The answer, as Henry March reminds us in his poignant and thought-provoking new memoir “Finally,” is, at times, yes.
When he learned of his diagnosis of advanced prostate cancer at the age of 71, Marsh, a neurosurgeon in London and author of two previous memoirs — “Do No Harm” (2015) and “Acceptance” (2017) — was shocked. At some point, he crossed into another world, patience (my mandate, not his). As he accepts this new situation, he is haunted by the faces and ghosts of Marsh’s former patients: “Now that I was so anxious and unhappy, and felt so abandoned, I realize how anxious and unhappy many of my patients are.”
Marsh’s honesty is disarming, and that makes up for it as he provides an explanation for his own shortcomings as a caregiver. He writes: “As a physician, you cannot do the work if you are truly sympathetic…you have to exercise a limited kind of sympathy, without losing your humanity in the process. While I was still working, I thought I had made it, but now, looking back And, as a patient, I was full of doubt.”
It is this kind of insight—exploring his fallibility, his shortcomings and even his complicity in an indifferent system—that makes Marsh’s writing so powerful and allows him to transcend the usual pathology. However, some of his observations about medicine seem like they shouldn’t have been as inspired as they seem: for example, his remark that “one of the worst aspects of being a patient is waiting—waiting in dark outside waiting areas, waiting for appointments, waiting for test results.” and scanning.”
Yet his book shows how disease unites us. Marsh is surrounded by insecurities and fears like no one else. He writes, “I find myself besieged by philosophical and scientific questions that suddenly seem so important—questions that in the past I either took for granted or ignored.” His book is an attempt to understand the questions, if not to come up with answers. As in his earlier work, Marsh’s exploration is intimate, insightful, intelligent, and deeply moving.
Marsh’s style of writing is such that one feels left behind as an assistant in the operating room, in his carpentry shop, or at his dining table; In doing so, one hears the musings of a scientist, neuroscientist, and neurosurgeon, and the inner dialogue of a patient feeling vulnerable. He weaves in science, philosophy, history, and personal anecdotes as he deals with everything from the nature of consciousness to deciding when it is time to pass on a difficult process to a younger and perhaps more capable colleague. It turns out that before he was diagnosed with cancer, Marsh had been grappling with a parallel issue: “As I approached 70, that cancer was already present but undiagnosed, it became increasingly difficult to deny that my body was past its best date.” By its limitations, the accumulation of minor injuries. “I didn’t want to die—but then who dies? But I didn’t want to be old and worn out, to state the obvious.”
As a super-grandfather, Marsh worries about the future of our species. The history of science is very much the history of refuting human exceptionalism—the earth is not the center of the universe; Humans are animals. As the great zoologist J.Z. Young noted, we are standing monkeys, not fallen angels. He explains that Marsh is “not deeply troubled by the thought of the approaching end of the human race”. In the long run, it is inevitable after all. … But I am horrified by the suffering that the decline and end of the human race might entail, and I think of my granddaughters and their great-grandchildren potential, climate change, and all that will bring about in its wake.”
For the reader looking for insight into how to face the end of life, Marsh shares that he has seen many people die, “some good, some bad.” Dying can be slow, painless, agonizing, or if one is lucky, it may pass away peacefully. “But death is seldom easy, and most of us will now end our lives in the hospital…in the care of strangers, with little dignity and without independence. Although scientific medicine has brought great and wonderful blessings, it has also brought a curse—death has become, For many of us, it’s a long-term experience.”
Long before he knew of his diagnosis, Marsh had assembled a suicide kit consisting of a few legally obtained drugs that could end his life. But after being diagnosed, he worries: What if the kit just isn’t doing the job? In desperation, he contacted a friend’s physician, obtaining a promise that the friend would secure the desired end. He asks his friend: “Isn’t it premature?” “Yeah…but I want to prepare myself for the worst.” The friend does promise, and with this, Marsh’s anxiety diminishes.
The book concludes with a reflection on a 1929 photograph of Marsh’s mother as a young girl, with her siblings. “Looking into my mother’s little eyes, my life now perhaps coming to an end, I felt as close as I could possibly have been to living in time—past, present, and future all rolled into one whole.” Fortunately, Marsh is still in the present, his cancer now in remission, and with this book he left for future readers a work to savor and learn from.
Abraham Verghese is professor and vice chair of the Department of Medicine at Stanford University. He is the author of “Cut for Stone”. His new novel, The Water Charter, will be released in May.
Matters of life and death
Saint Martin. 240 pages. $27.99.
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