“His handshake was firm, and I glanced surreptitiously at his hands, which were sturdy, with broad fingers, like the hands of a craftsman.”
This is how Norwegian writer Karl Ove Knausgård describes Henry Marsh upon their first meeting. In 2015, Knausgård was writing an essay for the New York Times about Marsh after having read the latter’s book Do No Harm. I kept Knausgård’s observations in mind during last night’s talk at the 2018 Autumn Literary Festival, which featured Henry Marsh in conversation with Christopher Bigsby. The topic of Marsh’ hands came up many times; they are what he uses to change lives as a brain surgeon, although he was fascinated by hands long before he specialised. He always liked working with his hands, and when he dissected amputated hands at medical school, after having rummaged through an entire plastic bag of them, he would do watercolour illustrations of the severed, dissected limb. (“There’s a sickness here”, Bigsby remarks.)
The lecture theatre is brim-full. Extra chairs have been placed at the back of the auditorium. Bigsby opens by informing us that each one of us possess the same amount of neurons as there are stars in the galaxy, and that we could all have “an aneurism that could burst at any moment.” This remark sets the tone for the remaining hour. Marsh has written two books about his career: Do No Harm from 2014 and Admissions: A Life in Brain Surgery from 2017. His next book, he tells us, will deal more with the metaphysical and philosophical aspects of his work, but he also says that when operating, “You really don’t want to think too much in those terms. You have a technical job to do.”
This statement appears to be typical of Marsh, who is refreshingly straightforward even when discussing the most serious parts of his job. He is quick to ascribe a mystic experience he had as a young man to a combination of sleep deprivation and recently having read Aldous Huxley’s hallucinogenic book The Doors of Perception. Marsh started out studying philosophy, politics and economics at Oxford, but was “immature psychologically and sexually” and therefore fell in love with a much older woman, failed to kill himself, and ended up running away without finishing his degree. After spending some time writing terrible poetry inspired by Sylvia Plath, he got a job at a hospital and decided to return to his studies.
Marsh did not immediately gravitate towards brain surgery after medical school. His son William got operated for a brain tumour when he was only three months old, and Marsh later wrote in The Telegraph that while this may not have been the reason why he ended up doing brain surgery, “it was certainly the reason why for many years I did all the paediatric brain surgery in my hospital.” He tells the audience that he would have been a worse doctor without the experience involving his son, and goes on to explore the tension between not wanting to lie to patients, while also not extinguishing all hope. Operating on a brain is one thing; dealing with paralysed patients or families who lose a child is very different. Marsh once asked a patient to sue him after she ended up paralysed when he failed to recognise signs of infection in her brain. As the French surgeon René Leriche once said: “Every surgeon carries within himself a small cemetery.”
Having done surgeries in places like Nepal, Albania and Ukraine, Marsh praises the NHS despite its flaws, simply because its doctors don’t have a financial interest in their individual patients. What he does not appreciate is the hospitals’ managerial structure. Bigsby reads out a memorable quote from Do No Harm, which ends with “Fuck the management, and fuck the government and fuck the pathetic politicians and their fiddled expenses and fuck the fucking civil servants in the fucking Department of Health. Fuck everybody.” This gets a round of applause from the audience, but the tone quickly shifts and Marsh is able to round off the evening by reading an extract concerning his mother’s death. Again, what he says is matter-of-factly yet deeply moving, proving that you can be both sensitive and sensible about the big issues in life without ever becoming sentimental; “entirely open but not confessional”, as Knausgård once described him.