Henry Marsh: ‘I am worried about drug pricing and caving in to the pharmaceutical companies’
Born in 1950, Henry Marsh grew up in London and studied politics, philosophy and economics at Oxford before taking up medicine. His decision to specialise in neurosurgery was influenced, in part, by his infant son’s successful treatment for a brain tumour. “A year later, by coincidence, I saw my first serious neurosurgical operation and it was a genuinely epiphanic experience,” he says, “and that’s all I’ve wanted to do ever since.” Until 2015, Marsh was a senior consultant neurosurgeon at St George’s hospital in south London. The year before retiring, he published his first memoir, Do No Harm, which Ian McEwan described as “exquisitely attuned to the tense and transient bond between doctor and patient”. A second book, Admissions: A Life in Brain Surgery, followed in 2017 and a third memoir (less medical, more “philosophical”) is under way. Marsh, who lives between London and Oxford with his wife, the author Kate Fox, continues to perform neurosurgery in Nepal and Ukraine, where he has worked since the early 1990s.
What compelled you to write Do No Harm?
I’ve always kept a diary but never thought of publishing until my wife read a bit of it and said: “That should be a book.” A literary agent said the same, so I spent the next 10 years rewriting my diary and telling stories.
Why do you think medical memoirs have become such a hit with the reading public?
There have been lots of medical memoirs in the past but, dare I say it, mine was the first one that talked about doubt and uncertainty and bad results. As junior doctors, we learned never to show our feelings, even though you’re often extremely anxious. And so, traditionally, medical memoirs were rather boring, and only talked about success and glossed over the difficult bits. But I think we live in a society of less deference, and there’s more and more critical reporting now about doctors and nurses. I didn’t realise this at the time, but I was, in effect, trying to tell the other side of the story, that, actually, doctors are human beings. We make mistakes, we get anxious, and being responsible for other people’s lives seems very wonderful but it comes with an enormous price.
What do you think of politicians going into hospitals on the election trail?
I find it pretty contemptible. The fact of the matter is, healthcare costs all over the world are going up, because more people are living into old age, and old age is expensive medically. This country spends less on healthcare as a proportion of GDP than all countries we would consider ourselves on a level with, such as Germany and Holland. So I wish the politicians would be a bit more honest and tell people, if you want high-quality healthcare, you’re going to have to pay more money.
Is there a country you think we could look to?
The problem is, all healthcare systems reflect their underlying society. Why the American healthcare system is so bad, in the sense of terrible life-expectancy figures, infant and perinatal mortality figures, is because of profound inequality. Scandinavian countries have very good healthcare systems, but they’re the most equal societies in terms of wealth and income. So to say we’d like to have a system as good as the Scandinavian ones, we’re really saying we want a society as reasonable and fair, with as strong a welfare state as the Scandinavian countries have.
What will Brexit do to the NHS?
It won’t help it, that much is clear. There’s already a huge shortage of both doctors and nurses. And I’m very worried about trade deals with America. I am worried about drug pricing and caving in to the pharmaceutical companies – they’re not altruists, they’re businessmen, and there’s no market economics in setting drug prices, it’s all power politics.
What single thing would improve the NHS?
There’s no easy answer to that, but it is underfunded. Having said that, the Labour government under Blair and Brown threw money at the NHS but mainly by lashing out on PFI [private finance initiative] contracts, which were very poor value for money. I think you need some kind of long-term commitment to put more money into it. And I might be naive, but if doctors had more autonomy again within the NHS, I think that might help a bit.
What is the best book – fiction or nonfiction – that you have ever read about hospitals and the medical profession?
I’ve just read a book by the palliative care doctor Rachel Clarke called Dear Life, which is coming out in January. It’s about death and dying, and about the death of her father, and I think it’s a very powerful book.
Who is your favourite fictional doctor?
I like Mikhail Bulgakov’s short story collection A Country Doctor’s Notebook. Bulgakov was a country doctor in the Russian countryside during the first world war. I like the rawness of it, and the fact that he admitted to being so terrified half the time, having to deal with medical emergencies on his own.
What’s the worst thing you’ve ever seen happen in a hospital?
Mistakes I’ve made, because I feel responsible for them. In neurosurgery, which is so serious and where there are so many bad results and deaths, the difficulty is not getting inured to it, not getting a bit institutionalised and desensitised to the reality of what’s going on. Also, the times when I spoke very badly to patients and families.
Do you think that was down to stress?
Usually, but also sometimes just laziness or being in a hurry or being a bit muddled. What I’ve learned is that talking to patients – it’s a cliche – is all about listening. Saying as little as possible but never appearing to be in a hurry. But I found that very difficult, it took me a long time. And one of the great problems in medicine is that, when you talk to patients, you never get any feedback afterwards, so how do you get better, if you never know how you come across? I think most doctors, including myself, have a rather rose-tinted view of how they are.
Do you have a good tip for staying healthy?
Get lots of exercise. I try to run and do exercises every day. My gloomy, anxious, depressive nature is greatly helped in the short term by running, but the only problem is, I’m now almost 70, and it does become more of an effort. Having a busy social life and a sense of meaning is important, too, because life by my age is not about how long you live. That’s irrelevant. The question is whether you still have a sense of purpose.
Killian Fox
Christie Watson: ‘The NHS is not failing, it’s being failed’
Christie Watson became a nurse at the age of 17. She trained at Great Ormond Street Hospital and spent most of her 20-year nursing career in paediatric intensive care. In 2011, after taking an MA in creative writing at the University of East Anglia, she published her first novel, Tiny Sunbirds Far Away, which won the Costa first novel award. Her memoir – The Language of Kindness – was published in 2018 and detailed some of the most challenging moments in her life as a nurse.
Why have medical memoirs become such a hit with the reading public?
We are living in politically chaotic times and I think people are searching for meaning and connection. Medical memoirs are about all of us; they are about life and death and everything in between. Every single one of us is going to be touched at some stage by illness, loss or grief, and understanding that we’re not alone at those times is a wonderful thing. These books remind people of what’s important: faith and tolerance and respect for every single human being.
What’s the best or most surprising reaction you’ve had to your memoir?
The best thing has been the sheer volume of people writing me letters and contacting me on social media who just want to share their stories. Sometimes I get a message about someone’s terrible day. They just want to tell me what they’ve been going through. It’s also striking how many student nurses contact me to say they have been struggling with their mental health. That happens a lot. I obviously then refer them to professionals or the Samaritans.
What do you think of politicians going into hospitals on the election trail?
It’s infuriating but it’s what politicians have always done pre-election. You see them with babies and dogs, going into hospitals and giving out lots of rhetoric about how they are going to transform the NHS. But I don’t think Boris Johnson turning up at the A&E ward is going to change the public perception of how bad things have become since austerity was introduced. The truth is, the NHS has been desperately underfunded and the staffing situation, particularly with nurses, is horrific. The NHS is not failing, it’s being failed. And the public can see the staff working their absolute hardest. Patients deserve better and staff deserve better as well.
Are you worried the NHS is creeping towards privatisation?
It’s not creeping, it’s marching. The number of NHS patients being sent to private hospitals at the expense of NHS trusts because the NHS is too busy and understaffed to cope with them itself is growing all the time. And the contrast between the private and the public sector is shocking. I remember borrowing a blanket from a private patients’ wing in an NHS hospital and taking it back to an elderly ward I was working on because the NHS patients didn’t have any blankets. In the private wing there were plump pillows and fluffy towels on the bed and Molton Brown products and a massive menu. Back in the elderly ward the patients were being fed slop, frankly, and shivering.
What single thing would improve the NHS?
More staff. We’re 42,000 nurses short in England and due to the bursary for student nurses being scrapped two years ago that number is going to get worse. We need safe staffing legislation: there should be a minimum number of nurses per shift per patient. The Brexit vote hasn’t helped at all. Five thousand EU nurses have left the NHS in the past three years and we desperately need those nurses. Some of the best nurses I’ve worked with and some of the best doctors are from the EU.
What gives you hope for the future?
The fact that the NHS is one of the most incredible organisations in the world and the people who work for it, despite the pressure they are under, provide the absolute best care, compassion and kindness to people every single day.
Who is your favourite fictional nurse?
Hana from The English Patient by Michael Ondaatje. She is such a complex character, a young nurse who is at times childlike and innocent yet also stoic and tough. She wants to believe the best about difficult people and somehow manages to be non-judgmental. Despite dire circumstances and personal trauma, she rolls up her sleeves and gets on with it, reminding the reader that nurses are soldiers too.
Do you have one tip for staying healthy?
The biggest health crisis we’ve got in this country is in mental health. So safeguarding your mental health is the most important thing you can do.
Gregory Robinson
Adam Kay: ‘I think it’s shameful that the NHS is used as a political pawn’
Adam Kay is a former junior doctor who left the profession in 2010. While working as a specialist in obstetrics and gynaecology, he kept diaries of his experiences, which he later realised were his form of therapy to deal with difficult experiences. In 2017 , those diaries formed the basis of his bestselling memoir, This Is Going to Hurt, which has sold more than 1.5m copies and won him a host of awards. His live show based on the book has been selling out at theatres around the country for the past year. Kay has been an outspoken advocate for junior doctors receiving greater emotional and psychological support, and for the NHS to be free of party politics. Last month he published his second memoir, Twas the Nightshift Before Christmas.
What made you want to become a doctor?
You decide to be a doctor when you’re 16, when you choose your A-levels, which is a very bad age to decide anything. I was from a family of doctors and went to a school that churned out a lot of doctors, and that seemed to be enough.
Why did you write This Is Going to Hurt and Twas the Nightshift Before Christmas?
When the junior doctors came under fire from the government a few years ago, and after they lost the battle, I realised that the public might benefit from knowing more about what doctors do: for example, that they’re not, in fact, in it for the money.
Why have medical memoirs become such a hit with the reading public?
We are – and always have been – obsessed with the human body and the exciting ways in which it will malfunction. It’s difficult to find an evening when there aren’t at least a couple of medical shows on television. A huge amount of our media boils down to medicine, crime and sex.
What do you think of politicians going into hospitals on the election trail?
I think it’s shameful that the NHS is used as a political pawn. I think it’s crucial that politicians know what it’s like on the frontline, but that’s very different to rocking up for a photo call with a list of empty promises.
Are you worried the NHS is creeping towards privatisation?
I am. I think it’ll be a slow, insidious process. I think the danger of Brexit is not that the NHS is “for sale” but that all the drugs we rely on will be [for sale], and that the cost of buying these drugs at inflated tariffs might be what pushes the NHS from being just about able to run on its reserves to not at all.
What single thing would improve the NHS?
Money. The NHS has been systematically starved of funds for the best part of a decade. We’re short 100,000 members of staff. We need to invest in the NHS and that probably involves, I’m afraid, putting our hands in our pockets.
What is the worst thing you have ever seen happen in a hospital?
I was drawn to working on labour wards for the height of the highs without ever appreciating quite how low the lows get. All you ever want is a healthy mum and a healthy baby. I’ll never get over the days I ended up with neither.
What is the best book – fiction or nonfiction – that you have ever read about hospitals and the medical profession?
Atul Gawande’s Complications.
Who is your favourite fictional doctor, nurse or medic?
I always modelled myself on Dr Nick from The Simpsons.
Do you have one tip for staying healthy?
In 10 years’ time we will know an awful lot more about the connection between what we put into our bodies and serious diseases such as cancer. But you’re probably on firm ground cutting out meat and processed foods.
What gives you hope for the future of the NHS?
How loved it is and how hard I believe people will fight for it when they are inevitably put in the position where they have to.
Hannah Beckerman
Joanna Cannon: ‘People who write promises on buses should be held accountable’
Joanna Cannon is a former NHS junior doctor specialising in psychiatry. She left medicine in 2015 to become a full-time writer, and her two novels to date – The Trouble With Goats and Sheep and Three Things About Elsie – have both been bestsellers. Her recent memoir, Breaking and Mending: A Junior Doctor’s Story of Compassion and Burnout, argues for a wider sociodemographic pool in medicine and more emphasis on the value of compassion during training and on the wards.
What made you want to become a doctor?
I was drawn to medicine because it’s all about stories and people: everything in medicine rests on a narrative.
Why did you write Breaking and Mending?
I thought very hard about it because I didn’t want to put people off doing medicine and I didn’t want to scare people who are in hospital. But I think it’s important to be honest and to talk about the bad as well as the good.
Why have medical memoirs become such a hit with the reading public?
Medical memoirs show that we are now interested in the lives of people around us who we might not have thought about before. And I think you don’t realise how important something is until there’s a chance of losing it – and there’s a very big chance of losing the NHS.
What single thing would improve the NHS?
I think people who write promises on the sides of buses should be held accountable for them. And if the people making the decisions about the future of the NHS were actually aware of life at the coal face then they would be perhaps more mindful of the decisions they make.
What is the worst thing you have ever seen happen in a hospital?
The whole system is upsetting and distressing because it’s broken, but it’s the individual stories that sadden me: they illustrate how fragile everything is. You walk past beds full of bewildered people and you just haven’t got the time to talk to them. And that’s tragic.
What single thing would have made your life as a doctor better?
Someone to talk to. Junior doctors are very isolated. You need someone to offload to because you’re collecting all this misery as you walk through your day and you have nowhere to put it. You need to put money into supporting the people who hold the NHS together. And this is perhaps why medical memoirs are so important: finally people are realising what it’s like at that coal face.
What is the best book – fiction or nonfiction – that you have ever read about the medical profession?
The Shock of the Fall by Nathan Filer. It’s an amazing book that fully illustrates living with mental health problems and life on a mental health ward.
Do you have one tip for staying healthy?
Be kind to yourself. We feel self-care is self-indulgent. We need to make space in our days for things that keep our minds quiet.
What gives you hope for the future of the NHS?
The people in it. The people who are going out to work now, who are going on to understaffed, underfunded wards full of small tragedies that they try to fix. And they do it every day, without any acknowledgement. These are the people who give me hope because they’re the people who glue the NHS together and without them it would fall apart.
Hannah Beckerman
Stephen Westaby: ‘Politicians saying an extra few bob is going to make a difference to the NHS is complete rubbish’
Born in Scunthorpe in 1948, Prof Stephen Westaby resolved to become a heart surgeon aged just seven, following the death of his grandfather from heart failure and after watching the BBC medical documentary Your Life in Their Hands. He started training as a surgeon in 1974 and later set up the Oxford Heart Centre at the John Radcliffe hospital in Oxford. By his own estimation, Westaby performed more than 11,000 open-heart operations over a 35-year career. He also helped develop an artificial heart pump, the Jarvik 2000, which broke records by keeping a patient alive for 1,513 days.
Westaby wrote his first memoir, the Costa-shortlisted Fragile Lives, shortly before retiring in 2016 – the Times said it “reads like a thriller, except with rather more corpses”. He followed it up with a second memoir, The Knife’s Edge, in March this year. Westaby is married to Sarah, a former nurse, and lives in the Cotswolds. “The development of heart surgery is the great romance of the 20th and 21st centuries,” he says, “and I had the great privilege of living all the way through it.”
Why did you decide to write a memoir?
I wanted to show kids that they could come from a very underprivileged background and, if they made the effort, do whatever they liked. Nobody in my family had ever been to university before, never mind a medical school, but I had grim determination to succeed. I also felt I needed to show what could be achieved with modern life-saving technology – I spent the latter part of my career developing technology that would be equivalent to an off-the-shelf heart transplant.
There was a further reason. When the newspapers started publishing surgeons’ death rates, the profession was intimidated, and became risk-averse, so patients suffered. Why get yourself into trouble by operating on the sickest patients? I argue that the best surgeons were bound to get the highest death rates because they operated on the sickest patients – you may succeed or you may not, but that’s what pioneering is about.
What do you think of politicians going into hospitals on the election trail?
Politicians saying an extra few bob is going to make a difference to the NHS is complete rubbish. It’s the system that’s the problem. The NHS offers what I call secondhand-shop healthcare: what you get is determined by cost, and even the time a patient has with their GP is rationed. The UK’s cancer death rates are worse than other places, not because we don’t have great doctors, but because of the system. And why should we have more overseas doctors registering per year than British trainees? Why can’t we train our own medical and nursing staff?
What would you do to improve the NHS?
I’m not saying you’ve got to privatise it. One positive step would be reintroducing rehabilitation. In Germany every patient that has major surgery goes to a rehabilitation hospital for a period afterwards. In the UK, rehabilitation hospitals have been abolished, so we can do fancy operations on people, but they suffer because they don’t make the sort of recovery that they could with a simple adjunct. Getting the government to adopt a simple raft of measures that would need some initial investment could transform the way the system works.
Have you read many books about the medical profession and does any one stand out?
I thought Henry Marsh’s Do No Harm was good. But a substantial amount has been written that is overemotive and not objective. I used to have to tell parents that they’d lost their child, and that’s not something that you can do and be emotional about – you’ve got to put it aside. It doesn’t stop us being empathetic, but you do need a detachment.
Do you have one tip for staying healthy?
I recommend exercise. I’ve got a lovely dog that I walk for an hour every morning. I used to play a lot of rugby, but I kept having accidents. In fact, one bad head injury from rugby completely changed my personality. I lost fear and inhibition, and that meant that, as a surgeon, I would do cases that were way out on the edge.
Killian Fox
