Henry Marsh: "Preparing to die has a lot to do with having had a good life"

Neurosurgeon Henry Marsh (Oxford, 73 years old), author of

was writing a book about the brain.

He thought that his, so active, would not have shrunk like everyone else, who ends up being the size of a walnut.

"Narcissistically I did a ct scan to check it out."

He found a tumor.

He tells it in

(Salamander), which has just been translated into Spanish.

He lives alone in Wimbledon, south London, in a semi-detached house where he has built almost everything: from the bookshelves to the skylight in the bright kitchen.

He has also planted the camellia in the garden.

Logs burn in the fireplace.

"I turn it on when someone comes," he says.

He wears his pants tucked into his socks.

"I come from the eight o'clock meeting at the hospital."

He tells that he is reviewing a book by Freud.

“It is not science, it is literature.

That is the key: he wrote very well”.

Also that his father, a lawyer, took him to Spain for the first time to a secret anti-Franco meeting.

“I was 16 years old and it seemed like a very primitive country to me.”

All this before you start asking.

“I am a person who goes up and down and I have learned to accept it”, he diagnoses: “As a friend told me: it is impossible to feel very optimistic and very pessimistic at the same time”.

“Emotions have guided me, the psychiatric term would be cyclothymic.

My life has been intense.

That's why I've been a neurosurgeon.

Most doctors don't want to be surgeons.

And most surgeons don't want to be neurosurgeons.

If you don't like risk, don't choose this profession.

Risk implies the possibility of the best, which only exists, of course, because its opposite exists.

In

Yes. As a neurosurgeon you may be able to save a life that person would not want.

It's a tough decision for the family to make, if you can find them.

The question is: do you know this person well enough to know if he would want to live in these conditions of dependency?

Or: do you love this person enough to take care of her if she can't?

He wrote that if he were diagnosed with a brain tumor, he would surely commit suicide.

He hasn't.

I defend the right to euthanasia, which they now have in Spain and we don't have here.

We must know how to look death in the eye.

It is part of existence.

When I was diagnosed with the tumor, I became obsessed until I thought: I am 73 years old and I have had a difficult life, but a long and good one.

I thought of my young patients who died.

And in their parents, who would never know them as adults.

The desire to survive is in our DNA.

The problem is that that made sense when people died at 40 years old.

Now fear is becoming a burden for who you love.

There are so many treatments that it has become a problem knowing when to stop.

When to stop?

Many treatments are expensive and the public health system cannot afford them.

More diapers are sold for the elderly than for children.

30 years ago I would have died of cancer.

Now I will die with cancer, but not cancer.

Cancer is, fundamentally, a disease of the elderly.

The probability of having it at 70 multiplies by a thousand that of having it at 20. But dementia terrifies me more.

I couldn't bear to be a nuisance.

Why are we afraid to disturb?

I would not want my children to see me as I saw my father at 96 years old.

I didn't know who he was.

He became a doctor due to a life crisis.

I started Political Science and Philosophy, but it was all verbal analysis, and I went to Ghana for a year as a volunteer with white, Catholic priests.

Although I am not religious, that experience shaped me.

Then I went to work as a stretcher-bearer.

Neurosurgeon Henry Marsh, pictured at his home in Wimbledon, south London. Manuel Vázquez

He fled Oxford out of heartbreak.

I was very immature.

I fell madly in love.

I had spent my teenage years reading poetry and, well…it was embarrassing.

She was a family friend who partly caused my crush...

Was married?

Yes. Typical of adolescence.

I couldn't get out of my obsession.

I even tried to commit suicide!

I know what it means to be madly in love... And I don't trust madness.

I believe that in relationships that work, love is work.

But then I became obsessed with that rigid American poet, Sylvia Plath.

Does it seem stiff?

He wrote very well.

But he was narcissistic.

And for me narcissism is only justified when it leads you to make the world a better place.

A doctor.

Well... I wanted to know the real suffering, not the one that had invaded my head.

And I found work in the operating rooms of a hospital north of Newcastle.

Then I went back to Oxford, studied like a madman, and met my first wife, a troubled relationship from the start.

Oh.

He learned with our divorce.

She has become a marriage counselor.

We had three children.

She kicked me out of the house.

I don't blame her.

She arrived at night, they called me from the hospital and I had to go again.

I was obsessed with my patients.

I put them ahead of everything.

Is that why you don't live with your second wife?

Kate Fox is a brilliant anthropologist.

Her book

is a mega

She [she Gets up and gives me a copy].

Separate lives make a happy marriage.

We don't live together because he has Crohn's disease.

Again the fear of disturbing.

Living with a chronic illness is difficult for everyone.

As a doctor I am alarmed, as a couple I must respect it.

He studied medicine without knowing that his maternal great-grandfather had been a doctor.

My mother was German and before she died she decided to write down that she stopped talking to her family because they chose to join the Nazi party and she didn't.

Do we wait until the end to ask ourselves the most important questions?

Preparing to die has a lot to do with having a good life.

I am privileged.

I have loved being a doctor and building wooden tables.

And that has everything to do with how lucky you were as a child.

That is, poor people are not lucky.

Therefore, we have an obligation to treat them better.

As a doctor it is automatic, an ethic.

To extend life, what should be done is to improve the first years.

Is ignorance of our own past carried over to the history of our country?

When you get older you realize how little you have questioned what you have learned.

Kate made me see that it was the slave trade that financed the industrial revolution.

Mistakes like that derive many current problems.

But it is easier to feel proud than ashamed, and historical repair is complicated.

Where do you stop?

What is a good death?

The one that allows you to look back and think: I have said what I had to say.

We are unable to accept death.

As if there was another possibility...

Our nature separates us from pain.

It is irrational to worry about something that, whatever you do, will happen.

That's why we live in the present.

Do we live in the present?

I do, ever since I was diagnosed with cancer.

Also every time I fall in love.

It's happened to me several times, but I've always watched it with suspicion.

You have to let six months go by for the hormonal system and the brain to calm down.

Then the work begins.

What we mean by love is very selfish.

Love consists in making the loved one happy.

Marsh makes his tables, shelves and even windows.

Marsh, pictured in the workshop that he has in his house.

Manuel Vazquez

Do you have a good relationship with your children?

I dragged the guilt of my absences.

I had problems with my son William, a great guy, lonely, childless.

But he did psychotherapy and it went as well for him as it did for me.

Why did you go to therapy?

When I came back from Africa I was 22 years old and I didn't know what to do with my life.

I didn't hold myself alone.

Going to the psychiatrist was like a religious conversion.

After the first session I spent the night crying.

At dawn she had dark circles under her eyes, but she had cried everything.

William James describes religious conversion as forgiveness, knowledge, and truth.

It wasn't crying, it was admitting that I needed help, finding it, accepting my fragility and letting go of my anger.

You have to be very strong to assume your fragility.

It is a paradox, like many psychological truths.

His career has hits and misses.

In the face of a bad result, you do not remember what you have solved.

Self-criticism is painful and people tend to avoid it or destroy themselves.

It's about learning from mistakes to grow.

I learned, for example, that I cannot operate while listening to music.

Their operations can last 15 hours.

They are a team effort.

A union would force a change of doctor after eight hours.

Would a patient want that?

In a very high percentage, the doctor is a vocational profession.

But passion is a personal choice.

You cannot expect such devotion in the new generation of neurosurgeons, the personal price is high.

I prefer to operate with a colleague, do it together, support each other and be able to rest.

The golden rule of humanity is to learn from our own mistakes and those of others.

But…it's rare that all doctors cooperate.

There is a lot of narcissism in my profession.

For a committee to work, egos must be abandoned, and in countries like Sudan or Ukraine the competition is economic: they only teach the family, nobody wants to teach the competition.

Defend the doubt.

Do we allow doctors to doubt?

Patients want certainty and doctors deal with uncertainties.

When I became a patient, I knew that no one ever knows how much you have left, unless it's two days.

And yet I couldn't help but ask the oncologist.

Uncertainty is difficult to live with, and all cancer patients must learn to do so.

I try to be useful: I have been teaching and going to Ukraine for 21 years.

Why did you start going?

It has to do with my father and his defense of human rights.

From him I learned that with a corrupt judicial system, democracy is not possible.

And what did Putin and Yanukovych do?

Corrupt the judicial system.

In Ukraine it does not teach only to heal.

I advise young doctors not to speak in a hurry.

To sit even if they have it, to look into the eyes.

Did you hesitate when telling the stories of your patients?

No. Since I was 12 years old I have been writing a diary.

I buried 10 years of my life there and I'm still ashamed to read what a fool I was.

But there are also the stories that have obsessed me.

Each story is a person.

Kate read it because our courtship was in writing: with emails.

And she told me that she had a book.

The only way to learn to be a neurosurgeon is by operating.

And… making mistakes.

Experience is about making mistakes.

"Bureaucracy costs lives."

The fundamental problems of public health are the increase in the number of patients —and their years of life— and the increase in technology —and its high price.

It is necessary to find a balance between the freedom of the patient and the medical organization to try to heal.

Organization is key in the war in Ukraine.

The Russians obey a hierarchy, they do not have independence of command.

The Ukrainian army changed in 2014. It follows the German model: officers at the front can make decisions.

Medicine is the same: you have to give some independence to the doctors and nurses in the trenches of the disease.

40 years ago doctors had too much independence.

Today we are at the opposite extreme.

Autonomy is essential to be decisive and to preserve your mental health: to take care of yourself.

Henry Marshall.

Manuel Vazquez

Do we spend our lives trying to repair what we did wrong?

In neurosurgery it's easy to think: it was going to happen anyway.

You have to fight yourself to ask yourself: could I have done better?

As it does?

Asking friends I trust.

Flattery nullifies thought.

The more you investigate, the more complicated your life is.

You open a door and arrive at a place with more doors.

Apparently, Freud was very dogmatic and when he gave lectures he did not admit questions.

The questions are the doors.

The more check-ups, the more diseases are found?

False positives happen daily.

And they obey bad practices.

This morning a woman came in to get a CT for a headache.

Either the family doctor was ignorant or he was lazy.

You cannot go accumulating X-rays in the body and in a CT scan abnormal forms can appear that cannot be treated unless they develop.

How do you tell the patient?

You can't tell him that he has nothing and at the same time he can't do anything for her.

Browsing too much has emotional consequences: you generate anxiety that can change your life.

If you don't need a brain scan, don't get it!

I, like so many cancer patients, now live in limbo.

The only thing I can do is not think about the revisions until the day comes.

My brain tumor originated in the prostate, and hormone therapy is basically castration.

And it's not a sexual thing.

It's not that you don't like how your body is, I didn't like it before either, it's that the muscles weaken and that affects you.

I thought I was unhappy because I had cancer.

I realized it was wrong because I didn't exercise.

The good thing about hormone therapy, which is like aging rapidly, is that when you finish it, it's like living backwards: I get younger every day!

Which country has the best public health?

The public health system is a reflection of society and the Scandinavian is rich.

Norway was poor 100 years ago.

They invested the oil money in improving the country.

Its prisons are veritable re-education centers.

And they are used to paying taxes to maintain their services.

They have much less inequality than the rest of the world.

I am not from the extreme left, but I do believe in the need to tax wealth.

Does the pharmaceutical industry decide how much we are worth?

They are not little brothers of charity, they are companies, and many cancer drugs are prohibitively expensive because they need to make a return on their investment.

We need your investigation.

But they must not forget that they benefit from the investment that governments make in universities.

I defend that they do not advertise and lower prices.

Does private healthcare overdiagnose more than public healthcare?

In the private sector, the risk of not operating is overestimated and that of operating is underestimated.

I don't think many doctors think about making money.

But if they know they're going to win it with a patient, maybe they'll be more amicable.

We are that way.

Above all do no harm

I have started an organization to support palliative care in Ukraine.

I want to write a fairy tale for my granddaughters.

I continue to teach at the hospital.

And I make shelves.

I live in the present.

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