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In this memoir, neurosurgeon Henry Marsh reflects on his four decades of medical practice, balancing the exhilaration of surgical successes with the emotional toll of his work. Through experiences in both London and abroad, he explores the profound responsibility of reducing suffering and the ethical complexities of prolonging life. As Marsh approaches retirement, he offers a personal and thought-provoking perspective on the impact of his career choices and what truly matters in the end.