SCOTT SIMON, HOST:
Henry Marsh had spent four decades in neurosurgery trying to find a balance, as he puts it, between detachment and compassion. Then he became a patient himself, diagnosed with an incurable form of prostate cancer. Looking over the cliff of life into his own mortality inspired his latest book about the race between life and death, the way we will all, God willing - phrase I don't think Dr. Marsh would use - one day just fall apart. His book - "And Finally: Matters Of Life And Death." Dr. Marsh is also author of the bestselling "Do No Harm" and a commander of the British Empire. He joins us from London. Thanks so much for being with us.
HENRY MARSH: It's a pleasure.
SIMON: How could a world-renowned doctor miss so many signals you said you had that you were ill?
MARSH: Because I'm a human being and a typical doctor. And I think typical doctors - we divide the human race into us who are doctors and them who are patients, and illness only happens to patients. So it was a combination of sort of excessive detachment and denial at a deep, more or less unconscious level. It's not unusual for doctors, I'm told, to present late with their cancer.
SIMON: And what was it like to go from being a revered figure in hospital scrubs to some guy in a gown with a flap over his derriere?
MARSH: To be honest, I thought it was funny. I was able to laugh at myself. I mean, it's not nice being a patient, but it kind of appealed to my sense of the absurd in a way, that having been this all-powerful surgeon, I was now just...
SIMON: Yeah.
MARSH: ...Another old man with prostate cancer.
SIMON: Did you find doctors - as I'm afraid I have noticed when I've been in a hospital - doctors talking to each other right over the patients' head as if the patients weren't there?
MARSH: That didn't happen to me, but I know it happens a lot, as I was talking to my sister, who has been in the hospital recently and had exactly that phenomenon. It's because - well, it's partly as doctors, we have to be detached to some extent from patients, particularly if you do very dangerous surgery, as I did. And patients rarely, if ever, criticize doctors to their face.
SIMON: Well, because we're afraid you'll pull the plug on us.
MARSH: Exactly. As a patient, one is terrified of displeasing the person upon whom your life depends, particularly surgeons, particularly brain surgeons.
SIMON: Tell us about that detachment you write about that's necessary for a surgeon to operate - not necessarily at the exclusion of compassion, but detachment has to take over.
MARSH: As soon as you become a doctor, you learn - I don't think anybody ever told me this, but the most frightening thing for a patient is a frightened doctor. And as a young doctor and even as a senior doctor, you're often pretty anxious, given the nature of the work. Patients want you to be calm, assured, encouraging, and you have to sort of swallow your doubts and anxieties. And, of course, the best way to deceive other people is to deceive oneself. And all doctors, particularly at the beginning of their careers - we sort of pump up our self-esteem with a considerable amount of pretense, although it's quite fragile.
SIMON: Do you believe that doctors - I won't put it this way - lying to, but you think doctors should humor their patients?
MARSH: Very much so, and this is another difficult balancing act you have to do between being honest - you must never lie to patients - but you must never deprive them of hope, more or less, and sometimes that is very, very difficult. But, of course, the way you talk to people - if you say there is a 5% chance this could kill you, it's very different from saying, look - there's a 95% chance everything will be fine. Yes, there's a small risk things might go badly. You can give them the same statistical information with a very different sort of emotional framing to it.
SIMON: Your cancer, I gather from everything I've read, is now in remission.
MARSH: Yes. And I don't know for how long.
SIMON: Do you see every day in a different way now?
MARSH: Well, I do now. It's very interesting, actually. I had two years of hormone therapy, which, as I discuss in the book, is essentially chemical castration - lots of side effects, most of them irritating but bearable, weight gain, slight breast development, getting muscular weakness. What I didn't realize until I came off it two months ago is that it really profoundly affected my mood, and I was actually quite depressed and felt very gloomy about my future and was ruminating morbidly about what time I had left. For the last few weeks, I've been completely happy. I've got my next PSA in three weeks' time. It may well show my PSA is starting to go up, and the cancer's coming back. Totally to my surprise, I've acquired this sort of Buddhist Zen outlook. Well, the future doesn't exist. I'm well. I'm happy at the moment. I've had a wonderful, exciting life. I've made lots of mistakes. I've trampled on people - yak, yak, yak, as I discuss in my books. But at the moment, today, the sun is shining. I'm very well. It's not that I'm in denial, but I think, well, all right. It may be bad news in three weeks' time, but that's three weeks away. At the moment, I'm well.
SIMON: I'm going to chance this question with you, Doctor. Having stared life and, for that matter, your own death in the face, what's important in life? What should we really try to achieve?
MARSH: A close, loving family and work position in society which is meaningful, which is about making the world a better place rather than getting a bigger - having a bigger bank account.
SIMON: Dr. Henry Marsh - his new book, "And Finally" - thanks so much for being with us.
MARSH: Thank you very much.
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