White Coat Black Art26:29Brain surgeon Henry Marsh reflects on getting cancer
British neurosurgeon Henry Marsh confronted aging and his own mortality following his diagnosis of advanced prostate cancer. But he also found sources of hope, which he calls the “most precious drug.”
Marsh, 73, reflects on his successful medical career, much of it at St George’s Hospital in London, in his 2022 book, And, Finally: Matters of Life and Death.
Currently in remission, Marsh chronicles the effects of hormone therapy and the difficulty of accepting aging, which can bring loss of autonomy and dignity.
He spoke to White Coat, Black Art‘s Dr. Brian Goldman in February at the University of Exeter, where they both gave talks.
What was your experience of being given the diagnosis by the oncologist?
I said, “Well you know, what are the chances of my being alive in five years time?” Rather like “how long have I got, doc?” Of course, no doctor knows how long a patient is going to live — not until they’re breathing, they’re gasping, their last [breath]. And he said, “Well you only have to make your will for five years,” and that’s all he said, which in retrospect, was not a perfect example of communication.
The future is uncertain. All that matters is I feel well at the moment, my family are well and I’m a lucky man.
What’s the mismatch between what the oncologist was telling you … about your prognosis and what you, the patient, needed to hear?
I wanted to be given a bit of hope, even though it’s only a statistical hope and it’s something I was well aware of because so many of my patients had glioblastomas [fast-growing brain tumour] and I would say, “Well, if you’re unusually unlucky you might be dead within less than a year. And if you’re unusually lucky, a few people are alive in five years time and in between these two extremes the tumour will probably come back. We may be able to treat you, we may not.” And that was as close to the truth as I could get.
But you want to have a feeling there’s some chance [that] all will be well. You want to feel somebody cares. And the really critical thing is the feeling your doctor cares for you. And that’s worth an awful lot, you know.
I’m often asked, “how do you handle complications, manage them?” by neurosurgical trainees. Now, I say the management of complications starts the minute you meet the patient and the family for the first time. Somehow you have to create their understanding [that] you really care for them. Not to the point of bursting into floods and tears. There’s nothing more frightening for a patient than a frightened doctor. But you have to create that feeling of trust and care.
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It’s amazing, and in particular in neurosurgery, where there are so many bad results, you have to prepare the patient and the family and yourself for the possibility of a bad result, without depriving them of hope. And obviously that’s often very difficult, but you have to try and — as I said in my last book — hope is the most precious drug we have at our disposal. [It] doesn’t necessarily cure cancer, but it makes life a lot more bearable.
I’m not a neurosurgeon but what I found in reading your book And Finally is that you and I have a lot in common between the ears. And in that book you described running, which I do as well. You describe that time when you were overtaken by a gazelle-like female runner. Now I run at 5:00 a.m. so the gazelles are sleeping, but I am quite certain that I have been overtaken by the same gazelle. So when I get passed, I have this urge to scream out my age and “how old are you?”
I scream out, “I’m 73, almost 73, and I’ve been castrated for prostate cancer.”
Oh, so you do the same thing.
So I win on that one.
So what is going on inside your head?
Oh, I now accept it. It took me a while to accept I’m running slower and slower and I’m now off hormone therapy for prostate cancer, hopefully not just temporarily. And I’m starting to get my muscle strength back again. So I managed to do an eight mile run on Monday, which didn’t feel too bad. I then made a mistake and did a six mile run yesterday and felt rather knackered. Outside of 18 miles in four days was probably too much. But physical fitness is hugely important to me, which is why all the effects of hormone therapy I found very hard to accept.
In the book you wrote about seeing a scan of your 70-year-old brain. Describe what you saw.
It was pretty atrophic and there were lots of white matter hyperintensities. It’s not really known what they signify. They signify brain damage in the white matter, presumably due to blood vessel problems. It’s connected to hypertension and there is a related risk to stroke. But [the link] with dementia — it’s not clear.
And although in retrospect, probably my scan was not that unusual for a 70 year old, I was totally horrified by it. I had to actually admit to myself I am 70 years old, even though that time was before I was diagnosed with cancer, I felt very fit and active and thought I was still pretty clever, you know. What it was I’ve lost without those white matter hyperintensities, I don’t know. I suppose poorer memory, mental arithmetic slowed down, things like that. But it’s old age and we have to accept it.