Neurosurgeon Henry Marsh has written a brutally honest account of his work – and bungling NHS bureaucracy
Why has no one ever written a book like this before? It simply tells the stories, with great tenderness, insight and self-doubt, of a phenomenal neurosurgeon who has been at the height of his specialism for decades and now has chosen, with retirement looming, to write an honest book. Why haven’t more surgeons written books, especially of this prosaic beauty? Of blood and doubts, mistakes, decisions: were they all so unable to descend into the mire of Grub Street, unless it was with black or, worse, “wry” humour?
Well, thank God for Henry Marsh. His speciality is drilling into people’s heads and sucking out or cauterising various problem globules, usually life-threatening. Those are the bald basics, but they disguise a multitude of traumas, not least those of a very human surgeon. He writes with near-existential subtlety about the very fact of operating within a brain, supposed repository of the soul and with myriad capacities for emotion, memory, belief, speech and, maybe, soul: but also, mainly, jelly and blood. He has been 4mm away, often, even with microtelescopes, from catastrophe.
"As I become more and more experienced, it seems that luck becomes ever more important." Not the most copper-bottomed reassurance you could wish from the man who’s going to plough your brain, but honest. And he has removed so many problems, with filigreed sure-handed finesse: there was a 15-hour operation once, but it had to be attempted. "The skull is a sealed box and there is only a limited amount of space in the head."
He’s been to Kiev, given selfless time there to fledgling neurosurgeons who might as well have been working with flints and candlelight, and saved many lives there too.
But he doesn’t flinch from admitting disasters. His chosen word is “catastrophic”. It applies to bleeding within that sealed nut of the skull, as in “Once I had sawn open the woman’s skull and opened the meninges, I found to my horror that her brain was obscured by a film of dark red blood that shouldn’t have been there.” He has “wrecked” patients, he woefully admits; patients left half-frozen, half-crippled, dead. But there was no option. Or was there? One of the finest admissions to emerge in this phenomenal book is that of every surgeon’s dilemma, which is the inability to play God: but instead to have to decide, after nights of soul-searching, whether it’s worth it. All moral oversimplifications steal away like morning mist.
Throughout, there runs a caustic commentary on the current target-setting woes of the NHS. Patients being shunted, at 3am, not between wards but between hospitals, sometimes 150 miles apart. Not the Ukraine, quite, but the idiocies could give it a run for its money.
"I have lost count of the number of different passwords I now need to get my work done every day."
He tells, briefly in the last chapter, the story of having to race up various flights of stairs, repeatedly, to ascertain a password for a ruinously expensive NHS-wide computer system, just the latest in a succession. “Try Mr Johnston’s,” he’s told. “That usually works. He hates computers.” Forty-five months have passed since the introduction of the latest doomed system. The password is “Fuck Off 45”.
Marsh tries it back in his office, in various upper/lower case and space-optional guises. He is sitting before a policeman who has had sudden serious epilepsy attacks, and his ageing parents, and waiting to get into the system to find the relevant x-ray, which will probably save the man’s life. He has to run again, two flights up, to double-check the password. Two months have elapsed. Turns out it is now “Fuck Off 47.”
Apparently Mr Marsh’s decision to retire has been hastened by the threat of disciplinary action, at the hands of an NHS manager, for wearing a wristwatch on his rounds. There is no evidence of the risk of infection being infinitesimally increased by the wearing of such. What a bloody loss. And what a bloody, splendid book: commas optional.
All this week on the AMAM Tumblr, we’ll be clearing out our queue of reblogs. Each day we will (finally!) re-blog a post that caught our eye or made us think over the past few months. Today’s a fun one from the Fly Art Productions Tumblr. If you like your art history with a splash of hip-hop, that’s the site for you. We don’t have this particular work in the AMAM collection, but we do have plenty of prints by Kuniyoshi.
Hatsuhana’s gonna have it her way or nothing at all
Hatsuhana doing penance under the Tonosawa waterfall, Utagawa Kuniyoshi (1798 - 1861) / Waterfalls, TLC
Faces: Kabuki PlayersThose Kabuki players you see in my photographs are not with the mainstream Kabuki companies in Tokyo. They are with localized small groups located in various parts of Japan. They are not professional actors in a sense, as they don’t get paid for their plays. They actually spend quite a lot of their own money to be in the plays. Kabuki is known for lavish make-up, costumes, and stage set-ups. As such, those who want to be in the plays must be committed and prepared. They spend their time and money because of their love for being in the theater—attention they get, pride, prestige, and joy of being part of their tradition.
One such company is based in a town called Nakatsugawa. The town is cozily nested at the foot of Japan Alps Mountains. It was situated at the halfway point between Tokyo and Kyoto of the old main road called Nakasendo in Edo era, and because of this strategic location, it flourished as a trading post about three hundred years ago. The town became rich, but had no cultures as they are away from big cities. They had to wait for Kabuki Company to arrive, which comes only once a year. Being tired of waiting, they finally decided to do Kabuki by themselves. They built a theater and hired make-up artists, costumers, and stage craftsmen from Kyoto just for themselves, and they started to play their favorite stories. Thus it became their tradition.
I believe good portraits are the ones that show the characters and personality of the subjects—their human beings. I find it a difficult task, as people are so well educated about photographs nowadays. People know how to pose, how to make impressions, and how to look good, and hardly reveal what they really are.
Those Kabuki players are also hidden in heavy make-up and wardrobes in a made-up world. But when they sit in front of my camera between plays, they are so much saturated (and worried) in their roles, that they pay very little attention to my existence. They are struck with stage fright and they repeat their lines over and over as I photograph. Remember this is not what they do everyday. On the other hand, they are not afraid of me, or of anyone else, as their faces are shielded by the heavy make-ups. They can be themselves without worrying about other people, as if they were in the masquerade. They feel that no one knows who he or she really is, or at least people know that they were in a fictional world. At those moments, they are much closer to me. (artist statement)
"My mother died rather suddenly when I was eighteen. One thing that I didn’t expect was the amount of resentment I would feel. I know it’s not fair of me to put that sort of thing on other people. But when I see someone walking down the street with their mother, I feel jealous. I know their relationship is going to have its ups and downs, and it’s going to evolve, and it will have this trajectory to it that I’ll never have, and it just seems unfair. Of course I know it’s absurd to talk about fairness in the universe."
"Why is that absurd?"
"Because there’s no such thing as karma. I mean, when you’re a good person, people can sense it and they’ll reciprocate that goodness. But the universe isn’t keeping some balance by guaranteeing you a reward."
Master of Sir John Fastolf - Saint Denis Holding His Head (c 1430 - 1440)
A cephalophore (from the Greek for “head-carrier”) is a saint who is generally depicted carrying his or her own head; in art, this was usually meant to signify that the subject in question had been martyred by beheading. Handling the halo in this circumstance offers a unique challenge for the artist. Some put the halo where the head used to be; others have the saint carrying the halo along with the head. The term “cephalophore” was first used in a French article by Marcel Hébert, “Les martyrs céphalophores Euchaire, Elophe et Libaire”, in Revue de l’Université de Bruxelles, v. 19 (1914).
In a first for laser-driven fusion, scientists at a US lab say they have reached a key milestone called fuel gain: they are producing more energy than the fuel absorbed to start the reaction.
Okay, okay, okay, okay, guys. Scientists at the National Ignition Facility have taken the first itty bitty baby steps towards fusion and I’m having trouble containing my excitement.
First of all, they’re using 192 laser beams, which are pointed at a gold chamber that converts the lasers into X-ray pulses, which then squeeze a small fuel pellet and make it implode and undergo fusion. That anyone ever figured out even how to do this is completely nutso.
Secondly, the lead researcher is named Omar Hurricane. I have never in my life heard a better name. He sounds like a comic book character. Please someone write a comic starring Omar Hurricane and his band of laser-wielding scientists.
And then there’s what it actually means. So far, they’ve been able to get 15 kilojoules of energy out of a fuel pellet that was blasted with 10 kilojoules. But, as The Guardian points out, much more energy is delivered by the lasers (and lost in the conversion to X-rays): “The lasers unleash nearly two megajoules of energy on their target, the equivalent, roughly, of two standard sticks of dynamite.”
Even so, this is a hugely significant tiny step forward toward recreating the clean energy production that happens in the heart of stars.
Due to a peculiarity of nuclear physics, you can release energy either by 1) breaking apart heavy atoms, or 2) forcing together light atoms. Breaking apart is called fission and forcing together is called fusion. We already know how to generate energy by man-made fission, but generating energy by man-made fusion remains an aspiration. (Of course, we know how to build bombs both ways. Nuclear and thermonuclear bombs respectively.)
Essentially, solar power is fusion, though. Because the sun is a fusion reactor, and its light lands on our planet and makes everything happen.(via clearscience)