And Finally

August 1, 2022

Author of the New York Times best-selling Do No Harm, which won the PEN Ackerley Prize and was short-listed for many other honors, retired neurosurgeon Marsh got a different take on the medical world when he was diagnosed with advanced cancer. Here he meditates on the move from doctor to patient, the challenges of illness and aging, and the beauties of family and science. With a 30,000-copy first printing.

Copyright 2022 Library Journal, LLC Used with permission.

October 24, 2022
In this immersive memoir, retired neurosurgeon Marsh (Admissions: Life as a Brain Surgeon) recalls the transformation he made from doctor to patient when he was diagnosed with advanced prostate cancer. After suffering a bevy of symptoms, 70-year-old Marsh received the news at the beginning of 2021 and plunged into a state of denial: “I thought I was being stoical when in reality I was being a coward.” He recounts his radiation treatment (“It all became very routine”) and the lessons he learned before he retired at age 65; for example, he once operated on the wrong side of a man’s neck, which taught him to be honest with patients, no matter how difficult the situation. Similarly, he recalls telling an elderly patient, who was completely paralyzed from the waist down, that he would never walk again, a memory that forces Marsh to imagine his own last hours of life: “I became increasingly desperate as I imagined how miserable my death might be.” Throughout, Marsh interweaves tender moments from his personal life, including storytimes with his granddaughters, with discussions of gene editing and other medical topics. Readers will find much to appreciate in this pensive probe into what it means to face mortality.

Starred review from November 1, 2022
After learning he has cancer, retired neurosurgeon Marsh quickly comprehends ""just how great is the distance that separates patients from doctors."" He writes candidly about his diagnosis of advanced prostate cancer, treatment with androgen deprivation (chemical castration) and radiation therapy, and the side effects. Surgeon Marsh (in control, self-confident, objective) and patient Marsh (in denial, self-pitying, despairing) occupy vastly different worlds, even though they sometimes overlap with shared uncertainty and remorse. He recalls former patients and recounts hard lessons learned and wisdom accrued during more than 40 years of surgical practice, such as locating ""a balance between compassion and detachment"" and telling patients the truth without robbing them of all hope. But becoming seriously ill himself is disorienting and grueling. Marsh admits to a fear of developing dementia, perceives empathy to be ""hard work,"" and finds hospitals reminiscent of prisons. His narrative includes discussions of consciousness, sleep, dreams, and the need for forgiveness. Marsh's exemplary first book, Do No Harm (2015), established a high bar for medical memoir. And Finally offers a tender, at times apologetic account of a doctor-turned-patient whose chronic disease and awareness of the inevitability of death are compellingly navigated: first denial and anxiety, then acceptance and coping, ultimately gratitude for every moment gifted.

COPYRIGHT(2022) Booklist, ALL RIGHTS RESERVED.

Starred review from November 1, 2022
The latest compelling memoir from the British neurosurgeon. In 2014, Marsh published the excellent Do No Harm; in 2017, he followed it up with an equally fine sequel, Admissions. Now past 72 and retired, he writes about becoming a patient. Doctor writers produce a steady stream of such books, but this is among the best. Despite being retired, Marsh "continued to think that illness happened to patients and not to doctors." He assumed that the urinary difficulties he had been experiencing for years were the result of benign prostatic enlargement, which affects most men as they age. In fact, he had prostate cancer, which had probably spread. The author does not hide his terror at this news. He reviews his life, finding much to applaud but plenty of regrets, and he capably describes his experiences as a patient. Like anyone, he hoped for good news, perhaps even that he may be cured, but it never came. More unnervingly, listening to his doctors revealed that he (like they) held too high an opinion of himself. Patients who love their doctors tell them so, while disappointed patients mostly keep quiet. Doctors who write memoirs admit flaws, but lack of compassion is rarely among them. To his distress, observing how the doctors dealt with him, Marsh realized that he could have done better in the compassion department. This is not a denunciation of the medical profession; almost everyone he encountered treated him kindly. Accepting that he would die but fearful that he might suffer, he reserves his hatred for opponents of assisted suicide: "It is as though they think that assisted dying is cheating" or "that there is something 'natural' about dying slowly and painfully." The author offers a fascinating account of his often disagreeable treatment but remains entranced by the wonders of the natural world, science, and love for his family. The conclusion finds him still alive and, readers will hope, writing another book. Another masterful memoir from Marsh.

COPYRIGHT(2022) Kirkus Reviews, ALL RIGHTS RESERVED.