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A Neuroscientist Faces Death, and Learns

Henry Marsh’s “And Finally” tests the limits — and comforts — of knowledge.

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By Kieran Setiya

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AND FINALLY: Matters of Life and Death , by Henry Marsh

It was said by the Roman philosopher Cicero that to philosophize is to learn how to die. He was echoed by the 16th-century essayist Michel de Montaigne, sometimes in earnest, at other times in jest. “If you don’t know how to die, don’t worry,” Montaigne playfully concluded. “Nature will tell you what to do on the spot, fully and adequately.”

We don’t need to learn the biological mechanics of dying in order to die. But it may help to know them in facing death. If the philosophers haven’t figured out how to do that — at least not to everyone’s satisfaction — might a physician have more luck? Henry Marsh is an author and retired doctor, in whom, said The Economist, “neuroscience has found its Boswell.” In his most recent book, the physician becomes a patient, confronting a diagnosis that will probably end his life.

Many years ago, Marsh read philosophy at Oxford University, but he left for the more practical world of medicine after a year. He finds himself returning in this book to philosophical questions about consciousness and fear of death, though he does so through narrative, not argument, his skills honed by years of storytelling as a clinician recounting case histories. Marsh knows how to set a scene, how to create suspense and how to surprise the reader.

Case in point: He opens with a bait-and-switch. “It seemed a bit of a joke at the time,” he writes, “that I should have my own brain scanned.” We know he’s about to be seriously ill and we assume that the scan will reveal a tumor; poetic injustice. In fact, what the scan reveals is the ordinary attrition of aging, a brain diminished by the years. The real diagnosis comes later: advanced prostate cancer, its detection delayed by the misguided fortitude of a doctor who assumes that only patients get sick. (About a friend’s calm response to news of an untreatable tumor, Marsh observes: “It was difficult to know whether this came from stoicism or frontal brain damage.”)

Not that the scan isn’t frightening; Marsh feels fear as well as wonder at the image of his slowly withering brain, comparing his experience to a vision of the night sky — an allusion to the philosopher Immanuel Kant. “Two things fill the mind with ever new and increasing admiration and awe,” Kant declaims in one of Marsh’s epigraphs, “the starry heavens above me and the moral law within me.”

I suppose the cerebrum is a suitably neuroscientific substitute for the voice of conscience. Marsh finds it “very hard to comprehend that ‘I’ am the 86 billion nerve cells of my brain,” its wiring longer “than the distance from the earth to the moon.” At one point he suggests, in passing, that “the real world is just a pattern of electrochemical impulses.” At moments like these, I wish he’d stuck with philosophy a little longer. We are not brains, but embodied beings — as philosophers have been arguing for at least a century — and the Cartesian “veil of ideas” that traps us in our minds is not helpfully replaced with a veil of neurons.

But these are minor elements of the book. For the most part, Marsh does not pretend to answer metaphysical questions about the mind, or even assume that they can be answered by the likes of us: “You can’t cut butter with a knife made of butter,” quips a neuroscientist friend. Instead, we reach for metaphors. Before the mind was a computer, it was a telephone exchange, and before that a steam engine, though Freud’s psychoanalytic theory “made the id and ego sound like the components of a flushing toilet.”

Marsh is often funny, sometimes at his own expense. Dismissing Freud on dream interpretation and complaining that other people’s are “quite remarkably boring,” he finds himself narrating a long nightmare about his wife. The fairy stories he tells his granddaughters have allegorical elements, like an “orphaned unicorn who develops the dreaded Droopy Horn Disease.” Like many others, Marsh was treated for prostate cancer by “chemical castration,” depriving cancerous cells of androgen, with side effects of breast development, impotence and muscle loss.

His account of the subsequent radiotherapy celebrates the technology, which is almost lyrically described; not so much the medical practitioners. It “was only when I was diagnosed with cancer myself,” he writes, “that I could see just how great is the distance that separates patients from doctors, and how little doctors understand about what their patients are going through.” Not that he’s judgmental. Marsh acknowledges his own failures of compassion as a surgeon and the detachment needed to function as a doctor from day to day. His advice to clinicians is pragmatic: “You should always be seated when talking to patients, and never appear to be in a hurry.”

What lessons does he have for the rest of us, as we learn how to die? In part, a measured argument for assisted suicide, which has not so far led to the abuses conjectured by its critics. In part, an argument against the immoderate wish to live forever. Seventy years should be enough — death is different when it comes to someone young — and we have to make room on the planet for other people. “I have had my time in the sun,” Marsh writes, “now it is the turn of the next generation.”

I’m not sure he does better than philosophy when it comes to facing death, but I don’t think Marsh does worse. There’s no false comfort here. Instead, there’s prose that breaks in gentle waves, its undercurrents deep, the surface of an ocean vast enough to put our lives in moral perspective. The narrative takes detours through DIY and dollhouses, hospital décor and Himalayan hikes. Marsh is seated, storytelling, and he is in no hurry.

Kieran Setiya teaches philosophy at M.I.T. and is the author of “Life Is Hard: How Philosophy Can Help Us Find Our Way.”

AND FINALLY: Matters of Life and Death | By Henry Marsh | 227 pp. | St. Martin’s Press | $27.99

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AND FINALLY

Matters of life and death.

by Henry Marsh ‧ RELEASE DATE: Jan. 17, 2023

Another masterful memoir from Marsh.

The latest compelling memoir from the British neurosurgeon.

In 2014, Marsh published the excellent Do No Harm ; in 2017, he followed it up with an equally fine sequel, Admissions . Now past 72 and retired, he writes about becoming a patient. Doctor writers produce a steady stream of such books, but this is among the best. Despite being retired, Marsh “continued to think that illness happened to patients and not to doctors.” He assumed that the urinary difficulties he had been experiencing for years were the result of benign prostatic enlargement, which affects most men as they age. In fact, he had prostate cancer, which had probably spread. The author does not hide his terror at this news. He reviews his life, finding much to applaud but plenty of regrets, and he capably describes his experiences as a patient. Like anyone, he hoped for good news, perhaps even that he may be cured, but it never came. More unnervingly, listening to his doctors revealed that he (like they) held too high an opinion of himself. Patients who love their doctors tell them so, while disappointed patients mostly keep quiet. Doctors who write memoirs admit flaws, but lack of compassion is rarely among them. To his distress, observing how the doctors dealt with him, Marsh realized that he could have done better in the compassion department. This is not a denunciation of the medical profession; almost everyone he encountered treated him kindly. Accepting that he would die but fearful that he might suffer, he reserves his hatred for opponents of assisted suicide: “It is as though they think that assisted dying is cheating” or “that there is something ‘natural’ about dying slowly and painfully.” The author offers a fascinating account of his often disagreeable treatment but remains entranced by the wonders of the natural world, science, and love for his family. The conclusion finds him still alive and, readers will hope, writing another book.

Pub Date: Jan. 17, 2023

ISBN: 978-1-250-28608-6

Page Count: 224

Publisher: St. Martin's

Review Posted Online: Oct. 10, 2022

Kirkus Reviews Issue: Nov. 1, 2022

BIOGRAPHY & MEMOIR | HEALTH & FITNESS | SCIENCE & TECHNOLOGY | GENERAL BIOGRAPHY & MEMOIR

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by Henry Marsh

Awards & Accolades

Our Verdict

New York Times Bestseller

by Stephanie Johnson & Brandon Stanton illustrated by Henry Sene Yee ‧ RELEASE DATE: July 12, 2022

A blissfully vicarious, heartfelt glimpse into the life of a Manhattan burlesque dancer.

A former New York City dancer reflects on her zesty heyday in the 1970s.

Discovered on a Manhattan street in 2020 and introduced on Stanton’s Humans of New York Instagram page, Johnson, then 76, shares her dynamic history as a “fiercely independent” Black burlesque dancer who used the stage name Tanqueray and became a celebrated fixture in midtown adult theaters. “I was the only black girl making white girl money,” she boasts, telling a vibrant story about sex and struggle in a bygone era. Frank and unapologetic, Johnson vividly captures aspects of her former life as a stage seductress shimmying to blues tracks during 18-minute sets or sewing lingerie for plus-sized dancers. Though her work was far from the Broadway shows she dreamed about, it eventually became all about the nightly hustle to simply survive. Her anecdotes are humorous, heartfelt, and supremely captivating, recounted with the passion of a true survivor and the acerbic wit of a weathered, street-wise New Yorker. She shares stories of growing up in an abusive household in Albany in the 1940s, a teenage pregnancy, and prison time for robbery as nonchalantly as she recalls selling rhinestone G-strings to prostitutes to make them sparkle in the headlights of passing cars. Complemented by an array of revealing personal photographs, the narrative alternates between heartfelt nostalgia about the seedier side of Manhattan’s go-go scene and funny quips about her unconventional stage performances. Encounters with a variety of hardworking dancers, drag queens, and pimps, plus an account of the complexities of a first love with a drug-addled hustler, fill out the memoir with personality and candor. With a narrative assist from Stanton, the result is a consistently titillating and often moving story of human struggle as well as an insider glimpse into the days when Times Square was considered the Big Apple’s gloriously unpolished underbelly. The book also includes Yee’s lush watercolor illustrations.

Pub Date: July 12, 2022

ISBN: 978-1-250-27827-2

Page Count: 192

Review Posted Online: July 27, 2022

BIOGRAPHY & MEMOIR | ENTERTAINMENT, SPORTS & CELEBRITY | GENERAL BIOGRAPHY & MEMOIR

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by Brandon Stanton

by Brandon Stanton photographed by Brandon Stanton

by Brandon Stanton ; photographed by Brandon Stanton

LOVE, PAMELA

by Pamela Anderson ‧ RELEASE DATE: Jan. 31, 2023

A juicy story with some truly crazy moments, yet Anderson's good heart shines through.

The iconic model tells the story of her eventful life.

According to the acknowledgments, this memoir started as "a fifty-page poem and then grew into hundreds of pages of…more poetry." Readers will be glad that Anderson eventually turned to writing prose, since the well-told anecdotes and memorable character sketches are what make it a page-turner. The poetry (more accurately described as italicized notes-to-self with line breaks) remains strewn liberally through the pages, often summarizing the takeaway or the emotional impact of the events described: "I was / and still am / an exceptionally / easy target. / And, / I'm proud of that ." This way of expressing herself is part of who she is, formed partly by her passion for Anaïs Nin and other writers; she is a serious maven of literature and the arts. The narrative gets off to a good start with Anderson’s nostalgic memories of her childhood in coastal Vancouver, raised by very young, very wild, and not very competent parents. Here and throughout the book, the author displays a remarkable lack of anger. She has faced abuse and mistreatment of many kinds over the decades, but she touches on the most appalling passages lightly—though not so lightly you don't feel the torment of the media attention on the events leading up to her divorce from Tommy Lee. Her trip to the pages of Playboy , which involved an escape from a violent fiance and sneaking across the border, is one of many jaw-dropping stories. In one interesting passage, Julian Assange's mother counsels Anderson to desexualize her image in order to be taken more seriously as an activist. She decided that “it was too late to turn back now”—that sexy is an inalienable part of who she is. Throughout her account of this kooky, messed-up, enviable, and often thrilling life, her humility (her sons "are true miracles, considering the gene pool") never fails her.

Pub Date: Jan. 31, 2023

ISBN: 9780063226562

Page Count: 256

Publisher: Dey Street/HarperCollins

Review Posted Online: Dec. 5, 2022

Kirkus Reviews Issue: Jan. 1, 2023

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Review: 'And Finally,' by Henry Marsh

NONFICTION: In his third memoir, Henry Marsh moves from being a doctor to becoming a patient. It's a difficult transition.

By Laurie Hertzel

When neurosurgeon Henry Marsh's third memoir opens, he has volunteered to take part in a study that requires a scan of his brain.

"It seemed a bit of a joke at the time," he writes in "And Finally." But weeks later, when the scan arrives in the mail, he puts off looking at it. Now 70 and retired, he understands that his brain might not appear as fresh and healthy as he would like to believe it is.

Given his age, he knows, "My brain is starting to rot." Looking at proof of that "is just too frightening."

This is one of the many compelling themes of this serious and wise book — how powerful denial is in the human brain, and how all of us, even physicians, can ignore uncomfortable truths.

As it turns out, Marsh's brain was not what he needed to be worried about. An array of dire symptoms, disregarded for years, eventually leads to a diagnosis of advanced prostate cancer.

By ignoring the signs, "I thought I was being stoical when in reality I was being a coward," he says. "I simply couldn't believe the diagnosis at first, so deeply ingrained was my denial."

For people in his profession, Marsh notes, the world is divided into two camps: doctors and patients. Moving from one camp to the other is painful — the doctors no longer treat him as a peer and he's reduced to googling his symptoms just like the rest of us. The hospital feels different, more intimidating and impersonal, and as he heads to the radiotherapy department, "I could feel myself lose height as I walked along the corridor."

In his 2017 memoir, "Admissions," a finalist for a National Book Critics Circle award, Marsh wrote about life on the cusp of retirement. He had bought an old cottage in Oxford that he was fixing up in hopes of moving there from London. But in "And Finally," he notes that his repairs were substandard, the house needs more work than he could manage, and, "I wasted too much time and energy in my determination to do everything myself, and too many of the roofs I have built leak when it rains."

It is impossible not to read this as a metaphor for his life. And yet there is nothing depressing about this book. Marsh's tone is measured, clear, sometimes wryly humorous, as he looks at himself, his foibles, his mistakes and decisions.

He is unflinching when he describes the changes that cancer and its treatment cause in his body — the occasional incontinence, the "chemical castration" that shrinks his tumors but also causes him to fatten up and lose his hair, giving him — a lifelong runner, who cycles everywhere — "the plump and hairless body of a eunuch."

Marsh also deftly weaves in other issues — his love of nature, his grandchildren and his unending fascination with the mysteries of the human brain.

What is consciousness? How do billions of nerves make us us , with thoughts, desires, personalities? "Answering one question just opens the door to a room with yet more doors."

And though Marsh also makes a case for assisted dying (he has a suicide kit, but doubts he will use it), this book is firmly an ode to life. "I so long not to die!" he says. "The wish to keep living remains as intense as ever."

I wish Marsh all the best with his cancer treatments. But rest assured, this book, written with passion and curiosity, makes clear that there's absolutely nothing wrong with his brain.

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

And Finally

By: Henry Marsh.

Publisher: St. Martin's Press, 240 pages, $27.99.

about the writer

Laurie hertzel.

Freelance writer and former Star Tribune books editor Laurie Hertzel is at [email protected].

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What one doctor learns when he becomes a patient

In ‘And Finally,’ British neurosurgeon and writer Henry Marsh gets a lesson in empathy

As a physician whose patients have included dying physicians, I have often been forced to wonder: Does it take serious illness for a doctor to understand the trials and indignities that patients suffer in our medical industrial complex, the lack of humanity that seems to go hand in hand with advanced Western medicine?

The answer, as Henry Marsh reminds us in his poignant and thought-provoking new memoir, “ And Finally ,” is, sometimes, yes.

A surgeon confesses his fears — and errors

When he learns of his diagnosis of advanced prostate cancer at age 71, Marsh, a neurosurgeon in London and the author of two previous memoirs — “ Do No Harm ” and “ Admissions ” — is shocked. In one moment, he has crossed into another world: patienthood. (My term, not his.) As he comes to accept this new status, Marsh is haunted by the faces and ghosts of 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.”

Marsh’s honesty is disarming, and it redeems him as he offers an explanation for his shortcomings as a caregiver. “As a doctor,” he writes, “you could not do the work if you were truly empathic. … You have to practice a limited form of compassion, without losing your humanity in the process. While I was still working, I thought that I had achieved it, but now, looking back, and as a patient myself, I was full of doubt.”

It is these sorts of insights — exploring his fallibility, his shortcomings and even his complicity in an uncaring system — that make Marsh’s writing so powerful and that allow him to transcend the usual pathography. Even so, some of his observations about medicine feel as though they shouldn’t be as much of a revelation to him as they seem to be: for instance, his observation that “one of the worst aspects of being a patient is waiting — waiting in drab outpatient waiting areas, waiting for appointments, waiting for the results of tests and scans.”

Still, his book shows how sickness unites us. Marsh is beset by fears and concerns much like anyone else’s. “I find myself besieged by philosophical and scientific questions that suddenly seem very important — questions which in the past I had either taken for granted or ignored,” he writes. His book is an attempt to understand the questions, if not to come up with answers. As in his earlier works, Marsh’s exploration is intimate, insightful, witty and deeply moving.

Marsh’s writing style is such that one has the feeling of trailing behind him as an acolyte in the operating room, or in his woodworking shop, or at his dining table; in doing so, one overhears the musings of a savant, a neuroscientist, a neurosurgeon, and the inner dialogue of a patient feeling his vulnerability. He weaves in science, philosophy, history and personal anecdotes as he tackles issues such as the nature of consciousness and deciding when it is time to pass a difficult operation on to a younger and perhaps more capable colleague. It turns out that preceding his cancer diagnosis, Marsh had been wrestling with a parallel issue: “As I neared seventy years of age, my cancer already present but undiagnosed, it had become increasingly difficult to deny that my body was past its Best Before date.” He had become more conscious of his limitations, the accumulation of minor injuries. “I did not want to die — but then who does? But nor, to state the obvious, do I want to be old and decrepit.”

‘When Breath Becomes Air’: Young doctor’s last words of wisdom, hope

As a doting grandfather, Marsh frets about the future of our species. “The history of science is largely the history of the refutation of human exceptionalism — the earth is not the center of the universe; human beings are animals. As the great zoologist J.Z. Young observed, we are risen apes, not fallen angels.” Marsh is not “greatly troubled by the idea of the human race coming to an end,” he explains. “In the very long term this is inevitable after all. … But I am appalled by the suffering that the decline and end of the human race will probably involve, and I think about my granddaughters and their possible descendants, and climate change, and all that it will bring in its wake.”

For the reader seeking insight on how to face life’s end, Marsh shares that he has seen many people die, “some well, and some badly.” Death can be slow, painless, painful or, if one is lucky, a peaceful fading away. “But only rarely is dying easy, and most of us now will end our lives in hospital … in the care of strangers, with little dignity and no autonomy. Although scientific medicine has brought great and wonderful blessings, it has also brought a curse — dying, for many of us, has become a prolonged experience.”

Well before he was aware of his diagnosis, Marsh had assembled a suicide kit consisting of a few legally obtained drugs that could end his life. But after his diagnosis, he worries: What if the kit doesn’t do the job? In despair, he calls a doctor friend, extracting a promise that the friend will ensure the desired ending. “‘Isn’t this a bit premature?’” his friend asks. “‘Yes … but I want to prepare myself for the worst.’” The friend does promise, and with that, Marsh’s anxiety diminishes.

The book concludes with a meditation on a photograph of Marsh’s mother as a young girl in 1929, posing with her siblings. “Looking into my mother’s young eyes, my own life now possibly nearing its end, I felt as close as I could ever possibly be to living in block time — past, present and future all combined in one whole.” Thankfully, Marsh remains in the present, his cancer now in remission, and with this book he has left readers of the future a work to savor and learn from.

Abraham Verghese is professor and vice chair in the Department of Medicine at Stanford University. He is the author of “ Cutting for Stone .” His new novel, “ The Covenant of Water ,” will be released in May.

And Finally

Matters of Life and Death

By Henry Marsh

St. Martin’s. 240 pp. $27.99.

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Book Summary and Reviews of And Finally by Henry Marsh

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And Finally

Matters of Life and Death

by Henry Marsh

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• Genre: Biography/Memoir
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About this book

Book summary.

From the bestselling neurosurgeon and author of Do No Harm , comes Henry Marsh's And Finally , an unflinching and deeply personal exploration of death, life and neuroscience.

As a retired brain surgeon, Henry Marsh thought he understood illness, but he was unprepared for the impact of his diagnosis of advanced cancer. And Finally explores what happens when someone who has spent a lifetime on the frontline of life and death finds himself contemplating what might be his own death sentence. As he navigates the bewildering transition from doctor to patient, he is haunted by past failures and projects yet to be completed, and frustrated by the inconveniences of illness and old age. But he is also more entranced than ever by the mysteries of science and the brain, the beauty of the natural world and his love for his family. Elegiac, candid, luminous and poignant, And Finally is ultimately not so much a book about death, but a book about life and what matters in the end.

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Reader reviews.

"[C]ompelling...Doctor writers produce a steady stream of such books, but this is among the best. The author offers a fascinating account of his often disagreeable treatment but remains entranced by the wonders of the natural world, science, and love for his family...Another masterful memoir from Marsh." - Kirkus Reviews (starred review) "[An] immersive memoir...Marsh interweaves tender moments from his personal life, including storytimes with his granddaughters, with discussions of gene editing and other medical topics. Readers will find much to appreciate in this pensive probe into what it means to face mortality." - Publishers Weekly "In the contemplation of death Marsh illuminates the gift of life, rendering it even more precious. And Finally has all the candour, elegance and revelation we've come to expect from Marsh. I read it straight through carried along by the force of its prose and the beauty of its ideas. It's a book to treasure and reread; I'm very grateful for it." - Gavin Francis, author of Adventures in Human Being and Shapeshifters "In this superb meditation on life and death, Henry Marsh tackles the matter of mortality with all his trademark wit, wisdom, grace and humility. He turns his formidable intellect and scalpel-sharp prose on himself as well as the medical profession - with marvellous results. Unflinching, profound and deeply humane, And Finally is magnificent." - Rachel Clarke, author of Dear Life " And Finally is a close and courageous look at the prospect of death by someone who has seen it more clearly and more often than most of us, and who writes with great fluency and grace. Henry Marsh is a great neurosurgeon: he is also a very fine writer. I admire this book enormously." - Philip Pullman, author of His Dark Materials

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Author Information

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Henry Marsh Author Biography

Photo: Simon Clark

Henry Marshstudied medicine at the Royal Free Hospital in London, became a Fellow of the Royal College of Surgeons in 1984 and was appointed Consultant Neurosurgeon at Atkinson Morley's/St George's Hospital in London in 1987. He has been the subject of two major documentary films, Your Life in Their Hands , which won the Royal Television Society Gold Medal, and The English Surgeon , which won an Emmy. He was made a CBE in 2010. He is married to the anthropologist and writer Kate Fox.

Other books by Henry Marsh at BookBrowse

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