#henry-marsh
I have always felt fear as well as awe when looking at the stars at night, although the poor eyesight that comes with age now makes them increasingly difficult to see. Their cold and perfect light, their incomprehensible number and remoteness, the near eternity of their lives are in such contrast to the brevity of mine. #stars
We accept that wrinkled skin comes with age but find it hard to accept that our inner selves, our brains, are subject to similar changes. These changes are called degenerative in the radiological reports, although all this alarming adjective means is just age-related. For most of us, as we age, our brains shrink steadily, and if we live long enough, they end up resembling shrivelled walnuts, floating in a sea of cerebro-spinal fluid, confined within our skull. And yet we usually still feel that we are our true selves, albeit diminished, slow and forgetful. The problem is that our true self, our brain, has changes, and as we have changed with our brains, we have no way of knowing that we have changed. It is the old philosophical problem - when I wake in the morning, how can I be certain I am the same person today that I was yesterday? And as for ten years ago? #self #growth #ageing
Hope is one of the most precious drugs doctors have at their disposal.
Hope is not a question of statistical probability or utility. Hope is a state of mind, and our brains are intimately connected to our bodies (and especially to our hearts). #hope #cartesian-duality #the-body
The human mind is always trying to reduce all events to single causes, but most diseases are the product of many different influences, and the presence or absence of hope is only one among many. #systems-thinking #health
We are condemned to understand new phenomena by analogy with things with which we are already familiar. The history of our attempts to understand our brains, and inparticular the relationship between its conscious and unconscious actions, is a history of metaphors. #self #the-brain #pursuit-of-knowledge
I find it hard to escape a marine metaphor. My conscious self is like a small boat sailing on a deep ocean, or perhaps more like a submarine that comes to the surface when I awake. I then delude myself that I am steering the boat, when in fact its course is determined by the wind and the deep currents. But this is a false metaphor, of course, as my conscious and unconscious selves are part of the same phenomenon, in a way that we find impossible to desbribe. The submarine is part of the ocean, not separate from it. #the-sea #the-brain #consciousness
My conscious and unconscious selves (for want of a better word) are made of the same material - the electrochemical activity of my 86 billion nerve cells. 'I' am both my conscious and unconscious - they are not separate entities. #self #duality
Some psychologists and philosophers delight in telling us that our sense of self is an illusion. I briefly studied philosophy at Oxford University, but eventually fled to the more practical world of medicine. But at least I learned from studying philosophy for one year the importance of the phrase 'It all depends on what you mean by'. The word 'self' is not easy to define, and the word illusion simply means something is different from how it appears. I have no intention of going down the rabbit hole of what the word 'self' means, but I realise that I find it very hard to know what it is tha tI might be losing as my brains shrinks. How can I compare myself now with my past self? #relativity #relative-correctness #self-awareness
I find it very hard to comprehend that 'I' am the 86 billion nerve cells of my brain. There are at least 500,000 kilometres of wiring connecting the nerve cells together at junctions called synapses - greater than the distance from the earth to the moon. A cubic millimetre of cerebral cortext (the surface layer of the brain) contains up to 100,00 nerve cells and a billion synapses. It has been estimated that there are about 125 trillion synapses in the adult human brain.
Eternity is not the infinite prolongation of time but instead its abolition. #time
But I also felt an almost overwhelming, tragic sense of loss. Life had come to a complete stop, and so you could see clearly into both the past and the future, no longer blurred by incessant movement. #clarity
It is a sombre experience to look at medical records outside the clinical context of a hospital. They become statements of our vulnerability and mortality, which we cannot escape. #documentation #context
Even apex predators like ourselves or lions are prey for bacteria. #vulnerability #ecology
It is very difficult to introduce environmental enhancements after a building has been built [...] you need to plan the enhancements from the beginning, and this rarely happens. #planning #architecture
Percentages are a problem for patients. Some of the oncologists I have worked with over the years told me that they would never give patients percentages. The problem, of course, is that the patient wants to know what will happen to him or her as a specific individual, and the doctor can only reply in terms of what would happen to a hundered patients with the same diagnosis. After a given number of years a certain percentage will still be alive, and the remaining percentage will be dead. There is no way of knowing into which group an individual patient will fall. Your doctor never knows how long you will live, not until the very end. #data
We are part of Nature, and everything we do - including all the technology that is so much a part of human life - is as natural as sex and trees. #nature
It is no good saying that trying to extend human life is against Nature, though whether it is sensible or not is a different matter. #ageing
Elderly, anxious billionaires are funding research into ageing and death, in the hope that they can avoid it, inspired by their pathetic belief that living longer is what matters most in life. #life-and-death #meaningfulness #death
Failure, of course, is cancer, which - in a perverse sort of way - is a fatal expression of the force to live. #cancer
Nature does sometimes get it terribly wrong. Yet it is miraculous how most of the time stable, reproducbile forms of life arise from so much complexity. #complexity
As the philosopher David Human observed on his deathbed, the thought of his no longer existing once he had died, bothered him no more than the thought that he had not existed before he was born. #life-and-death
According to Stanislas Dehaene, one of the leading researchers in this field, the conscious self is like the chief executive of a large corporation with thousands of employees. #business
The idea that brains and computers are essentially similar leads to all sorts of delightful cyberpunk fantasies about uploading our brains onto computers. And this leads to the further problem of how we could tell whether a computer was conscious or not. This has been a field day for philosophers, who write at great length about these problems, but I struggle to understand them. I cannot escape the feeling that mushc of this is just playing at word games. But nor can I quite escape the fear that I am simply not clever enough to understand philosophy. #philosophy #humans-and-machines #consciousness
In other words, we are allowed to choose to die, but not how, when or where. Only the doctors can decide that. And yet, as the great reforming judge Lord Denning once observed, the illegality of assisted dying in Britain means that it is illegal to help somebody to do something that is not illegal. Surely this is wildly illogical? #suicide #healthcare