Like the previous book, this one is cast as a memoir, with some descriptions of surgery but much else besides: travelogue, reminiscence, philosophical reflections. Although Marsh was only in his sixties when he wrote he was born in 1950 he is very conscious of age, mortality and the possibility of a descent into physical or mental incapacity.
He sets the tone on his first page, where he tells us that his most precious possession, apart from his tools and books and the pictures and antiques he has inherited, is his suicide kit a few drugs that he has acquired over the years. Characteristically, he is worried they may not work, in which case he will find himself in hospital in the embarrassing position of a failed suicide.
Partly in an attempt to stave off the threat of decline, he constantly sets himself demanding physical tasks. He runs regularly, although he hates it, and he is labouring to restore a tumbledown lock-keeper's cottage he has bought, where he continually has to replace the windows that are regularly smashed by local hooligans during his absence. He is prepared to take on daunting repairs to buildings and delights in the craftsmanship of making fine furniture.
His description of Nepal is fairly sympathetic; indeed, he says he has fallen in love with the country in the way that he has fallen in love with women in the course of his life, although he knows that both kinds of love are ephemeral. And he does not present an idealised picture of Nepal; the poverty and ignorance of its charming people are extreme and the Shangri-La character that Kathmandu may once have had has disappeared under a flood of over-population and urbanisation. Typically, although he longs to see the Himalayas they are always hidden by clouds.
In Nepal Marsh works in a hospital run by Dev, an old friend. Theirs is a warm relationship, but the same is not true of Marsh's relationship with Igor, the surgeon with whom he has worked in Ukraine. They fell out owing to a serious misunderstanding about a patient, and although Marsh had been coming to Ukraine for many years, and feels deeply involved with the country, it seems uncertain if he will return.
A confirmed atheist, he has no belief in postmortem survival.
I am a neurosurgeon. I know that everything I am, everything I think and feel, consciously or unconsciously, is the electrochemical activity of my billions of brain cells, joined together with a near-infinite number of synapses (or however many of them are left as I get older). When my brain dies 'I' will die. 'I' am a transient electrochemical dance, made of myriad bits of information; and information, as the physicists tell us, is physical. What those myriad pieces of information, disassembled, will recombine to form after my death, there is no way of knowing.I don't want to give the impression that this is a depressing book. Marsh is a lively writer and he holds the reader's interest. Anyone who read and enjoyed his previous book will certainly want to read this sequel. But the general tone of both books is sombre, perhaps more so in this one.