Book Review: ‘And Finally,’ by Henry Marsh - The New York Times

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Henry Marsh’s “And Finally” tests the limits — and comforts — of knowledge.

Dr. Henry Marsh wears bluish scrubs and a brightly patterned surgical headdress portion lasting successful a tiled operating theater.
The retired doc and writer Henry Marsh has been called “the Boswell of neurosurgery.”Credit...Karen Robinson/Guardian, via eyevine, via Redux

Jan. 17, 2023, 5:00 a.m. ET

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AND FINALLY: Matters of Life and Death, by Henry Marsh


It was said by the Roman philosopher Cicero that to philosophize is to larn however to die. He was echoed by the 16th-century essayist Michel de Montaigne, sometimes successful earnest, astatine different times successful jest. “If you don’t cognize however to die, don’t worry,” Montaigne playfully concluded. “Nature volition archer you what to bash connected the spot, afloat and adequately.”

We don’t request to larn the biologic mechanics of dying successful bid to die. But it whitethorn assistance to cognize them successful facing death. If the philosophers haven’t figured retired however to bash that — astatine slightest not to everyone’s restitution — mightiness a doc person much luck? Henry Marsh is an writer and retired doctor, successful whom, said The Economist, “neuroscience has recovered its Boswell.” In his astir caller book, the doc becomes a patient, confronting a diagnosis that volition astir apt extremity his life.

Many years ago, Marsh work doctrine astatine Oxford University, but helium near for the much applicable satellite of medicine aft a year. He finds himself returning successful this publication to philosophical questions astir consciousness and fearfulness of death, though helium does truthful done narrative, not argument, his skills honed by years of storytelling arsenic a clinician recounting lawsuit histories. Marsh knows however to acceptable a scene, however to make suspense and however to astonishment the reader.

Case successful point: He opens with a bait-and-switch. “It seemed a spot of a gag astatine the time,” helium writes, “that I should person my ain encephalon scanned.” We cognize he’s astir to beryllium earnestly sick and we presume that the scan volition uncover a tumor; poetic injustice. In fact, what the scan reveals is the mean attrition of aging, a encephalon diminished by the years. The existent diagnosis comes later: precocious prostate cancer, its detection delayed by the misguided fortitude of a doc who assumes that lone patients get sick. (About a friend’s calm effect to quality of an untreatable tumor, Marsh observes: “It was hard to cognize whether this came from stoicism oregon frontal encephalon damage.”)

Not that the scan isn’t frightening; Marsh feels fearfulness arsenic good arsenic wonderment astatine the representation of his dilatory withering brain, comparing his acquisition to a imaginativeness of the nighttime entity — an allusion to the philosopher Immanuel Kant. “Two things capable the caput with ever caller and expanding admiration and awe,” Kant declaims successful 1 of Marsh’s epigraphs, “the starry heavens supra maine and the motivation instrumentality wrong me.”

I accidental the cerebrum is simply a suitably neuroscientific substitute for the dependable of conscience. Marsh finds it “very hard to comprehend that ‘I’ americium the 86 cardinal nervus cells of my brain,” its wiring longer “than the region from the world to the moon.” At 1 constituent helium suggests, successful passing, that “the existent satellite is conscionable a signifier of electrochemical impulses.” At moments similar these, I privation he’d stuck with doctrine a small longer. We are not brains, but embodied beings — arsenic philosophers person been arguing for astatine slightest a period — and the Cartesian “veil of ideas” that traps america successful our minds is not helpfully replaced with a veil of neurons.

But these are insignificant elements of the book. For the astir part, Marsh does not unreal to reply metaphysical questions astir the mind, oregon adjacent presume that they can beryllium answered by the likes of us: “You can’t chopped food with a weapon made of butter,” quips a neuroscientist friend. Instead, we scope for metaphors. Before the caput was a computer, it was a telephone exchange, and earlier that a steam engine, though Freud’s psychoanalytic mentation “made the id and ego dependable similar the components of a flushing toilet.”

Marsh is often funny, sometimes astatine his ain expense. Dismissing Freud connected imagination mentation and complaining that different people’s are “quite remarkably boring,” helium finds himself narrating a agelong nightmare astir his wife. The fairy stories helium tells his granddaughters person allegorical elements, similar an “orphaned unicorn who develops the dreaded Droopy Horn Disease.” Like galore others, Marsh was treated for prostate crab by “chemical castration,” depriving cancerous cells of androgen, with broadside effects of bosom development, impotence and musculus loss.

His relationship of the consequent radiotherapy celebrates the technology, which is astir lyrically described; not truthful overmuch the aesculapian practitioners. It “was lone erstwhile I was diagnosed with crab myself,” helium writes, “that I could spot conscionable however large is the region that separates patients from doctors, and however small doctors recognize astir what their patients are going through.” Not that he’s judgmental. Marsh acknowledges his ain failures of compassion arsenic a surgeon and the detachment needed to relation arsenic a doc from time to day. His proposal to clinicians is pragmatic: “You should ever beryllium seated erstwhile talking to patients, and ne'er look to beryllium successful a hurry.”

What lessons does helium person for the remainder of us, arsenic we larn however to die? In part, a measured statement for assisted suicide, which has not truthful acold led to the abuses conjectured by its critics. In part, an statement against the immoderate privation to unrecorded forever. Seventy years should beryllium capable — decease is antithetic erstwhile it comes to idiosyncratic young — and we person to marque country connected the satellite for different people. “I person had my clip successful the sun,” Marsh writes, “now it is the crook of the adjacent generation.”

I’m not definite helium does amended than doctrine erstwhile it comes to facing death, but I don’t deliberation Marsh does worse. There’s nary mendacious comfortableness here. Instead, there’s prose that breaks successful gentle waves, its undercurrents deep, the aboveground of an water immense capable to enactment our lives successful motivation perspective. The communicative takes detours done DIY and dollhouses, infirmary décor and Himalayan hikes. Marsh is seated, storytelling, and helium is successful nary hurry.


Kieran Setiya teaches doctrine astatine M.I.T. and is the writer of “Life Is Hard: How Philosophy Can Help Us Find Our Way.”


AND FINALLY: Matters of Life and Death | By Henry Marsh | 227 pp. | St. Martin’s Press | $27.99

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