Life as a Brain Surgeon

nolead begins By Henry Marsh

Thomas Dunne/St. Martin's. 271 pp. $26.99 nolead ends

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Reviewed by

Christina Ianzito

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Now in his late 60s and retired from Britain's National Health Service, brain surgeon Henry Marsh isn't hanging it up yet. Much of his new book, Admissions, focuses on his post-retirement work training surgeons in Ukraine and Nepal. In vivid prose, he captures the terrifying risks he faces with each cut, each decision.

Here, for example he writes of removing a tumor from the brain of a 6-year-old Nepalese child: "The white corpus callosum came into view at the floor of the chasm, like a white beach between two cliffs. Running along like two rivers, were the anterior cerebral arteries, on either side, bright red, pulsing gently with the heartbeat, which you must not damage under any circumstances."

And yet, "the child was almost certainly doomed whatever we did." He explains that the tumor would kill her if it wasn't removed, yet was too big to completely excise without damaging her hypothalamus, the part of the brain related to hormone production - and "children with hypothalamic damage typically become morbidly obese dwarves." He finishes knowing her future will be short and probably painful. "There is no pleasure or glory in this kind of operating," he writes.

Marsh is widely respected in Britain but is sometimes described in news stories as a curmudgeon. He does have a bit of a temper. But it generally takes the form of righteous anger over what he perceives as incompetence and inefficiencies in the health-care system. He admits to feeling deep shame for one extreme incident, two weeks before his retirement, when he was so angry with a nurse for not removing a patient's needless and painful gastric tube, he shouted, "I hate your guts!"

And yet it's hard not to like Marsh, who is disarmingly self-effacing and honest about his regrets and failures and how much he hasn't learned along the way.

He writes that a long time ago, "I thought brain surgeons - because they handle the brain, the miraculous basis of everything we think and feel - must be tremendously wise and understand the meaning of life." With age, Marsh has come to realize "we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling." Rather, he concedes: "I have learnt that handling the brain tells you nothing about life - other than to be dismayed by its fragility."

Christina Ianzito is a writer and editor in Washington. This review originally appeared in the Washington Post.