Traveler. Woodworker. Volunteer. Philosopher. Wordsmith.

Henry Marsh has a number of avocations, all of which are underscored and informed by his quite unusual and uncommon vocation: neurosurgeon. Trained in London, Dr. Marsh performed surgeries for almost 40 years until he retired, when he began a second career as an unpaid surgeon in medically underserved Nepal and Ukraine (while also rebuilding a newly purchased cottage in the English countryside). In ADMISSIONS: Life as a Brain Surgeon, Marsh recounts fascinating and often heartbreaking stories of the practice of medicine in his home country of England as well as around the world, and of the challenges facing medical care, patients and their physicians.

To many, the work of the neurosurgeon seems shrouded in mystery as it deals with that most secretive organ: the human brain. This enigma is noted even by Marsh; he knows the worst that could happen with brain surgery or the removal of a tumor, as well as the best possible outcome. He understands and has seen the devastations on the body caused by brain injuries. One patient’s personality was changed when his undiscovered brain tumor enlarged and pressed on his brain, and it’s likely he never again will be the person he was even after the tumor is removed. He has treated patients who experienced paralysis, blindness and painful death.

"ADMISSIONS is a compelling read. It’s not necessarily a happy book, though it’s full of rich experiences and observations."

Of course, Marsh also saw excellent and positive outcomes in his patients. Perhaps these, coupled with his incredible skill and ability in brain surgeries, enabled him to want to serve in Nepal, where he both performed brain surgeries and shared his generous knowledge and experience with Nepalese physicians and medical staff alongside his friend and fellow neurosurgeon, Dev. The medical needs are unimaginably enormous in Nepal, yet there are few doctors, hospitals and medical supplies, so foreign surgeons frequently travel and perform surgeries there. Marsh also served as a neurosurgeon in Kiev with a Ukrainian spinal surgeon who he had met in 1991, off and on for years.

A meticulous observer, Marsh recounts his experiences with vivid and vibrant detail. One can immediately picture the Himalayas in the distance or the beautiful red clothing worn by the Nepalese, envisioning the fearful yet hopeful patient in Kiev or the beautiful snowfall seen from the hospital window there. Marsh describes his surgeries and his patients’ illnesses with enough clarity that the non-medically-trained reader can perceive what he’s talking about. Yet there’s not too much detail so as to nauseate the squeamish (although the details can be terrible to read sometimes).

And as a neurosurgeon with more than 40 years of surgical and hospital experience, Marsh is well-qualified to speak to the challenges of healthcare. He’s quite critical of the healthcare system in England. There, emergency surgeries can be simple to accomplish, but serious yet less emergent ones can be next to impossible to get on the hospital schedule (even in the doctor’s own family), and the bureaucracy can be debilitating not only for the patient-to-be but also for the physicians, nurses and medical staff to wade through. However, Marsh is equally as censorious of what he might term “big-business medical care” in the United States, or the poor or nonexistent care in other countries.

As a man who is also in the latter half of his life, Marsh spends significant time considering the end of life --- not only his patients’ but also his own eventual death --- and the existential questions all must think about. He is not a religious man (which he mentions several times here), although his parents were. But he questions what will happen to him, his remains and his soul when he passes away. He is hopeful that he will end his life well, even as he considers how many people experience serious illness at the end of theirs.

ADMISSIONS is a compelling read. It’s not necessarily a happy book, though it’s full of rich experiences and observations. Its account of Marsh’s life, service, surgeries and sorrows, as well as satisfactions, is a riveting read and a fascinating window into the world of a profession that many of us (unless we’re neurosurgeons) know very little about.