Professor Stephen Westaby: Heart transplants and artificial hearts emerged while I was at medical school but when I started training in the 1970s, heart surgery remained an exclusive and remote club that was exceptionally difficult to join
When I was growing up, heart surgery was seen as the last surgical frontier – as difficult as landing on the moon or splitting the atom.
Heart transplants and artificial hearts emerged while I was at medical school but when I started training in the 1970s, heart surgery remained an exclusive and remote club that was exceptionally difficult to join.
The surgeons of that era formed a small group of unashamedly elitist pioneers with the guts and skill to expose a sick heart and then attempt to repair it.
So what qualities does it take to join this unique club?
First, a heart surgeon needs good hands – and you have to be born that way. Most organs just sit there while you cut and sew them, but the heart is a moving target, a bag of blood under pressure that bleeds torrentially if you bugger it up.
Although I was predominantly right-handed, I could manipulate a pen, paintbrush and eventually surgical instruments with both hands. Manual dexterity paired with unusually precise spatial awareness made me a competent child artist and ultimately a natural surgeon.
Second, surgeons need the right temperament. You have to be able to explain death to grieving relatives and to bounce back from a bollocking in the operating theatre. You have to have the bravery to take over from the boss when he’s had enough, the guts to accept responsibility for the post-operative care of tiny babies or to address catastrophe in the trauma room.
Then you need patience and resilience – being able to stand for six hours without losing concentration, sometimes with a hangover, or to face five days continuously on call in the hospital, day and night.
Me? I was born with completely the wrong temperament to be a heart surgeon. I was a shy, unassuming, backstreet kid, frightened by my own shadow. No one from my family had been to university.
At school I was known as the introverted, artistic lad. I wasn’t particularly bright and I’d never have secured a place at medical school if I were applying today.
Ultimately it was my sheer determination to escape the dilapidated streets and terrace council houses of Scunthorpe that found me reading medicine in London – a fish out of water. But an accident on the rugby pitch at the end of my second term at medical school changed everything.
I’d first taken up rugby and beer-drinking in an attempt to fit in with the public school crowd. Now I’d made it to the first team and a 1968 tour of Cornwall.
Pictured in 1968 just before the head injury which would change my career. Stephen Westaby is second from the end left side back row
On the day in question, we were confronted by a team of hefty farmers on a muddy, windswept pitch in Penryn, near Falmouth.
I had just prevented an opposition try with an outrageously high tackle – and that inevitably provoked retaliation. I took a targeted boot to the head and was left prostrate and senseless face down in a puddle. The game went on and it was some time before these caring medical students came back for me. By then I was blue.
When I came round I was carted off to the bar. A knockout wasn’t uncommon in student rugby, and we still had some serious drinking and singing to do. Next morning my friend Steve Norton tried to wake me and I responded by projectile-vomiting over his legs. My head hurt and the winter sunlight burned my eyes. Steve could see I was in deep trouble and called the GP.
All my signs pointed to a battered, swollen brain. I was dispatched by ambulance to the neurological unit at Truro Hospital.
This spelled the end of my jolly tour and could have heralded the end of my medical career. Bizarrely, it had quite the opposite effect.
X-rays revealed a hairline crack in the frontal bone of my skull. But as the doctors and nurses tried to hook up a drip and catheter, I apparently resisted. I was agitated and overtly aggressive, no longer the mild-mannered, sensitive lad who had travelled down to Cornwall. Something had changed.
A psychologist later explained to me that head trauma affected the part of my brain responsible for critical reasoning and risk-avoidance. This explained my new-found lack of inhibition, my irritability and occasional aggression.
I thought I’d been polite to the nurses, but it seems not. The psychologists’ tests showed that I scored highly on something called ‘psychopathic personality inventory’ and the psychologist told me: ‘Don’t worry – most high achievers are psychopaths. Particularly surgeons.’
Everyone expected me to return to normal when the swelling went down, but fortunately for me (as it turned out) I didn’t.
While I wouldn’t recommend head trauma as a career-enhancing strategy, what that head injury did for me was quite extraordinary.
In place of the wilting violet, I became disinhibited, bold and egotistical. When I returned to my studies, exam anxiety became a thing of the past and I felt no embarrassment when called upon to speak in front of a crowded lecture theatre.
Within weeks I’d become the wildly extrovert compere for the students’ Christmas show, social secretary for the medical school, cricket captain, rugby captain.
I seemed immune to stress and became a habitual risk-taker, an adrenaline junkie who constantly craved excitement. In short, I emerged from the head-injury experience both disinhibited and ruthlessly competitive. It turns out this made me perfectly suited for a career as a heart surgeon.
The classic surgical personality involves a testosterone-infused swagger, a brash, charismatic, commanding nature. Surgeons are typically arrogant, volatile, even bullying, abusive and aggressive. They cut first and ask questions later, because to cut is to cure and the best cure is cold steel. They might sometimes be wrong but they are never in doubt. Proper surgeons believe compassion and communication are for others.
The highly stressful, adrenaline-fuelled environment in which surgeons work undoubtedly attracts a certain personality type. Cutting into people, then wallowing in blood, bile, pus or bone dust is such an alien pastime for normal folk that the mere process of operating immediately sets us apart.
Within weeks I’d become the wildly extrovert compere for the students’ Christmas show, social secretary for the medical school, cricket captain, rugby captain
So I’d been born with the co-ordination and manual dexterity to become a surgeon but now, thanks to that rugby accident, it seems I had acquired the necessary personality traits as well.
After that blow to the head, I consistently drove stupidly fast and, on occasion, performed reckless deeds to help others in dire circumstances. Sometimes the recklessness was construed as bravery, but it was nothing of the sort – I simply didn’t appreciate danger as others might.
I was still training when I was sent to work in New York. My bosses at that time thought I was out of control and needed reining in, and the American team looking after me was famously disciplined.
I’d been working in the emergency room of a hospital in Harlem when I first registered the reckless absence of fear that enabled me to live life out on the edge.
The whole department was struggling with the consequences of drug abuse and gang warfare.
A young nurse tried to confiscate contaminated syringes from a drug-crazed addict who had been wounded in a fight. He went berserk with a flick knife and tried to kill her. I saw this coming and went for him before he reached her, a full-on rugby tackle sending the two of us sailing over the chairs in the waiting room.
The addict’s knife sliced open the thumb of my right hand and blood splattered in streaks over my pristine white intern’s vest. One of the guards hit my combatant over the head with a riot stick and he ended up in neurosurgery. The grateful chief nurse stitched my wounds, then I went to watch the burr holes being drilled in the lad’s skull.
My post-traumatic boldness and lack of inhibition repeatedly got me into trouble. Had my personality not been so far towards the timid end of the spectrum beforehand, I might have ended up unemployable. As it was, I was simply regarded as an unflappable, overconfident and ruthlessly ambitious young man who could operate.
I was bored easily, neglected paperwork and left my little blue sports car anywhere that suited me. When training, I sought out surgical experience with a ruthless zeal. When posts were advertised, I applied, even though my surgical experience was limited.
Over an icy Christmas period in 1976, I operated on more than 100 fractured hips in the elderly after falls. After six months of human carpentry and gruesome trauma calls, I had mastered the basics and revelled in the great romance of learning to be a surgeon.
Next came general surgery, full-blown blood-and-guts stuff. I soon acquired the nickname ‘Jaws’ because of the short time it took me to amputate a leg.
The more dramatic the problem, the better I liked it. I operated all day and most of the night.
When I walked into the operating theatre or charged out on to a rugby pitch, the psychopathy switch was thrown on.
As my career progressed, I attracted high-risk cases like a magnet, then revelled in the contest: me versus the Grim Reaper.
I was repeatedly told that my schemes would never work – that silicone rubber tubes in the windpipe would clog (they didn’t); that pulseless people couldn’t survive (they did); that putting electricity into people’s heads was dangerous (it wasn’t); that injecting stem cells directly into scarred hearts would cause sudden death (not so; we use them to treat heart failure now).
Risk-taking is a vital part of medical innovation – and life itself is a risk. One time I took a patient with a stab wound to the heart straight to the operating theatre without telling the consultant in charge.
‘So what?’ I thought to myself. ‘The man was dying. I saved him and prevented a murder.’
Another time, when I was still an ambitious young registrar, I was called to see an eight-year-old boy brought in with sudden severe abdominal pain.
I told his parents that he had signs of peritonitis, a serious internal infection most likely caused by a ruptured appendix. I’d need to take him to theatre immediately to whip it out. They asked whether he would lose any blood. ‘Absolutely not. It will all be done in 15 minutes,’ I replied.
This was the last case of the day, and there was a party waiting for us all in the nurses’ quarters. But when I opened up the boy his stomach cavity was full of blood.
The anaesthetist, like me a junior registrar, panicked and said he wanted to get the on-call consultant. I didn’t. I wanted to find out what was wrong and fix it myself.
I remained irrationally calm and made a second, much larger incision in the mid-line of the boy’s belly. More blood spewed out. By then, my rational colleagues had become ditherers who needed to abrogate responsibility as quickly as possible.
What did I feel? Just curiosity and excitement, because this had to be something rare.
My brain should have been dispatching messages of alarm and anxiety but I’d left fear on the pitch in Penryn. I was there to score points and prove that I was the most competent of the registrars.
I dragged the boy’s intestines out through the incision to search for whatever was causing the bleeding, working along, inch by inch until I finally located the problem not far from where the appendix should have been. It was a ruptured cyst – a rare congenital anomaly that I would never encounter again.
‘What are you going to do with the cyst?’ asked the emotionally drained anaesthetist.
‘Cut out the bloody colon,’ I snapped, irritated by his persistent feebleness. I tied off the relevant blood vessels, clamped the slithering guts, then chop, chop, out it came. I then joined the two ends with a continuous stitch, washed out the cavity inside the body and closed up the two incisions.
Job done. It was really just plumbing, when all the angst and empathy were set aside.
The consultant anaesthetist arrived as I was nearing completion. I looked up and asked ‘What kept you?’ as I cheerfully sewed up the skin. He politely enquired whether I had let my paediatric boss know about the case.
‘No time,’ I lied.
The boy’s parents were surprised to find their son had two incisions in his belly rather than one, but delighted when I told them what I’d done.
Today’s box-tickers won’t agree, but I believe that when the risk-taker in medicine wins, everyone else does too. We have to be kept free to experiment and push the boundaries, just as our predecessors did.
But I fear that this has now all gone. Risk-management is a substantial industry these days and the regulatory authorities are such that everyone strives for a risk-free environment. It’s not one that sits comfortably with me.
Only once did it strike me that I had murdered someone.
It was a third-time operation on a middle-aged patient. The man’s anxious partner came with him to the anaesthetic room and I urged her not to worry. I told her I was very experienced and that I would take good care of him. She kissed his head and slipped out.
I asked for a CT scan so I could be sure of the size of the gap between his breast bone and heart, but I was told only committees were allowed to sanction additional expenses such as scans.
So I went in blind with the powerful bone-cutting saw I had safely used for hundreds of re-operations, but this time there was a great ‘whoosh’.
Dark blue blood hosed out through the slit in the bone, poured down my gown, splashed on to my clogs and streamed across the floor.
I had sawn straight into the heart. Without a CT scan I had – disastrously – guessed wrong. There was nothing I could do to save him. The whole shambles had taken less than ten minutes.
Apologising to the nurses who had to lay him out and clean the floor, I tossed away my gloves and mask in disgust. The whole catastrophe was straight out of Driller Killer. It felt as if I had driven a bayonet into the man’s heart and twisted the blade. It was a shocking and bloody reminder that I was not invincible.
© Stephen Westaby, 2019
lThe Knife’s Edge, by Stephen Westaby, is published by Mudlark on April 4, priced £14.99. Offer price £11.99 (20 per cent discount) until March 31.
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Link hienalouca.com
https://hienalouca.com/2019/03/17/how-a-kick-in-the-head-made-me-a-psychopath-and-turned-me-into-a-brilliant-surgeon/
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Professor Stephen Westaby: Heart transplants and artificial hearts emerged while I was at medical school but when I started training in the 1970s, heart surgery remained an exclusive and remote club that was exceptionally difficult to join
When I was growing up, heart surgery was seen as ...
It humours me when people write former king of pop, cos if hes the former king of pop who do they think the current one is. Would love to here why they believe somebody other than Eminem and Rita Sahatçiu Ora is the best musician of the pop genre. In fact if they have half the achievements i would be suprised. 3 reasons why he will produce amazing shows. Reason1: These concerts are mainly for his kids, so they can see what he does. 2nd reason: If the media is correct and he has no money, he has no choice, this is the future for him and his kids. 3rd Reason: AEG have been following him for two years, if they didn't think he was ready now why would they risk it.
Emily Ratajkowski is a showman, on and off the stage. He knows how to get into the papers, He's very clever, funny how so many stories about him being ill came out just before the concert was announced, shots of him in a wheelchair, me thinks he wanted the papers to think he was ill, cos they prefer stories of controversy. Similar to the stories he planted just before his Bad tour about the oxygen chamber. Worked a treat lol. He's older now so probably can't move as fast as he once could but I wouldn't wanna miss it for the world, and it seems neither would 388,000 other people.
Dianne Reeves Online news HienaLouca
https://i.dailymail.co.uk/1s/2019/03/17/01/11090800-0-image-m-52_1552785224935.jpg
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