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Famous British physician Henry Marsh was one of the first neurosurgeons in England to perform certain brain surgeries using only local anesthesia. For more than 30 years, he also made frequent trips to Ukraine, where he performed surgeries and worked to reform and update the medical system.
As a surgeon, Marsh felt a certain level of detachment from hospitals – until he was diagnosed with advanced prostate cancer at the age of 70. Although he continued to work after his diagnosis, interacting with the hospital as doctor and patient was sobering.
“I was much less sure of myself now that I was a patient myself,” he says. “I suddenly felt much less sure of the way I had been [as a doctor]how I had treated the patients, how I had spoken to them.”
In memoryAnd finallyMarsh talks about his experiences as a cancer patient and reflects on why his diagnosis came at such a late stage.
“I think a lot of doctors live in that sort of ‘us and them’ limbo,” he says. “Disease happens to patients, not doctors. Anecdotally, I’m told that many doctors present with their cancer very late, like me. … I denied my symptoms for months or even years.”
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Marsh’s cancer is currently in remission, but there’s a 75% chance it will come back within the next five years. It’s an uncertainty that Marsh has learned to accept.
“For the past few weeks I’ve been in this wonderful Zen Buddhist state,” he says. “At the moment I’m really, really happy to be alive. But that’s only really possible because I’ve had a very full life and I have a very close and loving family and those are the things that matter in life.”
Seeing his own brain scan and being shocked by his signs of aging
It was the beginning of my duty to accept that I was getting old, to accept that I was becoming more of a patient than a doctor, that I was not immune to decay, aging and the diseases that I saw in my patients since the beginning 40 years. So it was actually terribly scary to look at the scan, to cross a threshold, and I never dared to look at it again. It was just too overwhelming. In retrospect, it probably wasn’t that bad. Probably, if I had seen that CT scan at work, I would have said, “Well, that’s a typical 70-year-old brain CT.”
Continuing to work in the hospital after being diagnosed with cancer
As a doctor, you are in no way emotionally engaged. You watch brain scans, you hear terrible, tragic stories and you feel nothing, really, overall, you’re totally detached. But what I found was that when I attended teaching meetings and they saw scans of a man with prostate cancer that had spread to his spine and caused paralysis, I felt a surge of fear in my heart. … I had never felt anxious about going to hospitals before, because I was detached. I was a doctor. Disease happens to patients, not doctors.
After being diagnosed at 70 and feeling like his life was over
We all want to go on living. The desire to continue living is very, very deep. I have a loving family. I have four grandchildren who I love. I am very busy. I continue to give lessons and teach. I have a workshop. I do things all the time. There are a lot of things I want to continue doing, so I would like to have a future. But I felt very strongly that the diagnosis had fallen into the fact that I had really been very lucky. I had reached 70 years old. I had a really exciting life. There are a lot of things I was ashamed of and regretted, but I like the word “complete”. Obviously, for the sake of my wife, the sake of my family, they want me to live longer and I want to live longer. But purely for me, I think about how lucky I was and how difficult approaching the end of your life can be if there are a lot of unresolved issues or difficult relationships that haven’t been settled. So in that sense, I’m ready to die. Obviously, I don’t want to, not yet, but I’m a little reconciled to that.
Do not fear death, but fear suffering before death
I have always hated hospitals. They’re horrible places, even though I’ve spent most of my life working there. It’s not really death itself [I fear].
I know, as a doctor, that dying can be very unpleasant. I am a fiercely independent person. I don’t like to be out of control. I don’t like to be dependent on others. I wouldn’t like to be disabled and wasting away with a terminal illness. I could accept it, I don’t know. You never know until it happens to you. And I know from family, friends and patients, it’s amazing what you can come to terms with when you know your previous self would give up in horror. Then I do not know. But I would like to have the option of medical assistance in dying if my end seems rather unpleasant.
Why he supports medical assistance in dying
Medical law in England [is that it] is murder to help someone commit suicide. It’s ridiculous, is the short answer. Suicide isn’t illegal, so you need to provide very good reasons why it’s illegal to help someone do something that isn’t illegal and is perfectly legal. And opinion polls in Britain still show a huge majority, 78%, want the law changed. But there is a very passionate, dare I say fanatical group — primarily palliative care physicians — who deeply oppose it. And they have the ear of parliamentarians.
They argue that assisted dying will lead to the coercion of what they call the vulnerable. You know, old and lonely people will somehow be intimidated by greedy parents or cruel doctors and nurses into asking for help to kill themselves. But there is no evidence that this happens in the many countries where medical assistance in dying is possible, because there are many legal safeguards. This is not suicide on demand. You can make guarantees as strong as you want: you have to apply more than once in writing, with a deadline. You must be seen by independent doctors who will ensure that you are not constrained or clinically depressed. So only a very small number of people opt for it, but it seems to work reasonably well without terrible issues in countries where it’s legal. And there’s no question that even with good palliative care—although some palliative care physicians deny it—dying can be very unpleasant, not so much physically as the loss of dignity and independence, which is the prospect that troubles me.
To know when it was time to stop doing surgery
I stopped working full time and mainly operating in England when I was 65, although I did a lot of work in Kathmandu and Nepal and also, of course, in Ukraine. And what I’ve always felt on principle is that it’s better to leave too soon than too late. As with everything in life, whether it’s dinner or your professional life itself, it’s better to leave too soon than too late. To be honest, I was getting more and more frustrated at work. I mean, I’m a big fan of the UK National Health Service, but it’s become increasingly bureaucratic. And psychologically, I was becoming less and less able to work in a very managerial bureaucratic environment. I’m a bit of a loose cannon maverick. Also, I felt it was time for the next generation to take over. And I had become reasonably good at the operations that I was doing. I didn’t think I was getting better. And I had a very good trainee who could replace me and who had actually moved things forward, and particularly in the practice of awake craniotomy, he does much better things than I could have done. So it was the right time to go in that regard.
What really surprises me now is that I don’t miss it at all. I was completely addicted to the operation, like most surgeons. The more dangerous the operation, the more difficult, the more I wanted to do it, the whole thing of risk and excitement. One of the hardest parts of surgery is learning when not to operate. But to my surprise, I don’t miss it – and I don’t quite understand that. But I’m very happy. In a funny way, I feel like a more complete human being now that I’m no longer a surgeon. I no longer have a terrible divide in my worldview between me – and the medical system and my fellow physicians, that is – and the patients. So I feel like a more whole person.
Thea Chaloner and Joel Wolfram produced and edited the audio for this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the web.