As we age what happens to our brains? If over 70, you won’t like this

_{Dr Henry Marsh Photo: Wikipedia}

“For most of us as we age, our brains shrink steadily, and if we live long enough, they end up resembling shrivelled walnuts, floating within a sea of cerebro-spinal fluid, confined within our skull.” So wrote Henry Marsh, the brain surgeon whose book Do No Harm* set off the wave of doctors’ books we have seen in recent years. After 40 the deterioration of the brain starts; after 70 it speeds up. Our memories are not what they were, we think and walk more slowly, we will die. That’s it, Dr Marsh says. He does not believe in an afterlife. We come from stardust and return to stardust.

Dr Marsh did not want to look at his own brain scans as he grew old but did. “I was looking at ageing in action, in black and white MRI pixels, death and dissolution foretold, and already partly achieved. My 70-year-old brain was shrunken and withered, a worn and sad version of what it once had been. There were also ominous white spots in the white matter, signs of ischaemic damage, small-vessel disease, known in the trade as white-matter hyperintensities . . . They looked like some evil pox. Not to put too fine a point on it, my brain is starting to rot. I am starting to rot. It is the writing on the wall, a deadline.”

These quotes are from And Finally, Dr Marsh’s latest book, likely to be his last. He writes how he is suffering from advanced prostatic cancer, which invades the bones and can leave sufferers paralysed. Google him and you learn Dr Marsh is still alive. Not only is he an eminent neurosurgeon, he is a fine writer, one whose prose flows smoothly. If you’re like me, you forget most books three days after finishing them. But not Do No Harm. This book is unforgettable. Dr Marsh writes with brutal honesty about his successes and failures as a brain surgeon.

One case stands out. A young man, married with two daughters, presented with a tumour next to his spine. Dr Marsh had attended a conference where fellow surgeons described their successes removing spinal tumours. Influenced by his colleagues, Dr Marsh cut too deeply into the young man’s spine. Three years later visiting a hospital ward, Dr Marsh saw a young man curled up in a vegetative state. It was his patient.

“Why is it that only in old age, and closer to death, I have come to understand so much about myself and my past? We are like little boats that our parents launch onto the ocean, and we sail around the world full circle, to return finally to the harbour from which we started, but by then our parents are long gone.”

*_{If you haven’t read Do No Harm, you must. It is fascinating, shocking and unforgettable}

Dr Marsh moves on to the matter of death, which awaits us all. “As a doctor I have seen many people die, some well and some badly. There are many ways of dying. It can be fast, or it can be slow, it can be painless or painful, it can be horrible, even in the modern age (whatever some palliative care doctors might claim to the contrary) or a peaceful fading away. And sometimes it is dragged out with intensive care and resuscitation, which is all too easily can become a charade, a dance of denial. But only rarely is dying easy, and most of us now will end our lives in hospital (only a few of us die in hospices), in the care of strangers, with little dignity and no autonomy. Although scientific medicine has brought great and wonderful blessings, it has also brought a curse — dying, for many of us has become a prolonged experience, even if severe pain is rarely a problem. Further more modern diagnostic technology can predict our decline and death a long time in advance — just as it has done with me — while we are still relatively well and independent. Of course, we all know that death is inevitable . . .”

Dr Marsh is an advocate of assisted dying, a blessing we are unlikely to be allowed in Hong Kong, a conservative society.

Do No Harm: Stories of life and death and brain surgery by Henry Marsh – Phoenix (2014) ISBN-10: ‎ 178022592X ISBN-13: ‎ 978-1780225920

And finally: Matters of life and death by Henry Marsh – St. Martin’s Press (2023) ISBN-10: ‎ 1250286085 ISBN-13: ‎ 978-1250286086