What is the role of the surgeon? Is it to reduce harm or keep the patient alive as long as possible? Ideally, the answer is that the surgeon does both of these things for their patient. After all, the patient is the most important person in an operating room. Admissions, the English brain surgeon Henry Marsh’s new book, reveals how increasingly difficult it is for modern surgeons to abide by these two principles.

Admissions (brilliantly titled by his wife Kate Fox) vividly declares the reality of the operating room by recounting past cases with unflinching honesty.

I can remember two cases – both young women – from the early years of my career where my inexperience made me too timid and I failed to remove enough (of the brain) tumor.

This book is a personal ledger of the lessons gained from a lifetime of success and failure. Knowledge is provisional. Surgery is more probability than certainty. Who should decide when it is better for a patient to die? What does it take to provide a quality life for the patient and the patient’s families?

There has always been a the tension at the heart of medicine, he writes, between caring for patients and making money. The public English and American health systems promote medical intervention with the goal of increasing profit margins without considering the patient’s quality of life. Within the private hospitals he worked at in Ukraine and Nepal, where a single MRI scan costs as much as the family’s monthly income, competition between surgeons breeds corruption and unnecessary procedures. He doesn’t have an answer, just expresses remorse at how it is the patients and their families that suffer. 

Marsh tells his life story between intense philosophical diatribes and examples of surgery. He is, it seems, a chronic polymath. He pioneered the ‘awake craniotomy’ and did pro bono work for fellow surgeons in Nepal and the Ukraine as he entered retirement. He plants forests and gardens, hikes mountains, runs every day, speaks with elephants, installs lofts, builds tables, windows, sheds, and can sharpen about any tool you can think of. But Marsh is human, and does not try to hide his faults.

It is this sharply frank tone that I think makes this book so remarkable. It lifts the ‘magic curtain’ of medicine and reveals the human operating behind it.