Dr Henry Marsh

:00:10. > :00:19.Welcome to HARDtalk. Imagine you are a patient about to undergo brain

:00:20. > :00:24.surgery and if it goes well it could save your life, if it goes wrong,

:00:25. > :00:29.you could end up paralysed or dead. Of course you want to believe your

:00:30. > :00:36.surgeon is infallible, a superhero, but he is not, he is all too human,

:00:37. > :00:39.just like you. And that simple truth emerges from the extraordinary

:00:40. > :00:44.honest writing of my guests to date, one of Britain's leading rein

:00:45. > :00:49.surgeons, Henry Marsh. He has given us where insights into the mind of

:00:50. > :01:16.the doctor. Is that reassuring or troubling?

:01:17. > :01:24.Henry Marsh, welcome to HARDtalk. Thank you. The very job description

:01:25. > :01:31.brain surgeon, for most people it prompts a sense of all and maybe

:01:32. > :01:35.fear as well. And certainly mystery. To have decided to lift the veil on

:01:36. > :01:44.what it is really like and they wonder why. I have been subject to

:01:45. > :01:52.that of brain surgery myself. When I became a neurosurgeon many years

:01:53. > :01:57.ago. I am the youngest of four and I have been drawing attention to

:01:58. > :02:03.myself from an early age. I wanted to convey that medicine is a very

:02:04. > :02:10.uncertain, imprecise business. When I became a doctor, doctors buried

:02:11. > :02:16.their mistakes. There was deference and trust. Doctors are not really

:02:17. > :02:19.held to account for what they did. That has changed profoundly, at

:02:20. > :02:25.least in this country. You cannot open the newspapers without the

:02:26. > :02:27.medical scandals. It is the tabloid headlines that drive the politicians

:02:28. > :02:33.could the mistakes that they can change things in what is a very

:02:34. > :02:40.excellent health service. Patients are not consumers. Doctors are doing

:02:41. > :02:43.something in many ways much more difficult than what people realise.

:02:44. > :02:51.People think brain surgery is difficult technically. It is not,

:02:52. > :02:55.actually. The really difficult thing is the decision-making and dealing

:02:56. > :03:01.with the patients and all the human problems that arise. I wanted to

:03:02. > :03:04.convey that. By conveying that and focusing on the difficulty and

:03:05. > :03:08.sometimes the fallibility of yourself and colleagues, isn't the

:03:09. > :03:15.danger that you plant a new and horrible seed of doubt in the

:03:16. > :03:19.patient? I do not think so. If you had to go and see a doctor and you

:03:20. > :03:25.could only choose one quality, steady hands, famous reputation,

:03:26. > :03:33.nice bedside manner, nice smile, we would all go with honesty. If you do

:03:34. > :03:37.dangerous surgery, which neurosurgery certainly is, the

:03:38. > :03:44.mistakes all arise in the decision-making. It is not about

:03:45. > :03:49.dropping something, it is not like that. Occasionally surely manual

:03:50. > :03:56.errors occur, but it is very unusual. It is in the

:03:57. > :04:01.decision-making where things go wrong. That is all about thinking

:04:02. > :04:06.and psychology. When you've decided to go into brain surgery, you knew

:04:07. > :04:10.you were going to a field of medicine that came with enormous

:04:11. > :04:13.pressure. There are so many branches of medicine where anything you could

:04:14. > :04:18.do could lead to the most catastrophic... You become a surgeon

:04:19. > :04:23.because surgery is a blood sport in a way. That is not inconsistent with

:04:24. > :04:30.caring for your patience. What is making it exciting is being worried

:04:31. > :04:36.your patient should do well. You have to have supreme confidence,

:04:37. > :04:42.maybe bordering on arrogance to become a brain surgeon? It is all

:04:43. > :04:45.about balance. Absolute power corrupts absolutely. We have an

:04:46. > :04:51.enormous amount of power and it is easy to become arrogant. You need to

:04:52. > :04:56.be insensitive to some extent. This is a challenge of all medicine. It

:04:57. > :05:04.is acute in brain surgery. I the balance between compassion and

:05:05. > :05:10.professionalism. We should only treat patients as we wish ourselves

:05:11. > :05:14.or our family to be treated. But it is almost impossible. Finding that

:05:15. > :05:21.balance between compassion and detachment is difficult. Also self

:05:22. > :05:26.belief and self-doubt. It seems to me reading your book and other

:05:27. > :05:32.writings about the work you have done, as you have gained an

:05:33. > :05:39.experience and reputation, you have become more self doubtful. Very much

:05:40. > :05:46.so. Because I came to realise that once you master the technical skills

:05:47. > :05:57.of operating, mistakes a rise in the decision-making. I believe now that

:05:58. > :06:01.other people are better at seeing my mistakes than I am. That is a truth

:06:02. > :06:10.that applies to all of us, we are very bad at seeing our own mistakes.

:06:11. > :06:14.You need the arrogance and self belief to do the operating, but it

:06:15. > :06:18.is critical to have a good working relationship with your colleagues as

:06:19. > :06:23.well so they can criticise you and you can criticise them. That is

:06:24. > :06:26.difficult to get doctors to do. Let us get specific and talk about a

:06:27. > :06:34.case that you have been very honest about. Earlier in your career, he

:06:35. > :06:40.was a man in his late 50s who came to you with a huge brain tumour and

:06:41. > :06:48.you were appalled by it. Appalled and excited. He was sent off to see

:06:49. > :06:54.another consultant even more senior than you. He pushed it back to you

:06:55. > :07:01.and said, Henry, you do it. It is a young man's operation. Exact. And

:07:02. > :07:10.you were quite excited. It was a dozen hours or more. And it went

:07:11. > :07:14.badly. You said yourself, I could stop now, but I will get every

:07:15. > :07:20.single trace of this tumour out and before you finished, you have

:07:21. > :07:25.accidentally separate a branch of an artery and the man never recovered.

:07:26. > :07:34.The mistake was not severing the artery, it was deciding to remove

:07:35. > :07:40.that last bit of tumour. The answer is all neurosurgeons have terrible

:07:41. > :07:47.disasters and periods of despair. When I first became a consultant, my

:07:48. > :07:53.first few bad results I felt quite sick and miserable for weeks on end.

:07:54. > :07:57.In a sense you access it. Has it changed the way you work? We have

:07:58. > :08:05.talked about confidence and self-doubt. You develop lingos. You

:08:06. > :08:13.need to perceive yourself to some extent. A lot of medicine is an act.

:08:14. > :08:16.Very early on as a young doctor, the patient does not want the doctor to

:08:17. > :08:22.say, I do not know what to do. We want to do is to be experienced and

:08:23. > :08:27.confident. In my case, that is easy, because I am. But younger doctors

:08:28. > :08:32.are not. If you do not take on the difficult cases, how will you get

:08:33. > :08:36.better? You face an ethical problem from the moment to become a doctor,

:08:37. > :08:45.you have to start flying to patients. You have two pretend you

:08:46. > :08:49.are confident. You must deceive other people and you must deceive

:08:50. > :08:52.yourself. It is a necessary self-deception to help one cope. It

:08:53. > :08:58.is not a bad thing. As you get older, you can try to dispense with

:08:59. > :09:04.some of it and treat patients as equals. I wondered with that

:09:05. > :09:09.incident and others like it, you are very honest, you went to a hospital

:09:10. > :09:17.that specialised in long-term care. You said to fight -- operated on

:09:18. > :09:25.people who were in essence brain damage. I wonder what threshold of

:09:26. > :09:32.rescue are prepared to take changed over time. It goes up and down, is

:09:33. > :09:38.the answer. After the case you mentioned, I became group are

:09:39. > :09:42.conservative. But it reflected the working environment I was in 25

:09:43. > :09:47.years ago. Over the years, I discovered a way to do really

:09:48. > :09:52.difficult cases. They are very rare, so you only see a handful. When I

:09:53. > :09:59.was working in the poll recently we had a couple of cases like that. My

:10:00. > :10:05.colleague said, how wonderful a view to share in operation. A more

:10:06. > :10:11.collaborative way of working is very important in modern surgery. I

:10:12. > :10:15.wonder if it is more difficult to take on the risk of a very difficult

:10:16. > :10:21.operation which you know has a serious risk, sometimes catastrophic

:10:22. > :10:26.consequences. But whether it is more difficult to tell a patient who is

:10:27. > :10:32.desperate for you, even though you have explained all of the risks,

:10:33. > :10:38.that it is not the right decision and it is right for nature to take

:10:39. > :10:42.its course. Which is harder? It depends on the nature of the

:10:43. > :10:53.problem. I think it is harder to do nothing. It is harder to say, go

:10:54. > :11:02.away. That is very difficult. Sometimes you say it is the better

:11:03. > :11:09.outcome. Yes, you learn. I see my younger colleagues operating on

:11:10. > :11:15.cases which I did at my stage of that career. Now they wouldn't. I no

:11:16. > :11:21.longer do emergency work, but when I was your often called about

:11:22. > :11:29.emergencies. Emergency neurosurgery is actually very simple. The actual

:11:30. > :11:34.operating is very easy. It is based on moving blood clots. But the

:11:35. > :11:40.decision on whether it is worth operating is very difficult. You

:11:41. > :11:45.have strokes where if you do not operate they will die. If you do

:11:46. > :11:51.operate, they might survive, but they might be left disabled. If I

:11:52. > :11:56.say, thumbs up, operate, I get back to sleep. If I say thumbs down, I do

:11:57. > :12:05.not, because I am worried I was wrong. Is it important for you to

:12:06. > :12:10.get to know your patience before operating? I used to think it was.

:12:11. > :12:17.My son had a brain tumour when he was very young. He was a few months

:12:18. > :12:31.old. I was doing general surgery. That is not why I became a brain

:12:32. > :12:35.surgeon myself. I do not know what other. As are like, but it gave me a

:12:36. > :12:43.certain understanding and sympathy of my patients were going through.

:12:44. > :12:48.An essential part of the operating was to be quite close to the

:12:49. > :12:51.patients and their families. That is partly selfish. If you are close to

:12:52. > :12:57.them and things go wrong, they are less likely to lose trust in you. It

:12:58. > :13:04.is selfish and not selfish because you are more invested in the case

:13:05. > :13:11.commercial league. -- emotionally. My colleague and his team were doing

:13:12. > :13:17.all the talking because of the language barrier. In the past it

:13:18. > :13:24.would have been complete anathema. It did not make a difference. I was

:13:25. > :13:32.just as focused and intense about the operating. That was a surprise

:13:33. > :13:37.to me. I was better than I expected. Let me switch focus and talk to you

:13:38. > :13:44.about this most amazing organ of pounds. It is so complex, it is so

:13:45. > :13:51.mysterious in many ways. And yet you approach it with sometimes drills,

:13:52. > :13:58.saws, knives and the suckers and there is something quite bizarre.

:13:59. > :14:09.It is utterly bizarre. When I was younger, I took it for granted. As I

:14:10. > :14:15.get older, I am more and more amazed about this fundamental mystery. What

:14:16. > :14:23.I thinking or feeling is electric chemistry. It feels free and

:14:24. > :14:26.insubstantial but we are the product of the electrical chemical activity

:14:27. > :14:33.of nerve cells. What is fascinating is that modern science... We cannot

:14:34. > :14:44.even begin to explain how thoughts and feelings arise. We just do not

:14:45. > :14:47.know... Your career has spent 35 years, are you saying you have

:14:48. > :14:54.learnt little more about the electro chemistry works? We now how a brick

:14:55. > :15:01.is made but it is not tell us anything about the house made by the

:15:02. > :15:05.bricks. What really interests asked as human beings is ourselves, our

:15:06. > :15:13.feelings and consciousness. We cannot experiment on it either. You

:15:14. > :15:20.write about being struck, during an operation, that your sucker, the

:15:21. > :15:26.Hoover thing you suck jelly out of, is moving through thought and

:15:27. > :15:34.emotion and that memories and dreams should consist of this jelly is

:15:35. > :15:41.simply too strange... It is the last great mystery. You might be sucking

:15:42. > :15:48.up peoples imaginations or thoughts or dreams! The answer to that is the

:15:49. > :15:53.illness you trying to treat is even worse than the operation. The right

:15:54. > :16:00.bad results and complications but you think of the good results and

:16:01. > :16:07.most of the time things go well. -- there are. For all the patients are

:16:08. > :16:14.done badly, there are thousands that did well. That is the balance. But

:16:15. > :16:21.it is terribly important. Success is corrupting. Success makes us

:16:22. > :16:27.complacent and spoils us. The worse surgical crime is complacency. You

:16:28. > :16:33.must never forget the complications but it is terribly important to

:16:34. > :16:36.remain as humble and modest as you can even do you must present a

:16:37. > :16:43.confident and assurance to the patient. One more question on the

:16:44. > :16:52.more philosophical side of what you do. You said you believe in science

:16:53. > :16:58.with a capital S. But for centuries, philosophers have posited the notion

:16:59. > :17:05.that, it the end, our mind, our sole, maybe, is separate from the

:17:06. > :17:08.physical reality from the thing between our ears. Are you telling me

:17:09. > :17:19.you are absolutely could win the there is no possibility of that

:17:20. > :17:26.being true? Deeply in probable. We do not understand how it works. I

:17:27. > :17:35.find that mystery reassuring. We know the macrocosm of the big bank,

:17:36. > :17:39.the anniversary of Einstein's the Wii of relativity. But we are

:17:40. > :17:45.sitting on a mystery as great as the big bang. You have read the papers

:17:46. > :17:51.that address and near death experiences and some that we collect

:17:52. > :17:57.experiences when normally the machinery has told us they are brain

:17:58. > :18:04.dead. But you think it is a mirage? It is a complicated area. Brain-dead

:18:05. > :18:12.is rather different. Near death experiences are recognised phenomena

:18:13. > :18:18.in... Bad... -- Butt. Back to healthcare. We have talked about you

:18:19. > :18:22.as an individual dog and a surgeon and how you have approached a career

:18:23. > :18:29.dealing with the most terrible challenges in the brain. Another

:18:30. > :18:37.part of what you do is exist with a vast health-care system, one small

:18:38. > :18:41.cog component in a huge machine. It seems to me he had become

:18:42. > :18:49.disillusioned with that? Yes and no. You have to look at the NHS

:18:50. > :18:57.internationally, firstly and if you look... There is a lot of criticism

:18:58. > :19:02.in England about... Some mistake in the hospital. And the headlines are

:19:03. > :19:05.shamed to the NHS. The national health service provides by

:19:06. > :19:09.international standards very good healthcare in terms of overwrought

:19:10. > :19:16.outcomes in terms of life expectancy... The Americans would

:19:17. > :19:22.call it socialist healthcare... I have worked and visited so many

:19:23. > :19:28.countries where it is terrible... It is not if you can pay for it. It

:19:29. > :19:34.comes back to the fact that medicine is not like going in to a shop and

:19:35. > :19:38.paying for it. A lot of the decision-making is very unclear and

:19:39. > :19:42.the grave stop if you look at countries like America, at its best

:19:43. > :19:49.it is fantastic but it is incredibly extravagant. In all countries,

:19:50. > :19:54.healthcare costs are rocketing. I afraid doctors have a financial

:19:55. > :20:01.interest in what they are doing, they tend to do more. Taking the

:20:02. > :20:09.Nitish case of a socialised system -- British. At a time of ageing

:20:10. > :20:16.population and rising costs,... You need to pay more. Pay more tax or

:20:17. > :20:25.accept greater rationing. Exactly. It is basic economics. If it is in

:20:26. > :20:32.scarce supply, you end up with queues. Having all these targets can

:20:33. > :20:40.be. You think queues are OK? Note that you have to prioritise and deal

:20:41. > :20:45.with emergencies first. A lot of people have made points about the

:20:46. > :20:51.organisation, and you call it the chaos, in the system. Arrogance...

:20:52. > :20:58.You do not like being told what to do I manage us. You do not like

:20:59. > :21:05.being told to come wear a tie or a wristwatch or your car space has

:21:06. > :21:11.been taken... I do not drive a car I ride a bike everywhere. You are

:21:12. > :21:17.right. Some comment on my arrogance but, again, that criticism is

:21:18. > :21:22.probably fair to some extent but what patients want... They want

:21:23. > :21:33.individual care from a dog. They want a sense of responsibility from

:21:34. > :21:37.an individual. -- from a doctor. We have responsibility for their lives

:21:38. > :21:42.and deaths. If you are treated as a minor cog, it produces a lot of

:21:43. > :21:50.tension. So colleges will say that under stressful situations, to have

:21:51. > :22:01.a position of responsibility with no power. You have escaped the confines

:22:02. > :22:09.of NHS. You work abroad. Having worked. Long with sick people, with

:22:10. > :22:15.terrible health challenges of the brain, are you now frightened of

:22:16. > :22:22.your brain and deterioration? Oh, yes, I. Most of us have had one or

:22:23. > :22:29.two demented parents to care for. Dementia is an increasing problem in

:22:30. > :22:34.wealthy countries and I much more worried about dementia than dying.

:22:35. > :22:39.The evidence is a fairly clear that keeping busy, physical exercise, a

:22:40. > :22:44.very important to keep it at a but we cannot keep old age at bay,

:22:45. > :22:52.ultimately. You are committed to keeping on doctoring. You said an

:22:53. > :23:04.ageing dog is a better dog... You are all sympathetic. -- dog. --

:23:05. > :23:18.Doctor. We began by talking about where that you want an honest

:23:19. > :23:24.doctor... As you age, your hands are not as steady... I have been

:23:25. > :23:36.thinking about that a lot. I was operating in Nepal, and I felt two

:23:37. > :23:44.things. I felt sure that physically I was as good as I have been. But I

:23:45. > :23:50.felt increasingly ashamed and embarrass and help crude the

:23:51. > :24:02.operating I was doing compared to what I increasingly understand about

:24:03. > :24:10.the brain. That struck me. I need to gradually withdraw from operating,

:24:11. > :24:18.clearly but not yet. Please. I hope you keep going for quite sometime. I

:24:19. > :24:22.still totally in love with it. Dr Henry Marsh, it has been a pleasure.

:24:23. > :24:29.Thank you. Thank you very much indeed.