An unforgettable insight into the countless human dramas that take place in a busy modern hospital, and a lesson in the need for hope when faced with life’s most difficult decisions.
1) One of the most striking of the book’s many attributes is Marsh’s honesty. Having been in the profession for close to thirty years, Marsh has made many mistakes which is quite honest about.
What did you think about Marsh’s ability to own his mistakes? How does this differ from the American surgery perspective? What, if anything, does this has to do with differences in legal systems?
2) Marsh has come to realize that the most difficult decisions are not made on the operating table, but rather before it; and whether complex (and expensive) surgery will actually bring any additional value to the patient’s life. As Marsh states in this passage:
“Most neurosurgeons become increasingly conservative as they get older… I certainly have – but not just because I am more experienced than in the past and more realistic about the limitations of surgery. It is also because I have become more willing to accept that it can be better to let somebody die rather than to operate where there is only a very small chance of the person returning to an independent life… The problem, of course, is that so often I do not know just how small the chance of a good recovery might be because the future is always uncertain. It is much easier just to operate on every case and turn one’s face away from the fact that such unquestioning treatment will result in many people surviving with terrible brain damage.‘ (p.124)
This passage – and, indeed, the whole book – throws up some thought-provoking questions about the limits of medical science, and just how far it should be employed to extend life.
Has this book changed your perspective on medical care decisions? Is it better sometimes to accept that death is imminent rather than taking long-shot chances on prolonging life? What if there is a risk you will end up mentally diminished or even in a persistent vegetative state (remember the man “curled into a sad ball, on a bed in bed in the nursing home” in the chapter “Hubris”)?
3) In a similar vein Marsh observes: “Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.” (p.139)
What do you think of this observation? Is it true?
4) Marsh states that: “Neuroscience tells us that it is highly improbable that we have souls, as everything we think or feel is no more or no less than the electrochemical chatter of our nerve cells.” (p. 200). Yet, Marsh cautions, this does no mean we are reduced to mere “automata.” The actual mechanics of consciousness is still beyond human understanding (The Mind-Brain problem (p.120)). How many nerve cells are required for consciousness or to feel pain? Does a snail feel pain when crushed underfoot? No one knows.
How does one reconcile the concept of a soul and modern neuroscience? What are we truly if one’s intelligence, personality, and very nature can be completely changed from one sharp blow to the head or a brain hemorrhage? What about the fact our thoughts and feelings are embedded in this mass of jelly-like substance? Does this diminish us, that our identity is nothing by electrochemical chatter?
5). Relevant to a topic American constantly debates, the book exposes some of the negatives of a national health care system. The inefficiencies, the sometimes ridiculous bureaucratic decision-making (such has having to take a class that was irrelevant to Marsh’s practice), the lack of solicitude to the experience of the patient. Further, Marsh seems pleased that he can afford and take advantage of his private health care insurance.
Did reading this book change your perspective on the American health care delivery model?
6). Finally, did you like the book? Would you recommend it to others?
Fresh Air Interview with Henry Marsh: