Life and death on the operating table

Rebecca Wallersteiner reviews “Fragile Lives: A Heart Surgeon’s Stories of Life and Death on the Operating Table” by Stephen Westaby – at the cutting edge of medical memoir.

“The finest of margins separates life from death, triumph from defeat, hope from despair – a few more dead muscle cells, a fraction more lactic acid in the blood, a little extra swelling of the brain. Grim Reaper perches on every surgeon’s shoulder and death is always definitive. There are no second chances,” writes Professor Stephen Westaby in the opening sentence of his moving, brilliant memoir, published this spring. During the past twenty years Westaby has become internationally renowned for his pioneering heart surgery techniques including the use of heart pumps, artificial hearts and technology to circulate blood around the body and for dealing with complex congenital anomalies in babies and toddlers. He is famed for inventing the Westaby tube, an ingenious instrument shaped like a T on top of a Y which helps keep the entrances of badly damaged lungs open during surgery.

“All heart surgery is a risk. Those of us who make it as surgeons don’t look back. We move on to the next patient, always expecting the outcome to be better, never doubting it,” writes Westaby.” Cardiac surgery is not for the timid or nervy. In the operating room there is no room for doubt. The balance between life and death is so delicate and the heart surgeon walks the tight-rope between the two. An off-day can have dire consequences – this job has a steep learning curve, and the cost is measured in human life.

Professor Westably didn’t come from a medical family. He was raised “church-mice poor in a grimy council estate” in 1950s Scunthorp. He decided to become a heart specialist at the age of seven after watching American surgeons perform hole-in-the-heart surgery in the classic BBC series, Your Life in Their Hands, and seeing his beloved grandfather, a steelworker, who had smoked “twenty a day” die of cardiac failure, at the age of 63. Aged sixteen he got a job as a hospital porter in the school holidays.

As a pre-clinical medical student, aged 18, he illicitly watched from the Ether Dome, in the then Charing Cross hospital, as a 26-year-old woman called Beth was operated on for a heart weakened by rheumatic fever. The woman died. “Beth taught me a very important lesson that day in the ether dome. Walk away as her surgeons did and try again tomorrow,” writes Westaby. He quotes his mentor Sir Russell Brock, the most renowned heart surgeon of the era, who was known for his bluntness about losing patients – ‘I have three patients on my operating table today. I wonder which will survive.’ Even though it may seem insensitive, the heart surgeon cannot afford to dwell on death as to “indulge in sorrow or regret brings unsustainable misery.” One the important things he learnt from Brock was to regard his very ill patients as puzzles.

Soon Westaby was obsessed with his work: “Cardiac surgery is like quicksand. Once in it you’re sucked deeper and deeper, and I struggled to leave the hospital in case something remarkable happened and I missed it.”

He worked for thirty five years at the John Radcliffe Hospital in Oxford “without being sued or suspended, an increasing rare species.”

Later in his career Westaby grappled with necessary detachment when his interests veered towards complex cases: heart surgery for complex congenital anomalies in babies and young children. “Some came toddling happily into hospital, teddy bear in one hand, Mummy holding the other. Blue lips, little chest heaving, blood thick as treacle. They’d never known a different life and I strived to provide that for them. To make them pink and energetic and liberate them from impending doom.” In Saudi Arabia he battled for the life of an 18-month-old-boy who had an engorged heart on the wrong side of his chest.

Professor Westaby took chances and pushed the boundaries of heart surgery, saving hundreds of lives over the course of a thirty-five year career and in his fascinating and vividly written memoir he describes some of his remarkable and poignant cases – such as the baby who suffered multiple heart attacks by the age of six months, a woman who lived the nightmare of locked-in syndrome, and a man whose life was powered by a battery for eight years.

As he approaches his 69th birthday, Westaby continues to investigate the possibility that the adult heart might be regenerated with its own stem cells.

A powerful, important and riveting book, “Fragile Lives” offers an exceptional insight into the world of heart surgery and how it feels to hold someone’s life in your hands. Although its gory descriptions mean that it is not for the faint-hearted, it would make ideal summer holiday reading for doctors. Highly recommended!

Fragile Lives: A Heart Surgeon’s Stories of Life and Death on the Operating Table by Stephen Westaby, published by Harper Collins, 2017, £14.99