The Knife’s Edge
An intimate and compelling exploration into the unique psyche of the heart surgeon, by one of the profession’s most eminent figures.Although Professor Stephen Westaby was born with the necessary coordination and manual dexterity, it was a head trauma sustained during university that gifted him the qualities of an exceptional heart surgeon: qualities that are frequently associated with psychopathy. His thirty-five-year career has been characterised by fearlessness and ruthless ambition; leaving empathy at the hospital door as thousands of patients put their lives in his hands.For heart surgeons, the inevitable cost of failure is death and in The Knife’s Edge, Westaby reflects on the unique mindset of those who are drawn to this exhilarating and often tragic profession. We discover the pioneers who grasped opportunities and took chances to drive innovation and save lives. Often difficult, uninhibited and fearless, theirs is a field constantly threatened by the risk of public failure.Like those before him, Westaby refuses to draw the line in his search of a lifetime solution to problems of the heart. His determination is unerring – a steadfastness underpinned by his unusual mind. But as we glimpse into the future of cardiac surgery, for all its remarkable scientific advancement, one question remains: within the confines of socialised medical healthcare systems, how can heart surgeons – individuals often hardwired with avoidance of self-doubt, a penchant for glory and a flagrant disregard for authority – truly flourish?
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Certain details, including names, places and dates, have been changed to protect privacy.
Mudlark
An imprint of HarperCollinsPublishers
1 London Bridge Street
London SE1 9GF
First published by Mudlark 2019
FIRST EDITION
© Stephen Westaby 2019
Cover layout design Claire Ward © HarperCollinsPublishers 2019
Cover images © Granger/Bridgeman Images (heart engraving), Shutterstock.com (scalpel)
Stephen Westaby asserts the moral right to be identified as the author of this work
A catalogue record of this book is available from the British Library
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Source ISBN: 9780008285777
Ebook Edition: April 2019 ISBN: 9780008285807
Version: 2019-04-17
For Sarah, who saved me from myself, together with Gemma and Mark, then Alice and Chloe, the children and grandchildren who give me so much pleasure.
contents
1 Cover
2 Title Page
3 Copyright
4 Dedication
5 Contents
6 Preface
7 Introduction
8 1 Family
9 2 Sadness
10 3 Risk
11 4 Hubris
12 5 Perfectionism
13 6 Joy
14 7 Danger
15 8 Pressure
16 9 Hope
17 10 Resilience
18 11 Misery
19 12 Fear
20 Acknowledgements
21 Glossary
22 By the Same Author
23 About the Publisher
LandmarksCoverFrontmatterStart of ContentBackmatter
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Every single heart operation risks a life. This tension between kill or cure is unique to my specialty, with no professional equivalent, and few people can live with it on a daily basis. During my formative years, to operate within the heart was seen as the last surgical frontier. Direct vision repair was considered as difficult as landing on the moon or splitting the atom. Then the heart–lung machine and the swinging sixties changed everything. Heart transplants and artificial hearts both emerged during my impressionable medical school years. When I embarked on training in the 1970s, heart surgery remained an exclusive and remote club that was exceptionally difficult to join. Yet I was eventually granted the profound privilege of being able to improve thousands of lives.
Each heart is unique in its own way. Although most operations prove straightforward and uneventful, some evolve into an extraordinary battle for survival and a few are quite literally a bloody disaster. As my experience and knowledge increased, I became a last port of call for the cardiologically destitute, a depository for cases that no one else wanted, at home and abroad. Ultimately I lost patients whom I knew could be saved with equipment we were denied in the NHS. The recriminations that accompany death soon followed. An agonising interview with the bereaved, dismal discussions at the ‘Morbidity and Mortality Meeting,’ then a joyless visit to the coroner’s court. I was vehemently outspoken about the system’s deficiencies, and suffered as a result. The NHS doesn’t care for those who do not conform.
In this book I have set out to describe how it felt to be a heart surgeon as the specialty emerged and what it is like in the current hostile environment. I have depicted the physical and the psychological endeavour, the emotional highs and lows, the triumphs and the disappointments, and how being a surgeon affected me and my loved ones. When I was a young man, as we shall see, a peculiar quirk of fate helped me by dispelling my inhibitions and rendering me immune to fear. It’s not something I would freely recommend and it was a curious launchpad for a career at the sharp end, one that enabled me to embrace challenges that others would wish to avoid.
