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Your life in his hands

This is the latest in a growing genre of medical memoir books – Drs Kalanithi, Marsh et al – to appear in the book shops.   Prof Westaby has been a pioneering cardiac surgeon, carrying out over 1,000 operations on adults and children, a supremely non-PC person, a backstreet kid from Scunthorpe, winner of a BBC TV documentary award, a competent scribe of terse, concise prose and an extremely good storyteller.  

He must have kept detailed notes of his portrayed procedures or temporarily pilfered their case notes. He mingled and worked with the best in the UK and US. Prof Westaby was well described by the late American cardiac surgeon Denton Cooley: “A successful cardiac surgeon is a man who when asked to identify the three best surgeons in the world, has difficulty in naming the other two.” Prof Westaby has invented the Westaby tube and was the first to install a number of artificial heart pumps. He describes himself as a “flamboyant and confident performer”.

But who is this book for?  Despite a glossary of seven pages, many physiological and surgical details remain unexplained.  There is just one diagram when many more would have helped.  Prof Westaby was certainly a skilled, cool-headed operator with good judgement.  He describes himself as having “cerebral co-dominance” and able to operate with either hand. Cruelly, his surgical life was curtailed by a Dupuytren’s contracture of his right hand, which he left too long (typical doctor?). He is courageous and undaunted, critical of the current NHS and unafraid of commenting on poor previous diagnostic performance given to some of his referred patients. He had to fund some of his remarkable operations from his department’s own finances.

Prof Westaby is eminently quotable:

“As surgical trainees we were sleep deprived.  Sleep deprivation underpins the psychopathy of the surgical mind.”

“This is cardiac surgery.  Another day at the office for me, the end of the world for her.”

“Air in the brain, life down the drain.”

“Air in the head, dead on the bed.”

“Medical doctors are the Stasi from a hospital doctor’s standpoint. If you do anything like this again, you’ll be out.”

“But if we really considered the enormity and sadness of every tragedy played out in this unit we’d all drown.”

The essence of this gripping book is found in 10-plus stories and their outcomes – Peter, Julie, Stefan, Kirsty, Abel, Anna, Mr Clarke, Julia, et al.  Prof Westaby did most of his work in Oxford, but also operated in the Royal Brompton Hospital, which I recall as a lowly SHO many decades ago.  

Each story is given a chapter of gruelling surgery and life-changing outcomes. There are oodles of blood and drama, with perfusion, bypass, drains, pumps and the most modern medical paraphernalia. He was the first to install the Jarvik 2000 heart pump, which drive at 10,000 RPM and provides a pulseless circulation of five litres per minute.   Its recipient described himself as “the bionic pulseless man, a model cyborg”. Flow, not pulsation, was the key to the success of this and other pumps.

Many of Prof Westaby’s patients were in advanced cardiac failure, at death’s door, and were prepared to accept 50/50 risks or worse to achieve prolongation of life.   Several had a dilated cardiomyopathy secondary to viral (influenza) myocarditis. Most, but not all, of the chosen case histories had a happy outcome. One unfortunate man forgot his spare battery when away on holidays and ended up RIP when his electrical heart ceased. Others had to contend with noisy whirring pumps, a low blood pressure (70-90mm) pulseless state.

Prof Westaby comes across as a big man with a big heart, a brawny temper, a daring innovator, who thrives on challenges and confrontations and survives through his skilled hands and surrounding team. His operating theatre protocol is requests to medical colleagues but orders to the technical staff.  He admits to thriving on penetrating chest wounds, which stimulated an adrenaline rush. He warns readers not to remove knives in the chest prior to referring to hospital. 

The heart is a superb pumper, tirelessly efficient, silently contracting, meticulously pulsatile. By the time one reaches 70 years, the heart has contracted some 2.5 billion times without a rest.   The heart has one of the highest malformation rates amongst our organs, probably due to the complexity of its formation.  Prof Westaby operated on adults and children. One of the more memorable chapters covers the correction of anomalous left coronary artery from the pulmonary artery (ALCAPA) in a small child.

Cardiothoracic surgery is at the cutting-edge of modern surgery. Prof Westaby must be well up in performance league tables – which he hates. I reckon he would be a garrulous and enjoyable dinner guest. He writes well – telling of the US college footballer who caught a virus, went from virile to viral, athlete to asthenic. He opines that his personality and retirement were not compatible. 

A good read about cardiac surgery, which medics should enjoy.  

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