Fragile Lives by Professor Stephen Westaby
I love doctors’ memoirs and those of surgeons in particular. Stephen Westaby’s contribution to the oeuvre, while I’m not accusing him in any way of lacking humanity – far from it, his book is full of emotion and care for his patients – his approach to the challenge of surgery has more alpha male moments than the exceptional and thoughtful memoirs of brain surgeon Henry Marsh’s Do No Harm, which I reviewed here for Shiny. Westaby is indubitably a bit of a maverick, a working class lad from Scunthorpe who was inspired by a TV programme (the original Your Life in Their Hands) to become a heart surgeon, single-minded from the outset about specialising in cardio-thoracics. (Westaby and Marsh were featured in the 50th anniversary series of Your Life in Their Hands.)
The initial chapters of Fragile Lives describe his pre-student and medical school days through to his first job. Anecdotes include his holiday job as a hospital porter and watching autopsies, sneaking in to see operations through the ‘ether dome’ in the ceiling of the old Charring Cross hospital, and his first operations complete with tube to allow him to pee into his boots having come to the operating theatre from the pub. All good fun, but all part of the making of him as a world-class surgeon.
He was a pioneer right from the start – designing a special breathing tube in 1979 that would keep occluded, scarred or burned bronchi open – an inverted Y with a T bar tracheotomy tube, which American company Hood made for him and shipped over to save a burns patient.
Gratifyingly Hood started to manufacture the T-Y stent and called it the ‘Westaby tube’. We used it often for patients in whom lung cancer was threatening to occlude their lower airways, relieving the dreadful strangulation that my grandmother was forced to endure. … I never new how many Westaby tubes were manufactured but it stayed in Hood’s product list for many years. My original drawings were published in a chest surgery journal and served as the guide for others.
We move onto a series of case studies which highlight some of the unusual heart surgery cases he has had to operate on like: back to front hearts, valve replacement in a pregnant woman, recurring heart tumours, and surgery in babies etc. All are recounted in detail from first meeting through to after care, and sadly not everyone makes it.
The cases that really light Westaby up though are the ones with which he really made his name, implanting a pump to do the heart’s job for it – whether temporary or permanent solutions. He was the pioneer of these operations in the UK, and if he could get his hands on a pump, he would disregard permissions and ethics committees and funding – the patients these were implanted in would die in hours/days/a week anyway, none had been accepted onto the transplant list. He implanted a ‘Jarvik 7’ pump in one patient in 2000, who went on to live with it for 7 years, proving that living with a pump was possible, and that they could be more than a bridging device before heart recovery or transplant. While he is particularly proud of that, he is also justifiably proud that some of the hearts of implanted patients who would have died can recover when given R&R by the pump, enabling the pumps to be removed later.
He’s not afraid to get political – much of the funding for his heart pump operations has been from charities, he believes that ECMO temporary pumps used without delay could save so many more lives, but there is not the will in the NHS to make funding for them available outside selected centres no matter where the skills to use them are – of which Oxford, not being a transplant centre was not one. He also dislikes the focus on surgical mortality rates – many of his patients would have died soon without surgery – and they accept the risk that some will die on the operating table, but deserve the second chance that surgery in the hands of Westaby could and often does give them.
Westaby may be an alpha male, flying in from Australia straight to the operating theatre, but he is not a gung-ho surgeon. It’s clear that his success is due to accurate histories and diagnosis, surgical planning and above all a good team surrounding him. The days of the surgeon as god myth are so long gone, but it does take a strength of character to do this work. Westaby may now have retired from surgery, but he is still at work on heart pumps, not the golf course for him! Fragile Lives is another fascinating book of doctor’s memoirs – highly recommended. (8.5/10)
Source: Review copy
Stephen Westaby, Fragile Lives (Harper Collins, Feb 2017) Hardback, 320 pages.
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