"An early full moon rose low in the sky, gauze-white. A skylark was perched on the telegraph wire beyond the yew hedge, crest outlined against the washed-out sky, streaked breast feathers discernible as he flew off weaving and fluttering, all graceful lines and dipping flight. Dusk was gathering. I walked over the crest of the hill to where a tall hedgerow, remnant of old woodland, shields the top field from the north wind. The barley, ripening over the weeks from soft golden-green to bronze, was now bleached to blond and brittle whiskered. [...]
I stopped and listened. Skylarks were singing midsummer evensong as William Blake's 'mighty angels' filled the sky with liquid sound. An exultation of larks was spiralling upwards, hovering high over the field, filling the air with polyphony, pouring out a rain of notes (thirty-six notes to the second when slowed down) for several relentless minutes before dropping like winged pebbles into the barley. I walked slowly back down the sloping field. Two skylarks perched in profile on the fence-posts. The barley rippled behind them in the evening breeze, silver in the late light.
The lark and the light are one, wrote Richard Jefferies of the minstrel of our fields that carries its song to the heavens. There is sunshine in the song. [...]
"I have often wondered in four decades of writing how it is that time and again my stories seem to gather themselves, write themselves almost (the best ones really seem to), cover the empty pages almost effortlessly - once I get going, that is. Each one is, I believe, the result of forces of a creative fusion, a fusion that simply can't happen unless certain elements are in place [...]
The last and most important element in the alchemy that produces this creative fusion is the sheer love of doing it, of seeing if you can make magic from an empty page and a pen. The truth is that it is not a trick. It is an art and a craft and a marvellous magic, and I long with every story to understand it better and to do it better too."
I haven't been as gripped by a book of any kind for a long time. It's not that the cases Mr. Marsh describes have a grim or ghoulish compulsion to them (though it's true that many make harrowing reading), it's the honesty with which he writes, admitting to his own and others' mistakes - some of them avoidable errors - with a candour which makes human these 'god-like' men*, and when you contrast the surgeon's fallibility with the trust and faith put in them by patients and their families, and the fact that they so often operate on a knife-edge between success and failure, life and death, "wrecked" life or good life, you cannot help but read on. Add to that the writer's natural eloquence and the facility with which he tells his stories, his "wary sympathy" for those in his care, his clear self-knowledge, and what you have is an enthralling account of a very difficult job.
The brain is an organ of mystery, the surgeon's instruments "moving through thought itself, through emotion and reason [...]", and with a poetry of its own - the Sylvian fissure, the basal veins of Rosenthal, the Great Vein of Galen. Certain neurosurgical procedures are likened to bomb disposal work, and the surgeon learns to accept intense anxiety as a normal part of his day, and yet he would gladly spend all his working hours operating, practising his "craft", as medicine is described here.
Henry Marsh was a hospital porter before he became a doctor, and his unconventional career path - via a degree in PPE and without any science 'O' or 'A' levels - is traced in the book, as is his own engagement with various branches of medicine including neurosurgery as a patient himself or close relative of one. He is deeply frustrated by the apparently ludicrous rules and self-serving bureaucracy of our health service, and yet he has gone regularly to work in the desperately ill-equipped, primitive but byzantine world of Ukrainian neurosurgery in the hope of helping people who have no access otherwise to the standard of care that this country offers. He is skilled in the "Olympian detachment" necessary to assess cases and make the inevitable difficult decisions, but he brings to his patients a genuine empathy, and a willingness to go far out of his way for them. He writes of real people and events with a novelist's eye for telling detail and a playwright's sense of timing, and he describes the "heaven and hell" of the neurosurgeon's lot without sentiment or sensationalism.
The book is first rate and I can't recommend it too highly; it more than deserves its second outing here.