The heart-rending dilemmas of an atheist brain surgeon

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Possibly because we know so little about the workings of the body, we are fascinated in a slightly morbid way by what medical experts get up to when they deal with the frailties of human flesh. This is particularly evident in brain surgery that deals with the infinitely complex grey matter within our skulls. I have been reading brain surgeon Henry Marsh’s Admissions, a sequel to his earlier Do No Harm; I suspect that it is not a book to read if you have been diagnosed with a brain tumour.

This is because, as the author admits, surgery in this most delicate area can go wrong, despite the surgeon’s best efforts and many hours of skilled, concentrated work. Surgeons, Marsh reflects, tend to remember the times they failed rather than their successes – their “tombstones”. As in his earlier book, Do No Harm, Marsh raises the question of the relationship between the brain and human consciousness, i.e. the mind. He admits that as he has got older (he has now retired after 30 years as a consultant) he has come to realise “that we have no idea whatsoever as to how physical matter gives rise to consciousness, thought and feeling. This simple fact has filled me with an increasing sense of wonder…”

And although he adds that his understanding of neuroscience means “I am deprived of the consolation of belief in any kind of life after death” and that neurosurgeons who believe in a soul and the afterlife share the “same cognitive dissonance as the hope the dying have that they will yet live”, he has also come to acknowledge that his own nature, his “I – this fragile conscious self writing these words” is “as great a mystery as the universe itself.”

Marsh is also honest about the ethical dilemmas facing doctors today, when advances in surgery can prolong lives where, before antibiotics and modern, life-saving machinery, death would have swiftly intervened. The question he often raises concerning patients who have suffered intractable brain trauma or tumours is: should one do nothing, so that death will occur swiftly, or should one operate and thus give them several more months or longer, of suffering and severe disability? Doctors, he writes, “deal with probabilities, not certainties” and he cites one case where the patient, a young man, had suffered a massive brain haemorrhage and where, after consulting the man’s only relative, he decided not to operate.

He writes, “It’s a difficult truth that even now I find hard to accept. When I received phone calls at night about cases like this, if I told the surgeon on call to operate, I would roll over and get back to sleep. If I told him not to operate, and that it was better to let the patient die, I would lie awake until it was time to go to work.” Having to “play God” is clearly stressful, even for doctors.

Catholic teaching allows that one can refuse burdensome and futile treatment even if this refusal hastens death. Yet it is often hard for patients (and their relatives) to accept this: the will to live at all costs is very strong. Doctors also are trained to act, to intervene, to find solutions, to do something. The prospect of imminent death can be hard to face – especially in an age where a Christian approach to acceptance of death and belief the afterlife is absent.