The Knife’s Edge. Stephen Westaby

the parcel lottery that was out-of-hours surgery for aortic dissection. Eventually a decree was issued by the Society for Cardiothoracic Surgery that each regional centre must take responsibility for patients in their area. Special aortic dissection rotas were established in London and specific experienced surgeons designated to operate on the cases. That brought the mortality rate down. After UK Transplant prevented us taking a kidney for Steve’s son, the issue of organ donation was not discussed further. A healthy liver and two lungs could have gone in to the pool, had that single functioning kidney been used in Oxford.

Later that year Steve’s son Tom received a kidney donated by his wife. Steve’s daughter Kate was given one of her husband’s kidneys in 2015. Hilary was fortunate enough to meet a new partner and received one of his kidneys in 2011. They are all well.

3

       risk

      As a boy, my stoical and religious parents taught me that I should never take risks – never to gamble with money, never to be deceitful or steal, never to cheat in exams. Not even to climb over the stadium wall to watch Scunthorpe United, because that was a form of stealing too. Consequently, I began life as both boring and introspective.

      Eventually I learned that the ability to take risks is an indispensable part of human psychology. Victory in war depends upon risk-takers and recklessness, hence the adage ‘Who dares wins’. The economy depends upon financial risk-takers. Innovation, speculation, even the exploration of the planet and outer space – all depend on putting something you cherish on the line in the hope of greater rewards. Thus risk-taking is the world’s principal driver for progress, but it requires a particular character type, one defined by courage and daring, not reticence and prudence – Winston Churchill rather than Clement Attlee, Boris Johnson not Jeremy Corbyn.

In 1925, when Henry Souttar first stuck a finger into the heart and tried to relieve mitral stenosis, it posed a risk to his reputation and livelihood. When Dwight Harken removed a piece of shrapnel from a soldier’s heart in the Cotswolds, it was a risk that went against all he’d learned from the medical textbooks of the day. By exposing blood to the foreign surfaces of the heart–lung machine, John Gibbon took a huge risk, as did Walton Lillehei with his reckless but brilliant cross-circulation operations, the only medical interventions in history outside the maternity ward that posed the risk of 200 per cent mortality. All progress in medicine and surgery is predicated on risk, yet I was taught to avoid it. Fortunately, things changed.

      Character is said to be the product of nature and nurture, the former being the hand genetics deals to us. Then from birth onwards we are moulded by life’s events. I started out well enough. My mother was an intelligent woman who was deprived of an education but read The Times. During the Second World War with the men away, she managed the Trustee Savings Bank on the High Street. One of my earliest recollections was that every birthday she took me, along with a bunch of flowers, to another woman’s home. I thought that strange, but eventually I came to learn the significance of her pilgrimage.

After a long and painful labour my mother brought me safely back from the carnage of the delivery suite. She was exhausted, torn and bleeding, but elated to have a pink, robust son wailing from the depths of his newly expanded lungs. In the next bed, a wide-eyed factory girl was suffering noisily. Spurred on by the bossy midwife, she was preoccupied with pushing and pain. Finally, her perineum split. The straining emptied her uterus, bowels and bladder all at the same time, and the midwife caught the greasy, bloodied newborn like a cricket ball in the slips. The bonny little girl lay on a starched white towel soaked in urine, while the slithering umbilical cord was clamped and cut. Her baby’s only dependable source of oxygen was now gone. Finally, the whole placenta separated and squelched out, to join the party in the outside world. Mother would need a gynaecologist to put things back where they should be – but not yet.

      All babies are blue at birth, then they bawl as loudly as I did. It’s cold outside and they no longer hear that soothing maternal heartbeat. Freed from their claustrophobic cocoon, they thrash their little arms and legs around and suck in air for the first time. At that point they should turn pink. This little mite stayed blue and silent. Listless, with eyes wide open but seeing nothing.

The midwife recognised that things were not right. She vigorously rubbed the baby’s greasy back and swept her finger around its throat. Rough stimulation suddenly caused its breathing efforts to begin, but with a whimper not a roar. And the baby remained blue, a darker blue despite the rapid breathing, and still cool and limp. Now beginning to panic, the midwife called for an oxygen cylinder and some help. At first, the tiny oxygen mask helped. Baby’s muscle tone improved but her grim slate blue colour persisted. The doctor arrived and listened to the tiny heaving chest with his stethoscope. There was a heart murmur, not loud but clearly audible when searching for something specific. It transpired that the artery to the lungs hadn’t developed properly – pulmonary atresia, we call it. Dark blue blood returning from the tiny body streamed through a hole in the ventricular septum and back around the body. The chaotic circulation was progressively depleted of oxygen, accumulating more and more acid. The baby was doomed. A ‘blue baby’. The doctor shook his head and walked away. Nothing could be done to help.

      All this passed the mother by as she sweated in pain and perineal Armageddon. She was impatient to hold her new daughter. As they handed over the dying infant, the midwife’s grave expression told the story, as did the child’s pathetic face, lifeless and grey, eyes rolling aimlessly. Our factory girl pleaded for an explanation. Why so still and silent? Why not pink and warm like me in the cot next door? Milk started to flow, but there was no suckling. In 1948 blue babies died.

      They returned to the maternity bed next to my mother. There was a stark contrast in mood after nine months of excitement and anticipation – one woman radiant, proud and optimistic with her robust, pink son, the other desolate with a grey, motionless little girl left to die in her arms. The curtains were pulled around. Her expectant husband was stuck at work, rolling steel, never to see his daughter alive. The hospital chaplain arrived as a matter of urgency to christen the child as life ebbed away. It was probably too late, but they went through the motions.

This emotional meltdown already greatly saddened my mother, then the contrasts deepened at visiting time when the families arrived. There were repeated emotional breakdowns as the young woman’s parents, then the bereaved husband, arrived too late to see the dead baby before it was spirited away in a shoe box. Feelings of guilt quickly followed. What did she do wrong? Was it the cigarettes? Or was it the sickness pills? Should she have gone to church? My own family’s joy was tinged with compassion for the poor girl. My mother stayed in the maternity bed beside her for five days while she was taken for pelvic surgery, with nothing to bring home but sadness and stitches.