posted on 11 Jun 2017

Pen and Scalpel: The new school of surgeon-writers

There has been no shortage of doctor-writers over the years. Chekov, Mikhail Bulgakov, Conan Doyle, William Carlos Williams, Rabelais, and Somerset Maugham, to name just a few, were all doctors. And of these, some produced their best work as a direct result of their medical experience – Bulgakov’s A Country Doctor’s Notebook, for instance, is to my mind infinitely superior to The Master and Margarita.

But writers who were first and foremost physicians of one kind or another and continued to practice medicine alongside their literary careers throughout their lives are much thinner on the ground. One thinks of Oliver Sacks primarily, who perhaps more than any other single twentieth century writer elevated scientific-psychiatric writing to an art form and in so doing helped illuminate for the ordinary reader the mysteries that make us human.

But the present century has seen the emergence of a new school of surgeon-writers. Where Sacks took us into the mysteries of the mind and the nervous system, these new surgeon-writers – pen in one hand and scalpel in the bloodied other – take us deep into the human body.

One thinks of Richard Selzer, the US surgeon who died just a year ago this month (Mortal Lessons and The Doctor’s Story), Gabriel Weston (Direct Red), Atul Gawande (Being Mortal, The Checklist), or trauma-surgeons such as Jonathan Kaplan (The Dressing Station and Deep Wounds) or Khassan Baiev (The Oath).

Of this more recently emerged school of surgeon-writers, the one I have enjoyed most – and whose work seems both profound and politically necessary – is Henry Marsh, the London neurosurgeon.

Marsh came to fame in two TV documentaries before he was a published creative writer, but then sprang fully-formed into the literary world when his first book, Do No Harm was published in 2014 and read on Radio 4. His second book, Admissions has just been published.

What marks Marsh out from other writers, I think, is his thirty years’ experience as a practicing neurosurgeon, his accomplished prose, his ability to lift the bloody bone-flap of the skull and explain what lies beneath, his unflinching honesty about the surgeon’s trade, his coruscating critiques of the idiocy of successive waves of policy-making regarding the NHS, and his self-lacerating revelations about his own failures and egotism.

Do No Harm dodges back and forth between what I suppose are thematic essays – illustrating a particular kind of illness or malignancy, for example – and recollections of a long life spent in the operating theatre.

Yes, it makes for grim reading at times and is not for the squeamish, but it isn’t wholly a blood-bath. He can also be funny, self-deflating and contrarian – but most of all, what he writes about is never less than fascinating, revealing and, perhaps most important, utterly real and graspable. You can see and smell the inside of the hospital, the bloody post-op detritus (thousands of pounds-worth of single-use equipment awaiting disposal); you can feel the gritty-eyed exhaustion of sleep deprivation, the almost super-human focus required to spend eight or ten hours at the operating table; and the tedium of management meetings. And most of all, you can feel the bleak, small hours doubt and self-criticism he experiences when considering what the French writer René Leriche has called “the small cemetery” that every surgeon carries within himself, “where…he must look for an explanation for his failures”.

For Marsh is never under any illusion: while surgical ambition and personal skill can achieve almost miraculous results for some of the most desperately ill patients, exactly these same qualities can also result in catastrophic failures. He thinks particularly of Tanya, a twelve year-old Ukrainian girl, who had the largest brain tumour he had ever seen in a child of that age. She lived with her family in one of the most impoverished villages in Ukraine. He should have left her there, he reflects, but brought her to London where, instead of one brilliant life-saving operation, Tanya required a series of increasingly risky and complicated procedures, eventually leaving Marsh’s hospital “mute and disfigured” six months later, pushed in a wheelchair by her broken-hearted mother. She died eighteen months later. This is what surgeons must live with. What distinguishes Marsh from other surgeons is that he tells us.

I’ve just read Do No Harm for the second time and found it as riveting and as shocking as ever. I can think of no other writer in this new school who offers such a tangible and immediate picture of a surgeon’s life – all the better, I think, because it is rooted in the prosaic world of the busy modern hospital. Marsh is reporting from where we may all end up: propped upright on an operating table, skull sawn open, a quarter-million pound microscope enabling someone like Henry Marsh to navigate the millimetre or two that separates cure from disablement.

 

Alun Severn

June 2017