Pure surgical spirit

Masters | June Shannon | 27 May 2010 | 0 Comment(s)

Prof Barry O'Donnell

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In our new Masters of Medicine series, June Shannon speaks to some of Ireland’s most prominent retired clinicians. In the first installment Prof Barry O'Donnell shares his reflections

"I had the best job in the world" - that's how Professor Barry O'Donnell sums up his 37 years at Our Lady's Children's Hospital in Crumlin.

As well as being a surgical innovator, committed and compassionate clinician, highly respected professional and hugely popular raconteur, Prof O'Donnell was one of Ireland's first dedicated paediatric surgeons.

Prof O'Donnell was born in Cork in 1926 and studied medicine at UCC. He graduated in 1949. These days his sprightly step and razorsharp wit very much belie his 83 years. The son of a publican, Prof O'Donnell's father ran the Hi-B bar in Cork's Oliver Plunkett Street, which is still in the family today.

"They say you are nobody in Cork until you have been barred from the Hi-B bar," Prof O'Donnell smiles, adding that the people skills he learned from his father stood him well for a career in medicine.

It was his mother who instilled in him a love of words and story-telling. Of the three boys in his family, Prof O'Donnell was the only one to study medicine and while he initially toyed with the idea of being a lawyer or a journalist, his father told him there was "no living" to be had in either of those two professions.

"My best friend, who my father really admired, was going up to UCC to do medicine and he said ‘you should go up and do that, you will always get a job as a doctor'," Prof O'Donnell remembers.

Advice

"I signed up. I was barely 17. You could do that in those days. All you needed was a cheque for £70 and you were away."

Little did the young Mr O'Donnell know back then that his father's advice would lead him to a hugely successful international career in paediatric surgery, spanning more than 50 years.

During that time, he was to become Ireland's first Professor of Paediatric Surgery (1986-1993). He was also destined to become the only person in the world to hold the triple Presidency of the Irish Medical Association (IMA), the British Medical Association (BMA) and the Canadian Medical Association (CMA) at the same time (1976-1977).

Presidencies of the British Association of Paediatric Surgery (1981-82) and the surgical section of the Royal Academy of Medicine in Ireland (RAMI) (1990-92) were to follow, as was the position of Chairman of the Journal Committee of the BMA (1982-88).

In 1984, Prof O'Donnell was jointly awarded a National People of the Year award with Professor Prem Puri, the Hunterian Professorship of the Royal College of Surgeons in England (1986), the Denis Browne gold medal from the British Association of Paediatric Surgeons (1989), the Urology Medal from the American Academy of Pediatrics (2003) and a Distinguished Alumni Award from his alma mater, UCC, in 2004.

He has also been a visiting professor to six US universities, including twice to Harvard, and is the author of 64 peer-reviewed publications, and four books (two co-authored) including Terence Millin - a Remarkable Irish Surgeon and Irish Surgeons and Surgery in the Twentieth Century.

Somehow Prof O'Donnell also found time for hobbies including rugby (Colours, UCC, 1946-48 ‘hooker' - a position which he said gave "great joy" to his American friends), sailing and, in his own words, "incompetent golf".

According to Prof O'Donnell, it was said that he "exceeded his mother's expectations - and not many Cork boys do that".

Support

He puts the reasons for his success down to his "Rolls Royce training". However, key to everything, he says, has been the unwavering support and devotion of his wife of 51 years, Mary.

"Mary is very bright. She has a BA, BComm, and BL. She was prepared to put up with the life of a surgeon at that time. She had me out of the bed at 6.45am for 35 years and I was never home before 7pm."

Prof O'Donnell's "Rolls Royce training" began with postgraduate positions as house surgeon at a number of hospitals in the UK, including Great Ormond Street Hospital for Children in London.

The young Cork surgeon won the Ainsworth Travelling Scholarship from UCC, which brought him to the Lahey Clinic in Boston where he worked under some of the world's most distinguished surgeons of the time, including the great Dr Richard Cattell. Dr Cattell is famously reputed to have saved the life of Sir Anthony Eden (Lord Avon), who had twice undergone botched gall bladder surgery in London.

Lord Avon was the youngest foreign secretary in Great Britain's history and subsequently became Prime Minister, succeeding Winston Churchill.

Recalling with great respect and reverence his time working under Dr Cattell, Prof O'Donnell says: "Suddenly this man was the leading surgeon."

"I was up at 5.45am every morning and he came in at 6.45am. He felt it was his obligation to work as hard as he could for all his life.

"He was a tall, dignified and superb operating surgeon, a great brain."

"I loved the States. I loved Boston. It was endlessly stimulating. The whole medical world passed through Boston ...when I used him as a referee for my job in Crumlin he just wrote one sentence: "If you don't want him we would be very happy to take him back."

After his year in the US, Prof O'Donnell returned to Great Ormond Street at a time when, he explains, "BTA, or Been To America, was the big thing".

"I became senior registrar at the Hospital for Sick Children at Great Ormond Street on the basis of the people I worked with [in the US] and also the fact that I had been there before as a houseman, so a lot of people remembered me, for better or worse, as somebody who was trying, at any rate. So I suddenly became a trainee at the best children's hospital in Europe ... the people I worked with at Great Ormond Street were marvellous and very distinguished. I enjoyed it enormously.

"There were always famous people passing through Ormond Street.

"One of Ireland's most distinguished paediatricians was a man called Bob Collis, he was a very distinguished, lovely man who worked in Ormond Street and played rugby for Ireland. He said to me, ‘they are putting up a new Children's Hospital in Dublin; they will need you. They may not know it but they will need you'," Prof O'Donnell smiles.

At the age of just 29, Prof O'Donnell was appointed as the first and only dedicated paediatric surgeon at Our Lady's Hospital in Crumlin, a position which saw him working single-handed for nine years until the appointment of Prof Edward Guiney in 1965.

While Prof O'Donnell was the first fully-trained paediatric surgeon in Crumlin, he recalls with great fondness the welcome and support he received on his return to Dublin from Ireland's first ever dedicated paediatric surgeon, Mr John Shanley at Temple St.

Welcome

Coupled with the support from Mr Shanley, Prof O'Donnell also remembers the welcome and great assistance he received from Mr Anthony Burton (AB) Cleary, who was a senior surgeon in Crumlin at the time.

"AB used to make all the house surgeon appointments and one person was particularly bad. I was complaining to him about how bad he was and AB looked at me and said, ‘what you are telling me now is that this young fellow is no Barry O'Donnell,' he said, ‘and sure isn't that a great thing?'"

As the only paediatric surgeon in Crumlin, Prof O'Donnell recalls doing 1,100 operations in one year alone. He recounted that children with spina bifida and hydrocephalus made up much of his caseload at the time.

In one year, he operated on 70 children with spina bifida. He wasn't long in Crumlin, he said, when the American industrial technician Mr John Holter (whose son was born with hydrocephalus) invented Holter’s Valve, which enabled CF fluid to be drained from the brain into the heart.

Prof O’Donnell travelled to Great Ormonde Street in London to learn the procedure and brought it back to Crumlin with him.

Prof O’Donnell is probably best known worldwide for pioneering the endoscopic correction of vesicoureteric reflux, in tandem with Professor Prem Puri, Newman Clinical Research Professor at UCD, former Director of Research at the Children’s Research Centre and Consultant Paediatric Surgeon at Our Lady’s Children’s Hospital in Dublin.

Prior to the invention of the endoscopic procedure in 1984, children with this condition had to undergo a two-and-a-half-hour open operation, followed by a 10-day hospital stay. However Prof O’Donnell and Prof Puri’s invention meant that the procedure could be performed in just 15 minutes.

‘Light bulb’ moment

Prof O’Donnell explains that it was at a meeting in Washington that he had his “light bulb” moment during a discussion on the problem of vesicoureteral reflux with an American colleague. Prof O’Donnell recalls that the American paediatric urologist told him that the problem was not such a major one in Washington, where he worked, as 80 per cent of the population there was black and black children did not seem to suffer from vesicoureteral reflux.

“So I asked him, ‘when you are looking in, could you tell the difference between a white and a black bladder?’ and he said, ‘not really’.”

From that, Prof O’Donnell surmised that the difference between black and white bladders must have been very tiny and therefore something small would fix it.

From that, he worked out that what was needed was something very small to be inserted at the point where the ureter entered the bladder to stop the reflux and Prof Prem Puri found a special Teflon paste that did the job.

Putting the paste under the point where the ureter entered the bladder stopped the reflux in 80-90 per cent of cases. So the sub-ureteric Teflon injection (STING) was born. It is estimated that more than 250,000 children have had the STING procedure worldwide, with 20,000 of these having taken place in America in 2009 alone.

The procedure has now replaced open surgery in 80 per cent of cases.

While the STING gained him international acclaim, Prof O’Donnell says his proudest achievement was the development of the Children’s Research Centre at Our Lady’s, which he founded in 1965.

“I got the idea of a research centre from my time in America and at Ormond Street. I realised that research was absolutely essential and we got it started. That was the biggest thing that I did during my life.

Research

“The research centre produced the STING and I don’t think I would have been so into research if I didn’t get the research centre going,” Prof O’Donnell explains.

The Children’s Research Centre has been at the heart of paediatric research in Ireland and internationally for more than four decades.

It was the first dedicated research centre on the site of an Irish hospital and Prof O’Donnell credits Prof Puri with bringing it to international acclaim.

Asked why he chose paediatrics, Prof O’Donnell says he really enjoyed the specialty in Great Ormond Street and he liked the people he met there.

“They say paediatricians are a very nice group and I know that from my own experience. They are a very gentle group compared with some of the frosty surgeons in other areas.”

Negotiations

“I am as pushy as anything. As someone once said, there is only one thing worse than a pushy young man and that is a pushy old man. That is what I am – a pushy old man.”

His pushiness, however, was perhaps much needed in the development of yet another string to his career, which involved medical politics – or medical affairs, as Prof O’Donnell prefers to call it. Uniquely, he became the first and only person in the world to hold the triple Presidency of the IMA, BMA and CMA in 1976-1977.

Prof O’Donnell got involved with the IMA in his early 30s and at 35 was appointed Treasurer of the Association. Fifteen years later he was appointed President of the BMA, at a time when it was decided to appoint one president for all three associations for one year.

“They have not had a triple President since,” Prof O’Donnell laughs.

“I am sure they learned their lesson. As I say, most of my offices have been a great education to me and a great education to the people who appointed me.”

From 1970 to 1981, Prof O’Donnell was also heavily involved in negotiations between the IMA and the Department of Health on the consultant common contract, which continued until 1991.

“I did enjoy the medical affairs side of things. People said ‘did it interfere with your practice? ’ and yes it did, but I never felt the pain. I felt this was a worthwhile thing to do,” he says.

According to Prof O’Donnell, the main differences between paediatric surgery today and his time in Crumlin is the increasing subspecialisation of the profession and the many technical advances that have revolutionised the field.

When he returned to Dublin, Prof O’Donnell performed heart procedures, abdominal surgery, chest procedures and urology. In modern paediatric surgery, these have all become specialised areas.

In terms of remuneration for surgeons at the time, Prof O’Donnell says: “Financially, it was a disaster area.”

“I remember we were paid under £1,000 [approximately €40,000 a year] and the rest was private practice. Private practice was famously bad in paediatric surgery; it still is.”

Management

Thanks to his time spent with the IMA, Prof O’Donnell developed an interest in management. He very much welcomes the decision to roll out clinical directors throughout the HSE.

“Doctors should, in some ways, make themselves proper managers so that they manage their departments.

“I think clinical directorships are vital and the profession has to face up to taking these jobs. If I were of an age today, I would be interested.”

Prof O’Donnell retired in 1993 after 37 years at Crumlin. He says he enjoyed “almost every moment of it”.

In 1998, he was appointed President of the RCSI, which he describes as a further highlight of his career. “I enjoyed it immensely. It is a great institution,” he said.

Asked what advice he would give to somebody thinking of a career in paediatric surgery, Prof O’Donnell says it would be to get trained as soon as possible and to spend some time abroad as part of that training.

He would also encourage paediatric surgeons to incorporate some research into their work, otherwise, he says, life will be “very dreary”.

Abroad

“You have to go abroad to train, either go to England or America, preferably both because they are different systems. What I always say is that in Britain, if you have done a good job they say ‘he is a lovely fellow’. In America, if you have done a good job they will say ‘you have done a great job’. So the ideal reference says ‘we all liked him and he did a great job’,” he adds.

And his views on retirement? Prof O’Donnell smiles when he remembers what Dublin paediatric surgeon Prof Ray Fitzgerald once told him.

“He said the first thing they tell you, and please get this into your head, is that you are not being missed, there are people actually looking forward to your retirement. Don’t go back and haunt them.”

Prof O’Donnell is a veritable master of paediatric surgery. The profession and indeed the Irish health service owe him a great debt of gratitude for his dedication and commitment to caring for very sick children in Ireland. He was very well liked and he did a great job.

Prof O’Donnell’s favourite saying: “Never ask an Irishman where he’s from; if he’s from Cork he’ll tell you and if he’s not, you will only embarrass him.”

Professor Barry O'Donnell - at a glance

  • Professor Barry O'Donnell was born in Cork in 1926, the eldest son of Michael and Kitty O'Donnell. In 1959, he married Mary Leydon and they have four children - John, Michael, Nicholas and Catherine.
  • Prof O'Donnell was educated at the Christian Brothers College, Cork; Castleknock College, Dublin; and UCC. His qualifications include: MB (hons), UCC, 1949; MCh, NUI, 1954; FRCSI, 1953; FRCS Eng, 1953; FRCS Ed (ad hom.) 1993; FRCP& S (Glas qua chir), 1999; FACS (Hon.), 1999; FRCS Eng (Hon) 2007.
  • Postgraduate posts: Winchester; Brighton; Leicester; Hospital for Sick Children, Great Ormond Street, London; Registrar, Royal Northern Hospital, London; Whittington Hospital, London; Senior Registrar, Hospital for Sick Children, Great Ormond Street (Sir Denis Browne, Sir DI Williams) ; Ainsworth Travelling Scholarship from UCC to Lahey Clinic, Boston (Drs Richard B Cattell, Herbert Adams, Samuel Marshall, Ken Warren) ; and Boston Floating Hospital for Infants and Children (Dr Orvar Swenson).
  • Employment: Consultant Surgeon, Our Lady's Hospital for Sick Children, 1957- 93; Children's Hospital, Temple Street, 1977-88; National Children's Hospital, Harcourt Street, 1965-80.
  • Ireland's first Professor of Paediatric Surgery, RCSI, 1986-93.
  • Honorary Fellow, Singapore Academy of Medicine and Surgery, 1999; Malaysian Academy of Medicine and Surgery, 2000; College of Surgeons, South Africa, 2001; Section of Surgery, American Academy of Pediatrics; American Pediatric Surgical Association; American Surgical Association; New England Surgical Association; Boston Surgical Association.
  • President of the British, Canadian and Irish Medical Associations, 1976-77; British Association of Paediatric Surgeons, 1981-82; surgical section, RAMI, 1990-92, President of the RCSI 1998-2000.
  • Chairman, Journal Committee, BMA (including BMJ) 1982-88.
  • Awards: National People of the Year award with Professor Prem Puri; the Hunterian Professorship of the Royal College of Surgeons in England (1986); the Denis Browne Gold Medal from the British Association of Paediatric Surgeons (1989) ; the Urology Medal from the American Academy of Paediatrics (2003) ; and a Distinguished Alumni Award from UCC in 2004.
  • Publications: 64 peer-reviewed publications, four books (two co-authored) including Terence Millin - a Remarkable Irish Surgeon and Irish Surgeons.
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