Professor Stephen Westaby has said shame-and-blame culture stifles innovation He was a pioneer in cardiac technology who flouted rules and worked round the clock During his career, he carried out 11,000 open heart operations, at a rate of around 600 per year Professor Stephen Westaby does not possess the air of lofty self-importance you might associate with pre-eminence in the field of heart surgery. Bluff and genial, he grew up on a Scunthorpe council estate and still speaks with traces of a Lincolnshire accent. His career began 40 years ago before the strictures of the shame-and-blame culture made it impossible to save lives through innovation and experiment. A genius and a maverick, he was a pioneer in cardiac technology, who has flouted rules, ignored warnings from hospital bureaucrats, worked round the clock and continually pushed boundaries, deploying untested artificial hearts and mechanical blood pumps to extend the lives of patients who otherwise would have faced certain death. There have been occasions, however, when the technology he used in the operating theatre was less cutting-edge. Take the time when, as a young surgical trainee at the Brompton Hospital in London he was summoned from the pub, after a boozy pre-Christmas lunch, to assist in an emergency operation on a man injured in a car crash. ‘Bad problem,’ he recalls. ‘Not just the injury, but the beer. Not so much the amount of alcohol, but the volume of urine I was likely to pass during a four-hour operation.’ Knowing he could not maintain concentration with a bursting bladder, Westaby came up with a practical solution. He improvised a catheter with a length of rubber tubing attached with sticky tape to his inside leg, allowing it to decant into the short, white Wellington boots surgeons then wore in the operating theatre. It worked a treat, he discloses: ‘Though by the end of the operation, my boot was full of urine and I had to cough occasionally to disguise the squelching sounds.’ This anecdote sets the tone for a rollicking interview in which Westaby, 68, also reveals he carried out another emergency op — this time on a young motorcycle accident victim — while wearing his rugby kit and suffering from a broken jaw sustained in an ill-judged tackle. Then a registrar in general surgery, he’d been sitting in A&E at Addenbrooke’s Hospital, Cambridge, waiting for an orthodontic surgeon to fix his jaw when he was asked to intervene and stitch up the poor chap, who was haemorrhaging in his chest cavity. ‘Without me scrubbing up and having a go, he stood no chance because all the chest surgeons were operating at another hospital,’ he says. ‘So I opened him up, while still wearing my grubby rugby shorts and with muddy knees. His blood was spilling all over my rugby boots, and I was spitting my own blood into the scrub sink.’ Not pausing to recover from his own injury — in fact, he says he never took a day off sick during his entire working life — his work rate was prodigious. During his career, he carried out 11,000 open heart operations, at a rate of around 600 per year. While operating, he played records by Pink Floyd. Today, the average surgeon, constrained by working hours directives, staff shortages and inefficient use of hospital operating theatres, completes 150 procedures. Westaby was a swashbuckler, the Errol Flynn of the operating theatre. Three decades ago, if police caught him speeding in his Jaguar when racing to a medical emergency, they would give him a VIP escort, clearing his way to the hospital. Today, he’d rack up points on his licence and doubtless face being banned from driving. Usefully, too, he is ambidextrous and apparently capable of functioning efficiently with barely any sleep. Hungry for experience and eager to seek out the latest innovations, in the early days of his career he flew overnight — and uninvited — to Houston, Texas, where the eminent cardiac surgeon Denton Cooley had become the first to implant an entirely artificial heart. ‘I arrived at the Texas Medical Centre at 4am and settled down for a nap in the foyer,’ he says. ‘The receptionist thought I was a tramp. All that saved me from being thrown out was my English accent. ‘She said “Is Dr Cooley expecting you?” and I lied and said he was. When he arrived at 7am, I introduced myself and he was charming.’ It was to be the start of a career-long association between Westaby and a team of Texan heart surgeons, always readily distinguishable when they arrived in Britain to assist the professor by their Stetsons and cowboy boots. Westaby retired from the NHS last year, his departure hastened by the fact he had developed a claw hand — known as Dupuytren’s contracture — and needed an operation. Since then, he has published a book, Fragile Lives, a buccaneering account of the everyday world of a heart surgeon: the blood and flesh; the pumping of vital organs using bare hands; the perilous line walked between life and death. ‘A slip of the hand and life ebbs away,’ he writes. ‘You must stitch holes while the (heart) muscle pumps away — you are the mechanic fixing the car while it speeds down the motorway.’ It is not a job for the faint-hearted. Neither is it one for clock-watchers or those aspiring to routine or regular hours. Medical emergencies have a habit of happening at unpredictable times. Westaby records how he had just arrived in Australia after a 24-hour flight and had drifted into a deep sleep — assisted by the soporific effects of a bottle of Merlot — when, at 3.45am, his phone rang. On the end of the line was a colleague at Oxford’s John Radcliffe Hospital — Westaby was then heart surgeon at the paediatric cardiac unit there — urging him to fly back immediately to operate on a baby girl suffering from a rare congenital heart condition. At just six months old, Kirsty was perilously close to death, enduring agonising heart attacks and excruciating pain she could neither communicate nor understand. There was only one option for Westaby: he got up and caught the first available flight back to the UK, sketching in a notebook during the journey a bespoke operation for the little girl. ‘When I reached Kirsty’s cot, her heart failure was the worst I’d ever seen in any child,’ he says. ‘She was emaciated, and without immediate surgery would have been dead within days. A voice in my head screamed: “Oh s***!” My mouth said: “I’ll go to theatre now.” ’ There was no time to question the wisdom of attempting complex, ground-breaking surgery when he was sleep-deprived after criss- crossing the world twice. Without it, Kirsty would die. And so began the delicate process of repairing the baby’s damaged heart. When one technique failed, he could not face the awful prospect of telling her parents their child was dead, so he improvised; cutting, sewing and reconfiguring until the tiny heart — detached from its by-pass machine — finally began beating to its own rhythm. ‘Gloom turned to elation. Adrenaline kicked in. My tiredness lifted,’ he writes. Afterwards, joyous yet exhausted, he went for a run near his home in the Cotswolds, stopping near Churchill’s grave to observe to himself: ‘I’d followed his dictum: never surrender.’ Kirsty’s reconstructed heart continued to work and began to heal, the scar tissue disappearing. That a severely damaged heart was capable of such regeneration was a groundbreaking discovery. Today she is 18, a vivacious, athletic teenager who owes her life to Westaby. She was with him at the launch party for his book, together with Julie, who was a 21-year-old student teacher when she developed a potentially fatal viral infection that causes the heart muscle to fail. ‘By the time she was rushed to hospital, her liver and kidneys had also packed up and she was as good as dead,’ says Stephen. Without permission from the hospital’s ethics committee — though he claimed at the time he’d been given it — he used an American spinning blood pump called the AB-180 to do the job of her ailing heart. Until then, the pump’s failure rate in the U.S. had been an unedifying 100 per cent, but Julie survived, and remains obdurately alive and thriving, 20 years on. She works in a hospital. After this successful operation, Westaby was summoned by the hospital’s medical director. ‘They’re the Stasi as far as hospital doctors are concerned,’ he says. ‘Their job is to ensure no one does anything new or interesting. ‘He had a face like thunder. “How dare you use an unregulated device?” he asked. ‘I told him I wasn’t the kind of doctor who’d let a young patient die because of some bureaucratic detail. I sat there in my blood-stained theatre gear thinking “Get a life”, and his parting comment was: “If you do anything like that again, you’ll be out.” ’ It is this kind of intransigent adherence to unhelpful rules that infuriates Westaby, though he says he ‘loves’ the principle of free health care on which the NHS was founded in 1948 — the year that he was born. However, he regrets that the NHS now suffers from a disillusioned workforce, a parlous shortage of doctors and nurses and a burdensome bureaucracy. He recalls how he was reprimanded by a hospital medical director for failing to complete his ‘personal development plan’ adequately. It was the last straw, the crowning absurdity. ‘I was being asked to complete a form when I could have been up to my elbows in someone’s chest, doing some good,’ he says. He also laments the ‘nightmare’ of the NHS 111 telephone service — ‘paramedics and pharmacists are being forced to make decisions about sick people they’re simply not qualified to make’ — and mourns the change in GP contracts: ‘The worst thing ever was telling GPs that they didn’t have to work nights or weekends, because we lost the old family doctors and local surgeries, which were such a valuable commodity.’ How can the vast hole in NHS funding be fixed? Perhaps, he suggests, with a tiered insurance system based on the successful Australian model that mixes public and private health provision. Westaby is married to his second wife, Sarah, whom he met over a gaping chest when she was a theatre nurse, and they have a son Mark, 29. His daughter, Gemma, 38, from his first marriage to Jane, has produced two granddaughters, Alice and Chloe. That he missed much of his children’s childhoods when he was operating on other youngsters’ hearts is a regret, though Mark — who sits with us as we chat — says he remembers only an attentive and loving dad who was always at his rugby matches, the team’s unofficial medic. Today, though he may no longer be operating, Stephen is still at the forefront of cardiac technology, developing the first British artificial heart with a team at the Institute of Life Science, Swansea University. He hopes that by the end of next year, patients will be benefiting from it. Meanwhile, we can only hope for the day when medical science has advanced to such a degree that men such as Stephen Westaby can be cloned. Source
