Henry Marsh

HENRY MARSH INTERVIEWED BY ALAN MACFARLANE 7th JUNE 2024

AM
So it's a great pleasure and privilege to talk to Henry Marsh today. Henry, I always ask first when and where you were born?
HM
I was born in Oxford on the 5th of March 1950.
AM
And then something about your parentage.
HM
My father was a lawyer, at that point he was an academic lawyer, he was a law don at University College Oxford. My mother was German, she was a political refugee, she got into trouble with the Gestapo for expressing anti-Hitler opinions at work. She'd met my father in Halle in Germany in 1936, he'd gone to learn German because he was a passionate European. She had gone to train as a bookseller because she'd refused to join the Bund Deutscher Madel, the women's equivalent of the Hitler Youth. So she couldn't go to university, which otherwise she would have done. So the best thing she thought she could do was train as a bookseller, which in Germany was a serious profession. So she went to Halle and she was staying in digs, with a family called Wolfe I think, and there she met my father who was also staying in digs learning German. I don't know if they exactly fell in love at that stage, but certainly my father, my mother told me was the first person to whom she could actually talk openly about her deep understanding. I don't know where it came from, her sister was a passionate Nazi, my uncle became a Luftwaffe Messerschmitt pilot, but she just knew the Nazis were wrong and evil. And my father was really the only person she could talk openly about it to. But she was overheard at work with some other Nazi sceptics in the bookshop and they were denounced to the Gestapo by the janitor who was a member of the SA. And she was then interrogated all day I think by the Gestapo in Halle. Her two friends were put up for trial. The Gestapo officers told my mother, you're a stupid girl, she was only, what 18, 19 years old, you don't know what's good for you. But she was going to have to appear as a witness in the trial of her friends. And she felt she wouldn't be able to withstand cross-examination. So my father basically brought her to England to get her out and married her so she could stay in England. That was just before the war in fact. So it was a marriage in one sense based on, as much on sort of political activism, democracy and all that sort of stuff as anything else. But it was a very successful marriage, it lasted until they both died 60 or 70 years later. My mother didn't speak German at home. I was the youngest of four. My two sisters were born during the war and my mother said that she didn't feel like speaking German to them when German bombs were falling on London. Although without a doubt the great love of her life was the German language. She was very well read and would have done German literature or linguistics at university if she could have gone. She spoke and wrote absolutely perfect English. She had a great facility for languages which I didn't inherit alas. And shortly, in the years before she died she wrote a very beautiful autobiography primarily about her childhood because she lost everything. It was an unusual family in that both her parents were only, well no, her mother had a sister who was a lesbian artist, quite a good artist, a minor German expressionist. Her father was an only son and they could all be only children for several generations. In fact, I have no relatives in Germany and the family name on her father's side which is ChristinneckeComb has died out. So, the rest of my family learnt German and I didn't. It's one of my great regrets in life. I've been always slightly proud of being half German. I've always wanted to be a bit of an outsider. At the Dragon School in Oxford in the late 1950s you were running around, the other boys were Spitfires. I was a Messerschmitt. I was called Gerry Bags because I boasted of the fact I was half German. But at the same time I grew up with a tremendous awareness really, almost taking on my shoulders, my mother's form of survivor complex, guilt complex is something I never discussed with her. But in retrospect it's quite clear. She felt in a sense she'd betrayed her principles. She had run away, betrayed her friends. The day before she was interrogated by the Gestapo, there was a good guy, bad guy, routine, one shouting at her, one being nice. She'd actually joined the Confessing Church which was basically a fairly anti-Hitler organisation. The day before her interrogation she tore up her membership card at her sister's advice so she could say I'm not a member of the Confessing Church. But she told me once she felt like St Peter. She was a very devout but relaxed Christian. She felt she identified as St Peter for betraying Christ when the cock crowed thrice. And from a very early age, I mean certainly 11, 12 years old onwards, I immersed myself in concentration camp literature which I can't bear to read now. I find all human cruelty now just too painful. But I was very, very well read in all that and was also why when I went up to Oxford to read PPE, I went up partly because I thought philosophy would teach me the meaning of life which of course it didn't. But I was fascinated by totalitarian politics, particularly in Russia, partly because I was very impressed by Tom Courtney in Dr Zhivago as Strelnikov, a ruthless Cheka man, you know. I was all dressed in black but I was very interested by Russian history and I did a special paper in the Soviet politics under Archie Brown who went on to become a very famous communist historian at St Anthony's. I think I was more or less his first undergraduate student. And then, so going to Oxford to read PPE was kind of automatic. One was just expected to do that in the family. Not pushed but just expected. I actually grew up for the first three years of my life. I was actually in University College. My father, the family had one floor of a building called Kybald One. Harold Wilson's family lived on the floor below as Wilson was the economics don at that time. But I always felt by going to uni for myself, although I got an open scholarship, I felt I'd kind of cheated and taken the easy option, though I don't think I was given particular preference. And I'd taken a double gap year. I did a year of VSO up on the border with what is now Burkina Faso in northern Ghana, which actually was, I can't say it was formative, but I found it fascinating. I didn't want to leave actually. I wanted to stay but obviously I had to come back. And then two years, I found philosophy did nothing for me, didn't answer any questions. I was sexually terribly frustrated, terribly shy, didn't know how to approach girls at all. Fell inappropriately and madly in love with an older woman, a friend of the family's, which I still feel very embarrassed about it all. But I couldn't cope with it and rather than seek help, which I should have done, I ran away and I told my parents I'm leaving Oxford, which they were obviously deeply distressed about, but they accepted, well, we can't stop him. And by a strange coincidence..., I was very unhappy and I wanted to see proper suffering in a hospital, partly morbid but partly I suppose a muddled idea that somehow I should see people who had serious problems and mine were trivial in comparison. And the father of the girlfriend of a friend of mine, purely by coincidence, was a general surgeon in a mining town north of Newcastle called Ashington. It used to be called England's largest mining village. The Charlton brothers, famous footballers, came from Ashington. And Jane, my friend's girlfriend, rang her father up and said, I've got this friend Henry who wants to work in a hospital. So he said, well, he can come and work as a porter in my operating theatre. I mean, it wouldn't happen now. And purely coincidentally, this then became the great change in my life. I spent six months working in an operating theatre as a cleaner, dog's body, anaesthetic assistant, called an OTT, operating theatre technician. Getting on pretty well. The Geordies are very friendly. They find us slightly odd. You know, what is this very posh middle-class person who speaks RP doing here? But that was fine on the whole. There was only one that didn't like me. They were very friendly. And I decided during that time I did want a professional middle-class career, but one of my own choosing. And my inappropriate love was also muddled up with a sort of teenage, delayed teenage rebellion against my father. And my father was an extremely kind, reasonable person. And having reasonable parents is very difficult because you have to be unreasonable as I was. And I really wish I could go back in time and apologise to them for having caused them such a difficult time. So I decided I wanted to be a surgeon. I always wanted to use my hands. In retrospect, I wouldn't have been suited to an academic life. I'm too restless. I have to make things all the time. It's almost a compulsion I have. And I did that as a child as well. My mother said from an early age I should be this constant wanting to make things. And so “Univ”, University College, very kindly said, well you can come back and take your degree. So over the course of one year I worked. It sounds, this is not false modesty, I'm not particularly clever, but I can work extremely hard. And I worked sort of 14 hours a day, seven days a week for a year and got an un-viva'd first because I wanted to be a doctor. And on the basis of that degree, I was accepted by the only medical school in London which took people without science A levels. I'd assumed I'd have to go to a polytechnic as they were called at that time and do science A levels for two years. And I'd met my first wife. My father supported me financially, my first wife did, who worked as a social worker at that time. And amazingly I got a second grant from ILEA, the Inner London Education Authority. So looking back on that stage of my life, I was extremely fortunate and due to the kindness and support of other people. And then it was six years in medical school, which I enjoyed. I was pretty self-important I think, but happy and the marriage was fine. And we had our first child just after I qualified as a doctor.
AM
You didn't mention how you met your first wife.
HM
Oh we met, we met, she was doing greats at St Hilda's and she was a friend of a friend when we met. And in retrospect we were both desperate to get hooked up and married, but anyway the marriage lasted 27 years and we're good friends again now. Although the divorce at the time was very unpleasant for both of us. Divorce brings out the worst in people, did in me anyway. And, so I qualified as a doctor, my son at the age of three months in had a brain tumour and almost died. I don't think consciously that was a major influence, but I don't know, because I didn't know what I wanted to do. I'd wanted to be a surgeon, but actually I found I didn't actually enjoy it. It was all general surgery I'd seen, I'd seen no brain surgery. And then by chance, after already a year and a half I was working as a senior house officer in an intensive care unit, I saw an aneurysm operation, a brain operation. And although I suspect I'm gilding the lily a bit, it was a pretty epiphanic experience seeing this surgeon who became my patron and mentor, using an operating microscope, doing something very fiddly and very dangerous. It was irresistible. I more or less came home and said to my first wife, Hilary, I'm going to be a brain surgeon. Because up till then I'd really been very uncertain, I always felt like giving up medicine, it just didn't appeal to me. Certainly being a physician was out of the question, or being a GP was out of the question. So I've never, and that was now, that was in 1981, and I've never looked back. I've now retired from the NHS, but I still work, I lecture abroad mainly, I still teach in my own hospital. And I was doing a bit of operating indeed recently in Ukraine. So for many years I just devoted myself to work. As a junior, as a training surgeon 40 years ago in Britain, particularly in neurosurgery, you had no life outside medicine. In fact I was on call every night, every weekend, 48 weeks a year, which actually was against the law, but anyway, my hospital said that's what I had to do, so I did it. And on the whole I liked it, it appealed to my sense of self-importance. I think looking back at the totalitarian bit and becoming a brain surgeon and doctor, I was attracted to power. My anthropological wife says I'm a typical silverback gorilla alpha male. I now disguise it on the whole, but I'm very competitive, I'm the youngest of four, I was always drawing attention to myself. My mother said my first word was duk duk, meaning look look, which of course is quite ambiguous. It's both look, sharing something, but also drawing attention to yourself as well. I have a difficult relationship with my eldest sister, who's now retired, a very very eminent architectural historian, who replaced Pevsner, or succeeded Pevsner, as editor of the Pevsner Buildings of England. But I have what I call my inner older sister, who's always telling me I'm a attention-seeking nuisance. So I have this slight dichotomy within myself. As with many successful people, I have imposter syndrome, I feel I'm a bit of a fraud, all that fandangos, nothing very unusual. So I had a huge neurosurgical practice, a very large NHS practice, because I worked in a very famous hospital called Atkinson Morley Hospital, where CT brain scanning was invented, developed by Sir Godfrey Hounsfield, a few years before I was there. And I had a large private practice as well, so I made a lot of money. But it was all work, and in retrospect I neglected my three children, which I now regret, but it wasn't totally disastrous, because I have a good relationship with them now. But they all roll their eyes a bit when people say, you have this wonderful father. I wasn't. And it wasn't just the hard work. As soon as I came home I was busy doing mad do-it-yourself things, and building and making things.
AM
You're a wood-worker?
HM
Yes, but I mean to the exclusion of my children. I did things with them occasionally, but I also had this drive to do things and rather neglect people, which I'm better at now, and I'm certainly a better grandfather than a father. I've always kept a diary. I started keeping a diary when I was about 12 or 13. Sort of adolescent morbid self-interest, but also it's the making business, trying, both to persuade myself that somehow my life means something, and by putting it into words, not for other people to read, but simply for myself, it's always been incredibly important. Reading, I'm constantly buying books, half of which I only read half of, but it's a common problem. And it became, particularly as my neurosurgery is very dangerous, and I had lots of bad, lots of serious problems, some of them about my own making. And I wrote about these to myself in my diary. And again, when the marriage was falling apart, my first marriage, it was very traumatic. I had some psychotherapy. I'd had psychotherapy when I came back from my year away, when I went back to Oxford, because I was very unhappy, and I did understand I needed help, and I found psychotherapy immensely helpful. It didn't help me when the marriage was falling apart, but anyway, I had some more therapy then, which helped a bit. But I wrote more and more in my diary, both about the end of the marriage and about my work. Not for publication, simply for myself, trying to turn all my... I'm emotionally a very intense person, I think, trying to turn it into words. And then I met my second wife. After the end of my first marriage, I met my totally extraordinary second wife, Kate Fox, who was an anthropologist and a...
AM
How did you meet her?
HM
She and her business partner, they ran a sort of research agency organisation, did work for the government, for commercial companies, things like that. They were troubled by the extremely poor quality of reporting of science and medicine in the media, and wanted to set up a sort of committee to advise, to publicise better reporting. You know, eating eggs kills you with salmonella, you know, there's latest breakthrough for cancer, all these ridiculous, eye-catching headlines. And they... Her business partner, called Pete Marsh, no relation, knew somebody, it was Baroness Springfield, both famous and infamous perhaps, who was a very old friend of mine. And basically she said, if you want to find a medic, go and see Henry. So I met Kate, not expecting to meet her, I was expecting to meet this bloke, Pete Marsh. I came out of the operating theatre on a Friday afternoon, went round to my office, and there was this extraordinary creature, creature's not the word, but looked very much like Twiggy at that point, wearing a very, very short skirt, short blonde hair, big Russian hat and a long black coat, with Pete Marsh. And I was fascinated. It wasn't love at first sight, but it was profound curiosity at first sight. And we started to exchange emails, because we both love writing. And we only met, I think, three or four times, always in the presence of other people, before we decided that's it, then we started living together. And we haven't really looked back since then. Both of us, having come from failed marriages, I think, have been determined not to let our marriage fail, and it's worked well, very happily. But Kate's a wonderful writer, she's extraordinarily articulate, has a real gift for titles and words and wit. And she'd ask me, you know, what are you doing at work? So I used to read bits of my diary. And she said, oh that should be a book, go and see my literary agent. So I spent the next ten years, I was still working full time, I spent the next ten years mainly in Duke Humphrey at the Bod in Oxford on Saturday mornings, because I commuted from London to Oxford and I wasn't on call at weekends. And Kate's... I went on living in London, but she has a wonderful flat on Folly Bridge, and there was no way she was going to... she's lived in London for a while but wasn't happy. So I spent ten years mainly on Saturday mornings, sort of rearranging my diary into a book. I didn't quite know how to do it, and my literary agent, Kate's literary agent, was very helpful. He said, yes, you can write, but the problem people like you have is structuring it. And somehow one day it all seemed to fall into place. And then there was a bit of a bidding war between the major publishers to publish it. And it went to Weidenfeld and Nicholson, and I had a wonderful editor called Bea Hemming, who's the daughter of David Hemming, the South American history specialist who wrote the book Fall of the Incas. And she was very helpful. And everything I wrote I always showed to Kate first. And when I'm asked, now what's the secret of good writing? I say, well, the first draft of my first book was that thick, and Kate went through it and it was that thick. And then my agent went through it and it was that thick. And then my editor went through it and it was that thick. And it got better every time, you know. So just as my medical lectures are all about teamwork and criticism, ditto with writing, I think. And the first one, Kate came up with the title, Do No Harm, which of course is ironical. And the German edition, the publisher said the Germans won't understand the joke because in German, it's, das Totem, das Leben of Life and Death. They wouldn't get the irony of Do No Harm, because essentially the book is about doing harm, both to myself and some of my patients. There are a few stories of success and triumph. And obviously overall far more patients benefited from my attentions than didn't. But what always struck me as particularly interesting about brain surgery, other than the sheer fascination with the brain and caring for patients, is the fact you have to take risks. And, you know, things will go wrong every so often. And how do you cope with that? How do you deal with that? And I think it's true to say that my book was really the first book written by a senior doctor, openly discussing failure and harm, both to patients and myself. I'm accused of having started a whole new literary genre. And you go to WH Smith, you have crime, non-fiction, tragic life stories, and you've now got medical confessions, because there was nothing new about surgeons writing their memoirs. But the doctors' memoirs have tended to fall into two categories. There's the sort of kiss-and-tell ones by young doctors, satirical. They started with Richard Gordon 50 years ago, Doctor in the House, and those Dirk Bogarde films with James Robertson, Justice is the Lancelot Spratt. I can still remember some surgeons like that, but they don't exist now. And then you had books written by senior doctors, usually in retirement, which were essentially exercises, like political memoirs, in self-justification. So one of the reviews of my book was that it was a self-lacerating document. And I suppose that came partly from the inner elder sister, partly from having had psychotherapy and some ability, partly from being an outsider. Because I went into medicine late, although obviously I'm a doctor. I never really identified with the medical profession. My sense of identity came from somewhere else. Probably more from being a sub-Oxford, coming from a mid-20th century Oxford academic family, if anything. So the book was hugely successful. It was at the right time. Deference for doctors has not evaporated, but it's less than it was. I wasn't aware of what I was trying to do by publishing the book or writing it. It was simply my diary, it was just me trying to be more or less honest with myself. But obviously I can write quite well, for whatever reason, mainly because I read a lot. I did English A-level, and it was Keats and Yeats and The Tempest and King Lear. And this somehow was sort of burnt onto my cerebral cortex, this deep love of the English language. And the book was very successful. It was translated into, I think, almost 37 languages at the last count, which is unusual for non-fiction. It must have sold millions of copies now. And it's more or less compulsory reading for every medical student, so the royalties ten years down the line it's still selling. And I'm proud of that. I very rarely look at it again. I did recently, and I was feeling rather depressed for some reason. And I'm looking at it, and gosh, it's quite well written. It was quite pleasing. I wouldn't write it now. I'd write a different book, if anything. And then of course if you write a bestseller, your publishers want you to write another book, because even if it's terrible, they know they'll sell enough copies. So I wrote a second book, and that was also a bestseller. But that was about starting to move into retirement. The first book was published when I was still working full-time, which was quite deliberate. I didn't want to sort of retire and then spill the beans. I wanted to actually spill the beans while I was still working full-time as an NHS consultant. And then the second book was some medical, some about retiring, my obsession with making things, my love of tools and wood. And that was a bestseller, so of course they said, well, write another book. And I started writing. I wasn't quite sure what to do. I wanted to write a book about the brain, but not just another standard, neuroscience book. And I'd said everything I had to say about being a surgeon, although I was still working in Ukraine, I'll talk more about that later. So, but then the pandemic came along, and then I was diagnosed with cancer, and initially with prostate cancer. It was a very, very high PSA, 130, which is usually a death sentence within a few years. I mean, if you look at men with a PSA of over 100, 75% will be dead within a few years. So inevitably I was writing about it, and now it's something to write about. So the last book, which again Kate came up with the title, And Finally, partly because when I was writing it, I assumed I wouldn't live much longer, partly because I didn't want to write any more. I'd said everything I had to say. And that also was a bestseller, it got very well-reviewed, although it was just a fairly slim volume. But all three books have passages in them about...
AM
What was the title of the third one?
HM
And Finally. It was Do No Harm, Admissions, which didn't translate well into other languages, And Finally. But all three books have chapters devoted to Ukraine. I'm rather proud of the fact that Ukraine, which has become quite a sort of fashionable country to visit nowadays because of the terrible war, I've been going there since 1992. And I never thought I'd combine Kremlinology, which I suppose is maybe the academic career I didn't have, with brain surgery, but I did, again by chance. An English businessman, just after Ukraine became independent, that was in 1991, was hoping to sell English medical equipment, Vickers incubators for babies, in Ukraine. And his uncle was a local doctor near my hospital, and the businessman, Richard Christie, knew there was a famous Soviet-era neurosurgical hospital in Kiev. There were two big centres for all of the Soviet Union, the Burdenko in Moscow, and the Neurosurgical Research Institute in Kiev, or Kyiv as it was then. So he said, I want to take a brain surgeon to give some lectures to create goodwill. And his uncle said, well, back in Atkinson Morley's Hospital is where there are brain surgeons. So he rang up, it was in the days when you had a switchboard operator with sort of plugs, and it was Connie, who was lovely, and knew everybody in the hospital. And basically he rang up and spoke to Connie and said, I'm looking for a brain surgeon to go to Kiev next week. And Connie said, oh, well, I'll put you through to Mr. Marsh's secretary, she knows everything. And my secretary, Gail, who I had the same secretary throughout my career, we were very, very, very good friends, sort of put her head round my office and said, do you want to go to Kiev next week? And I said, no, I'm far too busy. I said, go on, Henry, you always say you want to go to Russia. Okay, no, Ukraine's not Russia. And then since I cancelled my outpatients and operating, Gail would have to field all the unhappy patients if she was telling me to go. I thought, well, if Gail says I should go, I ought to go. So I went, although I knew things would be bad, I was totally horrified by the conditions I found. I mean, first of all, Soviet neurosurgery was 50 years behind the West. They had one really bad quality CT scanner. By then we had quite good MRI scanners, things like that. No operating microscopes, really in the dark ages. And I met a very driven, fanatical young neurosurgeon. I didn't quite realize at the time, all he did was spinal surgery, which is all part of neurosurgery. And to cut a long story short, I told the head of neurosurgery in Kiev, Academician Romadanov, if this guy can come and work with me in London, I'll look after him. So Igor spent three months in London. In those days, I could just tell the one part-time hospital manager, I've got this Ukrainian guy coming, please provide him with accommodation. I mean, unimaginable now. And he could scrub up with me and operate with me. I was trusted, which I certainly wasn't towards the end of my career. That was fine. And he was incredibly driven, spent the whole time working, would be up all night photocopying all the textbooks in my office, drawing, illustrating all the instruments he saw me use. And then after three months, he had to go back and I said, look, I'm willing to commit to coming out to Ukraine once or twice a year to work with you. Because I realized, maybe partly because having done a year of VSO and worked in a foreign culture as a teacher, I realized that you've got to be committed, just flying in once for hit and run consultancy, as it was called, is humiliating for the locals and doesn't work anyway. It's just a vanity, it becomes virtue signalling. So, and again, my first wife just accepted I'd rather not go on holidays, I'd go to Ukraine. Again, neglecting my family. Though we did have family holidays as well, a bit. So I used to go to Ukraine regularly. And of course, he became very successful, then made enemies. You know, surgeons are all bitter rivals, particularly in countries like Ukraine, where it's all financially based, because they get paid under the table. They pay virtually nothing by mistake. It's still a problem now. So it was a very hierarchical society, all healthcare systems reflect the society they work in. The NHS, which we all worship, was always incredibly unequal, because English society is a very unequal class system. If you're seriously ill in London, you'll get world-class treatment, usually, in one of the big hospitals. If you're in Barrow-in-Furness or something like that, you won't. It's unequal. And all I'm trying to do is admit that inequality and try to reduce it. So my colleague became more and more famous against the opposition, he had a lot of opponents. And I'd go out there, and I was always a bit puzzled by the way, every time I went there, the doctors and nurses I'd met last time had all gone, and a new lot had turned up. And Igor would say, oh, it's Ukraine, it's a crazy country, that's normal here. But it gradually dawned on me that although he was an extraordinary, driven, hard-working fanatic, he was also impossible to work with, as were many highly successful people. And I thought I'd been helping him sort of rebel against the old Soviet professors, very hierarchical, we never make mistakes sort of thing. There's one of Solzhenitsyn's short stories, it's called We Never Make Mistakes, KGB arrests people randomly, we never make mistakes. And I then started to discover there'd been some bad results on patients he and I'd operated on, and he hadn't told me. And particularly, there'd been a young girl with a very large benign tumour. He did most of the operation closely supervised by me, and she woke up fine, and I thought this is a triumph. Both purely technically, but also as a triumph of training, but you know, over 20 years he'd actually learnt how to do a really difficult operation entirely due to my teaching. And it was only year two, and I heard now, I flew back to London in the way I did, and I assumed all was well, it was only by chance I learnt from his junior doctors, the two that stayed with him, that she died after surgery a few weeks later, from what was obviously completely mishandled as some kind of post-operative infection. So a complete tragedy, but this was completely against everything I thought I'd been trying to teach him, which was about being open about mistakes, seeking advice. If he'd rung me up and said, Henry, we've got this weird problem, I'd have cancelled everything and jumped on the next plane to try to come and help. So that was pretty shattering, but I made a mistake. I thought, well I remembered a similar case where I'd had a post-operative infection, I'd muffed, and the patient had...
AM
You describe it in one of your books.
HM
Yes, and the patient was left terribly disabled, so I kind of forgave him and thought, well these things happen. But I didn't really appreciate that actually this was a deep systemic problem, he actually was morphing into the various Soviet professors I thought I was helping him react to, rebelling against. And so I went on working with him a bit, but I became more and more uneasy. I began to see lots of faults and problems and felt I should not be encouraging him to take on these very difficult cases. As it was elsewhere in Kiev now, although when we started working together, I used to go there, take lots of second-hand equipment, operating microscopes, all sorts of stuff, which I either bought or begged or didn't steal, but I took a huge amount of equipment with me. People were very, very helpful and willing, if you have the contacts, mainly from theatre nurses, you know where all the old kit and redundant stuff is kept. But he was fine doing spinal surgery, but he was getting hugely over-ambitious, and above all he'd reverted to the standard thing of the only person he'd train was his own son. And he had two other doctors who joined because of me, and had stuck with him, and he treated them very badly, he wasn't really teaching them at all, he wasn't handing on all my training. I wrote a more or less complete textbook of neurosurgery for him over the years, sending him diagrams and pictures and advice. So eventually I had a sort of showdown with him and said I can no longer go on working with him. And that was now, that was just before the pandemic, it was about ten years ago now. And I worked, and then the two other doctors who'd been in his department both left because I was leaving. They both said to me afterwards, you know, the best thing that happened in our careers was when you started working with Igor and we joined him, and then the second best thing was when you left him and we left him. They're both very successful independently, one more or less in the state sector, the other not. And I've kept in touch with one of them particularly, but my great interest beyond all the technical stuff, which I don't do now, because the other problem with Igor was that other surgeons were becoming experienced and good, and actually there were some other surgeons in Kiev, one of whom again was a protégé of mine who'd come to London, who were dealing with big brain tumours much better than he could and were more experienced. But my interest was always the more sort of philosophical, ethical side of teaching about patient safety, ethics, doctor-patient relationships, which are terrible on the whole in Ukraine. Well, it's complicated, but it's still very hierarchical. It's not a culture where doctors like to criticise each other and mistakes are brushed under the carpet. So there's some very good, I can only speak for neurosurgery, but I'm sure it's similar in other specialities, there are some very good surgeons who do very well, but every time I go there I'll see those terrible mistakes being made, which are then just sort of brushed under the carpet, because patients have no redress. Although there are lawyers, in the past of course you couldn't sue the state. And although I did not enjoy being sued, which happened a few times, and I certainly had complaints made against me, and we all do, if patients don't have any redress against doctors, it's terribly corrupting, power corrupts, and all that business, or tends to corrupt. And so that's my interest really, was trying to influence young doctors. So my work there, mainly now when I go, is medical education, lecturing medical students. I'll be there again in a few months, I just got back two weeks ago, but I'll be there again in October, war permitting, and I'll be lecturing in Uzhhorod and Vinnytsia. Some of this is for doctors online, some of it is students, and that's what really interests me. But it's very difficult, because being a doctor there is very difficult, it's still terribly corrupt. You can bribe your way through the examinations, you certainly have to pay money to get into a department. There is no structured postgraduate medical education at all, it's the old Soviet system. And that requires change from the centre, the war has made everything more difficult, military surgery is coming along in leaps and bounds, because it's horribly experienced. So it's very difficult, but because I've been going there for 32 years, I'm very well known there, I'm respected, people love the fact I continue to go there. I've been going there more than ever now, because of the war. I don't go to the East or Odessa, because Kate, my wife, gets so anxious. I think the risk is small, it doesn't bother me, but I have to respect her anxieties. So I feel I can be openly critical, so I am. I'm always criticising Ukraine, the medical system, saying a lot of doctors don't like me, but a lot of doctors do like me, because I'm only saying in public what they all say to me in private anyway, about whether the system needs reform.
AM
What about Nepal?
HM
Nepal is another story. When I was a senior registrar, as it was called at the old Atkinson Morleys, one of my fellow trainees was a delightful man called Upendra Devkota, who'd been sent to London on a British Council fellowship to become Nepal's first neurosurgeon. He died, alas, a few, three or four years ago, and I miss him greatly still. Absolutely delightful man. Very will ball of a man, incredibly active and dynamic, very charming. And he flew from India, first class on BOAC, paid for by the British Council. Can you imagine the British Council paying first class now? Again, a different world. And we became good friends. We worked together as trainees. And then he went back to Nepal and started, right from the sort of bootstraps, creating a department of neurosurgery in the Bir, the main government hospital in the centre of Kathmandu. And he was doing his own direct puncture carotid angiograms. He'd made many friends in England. He'd trained in Glasgow as well as in Atkinson Morleys in Wimbledon. And so he built up this very good department. And then of course he had problems and arguments and rivalry, and he felt he couldn't really make any further progress in the state sector. So he then built, raised money, not quite sure how. He was a Brahmin and his wife, who was a professor of public health, was a Brahmin as well. They were very well placed in Nepali society. And he built his own private hospital, called Neuro Hospital, now called the Upendra Devkota Memorial Hospital, which was pretty good. I think, as with many highly successful people, as well as with my Ukrainian friend, he could be a bit of a tyrant at times. By the time I went to work with him, and I'll come back to that in a moment, I think he'd mellowed quite a lot. But I know a lot of his former trainees did not like him. They then set up their own neurosurgical units. Dev, as all his English friends called him, Professor Devkota, was very famous throughout Nepal. Firstly because he was Nepal's first brain surgeon, it was a myth of brain surgery. Secondly because he became the Minister of Health and Technology under the last King. The King then, very stupidly, this is after the royal massacre, when the Crown Prince machine-gunned his family. But the King, rather foolishly, then dismissed all the Cabinet, this is during the civil war, and tried to run it all himself, and obviously it was a disaster. But Dev, for a while, was ministerial. He said he reckoned he'd saved more lives by making crash helmets compulsory on motorbikes than he ever did as a neurosurgeon. So when I retired, I retired at the age of 65, not because I had to, but because I just got increasingly angry with the frustrations of an increasingly managed, inefficient NHS, where senior consultants like myself were not trusted, you're just sort of pushed around. I was just being angry all the time, and I didn't like that. Also, I didn't have enough work to do. I used to operate four days a week, but then they increased the number of consultants because younger consultants were not willing to be on call as much as my generation were. And I lived next door to the hospital, but my colleagues lived further and further away, and so there were more consultancies, but the workload didn't go up overall, so one's individual workload declined, and I was only operating two days a week. Even that night would be a lot. I mean, it's hard to believe, but my colleagues in the hospital, they may be lucky if they operate one or one and a half days a week. I didn't know what they'd do the rest of the time, but that's another story. So when I took on a part-time contract as a mentor, my trainee who'd taken my job, who remains a very close friend, and I'd help him with difficult operations to begin with. He's now completely independent. This is now 10 years ago. But I wasn't really ready to retire and stop being a neurosurgeon. So I wrote to Dev and said, look, I'm at a loose end. Would you like me to come and work in your hospital? He said, yes, please come. So I started going there regularly, so once a year. I've been given a lot of charitable money by my patients over the years because of my overseas work. I used to go to Sudan, that's another story, as well as Ukraine and Pakistan a bit as well. So I was very timid when I was younger and frightened by travelling. So I was trying to make up for it in the old age. And also because it was structured, I had a role, my local colleagues would look after me. So my timidity was kind of treated by that. So I could afford to pay my flights out there from my charitable fund. And like many Westerners, I kind of fell in love with Nepal. I mean, sure, it's a difficult country and a terrible civil war.
AM
What was the date you first went?
HM
It was just after the earthquake, actually, so that would have been in 1996. No, in 2016, I mean. 2016. The earthquake was in April and I turned up six months later. And the trainees there were delightful. They became very good friends. I've remained very good friends with them. I was there earlier this year. It was the Himalayas, and my son, William, the one who had a brain tumour, is a great outdoor person, so we go trekking in the Himalayas. We had some wonderful treks, particularly around Manaslu, which is, I mean, and the border circuit now is crowded and terrible. So it's very beautiful. The combination of Hindu and Buddhist culture is fascinating. I'm not unaware of the problems. I mean, in England, if patients are unhappy, they sue. In Nepal, they smash all the hospital windows or even kill doctors. It's a different culture. And, of course, there are endless, hundreds of tribes, hundreds of languages. It's very, very complicated. But this combination of Hinduism and Buddhism and Tibetan culture makes it quite unique. On the other hand, of course, Kathmandu was awful. The pollution is terrible. Luckily, the hospital where I've been working is in Bansbari, which is slightly to the north of the Ring Road, and the air isn't quite so awful. I had to cross one of the main roads every day to go to work, and I felt it was a major triumph every time I got across. You learn you've just got to walk through the traffic slowly and steadily, and then all the motorbikes and cars will weave their way around you. If you wait for a gap, you'll be there all day. So it took a while to master that skill. So I hope to go back there again, but it's quite expensive, of course, the flights. But it always has to be predicated on feeling I'm being useful and on friendship. Dev died, alas, a few years ago from cholangiocarcinoma, which is a very deadly cancer. The hospital has changed since then for various reasons. It's become much more neurological and neurosurgical. So when I was there earlier this year, I was teaching and lecturing. There wasn't really much, any operating for me to do. And although my colleagues want me to come back, I'm less certain what use I could be. In Ukraine, I'm still, there's more and more work for me to do in the way of lectures. In fact, in three days' time, I'm doing some online lectures for quite a large medical organisation. So I'm very lucky, I'm still busy. I'm 74. My cancer's in remission at the moment. I had two years of pretty unpleasant hormone therapy, which is reversible chemical castration, which leaves you pretty flaked out. So, but my terrible need to be busy, to be useful is still there. And at the moment, it's mainly directed to Ukraine, trying to be a good grandfather. But at root, there's a sort of restlessness and ill at ease in myself. I've always had. And that's why I was drawn to medicine, I think, because it was rather extreme. It was both morbid and trying to be constructive and helpful at the same time. At the same time, also terribly strongly, my role as a doctor only makes sense in the light of the lives one's patients lead. So many doctors end up, as I tended to be, to think they're terribly important, because you have so much power, your patients are in awe. I was telling my trainees, look, your patients are frightened of you. You think you're this wonderful sort of cool philanthropic guy, but it's a hugely unequal relationship, which I think I was probably fairly good at understanding, both because of my son's brain tumour, both because of my psychotherapy. Actually, I spent a time as an inpatient in a psychiatric hospital when I was particularly unhappy at the age of 21. So, there's a certain humility balanced against my enormous self-importance. But it's so easy as a doctor to become self-important, but it's not. The value of what we do is, if the entire human, as a reductio absurdum, if the entire human population were all doctors and nurses, and all we did was keep each other alive, the world would be an incredibly boring place.
AM
I'm just going to stop there. First, let's take you back to before the Dragon School, when you were sort of four, five, six, seven, did you have any particular hobbies or passions?
HM
Not at that age that I'm aware of. It was quite disrupted, because at the age of six, my father took a two-year sabbatical from Univ, and we went to the Haut Holland, to The Hague, Scheveningen. We lived in Scheveningen, the fishing harbour for The Hague, in 138 Neuverparklaan, I think. But I went to an English school, English school in The Hague, so I didn't learn any Dutch. And that was for two years. I was happy as far as I know. I remember a few events, but remarkably little on the whole. I was happy at school, no particular problems. And then I was very close to my brother, who was two and a half years older than me, and we shared a bedroom. And I remember the lighthouse light, a kilometre away, less than a kilometre away, flashing through the bedroom wall at night as it rotated. We then went back to Oxford and then I went to the Dragon School, but only for two years, because at the age of ten, my father then gave up on academia, and we moved to London, and he became the first director of something called the British Institute of International and Comparative Law. So it was sort of academic, but not in a...
AM
So you were only at the Dragon for two years?
HM
Only for two years, yeah.
AM
Do you have any particular memories?
HM
Yes, I spent the whole time fighting. I was in the middle stream. I was a sort of gang leader. I was very aggressive, I liked fighting, I was very physical, I was very strong. I still pride myself for being relatively strong in old age. My brother once recently told me, whenever we fought, I always won, so after he gave up, he said it wasn't worth arguing with me. And I was rather distressed to hear that. So...
AM
Do you remember any teachers, particularly?
HM
Well, I remember all their names. Yatto and Putty, Inky, Cutters...
AM
Gov.
HM
Gov. I remember all these guys. Rabbits, I liked history. My main interest academically then was history, and that was taught by an uncle called Rabbits, who was Mr. Roberts. And it was this very nurturing, inclusive atmosphere at the Dragon, which I could understand all the better, because when we moved to London, I went to a much more conventional prep school. I had to wear a proper uniform and a cap, which I hated. I only put the cap on when I was a few hundred yards away from the school. So I was already a bit rebellious then, I suppose. I mean, my parents... Essentially, my mother, although she hid it very well, had a profound lack of trust and belief in authority because of her background. She was really quite, in a way, quite subversive and transgressive, but she had a very, very strong Lutheran, North German... Well, not North German, it was the Magdeburger Heide, it's an Altmark where she came from. Very strong sense of German discipline and duty. Our father was very lucky, but she was a very, very obedient housewife. She hated housework, she hated cooking. She really was an intellectual, but she didn't go to university and had to bring up four children. We had au pair girls. So she was a housewife and did it very well and very beautifully. It was only as our father started to dement years later that my mother kind of came out, not out of a shell, but increasingly became her true self and that's when she wrote her beautiful memoir. My mother once said to me, to somebody else who then told me, she said that I used to drive her mad, but she felt that probably I was the finest thing she'd made. I say that a little bit reluctantly because it sounds outrageous, but I think my mother did rather slightly approve of my rather rebellious, wild nature, even though it drove her mad. And it's something to do with, some people say I'm deeply creative, I'm always making things, having to do things. Having said that, although I'm now a keen woodworker, I couldn't stand Barsonary at the Dragon. I had no interest in woodwork at all.
AM
That was woodwork.
HM
That was woodwork. Although when we lived in Holland, I loved collecting driftwood and making my own fleet of ships with little nails for masts and things like that. It was the only Dutch I learned to be kleine spijker, meaning small nails, going around to the hardware store and asking for klayin spiker so I could make my boats out of driftwood, the salt-stained, dried driftwood.
AM
Your mother was instrumental in helping to found Amnesty.
HM
Very much so. My father, through his connections with Harold Wilson, through his connections with Justice, the British Institute of International Studies, he was a bit of an in-outer. He wasn't a straightforward academic. I'll come on to him in a moment in more detail. You know, we take our parents for granted until it's too late and then we become more interested in them. And you also understand how one's not just, you know, doesn't inherit your DNA, you inherit a whole cultural baggage train. Most of us do, I certainly did. So there were friends of Peter Benenson, who was this sort of left-wing, I don't know, left-wing activist lawyer, who came up with the idea of Amnesty, totally his idea, where you'd set up small groups of people and send postcards to dictators all over the world saying why have you got this person in prison? We've imprisoned them purely because of their beliefs. And that was the beginning of Amnesty. And my mother got roped into it because there were lots of political prisoners in East Germany. She started running the sort of East German division, writing to all the groups of people who then sent postcards to Ulbricht and people like that. And she ended up running the whole registry of, I think, of all the political prisoners worldwide. And I think it was all voluntary work. But I think she played a crucial role in keeping Amnesty going, as did my father. He was financially on the brink at one point. He was a great collector and actually had managed to buy very cheap an original Rembrandt drawing, which had been sold for charity to keep Amnesty afloat. So she was pretty busy with that once we'd all grown up a bit more. And I'm hugely proud of that. My father was a very... It was very complex, full of contradictions. He came... His father was a jeweller in Bath, ran a... with his brother was H&R Marsh in Abbey Green, just off by the Bath Abbey, ran a jewellers' business. Came from... Slightly unusual... I mean, trouble is when my father demented, it was too late to get all the family history from him, which he knew. But it was slightly unusual. There was a warranty of real eccentrics in the background on his father's side, interesting people. Found him in Dallas. And so he claimed, my father claimed, that there are only three books in his family home in Bath. It may be a slight exaggeration, but certainly not at all intellectual. His mother was a farmer's daughter, who used to walk eight miles a day to work as a seamstress in Bath. This is now at the end of the 19th century. Ended up as a sort of proto-Margaret Thatcher figure, running a highly successful business, as it haberdasher seamstress and dressmaking, which I think she then dropped when she had a first son, called Cyril, who then died from meningitis. And then my father was born. I think he once commented that his parents, he was seen as a very poor substitute for Cyril, which perhaps contributed something to his character. And he then went to Monkton Combe, a public school which specialised in training evangelical missionaries and doctors. And he says what he suffered there was nothing compared to what you read about in Tom Brown's school days, having his compass needle stuck into his nose. There was a dark room where the fags were tortured by the older boys. And already then he was a sort of non-conformist, and yet he also was cadet sergeant major of the corps, played rugger for the first 15, rode in the first eight. So very conformist, at the same time a square peg in a round hole. But there was one history teacher, whose name I forget, who turned my father into a liberal intellectual. And he'd somehow opened up this whole world of books and history. And although my father had no science at all, and was sort of totally squeamish about anything physical, he was a huge polymath in every other area. I mean I grew up with all the first editions of Malinowski, the Routledge Kegan Paul editions, and Havelock Ellis, and Mannheim, and Carl Jung and Weber, and all that stuff, as well as he was a lawyer. He was a little bit like Kate's father in that sense. He didn't really fit into a standard academic, legal academic mould at all. So, and then he was in the officer training corps of course at school, and then he was at Oxford, at Pembroke College, and he already spoke pretty good French with a terrible accent, and he wanted to learn German, so that's how he met my mother. Then he was secretary of the League of Nations Association, because he was a passionate European. And all that, none of that was implicit in his parents or his childhood at all. So it was all implicit maybe in his DNA. And they said there was this one teacher. Years later, he didn't often get distressed about things, he got distressed by me, particularly when I ran away from Oxford. But he got a letter years later from this teacher, raising money for Monkton Combe. My father was a very charitable man, he supported all sorts of charities. He was very, very moral, not moralistic, but a profoundly good man with a capital G, very gentle, very mild, and I believe he was loved by his colleagues and people he taught. But rather the absent-minded professor as well, I can come back to that. But he got a little begging letter from this schoolteacher of Monkton Combe, and it caused him great angst, because he hated the school. And he didn't send money, he just couldn't, even though he owed so much to his one man. He found that very, very difficult. Yes, so, coming back to his eccentricities, I mean, I went to Univ years after he'd left, but the senior porter there still would remember all the stories about him. And my father was very good at making fun of himself. And one story, for instance, he said, he met one of his former students who said, you know, Mr Marsh, I must tell you, every time I had tutorials with you, I was absolutely terrified. And my father was rather upset, because he always thought he was benign. He said, it's the weak ones who need support, the good ones will look after themselves. And his former undergraduate went on to say, whenever in winter, this was in the room in the building in Univ where I grew up, in the next floor up, where my father had his rooms, well, you never had any matches for lighting the gas fire. So he used to turn on one of his electric fires with a bar and then press it up against the gas. So the tube always started with an enormous explosion. On another occasion, though, he said that one of his undergraduates was sitting on the sofa and sort of a bit bored, putting his hand down, and suddenly came up with a great bundle of five-pound notes. And my father said, I've been looking for that everywhere. He was the college bursar, and he used to go around the college farms, collecting the rent in cash from the tenant farmers, and he'd sort of lost it. So he was an enchanting man.
AM
Can we come to Westminster School?
HM
Yes. So, at the age of ten, we moved to London. I went to Westminster, under school, where I was pretty unhappy, I think. In Oxford, we lived in this amazing Elizabethan farmhouse in North Oxford at Upper Wolvercote. There was a two-acre orchard with thatch barns. It had been a working farm until 1946. My father bought it in 1953. He had a very good eye for property. So I had this idyllic childhood, really, both at the Dragon School, where I could run wild which was very relaxed and informal. I went back to the Dragon a while ago to take part in something, and all that. It's not very different. It still had this rather nurturing — you felt the boys were treated with respect, not like that. And then I went to London to Westminster, under school, admittedly with a very sympathetic headmaster. Another story there. But it was, you know, the masters were up there, and it was much more hierarchical and rigid. And also I'd lost this two-acre garden and paradise just on the edge of Portmeadow. So I was not happy, I don't think. Because I'd been so pushed along at the Dragon, and I was way ahead in Latin, I got put into the upper form with a view to taking the challenge, the scholarship exam for Westminster, big school. But I wasn't up to it, and I remember being summoned down to the headmasters' study to say, well, well, well, Marsh, you know, we don't think you're quite up to doing the challenge. And I remember having to fight the tears back. But it didn't bother me that much in retrospect, and just like being in the middle stream — at least I wasn't in the dud stream at the Dragon, my brother was in the brainy stream and got a scholarship to Westminster. So I didn't think it troubled me very much, but I also had my own interests. I was obsessed at that age by ancient Egypt, and I now don't like ancient Egyptian art at all, but I taught myself basic hieroglyphics and would go into the British Museum on my own and draw things. I mean, partly imitating my brilliant elder sister, I think. Huge benefit to being the youngest, because you get all the— I was reading Tolkien and C.S. Lewis at the age of eight, you know, I read the Morte d'Arthur when I was nine, I think. The obsession I had was King Arthur and his knights and medieval chivalry. So I've had this capacity to get very obsessed and interested in things. I still have it, I'm interested in everything. I could have been an anthropologist.
AM
Perhaps you are.
HM
And then, so Westminster, I toddled along, got my O-levels, didn't do particularly well. But then kind of took off for A-level, had a very good history teacher, very eccentric, but he was called Charles Keighley. He didn't approve of me because I was a bit wild, but he was very ironical but very unusual. And a very good English teacher called Jim Cogan, who was on one of his first teaching jobs, and again he treated me with respect. So I got three A's in A-level, which in those days was unheard of. Only one other boy in the school got that. Nowadays everybody gets A's. And then I got an open scholarship to Oxford. So academically I kind of took off then.
AM
You didn't talk about Westminster when we meet, about the library and...
HM
Yes, no, it was a pretty liberal atmosphere. The headmaster was a man called John Colton, known as Coot, as queer as a coot. But it was a very liberal atmosphere. Westminster was quite cosmopolitan. It was perfectly respectable to be intellectual. They sport water, the rowing station, was not that important. I missed the fact there was only football, no rugger. I loved playing rugger at the Dragon. It appealed to my violent nature. I remember my cricket report for the Dragon said, very aggressive. So I had this rather aggressive violent nature. Maybe that's why I became a surgeon, turning swords into ploughshares. But no, Westminster was pretty good to me. It was respectable to be intellectual. I had some very good teachers. I ran both the debating society and the literary and political society, which had fascinating minutes going back to the 1930s. And they used to get famous people to come and give talks, which was great. I was also the school librarian in charge of this very dusty, where I told you before I came across a complete edition of The Golden Bough, 12 volumes or something, which I loved delving into. I had this love idea, this profound scholarship. And at that point, well, my brother's a very skilled artist. I'm not professional, but a very gifted artist. He was painting a lot. I used to make things still. It wasn't then formal furniture or things like that, but always using my hands. But at that stage as a teenager, I saw myself essentially as a sort of intellectual, for want of a better word. And all I wanted to do was write poetry. But then because I became increasingly unhappy, all my peer group were having girlfriends, going to parties, and I was far too shy. I was increasingly self-conscious and tormented. My poetry became increasingly self-conscious and tormented. And then I had my two-year gap here. One year doing VSO in Ghana, and the other most of the year, six months working in the Public Record Office, editing medieval Latin manuscripts, a job my father organised for me, which I found quite interesting. But again it was all organised by my father. And then six months working in an adventure playground in Notting Hill, where I'd spend the evenings in the pub with the Irish navvies, digging the Victoria Line. And they'd put away literally 15 pints of Guinness, followed by five rum and blacks afterwards. I mean, it was charming Irish peasant boys, so the only people who would do the work, digging the tunnels. But they were just drinking themselves into oblivion. It was rather sad. But that was interesting.
AM
Can you, just going back to Westminster, certainly at my school, around the age of 15, we were confirmed into the Church of England. And I came from a sort of evangelical background. So I became, my most religious phase was between about 15 and 20. Can you tell me something about your religious...?
HM
None. Essentially, my parents were both observing Christians, in a relaxed sort of way, not evangelical. I cannot remember at any point ever believing in any kind of God. I think it was a peer group. It wasn't there. I had a series of mystical experiences when I was a teenager.
AM
Can you describe one?
HM
Oh, you know, intense colours, shadows. It's well described by Aldous Huxley in The Effects of Mescaline. In my case, I was partly provoked by staying up all night writing poetry and sort of sleep deprivation. And I read quite a lot about mysticism at the time, Evelyn Underhill, William James, The Varieties of Religious Experience. But, so, and that also then kind of morphed into my fascination with the brain and neuroscience, which was very profound for me. But, so I regard the inner workings of my brain, the inner workings of my conscious and unconscious self, with complete awe and amazement. But I've never felt for a moment any, sort of a deep sort of mystical sense. I mean Freud, you know, the oceanic feeling, which he claimed men and women don't have. I don't know what the evidence is yet for that. I remember realizing civilisation is discontent. So I regard myself as a deeply religious person, without any religious faith whatsoever. And obviously with Darwin as the explanation. Although, I mean, it's interesting, I was doing a.., I was interviewing at a book event three days ago in London, the American writer Sebastian Junger. He's a very good writer, journalist. He's written some very, very powerful books about war when he was an embedded journalist of American infantry in Afghanistan. And he then almost bled to death from a ruptured aneurysm in his abdomen. And has written a book about it. The book's a bit muddled in some ways. But he had a near-death experience. Very vivid. And in part of the book is he writes..., I was also interested in near-death experiences. And, you know, it is extraordinary. I don't think it's evidence for an afterlife. But the fundamental..., although it seems to me there are two fundamental problems in understanding the brain. One is how physical matter gives rise to consciousness. I believe, I see no option that the brain has to obey the laws of physics. It's a physical system. But the laws of physics tell us nothing about how consciousness is generated. So there is this huge central scotoma, as doctors call it, visual loss, in our understanding of the world, really, and our brain. And the second point is we do not have the metaphors to explain the relationship between the conscious and the unconscious self. We all have this sort of default position. My conscious self is in charge and somehow the Freudian id and whatever is sort of bubbling along below that. But that's a false metaphor. Because actually the conscious self and the unconscious self are two aspects of the same phenomenon. And the closest we can understand it to describe this is the work done particularly by Stanislas Dehaene in France on vision, where you can show that you flash up images on a computer screen and you can show when they're in the unconscious brain, because afterwards if you ask people they can recognise a word they haven't consciously perceived. And in unconscious visual experience there's electrical activation for a few hundred milliseconds, and then it's only local in the visual cortex and it fades away. If it's consciously perceived, it's ramped up, it lasts longer, there's more electrical activity and it spreads all over the brain. So what we perceive and think consciously is a sort of amplification of all sorts of unconscious processes for which we don't really have very much handle.
AM
And then the left and right brain stuff doesn't help?
HM
Not particularly, no. I mean that was all fascinating. Again, it's fascinating Sperry's work on split brains. But I mean first of all the brains weren't completely split. I mean the brain stem was intact. And I don't think many of his patients had complete calisthotomies, the standard operation, which I've only done once for drop attacks, is a two-thirds calisthotomy. But you have all these experiments showing the right brain is seeing differently from the left brain, and the left brain confabulates trying to explain things. But no, in terms of the relationship between consciousness and unconsciousness we don't know. But I mean, looking back at my life, on a slightly different level, half the time I was driven by things. I didn't really understand what was going on in myself at all. I think I was incredibly lucky. But I lived in Oxford in the 1950s and 60s in such a supportive, nurturing environment. You know, when I think of Ukraine, when I think of the conditions often in Nepal, what's happened in Sudan, a country I got to know recently well, I mean, it's terrible.
AM
Just two final questions. One is about music. Some people find it nearest they get to mystical experiences and so on. Has music been important in your life?
HM
Oh, hugely, hugely, hugely. I mean, most of my family play musical instruments, I don't. Yeah, no, music is very important. I mean, yes, it has a mystical effect on me, but I have a sense of almost permanent mystical excitement about being alive and being myself without music. But if you ask what work, what music do I most identify with, it's Beethoven, and in particular the late quartets and the late piano sonatas. These, for me, I mean, I love Bach, I love Mozart, my mother gave me all this. She was intensely musical. But, you know, for Beethoven, the struggle, overcoming, the suffering is just extraordinary. And the music I can only listen to very occasionally, and sometimes my most intense experience would be when I hear it by chance, or I mean, for some reason, I did listen to the Opus 131 String Quartet, and it's just, where's it coming from? It's just, how did he write it? It's just unbelievable. It really is. With Bach and Mozart, you can kind of get your head around in a way.
AM
You mentioned your parents met in Halle. What about Handel?
HM
Yeah, no, Handel, there are great moments in Handel. But, no, it's what I identify most with, which is closest to my self-experience, it's Beethoven. And that's because my mother would say to me, apparently I was fine for the first year of my life, but then from then on it was just constant emotional roller-coaster. I'm not a manic-depressive, but rather a silly, descriptive, psychological phrase, a cyclothymic, I tend to go up and I'm either very up or very down. It's flattened down a bit with old age, but it's still..., and of course you have no idea how other people live within themselves, whether they're in a permanent storm of feeling or not, but I am.
AM
Two final questions, in fact. One is that when I'm telling people about you, I misrepresent you perhaps as being very important in the development of the ability to undertake brain surgery while the patient is in a state of consciousness. Could you summarise in fact what your contribution was?
HM
Well, I mean, I just adopted a technique. The brain feels no pain, so there's nothing new about operating under local anaesthetic on a lot of people.
AM
Had other people done it before?
HM
Oh yes, oh yes. What they hadn't done, what was breaking new ground in England and Europe, there's one guy in America who was doing it a bit, was to operate on certain sorts of brain tumours within the brain, which had been considered inoperable in the past because it was too dangerous, because of patients asleep, if it's in the speech area, you have no way of knowing whether you're damaging speech or not. So it seemed fairly obvious to me that by operating in this way for a tumour, if you had the patient awake and talking, you got advance warning, if you were straying into what we call eloquent brain. So technically it was no big deal. Emotionally it was. I mean, operating on patients while they're awake, particularly if it's dangerous, it takes a certain, that's partly what appealed to me, it was a kind of challenge for me to do it. And it was a bit, I don't know if it was controversial, but it was considered to be rather eccentric, and the older generation said, yes, it's silly, it's a waste of time. But everybody does it now for these particular tumours. So it wasn't, if I hadn't started doing it, somebody else would have done. There was somebody, Munich I think, who was starting to do it as well. So no, it was not a major breakthrough. If I have made a major breakthrough, it was my first book, writing about failure as a surgeon. I don't think anybody else has written about it in quite that way. So if you're looking for unique contributions, that was that. And anyway, that's how I set off a whole literary genre.
AM
So that was the first book, and you mentioned three books that are published. What's the next book?
HM
Well, that's a problem. I mean, I've had a lot of building work I've been doing, and that's now finished. And I love writing. So I email quite a lot of friends I write emails to all the time. But I've said everything I have to say about myself and about medicine. People say I should write a book about Ukraine, but that's too difficult.
AM
Could you write about the changes you've seen in the health service, which you talked about last night?
HM
It would sound like an old, boring old man, you know, complaining things ain't what they used to be. And I think if you're going to complain about things, you need to try to change something.
AM
Or where medicine, given what's happened, what we could do now?
HM
Well, my main activity in that regard is campaigning for assisted dying. Which I feel very strongly in, subject to suitable safeguards. The other thing Kate's pushing me to do is to write up all the children's stories. I used to tell my granddaughters on Face Time during the pandemic. And I started doing it. I mean, I like something to write. But I'm always distracting myself by going to make things or something. So maybe if I go through a period where I'm not doing my self-endless physical tasks to do, I'll force myself to sit down and start writing the children's stories. Of course, then you start doing that, and it's all so derivative. I've had to come back there. It's a bit like JK Rowling, not like I'm going to do a JK Rowling. But you can see all the bits where it comes from. It's all been mixed up and very effective. I'm a great admirer of Philip Pullman, whom I know. He lives in Oxford. I think he's done very well at actually being really quite profoundly original.
AM
On that note, thank you very much indeed, Henry.