And Finally: Matters of Life and Death by Henry Marsh; Brainspotting: Adventures in Neurology by A J Lees - review by Salley Vickers

Salley Vickers

Meeting of Minds

And Finally: Matters of Life and Death

By

Jonathan Cape 230pp £16.99

Brainspotting: Adventures in Neurology

By

Notting Hill Editions 170pp £14.99
 

There is a well-attested connection between being a good doctor and being a good writer (think Keats). Neurosurgeon Henry Marsh’s Do No Harm, published in 2014, achieved unlikely but deserved success, and among his many praiseworthy qualities is the ability to write elegant, unpretentious prose. In this and his subsequent book, Admissions (2017), he explored the human brain from the vantage point of the practising surgeon. Now retired from practice in the UK, he has continued to work overseas, particularly in Nepal, Albania and Ukraine, the last a country for which he has a special affection, and whose currently beleaguered state he writes of movingly.

In his latest book, And Finally: Matters of Life and Death, Marsh turns his penetrating mind inwards. He starts by reflecting on the state of his own ageing brain, the condition of which comes as a shock when he is confronted with an image of it after casually – cavalierly, even – undergoing a brain scan. A yet more brutal blow comes with the discovery that he has advanced prostate cancer. As a consequence, he must face the possibility of an acceleration of his own end.

He writes with appealing candour about his reluctance to investigate his own symptoms after years of observing and attending to mortal symptoms in his patients. Marsh charts his journey through disbelief, denial, terror, fury and, finally, acceptance of the diagnosis. The accounts of the medical treatments he undergoes make for some of the most appealing – on account of the glimpses of his stoical good humour – as well as distressing aspects of the book.

I had been reluctant to undergo the biopsy as it can cause post-operative acute urinary retention. This is an emergency, although easily dealt with by inserting a catheter. I dreaded this, so when I found I could pass urine in the toilet … I felt very relieved. ‘Did you go OK?’ the friendly staff nurse … called out as I emerged from the toilet. ‘Yes,’ I replied happily. ‘It came out at an odd angle, but I have mopped up the floor.’

He is often drily funny. On the side effects of his hormone therapy, which blocks testosterone, he observes, ‘depression was also listed – but what man will not be depressed by castration and the possibility of imminent death?’

Marsh uses his condition to explore wider issues: consciousness, assisted dying and our possibly innate fear of death. Here the book loses some of its sharpness and vigour, but the affection one feels for the author, on account not simply of his current plight but also of his willingness to invite us so openly into his mind, with all its ups and downs and vulnerabilities, subdued, in this reader anyway, any inclination to carp. And we must all rejoice that, at the very end of the book, Marsh reveals that, against expectations, the treatment has worked and for the time being the death sentence has been commuted so that he has more years ahead of him to explore and enjoy life. Hurray! We can’t spare people like Marsh.

A J Lees’s exquisitely produced Brainspotting is a gem. He is a neurologist and happily shares Marsh’s ability to write elegant and lively prose. The book begins with an account of his birdwatching childhood. Lees suffers from colour blindness, which might in a different person have hampered his observations but which instead encouraged Lees to develop an acute eye for birds’ markings, an attention to physical detail that he has employed to unusual advantage in his career as a neurologist.

Lees fell into his specialisation through a process of serendipity, which also helped shape his admirably eclectic intellect. Through his early interest in ornithology, he came to read the poetry of John Clare and he describes how the poet introduced him ‘to the incredible power of passive attentiveness’ and how ‘by listening attentively to the distress calls of patients I could determine the source of their complaint’. It was his birdwatcher’s eye that discerned that the ‘tremor of Parkinson’s was akin to the kestrel’s hover’.

In a legacy of his birdwatching youth, at times when there were shortages of patients to act as teaching examples, Lees sent his students out on to the London Underground to observe people going about their daily lives and come back with detailed accounts of what they had noted: the posture, the gait, the gaze, the likely ethnic origin. Birdwatching also alerted him to the dangers of misdiagnosing diseases that mimic others. Huntingdon’s disease can present in early life as Parkinson’s, while ‘migraine chameleons included stroke, epilepsy and vestibular disorders’.

Lees also pays close attention to what his patients say: the rate of speech, the pauses, gaps, pitch, volume and inflections. Most importantly, ‘If I am told: “Doctor I am not feeling myself”, I always take it very seriously.’ He emphasises the need for expressions of sympathy and takes seriously the possibility that genuine sympathy really can be remedial.

Alongside this genial recounting of his approach to his work, Lees offers sketches of neurologists by whom he was taught or who have influenced his thinking and recollections of institutions where he has worked. One such place is the Maida Vale Hospital for Nervous Diseases, which is described in a chapter unnervingly titled ‘The Dead Hospital’. Here we encounter the dapper Dr Barnard, who arrived for work each day in a bowler hat and whose tutorials began with the offer of Earl Grey tea and a slice of Dundee cake, and Dougal, in charge of the mortuary, who had ‘a complete indifference to life and a loathing of humanity’ but was nonetheless an artist when it came to dissection of the human brain. In the chapter ‘Resurrection’ we follow Lees as he undertakes the examination of the brain of an unknown person, salvaged from the vaults of the now defunct Maida Vale Hospital. It’s a truly enthralling piece of detective work, of which Sherlock Holmes, whom Lees often quotes, would have been proud.

I loved this book. If ever I fall victim to a neurological disorder, I can only hope to God I come under the benign and intelligent care of Lees.

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