A dying doctor’s last words

Facing up to the prospect of one’s own mortality is always jarring; but when you’ve spent your life trying, and sometimes failing, to save others from a terrible death, it carries the knowledge that the journey may be more traumatic than the fear or grief of the end.

These are the concerns with which Henry Marsh, the eminent neurosurgeon and author, grapples after his own diagnosis of advanced prostate cancer more than a year ago. He believes this book will be his last and, unsurprisingly, he seems to be cramming everything into it. It makes for a discursive read and jumps about chronologically and topically, as if he wants to include all his important final thoughts. But since he’s deeply reflective, the result is a bit like sitting in the pub with the smartest person you know.

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There are three sections: ‘Denial’, ‘Therapeutic Catastrophising’ and ‘Happily Ever After’, which reflect the various stages of grief (denial, pain/guilt, anger, depression, reconstruction and acceptance). But the categories merge, and Marsh combines the description of his cancer treatment with themes, general and personal, that have long preoccupied him: ethics, philosophy, teaching and training doctors, creativity, physical and cerebral fitness and his family. It’s evident that he is more concerned with high standards for himself and others than with hubris. But inevitably there’s a difficulty, after a life of high achievement, in adapting to being a patient, the passive object of other people’s decisions.

Marsh is a fair man, both in his appraisal of his treatment and his private life, critical of his faults and equally ready to give positive and negative feedback. He is justifiably concerned with the importance of good doctors and nurses, and the need for medics to show they genuinely care about their patients – to listen and have time for questions.