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BOOK REVIEW

Henry Marsh, pioneering brain surgeon, navigates fear, powerlessness, and acceptance after a diagnosis of prostate cancer in his memoir ‘And Finally’

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Henry Marsh has led a long and notable life. A pioneering neurosurgeon, Marsh’s work in Ukraine performing high-risk brain surgery on desperately ill patients led to the Emmy Award-winning documentary “The English Surgeon.” His two books, 2015′s “Do No Harm” and 2017′s “Admissions,” immersed his readers in the agonizing choices faced by a physician who removes aggressive tumors from the human brain.

The most striking of many singular things about Marsh is that he’s a truth teller, willing to speak aloud both about the realities of modern medicine and his own professional shortcomings. So the most startling revelation about his new memoir, “And Finally,” is that for years, Marsh lied to himself. He ignored the signs of prostate cancer until the last possible moment, until no matter what the medical intervention, his death was more likely than not. That decision and its consequences placed him in a role he never imagined he would inhabit: that of a patient with limited odds for survival. It stripped him of any pretense of authority, superiority, or autonomy. It also presented him with the opportunity for a blazingly honest book, about life and death and his personal response to them.

“And Finally” follows Marsh through his diagnosis, his treatment, and its aftermath. Because he’s been knocked so thoroughly off his perch of all-powerful healer, Marsh excels in describing the powerlessness felt by most patients — he knows the medical system inside and out, and from his new perspective as a patient, he grasps the pain and uncertainty of his former patients. “Now that I was so anxious and unhappy, feeling abandoned, I realized how anxious and unhappy so many of my patients must have been, and yet how I had chosen to turn a blind eye to this,” he writes. The fear, the magical thinking, the despair — Marsh navigates all of these as he confronts his diagnosis, then turns for help to a daunting treatment regimen, which includes chemical castration (drug therapy that blocks testosterone, which feeds the cancer) and radiotherapy. And as he confronts his eventual leave-taking, he comes to an acceptance of the choices he’s made: “I understood that my life was, at the age of seventy, in a sense, complete.”

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Marsh’s narrative of his journey should be required reading in medical schools, but the reach of “Finally” is broader and deeper than a first-person account of a doctor’s journey through denial, diagnosis, and acceptance. He examines the underpinnings of science, the limitations of memory, and the nature of consciousness itself. He is an exemplary science writer, breaking down complicated topics with clarity and precision. His knowledge of biology and evolution leads him to a bleak view of the future he may not live to see — he mourns the havoc wreaked on the earth by climate change, and the ravaging of Ukraine, a country he loves. (“The Ukrainians will fight to the death. I always knew they would. They see no alternative.”)

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By now a potential reader may be thinking that this particular literary offering is best left to those with immediate concerns about their own mortality, but the key to Marsh’s appeal is his voice — wry, compassionate, honest, yet with the ring of utter authority. In one eloquent chapter, as he sorts old patient files before a move, he compares his present and past selves and comprehends the vast change wrought by his diagnosis: “Like most doctors I liked to think that I was kind and sympathetic, but it was only when I was diagnosed with cancer myself that I could see just how great is the distance that separates patients and doctors, and how little doctors understand about what their patients are going through.” He is, counterintuitively, a lot of fun, with a self-deprecating, wicked sense of humor, and his candor about modern medicine is bracing (one wonders if an American physician in the same predicament would be so forthcoming). As the narrative progresses, it’s impossible not to develop an abiding affection for this brilliant, prickly, and principled man. At times the interweaving of the treatment narrative (with digressions into his carpentry projects, beekeeping, and building a dollhouse for his granddaughters) and his more universal essays makes for a bumpy ride, but most readers will stick with Marsh all the way.

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And of course, readers will want to know what happens. Does Henry Marsh survive? I chose not to Google the outcome and I recommend that approach, because it makes his doubts, fears, and anxieties far more immediate. Other readers may make a different choice, but whatever you decide, be advised that this is a memorable book. You will look at your own life — and your own eventual death — differently when you’re done.

AND FINALLY: Matters of Life and Death

By Henry Marsh

St. Martin’s, 240 pages, $27.99

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Mary Ann Gwinn is a Pulitzer Prize-winning journalist who writes about books and authors.