And finally, p.17
And Finally, page 17
Olesya and Christabel had to rescue the eggs, and the babies after they were hatched, on more than one occasion from evil witches, who were crazy for designer handbags made from baby-dragon skin. The witches were evil, but young and beautiful, and terribly vain. They were not toothless old women with facial hair and crooked noses. Although both the girls had magic swords, I was a little reluctant to have too much violence in the stories, even though extreme violence is such an important part of so many of the most famous children’s stories. I therefore introduced the rule of law into Fairy Land. If you made a promise, you would drop dead if you broke it. By this means, Olesya and Christabel righted many wrongs without beheadings (although the occasional beheading of particularly obnoxious goblins did slip in).
Should fairy stories be an escape from the present or a preparation for the future? They are a form of play and play in children and young animals is universal. How can you doubt that animals have feelings just like ours, when you see young animals playing together? Evolution has made the young playful, as our brains cannot develop without play. It is a form of preparation for independence and yet at the same time a celebration of the wonder of the world and our ability to imagine worlds that do not exist.
Neuroscience tells us that reality is a construct built by our brains from only those aspects of the outside world that we have needed to perceive in order to survive and reproduce. We live in a model of the world, a story of sorts. The intense feeling of plot and narrative in our dreams, although it may well be meaningless, suggests that making sense of the world by telling stories is a critical part of being human. Fairy stories are about what doesn’t really happen, which is why typically they end: and they all lived happily ever after.
19
A year has passed since I was diagnosed with cancer. I have now joined the great underclass of patients with treatable but probably incurable disease, whose lives are ruled over by doctors. Our lives lurch from scan to scan, in suspended animation, from blood test to blood test. And yet, given my age, nothing very much has changed. I am approaching the end of my life in any case, and to be cured only means to die from something else.
I have not found it easy to come to terms with the proximity of my own death – either from the cancer for which I am being treated or, if the cancer treatment is successful and I am cured, from the dementia that I fear even more than death. Of the two possibilities, dying from cancer is surely preferable. This is not an easy or comforting line of thought. If I have to die from cancer, and if the dying is going to be distressing, I hope that assisted dying will be legalised in this country in time for me, and I have some choice in the matter of how, when and where I die. But I still find it hard to escape my deep biological optimism – with which evolution has both blessed and cursed me – that all will be well, that somehow I will be saved and death avoided. I can see the same folly in my initial insouciance – shared by so many others – about the Covid pandemic. Worst of all, I see it at work in the unfolding catastrophe of climate change – our clear understanding of what will happen if no action is taken and our failure to take effective action. Like most people my age, I am haunted by the thought of what kind of future awaits my granddaughters, and the ruined planet my generation might well bequeath them. But we have a duty to be optimistic – if we are not, and therefore do nothing, then the worst will certainly happen.
At nine o’clock in the evening, as it was getting dark, the stars just starting to appear, I walked along the towpath from my lock-keeper’s cottage, pulling behind me the small and battered four-wheeled cart I use for carrying building materials. On this occasion, however, I had loaded it with cushions and blankets. I met my daughter and her family at the lift bridge, where the track to the canal ends. My granddaughters happily climbed into the cart and under the blankets. I then pulled them back along the towpath to the cottage, where there was a fire burning in the stove waiting for them, and hot-water bottles in beds with freshly washed and ironed sheets. This had taken me all afternoon, paying particular attention to the many spiders who have taken up residence in the cottage, as my eldest granddaughter Iris suffers from mild arachnophobia. The girls called out excitedly when they saw the occasional bat flying overhead, and pointed to the stars, which they could see much more clearly than I could. We passed the narrowboats moored beside the towpath, a few with lit portholes, and figures seen dimly inside. There was a low mist over the canal.
I remembered my mother telling me of one of her clearest childhood memories – of also being pulled along in a cart at night, wrapped in a fur coat in autumn, beneath a sky full of stars in rural Germany in the early 1920s. Her mother was taking her to the railway station near Biere, a small village in the Altmark, south-west of Berlin, after staying in her grandparents’ house. Her grandfather was the local doctor and my mother had also told me stories of her fascination at occasionally seeing him at work. Reducing a dislocated shoulder by putting an empty bottle in the patient’s armpit and then pulling the arm; dealing with a severed artery pumping blood in a farmworker with a scythe injury. Perhaps these stories influenced me in my eventual decision to become a doctor. She was certainly very pleased with my choice, although I had caused her and my father much grief in the years before I made it.
I have a photograph on my kitchen wall of my mother at the age of eleven, with her elder sister and younger brother, in Magdeburg in 1929. It is beautifully done. I look at it every day.
They are looking directly at the camera, so that their questioning eyes, in black and white, follow you around the room. My mother and her sister Sabine are wearing simple white blouses, their young brother Hans Marquadt is wearing a sailor suit. This was six years after the German hyperinflation in which her parents had lost most of their modest wealth. The Great Depression had started, and the Nazis were on the rise. They could not have had any idea what the future held for them. Sabine was to become an enthusiastic Nazi, my uncle a Luftwaffe fighter pilot in the crack Schlageter 26 Squadron, and my mother a dissident, who fled to England in 1939, having been denounced to the Gestapo. Sabine was killed in a British air raid on Jena in 1945 and Hans Marquadt was shot down over Kent in 1940. He survived the war as a POW but never married and died from alcoholism in 1967.
My mother wrote a memoir of her life, working slowly at it over the years, which my brother and elder sister edited and had published privately after her death. It is written in perfect English. I reread it recently – to my shame I hadn’t read it properly before. It describes quite devastating loss, of her family, of her past, of her culture, of her childhood – all destroyed by the Nazis and war. She tells us of how there was a very strict rule in her family – a very close and loving family – that one should not make a fuss. Stell dich nicht so an. It is a rule she applied to a certain extent with her own four children in England, though with singular failure in my case. She unfailingly adhered to it in her writing, so she describes the destruction of her past in the most restrained and understated tones – almost infuriatingly so, as you can sense so much passion beneath it all.
Reading the book filled me with me an intense longing to talk to her again – and not just to reassure her that I have been successful in ways of which she would approve. It also filled me with deep sadness that I was so preoccupied with my own life that I took little real interest in hers while she was still alive. In the book, she writes of how when she was interrogated by the Gestapo, she denied belonging to the anti-Nazi Christian Confessing Church. She had torn up her membership card the day before as a precaution. This left her, she tells us, with the feeling that she had betrayed both her faith and her two colleagues with whom she had been denounced. They were tried and sentenced to prison, while she was able to flee to England before their trial, where she was to have been a witness. And yet I had never really appreciated during her life how much she suffered from the guilt of a survivor, and I never discussed this with her.
Why is it that only in old age, and closer to death, I have come to understand so much more about myself and my past? We are like little boats that our parents launch onto the ocean, and we sail round the world, full circle, to return finally to the harbour from which we started, but by then our parents are long gone.
My mother loved her grandparents and especially their garden, which she described as a paradise. Seventy years later, shortly before her death at the age of eighty-two from breast cancer – though we didn’t know at the time that she was already dying – my brother and I took her back to her home town of Magdeburg, and to Biere. Magdeburg had been largely destroyed by a single air raid on 16 January 1945. There was no trace of her family home or even of the street on which it had stood. We drove to Biere on the road along which she had been pulled in the cart seventy-five years earlier. She pointed out to us how the road was quite unchanged – with a cinder track beside the asphalt for horses and wagons. Her grandparents’ house was still standing, though the garden was overgrown and neglected. Her grandparents had been buried in the village churchyard, but there is a law in Germany that you are only entitled to a limited number of years’ rest in a cemetery and, to her disappointment, when we went to look, their headstones had disappeared.
In the first few weeks after I was diagnosed with advanced cancer and when I did not know if I had disseminated disease or not and might soon be dead, I would sit at the kitchen table and look at the photograph. Physicists talk of ‘block time’ – that the past, present and future are all equally real. In Einstein’s equations for relativity and space-time, time can run forwards or backwards. There is nothing inevitable about time always moving irredeemably forwards. The arrow of time that dominates our lives, ages our bodies and ultimately kills us, has no place, apparently, in theoretical physics. The present is a place, and past and future are simply other places, just as the place I am in at the moment is one place among many others on the surface of the planet. Looking into my mother’s young eyes, my own life now possibly nearing its end, I felt as close as I could ever possibly be to living in block time – past, present and future all combined in one whole.
Postscript
Six months after the radiotherapy finished, my PSA was measured again. Although I knew it was most unlikely that the cancer would already be growing back, I was anxious about the possible result for weeks before the blood test and could think of little else. I had been told I would receive a phone call at 11 o’clock in the morning but had to wait two hours before my phone eventually rang. I was told that my PSA had fallen to zero point one. This is as low as it can get. It does not mean that I am cured (as family and friends all like to think) – my very high presenting PSA comes with a 75 per cent probability of recurrence within the next five years. But chemotherapy could then be used, so I will probably live for a few years yet, although it can never be certain. This uncertainty produces a little flash of anxiety. But what, I then ask myself irritably, do you want? To live for ever? To become old and decrepit? And once again I marvel at my ridiculous inability to accept the inevitability of my death – indeed, its necessity.
The phone call brought great relief, and I was filled with mistaken optimism that my life would return to how it had been before the diagnosis of cancer. After a year of chemical castration, the side effects were becoming quite trying – mainly of fatigue and muscular weakness, which I found offensive. Perhaps, I told myself, my lack of energy was the product of anxiety and would now improve. At least I would not need to worry about the cancer coming back until the next PSA test in six months’ time. I would be free for a while.
But any relief did not last long, as ten days later Putin invaded Ukraine. I returned to a state of chronic anxiety and pre-occupation, my cancer now entirely forgotten.
When I first went to Ukraine thirty years ago, I encountered a medical system that reflected Soviet society in miniature: it was ruled over by totalitarian professors who would brook no dissent. I saw my role as political as well as clinical – I was helping young doctors rebel against the monolithic hierarchy that ruled over them. In retrospect, I was naive and misunderstood much of what I saw, and probably contributed very little to medicine in Ukraine. But I made many very close friends and came to see the country as my second home. Ukraine has been struggling since independence in 1991 to escape its past under the Russian yoke. The freedom it now enjoys would be a fatal threat to Putin’s despotic kleptocracy if it spread to Russia. Putin would rather have his soldiers commit mass murder and perpetrate atrocities than let this happen.
At the time of writing, in spring 2022, it is impossible to know what will happen in Ukraine, other than that the country will be devastated, with many thousands of people killed and millions displaced. But the Ukrainians will fight to the death. I always knew they would. They see no alternative.
I phone my friends in Lviv and Kyiv every day. Sometimes I can hear the air-raid sirens in the background. I know as much about the course of the war from the media as they do, so we ironically discuss the weather alongside the war crimes that Putin and his soldiers are perpetrating. I find the contrast between their lives and mine difficult, but I think they like to hear my voice, and to know that there is still a more peaceful, civilised world beyond the nightmare in which they are now living, and that so many people all over the world are concerned for their fate. My friends’ lives have been utterly changed, just as my mother’s was. I never dreamed that I would live to see history repeat itself, in such horror. I do not know if I will ever see Ukraine again, or even ever see my friends again. But we have a duty to be optimistic – if we are not, and we give up, then evil will certainly triumph. I will return.
Acknowledgements
Many friends looked at earlier drafts of this book, and all made very helpful comments. I would like to thank Robert McCrum, JP Davidson, Erica Wagner, Sarah Marsh, Rachel Clarke, David Fickling, Gina Cowen, John Milnes, Paul Klemperer, Pedro Ferreira and Roman Zoltowski.
Once again, I am indebted to my editor Bea Hemming who has played a very major role in sorting out the muddle with which I presented her. The support from my agent Julian Alexander has been second to none. The book would never have seen the light of day without the love and encouragement of my wife Kate.
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First published in the United Kingdom by Jonathan Cape in 2022
Copyright © Henry Marsh, 2022
The moral right of the author has been asserted
Cover Design © Suzanne Dean
Author photograph © Patrick Sherlock
ISBN: 978-1-473-56097-0
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Henry Marsh, And Finally
