'Never marry a neurosurgeon - their bad day is always worse than yours' - Henry Marsh

YOU LIVE AND LEARN: The semi-retired neurosurgeon on dumb management in the NHS, making mistakes and why brain surgery still fills him with awe.

by Adam Gale
Last Updated: 25 Feb 2016

I spent two years studying PPE at Oxford before I ran away to become a hospital porter in a northern mining town. I'd broken up with my girlfriend and wanted to see human suffering. Having some experience of the world helped when I later became a doctor. If I ruled the NHS, I'd make medicine a postgraduate degree.

When I first saw brain surgery, it was love at first sight. It still fills me with awe - I am electrochemistry. When you're operating, nothing else exists. In that way it must be like the best of drugs. I can’t think of anything more exciting.

I find the thought of neurosurgery very distressing now. There's so much damage you can do. If you take your eye off the ball for a moment the results can be catastrophic. We don't talk about our mistakes much. I’ve tried to remember many of mine for lectures and found it was the more unpleasant ones I’d forgotten, either consciously or not. 

You learn to lie to patients early on, and the best way to deceive others is to deceive yourself. You have to shut yourself off from their pain, otherwise you couldn't do it. You have to operate in the knowledge that someone else can probably do it better than you can, but if you don't take on difficult cases you'll never learn. So you wear blinkers.

I've always been deeply afraid my patients will think I'm indifferent to their sufferings. I'm sure at times I must have been. Empathy and compassion involve effort. It's so much easier to walk past a patient in a bed than talk to them.

As my second wife said, never marry a neurosurgeon, because their bad day is always worse than yours. You see the most terrible suffering, but it doesn't teach you any wisdom. You're still bothered by the trivia of your life, which is very annoying.

I'm not anti-management, just anti-dumb-management. Sending someone like me on a course about customer relations and how to lift boxes is just silly. Stupid regulations breed contempt for all paperwork and make people feel they no longer belong. My last few years working for the NHS felt like one long trudge into professional humiliation.

When I started, you worked longer hours but that made you feel special. That’s largely been destroyed by the European Working Time Directive. Shift working has been very bad for patient care. You only see a doctor for a few minutes a day, but at least before you’d see the same doctor. 

I'm now in semi-retirement. Why throw away 35 years of practical experience overnight? But it's nice not to be anxious all the time. I'm busy refurbishing a derelict cottage and derive enormous pleasure from making things. Yesterday, I was bricklaying. Tomorrow, I'll be doing delicate spinal surgery.

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