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S2025E01-Confessions of a Brain Surgeon
S2025E01-Confissões de um cirurgião cerebral
O cirurgião cerebral Henry Marsh está enfrentando seu próprio diagnóstico com risco de vida.
Ele revela os enormes riscos e o impacto emocional de um trabalho repleto de decisões difíceis de vida ou morte.
Originalmente Exibido 18 de agosto de 2025
Tempo de Execução 58 minutos
S2025E01-Confissões de um cirurgião cerebral
O cirurgião cerebral Henry Marsh está enfrentando seu próprio diagnóstico com risco de vida.
Ele revela os enormes riscos e o impacto emocional de um trabalho repleto de decisões difíceis de vida ou morte.
Originalmente Exibido 18 de agosto de 2025
Tempo de Execução 58 minutos
Categoria
📚
AprendizadoTranscrição
00:00Transcrição e Legendas Pedro Negri
00:30Transcrição e Legendas Pedro Negri
01:00Transcrição e Legendas Pedro Negri
01:10Henry's definitely prolonged my life, hasn't he?
01:12And we're thankful that Henry's done what he's done.
01:14This neurosurgeon operates on the most complex part of what makes us human.
01:19He's special because he cares.
01:21You play a spectacular stellar role in your patients' lives and things go well.
01:26And I loved it.
01:27And it was so profoundly meaningful.
01:29It was the brain, life itself.
01:31Normal brain has the consistency of very smooth cream cheese.
01:40I removed life-threatening tumours, when sometimes other doctors said there was no hope.
01:45You have a better chance of success if you are awake throughout the operation.
01:52Well, we will start removing the tumour.
01:58The tumour is gone. Hurrah!
02:00Thank you.
02:01Recently, in retirement, something happened to me that changed my life.
02:12It wasn't that I became a patient myself with cancer that I really understood just how miserable it is being a patient.
02:20Humiliating, demeaning, frightening.
02:22Now, I'm returning to my past, where every day came with difficult life-and-death decisions.
02:31The first doctor we saw there said, it's inoperable and it's incurable, and I can't tell you if you've got months or years.
02:37Go away and die.
02:39Yes.
02:39It's so very painful to confront our own mistakes, but we won't make progress if we don't.
02:47What are the lessons I've learnt to share with the doctors of the future?
02:52We are not gods.
02:53The trouble is, our patients want us to have godlike power.
02:56What impact did my career have on those closest to me?
03:01We abused each other so intensely for two years.
03:05It was a terrible time.
03:07What can I learn from the families of the patients who died in my care?
03:12When you lose a child, I think you have to blame somebody.
03:15I blamed you for so long, and the hate that's lived with me for 29 years.
03:31Say something, Henry, so I can check I can hear you all right.
03:34When in disgrace with fortune in men's eyes, I all alone beweep my outcast state and trouble deaf heaven with my bootless cries, and look upon myself and curse my fate.
03:44I've lived alone in my house in Wimbledon for 20 years.
03:52In my spare time, I was obsessed by home improvements and renovated the house from top to bottom.
04:00This is the attic of my house.
04:02It's a loft conversion I did myself 20 years ago.
04:06In retrospect, I don't quite know how I managed.
04:08I couldn't do it now.
04:10Anyway, it's a very nice room.
04:11I retired as a brain surgeon 10 years ago, but I can't cope if I'm not busy.
04:20I've started a new project, delving into my past.
04:24Scattered around me is the diary I've kept really all my life since the age of 12.
04:30And I write it basically every day, and I'm writing a diary every day for, what's it, almost 40 years, more than 40 years.
04:37I mean, it's a huge amount.
04:39Most of it's rubbish.
04:40It's about how miserable I am and about the weather.
04:43But every so often, I find a little sort of seam of gold in it, which I think probably is worth keeping.
04:51I haven't, I've never looked at these before, you know.
04:58As a very shy, awkward teenager, I was very, very inexperienced and desperately frustrated.
05:07All my friends were bonking away, and I wasn't.
05:13As a young man, I never even thought I wanted to be a doctor.
05:16I dropped out of university and got a job as a hospital porter before going to medical school.
05:24The doctors talking with the pornographic videotapes they played on the MES TV and the Falkland Islands War,
05:31of which latter they talked with armchair wisdom, potted from reading the day's papers.
05:38So that's quite funny.
05:421985, that's when I was a trainee neurosurgeon.
05:46Operating 830 to 5, I had to hypotense the patient and burst the aneurysm in order to get a right-angle clip.
05:54I do little diagrams as an aneurysm.
05:57In my opinion, neurosurgery is much more about decision-making than simply operating.
06:03That's the difficult part.
06:04Because everything we are, our feelings, our personality, our thoughts, our fears, our hopes, are all part of our brain.
06:14So that when I operate on a brain, it's as though I'm holding a human soul in my hands.
06:18I loved my work.
06:23The fact was microscopic and fiddly.
06:25I like using my hands doing fine work, but extremely dangerous.
06:29A bit like bomb disposal work, although bomb disposal work for cowards, I suppose you could call it.
06:34And I just completely fell in love with it.
06:40It made me feel I was doing something profoundly meaningful.
06:43And that's a great, that's a huge privilege.
06:46But it comes at a cost, that's the trouble.
06:47An unhappy day at work.
06:50The 16-year-old girl with the cranial pharyngoma suffered a major stroke this morning after the operation.
06:56And now, after all, she'll be left wrecked with brain damage.
07:00Wondered what suffering lies ahead for her and how much longer she has to live.
07:04This is so painful.
07:07I must have operated on thousands of people, and that's thousands of life stories.
07:12I'm not unusual, I think, as a senior, retired doctor.
07:17All I remember of it is disasters and problems.
07:20I simply don't remember the successes at all.
07:25I look at my diary I kept over the years, and I look back at this overwhelming sense of failure.
07:32But looking back on my career, all I can see is the inner cemetery.
07:37And that's a very, very painful truth.
07:39It's going to take me months to work through all this.
07:43I don't know if I live long enough to relive my life.
07:52Recently, my perspective has shifted somewhat.
07:55I've become a patient myself.
07:57I was diagnosed with advanced prostate cancer, which may well prove incurable.
08:04It all seemed pretty gloomy and serious, and I was very upset and very frightened.
08:09I thought that I was going to die quite soon, and I had radiotherapy.
08:15And I was also put on hormone therapy, which basically is chemical castration, for two years.
08:21Now, I've been off all treatment now for over a year, but basically you have a blood test every six months
08:27to see if the cancer's coming back.
08:29And if it's coming back, the disease will kill me.
08:32But you sort of tend to live in sort of six-month intervals, which is a bit trying.
08:38It's concerning.
08:40It makes one anxious.
08:42But at the same time, I have to be realistic.
08:44You know, I'm almost 74.
08:46I'm horrified by the idea of dementia and decrepitude.
08:50I watched my father, who was a very brilliant man, become profoundly demented.
08:56And although emotionally I feel very worried about the possibility of the cancer coming back,
09:03rationally I say, well, it's my vaccination against dementia, you know.
09:07So it's complicated, having been dealing with poor patients who have cancer throughout my professional life.
09:17I suppose I would have thought maybe I'd have been a bit sort of more phlegmatic
09:21and all of a segment of sanguine and not phlegmatic about it at all.
09:25But I also know I'm very frightened and very upset, and I still am to a certain extent.
09:37For much of my career, I worked closely with one of the country's top neurosurgical anaesthetists.
09:45Henry and his anaesthetist, Judith Dinsmore, have worked together for seven years.
09:51Look, there you are, the young Judith.
09:53Look at that youth.
09:57Together, we pioneered a controversial new technique called awake craniotomy.
10:03We removed brain tumors from patients' heads while they were still conscious.
10:07Judith and I were the first team in Britain to perform these operations.
10:14The way we did the awakes then is we had the patient anaesthetised to sleep
10:18while I sawed open the skull.
10:23Once I'd done that and exposed the brain,
10:26Judith would then wake the patient up and start talking to the patient.
10:30Adrian? Adrian? Hello?
10:33Adrian's tumour was immediately adjacent to the speech area on the left side of the head,
10:39and the tumour looks like the brain, basically.
10:43And the only way you have of knowing whether you're operating on tumour
10:47or operating on speech part of the brain
10:50is by having the patient awake and talking.
10:53It's a helicopter. It's for flying.
10:55Great.
10:55It's a broom for sweeping up.
10:58Fantastic.
10:59I think it's all tumoured, isn't it?
11:02The words coming easily?
11:04They seem to be.
11:05Words are still fine.
11:06Good.
11:06I was able to detect if there were changes in either his fluency
11:11or his word-finding ability,
11:14because the whole aim was to get out as much tumour as possible
11:17without causing any neurological damage,
11:22lasting neurological damage.
11:26I can hear it.
11:27Yeah, I know.
11:28It's pretty sordid, isn't it?
11:29You know, squelching sounds.
11:31I've already removed most of it, in fact.
11:33He's going to get as much out as he can.
11:35Yeah, did you hear that, Henry?
11:36Yes, Adrian, I'm working on it.
11:38Yeah, he's doing his best.
11:40What about this?
11:43Something you put the camera on to.
11:44I can't remember what it is.
11:46Tripod.
11:46Tripod.
11:48Tripod.
11:49Yeah, yeah.
11:50A little bit more muddled, Henry.
11:52Yeah, OK.
11:52I would say, you know, speech is slowing down.
11:55Then we would have to make the decision, do you stop?
11:58Right, let's call today.
12:01Yeah, I think so, yeah.
12:03With these tumours, the more you remove, the longer people live.
12:07These tumours are considered inoperable in the past.
12:10Hello.
12:11All right.
12:12How are you doing? All right?
12:12I feel fine.
12:14Good. Well done.
12:14Absolutely fine.
12:15I've got mace to be there.
12:16All right.
12:17But I'm now very deep down, so I don't quite dig around too much.
12:20But certainly most of the signs, I can tell you that much.
12:23And with Adrian's tumour, the fact he lived for years afterwards, you know, was because I'd removed most of it.
12:30And you're obviously taking incredibly long.
12:31You know, back then, when awake craniotomies weren't quite such standard practice.
12:38They were not standard at all.
12:39Now it is standard.
12:41I mean, it is taught in exams as a sort of gold standard for this type of tumour.
12:47Though I did occasionally remove too much tumour.
12:49I did damage a few patients.
12:51I remember them very well.
12:53A day does not pass when suddenly I remember a patient.
12:57Often from 30 or 40 years ago.
12:59Patients, they failed.
13:01It's funny because when I knew that I was going to come here and we were going to talk about this, I was remembering good results.
13:09Oh, that's true.
13:10Yes, I could, especially looking back to the awake.
13:14Yes.
13:15There were good outcomes, groundbreaking work.
13:17I mean, we have all got cases that haunt us.
13:23But I think as an anaesthetist, you're somewhat more removed from those bad results.
13:30At least anaesthetists don't have to go and see the patient every day for the next few weeks and look upon somebody whose life you're irrevocably ruined.
13:40And feel responsible for it.
13:42And that's probably the most difficult part of being a surgeon.
13:48When I took risks, I did it because I believed the risks of not operating were greater.
13:56Many of the cases that have stayed with me the longest are the ones where if we didn't operate, the patient would most certainly have died.
14:05It's the old conundrum.
14:06And if you do a dangerous operation, are you being reckless or are you being brave?
14:11And if you say, go away and die, are you being wise or are you being a coward?
14:15And there's no easy answers.
14:18But I still made some very, very critical mistakes.
14:21I can think of one operation where I should have abandoned the operation because I wasn't sure where I was.
14:29And I didn't.
14:30And I left the poor child horribly damaged.
14:33It still haunts me as with many of these things.
14:35And then there was Tanya, a nine-year-old girl from Ukraine.
14:46I started visiting Ukraine on a voluntary basis in 1992, after the fall of the Soviet Union.
14:58I went there and I knew things would look pretty rough, but I was absolutely staggered at just how bad the conditions were.
15:07And so it started as a sort of working relationship.
15:09I'd go out to Ukraine once or twice a year.
15:12We were doing operations that nobody else was doing in Ukraine.
15:15In Ukraine, the tumours were that much bigger because they'd often been left undiagnosed for years.
15:26I thought I could help many of these patients.
15:30Tanya came with her mother.
15:32She had an enormous, benign, non-cancerous tumour, which had been deemed inoperable.
15:38She had half her face paralysed because of a tumour and a pronounced limp.
15:45And I felt, well, maybe I can get it out if I bring her to London.
15:54There was one colleague who was there with me throughout Tanya's eight-month treatment in London.
16:01Remember me?
16:02Oh, yes, I remember you.
16:05How could I forget?
16:06Gail was my secretary throughout my time as a consultant, which was about 30 years.
16:12So she got to know quite a lot of my patients, and she was really devoted to them.
16:17We performed two operations on Tanya in an attempt to remove her tumour.
16:23It was one of the largest tumours I've ever seen.
16:26And that was after the first operation.
16:31We would do whatever we could for her.
16:33It was such a shame, really.
16:35So it was very difficult.
16:36The nurses must have found it very difficult.
16:42The second operation proved horribly difficult because the tumour was tangled up with the brain's blood vessels.
16:53Tanya had a stroke shortly afterwards.
16:55She survived, but she was stuck in hospital for six months.
17:03I mean, six months in intensive care, more or less, was a disaster.
17:07I look at this with complete horror.
17:13I really find it very distressing.
17:16Yeah, no, I find it very painful.
17:18Eventually, she got home to Ukraine, but she died a year later.
17:30You know, I bit off more than I could chew with Tanya.
17:48You know, the wound is there.
17:56I stayed in touch with Tanya's mother, Katya, for many years.
18:00And despite my failure, she still thanked me for the fact I'd tried.
18:05You're upset.
18:13Understood.
18:14You see, you witness terrible suffering.
18:20Blastel made some terrible mistakes.
18:23But you're human.
18:23Yeah, I'm human.
18:25Yeah, but as patients, we don't like to think our doctors are human.
18:28You know, if you want them.
18:30It's intolerable to think your doctor might make mistakes.
18:33The odd thing is that now in retirement, all I see is a cemetery.
18:39It's a challenge, but a pretty, pretty grim one.
18:42Well, I feel honoured, actually, to have worked with you.
18:45And I think if I were a patient, I would want somebody who actually had empathy with me
18:52and not someone who was just, well, you know, you've got a brain tumour, it's malignant,
18:59you're going to die in three months' time, thank you very much and goodbye.
19:02But you're not like that.
19:03Some surgeons are just cold-hearted, that's it.
19:07They go into theatre, they do what they can, come out and don't really think about it.
19:13But he thinks about it before, during and after.
19:17Yeah.
19:18That's nice to hear.
19:19That's part of the reason I stayed, doing the job I did for such a long while.
19:24I really enjoyed it.
19:24I've had 27 years.
19:26Yeah.
19:26That's quite a long time.
19:28With you, yeah.
19:29Did I ever lose my temper?
19:31Oh, yes.
19:32Oh.
19:34But do you know I get the impression when I was working with you that I was often very unhappy,
19:38or just stressed?
19:39I don't think perhaps your home life was as...
19:41No, it wasn't.
19:43You were very supportive when my first marriage was falling apart, yeah.
19:47You did need a lot of support to keep...
19:50Yeah, yeah.
19:51To keep you online.
19:52Yeah, it was an awful time.
19:53And I said, I owe you an awful lot, I really do.
19:57I can't really imagine doing neurosurgery without you, really.
20:02Gail, it's lovely to see you.
20:04I think.
20:05We were a very good team.
20:07So she was invaluable.
20:08And when I needed consoling, she would console me.
20:11So she was a sort of psychotherapist as well.
20:15I was extraordinarily lucky.
20:24Au revoir.
20:25Bye.
20:26Bye.
20:31True eccentric.
20:32Yes.
20:34What an eccentric.
20:35Nice meeting in the...
20:37I've seen him for ages.
20:37I feel irritable and alienated from my family.
20:52My dear, why did I feel that?
20:54Probably because I was just spending the whole time at work.
20:57I was working absurdly long hours.
20:59I was either on call all the time.
21:01Seven days a week, seven nights a week, 48 weeks a year.
21:04Or every other night, every other weekend.
21:06So I basically had no life outside medicine at all.
21:13If you went into neurosurgery 40 years ago,
21:16those were the hours you worked.
21:17And your family had to lump it.
21:19What I regret is my mania for home improvements.
21:22As soon as I got home, I'd start doing do-it-yourself
21:24and building work.
21:26And retrospect that was wrong.
21:28I should have spent more time, particularly with my children.
21:32But I put myself first because I was so obsessed and stressed all the time about my work.
21:42Looking back at my diaries, I can see that my total commitment to neurosurgery
21:47gave rise to one of the most traumatic episodes in my personal life.
21:53Goodness.
21:54That's very intense stuff.
21:56No, that was seven years before my marriage ended.
22:02And I wrote there, realizing that the marriage was failing.
22:07It was very troubled during the years at the end of the marriage.
22:10And that went on for about four or five years.
22:14And that was really pretty horrible.
22:15For both our children and my first wife and me.
22:21We were very happy together for many years,
22:23although it eventually fell apart
22:25because of my sense of drama and self-importance.
22:34Come on in.
22:36Do you want some tea, do you want anything?
22:38That would be lovely, yeah.
22:41Hillary and I were together for 27 years.
22:43We've never really talked about the impact that my career had on our marriage.
22:49Tea, tea, regular tea, please.
22:51Regular tea with, I hope you've got some milk.
22:53There is some milk and I did smell it and it's all right.
22:57I think it's all right.
22:58It's past its best by date, but it smelled all right to me.
23:02Are you happy with that?
23:03I think it's OK.
23:04No?
23:05It's gone off.
23:06A little bit, OK.
23:08Two or three years we were at war, weren't we?
23:11Yes.
23:12And my bad times when I was often terribly upset about work,
23:15did I bring it home visibly or not?
23:17Well, I think you did bring your work home.
23:19I didn't talk about it, I don't think, did I?
23:22Yes, you talked about it all the time, yeah.
23:25And did you ever feel differently about it as the years went by
23:28and I became more and more tormented and self-important and driven?
23:32No, I never felt differently about neurosurgery and your being a doctor.
23:37But at the same time, there was a sense in which I felt I was bringing up the children alone a lot of the time.
23:43And I think in the whole process of neurosurgery being the main theme in the family home,
23:49I myself got a bit lost.
23:51So that although that was what you were doing and this was what I was doing,
23:55it didn't mean that one was actually more important than the other.
23:58But that got lost a bit, didn't it?
24:00It did.
24:01I ended up thinking what I was doing was much more important,
24:05which now I fully understand was rubbish.
24:08And then I think when you were at home,
24:13not really being completely there, I suppose,
24:17that I think became a problem.
24:19Yeah.
24:20Yeah.
24:21You've gone quiet.
24:23Some of it was good and some of it wasn't so good.
24:26No, sure.
24:27Yeah.
24:28No, I agree.
24:29But I do regret it for the children.
24:31It did not help them one jot.
24:35When Hilary and I first started our family,
24:37I hadn't yet decided which area of medicine to specialise in.
24:42But that changed when our first child, William,
24:46was diagnosed with a brain tumour at just three months old.
24:50Before surgery, undiagnosed.
24:55Up to that point in my life,
24:57I had felt relatively invulnerable.
25:01And this completely changed that.
25:03And not knowing what was going on
25:05and also losing...
25:08...someone to me who was so precious.
25:13I couldn't cope with it at all.
25:19He was admitted to Great Ormond Street for a brain scan.
25:22He then was terribly ill.
25:23The illness was a complete nightmare.
25:25Absolute horror beyond horror.
25:28Well, I'd have thought it was a few weeks after surgery.
25:30Yeah, he's not sitting up on his own now.
25:32No, and the scar.
25:34The scar looked a little bit red, doesn't it?
25:36I'd have thought four to five weeks after the surgery.
25:39The operation had removed the tumour completely.
25:42And he had to repeat brain scans for ten years.
25:45He was a very cheerful little boy, wasn't he?
25:50He was, yeah, yeah.
25:51Oh, that's nice, yeah.
25:56He's alive and well 45 years later.
25:59Because of the success of William's operation,
26:02I think I saw neurosurgery in a lot of magnificent, benign light.
26:07And I came home, more or less, and said to my first wife,
26:12I'm going to train as a neurosurgeon.
26:13But from then on, I knew exactly what I wanted to do.
26:16And I've never regretted it.
26:18But in retrospect, I can see I paid quite a high price for it.
26:21And my family certainly did.
26:29The experience of having a son with a brain tumour
26:31was probably very good for me as a doctor.
26:34I feel it gave me a deeper inner understanding,
26:37particularly when I ended up doing
26:39paediatric brain surgery myself,
26:42which made my occasional failures all the more painful.
26:47The problem with this is it was a large tumour.
26:51I personally have had two children actually bleed to death
26:55during surgery for a very large brain tumour.
27:00After I qualified as a brain surgeon,
27:02I began working at the Atkinson Morley Hospital in Wimbledon,
27:06which was one of the most well-known
27:08neurosurgical hospitals in the country.
27:13Visually, hospitals are incredibly boring places.
27:17I put various pictures up.
27:20Because I was operating on children at that time,
27:22I thought a picture of Baba might be nice.
27:25I came in one weekend of a drill
27:27and put them all up myself.
27:29Of course, it's outrageous.
27:31Did you sterilise the walls first?
27:33But anyway, everybody calmed down
27:35and the pictures are still here 20 years later.
27:40A 12-year-old boy comes round
27:42after an operation on a brain tumour.
27:44Consultant surgeon Henry Marsh
27:46has helped build up
27:47the paediatric neurosurgery department
27:49at Atkinson Morley's Hospital
27:51over the past 12 years.
27:53Eventually, I became the senior neurosurgeon there
27:55and was full of my own self-importance.
27:59We provide a very good service,
28:00a very excellent service.
28:02I've always felt a bit of an outsider.
28:04I suppose it was partly
28:06my innate sort of arrogance
28:09and feeling special,
28:10which I had no business to feel, but I did.
28:13Now, that seems finding my shoes.
28:15One of the things
28:15always makes surgeons very angry,
28:17as if somebody walks off and is on shoes.
28:20Here it is, right there in the room.
28:22Because I no longer have people who tidy up.
28:27I suppose the answer is the surgeons
28:28we ought to be doing our own tidying up.
28:30I must say, I think I'm going to have to do
28:31a life-threatening operation.
28:33I shouldn't really have to be tidying up,
28:35cleaning up shoes and cleaning and things like that.
28:38That is what working in the National Health Service is like.
28:41And that's where I get across.
28:42I'm not being a prima donna.
28:44But, you know, you have to compose yourself
28:46in doing this sort of surgery.
28:48Do you think there was ever a time
28:50when you saw yourself as a bit of a hero?
28:53Yes.
28:54In my early years as a consultant.
28:56And then you have your first mega disasters
28:58and then you're humbled.
29:01In my day, you worked largely alone
29:05without anyone giving you feedback
29:07when things went wrong.
29:11After one of my many surgical disasters,
29:14I introduced a morning meeting
29:16for all the surgeons and the trainees
29:18to discuss problems.
29:19It's something I still attend to this day,
29:23even in retirement.
29:25It's a meeting that I started
29:26probably 30 years ago.
29:29Other people are better at seeing
29:30one's mistakes than you are yourself.
29:32It's very easy thinking you're as good
29:34as our poor patients.
29:36Have no choice other than to believe
29:38that we are wonderful.
29:39And one must never think one's wonderful.
29:42One must always be endlessly self-critical.
29:45So I still come in occasionally to teach.
29:47I don't get paid for it.
29:48I enjoy it.
29:49I've always loved teaching.
29:50And I still love neurosurgery
29:54for all its horrors.
29:55This is a 45-year-old woman
30:03who presented with a sudden onset headache
30:06fitting well prior to that.
30:08That's the absolute classic appearance
30:10of a giant aneurysm.
30:12If it gets a little bit bigger
30:13over a long period of time,
30:16you haven't actually made
30:17an ultimate operation any more dangerous.
30:20I would have thought nothing needs to be done.
30:22And then you just have to make sure
30:23you strongly reassure her
30:25that she doesn't spend the rest of her life
30:26terrified there's a bomb in her head.
30:31You have to be ambitious
30:32and a bit of an egotist
30:33to become a surgeon.
30:35But there's a certain amount of humility
30:36that's called for.
30:37And I didn't have that when I was younger.
30:40I saw it all as a huge glorious exercise
30:42in self-promotion, self-glorification.
30:49And then occasionally something happens
30:52which brings the past abruptly back.
30:56I was walking my bicycle home
30:58from the hospital yesterday
31:00because a chain had broken
31:01and I heard my name called out
31:04and there was a woman
31:04on the other side of the pavement.
31:07And it turned out she was a mother of a child
31:09I operated upon 30 years ago.
31:11And I thought the operation
31:12was a tremendous success.
31:14So I thought I was Superman.
31:15A few months later,
31:17it was clear the tumor had come back
31:18and the child had oncological treatment
31:20and died.
31:21And the mother said,
31:22no, we blamed you, she said.
31:23We blamed you for his death.
31:26But that was us yesterday
31:27walking along a local street.
31:30I could remember the case perfectly.
31:31The diagnosis, everything.
31:33It all came back in a flash.
31:34One of those many gravestones
31:38in my inner cemetery.
31:42I was walking home from work
31:43and for some other reason
31:45I took a different route
31:46and I just called across the road to him
31:49and the chain of his bike had broken
31:51so he doesn't normally go that way.
31:54And no, I said,
31:55you treated my son nearly 30 years ago
31:58and I gave my son's name, Max
32:01and he remembered straight away.
32:05And that meant a lot.
32:09OK, so this is Max.
32:12When he got to four,
32:14people used to ask him what his name was
32:15and he'd say, bloody handsome.
32:17That's what he used to tell people.
32:20You see why though?
32:23These are the harder ones to look at.
32:25Like this.
32:25That was at Christmas
32:28and then Max was five in January
32:31and he died six days after his fifth birthday.
32:40First of all, we were told that Max had an aneurysm
32:43and then that was after a CT scan
32:45and then he had to have an MRI scan
32:47and that's when we first met Henry
32:50and Henry told us that it was actually a brain tumour.
32:54But he said it wouldn't be a problem
32:55he could deal with it.
32:58So we put all our faith in Henry.
33:02We were told Henry was the best brain surgeon in the world.
33:06He was quite gung-ho about everything.
33:07Quite arrogant, really.
33:09That's where my...
33:11Henry didn't do what we thought he was going to do
33:15which was save Max.
33:18That's why I had a hate for him.
33:19And the hate has lived with me for, yeah, 29 years.
33:28I thought the Max's tumour was benign
33:30and if I removed it successfully, it wouldn't come back.
33:34But it was in fact a rare and highly aggressive cancer.
33:38It's here.
33:45Hello.
33:46Hello.
33:47Hello again.
33:49I'm going to...
33:50Sorry.
33:51No, no, no.
33:51I don't.
33:56Thanks for agreeing to do this.
33:57It's quite painful for both of us.
33:59Yeah.
34:00But we'll be all right, yeah.
34:01Yeah?
34:02OK.
34:03OK.
34:05That would have been Max when he first came in to you.
34:07Oh, sweetie.
34:08Yeah.
34:09Yeah.
34:09And obviously that was after he started his...
34:13Yeah.
34:13..his treatment, because he was on steroids.
34:16Yeah, yeah, yeah.
34:18It's not very nice.
34:19But that's much.
34:20Yeah.
34:20That's my favourite.
34:21That's super.
34:22I remember it all very clearly.
34:24But tell me and I'll then tell you what went wrong
34:27from my point of view.
34:29It was a Friday and you said there's only two people in the world
34:32that can do this operation.
34:34Gosh, I was very arrogant in those days.
34:37And...
34:38I hope I didn't say that, but I'll have to take your word for it.
34:41Yeah, well, I...
34:41Yeah.
34:42Yeah, OK.
34:42Yeah.
34:43Amazed.
34:44After the operation, you told us that it was benign
34:48and that even if there was a small piece left behind,
34:53it wouldn't grow back.
34:55And then Max started becoming poorly, very quickly.
34:59Mm-hm.
34:59And we asked for another scan and you wouldn't allow the scan.
35:04I remember all that.
35:05I remember all that.
35:06And then I think it was about 12 weeks after...
35:09Yeah.
35:09..you finally agreed to do another scan.
35:12Yeah.
35:12And then...
35:13Yeah.
35:14..you told us that actually it had grown back
35:17and it was quite aggressive.
35:19Yeah.
35:20And that possibly it shouldn't have been touched in the first place.
35:23Yeah.
35:25Um...
35:26Yeah.
35:29What I do remember is the analysis came back saying
35:32it was this rhabdoid pteratomus, an atypical thing,
35:36which I'd never come across before.
35:38That was my first mistake.
35:40I should have inquired what exactly that was.
35:43In fact, these are highly malignant tumours.
35:46Yeah.
35:46I remember it was being a very, very difficult operation.
35:49I was feeling very pleased with myself
35:51for having done the operation.
35:54And trying to understand
35:56why I made these mistakes in retrospect,
35:59it basically was just a wishful thinking and denial.
36:01I didn't want to actually confront
36:03the fact it was something very bad.
36:06But I just couldn't face it.
36:08And they always conclude, ask for help.
36:11Yeah.
36:11And I didn't do that.
36:12I should have asked for help.
36:14I didn't ask for help because I was arrogant,
36:17believed in myself too much.
36:19And also, to some extent, the working culture of medicine in those days
36:24was sort of, you were a bit feeble, a bit of a wuss if you asked for help.
36:29When you lose a child, I think you have to blame somebody.
36:32Oh, yes.
36:33So it's normal.
36:33And I blamed you for so long.
36:37And I had to...
36:38And after seeing you, after all those years, 28 years,
36:43I just needed to get it out that I didn't hate you, actually.
36:46No.
36:47And these things would have happened.
36:48Wouldn't have happened if my bicycle chain hadn't broken.
36:51I didn't know, which is strange.
36:52I was walking along the road.
36:54Yeah.
36:54But it was really...
36:55When I saw you, you knew straight away.
36:58Yeah, yeah.
36:59As soon as I mentioned Max's name.
37:00I told you, Tina, I remember...
37:03Scarce...
37:04I'm OK most of the time.
37:06But even in retirement, scarcely a day passes when I don't remember patients.
37:11I feel I failed.
37:13But to be fair, that made me feel good that you remembered.
37:16Of course I remembered.
37:18Of course I remembered.
37:20And, you know, the trouble is the work people like me do is you...
37:24I'm having to witness so much human tragedy and suffering all the time.
37:28It's easy to get a bit inured to it.
37:31And the fact I cocked up made it infinitely worse for you.
37:34Yeah.
37:35And for that, I'm deeply, deeply sorry.
37:37Very sad.
37:38Mm-hmm.
37:39But I'm so glad we met.
37:40So am I.
37:41It's been very good for me, actually.
37:43It's made me feel so good, honestly.
37:45It went super.
37:46It's like a weight lifted, really.
37:48That's wonderful.
37:49Mm.
37:50Thank you very much.
37:52Thank you.
37:53Good.
37:56I think that's enough emotion for you, Charlie.
37:58Do you know what I think it is?
37:59You can sod off.
38:01Sod off.
38:02God, that was emotional.
38:03Yeah, it was.
38:04Thank you.
38:05That was...
38:06Years later, she said, you know, feels it's a weight off her shoulders and she can move on.
38:11Because, in effect, she's forgiven me.
38:13As a doctor, if you make a mistake, you have no right to ask for forgiveness.
38:18But I have sometimes been forgiven.
38:19And it's, you know, one of the most moving, moving experiences you can have.
38:25The position you have as a doctor over patients is one of enormous power.
38:34So it's easy to become corrupted by that.
38:37And I had that perception.
38:38I fear I didn't always behave well towards patients.
38:42And it's a corruption of power.
38:44But I'm ashamed of the fact.
38:47Well, that's the man I was, you know.
38:49When I was a young consultant, I wore blinkers.
38:52You know, these are the lessons I've learned.
38:54But it's very painful and very difficult.
38:56It wasn't until I became a patient myself with cancer that I really understood what my patients were going through.
39:10But, you know, for years I'd walk into the opera and theatre in charge of everything.
39:16And then suddenly the world turns upside down.
39:19And there you are, an old man in a prostate cancer clinic, having to do your urinary flow studies and everything.
39:26It was a degrading, humiliating, deeply unpleasant experience.
39:36My work, my getting older, my own cancer have all changed me.
39:43I understand much better now how much I need my family.
39:47Hello.
39:52Kate is my second wife.
39:54So what was it like then when you got your diagnosis, Henry?
39:59What was it like for both of you?
40:00It was very upsetting, you know.
40:02One's just a human being.
40:03It's very frightening and scary.
40:04You just have to concentrate on the present and what you can do.
40:07And it's the same.
40:08I'm 74.
40:09I got cancer.
40:10Well, I mean, say what?
40:11You know, I'm well.
40:11Get on with it.
40:12You do remember, eventually I had to tell you to stop.
40:16He had these sort of phrases that he kept repeating about, I've had a wonderful life.
40:23I've had a completely full life.
40:26You know, I could die without any regrets or I'm not scared of dying.
40:31And I had to ask him to please stop saying that because although it was no doubt comforting for you to keep saying it, it wasn't actually lovely for those around you.
40:41It was almost an intervention.
40:43My sister was in on it, too.
40:45Could he please stop saying that?
40:46Could he please stop saying that?
40:48I've stopped doing it, I think, recently, haven't I?
40:50You're doing it a lot less, thank goodness.
40:52Yeah.
40:52Yeah.
40:58I might well die before you, of course.
41:03My surgical career had undoubtedly played its part in the breakdown of my first marriage to Hillary.
41:09But by the time I met Kate, I had learned some hard truths about myself.
41:14The marriage had ended with my first wife.
41:17It was all pretty traumatic at the time.
41:19I was determined to not to end my life alone.
41:25I wanted to meet another woman.
41:27I had no idea how to set about it.
41:30And it was just before, I suppose nowadays I'd be on Tinder or Bumble or something.
41:34This was before then.
41:35Down to the ground, down to the ground
41:38Down to the ground, down to the ground
41:44Brand new dandy
41:47We both had failed relationships behind us
41:50And were absolutely determined
41:51This wasn't going to happen again
41:54And that's all about
41:56Understanding love
41:58Is not about putting yourself first
42:02I promise to you
42:03I promise to you
42:05My love, friendship and support
42:07My love, friendship and support
42:09Through all our times together
42:11And we've never really looked back since then
42:20It's been a very happy relationship
42:21But the real reason for remaining alive now
42:24Is for my family and wife and friends
42:27Really
42:27I've neglected the garden a lot recently
42:36I hope to get more work done on the garden
42:39I love it when my granddaughters come here
42:41It's nice to hear the bees all buzzing down there
42:47They were flying earlier given the warm weather
42:51But they've all gone back indoors now
42:53In a few weeks I have to go through the Richard process
42:59Of being tested again
43:01To see whether my cancer has returned
43:03I can't deny that
43:05You know, when the test is imminent
43:08I start thinking about it all the time
43:11Which is a damn nuisance
43:12But I can't help doing that
43:14Even though, you know, rationally
43:16I'm completely reconciled to the situation I'm in
43:18But emotionally I'm not, you know
43:20I still want to go on
43:21Being fit and well and everything else
43:24The important thing is to get on and do things
43:27And be useful
43:28There's no point living into old age
43:30If you don't put it to some sort of use
43:31In terms of lessons for living
43:36I've always been driven
43:38By feeling I've got to be useful
43:40You know, I've got to try to make the world a better place
43:43In little ways
43:44I'm not done yet
43:46So the thing is to get on with things
43:48Although I no longer operate
43:51I still travel the world
43:52Teaching and lecturing
43:54About the lessons I've learnt as a neurosurgeon
43:57I'm packing to go to Ukraine
43:59Where I'll be lecturing to quite a large number of medical students
44:03I'm taking the first part of a
44:05Very expensive neurosurgical drill
44:09Which I've managed to get hold of for free
44:11And it's because a colleague of mine
44:13Was at the front line
44:15In a town called Pokrosk
44:16And the hospital there had a neurosurgeon
44:19But they only had a hand drill
44:21Since then the hospital has been bombed by the Russians
44:24So I feel a bit apprehensive
44:26But they have to live with it
44:28And I, you know, I can't say
44:30Oh dear, it's too frightening for me
44:32I couldn't live with myself
44:34If I didn't go out there
44:35If I couldn't do what little I can do
44:37To help Ukraine
44:38I take my running things
44:41And a toothbrush
44:42One shirt
44:44One change of socks and pants
44:46And that's it
44:46Well, I'm a pair of pants and socks
44:48How long are you going for, Henry?
44:50Oh, not quite two weeks
44:51Well, I washed them in the sink
44:53You know, then sleep on it overnight
44:54To dry them out
44:55It works quite well
44:57I see myself like a gyroscope
45:08If I'm not constantly spinning
45:09I'm worried about falling over
45:12I'm trying to keep busy
45:13To keep the existential angst wolf from the door
45:17We are now driving across
45:19The famous Black Earth region of Ukraine
45:23There have been fresh Russian attacks on Ukraine today
45:26With at least seven people
45:27Including three children
45:29Killed in the western city of Lviv
45:32In many ways, I've got more close friends in Ukraine
45:40Than I have here
45:41Everybody's very unhappy
45:44Everybody's lost friends
45:45There's no future in sight
45:48So people live from day to day
45:50It's grim
45:52Very grim
45:53But it really is a fight for freedom and decency
45:55I mean, Putin and Russia
45:57Is a real threat to Europe
45:59If not to the world order
46:00Our patients' lives are in our hands
46:04You'll be responsible
46:05For the lives of your patients
46:07One day in the future
46:09In my future, professionally
46:11Is the people I've trained
46:13And whether they've become
46:16A little bit more humble
46:18A bit more modest
46:19A bit better at cooperating
46:22Than I was
46:23But I'd like to think people would say
46:25Yes, Henry did influence me a bit
46:27In how to be a better doctor
46:29That'd be wonderful
46:30I thought I didn't miss the operating
46:35But in Ukraine, I was asked to step in
46:38I mean, my friends were keen I should help out
46:41Nothing very much
46:43I was just doing a little bit of an operation
46:44So my friend could have a tea break
46:46Sort of thing, you know
46:47It's like coming home after a long time away
46:52But it was nice to remember
46:54How wonderful I did find operating
46:57Smashed by Moscow's latest attack
47:07The historic centre of Lviv
47:10There was one missile attack
47:15Quite nearby
47:16Big explosions
47:17How do you think you would feel
47:20To be blown up in a bomb
47:21In Ukraine
47:23I would regard that
47:25As a very good end to my life
47:27Rather than
47:28Dying from prostate cancer
47:30Slowly or dementia
47:31And some old folks said
47:32I almost sacrificed my family
47:42And my first marriage
47:43With my complete obsession
47:45With neurosurgery
47:46It's my duty to stop the next generation
47:50Making the mistakes I made
47:51The tragedy for all of us
47:54Is we learn most from mistakes
47:56We have to be open about failure
47:59With ourselves, with our colleagues
48:01And to some extent with our patients as well
48:03In all my medical lectures
48:05It always ends up with a conclusion
48:07Ask for help
48:08That is my philosophy of life now
48:11And I've learnt it very painfully
48:13Through all the mistakes I made
48:15Over many, many years
48:16We are not gods
48:18Even though the trouble is
48:20Our patients want us
48:21To have godlike powers
48:23And we have to resist that pressure
48:25We must not let our patients
48:27Deep trust and faith in us
48:29Corrupt us
48:29And the message is all about
48:31Getting away from the
48:32Individual heroic view of surgery
48:35And this is nonsense
48:36Of neurosurgery being
48:37The sort of acme of
48:38All human achievement
48:40That's rubbish
48:41People say that
48:42Really because it's so dangerous
48:44And it's so frightening
48:45The idea that my brain
48:47Is going to be operated upon
48:49By this guy
48:49You inevitably invest them
48:51With superhuman abilities
48:53And of course they did have them
48:55I'm not a godlike surgeon at all
48:58I'm on my way to meet
49:09One final patient
49:10From the past
49:11Twenty years ago
49:14Jude was diagnosed
49:16With a malignant brain tumour
49:18We were then told
49:20That it was a grade two to three
49:21Which is cancerous
49:23And that it was inoperable
49:25And because it was inoperable
49:27It was incurable
49:28Jude, her husband David
49:30And their two young children
49:32Were suddenly facing a nightmare
49:34Henry
49:38Remember me?
49:39Oh yes
49:40Come on in
49:41When she came to see me
49:42I felt her only hope
49:44Was an awake craniotomy
49:45This is the morning
49:47When Posie's first step
49:48Through the night
49:49Twelve hours
49:50So what had happened to me
49:52Is I had just had
49:54My daughter Posie
49:55And then they said to me
49:56That I had an anomaly
49:57On my brain
49:58In fact the first doctor
49:59We saw there said
50:00Basically
50:01It's incurable
50:03And it's inoperable
50:05And it's incurable
50:06And I can't tell you
50:07If you've got months or years
50:08Go away and die
50:09Yes
50:10Which
50:11I mean
50:13It was just
50:13The most devastating
50:15News that you can really get
50:17As anyone
50:18Let alone as somebody
50:20With two very young
50:21Very vulnerable children
50:22But the first surgeon
50:25You saw
50:25Does said no
50:26Yeah
50:27Without any explanation
50:28I think I had
50:30Had most of my
50:31Normal optimism
50:32Bashed out of me
50:33By the time we were
50:34Coming to see you
50:35I thought I was
50:36On the way out
50:37I was trying to focus
50:38Most of my attention
50:39On my children
50:40And living
50:41What I did have
50:43Without wanting to sing
50:45My own praises
50:45The way I treated you
50:47Was controversial
50:48It was unorthodox
50:50But it sort of took
50:51A certain
50:52I wouldn't say courage
50:54A certain arrogance
50:55And self-belief
50:56But I think
50:58You know
50:59I've got nothing
51:00About gratitude
51:00For you
51:01I'm lucky to be
51:03In a position
51:03Where I can help people
51:04Honestly my children
51:09Have been
51:10It's been such a joy
51:11Watching them grow up
51:12So things like
51:13When Ned had his
51:15Graduation last year
51:16That was very emotional
51:18For me
51:19Because I hadn't
51:20Expected to see it
51:21That was
51:22Amazing
51:24Because that was
51:25Well beyond
51:26What I had ever
51:27Expected to have
51:29Oh
51:30David hello
51:32How does that mean
51:33Henry
51:33How does that mean
51:34How does that mean
51:35To see you
51:35What does that mean
51:36You said
51:36I just
51:39There's nothing
51:40Well there's nothing
51:40Really I can say
51:41No no no
51:41It's fine
51:41Well it's lovely
51:42To see Jude
51:43I mean
51:43As I was telling her
51:44With a wry smile
51:46Statistically
51:46She's done very well
51:47You have turned our lives
51:49Around
51:50That we didn't have her
51:51We were facing
51:53An absolutely
51:54Unimaginably awful situation
51:57And we'd sort of
51:58Given up hope
51:59Really
51:59Haven't we
52:00It just seems
52:02Amazing to me
52:03To have Henry
52:04Here
52:04In my kitchen
52:05So David
52:13I think this was
52:14For my 40th birthday
52:17He made this
52:18So
52:18It's just
52:19Like
52:19It was just
52:20Some black and whites
52:22Of the kids
52:23Over the years
52:25Yeah
52:26That's very nice
52:27Yes
52:28I love looking at it
52:29I just love the fact
52:33That it represents
52:34All those years
52:35That I wasn't
52:36Expecting to happen
52:37At all
52:37So
52:39Yeah
52:41The fact that
52:41I do get to see that
52:43Yeah
52:44I've been very lucky
52:46When an operation
52:56Went well
52:56It was a quite
52:57Wonderful feeling
52:58But now
53:03I'm a patient
53:04And I must await
53:07My own test results
53:08I'm waiting for a phone call
53:15From the Royal Marsden
53:16To tell me about
53:17My latest
53:18PSA result
53:20But if it becomes clear
53:21The cancer is still alive
53:22I guess
53:23We can then
53:24Know for certain
53:26That the
53:26Tumor has not been cured
53:28And is ultimately
53:29Incurable
53:30It's treatable
53:31But not incurable
53:32You know
53:34So be it
53:35I'm not happy about that
53:36But it is what it is
53:38And I mean
53:43This is the irrationality
53:44Of somehow
53:45Hoping to live forever
53:46To postpone death
53:48Indefinitely
53:48Which is unrealistic
53:49But I'm only human
53:52And obviously
53:53I'm a bit anxious about it
53:55Yeah
53:57Hello
54:00It's Henry Marsh
54:01Mr Marsh
54:02Is it a convenient time
54:03Yeah, yeah, yeah
54:04Sure
54:04Yeah
54:05So what's the news
54:06Yeah
54:07Well the good news is
54:08That your PSA
54:09Is only 0.25
54:11That's gone up a bit
54:12Hasn't it
54:13Compared to last time
54:14Yeah
54:15But still negligent
54:16So you're
54:17You're happy about that
54:18Well I'm happy
54:19Yeah
54:19Could be happier
54:20Surely good
54:21Alright
54:21Bye
54:23Bye bye
54:24Well it's not quite
54:262.5
54:270.25
54:28Which is
54:29Well within my
54:30Remission threshold
54:32As the oncologist
54:33Puts it
54:34So we
54:34Muddle on
54:36For another 6 months
54:38That's great news
54:39It's good news
54:40I mean it's short term
54:41But it's good news
54:42So hopefully
54:43We'll think about
54:44Other things
54:44Now on a
54:47Sunny evening
54:49The setting sun
54:52This shines
54:53On those trees
54:54And it really is
54:55Very very beautiful
54:56I sit here
55:07Just looking at
55:08The sunlight
55:09On the trees
55:10Which is rather nice
55:11In these small moments
55:16Henry
55:16Is this you happy?
55:17Never entirely happy
55:24The only moments
55:24I have of complete
55:26Calm
55:27Is after going
55:28For a long run
55:29And then for an hour
55:31Or two afterwards
55:31That is completely relaxed
55:33In particular as I get
55:48Nearer the end of my life
55:49And I'm threatened by dying
55:50And I can see why people
55:52Turn to religion
55:53In a sense of something
55:54Beyond oneself
55:55And in a sense
55:57Making things
55:59I'm always trying
56:00To create something
56:01Trouble is so much
56:03People say badly made
56:04In particular
56:05My building work
56:06Was appalling
56:06I've only made
56:08Two things
56:08That are reasonably good
56:09Which are the doll's houses
56:11For my granddaughters
56:12They actually
56:13I think
56:13I'm reasonably proud of
56:14And I tried to be
56:18A better grandfather
56:19When I was a father
56:21So Sam
56:22I'm going to mend
56:23The train for you
56:25Yes?
56:25As a grandparent
56:26They're really more important
56:27To me than anything else now
56:28You know
56:29They are the future
56:30And they're young
56:30And they're full of hope
56:32And optimism and play
56:33And it really cheers
56:34All that
56:35Cheers from up no end
56:37And it's the joy
56:38To have them here
56:39I mean I think
56:41My work was
56:43Particularly hard
56:44There are other branches
56:45Of medicine
56:46Which don't leave you
56:47With such a large
56:48In a cemetery
56:49But at the same time
56:51I get the sense with you
56:52That you are someone
56:53Who would never want
56:55To give up the cemetery
56:57No I think that's right
56:58I think as I'd feel
56:59Yeah
57:00You're quite right
57:01Not to care
57:02About all the suffering
57:04You see
57:04And some of the suffering
57:06You've caused
57:07And to stop caring
57:08About that
57:09I can't do that
57:11I have to
57:11It's not that I'm holding on to it
57:13I don't want to
57:13You know
57:14In a sense
57:15It's a burden
57:16But it's important
57:19To you
57:19Particularly now
57:21I'm a patient myself
57:22With cancer
57:23You know
57:24I do see things
57:25And I'm now emotionally
57:27On the other side
57:28Do you think you could
57:31Face your death
57:31Calmly
57:32Yes
57:34I think so
57:35I think so much
57:36About it
57:37I'll be jolly
57:37Across to myself
57:38If I don't
57:39I'll have to
57:40Take myself aside
57:42And give myself
57:43A good talking to
57:44I'll be very emotional
57:46Upset
57:47But I think
57:47I can cope with it
57:48By the age of 74
57:50I feel
57:50Well come on Marsh
57:51You know
57:51You've had a good life
57:53You're not dead yet
57:54Oh look
57:55There's a rhinoceros
57:56Up there
57:57I am sitting
58:01On me
58:02Not so rhinoceros
58:04Doing
58:05Oh we need
58:06That getting
58:06On the staircase
58:07He's going
58:08Oop
58:08He got stuck
58:10He's got stuck
58:12Further insight
58:14Into the work
58:15Of Henry Marsh
58:15Over on BBC4
58:16Your life in their hands
58:18Starting right now
58:19And the Scottish detectives
58:21On a quest for truth
58:22And justice
58:23Press Red
58:23To watch Murder Case
58:24On BBC iPlayer