An adventurous neurosurgeon

Why did you choose neurosurgery?

I went to the Royal Free Medical School, which had an enlightened policy of taking on eccentric graduates like me. I wanted to become a surgeon but did not find surgery attractive. It rarely is for students. I did not see a neurosurgical operation until I was a senior house officer in an intensive care unit, when I more or less fell off my donkey and immediately recognised that this was what I wanted to do. I had found neuroscience the most interesting part of my preclinical studies, and the seriousness, complexity, and drama of neurosurgery was irresistible. I was also impressed by the consultant neurosurgeon who was doing the operation. My baby son had been successfully treated elsewhere for a brain tumour a year earlier—I do not know how much that might have influenced me as well; less than one might think, perhaps.

How did your trips to the Ukraine come about?

I read politics, philosophy, and economics at Oxford University, specialising in studying the Soviet Union. In 1992 an English businessman who was trying to sell medical equipment to the Ukraine contacted Atkinson Morley’s Hospital, where I work. He was looking for a neurosurgeon to accompany him to Kiev and deliver some lectures about neurosurgical equipment because there was a neurosurgical hospital there, which had been famous during the Soviet era. It gave me an opportunity to combine Kremlinology with brain surgery—something I would never have thought possible.

What keeps you going back?

My friendship with my colleague, Dr Igor Kurilets, and the feeling that I can help and make a difference to some of the patients I see there. In the United Kingdom I am entirely replaceable.

How did you get involved in television and film making?

In 2003 the BBC wanted to make a new version of the popular series about surgeons Your Life in Their Hands. I specialise in “awake” brain surgery, which makes for dramatic viewing. When the producer came to see if I might be a suitable subject I said that I hated the past series because it made surgeons out to be heroes, which they are not. Perhaps that is why they decided to make a film about me.

In neurosurgery, where the stakes are so high, would you say that neurosurgeons are gamblers or good at assessing risk?

Neurosurgery attracts risk seekers, who are not quite the same as gamblers. The problem with so much neurosurgical decision making is that we often have only an approximate idea of what the risks are of operating or not operating, but it is the decision making in neurosurgery that is the most important and fascinating part of it—and where most of the mistakes are made.

You’ve talked about the effect the hospital environment can have on patient outcomes. What aspects of UK hospitals could be improved in this respect?

Having 100% single rooms as is happening everywhere else in the developed world with new hospitals—to reduce hospital acquired infections and to allow the peace, rest, and quiet that we so rarely get in hospitals. The NHS is lamentably behind the rest of the world in the design of hospital environments.

What is the most difficult aspect of your job?

Seeing patients and their families after an operation has gone badly and I have left the patient seriously disabled. Even more difficult is trying not to hurry past them on the ward rounds over the weeks afterwards and forcing myself to stop and talk to them.

What is the most challenging operation you ever performed?

I have occasionally operated on people I know—colleagues or family friends. On the whole I try to avoid this because the lack of emotional detachment makes me intensely anxious, and I fear that I operate less well as a result.

What has been the proudest moment in your career?

Passing the second part of the old FRCS exam first time—it was a real ordeal. I try not to take too much pride in operations going well because it means I must then beat myself up, which admittedly I do anyway, when an operation goes badly.

How do you balance work and personal life?

I don’t, and I don’t think neurosurgeons should. I know this is an unfashionable view. Work must always take priority. As far as I am concerned I am on permanent call for my patients. I would not recognise a “programmed activity” if it jumped up and hit me in the face, although I did sign up to the new contract for pension reasons.

What advice do you have for those wanting to be neurosurgeons?

A good neurosurgeon should always be in awe of the brain (and hence of his or her patients) and the astonishing fact that everything we think, feel, and experience is the electrochemical activity of nerve cells, which we do not even begin to understand.

Box for mini biography

Name: Henry Marsh

Position: Neurosurgeon at St George’s Hospital, London

Biography: Neurosurgeon for more than 20 years; featured in the BBC documentary Your Life in Their Hands and the film The English Surgeon (see review: BMJ 2008;336:671.)