No risk, no reward: the NHS needs mavericks.

Judith Harvey examines the memoirs of some eminent hospital consultants, who are not just summing up their careers, but reflecting on the changes they have lived through. And when they are retired, they can say what they think.

Neurosurgeon Henry Marsh set the trend with Do No Harm. Stephen Westaby, in Fragile Lives, tells how a lad from a council estate in Scunthorpe became a cardiac surgeon whose expertise is such that colleagues summoned him back from Australia to operate on a case they felt no-one else could tackle. From him I learned how ‘ventricular assist devices’ can tide patients over till their own heart heals or a transplant becomes available. And that patients given Jarvik artificial hearts are surviving as long as transplant patients do. And that they have no pulse – a trap for unwary first-responders.

Urology has fewer life-and-death dramas, but like his fellow memoirists, Gautam Das puts the reader in his theatre clogs. In Tender is the Scalpel’s Edge, he reminds us that the skills and judgement of the surgeon must be backed up by an experienced and dedicated team. Like his colleagues, he ponders how you give a patient a realistic picture of a grim future without destroying hope, even of a few more days of life.

Neurology can’t compete with the high-wire glamour of surgery. Patients may have intellectually fascinating diseases, but there are few happy endings: effective treatments are in short supply and cures are non-existent.

In his memoir, Andrew Lees reviews his career as a world expert in Parkinson’s Disease. Like Westaby, he explores new treatments. Like Marsh, his subject is the brain. Marsh wonders how the grey jelly on which he operates can generate consciousness. Lees can only help his patients if he can modify the brain’s neuronal activity.

How do you unravel the relationship of structure to function in an organ which has 100 billion neurones, 100 trillion synapses and hundreds of transmitters? We have barely begun. Dopamine wasn’t identified in the brain till 1955, and only in 1960 was it recognised that it is deficient in people with Parkinson’s. In the mid-60s the first trials of L-dopa treatment changed patients’ lives. But the shine wore off the miracle when patients developed motor complications. Research was decades from generating effective new therapies. Yet there are people with plenty of experience of the effects of chemicals on the brain. Lees turned to William Burroughs. And called his memoir Mentored by a Madman.

A middle-class American medical school drop-out, Burroughs joined the Beat generation and spent his life testing the effect of all the mind-altering drugs he could get hold of, and recording their effects. The truth of his life is barely less extraordinary than his fiction. The Beatles included him in Sergeant Pepper’s Lonely Hearts Club Band. When Lees was a disillusioned medical student he came across Naked Lunch, Burroughs’ semi-autobiographicals sex-and-drugs-and-degradation counter-culture novel. His interest in Burroughs was reawakened by Oliver Sacks’ unorthodox treatment of patients with encephalitis lethargica, described in Awakenings.

Lees reasoned that if the drugs Burroughs took evoked or mitigated either Parkinsonian symptoms or the side-effects of L-dopa, might they not be pointers to compounds with therapeutic applications? Ergot has a structure related to dopamine. Forty thousand patients had been treated with LSD, an ergot derivative, for alcoholism and mental disorders, with encouraging results, until 1966 when politics relegated LSD back to counterculture use. Lees investigated other, related, compounds. How about apomorphine, which Burroughs, and later Keith Richards, found the only effective treatment for opioid addiction? How about amphetamines? Or yagé, the hallucinogen sacred to Amazonian shamans?

Lees’ detective work takes him through a maze which twists and turns and leads up blind alleys and loops back on itself. He analyses the experiences of the self-experimenters for clues. He questions received opinion. He tries compounds on himself. At the age of 66, this eminent professor at Queen Square follows Burroughs’ footsteps to the Amazon, the source of so many hallucinogens, to experience for himself the effects of the yagé, and be blown away.

The highs, the lows and the frustrations of Lees’ search for treatments for Parkinson’s echo Westaby’s experiences in his work on artificial hearts. The NHS has become risk averse. But you cannot wait for a committee to approve the management of an intraoperative crisis. You cannot start large-scale trials until small-scale observational work has suggested a hypothesis to test. And as the story of marijuana for patients with MS shows, there is still huge sensitivity about trials of hallucinogenic drugs for therapeutic use.

Hospital authorities have their eye on mortality statistics and bottom lines. They question professionals’ judgement. Innovation may be seen as a threat. They aim to control doctors, managing their activities to minimise risk. But they still can’t tell a Stephen Westaby from an Ian Paterson.

Sick patients see things differently. Patients in end-stage heart failure know they are dying. Patients locked up by severe Parkinson’s exist in a living death. They have nothing to lose and are willing to take the chance that an experimental treatment offers of a life worth living. Should bureaucracy deny them an informed choice?

The sense of vocation which has propelled these doctors to give so much shines out of these memoirs. So does the stress: to be always available, to sacrifice marriages and family life and sometimes health. They hear politicians being dishonest about the capabilities and funding of the NHS, and denigrating doctors. They see managers who appear to be more concerned about dress codes than patients. They all worry that the commitment and training of young doctors is being eroded by 21st century ambitions, shift work and the end of anything like apprenticeship. When medicine is just another job and doctors are no longer professionals but cogs in a big corporate machine, they, patients and society – all of us – will be the poorer.

See also

  • Henry Marsh 2017 Admissions: A Life in Brain Surgery ISBN: 1474603866. Marsh looks to the future, and does not like what he foresees
  • Paul Kalanithi 2017 When Breath Becomes Air ISBN-13: 978-1784701994 Neurosurgeon Paul Kalanithi wrote his memoir in the months before he died of cancer at the age of 37.

1 Response

  1. David Church
    This article deserves far wider distribution than sessional GPs. Can we send it to GMC,BMA, RCGP, Health Boards, Government, Opposition?

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