Heart and Soul: Stephen Westaby on Why He Wrote Fragile Lives
I spent more than 35 years as a heart surgeon performing almost 12,000 operations for the NHS. Whilst training, and throughout most of my consultant career, we were a pioneering profession. We developed techniques and technology to improve safety and broaden the scope of what we could achieve. We sought to help younger, older and sicker patients. I played my part by identifying what it was about the ‘Heart Lung Machine’ that caused damage to the patients.
What I discovered was harmful synthetic materials that triggered inflammation in the blood. The manufacturers removed those plastics and the equipment became safer. This simple scientific contribution saved thousands of lives. This took many hours in the laboratory at night after long days in the operating theatre. There was no such thing as work life balance. We were a proud, charismatic speciality; heart surgeons were trusted and admired, we cared for our patients and their families at the most vulnerable period of their lives.
So why did I write Fragile Lives? Certainly not as a biography, for me, the patients are the stars. When I began this journey, one in three died during or after surgery. Now it is three in one hundred, or less. Throughout my whole career it was me versus The Grim Reaper, and I beat him consistently. The cases featured in the book were all exceptional. Several are ‘world firsts’ from the standpoint of the artificial hearts used or the operations performed but it was the humanity of the struggles that I wanted to convey; not the technical aspects but the courage of the patients, the nightmare for their relatives, the dedication of my staff.
In these days of NHS misery and distress, I wanted to show that the medical staff do care and will go to extreme lengths at great personal cost to help their patients. It’s what we signed up to do and why we each trained for many years. We cannot be discouraged despite the endless difficulties and bureaucratic rubbish we have to contend with for the privilege of saving lives. Henry Marsh expressed the same frustration in his book, Do No Harm. We both had the honour to make the award winning series ‘Your Life in Their Hands’ for the BBC, the program that, back in 1955 made me decide to be a heart surgeon at the age of 7 when I was a street urchin in the backstreets of a Northern steel town. So a second reason to write Fragile Lives was to convey the message to those in similar circumstances – if I could do it, so can you. Just work hard and make it happen.
There was a third reason: I have always loved the NHS. I was born within two weeks of its inception in 1948 and it remains a treasured resource of the British people. But I have never seen doctors, nurses and ancillary staff as miserable as they are now. Many of the ‘great saves’ in Fragile Lives could only be achieved using lifesaving equipment paid for using charitable funds. When charity ran out, patients that I could have helped instead died without intervention. Proud hospitals like the Hospital for Sick Children and Great Ormond Street also rely on charity for modern equipment. I call this ‘second-hand shop’ healthcare. The British Medical Association does not exaggerate when it warns that fewer medical graduates go on to practice, that junior doctors prefer to find work abroad and that senior doctors are retiring in droves because of the tedium of the revalidation process. Someone needs to get to grips with all of this before it is too late. Recruitment drives from Eastern Europe, Africa and Asia are not the answer.
The outstanding question was whether I could write a book fit for the public arena, and whether graphic depiction of operating theatre battles would appeal to the reader. I had already edited 15 surgical textbooks and 350 journal papers. But I was an educator, not an author in the true sense. Those who encouraged me to write loved the stories. And ‘Your Life in Their Hands’ was a hugely popular series. In truth, I rewrote the first chapter ‘The Ether Dome’ many times, treading the fine line between a literary work and voyeuristic experience. Every heart operation is immediately life threatening. We attach the patient to a complex external circuit – the heart lung machine, which takes over from their natural organs. We stop the heart with powerful chemicals so that it becomes cold and flaccid, lying there like a wet fish in a bowl. Then we open it, identify the defect and repair it. Put yourself in my theatre shoes - or boots as they used to be when we were swimming in blood - Fragile Lives takes you there. The scalpel, the saw, the scissors and that wide open chest, then the stitches and technology used to put it all back together again. Only the surgeon carries the can. It is a lonely place to be and it takes a particular personality type to cope with that.
Now I have a new career. My book is out there in the public domain in full view of the critics. It has been a curious but invigorating experience to watch it rise towards the top of the Sunday Times Bestsellers list with gratifyingly positive reviews. Anticipating the opposite, my first instinct was to say ‘If you don’t like my bloody writing come and watch me in the operating theatre – that’s what I’m really good at!’ But I didn’t have to resort to that. And I realise that literary life is not that simple.
Heart surgery is huge incisions, blood, guts and constant peril. Contemplate reconfiguring a congenitally deformed baby’s heart the size of a walnut to give it 70 years of extra life. Or implanting an untested mechanical pump into a young girl’s heart to stave off Grim Reaper. That was my day job. Day, night and weekends. Long taxing operations, anxious relatives, vigils by the intensive care bed and the risk of public exposure for a run of bad luck.
So if you read Fragile Lives, as I hope you will, just please enjoy the ride. Don’t waste time comparing my blood and guts career with the works of great medical authors and philosophers. I was the Winston Churchill of heart surgery. I never, never, never gave up. It was a difficult road and a lonely destination – but a rare privilege for a lad from Scunthorpe!