Dr Henry Marsh HARDtalk

Welcome to HARDtalk. Imagine you are a patient about to undergo brain

surgery and if it goes well it could save your life, if it goes wrong,

you could end up paralysed or dead. Of course you want to believe your

surgeon is infallible, a superhero, but he is not, he is all too human,

just like you. And that simple truth emerges from the extraordinary

honest writing of my guests to date, one of Britain's leading rein

surgeons, Henry Marsh. He has given us where insights into the mind of

the doctor. Is that reassuring or troubling?

Henry Marsh, welcome to HARDtalk. Thank you. The very job description

brain surgeon, for most people it prompts a sense of all and maybe

fear as well. And certainly mystery. To have decided to lift the veil on

what it is really like and they wonder why. I have been subject to

that of brain surgery myself. When I became a neurosurgeon many years

ago. I am the youngest of four and I have been drawing attention to

myself from an early age. I wanted to convey that medicine is a very

uncertain, imprecise business. When I became a doctor, doctors buried

their mistakes. There was deference and trust. Doctors are not really

held to account for what they did. That has changed profoundly, at

least in this country. You cannot open the newspapers without the

medical scandals. It is the tabloid headlines that drive the politicians

could the mistakes that they can change things in what is a very

excellent health service. Patients are not consumers. Doctors are doing

something in many ways much more difficult than what people realise.

People think brain surgery is difficult technically. It is not,

actually. The really difficult thing is the decision-making and dealing

with the patients and all the human problems that arise. I wanted to

convey that. By conveying that and focusing on the difficulty and

sometimes the fallibility of yourself and colleagues, isn't the

danger that you plant a new and horrible seed of doubt in the

patient? I do not think so. If you had to go and see a doctor and you

could only choose one quality, steady hands, famous reputation,

nice bedside manner, nice smile, we would all go with honesty. If you do

dangerous surgery, which neurosurgery certainly is, the

mistakes all arise in the decision-making. It is not about

dropping something, it is not like that. Occasionally surely manual

errors occur, but it is very unusual. It is in the

decision-making where things go wrong. That is all about thinking

and psychology. When you've decided to go into brain surgery, you knew

you were going to a field of medicine that came with enormous

pressure. There are so many branches of medicine where anything you could

do could lead to the most catastrophic... You become a surgeon

because surgery is a blood sport in a way. That is not inconsistent with

caring for your patience. What is making it exciting is being worried

your patient should do well. You have to have supreme confidence,

maybe bordering on arrogance to become a brain surgeon? It is all

about balance. Absolute power corrupts absolutely. We have an

enormous amount of power and it is easy to become arrogant. You need to

be insensitive to some extent. This is a challenge of all medicine. It

is acute in brain surgery. I the balance between compassion and

professionalism. We should only treat patients as we wish ourselves

or our family to be treated. But it is almost impossible. Finding that

balance between compassion and detachment is difficult. Also self

belief and self-doubt. It seems to me reading your book and other

writings about the work you have done, as you have gained an

experience and reputation, you have become more self doubtful. Very much

so. Because I came to realise that once you master the technical skills

of operating, mistakes a rise in the decision-making. I believe now that

other people are better at seeing my mistakes than I am. That is a truth

that applies to all of us, we are very bad at seeing our own mistakes.

You need the arrogance and self belief to do the operating, but it

is critical to have a good working relationship with your colleagues as

well so they can criticise you and you can criticise them. That is

difficult to get doctors to do. Let us get specific and talk about a

case that you have been very honest about. Earlier in your career, he

was a man in his late 50s who came to you with a huge brain tumour and

you were appalled by it. Appalled and excited. He was sent off to see

another consultant even more senior than you. He pushed it back to you

and said, Henry, you do it. It is a young man's operation. Exact. And

you were quite excited. It was a dozen hours or more. And it went

badly. You said yourself, I could stop now, but I will get every

single trace of this tumour out and before you finished, you have

accidentally separate a branch of an artery and the man never recovered.

The mistake was not severing the artery, it was deciding to remove

that last bit of tumour. The answer is all neurosurgeons have terrible

disasters and periods of despair. When I first became a consultant, my

first few bad results I felt quite sick and miserable for weeks on end.

In a sense you access it. Has it changed the way you work? We have

talked about confidence and self-doubt. You develop lingos. You

need to perceive yourself to some extent. A lot of medicine is an act.

Very early on as a young doctor, the patient does not want the doctor to

say, I do not know what to do. We want to do is to be experienced and

confident. In my case, that is easy, because I am. But younger doctors

are not. If you do not take on the difficult cases, how will you get

better? You face an ethical problem from the moment to become a doctor,

you have to start flying to patients. You have two pretend you

are confident. You must deceive other people and you must deceive

yourself. It is a necessary self-deception to help one cope. It

is not a bad thing. As you get older, you can try to dispense with

some of it and treat patients as equals. I wondered with that

incident and others like it, you are very honest, you went to a hospital

that specialised in long-term care. You said to fight -- operated on

people who were in essence brain damage. I wonder what threshold of

rescue are prepared to take changed over time. It goes up and down, is

the answer. After the case you mentioned, I became group are

conservative. But it reflected the working environment I was in 25

years ago. Over the years, I discovered a way to do really

difficult cases. They are very rare, so you only see a handful. When I

was working in the poll recently we had a couple of cases like that. My

colleague said, how wonderful a view to share in operation. A more

collaborative way of working is very important in modern surgery. I

wonder if it is more difficult to take on the risk of a very difficult

operation which you know has a serious risk, sometimes catastrophic

consequences. But whether it is more difficult to tell a patient who is

desperate for you, even though you have explained all of the risks,

that it is not the right decision and it is right for nature to take

its course. Which is harder? It depends on the nature of the

problem. I think it is harder to do nothing. It is harder to say, go

away. That is very difficult. Sometimes you say it is the better

outcome. Yes, you learn. I see my younger colleagues operating on

cases which I did at my stage of that career. Now they wouldn't. I no

longer do emergency work, but when I was your often called about

emergencies. Emergency neurosurgery is actually very simple. The actual

operating is very easy. It is based on moving blood clots. But the

decision on whether it is worth operating is very difficult. You

have strokes where if you do not operate they will die. If you do

operate, they might survive, but they might be left disabled. If I

say, thumbs up, operate, I get back to sleep. If I say thumbs down, I do

not, because I am worried I was wrong. Is it important for you to

get to know your patience before operating? I used to think it was.

My son had a brain tumour when he was very young. He was a few months

old. I was doing general surgery. That is not why I became a brain

surgeon myself. I do not know what other. As are like, but it gave me a

certain understanding and sympathy of my patients were going through.

An essential part of the operating was to be quite close to the

patients and their families. That is partly selfish. If you are close to

them and things go wrong, they are less likely to lose trust in you. It

is selfish and not selfish because you are more invested in the case

commercial league. -- emotionally. My colleague and his team were doing

all the talking because of the language barrier. In the past it

would have been complete anathema. It did not make a difference. I was

just as focused and intense about the operating. That was a surprise

to me. I was better than I expected. Let me switch focus and talk to you

about this most amazing organ of pounds. It is so complex, it is so

mysterious in many ways. And yet you approach it with sometimes drills,

saws, knives and the suckers and there is something quite bizarre.

It is utterly bizarre. When I was younger, I took it for granted. As I

get older, I am more and more amazed about this fundamental mystery. What

I thinking or feeling is electric chemistry. It feels free and

insubstantial but we are the product of the electrical chemical activity

of nerve cells. What is fascinating is that modern science... We cannot

even begin to explain how thoughts and feelings arise. We just do not

know... Your career has spent 35 years, are you saying you have

learnt little more about the electro chemistry works? We now how a brick

is made but it is not tell us anything about the house made by the

bricks. What really interests asked as human beings is ourselves, our

feelings and consciousness. We cannot experiment on it either. You

write about being struck, during an operation, that your sucker, the

Hoover thing you suck jelly out of, is moving through thought and

emotion and that memories and dreams should consist of this jelly is

simply too strange... It is the last great mystery. You might be sucking

up peoples imaginations or thoughts or dreams! The answer to that is the

illness you trying to treat is even worse than the operation. The right

bad results and complications but you think of the good results and

most of the time things go well. -- there are. For all the patients are

done badly, there are thousands that did well. That is the balance. But

it is terribly important. Success is corrupting. Success makes us

complacent and spoils us. The worse surgical crime is complacency. You

must never forget the complications but it is terribly important to

remain as humble and modest as you can even do you must present a

confident and assurance to the patient. One more question on the

more philosophical side of what you do. You said you believe in science

with a capital S. But for centuries, philosophers have posited the notion

that, it the end, our mind, our sole, maybe, is separate from the

physical reality from the thing between our ears. Are you telling me

you are absolutely could win the there is no possibility of that

being true? Deeply in probable. We do not understand how it works. I

find that mystery reassuring. We know the macrocosm of the big bank,

the anniversary of Einstein's the Wii of relativity. But we are

sitting on a mystery as great as the big bang. You have read the papers

that address and near death experiences and some that we collect

experiences when normally the machinery has told us they are brain

dead. But you think it is a mirage? It is a complicated area. Brain-dead

is rather different. Near death experiences are recognised phenomena

in... Bad... -- Butt. Back to healthcare. We have talked about you

as an individual dog and a surgeon and how you have approached a career

dealing with the most terrible challenges in the brain. Another

part of what you do is exist with a vast health-care system, one small

cog component in a huge machine. It seems to me he had become

disillusioned with that? Yes and no. You have to look at the NHS

internationally, firstly and if you look... There is a lot of criticism

in England about... Some mistake in the hospital. And the headlines are

shamed to the NHS. The national health service provides by

international standards very good healthcare in terms of overwrought

outcomes in terms of life expectancy... The Americans would

call it socialist healthcare... I have worked and visited so many

countries where it is terrible... It is not if you can pay for it. It

comes back to the fact that medicine is not like going in to a shop and

paying for it. A lot of the decision-making is very unclear and

the grave stop if you look at countries like America, at its best

it is fantastic but it is incredibly extravagant. In all countries,

healthcare costs are rocketing. I afraid doctors have a financial

interest in what they are doing, they tend to do more. Taking the

Nitish case of a socialised system -- British. At a time of ageing

population and rising costs,... You need to pay more. Pay more tax or

accept greater rationing. Exactly. It is basic economics. If it is in

scarce supply, you end up with queues. Having all these targets can

be. You think queues are OK? Note that you have to prioritise and deal

with emergencies first. A lot of people have made points about the

organisation, and you call it the chaos, in the system. Arrogance...

You do not like being told what to do I manage us. You do not like

being told to come wear a tie or a wristwatch or your car space has

been taken... I do not drive a car I ride a bike everywhere. You are

right. Some comment on my arrogance but, again, that criticism is

probably fair to some extent but what patients want... They want

individual care from a dog. They want a sense of responsibility from

an individual. -- from a doctor. We have responsibility for their lives

and deaths. If you are treated as a minor cog, it produces a lot of

tension. So colleges will say that under stressful situations, to have

a position of responsibility with no power. You have escaped the confines

of NHS. You work abroad. Having worked. Long with sick people, with

terrible health challenges of the brain, are you now frightened of

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

two demented parents to care for. Dementia is an increasing problem in

wealthy countries and I much more worried about dementia than dying.

The evidence is a fairly clear that keeping busy, physical exercise, a

very important to keep it at a but we cannot keep old age at bay,

ultimately. You are committed to keeping on doctoring. You said an

ageing dog is a better dog... You are all sympathetic. -- dog. --

Doctor. We began by talking about where that you want an honest

doctor... As you age, your hands are not as steady... I have been

thinking about that a lot. I was operating in Nepal, and I felt two

things. I felt sure that physically I was as good as I have been. But I

felt increasingly ashamed and embarrass and help crude the

operating I was doing compared to what I increasingly understand about

the brain. That struck me. I need to gradually withdraw from operating,

clearly but not yet. Please. I hope you keep going for quite sometime. I

still totally in love with it. Dr Henry Marsh, it has been a pleasure.

Thank you. Thank you very much indeed.