Professor Stephen Westaby

Presenter0:00

Hello, 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.

Presenter0:48

My castaway this week is the surgeon and writer Professor Stephen Westerby. He's been described as the greatest heart surgeon Britain has ever produced, and his reputation for excellence and innovation stretches 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. His 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 Westerby, welcome to Desert Island Discs.

Professor Stephen Westaby2:00

Well, many thanks. It's uh it's a great honor for me to be here.

Presenter2:04

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?

Professor Stephen Westaby2:16

When I first saw a heart, I was just totally mesmerized 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. It's a beautiful thing.

Professor Stephen Westaby2:35

The heart lung machine and something called cardioplegia, cold solution with potassium that that stops the heart in a flaccid condition is what allows us to oper operate with accuracy. So virtually every heart operation I did

Professor Stephen Westaby2:55

involved stopping the blood supply to 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,

Professor Stephen Westaby3:08

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.

Presenter3:22

We'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?

Professor Stephen Westaby3:34

It it helps because I can use either hand to tie knots, and I can shift instruments from one side to the other, and uh it it just greatly helped with the accuracy. It's it's a spatial phenomenon.

Presenter3:49

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?

Professor Stephen Westaby3:55

Got it.

Professor Stephen Westaby3:58

It made me impatient.

Professor Stephen Westaby4:00

And the combination of being able to operate quickly through the ambidexterity and the impatience that I had. I 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 A D D that have a label put on them to realize that it shouldn't hold you back.

Professor Stephen Westaby4:23

You should take it on and make the best of what you've got, because it'll probably turn out to be very successful.

Presenter4:29

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?

Professor Stephen Westaby4:41

Well, wonderful land. I remember the shadows from my youth, my teenage years, and when the blast furnaces opened at night and the sky lit up all red. Sconthorpe was was wonderful. I worked in the blast furnaces. I saw the steel bin poured and I thought

Professor Stephen Westaby5:02

As a young man that was wonderful. So wonderful land here's the shadows.

Presenter5:40

The Shadows and a 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?

Professor Stephen Westaby6:03

Back in 1948 when I appeared in the world, there was no real heart surgery.

Presenter6:24

So that was a baby that wasn't that wasn't getting enough oxygen round the body.

Professor Stephen Westaby6:27

Yeah, not getting enough oxygen and a hole in the heart.

Professor Stephen Westaby6:31

Uh so that little baby didn't make it and um

Professor Stephen Westaby6:35

I only learnt 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 I asked why why are we going to this lady's house? and and she explained that her baby had died the same day that I was a thriving, vigorous

Professor Stephen Westaby6:58

Noisy young baby.

Professor Stephen Westaby7:01

And she felt very, very bad, and uh uh it affected her. She uh she was a very, very kind lady, my mother.

Professor Stephen Westaby7:09

So it it's a coincidence that life for me started out next to uh a baby and um twenty five, thirty years later I'd be learning how to make those hearts better.

Presenter7:25

So your mother, Doreen, very kind, as you said. How else would you describe her? What what kind of person was she?

Professor Stephen Westaby7:33

Oh, she would do an

Professor Stephen Westaby7:34

anything for anybody. She was warm.

Professor Stephen Westaby7:39

Very uh sociable.

Professor Stephen Westaby7:42

She became a a manager of the Trustee Savings Bank in on Scunthorpe High Street.

Professor Stephen Westaby7:48

when all the men went off to war. And um afterwards, I mean, we didn't have much money, so she continued to work. Um so with both both my parents working, I used to come home from school and and spend time across the street with my my grandparents.

Presenter8:07

Two grandparents. And what about your father, Kenneth? So he was in the RAF and he'd been active in the war. You know, how did that experience affect him? Were you aware of that? Well, he never.

Professor Stephen Westaby8:17

He was one of these people that never talked about

Professor Stephen Westaby8:21

The war. I think that was fairly common in in in the old days. I mean, it had only uh the war Second World War had only just finished a couple of years before I was born. So that there was the aftermath of the the war was was still there to see. Um the steelworks had been bombed. So I I I grew up knowing uh knowing about the the war.

Speaker 18:25

Yeah.

Speaker 18:31

Mm-hmm.

Presenter8:46

One of the things that broadened your horizons, Steve, was getting a T V. I think you would have been about six or seven when you got your first T V set.

Professor Stephen Westaby8:55

Yeah. We got a little nine-inch black and white television set.

Professor Stephen Westaby9:00

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. The program came from the Hammersmith Hospital in London and said that the Americans had developed a device called the Heart Lung 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.

Presenter9:50

Did you tell anyone about that dream?

Professor Stephen Westaby9:53

Yes, I I gi did. I t I told my parents, I said, you know, after all that's gone before, I would love to get to medical school and my my father that no 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.

Professor Stephen Westaby10:22

But I was determined.

Presenter10:24

Let's have some more music, Steve. Disc number two. What have you gone for and why?

Professor Stephen Westaby10:29

Viva la Vida by Cold Play

Professor Stephen Westaby10:33

I used to listen to Cold Play in the Operating Theatre a lot. Um m uh my staff used to like to have music and some sort of amusement because heart operations are long.

Professor Stephen Westaby10:47

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. For 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.

Speaker 411:17

The world sees it rise when I gave the word Now in the morning I sleep alone Sweep the streets I used to own

Speaker 411:43

I used to roll.

Presenter11:46

Coldplay and Viva Levida. 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?

Professor Stephen Westaby11:59

Well, he was very kind. He'd been the air raid warden uh for the the area in Scunthorpe during the war and um uh s a steel worker all his life and uh he took time to

Professor Stephen Westaby12:17

Sit and teach me how to draw and then paint. What kind of thing would you draw?

Professor Stephen Westaby12:23

Oh, the landscapes I saw in Sconthorpe. And as I always used to say, there were no golden sunsets over Sconthorpe, but when the blast furnaces opened at night, it was it was wonderful. My best painting ever, I think, was a courting couple standing under an old-fashioned lamppost at night looking at the Scunthorpe sky.

Presenter12:48

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?

Professor Stephen Westaby12:58

He like everybody else in those days, he he was a smoker and he worked in smoke. And sadly, I witnessed him having several heart attacks and and with each individual heart attack his heart function got worse. When you have a heart attack, scar replaces muscle.

Professor Stephen Westaby13:24

And once a certain amount of scar forms, the scar stretches and the heart just dilates and fails.

Speaker 413:32

Yeah.

Professor Stephen Westaby13:33

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 Healy 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 the good old GP gave him uh a slug of morphine to make him comfortable.

Presenter14:11

Uh

Professor Stephen Westaby14:11

And that was the end.

Presenter14:14

And he was he was sixty-two, I think, was he?

Professor Stephen Westaby14:16

He was only sixty-two.

Presenter14:18

Hmm.

Professor Stephen Westaby14:18

That

Professor Stephen Westaby14:20

Stayed with me, and that was the motivation that I had.

Professor Stephen Westaby14:26

to be able to help people in that situation.

Presenter14:29

Because in those days, what was the prognosis?

Professor Stephen Westaby14:31

Well, there was no heart surgery then.

Presenter14:33

Mm.

Professor Stephen Westaby14:33

So I thought, something needs to be done about this. We have to be able to do something about this.

Presenter14:39

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?

Professor Stephen Westaby14:46

Well, it's Jerry Rafferty's Baker Street, and uh it just reminds me of the transition between the back streets of Sconthorpe

Professor Stephen Westaby14:56

And um the City of London and the Strand and Baker Street and

Professor Stephen Westaby15:04

What a different life it was once I'd got to medical school.

Speaker 415:18

Winding your way down a baker street

Speaker 415:23

Light in your head and then on your feet well another crazy day

Speaker 415:29

Drink the night away and forget about everything.

Speaker 415:35

This city design makes you feel so cold It's got so many

Presenter15:41

Jerry 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.

Professor Stephen Westaby15:53

Well

Professor Stephen Westaby15:54

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 back street kid from Sconthorpe, basically. I'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.

Speaker 416:14

Basically.

Speaker 116:15

Okay.

Speaker 416:15

Yeah.

Presenter16:29

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 sixteen.

Professor Stephen Westaby16:37

Yes.

Professor Stephen Westaby16:38

I used to be a theatre porter and I was very taken by going and watching the operations and the the the surgeons could see that

Speaker 116:46

The surgery

Professor Stephen Westaby16:49

You know, I 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 uh asking the pathologist whether I could watch the post mortems.

Professor Stephen Westaby17:08

Yeah.

Presenter17:08

So you weren't intimidated by any of that? I mean, if you're only sixteen, that's.

Professor Stephen Westaby17:10

And so

Professor Stephen Westaby17:12

Yeah, I w I wasn't. I was fascinated by human anatomy.

Presenter17:14

Bye.

Presenter17:17

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?

Professor Stephen Westaby17:27

Well, you know, I I remember trying to find the college that I was going to um uh for the interview, and I was walking along in Cambridge looking lost, and I walked past the Addenbrookes the old Addenbrookes hospital, and and a nurse came out coming off

Professor Stephen Westaby17:46

duty and and she said, Can I help you? You you're you're looking lost and I said, Well, I'm trying to find such and such a college. I've got an interview there and she said, I'm going that way. Let let me show you where it is. So we walked along and she said, Where are you from?

Professor Stephen Westaby18:03

and I thought to myself, if I say Sconthorpe, she'll laugh.

Professor Stephen Westaby18:08

Um because it was the butt of music ho hall jokes in the old days. So I said, Well, I'm from Lincoln.

Professor Stephen Westaby18:16

And she said, Oh, that's funny. I'm from Lincolnshire. I'm from such and such a village just outside Scunthorpe. And I I felt sort of two feet tall and um

Speaker 118:25

Uh

Speaker 418:25

No.

Speaker 118:26

The

Professor Stephen Westaby18:27

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. So 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.

Presenter18:56

So, this is Charing Cross Hospital, nineteen sixty-six. You are in.

Professor Stephen Westaby19:00

Fantastic place.

Presenter19:00

Yeah.

Presenter19:01

No, but preclinical students there weren't supposed to watch heart operations, were they, Steve?

Professor Stephen Westaby19:07

No. Uh, preclinical students were meant to keep themselves in the in the medical school and and not go across the road to the hospital until

Presenter19:15

I can tell by the look on your face that you did not keep to this rule.

Professor Stephen Westaby19:20

No. I was so I was so desperate. Uh I heard they were doing heart surgery once a week on a Wednesday.

Professor Stephen Westaby19:29

I 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 her heart for the first time. And I could see the heart-lung 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-lung machine, but the suture line on her aorta, the largest blood vessel coming out of the heart,

Professor Stephen Westaby20:22

Ruptured.

Presenter20:23

What did you take away from that experience?

Professor Stephen Westaby20:25

that heart surgery would get better. They those were the very early days.

Presenter20:25

Uh

Presenter20:30

Steve, let's take a minute for some more music. Your fourth choice today. What are we going to hear?

Professor Stephen Westaby20:35

Well, the great pivotal moment was being sent to America to the world's top heart surgery unit.

Presenter20:45

So where was it? Where did you go?

Professor Stephen Westaby20:45

Three.

Professor Stephen Westaby20:46

Birmingham, Alabama, under a very famous surgeon called John Kirkland, who was the first man to make a success of the heart-lung machine. And when blood comes out of the body into a circuit made of synthetic materials, it used to generate an inflammatory response.

Professor Stephen Westaby21:09

which was fed back into the patient, and it would produce something called the post perfusion syndrome.

Professor Stephen Westaby21:16

And the longer you were on the heart lung machine, the more likely you were to have the postperfusion syndrome. And if you were frail, elderly or a baby, it could actually kill you.

Speaker 421:28

Mm-hmm.

Professor Stephen Westaby21:29

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.

Professor Stephen Westaby21:41

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.

Professor Stephen Westaby21:57

and put the patient at risk. And when I identified nylon as the principal cause, the manufacturers took nylon out of the circuit and heart surgery became safer overnight.

Presenter22:09

How many lives do you think that change saved?

Professor Stephen Westaby22:12

I think that changed the whole profession of cardiac surgery. So America by Simon and Garfunkel always resonated with me.

Speaker 422:24

Let us be lovers will marry our fortunes together.

Speaker 422:33

I've got some real estate here in my bag.

Speaker 422:39

So we've got a pack of cigarette

Speaker 422:43

And the shoes wiped her eyes and walked off to look for one day.

Presenter22:57

Simon and Garfunkel and America. So Steve Westerby, in nineteen sixty seven, 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?

Professor Stephen Westaby23:12

Well, I I got a knee in my head, that's what I was told, because I I was out like a light, but I flopped down in a pool of water.

Professor Stephen Westaby23:22

And needless to say, a medical school rugby team is full of caring people. They 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.

Presenter23:37

And when you did they took you to the pub, I think.

Professor Stephen Westaby23:39

Yes, and um but uh I deteriorated very markedly overnight and ended up in hospital for quite a while.

Presenter23:47

For quite a while.

Presenter23:48

So tell me about that then. What what kind of effect did you have? It was when you started to come round, everyone realized something about you had changed completely, or your behaviour had changed.

Professor Stephen Westaby23:58

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? I did. I did, more or less. I simply didn't see fear or trepidation

Professor Stephen Westaby24:35

in major cases.

Professor Stephen Westaby24:38

And there they were destructive.

Professor Stephen Westaby24:41

sides to the change in personality. I I m married after medical school a a very, uh very nice teacher who trained in

Professor Stephen Westaby24:54

Cambridge, who was at school with me in Sconthorpe. But after the personality change,

Professor Stephen Westaby25:01

I was completely different. So that was the end of marriage number one. I 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.

Presenter25:15

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.

Professor Stephen Westaby25:24

I 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.

Professor Stephen Westaby25:43

And that that's that's not a a a bad thing. I think these days

Professor Stephen Westaby25:49

Things have changed absolutely dramatically. They started publishing surgeons' death rates and so on, which may

Professor Stephen Westaby25:58

many surgeons paranoid and risk averse.

Presenter26:02

But some patients might find league tables reassuring. Can you see that?

Professor Stephen Westaby26:07

We're there to do the best for an individual patient. And if a patient comes to you in desperation with

Professor Stephen Westaby26:15

all sorts of type of things that will will kill them in days or weeks. We're there to try and help. We we're not there to reflect and say, oh gosh, if I have a death, I'll go to the top of the um mortality rate, um league tables and so on. That's a very bad thing.

Presenter26:38

Let's have some more music, Steve. What's your next track?

Professor Stephen Westaby26:41

I'm going for

Professor Stephen Westaby26:44

A v a beautiful

Professor Stephen Westaby26:46

Song Called Forever Autumn by Justin Haywood

Presenter26:50

Where does this take you back to?

Professor Stephen Westaby26:51

It it takes me back to the time when uh having made that discovery in Alabama, I started being invited to lecture about it, and I remember going to

Professor Stephen Westaby27:02

Chattanooga

Professor Stephen Westaby27:04

And I stayed overnight at the Chattanooga Choo Choo, the old railway station, in in in the carriages. It was wonderful. But then I was driven back from Chattanooga through Tennessee

Professor Stephen Westaby27:16

and through the northern part of Alabama, and it was the fall.

Professor Stephen Westaby27:20

And the scenery, the woods, the colours were just totally, totally sensational. And Forever Autumn encapsulates that for me and it it's so romantic.

Speaker 427:35

The somber sun is fading as the year grows old

Speaker 427:44

And darker days are drawing near

Speaker 427:52

The winter winds will be much cold

Speaker 427:58

Now you're not here

Presenter28:07

Justin Hayward and Forever Autumn.

Presenter28:11

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?

Professor Stephen Westaby28:22

Mr. Panath

Professor Stephen Westaby28:23

in the outpatients' department sent me in to start a case for him.

Professor Stephen Westaby28:29

And when I got into the theatre, they'd already prepped and draped. The nurses had got it all ready, so there was just.

Professor Stephen Westaby28:37

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 valveotomy. So there were adhesions in the sac around the heart, but I didn't know. So I took the saw, as I'd watched many times before at the Brompton, and my very first incision through the chest.

Professor Stephen Westaby29:03

ran up the saw,

Professor Stephen Westaby29:05

and blood came pouring out the chest.

Professor Stephen Westaby29:08

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 breast bone. Anyway, me being me and and disinhibited as I I was, I'd just carried on, opened the

Professor Stephen Westaby29:28

The breast bone, dissected it out, put my hand on it.

Professor Stephen Westaby29:32

took a stitch from the nurse and closed the hole.

Professor Stephen Westaby29:36

So when

Professor Stephen Westaby29:37

Mr Panoth came in to his um mitral valve operation, there there was his very, very junior assistant already with a an incision full of sutures on the front of the heart. And he looked over the top and he looked at me and he said, Westerby, Westerby, have you done this operation already?

Presenter29:59

How did you feel afterwards? Was there a big crash, come down?

Professor Stephen Westaby30:02

No, I was really pleased with myself. I thought, boy, if I got away with that, I can get away with anything.

Presenter30:08

And how did it turn out for the patient? Very well. She was fine.

Presenter30:12

A great result, but how did you come back from less happy outcomes?

Professor Stephen Westaby30:16

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 uh

Professor Stephen Westaby30:32

array of outcomes.

Presenter30:34

And you also wrote that, you know, you you learned never to get involved.

Professor Stephen Westaby30:40

Yeah.

Professor Stephen Westaby30:42

I wasn't very good at never getting involved, to be honest. That's why I've still, at my age, got a 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 got to walk away from

Professor Stephen Westaby31:03

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.

Professor Stephen Westaby31:15

And there were a lot. In the eleven, twelve thousand heart operations I did, at least two or three hundred patients didn't make it. So I I had a lot of ghosts in the end.

Presenter31:27

Steve

Professor Stephen Westaby31:27

Uh

Presenter31:27

It's time to go to the music. Tell us about your next disc.

Professor Stephen Westaby31:31

I chose Moonlight Shadow by Mike Oldfield and Maggie Riley, and I had a very specific reason for that. I used to operate very frequently at night on emergencies, and sometimes they they didn't make it. That that's just the way it is. And there was a graveyard outside the back of the hospital, not far from the operating theatre block. And during the summer, when somebody died, I just wanted to

Professor Stephen Westaby32:06

Cool down a little bit and reflect and think about whether anything could have been done better, which I think is a very reasonable thing. And I used to walk out the back of the hospital and into the graveyard and simply sit up against a grave and look at the sky and look at the stars and think, well, hopefully they're on the way up there by now. So Moonlight Shadow kind of had a special significance for me.

Speaker 432:37

The last that ever she saw him Carried away by a moonlight shadow He passed on, worried and mourning

Speaker 432:48

Carried away by a moonlight shadow Lost in a riddle that Saturday night

Speaker 432:56

Far away on the other side, he was caught in the middle of a desperate fight. And she couldn't find how to push through the trees and whisper

Presenter33:08

Moonlight Shadow, Mike Oldfield with Maggie Riley. Steve Westerby, by 2000 you were head of a new cardiothoracic centre at the John Radcliffe Hospital in Oxford, where you implanted a revolutionary new heart pump into a man who was terminally ill with heart failure. Now temporary devices known as bridge to transplant devices had been used to stabilize patients while they waited for a donor heart but this surgery, transplanting a permanent artificial heart instead of a donor heart, was the very first of its kind. The device was designed by Robert Jarvik, an American heart engineer, and was called the Jarvik 2000. Tell me more about it. How would you describe it?

Professor Stephen Westaby33:50

a thumb size device with a vascular tube attached to it, and I tested this device and we tested it in blood, and it didn't damage the blood. So I got permission to use it, but with great difficulty because there's no pulse in the patient.

Presenter34:11

So previously any any artificial hearts or anything that it these bridge to transplant hearts they would always use that vowel

Professor Stephen Westaby34:16

Always use that valve system.

Professor Stephen Westaby34:20

systems that emptied and filled with valves in them and needed a lot of power.

Presenter34:26

And the Javik 2000 is more like the flow from a tap.

Professor Stephen Westaby34:29

It's like a high-speed rotor.

Presenter34:31

Mm-hmm.

Professor Stephen Westaby34:32

like a torpedo spinning at five thousand revolutions per minute in blood.

Presenter34:37

Yeah.

Professor Stephen Westaby34:37

I eventually persuaded enough people that humans could manage without pulse in their circulation and got permission to use it. And the patient came along to see me in a wheelchair. He he'd been turned down for transplant twice and couldn't even walk.

Professor Stephen Westaby34:57

through breathlessness.

Professor Stephen Westaby35:00

And um I showed him the pump and and he said, Yes, please, because he had no life.

Presenter35:06

This is Peter Houghton, who he sounds like quite a very interesting character.

Professor Stephen Westaby35:10

He was an interesting character. He worked in hospitals doing psychotherapy.

Professor Stephen Westaby35:18

And he had no hope, and he came along expecting to be turned down like he was at his transplants.

Professor Stephen Westaby35:25

Um anyway, uh I said, yep, we'll get on, we'll do it.

Professor Stephen Westaby35:29

And we put it in and in short we made a great success of it and Peter was completely rehabilitated and he started to travel the world again to tell everybody what a brilliant thing it was to have a one of these miniature artificial hearts.

Presenter35:46

And how did it actually work? I mean, it requires power, it required power, the Javik 2000. How did that.

Professor Stephen Westaby35:52

Yeah.

Professor Stephen Westaby35:53

Well, if this is electrical power and the previous devices, the pulsed devices I'd used required power and that involved a drive line coming out through the abdominal wall and through fat beneath the skin. And the big problem with those systems were that the the interface between the

Professor Stephen Westaby36:19

stiff cable and the skin broke down and got infected. And that was the beginning of the end because infection would trigger the coagulation system and then the patient would have a stroke and that that that had happened to me many times.

Speaker 136:34

Yeah.

Professor Stephen Westaby36:35

So I decided I'd do something different. I decided I would screw a a plog to the skull.

Professor Stephen Westaby36:41

so that the inlet for the power wouldn't move against the skin, and there's very, very, very little subcutaneous fat in the scalp.

Professor Stephen Westaby36:52

So I screwed in a pedestal and took the internal power cable down into the chest and put the device in the apex of the heart.

Professor Stephen Westaby37:01

And um then the external power

Professor Stephen Westaby37:05

plugged into the the plug in the patient's head.

Presenter37:08

There's a little battery that you would keep with you on the outside and then to your heart on the inside.

Professor Stephen Westaby37:12

The patient carried a battery and controller, but having a plug-in there made me the first real Doctor Frankenstein.

Presenter37:19

So talk to me about your mindset before because obviously there's a lot of pressure. There was only judged to be a thirty to fifty percent chance of success. You wanted obviously wanted Peter to be well and also wanted to prove that the technology could work. I mean, how did you prepare for the operation? How did you feel going into it?

Professor Stephen Westaby37:40

It's back to the old um

Professor Stephen Westaby37:43

Head injury, I j I just didn't have any fear about doing it.

Professor Stephen Westaby37:51

The fact that the device cost about a hundred and twenty thousand pounds

Professor Stephen Westaby37:56

I completely ignored. Of course, as you probably realize, the National Health Service would never.

Professor Stephen Westaby38:03

take these devices on because there are

Professor Stephen Westaby38:06

as I've said, thousands and thousands of heart failure patients, and you can't pay one hundred and twenty thousand pounds for each one to make'em better. But I I d I didn't worry about um not succeeding.

Presenter38:19

Uh

Professor Stephen Westaby38:19

The

Presenter38:19

So Peter, he he lived for almost eight years after his operation and and his death he died of renal failure in in two thousand seven, but his heart was still functionally well, wasn't it?

Professor Stephen Westaby38:24

Yeah.

Professor Stephen Westaby38:27

Yeah.

Professor Stephen Westaby38:30

Yeah, that was always my career's ambition to develop

Professor Stephen Westaby38:34

An alternative to a donor heart. And indeed,

Professor Stephen Westaby38:40

Having been inspired by Your Life in Their Hands, I was asked to do Your Life in Their Hands after that. They wanted me to put an artificial art in on the programme, which I did.

Presenter38:51

And how did it feel to have your own episodes of the programme that had inspired you and set you on your way as a surgeon?

Professor Stephen Westaby38:57

I was very, very happy. It was it was like a life cycle, if you like.

Professor Stephen Westaby39:03

And the patient I implanted on that occasion with the Javik 2000 was from Scotland and he went back to Scotland and the programme ended with him walking along a beach with his wife hand in hand into the sunset. It was lovely. And then he went out shopping to buy his wife a Christmas present.

Presenter39:03

And the potential

Professor Stephen Westaby39:27

And didn't take a spare battery, and his battery ran out, and uh he died.

Professor Stephen Westaby39:35

Such a terrible thing. So, life on a blood pump.

Professor Stephen Westaby39:39

Driven by electricity is is not normal life. Um you have to compensate.

Speaker 439:43

Uh

Presenter39:43

Uh

Speaker 439:43

Uh

Presenter39:43

Uh

Speaker 439:45

Yeah.

Presenter39:45

Mm.

Presenter39:47

Let's have some more music, Steve. What's your next track?

Professor Stephen Westaby39:50

Well, you might not be surprised that I chose a record called Go Your Own Way because

Presenter39:55

Because

Professor Stephen Westaby39:56

That's what I did all my career and and

Professor Stephen Westaby40:00

We went from being the smallest heart surgery centre in the country to the second largest in less than ten years.

Professor Stephen Westaby40:10

And we were visited by so many international surgeons who took away our techniques back to their own countries. So go your own way is what I did. So here's Fleetwood back.

Speaker 440:27

Loving you

Speaker 440:29

Is the right thing to

Speaker 440:34

How can I ever change the things that I feel?

Speaker 440:41

If I could, maybe I'd feel my world.

Speaker 440:48

Have you now

Speaker 440:50

When you go take it from

Presenter40:53

Fleetwood Mac and go your own way.

Presenter40:56

So Professor Steve Westerby, how close are we to the routine use of fully mechanical, lifelong heart replacements in 2026?

Professor Stephen Westaby41:05

In affluent healthcare systems in the United States, in many European countries, patients that can't get a donor heart will get a left ventricular assist device. And now the survival of patients with left ventricular assist devices is the same as transplantation. But because you don't have the complications of immunosuppression,

Professor Stephen Westaby41:31

Patients uh tend to have a more comfortable life.

Professor Stephen Westaby41:35

There's no risk of infection, apart from

Professor Stephen Westaby41:38

With the driveline, and there's no risk of uh cancer through immunosuppression.

Presenter41:46

And are they are they permanent, those devices?

Professor Stephen Westaby41:50

Yes. In most countries they're used as permanent alternatives to a donor heart. And they're used in patients into their eighties and there have even been patients in America in their nineties that have had left ventricular assist devices to relieve severe heart failure.

Presenter42:08

I mean, the NHS doesn't currently fund the use of permanent mechanical hearts as an alternative to donor organs, though research is ongoing to find alternatives to transplantation. Are you hopeful that advances in cardiology here are going in the right direction?

Professor Stephen Westaby42:24

Look, I did it myself, um, when Peter Houghton had been

Professor Stephen Westaby42:28

Alive for five years after his operation. They gave us a reception in Downing Street. They recognised that it was getting the longest survival with any type of artificial art was of significance. At that reception, it was made clear that the NHS couldn't afford it. So, me being me, I said, well, we'll make a British one.

Professor Stephen Westaby42:54

So twenty years ago we started with that. Ironically after twenty years of pioneering with a great team.

Professor Stephen Westaby43:01

Uh we've just gone into liquidation.

Professor Stephen Westaby43:04

Which is very sad for me, but I think it's very sad for the heart failure population of the world.

Professor Stephen Westaby43:13

I'm not giving up. I rather hope that the liquidation process will see us through and we can start again one way or another.

Presenter43:23

Steve, as busy as you are and all the stories that you've been telling us and everything you've been working on, you retired from the NHS in 2016. You were 68 then.

Professor Stephen Westaby43:31

Yeah.

Presenter43:33

Do you miss operating? Do you miss surgery?

Professor Stephen Westaby43:36

No, I wa the reason I retired was very straightforward. I I'd I'd done so many operations that where the instruments were smacked into my right palm, I ended up with a very deformed palm. It it's what's commonly known as Jupitron's contracture. And the nurses couldn't slap the instruments into my palm any longer. I n I needed surgery on my hand and I'd worked in the NHS for

Professor Stephen Westaby44:07

Almost 50 years. I'd operated for 40 years. I'd done almost 12,000 heart operations. I'd got nothing to regret. I'd had an innovative, exciting career and I'd got to the stage where I was on aeroplanes going to conferences alternate weeks and I was getting tired. So to walk away gave me other opportunities to spend time with my family and to work on our own artificial heart.

Speaker 444:32

Yeah.

Speaker 144:32

And

Presenter44:43

Steve, it's almost time to cast you away. How do you think you'll get on on the Desert Islands? I mean, you've spoken so much about your connection to other people, your, you know, instinct to care for other people. Will you be lonely?

Professor Stephen Westaby44:57

I I'd be l be lonely and I'm I'm sure I'd fade away any time.

Presenter45:02

There's no fading away for you, I don't think. That w doesn't sound like it's your style, Steve. We're going to give you one more disc before you go to the island, though. Your final choice today. What is it?

Professor Stephen Westaby45:12

Rachmaninoff's rhapsody on a theme of Paganini is, for me, so powerful, it kind of sums up

Professor Stephen Westaby45:20

my feelings about my career and what a struggle it all was, but um coming out at the other end with very satisfying memories.

Presenter46:32

Part of Rachmaninoff's Rhapsody on a Theme of Paganini, performed by Vladimir Ashkenazi, and the London Symphony Orchestra, conducted by Andrei Previn.

Presenter46:41

So, Steve Westerby, it's time to cast you away to the island. I'm giving you the Bible, the complete works of Shakespeare, and one more book to take with you. What's that going to be?

Professor Stephen Westaby46:51

There's a book that was written in 1628 called De Moto Cordis. It was written by William Harvey, the doctor who described the circulation of the blood for the first time. And it was rejigged in 1928. And I was given a copy of that book by one of my patients, a grateful patient, one day. And Harvey was made warden of Merton College in Oxford. So he did a lot of his work right where I live. So that's why the book's got special significance for me.

Presenter47:29

Uh you can also have a luxury item, Steve. What will that be?

Professor Stephen Westaby47:32

Well, I've been married twice to two wonderful ladies, and I I've got one child, uh a daughter from my first marriage.

Professor Stephen Westaby47:41

And a son from my second, and they all mean more to me than anything. My brother is a very eminent doctor.

Professor Stephen Westaby47:50

So when my father was getting very elderly, he got COVID and come out of a hospice, the local hospice. So I took him home to look after him and he had his hundredth birthday at my home. So the whole of the family came and we had a beautiful picture taken and that that picture

Professor Stephen Westaby48:18

In its silver frame would be what I took off to the island.

Presenter48:21

Oh, absolutely. It's yours. And finally, which one track of the eight that you've shared with us today would you save from the waves if you needed to?

Professor Stephen Westaby48:31

I think for me

Professor Stephen Westaby48:34

Forever Autumn reminds me of my formative years training and particularly that beautiful Alabama year.

Professor Stephen Westaby48:46

So I think Forever Autumn would be the one that I took with me.

Presenter48:51

Professor Stephen Westerby, thank you so much for letting us hear your Desert Island Discs.

Professor Stephen Westaby48:56

Thank you. It's been a real pleasure.

Presenter49:18

Hello, I hope you enjoyed my conversation with Stephen. We'll leave him reading even more about hearts and blood circulation. We've cast away many surgeons, including David Knott, Professor Avril Mansfield, and Sir Roy Kane. The studio manager for today's programme was Jackie Marjoram, the assistant producer was Christine Pavlovsky, the executive production coordinator was Susie Roylance, the content editor was Mugabe Turia, and the producer was Paula McGinley. Next time, my guest will be the comedian and writer Sarah Pascoe. I do hope you'll join us.

Speaker 150:05

I'm Jamie Bartlett, and for BBC Radio 4, I'll be looking at how fakery took over the world. No, no, hang on, hang on, sorry. You're not Jamie Bartlett, I'm Jamie Bartlett. Oh, really?

Professor Stephen Westaby50:17

Oh really?

Speaker 150:17

Well, who am I then? I'm afraid you're not real pal. You're just an imitation chatbot I created to help me make this series on modern fakery and why it's everywhere. Sounds good. What's going to be in it? Well, there's a lot. 1980s professional wrestling, dodgy academics, AI psychosis, COVID vaccine, sceptics. What's it called? Everything is fake and nobody cares with me, Jamie Bartlett. And me, Jimmy Botlett. Listen first on BBC Sounds.

Professor Stephen Westaby50:18

Who am I then?

Professor Stephen Westaby50:39

What's it called?