Get Booked – Kevin Lafferty, Cutting It 190421

Hello, I'm Hazel Butterfield and you're listening to Get Booked for Women's and Men's Radio Station. Here on Get Booked, we love talking to authors about their new releases, going into detail about the topics covered, topic inspiration, the mental health and wellbeing elements, and giving you the extra special insight into a different book and the author each week. Now this week we have Kevin Lafty with the book Cutting It. What an authentic, candid, quite unique account of the world of vascular surgery, a bit like Casualty with a bit less adultery or non-surgical drama, but still quite gossipy, a kind of chronological look at how surgery has evolved over the last 100 years or so, who's who and all that with a knife, and also who's not. Cutting It explores the life of a consultant dealing with life or death odds, making your mark figuratively and literally, stories of lost recovery and thinking outside the box to aim to get it right for each individual. Kevin, hi, thanks for joining us. Good morning, Hazel, nice to have you. No, thank you for having me. You're very welcome. So I've been working through this book and I've loved it. You go into so much detail, but in a way that you can tell you've done teaching because even for somebody like me who's a bit squeamish, I devoured it. Oh, I'm very pleased. That's exactly why I wrote it, for people like you who are interested and are on a layman's level. Yeah, definitely a layman. And it was interesting, I think I said to you earlier via email that my friend had a C-section last week, and it was— and normally I'm so squeamish and I can't, I don't even particularly like looking at a paper cut, and she's like, do you want to see the scar? And I'm like, I don't know, and then I was like, actually, yeah, I do, I want to see, because I'm a little bit more intrigued, and there she showed me this perfect scar, and I was like, oh, that's quite interesting, I'm sure Kevin would be very impressed. But yeah, for somebody who's incredibly squeamish, I've read all the finer details, and I love the way that you kind of, you talk about a particular case, and then you explain the procedure and the particular history and elements to kind of get people to understand why you might have to go down a particular route, and then you kind of finish off talking about the case. And each are quite unique and different, and we know every single human being is different, and the wonderful world of surgery And it's, uh, you've definitely been doing it a while and you know your stuff. Well, hopefully. I qualified in 1975 and I'm a very old man now, so I'm what, 69 this year, and retired about 6, 7 years ago and bored stiff and wondering what to do. I started coming across the various books by Henry Marsh on neurosurgery, and there's another bestseller on heart surgery by Stephen Westermead, and a number of other ones by junior doctors, and a fantastic one by David Knott who did War Doctor. Um, and I thought, well, no one's flying the flag for general surgery here, and general surgery, vascular surgery, which is my specialty, and general surgery really is the backbone of all the other surgical specialties. Uh, the likes of neurosurgeons and heart surgeons have all done general surgery to start with before specializing, but the vast majority of us stay in general surgery, and we're the sort of guys you see when you go into the local casualty department— or sorry, A&E— uh, with your appendicitis or bellyache or having been fallen off a roof or whatever. And you always— it's always the general surgeons that scoop you up to start with and then carry on from there. So you are the dons of the medical world, should we say? Well, we're the frontline troops, should we say. Yes, I do find it interesting, especially at the beginning where you were kind of saying what all the different surgical practitioners think of each other, but the one that doesn't seem to have any kind of negativity— lovely pre-statement— it's the nurses. The nurses are the ones that you all seem to like. Oh, of course we do. Nurses are— they're also the frontline troops, aren't they? Yeah, absolutely. They're the ones that support. Yes, I mean, I mentioned a couple of the scrub nurses throughout, and one particular scrub nurse was a, a lady called Betty who I've— well, I did know before she sadly died. I must have known her for about 40 years, and she taught me a lot of surgery when I was a young man because she was always on at night while I was— and I was doing, you know, most of the emergencies all happen at night for some reason. So she was the one who taught me a lot of surgery at 3 o'clock in the morning over several years. And then years later, she was still scrubbing for me when I was a consultant. And then she retired and sadly died far too quickly a few, a few years after she retired. So yeah, she's one of my heroines in the book, um, and all nurses are, of course. Well, yeah, when you find a good one— and that's the thing, isn't it? Finding a dream team where, you know, you can get on with what you do best because because you've got somebody supporting you in the best way possible. And it's— I did kind of giggle quite a bit all the way through the book. I love your kind of candid prose. You're quite the wordsmith, and a perfect amount of swearing for me as well. Excellent. It was one of my dog walking buddies is a GP, and Yeah, I did. I really enjoyed chatting away to her about the book. Have you read the other book as well, from the GP who eventually gave up, and he seems to have done particularly well and now does stand-up? Well, I think that's Adam Kay, isn't it? It is, yes. Well, he wasn't a GP, was he? He was a gynaecologist and obstetrician, but only for about 6 years. He was a junior doctor. And there's a number of junior doctor books, uh, which were basically— they all sort of throw in the towel, which is very sad really. Although Adam Kay's book is very, very funny. He was only a junior doctor for 6 years and then, um, he had some problem with an obstetric patient. I think it, um, it soured him away and he, he chucked in the towel and went off to do Comedy, didn't he? Well, yeah, so those who can do, and those who can't turn to comedy. Yes, but I mean, I mean, although it's a very good book, I mean, there's, uh, and it is very funny. The fact is, um, people have interpreted his criticism of the NHS and how it all works, uh, on a junior doctor of only 6 years standing. Which, not being ultra-critical, but it occurs to me that's a bit like asking a 12-year-old what they think of the British education system. I agree, actually, but it does— it still gives you a bit of an idea of the process that people have to go through. And it's not a case of you go to university for 3 years, you train as an accountant, and bang, you're an accountant. You just kind of learn a little bit along the way and things change. It's— I mean, It took you, what, 15 years to get to— about 12, yeah, about 12, from including medical school, that's 1970 to '87, so 17 years, and then 25 years after that as a consultant. And you, I think you get a better overview of how the NHS works and how training works and all the rest of it, um, from doing it for that long. I mean, over 25 years I trained many, many juniors. And I think most of them are consultants themselves now and still good friends. I can't remember any who actually threw in the towel. In fact, none at all. Well, and as you say, there's a lot of consultants around who are about 20 years younger than me who bear my stamp of approval, if you like. I like that. And as you say, now the only time you get to see them is pretty much at funerals. Well, not the younger ones, but the old ones certainly. But they do turn up, and probably a few of them will probably turn up for mine, um, as I did for my bosses. Which, uh, because there is a, uh, there's a tradition in medicine of teaching and learning which is passed on from one generation to the next, and it's very much an apprentice system. And, um, Sadly, Adam Kay, and presumably a number of others like him, found it too difficult and presumably weren't getting the support and encouragement they needed, or simply found it a bit too tough and got out. Well, I mean, it is tough. I've got, I've got a paramedic friend and he's been doing it for 20-odd years and he's fantastic at it, But every day you're seeing something absolutely heartbreaking, and so you've got to be made of pretty strong stuff to be able to keep on doing it. It's— I mean, the fact that you've been going so long shows that it was definitely your calling, and I think the passion you've put into cutting it kind of does exemplify your whole attitude towards your career. And I think it's, I've thoroughly enjoyed kind of understanding and the way that you've actually helped the reader to understand how complicated it can be in that profession. It's not just as simple as somebody is a surgeon, bing bang bosh, they're a mechanic, they can pretty much fix anything in the car. Oh well, no, I mean, I mean, you're medically qualified first of all, so you're not— so you're certainly not just a mechanic. I mean, it's, it's a very— it's a, you know, medicine is a holistic process and you treat everyone, um, appropriately. Um, you know, you wouldn't necessarily start doing major surgery on a 99-year-old chap who hasn't got long to live, whereas you'd pull all the stops out for a 15 or 20-year-old or, you know, younger person. So it's, you know, it's tailored treatment and every doctor gives tailored treatment to a certain extent depending on the age and the frailty of the patient or indeed the youth of the patient. Well, I was just reading about that section in your book as well where you've got to make these decisions where you know full well if you go into surgery with a particular patient that it is not going to end positively, and yet you still have the family saying, but please just try anything. If they die, then at least we tried. But that, you know, from your perspective, it's like, well, actually, I think that's not a great way to go. Well, quite. I mean, it's difficult, isn't it? I mean, on that section I'm talking about this, the guilt trip You're, you're probably not as old as me, Hazel, certainly not as old as me, but, um, when your parents, uh, start— when it becomes obvious that your parents are nearing the end of their life, um, middle-aged people, middle-aged, uh, children particularly, um, start going on a sort of personal guilt trip and thinking they haven't been doing enough for their elderly parents all these years. Um, which is difficult with a career and jobs and, yeah, children to look after. And, you know, we all live busy lives at the age of 40 to 50, and that is about that time when your elderly parents start approaching the end of their life. Um, and so most of them, it's quite real, you know, you can, you can— I've got every sympathy for them. Most, most Most siblings will come along and say, 'You've got to do everything you can for my mum,' and I tell them, 'Well, your mum is very frail and she's better off with terminal care rather than being given some major operation which she won't recover from.' And then so, and that argument goes backwards and forwards, but with sensible counselling and care, the right result the right decision is usually made. Well, it is always made. Yeah, so that's a common scenario that every doctor in their clinic comes across at a time when people are hugely emotional and distraught. And there's so many different elements to just kind of wielding the knife, you know, the deciphering each individual case. Well, the operation's only ever— surgery's only over 50% of the treatment that you give to a patient as a surgeon, and often you don't give any surgery at all, just simple advice and medical care, and that's good enough. And actually listening to people's history, not just notes on a medical record, to actually figure out and, as I said, decipher what the best course of treatment and what possibly could be an underlying condition. I mean, I love the way that you, you know, everything that you talk about is thinking outside the box. And I love all the little stories that you come across and the similes and metaphors and liking certain elements of surgery to, you know, a kink in your hosepipe, which I must say is the most annoying thing ever. What, a kink in your hosepipe or intestinal obstruction? The kink in the hosepipe? I can't imagine having to deal with that inside the body. I get annoyed just enough with it in the garden. Well, I thought that was a good analogy, which obviously it's stuck in your head, so it is good. Intestinal obstruction or obstruction of the bowel is where something— stuff goes in the top end but nothing comes out of the bottom. And, um, again, a good analogy is the kinked hosepipe, and you have to operate and find where the kink is and straighten it out and relieve the obstruction. That's a very common general surgical operation for one reason or another. In that particular patient in the book— and all those patients are real, by the way, although they have been anonymous. Um, that particular young lady has had some adhesions after an appendix operation about 4 or 5 years earlier. And again, that's a common scenario. Um, but a few quick snips of the little, uh, scar tissue around the previous operation released it, and she was soon good to go. But that's something I must have done hundreds and hundreds of similar operations like that over the years. And yes, it is all very satisfying. I mean, surgery is very satisfying. Being able to fix someone with your hands, I think, is a lot more satisfying than necessarily giving them 10 days' worth of antibiotics. Oh yeah, that's boring. You don't see any sort of immediate result. Yes, there is definitely an immediacy about surgery. You know, you've got it all fixed and done. Uh, no, it's good. I'd do it all again, I think, but I'm not sure I'd do it in this era where the way the surgeons are trained is not necessarily as, um, the way we were. We were sort of thrown at the deep end, um, and, and helped to swim. We weren't allowed to sink. But, um, these days it's all shift systems, and there's no great allegiance to any particular consultant. In my day, I would have a firm of a registrar, and one below that's called an SHO, and then a houseman. And they'd be with me— the registrar would be, would be with me for about a year, and the two lower ones for about 6 months. And it was great fun to take the firm out. To go bowling or have a curry and all the rest of it. And it was really quite a big, you know, a happy family. And these days the juniors come into work, they work from 8 till 8, they don't quite know, I don't think, who they're actually working for. And the consultants probably don't quite know who's working for them either, although they're nominally— the juniors are nominally attached to a consultant with a shift system. It makes it very difficult to see them regularly, and I suspect the days of the firm going out for a booze-up and a curry are long gone, which is sad. Yeah, but so you definitely say that your time was more of the good old days? Well, oddly enough, I've had a couple of my contemporary retired surgeons read the book as well, and one of them just last night sent me a text to say, 'This is like looking at a mirror of myself each time I turn,' which I thought for another old boy was quite good. I like that. Do you know what? I thoroughly loved actually learning about the history as well, where, as I said before, the case comes before you, you then kind of go off onto a bit of a tangent and say, 'This is what's happening, this is what's happened in the past, this is the process we need to do, and this is how it could possibly go wrong.' and then you go on to kind of explain everything. And what I found quite interesting, page 127, the— where the name derived from for a cesarean and how it's completely bogus. Well, everyone— I mean, most people think that cesarean section is so called because Julius Caesar was born that way. Uh, but I mean, you're looking about, you know, 2,500— over 2,000 years ago. No woman would have survived a cesarean section in those days. Uh, if the infection in the opera— if the operation and the bleeding didn't kill her, the infection afterwards surely would. And Caesar's mother Aurelia was still alive and kicking well into his adulthood. So she couldn't have delivered him by a cesarean section. But in the ancient— in ancient Rome, it was forbidden for pregnant— for pregnant women who died, for them to be buried with the child. And the child and the baby was cut out beforehand and presumably was buried separately. And then the dead body of the mother was buried separately again. But they— one of the emperors decided if they— if anyone died in childbirth, it might be a good idea to try and cut out the baby. And that's where the word caesare is. It means to cut in Latin, was the past participle. But however, and, um, there's a— the story goes that, uh, an ancestor of Julius Caesar was delivered that way. Uh, the mother died but the baby lived, and the child, who was presumably male, then went on and he was given the surname, uh, Caesar. So Caesar, and that was then passed on through generations until it got to Julius Caesar. But Caesar, of course, the name Caesar eventually became synonymous with emperor. And it's of some— and it's of some interest that in Germany, for example, an emperor is a Kaiser, and women over there don't get a cesarean section, they get a Kaiser section. And in Japan, I don't know what they have— I wouldn't be able to pronounce whatever the word for emperor is in Japan, but it's the same there. Japanese women don't get a cesarean section. They get an emperor section with whatever— however you would say the word emperor in Japanese. It's interesting, isn't it? Yeah, I mean, there are quite a lot of interesting bits and bobs in your book. I mean, you know, well done you. Uh, what I do find interesting is I'd love to know how long it took you to write this book because there's so much information that goes into quite a lot of, you know, intricate terminology, but also, you know, when you've been doing— been a surgeon for as long as you have, I guess, is it a bit like, you know, just regurgitating your life? Was it easy or did it take forever? No, it's difficult. Any author will tell you writing is hard, and I'm bone idle as well, so that doesn't help. No, not really. I think, as I said earlier, the impetus to write it was all this neuro— all these neurosurgery and heart surgery books and junior doctor books, uh, but no one was flying the flag for general surgery and getting on. And if you like, cutting it and, you know, making them— making a good deal of it and doing it all and getting through to the end. But I write mainly, I think, during the winter months, because during the summer, and particularly looking out the window today, it's an absolutely perfect day for going flying. My hobby is tugging gliders into the sky in an old plane called a Pawnee. So that's what I do during the summer months, but in the cold, dark winter months, that's when I knuckle down and start and do the writing. And it's quite interesting having a summer break, and I think most authors will say this, if you have a break from the writing, you then go back as I do at the end of summer, autumn, I then open the computer again and see what I've written and see everything with fresh new eyes, and it gives me new ideas. So yes, it was a long slow process interrupted with lots of, lots of flying and gliding in the summer, but I eventually got it done, and the break each time I think was very good for the, for the final product. Yeah, give you time, it's giving you time to reflect as well, isn't it? And yeah, walking the dog helps as well. What dog have you got? We're both in the situation at the moment where we're recording from our respective homes because of the joys of COVID So what dog have you got? Sorry, a black lab. Oh, I love a lab. Charlie, my beagle. One of her favourite friends is a Labrador. Oh well, there's a neighbor down the road, they've got— she's got a lab, um, a golden retriever, and a mongrel of some description. And the four of them go out every morning and have a fine old time. And then the black lab comes in, jumps on the bed, and snoozes till lunchtime. So he wants to be fed and taken out for an afternoon walk as well. He lives the life of Riley. Don't they just though? I mean, even my dog's just sitting there staring at me going, come on, just get on with it, Mum, I'm ready for a walk, and then I want to go for my nap again. She doesn't know she's born, seriously, when we all have to go back to the office properly and we're allowed back in studio, she's going to be like, you've been at home for a whole year, this isn't fair. Unlike yourself who's retired and you're either— have you ever taken your dog up in the glider? I've tried getting him into the back of a plane, he doesn't like it, it's a bit too dark. He'll get in the car okay, but he doesn't like, he doesn't like the darkness inside the cockpit of a plane. So no, I have tried, but you won't have it. I do know some people who have earmuffs for their dogs and put them in, in the plane, and, uh, some of them, you know, it works very well. I think for smaller dogs particularly, but for a big black lab of 30-odd, uh, 32 kilos here, I think he's a big lad as well, right? Yeah, he doesn't feel comfortable in a confined space. He'll stay in the back of the car all day. I've got a hatchback, a hatchback 4x4, he sits in there all day. But no, he sits in the plane, he sits on the gliding field though and just sits there and watches me take off and come back. And the boys, the boys at the club look after him, so he's very happy going flying. They're not in the, not in the plane. The thing is, the gliders, they're, um, they're definitely not as sturdy, and they're probably quite noisy, I would imagine. In the gliders, no, quite really compared to a power plane and quite silent, and you don't need earphones or anything. There is the wind noise, but no, gliding's beautiful. You really ought to go and try it. It's fantastic. Do you know what I used to— My next door neighbor, when I was younger, he used to have one of those two-man planes. So he used to have gliders and then the really light aircraft. So I actually went in the light aircraft. He never took me out on the glider. I loved it. But that whole idea, the size of the planes, I mean, it's definitely more at one with nature and up with the skies, isn't it? Rather than being protected by all the Boeings. It's, uh, you're Boeing girl. Do you know what? I like heights, so I mean, I've jumped out of planes. I'm a huge fan of anything that's to do with heights and being up there, but I don't think I've— I've not been in a glider. I would like to. Well, I'll arrange it. Wait till this COVID rubbish is over and we've all had our injections, and I'll get you up in a glider if you want. That'd be brilliant, actually, because you live quite close to where my mum made all of the family go for for, I think it was her 60th birthday, because you're out in, in the sticks in Elyway, aren't you? Yes, indeed. I was watching, I'm watching the boat race on, um, on Saturday. That's given the, that's given the date of this, uh, interview away, hasn't it? Anyway, the boat race on Saturday, I was watching almost, not quite my backyard on the TV, which is quite interesting. Well, yeah, because we— I'm Southwest London, so, and I used to have an office that overlooked just before you're getting to the end, so it's kind of the Malt Lake barns area. So we always used to just sit on and, you know, get to Majestics, get lots and lots of booze in and look down at everybody who are in the pub spending £20 a pint. And you can see why they moved it because there's just not a chance that people wouldn't have gone out in droves to go and watch it. So I see why they, they trusted you lot a little bit more than the Londoners to, uh, not come a bit too much. Hammersmith Bridge is in danger of falling down, isn't it? So that was the other reason they moved it. Oh, was it? Oh yeah, because it's still under construction, isn't it? Well, they're trying to mend it, I think. If you took too many people on, they'd all end up in the river, which— because that Hammersmith Bridge is normally packed, isn't it, on boat race day. Oh yeah, I mean, it's absolutely bonkers. Great to do though, great fun, nice way to kind of get through Easter. Oh, absolutely. I've been there before, I've been at the boat race years ago, I think when I was a student, so you know, it's a great day out. But very interesting having it up here in the wilds and wind of East Anglia, but they do it well. Interesting fact actually, my grandma, who is still alive and 94, she's due to turn 95 this month, actually rode in the women's boat race back in the day. Fantastic, there we are, you must have sturdy thighs then. Do you know what, she's as fit as a butcher's— well, she was as fit as a butcher's dog up until a few years ago, now she's not so much. Interestingly, actually, I was going to point out, because my grandma's really— she's not in a great way, and she's now got cancer and whatnot, and even as a family we've all turned around and said, you know, we wouldn't put her under the knife now because it's too— it would be more upsetting. Or it's sensible. Yeah, she needs tender loving care, doesn't she? And especially when there's Alzheimer's and dementia involved, you— there's so many different factors. It's not just a case of somebody needs operating on, you operate. Well, I mean, I saw my mother die about 5 years ago. She died at 95, having had Alzheimer's for 12 years, and for all that time she called me Sue, strangely enough. And then my dad died just, um, uh, just over a year ago now, and he, he reached 95 as well. So I've got a long way— I've probably got a long way to go myself, but I don't want to get Alzheimer's because it's, uh, pretty grim. It is. And I think quite importantly, do you suit the name Sue? No, my name's Kevin. She called me Kevin for, uh, well, 8— well, not quite 80 years. She called me Kevin for 67 years, and for the last 10 years when she was completely out of it— and that's the sadness of Alzheimer's, you've got this shell of a body that looks like your parent, but there's no one at home, is there? So no, she called me Sue, and then eventually she didn't really speak at all. And then, um, one day she didn't get out of bed, and a few days later, uh, she's passed away quite peacefully, really, which was a blessing. Um, there are definitely worse ways to go, aren't there? Absolutely. I'd rather— that's the way I'm going to go. That couple, you know, nice. And, uh, the way to go is, uh, what did, uh that poet say? Um, come on, help me out here. Oh, do you know what, it's towards the end of your book as well. Dylan Thomas wrote that poem about, um, rage, rage against the dying of the light, uh, do not go gentle into that dark good— into that dark good night. And he would think he was talking about his father and railing against his father not to die and to fight back and fight fight it off and all the rest of it. But that's definitely the— uh, I don't— I personally don't think that's a good way of facing death. To face death, you go into it gently, um, knowledgeably, uh, and taking enough drugs to keep you pain-free and comfortable. And then you slowly slip away, you know, without any of the nasty bits of dying, like breathlessness, pain, Dementia, well, dementia as well, but incontinence, all the things that you never see on the Hollywood films. Oh, well, that wouldn't be good telly though, would it? Well, no, but that's the truth. That's what everyone expects to see. Because I mean, I suppose any doctors really, I mean, I've seen literally hundreds, well, possibly certainly hundreds and hundreds of deaths and I know the best way to go is peacefully and pain-free and not in agony, um, and not getting enough painkillers. And I personally, when I go, I'll supplement my, um, alcohol with, uh, supplement my painkillers with good drafts of East Coast Scotch whisky. I was just about to say you're, uh, you're an East Coast rather than a West coast single malt fan. Oh, it's all too peaty, isn't it? Talisker and, uh, Laphroaig. I find it, uh, I find it very peaty and unpalatable. But of course, each to his own. I don't want to be getting— I don't want to be getting any nasty comments from those, those particular manufacturers. And many of many people love Talisker and Laphroaig and the like. In fact, I used to drink Talisker quite a lot years ago. But I've migrated to the East Coast now, which is the smoother stuff as far as I'm concerned, not so pithy. Well, each to their own, you know, and we're all individuals. Absolutely. Now, interesting, just as we were talking about the difficult decisions that surgeons have to make, you know, surgeons do take the glory when something incredible has gone gone on in surgery, and there's, you know, there's 30 of you quite often involved. However, they also take the brunt when it goes wrong as well. We need to point that out, don't we? Well, hopefully things don't go wrong too often. I mean, a surgeon never intends to operate on anyone who's going to die. If they're going to die with that surgery, it'll be without surgery. And they're made comfortable and given a peaceful death. Um, much by the sound of things as your grandmother's going to face in the not too distant future. Yeah. Um, certainly there are operations that surgeons tackle, um, that are often 50/50. I mean, uh, people who've been shot or stabbed, you never know what you're going to find, but you can't say You know, you can't— you've got to try and do something. I remember years ago seeing a young chap from a pub had been run through in a knife fight, but one of the knives was a samurai sword, and he was run through with the samurai sword. And I spent, I would think, probably 6 hours at night trying to stop him bleeding from here and there. Um, inside his belly. And after about 60 units, uh, the only thing I could do, having done what I could, was packed it— packed his abdomen to put pressure on the bleeding. Because after that amount of blood transfusion, you don't have any what are called clotting factors left in your blood. And sadly, he passed away. And there's, um, there's, there's other sorts of operations where if you open someone, they've got massive, uh, irredeemable cancer or sepsis, or sometimes you open up— particularly older people, you open them up and they've got gangrene of the whole gut, and that's, that's irredeemable as well. So there are lots of things, lots of patients who will die after an operation, but it's usually because it's irredeemable with surgery. Very few, thankfully, die as a result of routine surgery, although obviously that happens. But one chap, um, sudden something disorder— what was it? It's called SADS. What's it called? Sudden Arrhythmic Death Syndrome. Yes. So I've done a perfectly good hernia repair, which was not, you know, there's nothing like falling off a cliff. I mean, easy peasy stuff. Um, and he was fine. And he did half a dozen other similar operations on the same list. And that afternoon at 5 o'clock, he suddenly keeled over dead. We couldn't— couldn't get him back again with all the cardiac massage and all the rest of it. And it eventually transpired even the pathologist couldn't find out what was wrong with him. But that worried me sick for about 3 months, because obviously if you stick a knife into someone and then they die immediately afterwards, you wonder if you've made a mistake somewhere and missed it. So yeah, there's always worries, some patients like that. But he— all the patients in the book are ones that particularly stick in my mind for one reason or another, and all have their own, if you like, individual story to tell in terms of what condition or what disease they had in the first place. And I chose them particularly. I suppose if I haven't— if I wasn't quite so idle, I'd already be writing book 2 about all the other patients I can remember. But for the time being, the sun's shining. Yeah, you're gonna go out in the glider for a bit, you know, make sure the dog's happy on the sidelines, and start book number 2 once it gets a little bit miserable again. We can— I'll see how book number 1 goes as well. Well, yeah, and also, you know, as the listeners have already heard, you promised to make sure that I get to go up in the glider at some point. That'll be— I was supposed to be taking this more today actually, but I had to put it off. So sorry. I'll shoot over there after this and lend a hand. Yeah, no, right, you carry on. As you are. There's a couple of my favourite stories in the book. Now, one on page 75 in particular about a patient that you got to see 30 years later. Now, I love it when kind of worlds collide, and I had my grass redone the other day, and I live 200 miles away from where I was brought up, and the guy that had come to quote used to live next next door to my stepdad back when I was 8 years old. I was having the grass remade. Your grass? Yeah, I'm a northerner, so it's grass. Oh, grass, yes, but lawn. Yeah. All right. No, he lives 2 minutes away from where I live now, but he used to live 5 minutes away from where I was brought up, 200 miles away, and he used to be the door neighbor of my stepdad. So we'd actually come across each other at some point when I was about 8 or 9. Well, you're only 6 degrees removed from someone you know, aren't you? Well, exactly. However, walking into, you know, a consultation 30 years later and recognizing a lady's scar, that must have been quite an interesting moment for you. Well, that story is, I think, the first main story in the book, isn't it? Because that's, that's the one that really sticks in my, my mind and memory out of all of them, so that one had to come first. And this was when I was a very young junior houseman, as lowest of the low, at about the age of 23. And this 10-year-old girl came in having fallen off her pushbike, I think presumably in the middle of the summer holidays, uh, and she was clearly in desperate straits and belly was swollen, and to all intents and purposes, clinically, she'd ruptured her spleen and was bleeding to death. So as I say, I was only the junior— I was only very junior. My job was to get her up to theatre as quickly as possible and get the boss to take her spleen out, which I describe in the book, which was obviously a fairly bloody process. But I suppose in a way that was one of the things that really turned me on to surgery. Because this girl, uh, at the age of 10 survived and, um, was discharged. And I forgot all about her, but her spleen was so big that instead of just one incision on her belly, the boss at that time had to do another incision to open that, to get the hole big enough to remove this enormous spleen, which is about the size of a rugby ball. So that's stuck in my mind, or in the summer, in the back of my mind. Then 30 years later, I was in a clinic and saw this lady coming in for— I can't remember, something minor anyway— and, uh, I noticed that she had a little scar on her ankle. Surgeons are quite good at scars, and I knew immediately it was a cut-down incision on a vein at the ankle where you can always get an intravenous line in at that part of the ankle into a vein which is always there, and it's called a cutdown. Uh, and I said, so you told me you hadn't had an operation, any operations. He said, I forgot about it. And then so she showed me a tummy, and there was the scar, the very unusual scar that I'd seen something like 30 years earlier at the age of 23. And it could only have been her. And I We had a bit of a chat and clearly it was her, and she was as dumbfounded as me. 30 years later, this woman is now— was now 40, um, a mother, wife, uh, I think she had 3 kids or something. And it's just fantastic. And, you know, it took me straight away back to that day when I was still a green houseman. So yes, that was a good story, and it's all true, as I say. There's no exaggeration, although there is anonymization, which has to be legally. Yeah, I've always liked that one. Well, my other favorite one, which unfortunately was bittersweet, but, um, again, near the beginning, page 40 or something around there, um, Anisha Oh yeah, Ugandan Asian girl. And it was just the way that, you know, thinking outside the box and giving her a bit of purpose, but also utilizing her in a way that really actually helped you along the way. Well, she was a 16-year-old girl. It's just gorgeous little 18, uh, 16-year-old Asian child, really. And she had, um, a medical condition whereby One of the valves in your heart gets infected with a Streptococcus germ from your throat. It's called bacterial endocarditis. And she was being treated and she was getting better. This was back in 1975, so it was intravenous antibiotics and antibiotics, and the antibiotics back then weren't as good as they are today, and they often made people feel sick and all the rest of it. And she'd been in hospital for about 3 months or more. And one day, one morning, I went to see her and she clearly had a stroke. And some rubbishy bits of the bacteria in her heart had somehow ended up in her brain. And this sweet, gorgeous 16-year-old, um, basically stroked out. And then she went brain dead. And, uh, she was put on a ventilator in the ICU, but then eventually everyone agreed she was brain dead and they switched the ventilator off, um, which— and at that point I retired to the nearest park and cried my eyes out. So, um, yes, that's a fairly poignant— that still makes me feel quite sad talking about it now, actually. It's quite harrowing. You are dealing with life and death, and you're dealing with people who are at the most vulnerable state. Well, she was, but I mean, I became— I mean, I was only a young man myself, I was 23. So, um, but I've had a sister, uh, of that— at that age, you know, 23. You go back quite regularly to see all— because I'm the oldest, so I had younger siblings of her age and below. And it was like, um, having treated for so long and she was getting better, suddenly um, proper clogs like that was, uh, absolutely heartbreaking. Uh, you know, it was almost, as I say, it was almost like losing one of my little sisters. So, um, yeah, so it shows we're not all hard-nosed— well, not all hard-nosed surgeons. We're all quite normal human beings. But, um, over the years, I think she was the only one I really cried over, frankly. And after that, I think I inured myself to any deep emotional involvement with patients. But it's very difficult with children, isn't it? You get involved with children anyway. It is. But I do like how, you know, it was, it was utilized, her, um, translation skills. Oh, that bit? Yes. Well, yeah, this was, I think, at the time I was, I was a houseman in northwest London, and it was shortly after Idi Amin had kicked out all the Ugandan Asians, and there was a huge population of them in northeast London near a hospital called Central Middlesex. So a lot of them, um, a lot of my patients at that time spoke very little or no English, but because, uh, Anisha had been to school in England for a couple of years She spoke perfect English, so she provided me with a little translation sheet to use to ask my patients whether— where was the pain, do they feel well, are they coughing up blood or pus or the rest of it. It all started out because of an old Indian man who couldn't explain to anyone that he was constipated. So here comes Anisha, right, can you give me the translation of constipated and flat? You want the word for constipation? I sorted it out. But of course, poor Anisha, she's only 16 years old, and not many 16-year-olds— perhaps they do— would understand implicitly what constipation means, or phlegm. I think it was like that. But anyway, what is phlegm? Let me explain it to you. It's a 16-year-old girl of Asian extraction. But, uh, yeah, she got— we got around that. But she was a dear little child, and all the nurses called her the princess, which made it even more painful. Such is the life of a surgeon, of which you've had quite, quite an interesting kind of life. I've loved reading about as well, kind of climbing up the— rather than the greasy pole, more the bloody pole of hierarchical structures of the world of surgeons? Well, in a way it's a bit like the world of pilots, isn't it? I mean, as a junior, you don't get to fly, um, 747s around the sky, um, until you've been at it for a long, long time. So you start off as a junior officer, then you go up to a second officer, and then first officer, and then after many years as first officer, you become a captain. So the hierarchy of piloting is very much similar to the hierarchy hierarchy of surgical training. And you start off as a little junior taking off lumps and bumps and little fatty things and ingrowing toenails. And, uh, 12 or 15 years later, you're doing the big stuff like heart surgery or aneurysm surgery or whatever. So it's a— it's— but you learn by increments, and each little step adds on to the next until you actually become quite good at the job. As long as you don't somewhere along the way lose heart or have some sort of tragedy which puts you off the job. It seems to be your modus operandi, it's what you're used to. And now you've been retired since 2014, completely retired should I say, from 2014, because I think you tried to do it bit by bit didn't you? I was frightened to death of retirement. I didn't know what I was going to do. I thought I'd be bored stiff. And of course, I mean, the whole purpose of doing the job is because you love patients, and I particularly loved surgery, and I love the patients. So in a way, the book is a bit of a love letter to patients and to all the surgeons who trained me and to all the surgeons who I've trained as well. So it was just a celebration of all that really. I know it does come across as a love letter to all the counterparts. Yeah, definitely. I mean, I was, as I said at the beginning of our chat, I was worried that I wouldn't be able to hear all the gory bits, but it's not. It's written with affection and definitely quite kind of satirical and quite pragmatic as well. You definitely have a way with words. I mean, I take it you're somebody that likes to regale people with stories in a pub or over a single malt whisky when the pubs are open? Well, possibly. I suppose all surgeons swap stories. I do go fishing every October with a few Lancashire lads. I say lads, we're all getting on for 70 now. I've been doing that for about 20 or 30 years, uh, on the same week. It's like a time share. And, uh, we've all grown old together, and they're tired of all my stories. But they did say to me, like, well, I mean, I think when people meet a surgeon, the first thing they want to do is get them into a corner and ask them questions about surgery, isn't it? Well, yeah, I suppose you do. Anyway, these boys have got tired of all my stories, or I've got tired of answering them, answering their questions. But they, one of the, I mean, they were partly the reason I wrote the book. They said, "You ought to put all these down in a book." So I did, and then took it back to them the following year, said, "Right, read that and tell me how to correct it." And they all got very miserable. Because when we were rained off the river, they had to sit down and read all these hundreds of pages of typescript and do some editing and correction for me, but they're good lads. And, uh, their job is their friends, as your friends. Exactly. You got me into this, so they can get me out of it as well. Yeah, they're acknowledged in the book, uh, but lots of people have helped. Well, have your two daughters read the book? Uh, no, my daughters haven't, but one of my sisters who is a journalist, read the book as far as— because she was one of my beta readers. I've learned a lot about this publishing business. I never knew, I never knew the difference between an alpha reader and a beta reader. But my sister read the book and she wrote back to me, and because one of the chapters deals with cesarean sections and things, doesn't it? Yes, she said— she wrote in the book, I will now forever— she wrote to me about the book— I will forever regard my ovaries as being in Birmingham and my uterus in London or Cardiff, which I thought that was very funny. Um, yeah, it did help to visualize it though, because, you know, you've gone through 12 years of training and you've managed to kind of sort of accidentally put it into 390-odd pages. Yeah, well, I've always been a teacher. I was, uh, I've written a, written a couple of textbooks for students over the years, and I was a lecturer at King's for a number of years, and that's got quite a lot of teaching into it. So I've always had the teaching ethic, and I quite like teaching, but I don't like writing, certainly writing surgical textbooks and scientific papers. Is ever so boring and tedious because you have to do it in a, you know, whatever the scientific style of the day is. So you're very strict on how you can write professional scientific papers. Well, it's very academic and it's not for gen pop, is it? No, that's right, which is why at the end of it I have thoroughly enjoyed writing this book because it's aimed directly at the public, and hopefully I wanted to make them laugh as well as cry. And I think as long as you've laughed as much as you have wept the odd tear here and there, I think I've done my job. Well, I think what's important in what you've done actually is, the reason why I love books is because it gives somebody another insight. Yes, it's distraction, it's entertainment, but the more we understand each other and each other's roles, the less judgmental, or the more— the easier we can be on people, especially in situations like yours when it's always— when people are already going to be quite fractious or in pain or, you know, panicking. The more we understand of each other's place and position and role, the nicer we can be to each other. I suppose so, but I mean, uh, Being a doctor helps, I suppose, so because you see all these people in dire straits. But I found that age helps as well. As you get older, yeah, you become more tolerant of most things. I've even become tolerant of, um, political parties these days, so I take no notice of either of them. Well, actually, funnily enough, um, a question I ask, um, all my guests on Get Booked Here for Men's and Women's Radio Station is, you know, is there somebody— now if you want this to be somebody from, from the medic world, that's absolutely fine— is there somebody you think is just brilliant? They are a great example of a human being, they're smashing it out the park, whether there's somebody in the public eye, somebody that you know, um, Who would that be? Jürgen Klopp. Oh, oh yeah, I think he's a fantastic football manager and the best thing that's come to Liverpool in many years. And he's also a very funny chap. And also he doesn't look so bad either, he pulls off a pair of glasses like no one's business. I mean, he makes me interested in football. He has got a good row of teeth though, hasn't he? He has, hasn't he? Um, I've never thought of that. I think, um, I don't think there's anyone living, but I mean, one of my old bosses, um, was really my greatest mentor, um, and he taught me— he taught me how to fly fish, he taught me how to operate, and he taught me how to— how to drink scotch, and he taught me how to be a human being. And I am a huge amount. Well, he died a few years ago and I ended up at his funeral. In fact, I just had to speak to it at it. But, um, that's where this continuous cycle of, um, over the generations that all medicine goes through, and each, each generation adds an extra layer of knowledge and skill to the one before it. Well, I do— I love that question because it helps us remind ourselves what it is that we actually aspire to, or who we look up to and why. And it's, it's a positive question. I think that it's, it's nice to rein in on positivity and have that mindset. Um, we're hugely running out of time. I've got like about a minute and a half left, and I normally ask my guests what their 3 tops of mental health and well-being, things that they do to make them happy, are. And I know you're a huge fan of gardening, but could you squeeze it into a minute because we've been chatting for nearly an hour. There's not— if you're, um, if you're down and out and feeling miserable, there's nothing like going for a fly because you can't think of anything else apart from survival. So, and it's, it's also beautiful. I mean, flying between clouds and canyons of white and, uh, white fluffy things is just beautiful. And watching a glider, um, thermal, and being in a glider as it's going up is fantastic. So you might— I will— I won't let you— I won't let you down. I will get you into a glider as soon as possible. I can't wait. I'm holding you to that because that's something I really want to do. Favorite book of all time for me— is that a good question? Yes, do it! Illusions by Richard Bach, who's the same chap who wrote Jonathan Livingston Seagull. A long time ago, before you were born, I would think. But, uh, Richard Bach, Illusions. That's my lifetime desert island book. Oh really? I'm gonna go and check that out now. I love getting recommendations. Quite a short book, but you've— once you've read it, you'll keep it on your bookshelf and read it again and again throughout your life. I love that. Well, thank you. Do you know what, Kevin? I've absolutely loved chatting to you. I can't wait to see you again and and have a go on in the glider. I didn't even get to chat to you about your opinion of Hugh Laurie in House, but maybe we'll have you in, we'll have a good chat again maybe in the studio when you release book number 2. Right, will do, I look forward to it. Brilliant, thank you so much. Everybody go out and get Kevin Loftus' Cutting It. I'll put up a nice and simple easy link for you to go and get your hands on it up on all the social media. Thanks for joining us here at Men's and Women's Radio Station.