About a year and a half ago while doing research on the brain, I stumbled across the trailer of a documentary called, The English Surgeon by director Geoffrey Smith, which centers around neurosurgeon, Dr. Henry Marsh and his attempts to improve upon the primitive neurosurgical care in Kiev, Ukraine. In less than three minutes, this trailer had a profound impact on me, striking a deep chord within my spirit that still resonates strongly even to this day. While it is true that I had just begun my love affair with neuroscience because of a serendipitous moment in my life and was smitten by anything brain-related, it was the authentic humanity within Dr. Marsh that elicited my strong reaction to the film, which I have now seen no less than ten times and remains as my all-time favorite documentary.
The film catapulted my determined efforts of creating more public awareness of this neurosurgeon’s remarkable and significant humanitarian contributions to Ukrainian neurosurgical care and his professional and valiant emotional commitment to the doctor-patient relationship in hopes of inspiring all those who wish to make a difference in the world and those medical professionals who struggle with balancing compassion and detachment in their doctor-patient relationships.
In the first opening moments of the film, a brain sits in a jar of formaldehyde. It is almost inconceivable to imagine that this organ, approximately five pounds in weight, with all its folds of wrinkles containing billions of cells that make approximately trillions of connections, is the engine behind so many human functions such as: the ability to forgive, dreaming, motor skills, language, thought, memory, intellect, emotions, personality, logic, awareness, the five senses, creativity, imagination, sexual drive, love, the ability to endure, and many more.
Imagine operating on this organ with the inherent understanding that if something goes wrong, a person’s character can be crippled or completely annihilated. These are the pressures that brain surgeons face in this high risk field and through this film we step into the shoes of this extraordinary neurosurgeon, Dr. Henry Marsh, and get a taste of the internal dilemma he wrestles with every time he makes a medical decision. What we see is far from the Hollywood portrayal of ego driven maniacs who are so procedural based that the patient is dehumanized, or the neurosurgeon that is driven by money and prestige, or the one who operates under such extreme certainty, over-confident with his ‘God-like’ powers and avoids all other aspects of his humanity except the doctorial and (over-rated) favorite “logic” or “rationality”.
No. This film exposes a different type of neurosurgeon, one on the very opposite side of that spectrum. Marsh says: “It is very difficult to cross to the other side of the street. It is very difficult to know whether one is being brave or reckless or when one is being wise or being a coward.”
Marsh is transparent with his internal struggle of doubt, his conflicting inner emotions, and his fallibility even though he is a prominent neurosurgeon in England. I will argue that it is these very human traits combined with his extraordinary hands that make him a stand out in the neurosurgical arena.
Harvey Cushing, the pioneer of neurosurgery said: “I would like to see the day when somebody would be appointed surgeon somewhere who had no hands, for the operative part is the least part of the work.”
I suspect that Cushing recognized the dangerous pitfalls of surgeons behaving like ‘robotic car mechanics’ and would have been very uplifted to find an out-of-the box feeling comrade like Marsh.
There is a great challenge in medicine to strike a balance between compassion and detachment, and Marsh often finds that “doctors veer towards detachment as a way of coping with the risks involved in patient care. The patient, however, is often compromised in this scenario.”
I don’t believe that Marsh understands the word detachment as he’s so emotionally invested in his patients and in the work that he does. Yet, he struggles just as much as any other neurosurgeon in finding the perfect equilibrium. He is so devoted to his patients that on the evening before surgery (Sundays and Tuesdays) he visits them to talk about their concerns and fears because “waiting for major brain surgery is horrible.”
Marsh candidly revealed that his emotional state before surgery is a mixture of dread and excitement. In his younger years, he would often feel triumphant if an operation had gone well but experience has given him some bitter disappointments after an operation initially seemed to go well.
There is a saying by a French surgeon named René Leriche: “Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reasons for certain of his failures.”
Marsh certainly carries some battle wounds of patients who have been gravely damaged after surgery, which often happens in this high-risk field. In particular, the film highlights his deep regret over a patient’s death. While this failure haunts Marsh, it also serves as a humbling reminder of his human fallibility and the grave consequences neurosurgeons face in their operations.
US surgeon Dr. Chris Lillehei sums up failure as: "Good judgment comes from experience; experience comes from bad judgment."
Marsh also presents a very dry aspect to surgery. He wryly says: “Surgery isn’t just about rational altruism. It is a blood sport. Surgeons become surgeons for the excitement of it, for the fierce joy of operating in it.”
While this may indeed be a truth, Marsh’s humanity and desire to help those in need, are the absolute prominent driving factors in his neurosurgical care and certainly support the Hippocratic Oath that all licensed medical doctors take that says: “I solemnly pledge myself to consecrate my life to the service of humanity” or in Marsh’s own words, “What are we if we don’t try to help others? We are nothing, nothing at all.”
Dr. Marsh’s work in the Ukraine
During a visit to the Ukraine in 1992 as a guest lecturer, Marsh discovered a decayed, archaic medical system that shed light on the glaring stagnancy of this sovereign nation. The Soviet Union had collapsed just a few months prior and while the Ukraine was now an independent state, it was in the process of figuring out just how it would operate as a standalone entity: Post Communism. In the process of this learning curve, the country had a catastrophic economic collapse resulting in unemployment and high inflation. “It was as if the entire nation was out of work,” Marsh said. The working conditions of hospitals he visited were horrifically primitive. Operating conditions were dire and there was inadequate equipment to treat patients as well as a lack of proper training. The Neurosurgical Research Institute, where he visited, “smelled of stale air with wisps of cheap tobacco”, corridors were dimly lit and the entire institution felt, “tired, faded and stagnant”. Marsh told one reporter that it was “like being in a horror film.”
There is no doubt that these circumstances were jarring, but instead of walking away and returning to the safe confines of his comfortable life in London; Marsh offered to roll up his sleeves and volunteer his services, believing that he could help make a difference and improve Ukrainian neurosurgical care.
The pessimist might associate this philanthropic gesture with a neurosurgeon’s stereotypical inflated ego actually having such high self-regard that he can use his “God-like powers” and be the “Western Cowboy” to help this poor suffering nation turn around their lack of proper medical care. The realist would probably recognize that this neurosurgeon acted quite recklessly with his illogical attempt of altruism considering the country’s overwhelming poor economic conditions, the stifling political canopy curbing individuals seeking change outside of the state system and the mere odds of not succeeding in this uphill battle. Finally, the optimist will embrace that Marsh reacted on pure human instinct and this passionate and determined impulse beat with goodness, efficacy and the true ability to change the status quo and make a difference.
As one could suspect under the given circumstances, Marsh’s altruism, (a phrase that makes Marsh fidget uncomfortably) was met with resistance by a Ukrainian doctor who told him that it was a waste of time and that anything he did was just a drop in the ocean. One would think that this would deter Marsh and encourage him to leave these matters for the local medical arena. After all, he had a busy practice as the senior consultant neurosurgeon at the Atkinson Morley Wing at St. George’s Hospital in London, England - one of the country’s largest specialist brain surgery units, professorial duties at the University of Washington – Seattle, and was a husband and father to three children.
The next day, Marsh met Dr. Igor Kurilets, the Director of the Spinal Emergency Department at the Kiev Emergency Hospital, who said in broken English: “Everything terrible here. Can you help?”
Marsh saw even worse conditions than what he had seen at the prestigious Research Institute. A majority of patients with severe spinal trauma and paralysis died and very raw and unnecessary operations were being facilitated routinely. Marsh describes Kurilets's department as “squalid and neglected backwater.”
That day would not only mark the beginning of a twenty-year collaboration to improve Ukrainian neurosurgical care, but a life-long friendship.
For the next three months, Dr. Kurilets became Marsh’s pupil in London but when he returned back to Kiev zealously seeking to improve the standards of neurosurgery, he was met with threats on his life and officials trying to close his department. Marsh stood by Kurilets during these turbulent times, sending him second-hand medical equipment and bringing Kurilets's junior doctors to study with him in London. He feverishly wrote articles for the Ukrainian press to help support Kurilets's efforts but was eventually "publicly condemned by every senior professor in a letter to former Prime Minister Pavlo Lazarenko with accusations of Marsh costing the Ukraine millions of hrivnas and a tremendous amount of suffering for his advice to Dr. Kurilets." (Prime Minister Pavlo Lazarenko was eventually convicted in a U.S. Court for extortion and money laundering charges.)
But, despite this deterrence, both Marsh and Kurilets forged on with their efforts, with Kurilets on the front line taking the brunt of the political bullets fired at him. Kurilets started his own independent clinic which made him a walking target and threat to state-run hospitals which were layered with bureaucratic corruption; patients often being forced to pay doctors under the table in a healthcare system that was supposed to be paid for by the state. With Marsh as his strong ally, however, Kurilets relentlessly focused on revolutionizing Ukraine’s neurosurgery.
Marsh visited the Ukraine approximately three times a year, often spending his own money, providing his services and expertise on difficult operations, and bringing makeshift equipment and second hand medical equipment in his suitcase.
Marsh saw eye-popping medical conditions with the brain that “hadn’t been seen in the West for about fifty or sixty years”. Corridors were filled with impoverished patients seeking hope that had been deemed inoperable, but could have been treated in a more developed country. Others were afflicted with large brain tumors because they didn’t have the financial means to pay for treatment. Some had delayed diagnosis because they couldn’t afford the cost of a brain scan inevitably causing grave medical conditions, which could have been otherwise prevented. Others had been told they needed an operation when an operation wasn’t necessary at all. Some were so grossly misdiagnosed that they couldn’t be saved even with the most heroic efforts. The human suffering was intolerable, tremendously burdening and emotionally taxing. But, Marsh and Kurilets plunged forward trying to save as many lives as they could.
Marsh lives by the credence that “hope is more important than anything else in life” and “whatever the risks, whatever the costs, we have to do something.” Marsh’s son had a brain tumor as a baby and he was desperate for someone to help him. As a result, he is inept at walking away from that need in others.
For over twenty years, Marsh has operated on 4-5 patients per year, performed approximately 200 outpatient consultations per year and numerous email consultations based on brain scans. Marsh and Kurilets have made tremendous progress in closing the gap between Ukrainian and Western Neurosurgical Care. There is now better training, better equipment, and better operating. Kurilets is currently introducing Epilepsy Surgery and steadfastly trying to build an independent hospital for his work. But, there is still progress to be made and setbacks are looming as the political situation in the Ukraine is in chaos and the nation is once again gurgling with corruption. State officials have become a great nemesis to Dr. Kurilets extorting him for money and imposing various hurdles on him to deter his efforts. But, this is par for the course in the Ukraine until reform is implemented and corruption is eradicated. In the meantime, Kurilets determinedly focuses on a better neurosurgical future with the help of his fellow comrade, Marsh.
In the fall, Marsh will make another trip to the Ukraine and if the pieces do fall apart a bit, you can be assured that Marsh (along with Kurilets) will pick up right where they left off trying to help and save as many lives as they can.
His efforts in other parts of the world:
Dr. Marsh’s work in Khartoum, Sudan
In 2007, Marsh tackled another part of the world: Khartoum, Sudan where he assisted two western-trained neurosurgeons in attempts to improve neurosurgical training. For three years, this devoted neurosurgeon dedicated his services to well-equipped neurosurgical units which lacked properly trained neurosurgeons. Not many obstacles can stop Marsh from helping people, but unfortunately the erupting civil war halted his efforts in 2010. To circumvent the circumstances, Marsh currently has a Sudanese neurosurgeon training with him in London. Marsh hopes that at some point, he will be able to return to Sudan and resume his efforts.
Dr. Henry Marsh has made a strong impression in this world, giving hope to those who wouldn’t have otherwise had it. He’s an exceptional neurosurgeon, an inspiring humanitarian and an extraordinary man whose work might not have been exposed to the public if it weren’t for BBC Storyville and Director Geoffrey Smith unfolding his story via a documentary. Marsh doesn’t Twitter, use Facebook, or utilize any type of personal publicist or media strategist to create awareness of all that he is putting out into the world. This old-school, quirky, bespectacled man, who rides his bicycle to the hospital, prefers to focus on the task at hand, which is helping people.
In hopes of shedding light on Marsh’s efforts, I have nominated him to be considered for CNN’s program: CNN’s Heroes: Everyday People Changing the World. Marsh humbly accepted with his usual British self-deprecating mannerisms.
I consider Dr. Marsh a hero because he has tapped into his humanity, that all of mankind was gifted with equally, but often doesn’t recognize, or put to good use for one reason or another.
He is a fine example of how to use one’s humanity, with all of its imperfections and frailties, and do good things with it.