Name: And Finally
Rating: 4.4 (24 reviews)
Author: Henry Marsh

What’s in it for me? Reassurance from a renowned surgeon.

We can’t escape aging, but can we accept it?

For most of us, the answer is no. But we shouldn’t feel bad about that. Even doctors who’ve observed the effects of aging on their patients for years can still be surprised when time finally catches up with them.

That’s the case for Dr. Henry Marsh.

In this Blink to And Finally, we find out that Marsh fooled himself into thinking he’d be an exception to the aging rule, just like many doctors before him fooled themselves. We also share in his shock and fear as he realizes he can age and get sick just like the rest of us.

The transition from doctor to patient isn’t an easy one for him. He does things he’d advise his former patients not to do, like searching for medical advice online and obsessing over his illness. He forgets to ask questions during his appointments and daydreams about horrible deaths.

Watching Marsh struggle is difficult, but it’s also reassuring. If a well-known doctor and thinker has a hard time accepting aging and illness, we can have sympathy for ourselves if we feel the same.

A Sick Doctor

A phenomenon occurs among many new medical students – they become hypochondriacs, at least temporarily. They’re convinced they have at least a dozen of the different maladies they’re studying. Eventually, they outgrow the phase and delude themselves in the other direction by believing that doctors don’t get sick, only patients do.

That’s still the mindset for Dr. Henry Marsh when he volunteers for a brain scan study at the age of 69, four years after he retired from full-time practice. Marsh is a well-known British neurosurgeon who specializes in removing cancerous brain and spinal tumors. When he views his own brain scan after a volunteer study, he’s stunned. Since he’s a doctor – and a clever one at that – and doctors don’t get sick, he expects his brain to appear young and vibrant. Instead, it’s aged and shriveled just like a normal human brain.

That same sense of invincibility has also kept Marsh from scheduling a prostate exam, even though he’s been experiencing prostate issues for 25 years. His vague plan to see a colleague for the exam is delayed again by the onset of COVID-19. The pandemic pushes thoughts of decreased urine flow to the back of his mind.

When he finally sees his colleague in the fall of 2020, the exam reveals a firm prostate that calls for more tests. Marsh is hesitant, the former doctor clinging to his immune status, but eventually, he relinquishes. The results aren’t good.

Marsh’s blood work shows he has a prostate-specific antigen or PSA level of 127, which is extremely high. Even in men with prostate cancer, the average PSA is below 20 and very few ever reach 100. Marsh conducts some hasty internet research and reads that most men with a PSA over 100 will be dead within two years.

He’s referred to an oncologist at a well-known London hospital, the Royal Marsden. The oncologist there has more bad news. As Marsh feared, he has prostate cancer. And with his PSA so high, there’s a 70 percent chance the cancer has metastasized and spread beyond the prostate. They’ll need more tests, but if it has spread, treatment is essentially pointless, and the cancer will likely kill Marsh within two years. The internet may have been right.

Returning to the Royal Marsden

When it was built in 1851, the Royal Marsden was the world’s first dedicated cancer hospital. Marsh knows the place well. Two years previously he wasn’t a patient at the Marsden, he’d given the hospital’s annual memorial lecture. He’s also operated on many Marsden patients who needed his specialized skill set.

So, when he walks in for that first visit with the oncologist, Marsh feels like he’s on familiar ground – until he’s weighed, undressed, and shuttled around to various waiting and examining rooms. That’s when his transition from doctor to patient takes hold and shakes him with fear.

Ghosts of Patients Past

Prostate cancer feeds on testosterone. Suppressing the hormone through castration can shrink the cancerous tumors. Marsh understands the methodology and the risks, but that doesn’t stop him from Googling side effects, potential complications, and life expectancy estimates. His haphazard online medical research causes the same kind of emotional swings it would for most of us. Marsh deflates with dread as he reads the worst-case scenarios and then rises with hope as he reads about optimistic outcomes.

But eventually, he turns off the computer. He knows any advice or hope he might find online can’t compare to the advice or hope he’d get from a real doctor – someone who actually cares about him, listens to his story, understands his fears, and looks him in the eye. Sadly, Marsh realizes that he wasn’t always that kind of doctor. He didn’t fully understand, or want to understand, the anxiety and unhappiness his patients were feeling.

Acceptance and Magic Doors

Not only does the cancer diagnosis have Marsh critiquing his past actions as a doctor, it also has him critiquing himself as a patient. He beats himself up for waiting on the prostate exam. He lies in bed wanting to die. He imagines grisly endings, what his corpse will look like, and his wife, Kate, sobbing beside his cold, dead body.

Fantasizing about these worst-case scenarios is actually therapy for Marsh. He works the negativity out of his system and realizes he needs to make the most out of whatever time he has left. He begins to accept the natural cycle of aging. He’s been fortunate and has lived a full life. Now, it’s time to step aside and make room for the next generations. He stops obsessing over his illness and practices daily gratitude. Fear and worry still creep into his mind, but he learns to ignore them.

Remission and Invasion

Marsh’s Oleysa stories often have a typical fairy tale ending: “And they all lived happily ever after.” But that’s not how cancer stories usually end. Even so, six months after he finishes radiation therapy, Marsh gets some very happy news: his PSA has dropped to 0.1. That’s as low as it can get. It doesn’t mean he’s cured, but the cancer is gone for now.

Marsh is thrilled, but he doesn’t enjoy it for long. Ten days after Marsh is cleared, Russia invades Ukraine. Marsh has been traveling to Ukraine and working there, pro bono, for years. He’d been operating and teaching new techniques to Ukrainian neurosurgeons, and still has many close friends in the country. He makes nightly phone calls to Lviv and Kyiv to check on his friends. Some of the calls are interrupted by the wail of air raid sirens.

Kernaussagen in And Finally