The thrill of cutting into a human brain

In the first sentence of the first chapter of this book, Henry Marsh, a consultant brain surgeon, says, ‘I often cut into the brain and it is something I hate doing.’

What a compelling start! Marsh takes us through an operation. First, he looks at a scan. A middle-aged man has a tumour of the pineal gland, which means a very tricky operation. Brain surgeons, says Marsh, look at pineal tumours ‘with both fear and excitement, like mountaineers looking up at a great peak they hope to climb’. And with this, he sets the tone for the book, which is excellent. For Marsh, brain surgery is terrifying, but also addictive. You become obsessed. Cutting people’s heads open, it turns out, really does your head in. On the positive side, the fear and the self-doubt usually fall away once the operation has begun. But sometimes, horribly, they don’t.

Now for the pineal tumour. Marsh talks to the patient the night before. It’s easier for the patient if you’re positive and reassuring, but stressing the downside takes the pressure off the surgeon. A difficult balance. In this case, he’s still tormenting himself about the last operation that went wrong; he accidentally paralysed a woman down one side. And he can’t work out how it happened: ‘The operation had seemed to proceed uneventfully.’ Now he’s really desperate for the next one to go well.

So desperate, in fact, that he gets ‘severe stage fright’. He needs to cut blood vessels inside the man’s brain — but which ones? It’s not unlike bomb disposal. One false move and he’ll be lost in a torrent of blood. He snips away, pushing down his anxiety. Afterwards, he needs to have an agonisingly awkward bedside conversation with the woman he has accidentally paralysed.