Professor Stephen Westaby, surgeon and writer

0:00Hello, I'm Lauren Laverne and this is the Desert Island Discs podcast from BBC Radio 4. Every week I ask my guests to choose the eight tracks, book and luxury, that they'd want to take with them if they were cast away to a desert island. For rights reasons, the music's shorter than on the original broadcast, but you can find a version with longer music tracks on BBC Sounds. Listeners will also get access to episodes 28 days earlier than everyone else. I hope you enjoy listening.

0:30Thank you.

1:00stretches around the world. In his long career, he's performed over 11 ,000 operations and saved many lives with the new ideas and practices he's brought to his specialism. Though he says if it wasn't for a quirk of fate, he may never have had the guts to do it. He was born in 1948, in the same month as the NHS, and grew up in Scunthorpe. Dexterous and creative, he was at home with a paintbrush as much as a textbook. Gifted but shy, he dreamed of a career in medicine but turned down a place at Cambridge as he wasn't confident enough to take it up. Until, that is, a head injury he sustained in a rugby match changed his personality.

1:40His inhibitions disappeared overnight, though his ambition, his empathy and his obsession with the human heart remained. He says, guts just wriggle and squirm, lungs inflate and deflate, but the heart dances. For me, it was Swan Lake in the chest. Professor Stephen West, welcome to Desert Island Discs. Well, many thanks. It's a great honour for me to be here. Well, we're delighted to have you, Steve. The human heart dancing, I mean, what a poetic metaphor, but what a nightmare to operate on. I mean, a real challenge. Was that part of the appeal for you too, the fact that it was so difficult? When I first saw a heart, I was just totally mesmerised by its rhythm, its efficiency, the way one set of chambers contract and then the second set of chambers contract to pump the blood round the body into the lungs.

2:33It's a beautiful thing. The heart-long machine and something called cardioplegia, cold solution with potassium that stops the heart in a flaccid condition is what allows us to operate with accuracy. so virtually every heart operation I did involved stopping the blood splite of the heart putting in the cold fluid watching it slow down stop and collapse as it emptied and then at the end when you repaired it it would start up again start contracting again and usually if you'd done a good job with the repair it would look totally different transformed and that was an enormous sense of satisfaction for me.

3:22We'll talk today Steve about some of the characteristics that have helped you become a world-class surgeon some of them you were born with including ambidexterity how did that help you in your work? It helps because I can use either hand to tie knots and I can shift instruments from one side to the other and it just greatly helped with the accuracy. It's a spatial phenomenon. So I mean you found out later in life Steve that you have ADHD. I mean looking back at your career how do you think that played into your working life? It made me impatient and the combination of being able to operate quickly through the ambidexterity and the impatience that I had.

4:08I didn't want to spend all day on one case. I wanted to do three, four, five cases a day if I could. And I would just love children with ADD that have a label put on them to realise that it shouldn't hold you back. You should take it on and make the best of what you've got because it'll probably turn out to be very successful. Steve, we've got so much to talk about today, but of course we've also got your discs to hear. I think we should get started with your first one. Tell us about your first choice today. Why are you taking it to your desert island? Well, wonderful land. I remember the shadows from my youth, my teenage years.

4:47And when the blast furnaces opened at night and the sky lit up all red, Sconthorpe was wonderful. I worked in the blast furnaces. I saw the steel bin poured. and I thought as a young man that was wonderful so wonderful land here's the shadows

5:40The shadows and wonderful land taking you back to Scunthorpe where you grew up, Steve Westerby. So you were born in 1948, the same month as the NHS. And growing up, you always took flowers to a lady who lived locally on your birthday with your mother. Tell me the story behind that. Why did you go to visit her? Back in 1948, when I appeared in the world, there was no real heart surgery. And indeed, I learned from my lovely mother years after I was born that the baby in the next cot actually was a blue baby and died shortly afterwards. So that was a baby that wasn't getting enough oxygen around the body.

6:27Yeah, not getting enough oxygen and a hole in the heart. So that little baby didn't make it. And I only learned about that when I was about five or six, because my mother used to take me on my birthday to a lady's house to give her flowers. and finally I asked why are we going to this lady's house and she explained that her baby had died the same day that I was a thriving, vigorous, noisy young baby and she felt very, very bad and it affected her. She was a very, very kind lady, my mother. So it's a coincidence that life for me started out next to a baby and 25, 30 years later, I'd be learning how to make those hearts better.

7:25So your mother, Doreen, very kind, as you said. How else would you describe her? What kind of person was she? Oh, she would do anything for anybody. She was warm, very sociable. she became a manager of the trustee savings bank on Scunthorpe High Street when all the men went off to war. And afterwards, I mean, we didn't have much money, so she continued to work. So with both my parents working, I used to come home from school and spend time across the street with my grandparents. Two grandparents. And what about your father, Kenneth? So he was in the RAF and he'd been active in the war. How did that experience affect him?

8:15Were you aware of that? Well, he was one of these people that never talked about the war. I think that was fairly common in the old days. I mean, the Second World War had only just finished a couple of years before I was born. So the aftermath of the war was still there to see. The steelworks had been bombed. So I grew up knowing about the war. One of the things that broadened your horizons, Steve, was getting a TV. I think you would have been about six or seven when you got your first TV set. Yeah, we got a little nine inch black and white television set. and one day on the television set in the early evening I saw a BBC programme called Your Life in Their Hands and this was a pivotal moment for me because there was great excitement.

9:17The programme came from the Hammersmith Hospital in London and said that the Americans had developed a device called the heart-loan machine and that we were soon going to be able to operate on patients' hearts. So, of course, this rang a bell for me immediately after the blue baby, and I thought to myself, gosh, if there's going to be a heart-lung machine, I'd like to use it. I want to be a heart surgeon. And I actually decided that's what I would love to be when I was about eight years old. Did you tell anyone about that dream? Yes, I did. I told my parents. I said, you know, after all that's gone before, I would love to get to medical school.

10:02And my father, nobody in my family had been to a university before. So they just said, well, you better work very hard then because that's not an easy route. And I don't think anybody had any expectation that I would ever achieve that. But I was determined. Let's have some more music, Steve. Disc number two, what have you gone for and why? Viva La Vida by Coldplay. I used to listen to Coldplay in the operating theatre a lot. My staff used to like to have music and some sort of amusement because heart operations are long. Mine were certainly shorter than most, but I used to play music and Viva La Vida was one that really set me off because I just was enjoying life.

11:00For me, being a heart surgeon wasn't onerous in any way. I didn't even regard it as an occupation. It's just what I did and I was happy to do it all day and all night, much to the disgust of my family.

11:22Now in the morning I sleep alone Sweep the streets I used to own I used to roll the dice Coldplay and Viva La Vida. Steve Westerby, you were very close to your maternal grandparents who lived just across the street from you in Scunthorpe. You were particularly close to your grandfather. How do you remember him? Well, he was very kind. He'd been the air raid warden for the area in Scunthorpe during the war and a steel worker all his life. and he took time to sit and teach me how to draw and then paint. What kind of thing would you draw? Oh, the landscapes I saw in Scunthorpe. And as I always used to say, there were no golden sunsets over Scunthorpe.

12:31But when the blast furnaces opened at night, it was wonderful. My best painting ever, I think, was a courting couple standing under an old-fashioned lamppost at night looking at the sconthorpe sky. So your grandfather, as you say, was a steel worker all his life and that carried with it risks of lots of industrial diseases and he struggled with his health, didn't he? What was he dealing with? Like everybody else in those days, he was a smoker and he worked in smoke. And sadly, I witnessed him having several heart attacks. And with each individual heart attack, his heart function got worse. When you have a heart attack, scar replaces muscle.

13:24and once a certain amount of scar forms, the scar stretches and the heart just dilates and fails and it's an awful thing. And I watched the natural history of heart failure in my grandfather until one day I came home from school and the GP's black Austin Healey was parked outside and I knew there was trouble. I peeped through the curtains and I could see my mother and my grandmother, either side of my grandfather, and his face was dark blue. And indeed, the good old GP gave him a slug of morphine to make him comfortable. And that was the end. And he was 62, I think, was he? He was only 62. that stayed with me and that was the motivation that I had to be able to help people in that situation Because in those days, what was the prognosis?

14:31Well, there was no heart surgery then so I thought, something needs to be done about this we have to be able to do something about this Steve, it's time to go to the music your third disc today what's next and why are you taking it with you to the island today? Well, it's Gerry Rafferty's Baker Street, and it just reminds me of the transition between the back streets of Scunthorpe and the City of London and the Strand and Baker Street and what a different life it was once I'd got to medical school.

15:18Winding your way down to Baker Street Lighting your head and dead On your feet well another crazy day You'll drink the night away And forget about everything This city desert makes you feel so cold It's got so many people... Gerry Rafferty and Baker Street. Steve Westerby, your personality, growing up was quite different to what it became later. What kind of kid were you? Tell me about you as a little boy. Well, I was actually a very shy kid and I was always very well behaved because my father was very regimented and so I had to come home from school and do my homework. So I went off to medical school as a shy backstreet kid from Sconthorpe, basically.

16:15I'd never have got to a medical school these days I mean I was good at biology, average at chemistry and even though I got a degree in biochemistry later on and physics and maths I was totally hopeless So tell us a bit about the route that took you there It started out I think with a holiday job as a hospital porter when you would have been about 16? Yes it did I used to be a theatre porter and I was very taken by going and watching the operations and the surgeons could see that, you know, I delivered the patient but then wanted to hang around and look over the drapes. I remember going to the mortuary, taking bodies from the operant theatre to the mortuary and then I started asking the pathologist whether I could watch the post-mortems.

17:08So you weren't intimidated by any of that? No, I wasn't. You were only 16. Yeah, I wasn't. I was fascinated by human anatomy. So this is around the time, Steve, that you were offered a place to study medicine at Cambridge University. And despite it being your dream, you turned it down. Why? Well, you know, I remember trying to find the college that I was going to for the interview. and I was walking along in Cambridge looking lost and I walked past the old Addenbrookes Hospital and a nurse came out coming off duty and she said, can I help you? You're looking lost. And I said, well, I'm trying to find such and such a college.

17:55I've got an interview there. And she said, I'm going that way. Let me show you where it is. So we walked along and she said, where are you from? and I thought to myself, if I say Scunthorpe, she'll laugh because it was the butt of music hall jokes in the old days. So I said, well, I'm from Lincoln. And she said, oh, that's funny. I'm from Lincolnshire. I'm from such and such a village just outside Scunthorpe. And I felt sort of two feet tall and seeing the Dons riding their bikes on the way to the fancy dinners in the colleges in the evening. I thought, gosh, this is a wonderful place, but it's not me.

18:39So I went down to London. I had an interview in London, and in London they just selected people that they thought had aptitude and said if you just pass your three A-levels, biology, chemistry and physics, you've got a place. So this is Charing Cross Hospital, 1966, you were in. fantastic place now but pre-clinical students there weren't supposed to watch heart operations were they steve no uh pre-clinical students were meant to keep themselves in the in the medical school and and not go across the road to the hospital until i can tell by the look on your face that you did you did not keep to this rule no i was so i was so desperate uh i heard they were doing heart surgery once a week on a Wednesday.

19:29I got the hospital porter to tell me how to get up to the top floor of the hospital and into the viewing gallery and I went up there into the viewing gallery and there was nobody else there and I was just looking down directly above the operating table and there was a young woman with a chest wide open and I could see a heart for the first time and I could see the heart-long machine and so on and so forth still spinning. And then I remember the surgeon said, off bypass, and the patient didn't do well. So they gave a huge dose of adrenaline to try and boost the blood pressure. And indeed she came off the heart-long machine, but the suture line on her aorta, the largest blood vessel coming out of the heart, ruptured.

20:23What did you take away from that experience? That heart surgery would get better. Those were the very early days. Steve, let's take a minute for some more music. Your fourth choice today. What are we going to hear? Well, the great pivotal moment was being sent to America to the world's top heart surgery unit. So where was it? Where did you go? Birmingham, Alabama, under a very famous surgeon called John Kirkland, who was the first man to make a success of the heart-long machine. And when blood comes out of the body into a circuit made of synthetic materials, it used to generate an inflammatory response, which was fed back into the patient.

21:11and it would produce something called the post-perfusion syndrome. And the longer you were on the heart-lung machine, the more likely you were to have the post-perfusion syndrome. And if you were frail, elderly or a baby, it could actually kill you. And the chief, John Kirkland, who put me on the project to find out what it was about the materials that was killing the patients. And I succeeded in that. It was one particular material, nylon, activated something in the blood called complement. And that produced damaging chemicals that hit the lungs, hit the kidneys, hit the brain and put the patient at risk.

21:59And when I identified nylon as the principal cause, the manufacturers took nylon out of the circuit and heart surgery became safer overnight. How many lives do you think that change saved? I think that changed the whole profession of cardiac surgery. So America by Simon and Garfunkel always resonated with me. Let us be lovers when I read our fortunes together

22:32I've got some real estate here in my bag So we bought a pack of cigarettes And this is when the pies And walked off to look for America

22:56Simon and Garfunkel and America So Steve Westerby, in 1967 you suffered the severe head injury that would change your life You were playing a rugby match and I think you tackled an opponent. Talk me through it. What actually happened? Well, I got a knee in my head. That's what I was told because I was out like a light, but I flopped down in a pool of water. And needless to say, a medical school rugby team full of caring people, what they cared about was scoring a try. So I was left face down, unconscious in the water. and I didn't come round for quite some time. And when you did, they took you to the pub, I think.

23:39Yes, but I deteriorated very markedly overnight and ended up in hospital for quite a while. So tell me about that then. What kind of effect did you have? It was when you started to come round, everyone realised something about you had changed completely or your behaviour had changed. I was fearless after the frontal head injury. I lost inhibitions and I lost my shyness. I didn't lose any intellect. I just lost the inward looking inhibitions. And of course, becoming an extrovert with ambidexterity and everything, I was all set to become a heart surgeon. That was pretty perfect. So you constantly craved excitement?

24:27I did. I did more or less. I simply didn't see fear or trepidation in major cases. And there were destructive sides to the change in personality. I married after medical school a very, very nice teacher who trained in Cambridge who was at school with me in Sconthorpe. But after the personality change, I was completely different. So that was the end of marriage number one. I felt terrible about that for the rest of my life. I had the most beautiful daughter who I'm very close to now, Gemma. And what about your attitude to risk, Steve? How did that change? Because presumably for a surgeon, that's a critical element of your assessment of each case that is in front of you.

25:24I stopped acknowledging risk. For me, risk didn't matter. For me, all that mattered was focus. If I had a problem in front of me, it was there to be solved, whatever the risk of the patient recovering or not. And that's not a bad thing. I think these days things have changed absolutely dramatically. They started publishing surgeons' death rates and so on, which made many surgeons paranoid and risk-averse. But some patients might find league tables reassuring. Can you see that? We're there to do the best for an individual patient. And if a patient comes to you in desperation with all sorts of type of things that will kill them in days or weeks, we're there to try and help.

26:23We're not there to reflect and say, oh, gosh, if I have a death, I'll go to the top of the mortality rate league tables and so on. That's a very bad thing. Let's have some more music, Steve. What's your next track? I'm going for a beautiful song called Forever Autumn by Justin Haywood. Where does this take you back to? It takes me back to the time when, having made that discovery in Alabama, I started being invited to lecture about it and I remember going to Chattanooga and I stayed overnight at the Chattanooga Choo Choo, the old railway station in the carriages. It was wonderful. But then I was driven back from Chattanooga through Tennessee and through the northern part of Alabama and it was the fall and the scenery, the woods, the colours were just totally, totally sensational.

27:28And Forever Autumn encapsulates that for me and it's so romantic. The summer sun is fading as the year grows old And darker days are drawing near

27:51The winter winds will be much colder Now you're not here

28:07Justin Hayward and Forever Autumn. Steve Westerby, tell me about your first heart operation. You were a trainee under Matthias Paneth, who is an experienced cardiothoracic surgeon. What do you remember about it? Mr Paneth in the outpatients department sent me in to start a case for him. And when I got into the theatre, They'd already prepped and draped. The nurses had got it already, so there was just the chest on view. What I didn't know, there was an incision round the side where she'd had a previous, what we call a mitral valvotomy. So there were adhesions in the sack around the heart, but I didn't know.

28:53So I took the saw, as I'd watched many times before at the Brompton, and my very first incision through the chest ran up the saw and blood came pouring out the chest. And I'd put the saw straight into the front of the right ventricle, the right pumping chamber, because it was stuck to the back of the breastbone. Anyway, me being me and disinhibited as I was, I'd just carried on, opened the breastbone, dissected it out, put my hand on it, took a stitch from the nurse and closed the hole. So when Mr Panath came into his mitral valve operation, there was his very, very junior assistant, already with an incision full of sutures on the front of the heart.

29:51And he looked over the top and he looked at me and he said, Westerby, Westerby, have you done this operation already? How did you feel afterwards? Was there a big crash, come down? No, I was really pleased with myself. I thought, boy, if I get away with that, I can get away with anything. And how did it turn out for the patient? Very well. She was fine. A great result. But how did you come back from less happy outcomes? The mortality of heart surgery when I started training in heart surgery was still very high. so if you were going to do it you you had to be thick-skinned it was death was part of the array of outcomes and you also wrote that you know you learned never to get involved

30:41yeah I wasn't very good at never getting involved to be honest that's why I've still at my age got a whole series of patients who still come and see me and send me cards and everything but you haven't got to let anything put you off what you meant to do you've you've got to walk away from a corpse on an operating table and and get on and start the next one but particularly as I got older you know I always remembered people that didn't make it and there were a lot in the 11 ,000, 12 ,000 heart operations I did, at least two or three hundred patients didn't make it. So I had a lot of ghosts in the end.