Quotes from Henry Marsh

Life without hope is hopelessly difficult but at the end hope can so easily make fools of us all.

Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures.' René Leriche, La philosophie de la chirurgie, 1951

The operating is the easy part, you know,' he said. 'By my age you realize that the difficulties are all to do with the decision-making.

Anxiety might be contagious, but confidence is also contagious

Surgeons must always tell the truth but rarely, if ever, deprive patients of all hope. It can be very difficult to find the balance between optimism and realism.

Most medical students go through a brief period when they develop all manner of imaginary illnesses – I myself had leukaemia for at least four days – until they learn, as a matter of self-preservation, that illnesses happen to patients, not to doctors.

But death is not always a bad outcome, you know, and a quick death can be better than a slow one.

Hope is beyond price and the pharmaceutical companies, which are run by businessmen not altruists, price their products accordingly.

We have achieved most as surgeons when our patients recover completely and forget us completely. All patients are immensely grateful at first after a successful operation but if the gratitude persists it usually means that they have not been cured of the underlying problem and that they fear that they may need us in the future. They feel that they must placate us, as though we were angry gods or at least the agents of an unpredictable fate.

When push comes to shove we can afford to lose an arm or a leg, but I am operating on peoples thoughts and feelings... and if something goes wrong I can destroy that persons character... forever.

Psychological research has shown that the most reliable route to personal happiness is to make others happy. I have made many patients very happy with successful operations but there have been many terrible failures and most neurosurgeons' lives are punctuated by periods of deep despair.

Angor animi - the sense of being in the act of dying, differing from the fear of death or the desire for death.

We lauhed together for a long time. When we had first met, her eyes were dull with pain-killing drugs and if she tried to talk, her face would controt with agonizing pain. I thought how radiantly beautiful she now looked. She stood up to leave and went to the door but then came back and kissed me. `I hope I never see you again,' she said. `I quite understand,' I replied.

When I tell a patient that I think I should do their operation under local anaesthetic they usually look a little shocked. In fact the brain cannot itself feel pain since pain is a phenomenon produced within the brain.

You might expect that seeing so much pain and suffering might help you keep your own difficulties in perspective but, alas, it does not.

There is no evidence that the complete head shaves we did in the past, which made the patients look like convicts, had any effect on infection rates, which had been the ostensible reason for doing them. I suspect the real – albeit unconscious – reason was that dehumanizing the patients made it easier for the surgeons to operate.

Some of my operations are great triumphs and tremendous. But they're only triumphs because there are also disasters

Informed consent' sounds so easy in principle – the surgeon explains the balance of risks and benefits, and the calm and rational patient decides what he or she wants – just like going to the supermarket and choosing from the vast array of toothbrushes on offer. The reality is very different.

Doctors need to be held accountable, since power corrupts. There must be complaints procedures and litigation, commissions of enquiry, punishment and compensation. At the same time if you do not hide or deny any mistakes when things go wrong, and if your patients and their families know that you are distressed by whatever happened, you might, if you are lucky, receive the precious gift of forgiveness.

We have been most successful, however, when our patients return to their homes and get on with their lives and never need to see us again. They are grateful, no doubt, but happy to put us and the horror of their illness behind them. Perhaps they never quite realized just how dangerous the operation had been and how lucky they were to have recovered so well. Whereas the surgeon, for a while, has known heaven, having come very close to hell.

The only meaning of death is how I live my life now and what I will have to look back upon as I lie dying.

If patients were thinking rationally they would ask their surgeon how many operations he or she has performed of the sort for which their consent is being sought, but in my experience this scarcely ever happens.

But I then thought of how the value of my work as a doctor is measured solely in the value of other people's lives, and that included the people in front of me in the check-out queue.

I learned a long time ago in the outpatient clinic to make no distinction –as some condescending doctors still do –between 'real' or 'psychological' pain. All pain is produced in the brain, and the only way pain can vary, other than in its intensity, is how it is best treated, or more particularly in my clinic, whether surgery might help or not.