Neurosurgeon Henry Marsh: Hard to imagine anything more repulsive than Putin's conversation with Xi Jinping about organ transplants for eternal life

Henry Marsh is a neurosurgeon, writer, one of the most candid voices in modern medicine and a genuine friend of Ukraine, Marsh first came to Kyiv in 1992 – almost by accident. What started as a chance trip turned into a decades-long relationship with Ukrainian doctors and hospitals.

Over the years, he brought surgical equipment in his luggage, lectured young medics, operated side by side with Ukrainian colleagues, and became a part of the country's medical history, pioneering brain surgery in Europe using only local anaesthetic.

Now 75, Marsh is living with cancer and reconsidering his relationship with death. He continues to visit Ukraine – not to operate, but to teach. To teach not just how to hold a scalpel, but how to be a better doctor, and perhaps, an even better human being.

With members of the UP Club, we met Henry Marsh at the Ukrainska Pravda office in Kyiv. Our conversation began – fittingly – from the beginning: from that first visit to Ukraine in 1992, which changed not only his life, but, in a small way, ours too.

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"Ukraine is an important country"

Let's start from the beginning – from 1992. This was the first time you came to Ukraine. As you wrote in your book, it was a coincidence that you arrived here.

It was purely a random chance, really. An English businessman who had studied Russian set up a business importing British medical equipment to the Soviet Union. After independence, because there was a famous Romodanov Neurosurgery Institute in Kyiv, he thought it would be good to take a British neurosurgeon with him to give lectures on modern neurosurgery. It would create goodwill and help him sell medical equipment.

Although I knew medicine in the Soviet Union was very backward compared to the West, I was nevertheless amazed at just how bad it was. And because everything was much worse in the first few years after independence anyway because the whole economy had collapsed.

I said, "Well, look, you know, I will come out to Ukraine once or twice a year with equipment – operating microscopes I can find, second-hand things like that". I stopped working about 10 years ago – I no longer operate in England or anywhere, I'm 75 years old.

But I spend most of my time when I come here giving lectures to young doctors and medical students, which I've been doing over the last few days in Ivano-Frankivsk and Poltava and here in Kyiv.

It feels that you didn't fall in love with Ukraine at first sight. You mostly write about poverty, about bad conditions in hospitals. What made you come back for a second time?

I think I understood right from the start that Ukraine was a very important country on the borderland between Russian autocratic kleptocracy and the more free democratic abd semi-democratic countries of Western Europe.

And although the work was sort of medical, I thought I was trying to introduce more modern concepts of openness, honesty, learning, and less hierarchical medical practice. I was disappointed in that eventually, but since then I hope I've made some progress in that direction.

Of course, initially, when I came back to England from being in Ukraine, people said, "Where is Ukraine? Isn't it Russia? And why are you spending all this time and money going to Ukraine?" And I'd say, "It's an important country." I think I was thought of as not mad, but eccentric. But now, of course, I can say, "Well, I was right. I told you so."

So, you travelled to Ukraine twice a year instead of spending holidays with your family.

Not really. No. When I was working for the UK's National Health Service, the NHS, which I I was working about 60 hours per week. I had six weeks of holiday a year. And three weeks I would spend with my family. The other three weeks, more or less, I would spend in Ukraine.

How did your family take this?

Well, I think they accepted it, but the first marriage ended eventually. I'm very lucky – I have a very good relationship with my three children, who are all now in their forties, and I have four grandchildren. I try to be a better grandfather than I was a father. I think I'm very lucky. I'm on good terms now with my first wife as well, we both married second times. But there was no question of the fact that my work-life balance, as we say in English, was an issue.

There was no question of the fact that for most of my working life, there was no balance – it was all work first, and that included coming to Ukraine. In one sense, it was very selfish and egotistical of me, but in another sense I was trying to make the world a better place.

How, from your point of view, Ukraine has changed through these 30 years?

Well, it's changed enormously. I mean, it's changed. First of all, medically, there's been great progress, though there are still lots of problems. But I think the biggest change, of course, is a new generation of young people. You have access to the internet, you have access to the rest of the world, and they can see that there is a better way of doing things than the old Soviet Russian way.

"We learn much more from failure than we do from success"

You've just come back from a lecture at the university. What did you tell the students today?

Today I was talking about my favorite subject, which is about all the mistakes I made when I was a surgeon.

Tell us a little bit about your mistakes too.

There were many of them. The point is, medicine is dangerous. It is not safe. We are dealing with life and death, and some branches of medicine like neurosurgery are inherently very dangerous. You have to accept that because we are human beings, we're going to make mistakes. And the challenge is to learn from these mistakes, to try to stop them from happening again.

But the trouble is that the consequences of the mistakes can be so terrible, and the loss of trust patients have in us as doctors is so painful – both for the patients and the doctors. The tendency is always to hide mistakes, deny mistakes. And if you do that, you will not learn, you will not make progress, because most progress – in all aspects of life – we learn much more from failure than we do from success.

And this is what I was talking about today at Dobrobut. And I illustrated this talk with brain scans and illustrations of patients I harmed or even who died because of the mistakes I made. So, this is a version of a talk I gave two weeks ago in Vienna, in Spain and Santander. When I get back to London next week, I'll be giving it at a hospital in England. So, this is my sort of specialty – talking about my failures.

My books are partly about this, and I think that's one reason why they're being successful – because it is slightly unusual for doctors to be so painfully honest as I have been. And of course, there is a paradox here to stand up in public and say, "I make mistakes". You have to be very self-confident, as of inner self-confidence.

Where I get that from, I don't know, but it's partly because I'm retired. It would be more difficult to say these things in public if I was still working. But having said that, my first book was published in England before I retired, and patients would come and see me in my outpatient clinic clutching my book, asking me to sign it. I'd say, "I recommend you read the book after the operation rather than before it."

"The question is not about death being terrible – it's a question of the quality of the death"

You write very honestly about your mistakes in your books, and also you write very honestly about the inseparable presence of death. Here in Ukraine, we also feel the presence of death – even if we don't wish to. However, the question is: what's your relationship with death now, after all of these years of work?

Well, the strange thing about that is that, as I went through the years of my career, I would often see terrible things happening. In fact, every day I'd see terrible things happening to my patients. And yet, at the same time, it never stopped me from being bothered about my bank balance or trivial things like that. You know, it was there, but I had to detach myself from what I saw at work. So, it didn't really teach me that much wisdom.

I learnt a lot at the beginning of my career. My baby son had a brain tumour, which he survived – very unusually. And that was a very intense experience of what it is like to be the parent of a child who comes close to death. I think that probably made me a better doctor, but it's hard to judge. You would have to ask my patients and their families.

But it was really only when I became a patient myself that I really understood. Well, that's not true because my second wife is an anthropologist with Crohn's disease and has often been in hospital and has been very ill. But as an anthropologist, she is a trained observer of human beings. We met 25 years ago. She explained to me that being a patient is a horrible, frightening, intimidating, humiliating, demeaning, disempowering experience. And, believe it or not, most doctors don't realise that. They don't realise that actually our patients are frightened of us. It's a very very uncool relationship. And this easily corrupts doctors into lacking sympathy and lacking care. It's such a common observation that when doctors themselves become patients, they understand. I didn't really understand what my patients were suffering until I became a patient myself.

And does your perception of death differ from your feelings here in Ukraine?

I'm 75 years old. I have cancer. It hasn't killed me yet – it probably will, but something is always going to kill me. My brother, who I'm very, very close to, is dying from oesophageal cancer at the moment, he's 78. The fact of the matter is, we live to old age. The question is not about death being terrible – it's a question of the quality of the death: how much you suffered, and, above all, whether you lived a good life, whether you did good things. In the Christian or Catholic tradition, these would be your good works. Death is always sad, but we all have to die, and we should not get too worked up about people dying when they're in their late seventies or eighties. That's natural – it's part of life.

What is quite different is when young people die or children die, and, in war, the deaths of so many young men and women at the front. That is terrible. Those are wasted lives, and the fact that these lives are wasted is because of the ghastly greed and ego of the man in the Kremlin. That conversation overheard between Putin and Xi Jinping – talking about organ transplants so they could live forever – I mean, I cannot imagine anything more grotesque. And then Putin is killing tens of thousands of young Ukrainians, hundreds of thousands of young Russians just for him, and that's awful. It's obscene, disgusting.

Do you believe that in the future people will live longer?

Not Putin. It's Silicon Valley businessmen who invest in old age research. We know that aging is under genetic control. The Galapagos tortoises live up to about 300 years. The Greenland sharks and bowhead whales lived up to 500 years old. But they do live very slowly, at the speed of tortoises. So it's one thing to say that aging is under genetic control. It's another thing to say that we can hack genes for people to live longer.

I think doing research that will get people to live to 150 years old is a really bad idea, because only billionaires will be able to afford it and it will only worsen the inequality, which is becoming such a cancer growing in many societies, particularly in Britain and America, where wealth and inequality gap is getting worse and worse.

We don't need billionaires like Musk. There's no reason why they shouldn't pay higher taxes. Anyway, that's another story.

So it's possible that research will come up with ways to live longer. There's a lot of hype about AI. You know how silly Silicon Valley is. Fake it till you make it. In other words, you say "I've got this great idea – please give me billions of dollars and then hopefully I'll make the idea a reality."

The joke of course about Jinping and Putin is that they were talking about organ transplants. And of course you know that in China prisoners have been executed and their organs used for transplants, which is rational but not very attractive. But you cannot do brain transplants. And as I said, by the age of 85 we have a 45% risk of Alzheimer's. So you might have Jinping and Putin with fresh young kidneys and blood transfusions from young people and liver transplants and lung transplants, but with a rotten brain. A bit like Brezhnev, the old Soviet leader.

You also write about aging, especially brain aging, and you mention that our external changes are less visible than our internal changes. Nowadays we have different methods to become younger, to fight wrinkles. Do you have any suggestions about how to keep our brains young?

We know that early childhood has a big impact on how long you live and on your health. If you have what are called adverse childhood events, if you've grown up in a bad family or a bad orphanage, abuse, violence, drugs, you'll die younger and have worse health and your brain will not develop well. We know from studies of orphans in the Romanian Ceausescu Orphanages that these kids have smaller brains and lots of serious psychological difficulties when compared with children who grew up in normal, loving families.

So your early childhood has a huge impact on how long you live and your health. Well, we do know, for instance, with Alzheimers or dementia, your risk... I mean, the older you get, the higher the risk. By the age of 85, we have a 45% risk of developing Alzheimer's. So you can never escape it, but lifestyle factors have about 30% influence on your risk. Which is basically exercise, not being diabetic, not smoking, not drinking too much and having higher education.

This has been shown with international studies. People who've been to university have a lower risk of Alzheimer's than people who haven't. I mean, there are many possible reasons for that, but one is, the cerebral reserve theory that if you studied more at university, well, you don't have a bigger brain, but you have more connections in your brain, and therefore, it takes longer for the brain, like a battery, to run down. Whether that's true or not is not certain.

So lifestyle is important. When you're stressed, things like that have a bad effect as well.

"We all break beyond a certain point"

So how will the war influence Ukrainians in this context?

Well, I mean, it's a unique experiment because there has not been a war in Europe like this for a long time. Obviously there'll be a big problem with post-traumatic stress disorder. We know a little bit about post-traumatic stress disorder from scientific studies on many American and some British soldiers in Iraq and Afghanistan.

We know that if you had psychological problems before combat, you're more likely to have PTSD. We know that good leadership is very important. In good leadership, soldiers are less likely to develop PTSD. But we all break beyond a certain point, you know? All, all, all soldiers will have a breaking point at some point.

Of course, in America with Vietnam when PTSD was first identified, the problem was amplified because the soldiers came home and nobody wanted to know about them.

The war was a bad war. At least when Ukrainian soldiers come home, they know they were fighting for the right cause. But the circumstances here – obviously the reconstruction of Ukraine after the war – are big, big problems. And again, the effect on children, we know that war affected kids in Gaza, for a start. There is a generation of Ukrainian children who will have been profoundly traumatised by the war. Even their education will have been disrupted. So there will be many, many long-term effects.

In your books you write about different kinds of tumours which sometimes are really scary. In some cases you decided not to do surgery because it would have made the life of the patient worse. When you made this decision, what did you feel and how did you make this decision?

Well, it's complicated, because there are many different things. I'll illustrate it instead by talking not about tumours, but about hemorrhages in the head. These might be from trauma, from a bang on the head, or they can be from blood vessel problems or a stroke. And if there is a large blood clot developing, the skull is like a sealed box, and if there is a large blood clot developing in the brain, it will press on the brain and often kill the patient. The problem is that often the blood clot has developed because a large part of the brain has been irreversibly damaged.

So if you operate to take the blood clot out, to relieve the pressure on the brain, the patient is more likely to live, but they'll certainly be left very disabled. If you don't operate, they'll almost certainly die, but they may just survive. But in either case, whether you operate or not, the patient will be left disabled. And these patients are often admitted as emergencies in the middle of night. I'd be in bed, my junior doctors would be in the hospital and they would ring me up at night and send me the brain scans over the internet and I would look at them. And if I said, "Don't operate, let the patient die", I'd find it very hard to get back to sleep again, because I would be worried I might be wrong.

Or if I said, "Go ahead and operate", and I could get back to sleep. By operating, it makes it easier for you in the short term, but you may end up leaving a patient alive but terribly disabled.

Life is about more than just being alive when it comes to brain damage.It is very difficult, and in modern medicine I feel very strongly that we treat too many patients in brain surgery. We keep too many people alive where the patients themselves would not want to live, but they have no choice.

You have to talk to the family. If you say to the family, "If we don't operate, the person you love will die. If we do operate, they'll probably survive, but be very disabled." You are saying, in effect to the family, "Do you love this person enough to look after them even though they're very disabled?" And, of course, the families say, "Yes, you must operate."

But these are very difficult questions. You never really know whether you made the right decisions or not.

"Support for Ukraine remains unquestioned in England"

Before helping Ukrainian doctors to provide surgeries in Ukraine, what impressed you most about hospitals, surgeries and your colleagues here?

I've always been impressed by the inventiveness and resilience of Ukrainians, both medically and in the broader sense. And how good you are at helping each other when you do not have great confidence in the state or authorities.

So, there are very strong social networks which we see, of course, with all the voluntary support for the soldiers at the front line. The word you read in the Western media by people who come here is the "resilience" of Ukrainians, and, of course, if you know a little about Ukrainian history, as I do, you understand that there is this resilience because the history of Ukraine is written in blood and suffering and oppression for hundreds of years.

During your first visits, you brought second-hand medical equipment?

A lot, yes. Loads, vast amounts. Yes.

And returning to today, you support not only Ukrainian surgeons, but also support Ukrainian soldiers. I saw photos of the car that you bought.

Oh, yes. Well, I bought it. Some friends said they were trying to buy a car for some soldiers up front, so I got some money together with the help of friends. We drove a 4x4 to Kyiv with some frontline guys. That was nice.

I think we must all do what we can. Support for Ukraine remains unquestioned in England at the moment.

Without wanting to sound too pessimistic, I am worried about the political events in Europe over the coming years with the rise of anti-migration, right-wing politicians. Migration is irrelevant to the problems, which are really economic problems in Europe.

The horrible populist politicians often funded by Putin are trying to make something out of it..

And how do you think popular support for Ukraine is in the UK right now after three and a half years of the full-scale invasion?

Well, you cannot hear any voices, politically or in the media, of anybody questioning support for Ukraine.

Maybe that will change, but I mean, no politicians are saying you must stop supporting Ukraine. Nobody at all. And I think that will continue. Britain, for all its faults, has a strong tradition of supporting what we call "underdogs". It's this strong sense of fair play. You know, most of the international sports – football, rugby, tennis, cricket, whatever – all came from Britain. Obeying the rules and fair play is very much part of our culture, and it is clear that the invasion of Ukraine is utterly wrong.

So I think support for Ukraine will continue. If in four years' time, we have a far-right government, God help us, I don't know. But that four years is a long way away.

"Hope is one of the most powerful drugs we have"

In your book you give your thoughts on how to be a neurosurgeon, and in some ways it's similar to being a journalist too. We both have to find a balance between compassion and the need to stay detached, especially now during the war. How do you manage this balance?

Well, with difficulty. That's my answer.

It was funny giving a lecture on this balancing business a few years before the pandemic to a group of neurosurgeons at Ann Arbor, the University of Michigan and Illinois. The wife of one of the neurosurgeons came up to me afterwards and said she worked in the State Department under Barack Obama. And everything I said about neurosurgery applied to diplomacy and working in the White House.

And these are the problems of life – individualism versus team working, compassion versus detachment. It's just in medicine, in particular in neurosurgery, it's very in your face because, you know, patients are dying or coming close to it, so it's very real. But yes, I think that's one reason that my first book was popular, because it's really all about living rather than just about brain surgery.

You have said, "empathy can be compared with hard physical work, and it's natural to look for ways to escape it." At the same time, when you write stories about your patients, you feel a lot of empathy for them, so you didn't try to escape it, right?

Well, the more you care for your patients, the more it hurts, you know? So it's a difficult balance. To be honest, I was always frightened that my patients would feel I didn't care for them. I just had that. So it was sort of based on anxiety rather than immediate love. I find that a little bit hard to explain, but throughout my career I was so aware of how patients in hospitals get treated in this institutionalised way, but I was also fighting against it, I think.

At least, I like to think that. You'd have to ask my patients whether I really was like that. I hope I was. In the lecture that I gave this afternoon, I was saying that one of the many challenges in medicine is to treat our patients as our equals, you know? That our patients come to us with expert knowledge and skills, and they come to us as our equals to ask for our expert advice. And we should not sort of look down and be condescending towards them. And if you have that more open approach to patients, it is actually much more interesting. You have a much more interesting relationship with the patients, but it really can be difficult.

What did your patients teach you?

That it's amazing what people will put up with if they have hope. Hope is one of the most powerful drugs we have. One of my surgical teachers, when I was a student, said, "We must never lie to patients, but we must never deprive them of hope", which can be very difficult sometimes.

But that is why, as doctors, we must appear hopeful, confident, positive, caring. These are all very, very important parts of the whole surgical package. Being a surgeon is about much, much more than just operating in the operating theatre.

Part of your job is to tell people that they're going to die. Which is more difficult – to operate on people, or to give them bad news?

Bad news is much worse. Operating is easy. Talking to patients is much more difficult. And the other really difficult thing is colleagues, talking to colleagues, getting on with colleagues. Those are the difficult parts of medicine. The operating part is easy by comparison.

That sounds silly, but it's true. I was talking to a young doctor who's at Dobrobut this afternoon. The problem with talking to patients is patients never criticise you. How can we do something better in life if we don't get feedback? As journalists, people read what you write, and they'll criticise it and comment.

A lot.

A lot. As a doctor, you can talk to a patient and get no criticism or feedback at all because, as I said earlier, as patients, we are frightened of doctors. We do not want to fall apart in front of them. We don't want to upset them or doubt them in any way, which means that many doctors think they are much better at talking to patients than they really are. I would like to think I spoke to patients well.

I'm pretty sure I spoke to parents of children with brain tumours well because I've been there myself, but you never know. You never know for certain, and it's difficult to learn. You often learn most from being a patient yourself.

Alina Poliakova, UP
Editing: Shoël Stadlen