By Sirin Kale

The author of three bestselling memoirs was a swashbuckling presence on the wards for three decades. Now undergoing treatment for advanced prostate cancer, he talks about facing death and living without regrets

In his retirement, Henry Marsh is visited by all the patients he used to treat. But his doorbell never rings. They are spectres, or as Marsh might more accurately describe it, synaptic impulses. “There are thousands of them,” says the former neurosurgeon and bestselling author. “I must have forgotten quite a lot. They’re all there. On the whole they’re benign ghosts.”

The visits began after Marsh, who is 72, was diagnosed with advanced prostate cancer in early 2020. He wondered whether, “if I remembered them all, and they forgave me, then I would survive”. Marsh succumbed to other forms of magical thinking. When cycling around London, he would tell himself that if the traffic lights changed at a particular time, he would be all right. “It’s totally ridiculous,” he says. “But the idea of our future being out of our control is very frightening. We have all these mechanisms for trying to feel in control, and superstition is one of them.”

We are sitting in the kitchen of Marsh’s Wimbledon home, which will be familiar to readers of his trio of memoirs – "Do No Harm","Admissions" and the just-published "And Finally" – as the site of his frequent home-improvement projects. Marsh did the loft extension himself; he spent the weekend laying patio flagstones.

The house overflows with books, throws, rugs, wall-hangings. Marsh shows me, with considerable pride, an ornate doll’s house he is building for his granddaughters. Bees buzz around a hive in a densely planted back garden. A black toy bear, rearing on its haunches, watches our interview. After we finish speaking, he takes me into a side building he has converted into a guesthouse, complete with hand-carved oak woodwork, running water and electricity.

"And Finally" documents the months after his cancer diagnosis, a strange and melancholy time that coincided with the first Covid-19 lockdown. Gone is the swashbuckling brain surgeon who dominated the neurosurgical ward at St George’s hospital in south London for three decades. A 2015 Newsnight segment shows him on imperious form.

He was described as the “Knausgård of neurosurgery”, and achieved international fame with the 2014 publication of "Do No Harm", a bestseller that was translated into 37 languages. It did so well, observes Marsh, “because it was so blindingly honest, and read like a thriller. Each chapter, you don’t know if the patient is going to be alive or dead at the end. Normally medical memoirs are all senior doctors and it all ends happily.”

"And Finally" introduces us to a depleted, humbled Marsh. He is a patient in his former hospital, where staff do not recognise him. “Ah,” he writes, “I have crossed to the other side. I have become just another patient, another old man with prostate cancer, and I knew I had no right to claim that I deserved otherwise.”

Chemically castrated as part of his treatment, he gains weight, acquires breast tissue, and loses his body hair, resembling “an outsize geriatric baby”. Marsh wanted to be honest about the degradations of ageing, he says, because “why not be open about it? Call a spade a spade.”

Transitioning from doctor to patient made Marsh reflect, painfully, on the times he had been harried, short or obtuse with patients. “Doctors are all busy,” he says. “But not appearing to be in a hurry is very important. And listening to patients. But that all takes time. It’s really about doing as you would be done by.”

The difficulty, says Marsh, is that to perform dangerous surgery, you need to detach from the patients, otherwise you would be too racked by fear. “You can’t operate,” he says, “if you’re a nervous wreck all the time.”

During his career, Marsh pioneered a type of neurosurgery in which the patient is awake, but under local anaesthetic. What is apparent from reading "Do No Harm" is the push-pull of terror and exultation that defined his career. He longed to perform high-wire surgeries, but was sickened by the fear that they might go wrong.

“The more difficult, the more challenging, the more dangerous the operation, the more I wanted to do it,” he says. But unlike other surgeons, he was never able to detach from his patients. He would cycle into work on his days off to check on them, because “I was really frightened that my patients would feel I didn’t care for them”.

In person, Marsh is candid, self-deprecating and forthright. Our conversation revolves, perhaps inevitably given the subject matter of And Finally, around death. Marsh put off going to the doctor about his prostate symptoms for three years before finally getting checked out. “I don’t regret that now,” he says. “I was terribly upset at the time, because I felt I had betrayed [my wife] Kate and my family by being so stupid. But I’ve accepted it.” His type of cancer has a 75% chance of tumour recurrence within five years of diagnosis, meaning that he would be fortunate to reach his 80th birthday.

“Actually,” says Marsh, “what’s the difference? If I die in two years’ time, what will I do between now and then which I don’t want to do now? The main reason for living longer now is for the sake of my family and my wife. And this is not rationalist bravado entirely. I’ve had a wonderful life. Yes, I’ve done a lot of things I shouldn’t have done. But you know, I’ve had a full, complete life, and there’s nothing more I can do to complete it. Dying when you’re younger is obviously a totally different situation. Or losing a child. I mean, that’s beyond words.”

He is a passionate campaigner for assisted dying. “There’s a fanatical clique made up of senior palliative care doctors,” he says, “who I think probably have religious objections to assisted dying, but dress up their objections in practical arguments, [by saying] it will be abused or it will lead to a reduction of funding for hospice care.” He believes that assisted dying will eventually be legalised in the UK. “Hopefully in time for me. I would much rather go legally.”

Marsh believes that the public is unrealistic about what it means to grow old. “We might be lucky and terribly hale and hearty and compos mentis in our late 80s. But it’s more likely that we’ll be pretty knocked off and demented and physically very frail and not enjoying life very much.”

We meet shortly after the Queen’s funeral. “How wonderfully well the Queen did,” he says. “Sufficiently well to see Johnson and Truss and then two or three days later, she’s dead. I thought, that’s fantastic. That’s something to celebrate. That’s a great death.”

He was not always so sanguine about his own mortality. In the initial aftermath of his diagnosis, “I was terrified,” he says. But now he has no fear of death – although the process of dying bothers him. Instead, it is a terror of the climate crisis that keeps him up at night.

“This climate change thing is a nightmare,” he says. “I think about my granddaughters.” After so many years of staring into the source of human consciousness, Marsh is certain there is no afterlife. “It’s very hard to believe there is something beyond,” he says. “That consciousness is not produced by the electrochemical activity of our brains.”

Marsh was born to a mother who fled Nazi Germany due to her opposition to fascism, while his father was an eminent law reformer and academic. “They were not respecters of power and authority,” he says, “and some of that has rubbed off on me, even though I threw my weight around as a self-important surgeon.” He regrets not spending more time trying to understand his parents while they were alive. “They were both remarkable people … there are so many things I’d like to talk to them about now,” he says.

Marsh’s path into medicine was unconventional. He studied philosophy, politics and economics at Oxford, before dropping out due to depression. He spent time as an inpatient at a mental health hospital, and worked as a porter in a hospital in the north of England. He later returned to Oxford to finish his degree, before studying medicine at University College London. What makes Marsh such an interesting writer is his willingness to confront his failures head-on. He self-flagellates throughout his memoirs about the mistakes he has made, personal and professional.

His first marriage ended in an acrimonious divorce. “I spent the whole time working seven days a week,” Marsh says. “That was the nature of the work and I always put work first. I kind of took the family for granted. Having said that, I have a good relationship with them now.”

His ex-wife cited the trauma of coming downstairs to find that Marsh had demolished a structural wall in their kitchen overnight, nearly bringing the house down, in her divorce filings. “It’s really very embarrassing,” he says. “I’ve got a bit better at working out which walls you can knock down and which ones you can’t.”

Marsh is similarly regretful about the mistakes he made in his career: the patients he left in vegetative states, or the ones who died on the table. He is able to be honest “because I went into medicine late”. He is passionate about this. “We need to be honest. The only way we can make progress is ruthless honesty. I don’t regard my writing as confessional. Confessional is about asking for forgiveness, which I’m not trying to do. I’m trying to set an example. Because mistakes are going to go on happening in medicine. The only way you can lessen them is by being open about them.”

Marsh retired from the NHS at the age of 65, after growing disenchanted with bureaucratic managers and his reduced surgical schedule. “I just got more and more frustrated,” he says. “Which is very sad because I believe deeply in the NHS. I think straying away from a tax-funded system is a terrible mistake.”

The final straw was a meeting in which Marsh was threatened by a senior manager with disciplinary action for wearing a tie on ward rounds. “That was the end as far as I was concerned,” he says. “Being threatened with disciplinary action by a fellow doctor because I was wearing a tie! That was too much.” He is concerned about the long-term prospects for the health service. “There are a lot of unhappy doctors around,” he says.

For a while he lectured at his former hospital, but now only occasionally attends morbidity and mortality meetings, where surgeons discuss procedures that went wrong. “I’m the only person who can be rude to all the consultants and criticise them,” he says.

Marsh also spent time teaching and operating in Nepal and Ukraine – he recently returned from a trip to Lviv and Kyiv, although his wife, the anthropologist Kate Fox, forbade him from going on a trip to Odesa with the trauma surgeon David Nott. She “wouldn’t hear of it,” he says. Instead, he spends his time working on the Wimbledon home – which seems to be in a process of never-ending improvements – and writing up the fairy stories he first started telling his granddaughters during the pandemic. “If they’re publishable,” he says, “fine, but the main thing is to make them a unique legacy.”

It is an unlikely final act to a glittering career, but Marsh has nothing left to prove. “I’m done,” he says. “There’s nothing more I want to say. I might do book reviews and some occasional journalism, but I’ve said all I want to say. Now, it’s all fairy stories.”