many of his generation and those a little younger. He’s a prickly dinosaur, alright, but one with his heart in the right place who has much to say and says it in a compelling way.
Buy this book if you are:
Interested in life and death.
Interested in medicine.
Interested in neuroscience and the roots of consciousness.
Interested in what it is to be a doctor.
Interested in what it is to be a person.
Interested in the search for meaning.
Interested in the philosophy of healthcare.
Interested in a thought-provoking, entertaining read, which you won’t be able to put down.
Don’t buy it if you:
Are feeling psychologically fragile.
Are unable to deal with paradox, nuance and not having a clear answer.
This book deserves to become a bestseller and to reach a broad audience, both due to its content and the quality of its writing. I don’t know if it will or not, but it is certainly a profound addition to the corpus of human literature.
(Disclosure: I am a GP, recently moved to practise abroad, partly because I couldn’t stand the NHS any more. I haven’t seen Mr. Marsh since 1990 and he wouldn’t know me from Adam. He wouldn’t have known me from Adam then, so I’m certainly not puffing the book through any personal connection.)