"Every surgeon carries within himself a small cemetery."
May 13, 2015 8:28 PM   Subscribe

“Nobody, nobody other than a neurosurgeon, understands what it is like to have to drag yourself up to the ward and see, every day—sometimes for months on end—somebody one has destroyed and face the anxious and angry family at the bedside.” The schoolteacher lived on in just this way. Seven years after that failed surgery, Marsh was visiting a home for vegetative patients when he looked into a room and “saw his grey curled-up body in its bed.” Of the feelings such experiences produce in him, Marsh writes, “I will not describe the pain.” posted by un petit cadeau (28 comments total) 68 users marked this as a favorite
 
The most depressing book I've read thus far was "When the Air Hits Your Brain", memoirs of neurosurgeon Frank Vertosick Jr. It may have been where I was at because others have not had that reaction, but a few of the less cheerful stories in that book put me in an existential crisis for days.
posted by callistus at 8:49 PM on May 13, 2015 [3 favorites]


I used to work in a coffee shop in the lobby of a hospital. Jokey chit-chat was the way we developed a rapport with the regulars. One day, a neurosurgeon asked for a triple cappuccino, and I said, "Damn, hope you're not about to put your hands in somebody!" He looked a little confused then said he had no scheduled surgeries that day. I later told this conversation to an orthopedic surgeon, who shrugged and said, "Well yeah, you wouldn't have much a sense of humor either if like 80% of your patients died." That sunk in for a few days afterwards. Reading this, he's right; I would absolutely not have any room for joy left if I were a neurosurgeon. Felt awful about the joke, even now.
posted by Aya Hirano on the Astral Plane at 8:57 PM on May 13, 2015 [19 favorites]


“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray.”
- René Leriche, French Doctor

How is it that this quote wasn't dropped* in a M*A*S*H episode? Fits Hawkeye to a T.

*Just completed a re-watch of the series, forgive me if I'm wrong.
posted by RolandOfEld at 9:00 PM on May 13, 2015 [2 favorites]


Wonderful article - thanks for posting. I'd quite like to read Marsh's book now, but don't think I can bear it.
posted by two or three cars parked under the stars at 9:07 PM on May 13, 2015 [7 favorites]


This is an excellent article. I never really considered that neurosurgeons deal with these kinds of psychological realities. Thanks for the post, un petit cadeau.
posted by rmmcclay at 9:56 PM on May 13, 2015


This goes a long way towards explaining the stereotype of surgeons as brash, arrogant assholes with little in the way of human compassion (or at least no visible signs of it). It would be a useful quality to have in terms of sustaining your ability to keep performing the job. I feel guilty when I give someone wrong or incomplete information, I can only imagine how much worse Marsh must feel and how, if you started out with compassion, you'd try to cure yourself of it.

All the same, I'm grateful Marsh does feel things so strongly, and shares his feelings. I'd still rather have someone like him poke around in my brain than someone brash and arrogant, though I hope I don't need anyone to.
posted by Athanassiel at 10:10 PM on May 13, 2015 [3 favorites]


After years of personality changes and declining health, my mother was diagnosed with an enormous, but benign brain tumor last year. The surgeon who removed it made it possible for her to once again be the person I'd grown up with. It's not an exaggeration to say that she got her life back thanks to him.

For all the pain neurosurgeons must have to cope with, they're also on the receiving end of enormous amounts of gratitude.
posted by teponaztli at 10:14 PM on May 13, 2015 [21 favorites]


I'd be willing to trust my life to a surgeon whose mistakes weigh so heavily on him or her.

One note on the article, though - the victims of lobotomy were never the victims of "historical errors," unless you would count the crimes of Josef Mengele as "historical errors". Lobotomies were conscious atrocities carried out against psychiatric patients intended to destroy their humanity in the same way Marsh refers to his vegetative patient as "it." The key difference being the latter was a just word he used; the former was a practice that even the Soviet Union outlawed in 1950 - the US not until 1977.

That said, the silence he's greeted with when speaking to other neurosurgeons about his mistakes speaks volumes and suggests there are way too many arrogant assholes out there who see poking around in a brain as just another thing to brag about on the golf course. Not that it's something one randomly decides to do one day, mind you, but for all of the training and expertise that does into it, I guess there's enormous professional pressure to not say, "Fuck. Yeah, I had this patient, and..." and kind of lose your humanity in the inside baseball of the technical aspects of it all.

So, go with god or dog, doctor. You've kept you humanity intact despite doing work that is either miracle or catastrophe, and you can never say to yourself with certainty "We know for sure how this will turn out."

I will probably read his book. This is really fascinating. Thanks for posting it.
posted by mandolin conspiracy at 10:31 PM on May 13, 2015 [10 favorites]


No, RolandOfEld, that is very Hawkeye. That show could be shockingly eloquent at times. I can't think of another sitcom that loved words so much. Equally amazing, those great lines usually didn't sound "written". If you took them out of context they could sound contrived, but they almost always worked in the scene. ALSO amazing, every character had their own distinct voice, whether it was Hawkeye's heartbroken Groucho poetry or Frank Burns' daffy-sinister backwards-isms. As endlessly celebrated as that show was, part of me feels like it was kind of underrated. How can a show be so damn honest, and angry, and sad, and sweet, and funny too? How?

I'm talking about MASH because I'll jump on any excuse to talk about that show, but I'll be damned if I'm reading this article. I am all maxxed out on despair this week.
posted by Ursula Hitler at 10:36 PM on May 13, 2015 [10 favorites]




Firstly, an excellent piece of writing - concise, sharp and very effective. In a world of hyper reality seemingly enthused with a celebrity culture that promotes the shallow and instaneous as meaningful, this piece stopped me in my tracks. I, like 2or3carsparkedunderthestars, am tempted to read the book but am not sure I could bear it either. There is something deeply powerful about this glimpse into such a niche world of people who operate at the very extreme edge of risk and reward. I cannot help but note with interest from the wikipedia entry of Henry Marsh, that he lists making furniture and keeping bees as interests. To me there is something very telling in that.
posted by numberstation at 2:24 AM on May 14, 2015 [2 favorites]


A relation had a colon resection due to Crohn's disease and the surgeon who did it displayed all that typical arrogant, cocky swagger you come to expect from surgeons.

Later he confessed he confessed to her he hadn't slept for a week after the surgery out of panic that the resection would separate and faecal matter would start pouring into her abodmen.
posted by PenDevil at 3:06 AM on May 14, 2015 [1 favorite]


I imagine this is like the game of golf. The best golfer may hit beautiful shot after beautiful shot, but occasionally chops a terrible shank into the trees.
posted by fairmettle at 3:12 AM on May 14, 2015


"Controlled and altruistic violence." Ah, what a phrase. Just needs GSV in front of it. The best surgeons really have something of the Old Testament deity about them, including the King James cadences, and while that's an old joke ("what's the difference between God and a surgeon?") the same psychology probably informs both beings.

I once had a long train journey where I got to talking to the chap sitting opposite me. We never swapped names - there was a sense of tacitly agreed anonymity - but I did learn that he was a surgeon who set the rules for teaching and assessing trainee surgeons. If only I had a recording...

He talked about so many things: about how surgeons see themselves, how they develop, the internal politics of the profession, about success and failure, the difficulties of reform. I realised afterwards that I had accidentally and unconsciously just conducted one of the best journalistic interviews of my life, entirely just by being there and nudging, and I couldn't use a word of it.

But mostly, I just tried not to look at his hands. His normal conversational gesticulations were made with a fluidity and precision that were other-worldly, llke slo-mo in real time. The opposite of uncanny valley. Manu dei.
posted by Devonian at 4:54 AM on May 14, 2015 [14 favorites]


(PS - on re-reading, what a marvellous piece. I am even more forcibly struck by the way the anthropology behind Jehova mirrors the psychology of surgery.)
posted by Devonian at 5:19 AM on May 14, 2015


The bbc documentary is wonderful - worth taking the time to see.
posted by Dashy at 5:30 AM on May 14, 2015 [1 favorite]


Seems like less of a Hawkeye quote and more of a Sidney quote to me
posted by MOWOG at 5:59 AM on May 14, 2015


Aya Hirano on the Astral Plane:Felt awful about the joke, even now.

With an 80% kill rate that guy was lucky to be working at all. Joke on.
posted by dr_dank at 6:20 AM on May 14, 2015 [1 favorite]


On reading this, I must recommend the book Working Stiff by Judy Melinek, M.D., Dr. Melinek started a surgery residency and left to become a medical examiner. The first chapter includes some of the horrors of being a surgeon and it is, in my opinion, an engaging, well written look at what a medical examiner actually does (as opposed to what TV dramas show).
posted by Sophie1 at 6:35 AM on May 14, 2015 [4 favorites]


Two years ago when a minor car accident combined with blood thinners caused my father's brain to bleed out and his to quickly deteriorate into a coma, multiple strokes, and massive sections of his brain to die, his neurosurgeons had the decency to tell my family the truth. My father as we knew him was already dead, they could work miracles and keep him alive indefinitely, but he would never be the same, never talk, never walk, the best we could hope for was a glimmer of recognition from him. They did not ask but they clearly wanted us to tell them to stop doing their jobs and let dad's body die. We've never forgotten how much they did for us and the honorable and diplomatic way they handled our situation.
posted by The 10th Regiment of Foot at 7:12 AM on May 14, 2015 [2 favorites]


What a fascinating man and a life well spent. 20 years performing pro bono neurosurgery in the Ukraine? Bravo, sir.
posted by onlyconnect at 9:11 AM on May 14, 2015 [1 favorite]


Thirding the TV documentary recommendation, which is good on so many levels (and check out who did the music...).
posted by Devonian at 9:47 AM on May 14, 2015 [1 favorite]


This reminds me of Sharon Farber's short story (writing as S N Dyer): The July Ward. I understand that it was reprinted in A Woman's Liberation: A Choice of Futures By and About Women, edited by Connie Willis and Shelia Williams. It's worth reading. You can also find one of Ms Farber's non-fictional anecdotes about medicine in the collected "best of" Mimosa, here.
posted by Joe in Australia at 3:36 PM on May 14, 2015


Something about the article - and probably the photograph attached - made me think about Marsh, The English Surgeon, which I saw some years ago. And it might have been the contrast between the admissions of hesitancy and regret in the article and the way Marsh appears in that film, because his manner in person is the most decisive, precise and uncompromising imaginable. But what a job. It's brought home to the viewer that terrible and ruthless decisions have to be made: there's no way you could approach doing the work without that uncompromising, precise decisiveness.

Iirc in Ukraine they are working out of someone's private flat with queues forming in the corridors and out into the hall. Marsh brings over equipment that has been retired from his hospital but still very much appreciated elsewhere. There are some tragic cases and you see how much the doctors are affected (in a buttoned-up kind of a way.) Marsh is one hell of a man. And his Ukrainian colleague too.
posted by glasseyes at 4:21 PM on May 14, 2015


Devonian, you were star-struck!
posted by glasseyes at 4:22 PM on May 14, 2015


Glasseyes - He clearly was an exceptional man near the top of a very exceptional profession. In my defence, I've met a few people in that boat, and none had hands that moved like those.

(Starstruck? No. Let me tell you, however, about the day I met Eno...)
posted by Devonian at 6:36 PM on May 14, 2015


I kinda liked this. It's really difficult work that needs to be done and it goes sideways despite everyone's best efforts... I think it's important he's willing to admit he screwed up and apologize. In my mind that makes all the difference.
posted by iffthen at 6:02 AM on May 15, 2015


The documentary link above is a must see...
posted by fistynuts at 1:19 PM on May 15, 2015


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