His second neurosurgical memoir is transgressive, wry and confessional, sporadically joyful and occasionally doleful. It is in many ways a more revealing work than his bestseller Do No Harm, and the revelations it offers are a good deal more personal. Much will be familiar to admirers of that book – Marsh skilfully articulates the subtleties and frustrations of neurosurgery – but there is a deeper examination of death, and an angrier exposition of the shameful betrayal of the NHS by successive generations of politicians ... There is something valedictory about Admissions, a clever title for a book that mingles case studies with confessions. It’s elegiac but consistently entertaining ... His book is infused with a sense of urgency, as if he senses his time might be short. For his sake, and for the sake of his readers, I hope he’s wrong.
...an elegant, thoughtful examination of his life as a neurosurgeon. The book is not just a recounting of memorable patients and cases, but a steady, fearless look in the mirror: at what brought him to medicine; his regrets (patients he lost; patients he wished he had lost, if only to save them from a slow, difficult death); his anxieties with each new case; his successes and failures; and his mixed emotions about his imminent retirement, which he views both as freedom and as empty, purposeless void ... Marsh’s writing is elegant and tactile. He is sharply observant, both of people and of nature — the smell of cut wood and chain-saw oil, the color of faded reeds along the riverbank, the haughty glide of swans on the water. His descriptions are precise and careful, laden with meaning ... It is a pleasure to get lost in such a wise and beautiful book.
Like “Do No Harm, Admissions is wandering and ruminative, an overland trek through the doctor’s anxieties and private shames. Once again, he recounts his miscalculations and surgical catastrophes, citing the French doctor René Leriche’s observation that all surgeons carry cemeteries within themselves of the patients whose lives they’ve lost ... But in this book, Marsh has retired, which means he’s taking a thorough inventory of his life. His reflections and recollections make Admissions an even more introspective memoir than his first, if such a thing is possible ... The most startling aspect of Admissions, however, has nothing to do with medicine. It’s how Marsh portrays himself. As a young man, he writes, he was close to suicidal and spent time in a psychiatric hospital...He opens Admissions by telling us he’s acquired a suicide kit, in case his death is painful and slow, and he closes with a civilized discussion of euthanasia. But he confesses he doesn’t know if he’d ever have the courage to hasten his own death. Which may be his most profound admission of all.
It was the privileged insights into neurosurgery which made Do No Harm such a remarkable book. Admissions, to some extent, offers more of the same ... His writing is at its vivid best in the 'muted drama of the theatre,' with 'the bleeping of the anaesthetic monitors, the sighing of the ventilator' and 'the sucker slurping obscenely' as he removes a tumour from someone’s brain. There are, though, fewer such moments in Mr Marsh’s new book. Those expecting a second Do No Harm will be surprised, but not disappointed. Admissions is more about the man than the surgeon, but it is excellent in its own right.
In vivid prose, he captures the terrifying risks he faces with each cut, each decision ... it’s hard not to like Marsh, who is so disarmingly self-effacing and honest about his regrets and failures (he didn’t have to include the fact that he once operated on the wrong side of a man’s head, for instance ) and how much he hasn’t learned along the way. He writes that a long time ago, 'I thought brain surgeons — because they handle the brain, the miraculous basis of everything we think and feel — must be tremendously wise and understand the meaning of life.' With age Marsh has come to realize 'we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling.' Rather, he concedes. 'I have learnt that handling the brain tells you nothing about life — other than to be dismayed by its fragility.'
His book is in this sense an epitaph to an incarnation of the NHS that existed in gentler, better-funded and less-regulated times. As one might expect, however, from a high-spirited individual such as Marsh, his 'retirement' is no less vigorous and varied than his former life. From his regular travels to Nepal to assist a former pupil at his neurosurgical unit in Kathmandu and jaunts to Ukraine to operate with a friend in Kiev, to his Zen-like renovation of a derelict canal-side cottage in Oxford, Marsh’s eloquent book is — among many other things — a testament to the tenacity of the human spirit.
The author’s first book received rave reviews and sold well. While follow-ups to exceptional first books have a spotty record, readers who open Marsh’s sophomore effort will quickly realize that they are in the hands of a master ... Another thoughtful, painful, utterly fascinating mixture of nut-and-bolts brain surgery with a compassionate, workaholic surgeon’s view of medicine around the world and his own limitations. Readers will hope that a third volume is in the works.