This month we welcome to our shores the renowned British neurosurgeon Henry Marsh. But he’s not here to attend a medical conference, or indeed for any medical reason at all: he’ll be promoting his new book, Admissions, at the Sydney Writers’ Festival. Professor Marsh is one of a new breed of doctors: the memoirist.
Literary history is littered with doctor writers. Anton Chekhov, Somerset Maugham and Arthur Conan-Doyle are just some of the many who hung up their stethoscopes to devote themselves to literature. There have been doctor novelists, and doctors who write eloquently about their patients or their discipline, but doctors who write self-consciously about themselves are a newer phenomenon.
The trend for doctor memoirs broke out into the open with the 2015 publication of Paul Kalanithi’s extraordinary When Breath Becomes Air, a global bestseller. Kalanithi, an Indian-American physician, was diagnosed with stage 4 lung cancer at the age of 36.
A brilliant man who was clearly driven to succeed, Kalanithi was on the verge of qualifying as a neurosurgeon and starting a family when he started being plagued by terrible back pain and rapidly declining weight.
But even after being handed the CT scans showing widely disseminated cancer, Kalanithi continued to work at the punishing pace of his chosen discipline. By way of explanation, he quotes the famous line from Samuel Beckett: “I can’t go on… I’ll go on”.
“Before my diagnosis, I knew that someday I’d die, but I didn’t know when,” he writes. “After my diagnosis, I knew that someday I’d die but didn’t know when.”
As the end approaches – too fast for him to finish his manuscript, which his wife assembled into a book after his death – Kalanithi eventually finds solace in the English literature he’d studied as a student at Stanford University, before taking up medicine.
Professor Marsh, too, has a background in humanities, having studied philosophy. It’s significant, in that both Marsh’s and Kalanithi’s memoirs – and indeed the whole genre – are about a restless quest for meaning in the face of death.
In that regard, doctor memoirs are clearly related to another burgeoning genre, the cancer memoir (Australian novelist Cory Booker’s Dying: A Memoir is a superb example of this). Just as we consider terminal cancer patients as having special insight into death because of their nearness to it, so we have started to think the same way about doctors – the new gatekeepers of life in modern society.
Death is a constant in Henry Marsh’s two memoirs, Do No Harm and Admissions, both haunting examinations of a life in surgery. While he has yet to face anything as dramatic as a Kalanithi’s stage 4 cancer, Marsh nonetheless admits to having assembled a “suicide kit”, that would enable him to avoid the fate of dementia, of which he is particularly fearful.
Marsh lays bare the dreadful pressures neurosurgeons are under, where a minute slip of the scalpel can lead to terrible disability. He is haunted by his failures, the cases where he has been “too sure” of himself.
He recalls one case where he removed a tumour from a young woman’s spinal cord. It seemed to go well, but the woman woke up paralysed down one side. Marsh had been “insufficiently fearful” and removed too much of the tumour, thus damaging the spine.
Stephen Westaby, a UK doctor, is another of the new doctor memoirists. He is a cardiac surgeon, and indeed surgery predominates in many of these memoirs. Professor Westaby’s book is replete with images of breastbones being sawn and blood gushing – it is in surgery that we realise that to be human is to be flesh.
Professor Westaby’s memoir, Fragile lives: a heart surgeon’s stories of life and death on the operating table, describes how he decided to be a surgeon after living through his grandfather’s awful death by heart disease at the age of 63.
He is a good surgeon, but despite his best efforts, he frankly admits that “some patients took the fast road to heaven. How many, I don’t know. Like a bomber pilot, I didn’t dwell on death”.
The neurologist Oliver Sacks is of a previous generation of doctor-writers, and his books mostly consist of fascinating histories of his patients, often exploring themes of identity. But when Sacks got his own diagnosis of terminal cancer, he finally published his own memoir, On The Move, detailing a life that had been strangely absent from his previous works.
Here, he reveals hitherto long-held secrets about himself, such as his homosexuality and past drug addictions. But he shows himself to be a man finally at peace with himself at the end, perhaps less haunted than the other memoirists.
In a valedictory piece for the New York Times, Sacks describes how his terminal diagnosis has enabled him to see is life “as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts”. But, he adds, “this does not mean I am finished with life”.
If it’s significant that surgery figures large in this genre, it’s also not surprising that disciplines of the brain are important. Marsh and Kalanithi were both neurosurgeons, while in his memoir, Sacks comments that “neurology is the only branch of medicine that could sustain a thinking man.”
Just as surgery reveals ourselves as bodies, neurology and neurosurgery gets to the heart of the Cartesian mystery, of how we can be at once both thinking and material beings.
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