by Henry Marsh
I had been given only two weeks’ notice about the hearing – strictly speaking, the ‘deposition of evidence before a Court-appointed Examiner’. I was told that I was required to attend but there was no mention of legal compulsion. My secretary had told the woman solicitor who had sent the letter that I could not attend as I was already committed to operations and outpatient clinics. As I had heard nothing more after my secretary had told the solicitor this, I had assumed that it had been accepted that I would not be coming. It seems that the solicitor, however, decided that I needed to be taught a lesson and served me with the court order. I had some urgent cases to do, which could not be postponed. I therefore started operating at seven in the morning on the day of the deposition, at high speed, something I hate doing; nor had I slept well, as I was angry that I was being dragged away from my work in this way.
I was not going to be paid, but doubtless the lawyers would be paid hundreds of pounds, probably thousands, for trying to extract a medical opinion from me for free. I knew the business would be absurd – I had seen the patient only twice, four years ago, had no memory of her whatsoever, and the lawyers already had copies of my correspondence. I clearly would have nothing to add. So I was angry, and had already telephoned the solicitor the day before and told her so.
The law firm’s offices were housed in a huge postmodern marble and glass office block just beyond the Tower of London. I marched into the building full of righteous indignation, past the men in suits smoking cigarettes on the piazza outside, and clutching my folding bike and attaché case. I collected a laminated visitor’s pass from a receptionist in a smart uniform, pushed past the barricade of the revolving stainless-steel turnstile and ascended to the seventh floor in one of the many tall, swift lifts lined with dark mirrors. If only my hospital had such lifts – how much time it would save!
I emerged into a three-storey-high atrium, walled and floored in marble, even though already on the seventh floor. High plate-glass windows showed a panoramic view over the City towards the Lloyd’s Building and the various high and imposing office blocks around it. Having announced myself, I had to wait for a while, and looked with sour awe at the City under a clear blue sky. Babylon! I thought – the heart of an extravagant culture, consuming itself and the planet, sheathed in glittering glass. A slim and polished barrister in a light-charcoal pinstriped suit, the Court-appointed Examiner, descended the elaborate glass, steel and hardwood spiral staircase at one side of the atrium and introduced himself. He was, perhaps, just a little apologetic and thanked me for coming.
‘I am not pleased to be here,’ I growled.
‘Yes, so I heard,’ he answered politely.
He led me to an anonymous, luxurious and windowless meeting room, the furniture all in white ash and chrome, where the English QC for the plaintiff and the American lawyer for the defendants were waiting for me. The American lawyer was in his fifties and was fit and trim, with short grey hair and a designer sports jacket. The elderly English QC, however, did not look as though he worked out in a gym every day and was rather overweight, with a florid face, and wore a crumpled white linen suit and half-moon glasses.
‘Good morning gentlemen,’ I said as I entered, feeling a little superior, knowing that they were not going to get anything out of me. I sat down and after the introductions a man with a video camera read out, in a bored voice, the description of the proceedings. I was sworn in (I affirmed rather than swore on the tatty little Bible on offer) and briefly cross-examined. This could only mean that I could agree that the notes I made four years ago were indeed mine and that I had no memory of the case. The American lawyer, of course, wanted to extract my opinion about whiplash injury, but I refused to be drawn.
‘It is a medico-legal question,’ I said, ‘and I therefore have no opinion. I never give medico-legal opinions over personal injuries.’ Whether they heard the disdain in my voice or not, I do not know.
I had seen the patient and had advised against surgery. The English QC wanted me to agree that if her symptoms had not got better as I had said they probably would, it was reasonable for her to seek a further opinion. I agreed that it was.
‘Did you know,’ the American lawyer then asked, ‘that she did eventually undergo surgery on her neck?’
‘No,’ I said.
How much I could have said! I had affirmed that I would tell the truth, the whole truth and nothing but the truth, but not that I would not be economical with it. I could have explained the psychosomatic nature of whiplash injury, the nonsense written about the alleged mechanism, the fact that all the neurosurgical textbooks state that one should never operate on the spine of somebody involved in compensation litigation. They never, ever get better. Some greedy surgeon must have operated on her neck and now, most probably, her symptoms were even worse and the lawyers would be arguing over whether her disability was the result of the original trivial injury or the operation. I could have told the lawyers that they themselves were more responsible for her problems than the original minor car crash. The principal consequence of that trivial accident, and the millions of other ones like it, was not just the plaintiff’s pain and suffering, but also the Babylonian marble offices where we were now meeting. The humourless men seated round the table before me were part of the great industry of personal injury compensation, with its army of suave and accomplished lawyers and assured expert witnesses, rooting in a great trough of insurance premiums.
At the end of the meeting the American lawyer went through my CV, which he had in his hand. His face was impassive but he seemed a little puzzled by it. I am rather proud of my CV and academic record, and I thought that perhaps he too would be impressed by it and would be arguing that since an English surgeon with such a brilliant CV had advised against surgery, the operation carried out by somebody else could not have been a good idea.
‘How did you get all those prizes at college?’ he eventually asked.
‘By working very hard,’ I replied, feeling deflated. He remained expressionless – perhaps he was just bored and wanted a little distraction – but the English QC smiled.
And that was that. The video camera was switched off and the Examiner thanked me for coming.
‘Well, I’ll get on with my day,’ I said. I descended the spiral staircase, collected my folding bike from the reception desk and left.
9
MAKING THINGS
A long time ago I had promised my daughter Sarah that I would make her a table. I am rather good at saying I’ll make things, and then finding I haven’t got the time, let alone getting round to make the many things I want to make or mend myself.
A retired colleague, a patient of mine as well, whose back I had once operated upon, had come to see me a year before I retired with pain down his arm. Another colleague had frightened him by saying it might be angina from heart disease – the pain of angina can occasionally radiate down the left arm. I rediagnosed it as simply pain from a trapped nerve in his neck that didn’t need treating. It turned out that in retirement he was running his own oak mill, near Godalming, and we quickly fell into an enthusiastic conversation about wood. He suggested I visit, which I did, once I had retired. To my amazement I found that he had a fully equipped industrial sawmill behind his home. There was a stack of dozens of great oak trunks, twenty foot high, beside the mill. Eighty thousand pounds’ worth, he told me when I asked. The mill itself had a fifteen-foot-long sawbed on which to put the trunks, with hydraulic jacks to align them, and a great motorized bandsaw that travelled along the bed. The tree trunks – each weighing many tons – were jostled into place using a specialized tractor. All this he did by himself, although in his seventies, and with recurrent back trouble. I was impressed.
I spent a happy day with him, helping him to trim a massive oak trunk so that it ended up with a neatly square cross-section, and then rip-sawing it into a series of thick two-inch boards. The machinery was deafening (we wore ear defenders), but the smell of freshly cut oak was intoxicating. I d
rove home that evening like a hunter returning from the chase, with the planks lashed to the roof rack of my ancient Saab – a wonderful car, the marque now, alas, extinct – that has travelled over 200,000 miles and only broken down twice. The roof rack was sagging under the weight of the oak and I drove rather slowly up the A3 back to London.
The next morning I went to collect my bicycle from the bicycle shop in Wimbledon Village, as it likes to be called, at the top of Wimbledon Hill. Brian, the mechanic there, has been looking after my bicycles for almost thirty years.
‘I’m afraid the business is closing down,’ Brian told me, after I had paid him.
‘I suppose you can’t afford the rates?’
‘Yes, it’s just impossible.’
‘How long have you been here?’
‘Forty years.’
He asked me for a reference, which I said I would gladly give. He is by far the best and most knowledgeable bike mechanic I have ever met.
‘Have you got another job?’ I asked.
‘Delivery van driver,’ he replied with a grimace. ‘I’m gutted, completely gutted.’
‘I remember the village when it still had real shops. Yours is the last one to go,’ I said. ‘Now it’s all just wine bars and fashion boutiques. Have you seen the old hospital just down the road where I worked? Nothing but rich-trash apartments. Gardens all built over, the place was just too nice to be a hospital.’
We shook hands and I found myself hugging him, not something I am prone to do. Two old men consoling each other, I thought, as I bicycled down the hill to my home. Twenty years ago I lived with my family in a house halfway up the hill. I assume that the only people who can afford to live in the huge Victorian and Edwardian villas at the top of the hill are bankers and perhaps a few lawyers. After divorce, of course, surgeons move to the bottom of the hill, where I now live when not in Oxford or abroad.
The oak boards needed to be dried at room temperature for six months before I could start working on them, so I clamped them together with straps to stop them twisting and left them in the garage at the side of my house (yet another of my handmade constructions with a leaking roof), and later brought them into the house for further drying.
Now that I was retired and back from Nepal, the wood was sufficiently dry for me to start work.
When my first marriage had fallen horribly apart almost twenty years earlier and I left the family home, I took out a large mortgage and bought a small and typical nineteenth-century semidetached house, two up and two down, with a back extension, at the bottom of Wimbledon Hill.
The house had been owned by an Irish builder, and his widow sold the house to me after his death. I had got to hear that the house was for sale from the widow’s neighbours, who were very good friends of mine. So the house came with the best neighbours you could wish for, a wide and unkempt garden and a large garage in the garden itself, approached by a passage at the side of the house. Over the next eighteen years I subjected the property to an intensive programme of home improvements, turning the garage into a guest house (of sorts) with a subterranean bathroom, and building a workshop at the end of the garden and a loft conversion. I did much, but not all, of the work myself. The subterranean bathroom seemed a good idea at the time, but it floods to a foot deep from an underground stream if the groundwater pump I had to have installed beneath it fails.
The loft conversion involved putting in two large steel beams to support the roof and replacing the existing braced purlins (I had taken some informal advice from a structural engineer as to the size of steel beam required). With my son William’s help I dragged the heavy beams up through the house and, using car jacks and sash cramps, manoeuvred them into position between the brick gables at either end of the loft. There was then an exciting moment when, with a sledgehammer, I knocked out the diagonal braces that supported the original purlins. I could hear the whole roof shift a few millimetres as it settled onto the steel beams. I was rather pleased a few years later to see a loft conversion being done in a neighbouring house – a huge crane, parked in the street, was lowering the steel beams into the roof from above. I suppose it was a little crazy of me to do all this myself, and I am slightly amazed that I managed to do it, although I had carefully studied many books in advance. The attic room, I might add, is much admired and I have preserved the chimney and the sloping roof, so it feels like a proper attic room. Most loft conversions I have seen in the neighbourhood just take the form of an ugly, pillbox dormer.
I have always been impatient of rules and regulations and sought neither planning nor building regulation permission for the conversion, something I should have done. This was to cause problems for me when I fell in love with the lock-keeper’s cottage. I could only afford to buy it if I raised a mortgage on my house in London (I had been able to pay off the initial mortgage a few years earlier). The London house was surveyed and the report deemed it fit for a mortgage, ‘subject to the necessary permits’ for the loft extension from the local council, which, of course, I did not have.
With deep reluctance I arranged for the local building inspectors to visit. I expected a couple of fascist bureaucrats in jackboots, but they couldn’t have been nicer. They were most helpful. They advised me how to change the loft conversion so as to make it compliant with the building regulations. The only problem was that the property developers who were selling the lock-keeper’s cottage were getting impatient. So, over the course of three weeks, working mainly at night as I had not yet retired, I removed a wall and built a new one with the required fire-proof door, and installed banisters and handrails on the oak stairs – the stairs on which I had once slipped and broken my leg. I also installed a wirelessly linked mains-wired fire alarm system throughout the house. This last job was especially difficult as over the years I had laid oak floorboards over most of the original ones. Running new cables above the ceilings for the smoke alarms involved cutting many holes in the ceilings and then replastering them. But after three weeks of furious activity it was all done, and I am now the proud possessor of a ‘Regularisation Certificate’ for the loft conversion of my London home, and I also own the lock-keeper’s cottage.
As soon as I had moved into my new home in London seventeen years ago, after the end of my first marriage, I had set about building myself a workshop at the bottom of the garden, which backs onto a small park and is unusually quiet for a London home. I was over-ambitious and made the roof with slates and, despite many efforts on my part, I have never been able to stop the roof leaking. I cannot face rebuilding the whole roof, so two plastic trays collect the water when it rains, and serve as a reminder of my incompetence. Here I store all my many tools, and it was here that I started work on Sarah’s table. In the garden, which I have allowed to become a little wild, I keep my three beehives. London honey is exceptionally fine – there are so many gardens and such a variety of flowers in them. In the countryside, industrial agriculture and the use of chemical fertilizers, pesticides and herbicides have decimated the population of bees, as well as the wild flowers on which they once flourished.
It took many weeks to finish the table, sanded a little obsessionally to 400-grit, not quite a mirror finish, using only tung oil and beeswax to seal it. The critical skill in making tabletops is that the edges of the boards should be planed so flat – I do it all by hand – and the grain of the wood so carefully matched that the joints are invisible. You rest the planed edges of the boards on top of each other with a bright light behind them so that a gap of even fractions of a millimetre will show up. This requires a well-sharpened plane. A well-sharpened and adjusted plane – ‘fettled’ is the woodworker’s traditional word for this – will almost sing as it works and minimal effort is required to push it along the wood.
It took me a long time to learn how to sharpen a plane properly. It now seems obvious and easy and I cannot understand why I found it difficult in the past. It is the same when I watch the most junior doctors struggling to do the simplest operating, such as stitc
hing a wound closed. I cannot understand why they seem to find it so difficult – I become impatient. I start to think they are incompetent. But it is very easy to underestimate the importance of endless practice with practical skills. You learn them by doing, much more than by knowing. It becomes what psychologists call implicit memory. When we learn a new skill the brain has to work hard – it is a consciously directed process requiring frequent repetition and the expenditure of energy. But once it is learnt, the skill – the motor and sensory coordination of muscles by the brain – becomes unconscious, fast and efficient. Only a small area of the brain is activated when the skill is exercised, although at the same time it has been shown, for instance, that professional pianists’ brains develop larger hand areas than the brains of amateur pianists. To learn is to restructure your brain. It is a simple truth that has been lost sight of with the short working hours that trainee surgeons now put in, at least in Europe.
The boards are glued together using what is called a rubbed joint – the edges rubbed against each other to spread the glue – and then clamped together for twenty-four hours with sash cramps. The frame and legs are held fast with pegs, and being oak, the table is very solid and heavy. I had taken great care, when sawing the wood with my friend, that it was ‘sawn on the quarter’, so that the grain would show the beautiful white flecks typical of the best oak furniture. Sarah was very happy with the result after I delivered it, and subsequently sent me a photograph of her eighteen-month-old daughter Iris sitting up to it, smiling happily at the camera as she painted pictures with paintbrush and paper. But, just like surgery, there can be complications, and to my deep chagrin a crack has recently developed between two of the jointed planks of the tabletop. I cannot have dried the wood sufficiently, I was impatient yet again. I will, however, be able to repair this with an ‘eke’ – a strip of wood filling the crack. It should be possible to make it invisible, but I will probably have to refinish the whole surface.