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291 of 296 people found the following review helpful
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.)
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14 of 14 people found the following review helpful
on 18 October 2014
As a junior neurosurgical trainee this book has been an unexpected delight. It has provided another entity to help contextualise my future learning before I become a more senior neurosurgical trainee and in time a consultant neurosurgeon. Having heard Mr. Marsh speak at conferences, once standing on a bar top in Bratislava at a Eurpoean neurosurgical meeting, it is all too easy to form an impression that he comes from a line of privilege and that neurosurgery was almost pre-ordained. But indeed on reading this book it wasn't and that is what makes this book even more special. His humility is incredible in this book (although this is easy to say as a junior neurosurgical trainee that has not worked under him and therefore this observation is through a book from a distance).

There are too many parts to this book to compose a proper review in a mere few lines. But the overwhelming triumph in this book is that he is retiring and can therefore blast out loud his distaste for how things go. This is not isolated to him but sadly reflects a good number of senior trainees and junior colleagues, e.g. him almost getting a ticket during a certain scenario is ludicrous and the rampant hospital policies that management think safeguard patients act enormously to smash out morale that actually puts patients at risk. I once asked a prominent MP in 2004 if the brain drain in science and engineering could affect doctors and the NHS. He proudly declared no as doctors in Britain are committed to the NHS. Well at one point one third of my social circle of doctors left Britain and most are not coming back.

On a more inspirational note his constant desire to seek out Ukraine, to help colleagues out there to ultimately help people has acted in concert to other books, e.g. the Dressing Station, that I might have to explore working overseas in improverished places in combination to pursuing my NHS career to make the most of my surgical and individual experiences. A sueprb read, full of humour, anecdotes, sarcasm and ultimately a very personal account of the grim realities of neurosurgery: that it dares to reset often irreversible disease processes that have the all too common potential to irreversibly change who we are as a person. This is one of the best surgical accounts I have read in the popular press and I have encouraged all my colleagues and friends and family to read it.
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64 of 66 people found the following review helpful
Henry Marsh is one of the UK’s leading neurosurgeons, and has been the subject of two award-winning TV programmes. His background is unconventional, having done a series of rather menial jobs, and taken a degree in PPE at Oxford, before starting medical training and eventually deciding to specialise in neurosurgery. Now nearing retirement, he has written this superb, compelling book about what it means to be a surgeon working in a field where every day one is required to make agonizing decisions, and where even a minor error can have catastrophic life-changing consequences for the patient.

Many of the short chapters describe specific cases, from the initial consultation, through to the diagnosis, then the operation, and finally the outcome. The descriptions of the operations are given in ‘real time’ and are riveting. One can almost see the surgeon cutting his way through the brain to reach the offending material and share his elation when the operation is successful; but also his anxiety when he encounters something unexpected, and his dismay when things go wrong. Marsh does not prevaricate when this happens and honestly admits that he has made many mistakes over his long career that have ruined the lives of his patients. One such error eventually cost the insurers £6M. This openness is rare in the culture of today’s NHS. These accounts are interwoven with personal details about his own life: for example, the fears he experienced when other members of own family have become ill, the moving description of the final days of his mother, and his long-term charity work in Ukraine.

Marsh is obviously ‘old school’, irascible and hierarchical, having little sympathy with NHS managers and other apparatchiks, and their political masters. Doubtless he has made enemies. His blunt question to one arrogant junior surgeon ineptly presenting a case in the morning case conference ‘What are you planning to do when you grow up?” says it all. But beneath this surface arrogance there emerges a man of great compassion and sensitivity, who cares deeply about his patients and the health service in which he has worked for all his medical career. It was a privilege to read this book.
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52 of 56 people found the following review helpful
on 15 March 2014
Having worked as a theatre nurse with several neurosugeons I always found brains, brain surgeons and their work fascinating. Mr Marsh manages to paint a picture in the readers mind of the patients, the hospital staff and his reasons for choosing his line of work, I wont go into more detail in case of spoilers. I read an extract in The Times and couldn't wait to get my hands on the book. It arrived yesterday and by the evening I'd finished it. I had to keep reading to find out what would happen next to Henry and his patients. He's an excellent storyteller with a fascinating and varied CV and obviously cares deeply for his patients. By the end of the book I was Googling about a career in neurosurgery and wanting to work with him!
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19 of 20 people found the following review helpful
on 16 March 2014
As a friend of someone going through a neurological diagnosis I found this book to be both harrowing and hopeful. It have me an insight into what goes on as we as friends and family patiently wait.
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34 of 37 people found the following review helpful
I have put off reading this book for several months because just after I bought it someone close to me died of a brain injury. Having steeled myself to read it, I found it a harrowing but ultimately reassuring read. It seems that any sort of brain surgery has a relatively large failure rate and that medical science still doesn't know as much about the brain and how to treat its problems as everyone would wish.

I liked the author's style and even though he does not spare himself when it comes to cataloguing his failures I felt if I was being treated by him I would trust him implicitly. It must be hugely difficult not to be able to offer patients and their families hope when someone has an injury or a tumour on their brain but sometimes it is kinder to do nothing and let nature take its course. Hardly anyone would think that being in a persistent vegetative state is preferable to death. The skill of any medical professional lies as much in knowing when to do nothing as it does in when to intervene.

Even when surgery goes well there are always dangers of possible complications afterwards. Strokes are a very really possibility after any sort of brain surgery. This book is far from being all doom and gloom. There is plenty of black humour, some marvellously touching moments and a fascinating insight into the problems of operating on the brain. There are some success stories as well which to the patients concerned appear miraculous.

If you like reading about things medical then I recommend this book whole heartedly. It isn't an easy read and you may well need plenty of tissues to hand at times but it is a worthwhile read.
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5 of 5 people found the following review helpful
on 13 July 2014
Prof. Marsh comes across as a profoundly caring and modest, yet brilliant individual who is not afraid to describe the changes in the attitudes of a good surgeon as he/she gains more experience but increasingly accepts the limitations of his/her craft.

Prof. Marsh has now, unfortunately, retired from surgical practice in the UK but continues to pursue his long-established unpaid work in helping desperately needy patients in Ukraine.
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3 of 3 people found the following review helpful
TOP 100 REVIEWERon 11 December 2014
Compelling reading. Henry Marsh pulls no punches for the lay reader. All life and death is here and at times it's a harrowing read. But it's good to be challenged by someone who writes with authority and compassion. Above all, Marsh comes across as a man who brooks no nonsense; from patients, colleagues and above all low life 'administrators' whose primary interest lies in budgets and politics. His dislike of those who control treatment options by concentrating on irrelevant trivia is almost palpable and should be applauded.

It's a pleasure to read a relevant account of so many issues which affect healthcare by someone who isn't afraid to speak out. I admire his honesty and integrity and if I ever have the misfortune to need neurological care, I could only hope that my treatment options and outcomes would be in line with views expressed here.

In addition to being a compelling and heart wrenching account of Mr Marsh's cases, this is a searing indictment of many of the current NHS failings. It provides an honest and rare insight into issues and attitudes which should be challenged if they arise. It wasn't always a comfortable read, because of the loss involved, but it was certainly rewarding and upbeat.
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4 of 4 people found the following review helpful
on 23 May 2014
What a phenomenal working life - to help people in distress but to be ready to take the blame if it all goes wrong...to pick up the scalpel and begin to operate is the bravest thing I have encountered. From the earliest surgeons to those working in the 21st Century - they are all the most courageous people you could ever meet.

This is an absolutely fascinating book, and one it's hard to put down. The decisions required as the surgeons do their work are crucial, but have to be taken calmly and with full recognition of the possible consequences. Not many folk have life-changing decisions to make every day, but this unassuming and humble man made me cry as I read the story of his work.
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4 of 4 people found the following review helpful
on 20 August 2014
Wonderful book - memento Mori - honest, refreshing and like Marcus Aurelius it reminds us on every page of our frailty, transience and humanity. Life is short. Make the best use of every day you can. This man has done that and his book is an inspiring read. How invigorating to find that he, a senior and respected neurosurgeon, admits openly to all the human faults, including pride, accepts his own responsibility for mistakes and is unafraid to criticise the idiocies of the present NHS, among other things. I saw him at Hay Festival this year interviewed by Ian McEwan and I'm very glad that led to me buying his book. It has no pretentious, made me laugh and cry. And I could not put it down,
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