In this follow-up to his masterful memoir Do No Harm, British neurosurgeon Henry Marsh must deal with old age and retirement after nearly four decades as a doctor. Stepping down engenders mixed feelings, and he confesses to "longing to retire, to escape all the human misery that I have had to witness for so many years, and yet dreading my departure as well" (p17).

Marsh keeps busy by spending time in Nepal training young doctors and operating. He also makes visits to the Ukraine to perform surgery and teach. He has a fondness for creating things and purchases a fixer upper cottage that he struggles to repair. Marsh recounts previous neurosurgical cases, mostly patients with brain tumors. He remembers the distress at being sued by patients. He reveals his own admission to a psychiatric hospital as a young man. Regrets, both personal and professional, are confessed.


Admissions is a bleaker book than Do No Harm. The mood is at times sad, lonely, angry, and even a bit bitter. Marsh has clearly had his fill of bureaucracy and government regulation: "Years of frustration and dismay at my steady loss of authority, at the erosion of trust and the sad decline of the medical profession, had suddenly exploded" (p48). He calls out the tension in medicine "between caring for patients and making money" (p72). He points to physician's complacency as the vilest of any medical transgression.

Yet despite the gloom, Marsh carves out a prominent place for hope in the practice of medicine. He believes our brains are hardwired for it. He recognizes that "patients want hope, as well as treatment" (p244), but cautions that decent doctors "will neither lie nor deprive the patient of hope" (pxv).

Marsh reflects on how things can go wrong in the medical field and the consequences of medical mistakes. He considers the necessary balance between confidence and humility, compassion and detachment. Medical knowledge alone is not enough. Proper judgement must accompany it. Even in retirement, Marsh remains a prudent and powerful voice about what it means and what it takes to be a good doctor.

Primary Source



Thomas Dunne Books/St. Martin's Press

Place Published

New York



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