The eminent retired neurosurgeon, Dr. Henry T. Marsh, who introduced and popularized awake craniotomy under local anesthesia in England and became a Commander of the British Empire, is also an extraordinarily talented writer. Depending on whether one’s reference point is British or Norwegian, Dr. Marsh has been lauded as the Boswell, as well as the Knausgaard, of neurosurgery. Since his retirement from clinical work in 2014, Marsh has graced us with a trilogy of memoirs,1,2 one of which was reviewed in the October 2022 issue of Anesthesiology.3 His most recent volume, titled And Finally: Matters of Life and Death, is the story of how he became a patient. It is, however, much more wide-ranging and nuanced, exploring with elegance and unflinching honesty such thorny topics as ageing, the mystery of consciousness, and other neuroscientific enigmas, as well as such philosophical themes as the meaning of life, the inevitability of death, and what really matters to all of us in the end.In taking a comprehensive, multifaceted inventory of his life, the author is characteristically and disarmingly candid, observing, “Most neurosurgeons are not neuroscientists—to claim that they are would be like saying that all plumbers are metallurgists.” That said, the self-described curmudgeon has a rich and inquisitive mind and a generous, compassionate heart. Curiosity led Marsh to volunteer, at age 70, to participate in a study of brain scans in purportedly healthy people. When eventually he viewed his own scan, the author was appalled as he looked at “ageing in action, in black and white MRI pixels, death and dissolution foretold.” His brain was shrunken and withered, littered with white-matter hyperintensities, whose presence is associated with an increased risk of stroke; whether they predict dementia or not is unclear. Nonetheless, Marsh felt he saw the writing on the wall, a deadline, as his brain was “starting to rot.” He muses, although we accept that such degenerative changes as wrinkled skin come with age, we find it difficult to accept that our inner selves, our brains, are subject to similar alterations.The author reminds us that although Hippocrates, in the 4th Century BCE, positioned the brain at the center of human thought and emotion, most early medical authorities considered the brain to have minimal, if any, importance. Despite the copious amounts of neuroscientific research conducted since the 17th century, our comprehension of our brains remains quite limited. We understand the brain’s topography and some basic electrochemical physiology, but the answers to other vexing questions elude us. How does the physical matter of our brains, for example, generate the thoughts and feelings that are both conscious and unconscious? How can we describe the relationship of the unconscious to the conscious when they are not separate entities, but parts of the same phenomenon?The typical adult brain has 86 billion nerve cells, 125 trillion synapses, along with an additional 85 billion glial cells and more than 100 neurotransmitters. In thinking about his shrunken brain, Marsh sought consolation by reminding himself that mental abilities are not merely a matter of brain size and the number of synapses. Besides, the scan did not reveal whether his white matter or gray matter was predominantly diminished!The author relates that, 20 months after he had his brain scanned, he was diagnosed with advanced prostate cancer. He excoriates himself for ignoring typical symptoms for more than two decades, deluding himself into thinking that the progressive indicators were reflective of benign prostatic enlargement rather than cancer. It took him a long time before he could bring himself to ask for help, mistakenly thinking he was being stoical rather than cowardly. He continued to think that “illness happened to patients and not to doctors.” In fact, his denial was so deeply ingrained that he was initially unable to believe, much less accept, the diagnosis. He oscillated between hope and despair, transitioning through stages of grief not entirely dissimilar to the 5 stages of grief described by Elisabeth Kübler-Ross more than 50 yr ago: denial. anger, bargaining, depression, and acceptance.4Until he became a patient himself, the distinguished neurosurgeon did not understand that a vast distance separates patients from physicians, and that doctors comprehend very little about their patients’ experiences. He soon discovered being a patient is a disempowering and humiliating experience. And although patients want certainty, physicians can only deal in probabilities and uncertainty. Marsh writes, “Hope is one of the most precious drugs doctors have at their disposal…” Rather than being an issue of statistical probability, “…hope is a state of mind, and states of mind are physical states in our brains, and our brains are intimately connected to our bodies (and especially to our hearts).” Hence, a compassionate physician will conscientiously strive to find an appropriate balance between hope and realism. But how does a physician balance hope against truth when talking to a patient with a potentially fatal illness? Marsh ruminates that reading about one’s medical condition on the Internet is a poor substitute for a sympathetic physician who genuinely cares about the individual patient, and who can guide him or her through the coppice of statistics and impart some hope despite them. Marsh’s dual role as physician and patient reinforced his belief that respectful communication is the bedrock of all medicine. (Why is it, I have often wondered, that the so-called soft skills of medicine are the truly hard proficiencies to teach and to learn?)Marsh soon learned that one of the worst aspects of being a patient is waiting, whether it be for appointments or test results. When he finally received his test results, Marsh was dismayed to learn that his prostate-specific antigen was an astronomically high 127 ng/ml, but his scans showed no metastatic spread. He had locally invasive prostate cancer (into the seminiferous tubules) that required initial treatment with androgen deprivation therapy before radiotherapy could be instituted. After 6 months of androgen deprivation therapy, Marsh’s prostate-specific antigen decreased to less than 1, making him an acceptable candidate for a month of 5 days per week radiotherapy. As of late 2022, Marsh’s prostate cancer is in remission, but he will require careful and frequent follow-up. He has “joined the great underclass of patients with treatable but probably incurable disease, whose lives are ruled over by doctors,” living in a state of suspended animation from test to test and scan to scan.He lives in the present, without a bucket list. This vocal advocate of physician-assisted death in circumstances when a competent person has persistently expressed his or her wish for that intervention, unabashedly states that his desire to continue living is “overwhelming and incontrovertible.”Henry Marsh poignantly asks, “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?”The driven neurosurgeon who once lived to operate finds that, after hanging up his gloves, he does not in the slightest miss operating. Rather, he is enjoying teaching, passing the torch to the next generation. Importantly, the sometimes irascible, impatient, and arrogant former neurosurgeon has become the consummate family man. He adores his three young granddaughters, regaling them with whimsical adventure stories, including an orphaned unicorn who develops Droopy Horn Disease, and building them elaborate dollhouses. Although he admits to having neglected his own children when he was younger and focused on his career, he now savors their companionship and takes comfort that all three of his children reside nearby in London. He cherishes his wife of 20 yr, social anthropologist Kate Fox, whom he credits with making him a better person. He has even made peace with his first wife from whom he had an acrimonious divorce decades ago and now considers her a friend!Literature can be a powerful reflecting tool for thinking about life. The late Dr. Paul Kalanithi, also a neurosurgeon, wrote eloquently about grappling with mortality while battling stage IV, non-small cell, epidermal growth factor receptor–positive lung cancer, which led to his death at age 37. His luminous book titled When Breath Becomes Air, published posthumously in 2016, underscored the profound meaning he continued to experience despite his illness.5 Recently, Dr. Karla Castro-Frenzel, a pediatric anesthesiologist, affectingly and insightfully described the distinct strengths and vulnerabilities experienced by physicians-as-patients, while she lives—and thrives—with advanced stage lung cancer that has thus far (4 yr) been responsive to targeted therapy.6 Now Henry Marsh joins his colleagues who have experienced both sides of the aisle. Far from being depressing, their stories are inspirational, illuminating both the great strides medicine has made in treating cancer and the courage and resiliency of the human spirit. Their dual perspectives as physicians and patients provide a singular clarity to understanding the human impact of disease, ultimately causing us to rethink life and the way we live it.The author received no funding for this article. During the past 36 months, she has received money from the Accreditation Council for Graduate Medical Education (Chicago, Illinois), Current Reviews in Clinical Anesthesia, and UpToDate. These financial relationships, however, are not relevant to this book review.