Review: 'Admissions: Life as a Brain Surgeon,' by Henry Marsh

Henry Marsh's second memoir, "Admissions," is an elegant, thoughtful examination of his life as a neurosurgeon in England.

The book is not just a recounting of memorable patients and cases, but a steady, fearless look in the mirror: at what brought him to medicine; his regrets (patients he lost; patients he wished he had lost, if only to save them from a slow, difficult death); his anxieties with each new case; his successes and failures; and his mixed emotions about his imminent retirement, which he views both as freedom and as empty, purposeless void.

Mostly, though, this is a book about death, which haunts him on every page. Doctors, more than anyone, and perhaps neurosurgeons most of all, are hyper-aware of the line between life and death, and as Marsh cuts away at tumors and gently prods gray brain matter, this is always on his mind.

"I have learnt that handling the brain tells you nothing about life — other than to be dismayed by its fragility," he writes.

He thinks about this in regards to his patients, but also in regards to himself, taking keen note of changes in his own aging body. When he tires, is it because he has worked hard, or because he is growing feeble? That mole in front of his right ear — has it always been there? Might it be deadly? And his memory — could he be developing the same dementia that killed his father?

He is pragmatic. He has a suicide kit, although he admits, "I'm not at all sure that I would ever dare to use" it.

"I cannot predict what I will feel when I know my life is coming to an end," he writes. "As a doctor, I cannot have any illusions. But it wouldn't entirely surprise me if I started to cling desperately to what little life I had left."

Still, the book is not depressing; Marsh is far too curious and engaged for that (if occasionally prickly), and when he treks off to Nepal and Ukraine to teach brain surgery and volunteer in hospitals there, he brings that curiosity with him.

The spine of the narrative follows Marsh's renovation of an old lock-keeper's cabin along the Thames, which he buys shortly after announcing his retirement. The place was once sturdy but is now collapsing, and he struggles to clear away mountains of trash, cut back the overgrown garden, repair broken windows and shore up walls — work that is often subsequently undone by vandals.

When he writes about these efforts, it is impossible not to think he is also writing about his own body, and his own life.

"Each time I walk towards the cottage I feel a sinking feeling at what further damage I will find," he writes. "Will they have broken the little walnut tree or snapped off the branches of the apple tree? Will they have managed to break open the metal shutters? … It fills me with a sense of despair and hopelessness, when I had hoped it would give me a sense of purpose."

Marsh's writing is elegant and tactile. He is sharply observant, both of people and of nature — the smell of cut wood and chain-saw oil, the color of faded reeds along the riverbank, the haughty glide of swans on the water. His descriptions are precise and careful, laden with meaning.

"I walked with mixed feelings along the towpath, rain falling from a dull grey sky, past the line of silent narrowboats moored beside the still, green canal. The air smelt of fallen wet leaves."

It is a pleasure to get lost in such a wise and beautiful book.

Laurie Hertzel is the senior editor for books at the Star Tribune. @StribBooks.

Admissions
By: Henry Marsh.
Publisher: Thomas Dunne Books/St. Martin's Press, 271 pages, $26.99.