I found Marsh's book captivating, though sometimes hard to read. Not just because the stories he tells deal with the harsh reality of life-threatening conditions but because witnessing his flawed actions is, frankly, off-putting. We all want to think of doctors, and surgeons in particular, as being infallible paragons of virtue and perfect decision-making. Yet, recognizing they're as human and flawed as the rest of us is terrifying.

My favourite chapter was the last one, where Marsh described his views on death, end-of-life care, and what it really means to die "a good death." I also appreciated his take on practicing medicine in Nepal. The parts set in Ukraine were more challenging to read - perhaps because I was born in Romania, and some of the descriptions hit a little too close to home.

Overall, I found this a complex, interesting, thought-provoking book, one I'm glad to have read. ( )

The case studies within this book give a fascinating insight into working on the surgical front line in the UK. Henry Marsh (Author), has certainly dedicated his entire working life to help and save others however for me I feel as though he came across as very arrogant and as though he has a God complex. I noticed from early on that the book was more about his own journey and less about the people that he had helped and saved. This ruined it for me as I would have liked to know more about his patients and less about what he does/plans on doing with his retirement which is the majority of this memoir.

Henry discusses his collegues, patients, junior doctors, and his own responsibilities as an attending surgeon with a lot of bitterness and complained throughout about regulations and changes within his role that he did not agree with as to me he was stuck in the past having done the job for over four decades. Hi frequent complaints about the NHS and also his work within other countries left me feeling as though he saw himself as better than everyone else within the field.

Despite this, way in which Henry talks through the cases that are included is truly captivating, although maybe not for the faint hearted. As someone with little to no medical knowledge, the cases were described fantastically and I was able to follow along with ease which some authors within an area of expertise fail at with too much terminology the everyday person would not understand. The variety of cases discussed was fascinating to me as there were some fairly common cases but also rarer cases that you do not come across everyday.

The chronology of the writing could have been a lot better as often there would be jumps of time both forwards and backwards which left me often a little puzzled and difficult to follow the timeline.

Overall I did enjoy this book and the insight it gave me, however due to the God complex I feel that Henry Marsh has and his constant complaining has led me to not wish to read another of his books and ultimately I give 2 stars. ( )

Atul Gawande's Being Mortal is a more thoughtful examination of life and death on those growing older. His manner is more comforting and his writing style more comfortable. That said, Henry Marsh is grumpy, a little crotchety, and, refreshingly, he allows those manners to come through in his writing, taking to task his friends and patients and families and even episodes from his own personal life.

I made a number of passage notes, but these two excerpts come from the final chapter, which was my favorite for their summing up:

Life by its very nature is reluctant to end. It is as though we are hardwired for hope, to always feel that we have a future. (264)

We have to choose between probabilities, not certainties, and that is difficult. How probable is it that we will gain how many extra years of life, and what might the quality of those years be, if we bust ourselves to the pain and unpleasantness of treatment? And what is the probability that the treatment will cause severe side effects that outweigh any possible benefits? … And yet it has been estimated that in the developed world, 75% of our lifetime medical costs are incurred in the last six months of our lives. This is the price of hope, hope which, by the laws of probability, is so often unrealistic. And thus we often end up inflicting both great suffering on ourselves and unsustainable expense on society. (265-266) ( )

Compared to Do No Harm, this book doesn't dwell on brain surgeries that much. Marsh focuses more on his experiences in Nepal and Ukraine and dwells on subjects such as death and religion. More than once, he explained why he doesn't think there is life after death. I am not sure why this is such a preoccupation with him but at least he wasn't dogmatic. And of course, expect the bashing of NHS. Nevertheless, still a good read as Marsh writes of his fragility, again throwing off the cloak of invincibility of doctors. ( )

Indeholder "Forord", "1. Slusevogterhytten", "2. Opbrud fra London", "3. Nepal", "4. Amerika", "5. Vågen kraniotomi", "6. Sind eller hjerne", "7. En ridetur på en elefant", "8. Advokater", "9. Håndværk", "10. Knuste vinduer", "11. Minder", "12. Ukraine", "13. Undskyld", "14. Opbrud fra Ukraine", "15. Hverken solen eller døden", "Tak".

Bogen starter med tanker om døden. Vil man vælge døden, hvis demens eller en ondartet hjernetumor banker på en dag? Eller vil man hele tiden vente til næste dag? Han køber en lille hytte i Oxford tæt ved sit barndomshjem. Og tænker at han vil bruge den som værksted, når han går på pension efter fyrre år som læge og neurokirurg. Han er grundigt træt af bureaukrati. Som noget af det sidste opererer han på en patient med en invaderende form for frontallapstumor. Formentlig lidt livsforlængende, men om det er en god ting?
Han er gift med Kate Fox og får den ide at han kan tage til Nepal og hjælpe Dev, som er Nepals absolut førende neurokirug (og hedder professor Upendra Devkota). Hans sidste patient i London får stoppet en nasogastrisk sonde ned i halsen og Marsh tænder af på en sygeplejerske, der ikke vil fjerne den. Fantastisk måde at forlade sit job på efter fyrre år?
Nepal er noget helt andet og han er forelsket i landet med smukke, høflige mennesker og knusende fattigdom og skyer af udstødningsrøg og bjerge af skrald. Mange af neuropatienterne er ofre for motorcykeluheld. Marsh taler ikke sproget og han forstår heller ikke kulturen, så han føler sig som en dyrlæge. Et års tid tidligere var han i USA i Houston til en workshop. De opererer på grise og afskårne menneskehoveder for at øve sig i at afhjælpe aneurismer. Marsh bemærker de slående forskelle på hundedyre hospitaler og hjemløse der sover i byens parker.
Han tænker meget over om det egentlig er en fordel for patienter at blive opereret eller om det var bedre at lade dem dø en værdig død. I Nepal er der mange fremskredne tumorsygdomme, fordi det tager længere tid at få en diagnose. Til gengæld insisterer mange så på en dyr MR-skanning, selv om resultatet er givet på forhånd. Han dyrker motion, løber og tager koldt styrtebad, men hader det meste af det.
Inden rejsen til Nepal fik han fjernet en knop i panden. Det var hudkræft, men havde ikke bredt sig. Pyh! En tur på elefantryg giver også anledning til at se et par piger fra Tyskland, der sidder og ruller riskugler til elefanterne. Han kan ikke finde ud af hvad han skal mene om at se disse børn af det velhavende Vesten lege bønder. Han tænker over elefanters store hjerner og hvalers store hjerner og hvordan bevidsthed og smertesans skal tolkes. Vel tilbage på hospitalet hjælper han med en operation på en dreng. Han overlever men er blevet helt blind. Under en senere tur til Nepal får han besøg af sin søn William og går ud på en vandretur i bjergene. En kilometerlang stentrappe tager pippet noget fra Marsh. Udkantsnepal er ved at blive affolket, for folk her tager til Pokhara. Flere stentrapper føles som en opstigning til helvede i stedet for den traditionelle nedstigning. Og patienter, der dør, udløser tit vrede fra familien. Det er lidt hårdt at være forhadt, når man bare passer sit arbejde.
Tilbage i London er han sagsøgt. Det er et vilkår ved arbejdet, men han er ikke begejstret for sagsøgerne eller deres advokater.
I stedet nyder han at arbejde med træ. En kollega havde overraskende nok et helt professionelt savværk og hele stammer af træ liggende, så han har fået sig nogle egeplanker at lege med. Han funderer en del over hvor mange ting, man kan rage til sig gennem et langt liv.
Han køber slusevogterhytten (takket være et lån i Londonlejligheden, hvor han selv havde renoveret noget af den uden lige at følge byggeregulativet). Men mens han er i Nepal er der indbrud og hærværk. Desuden er der sækkevis af affald fra den tidligere beboer. Marsh er ved at køre lidt sur i hytten, men der er pramme, der sejler på floden og han slipper af med to pramladninger affald på den vis!

Der er nogle gode tilbageblik over forældrenes liv og hans egen opvækst. Og steder han har boet. Og hans første ægteskab, som ikke endte godt.

Han tager til Ukraine, hvor han side 1992 har kendt Igor, men Ukraine er et barsk og mishandlet land. Og Igor laver fejl og har svært ved at indrømme dem. Marsh føler at han bare skulle have nægtet at hjælpe Igor med at operere hjernetumorer.

En patient med sukkersyge dør, fordi hendes blodsukker ikke bliver kontrolleret. Ren sjusk. Men Marsh siger undskyld til familien og de lader være med at sagsøge hospitalet, selv om han opfordrer dem til det. Han er grundigt træt af bureaukrati.

Hans samarbejde med Igor går ikke godt og han ender med at tage hjem til London og leve med brexit-afstemningen og andet lort fordi han kan slås fysisk med ukrudt og knuste ruder i sin hytte.

Superpersonlig bog, hvor forfatteren delagtiggør læseren i sine tanker om livet og døden. Og døden har han haft som fast følgesvend gennem hele lægegerningen. ( )