A surgical superstar by asafwewe


									A surgical superstar

Peter Cross is wowed by Harold Ellis
                                                                    firms with surgeons who did good ward rounds, checked our
                                                                    notes, and took us into theatre.”
                                                                       National service was spent in the army. He enjoyed
                                                                    the surgery but the services were not for him and are best
                                                                    summed up by a remark made to him by his colonel: “Ellis
                                                                    you may be a good doctor but you’re a damn poor officer.”
                                                                    He took this as a compliment.

                                                                    Birth of the NHS
                                                                    Ellis qualified in July 1948, the month the health service
                                                                    started. For the past nine years he has given a lecture
                                                                    initially called “50 years of the National Health Service;
                                                                    an old surgeon looks back.” There have been some
                                                                    remarkable changes. Diseases are different now. “I tell
                                                                    these young kids that in their lifetime they’re going to see
                                                                    diseases disappear, which they’re seeing every day. And
                                                                    they’re going to see other diseases, which I never dreamt
                                                                    about. When I started, if you saw an obese patient, you’d
                                                                    say ‘what’s this?’ At the end of the war, everyone was
                                                                    skinny. Anyhow, diseases change. Treatments change.”
                                                                    Things that were taken for granted now seem odd, patients
                                                                    with head injuries were kept in a dark room to get over the
                                                                    brain damage; “After a few days you’d say ‘well they must
                                                                    be over the concussion now,’ you’d pull the curtains back,
                                                                    get them to stand up, and they’d faint. You’d say ‘my God,
                                                                    they’re more concussed.’ Back into bed, draw the curtains.
                                                                    The treatment for coronary thrombosis was weeks of strict
                                                                    bed rest ‘to let the heart heal up.’ They would all die of
                                                                    deep vein thrombosis and pulmonary embolism. You’d see
                                                                    young people in their 20s with rheumatic fever, which you
                                                                    never see today. And the wards were full of patients with
                                                                    duodenal ulcer on milk drips.”
                                                                       In the early 1960s Ellis moved to Westminster as the
           AROLD ELLIS doesn’t seem like someone who’s              foundation professor for a newly opened surgical unit. He

H          entered his ninth decade. But he has. Soon it will
           be 50 years since Clinical Anatomy, the standard
           anatomy textbook, first appeared. It’s now in its
11th edition, and still going strong. Professor Ellis has slowed
down a bit: now he says he works part time—Monday to
                                                                    is proud of the team he was able to select, which included
                                                                    as senior lecturer a “boy genius” called Roy Calne who he
                                                                    considers our greatest living surgical scientist. Calne did the
                                                                    first 13 human renal transplants at Westminster, of which
                                                                    12 died of every unknown (at that time) medical complica-
Fridays—when once he also worked weekends and evenings.             tion. He also brought on Norman Browse (later Sir Norman),
                                                                    president of the Royal College of Surgeons, and Barry
                                                                    Jackson, also knighted, serjeant surgeon to the Queen.
Public lecture
I first chanced across Ellis some years ago at a public lecture
at the Old Operating Theatre near Guy’s Hospital, London.           Teaching methods
His talk was nigh on perfect: engaging, informative, brought        For almost six decades teaching has been an important part
alive with vivid word pictures and a peppering of anecdotes         of his life. He reckons that he was at his best when he had
and amusing asides. When he isn’t lecturing he is based in          just taken his FRCS (fellowship of the Royal College of
the Hodgkin’s Building at Guy’s. You get to his office on the       Surgeons) and has got progressively worse the further he
top floor passing en route a collection of marble busts of          has got away from being a candidate. Teaching, as far as
medicine’s good and great.                                          he is concerned, is something that can’t be taught. You can
    Given his passion for the history of surgery, it seems          pass on tips and make a good teacher brilliant but you can’t
appropriate that his father was a barber. There wasn’t a doctor     make someone teach who hasn’t got it. He was teaching
in the family. He was good at biology at school; the two options    postgraduates at the Royal College of Surgeons recently and
were medicine or teaching and his old biology teacher advised       was chased by an educationalist after the lecture, “I’ve heard
against the latter. He studied medicine in Oxford, quickly          about you,” she told him, continuing, “The way you teach
settling for surgery as it seemed to him that medical patients      goes against everything that I teach. You do the opposite.”
died whereas a proportion of the surgery cases recovered. He        Apparently she teaches people not to be confrontational,
flirted with the idea of going into obstetrics and gynaecology      and that’s what he does: “I say to a girl who can’t point
and now feels he made the right decision.                           out biceps in the dissecting room, ‘wretched, tedious, idle,
                                                                    peasant girl,’ which you’re not meant to say. But I do it with
                                                                    a smile. Yes I shout at them, and I tell them off, I tell them
Oxford days                                                         that patients die because of their ignorance, for things like
At Oxford he strove to work for surgeons with a reputation          putting a knife through the aorta. But they’ll never forget
for teaching as well as being excellent clinicians, and it seems    that. Fortunately it happens on a cadaver and they’ll never
these qualities are inextricably linked. “I tried to get onto the   do it again and I’ve saved many lives.”

student.bmj.com                                                                                                             159
                                                                                                                        Yes I shout at
                                                                                                                      them, and I tell
                                                                                                                       them off, I tell
                                                                                                                   them that patients
                                                                                                                       die because of
                                                                                                                     their ignorance,
                                                                                                                        for things like
                                                                                                                       putting a knife
                                                                                                                   through the aorta.
                                                                                                                     But they’ll never
                                                                                                                            forget that

         Things have also changed in lecture halls. Blackboards                  He has something to say about the move to bring back
         have been replaced by whiteboards, then overhead projec-             matron. “The matron that I knew will never be the matron that
         tors were introduced and now we have PowerPoint. He can              comes back in. The ward sisters that I knew, you’re never again
         and does use PowerPoint if there is no choice but finds it           going to have a sister who’s running everything, who will live
         terribly restrictive, preferring the plasticity he gets from his     in the hospital; who will not marry (because if they marry they
         trusted slides. He is scathing about people who stand in front       can’t live in the sisters’ quarters) who’s going to be on duty day
         of an audience and read notes, suggesting better use would           and night; who if there’s a sick patient will stay up all night. I’d
         be made if handouts were passed around and the speaker               be called down to change a drip, sister would still be there. ‘Oh
         took questions afterwards. But he admires technical advances         sister you still here?’ and, ‘Oh well George was very ill, I didn’t
         that allow clips of film to illustrate a talk but concludes that     think I could leave him.’ Now you can’t bring that back, things
         nothing can beat blackboard and chalk, especially, as in his         change. So we’re never going to say bring back the 120 hour
         case, when you can do so without referring to notes.                 week.” He talked about a time when he arrived at 3 am in his
                                                                              pyjamas to see a coal miner who’d just been brought out of the
                                                                              pit squashed, and the man asked, “Are you the night shift?” I
         Publications                                                         said, “No, I’m the day shift.”
         Ellis wrote his first papers during 1953 and 1954 while
         working on his master of surgery thesis. He managed to get
         three papers from it before writing an historical account of         New ways of working
         fractures of the leg. Later he favoured writing papers using a       “We’ve got to work out new ways of training people,” he tells
         dictaphone but now he hasn’t a secretary he’s learnt to type.        me. Today’s surgeons don’t get the hands on experience they
         So far he has written 25 textbooks and number 26 is coming           once had. For example, he removed 200 appendixes while still a
         out next year. His first book came out at the time his first child   resident surgical officer. But far from being gloomy he is encour-
         was born in 1960 while he was a senior surgical registrar. In        aged, knowledgeable, and enthusiastic about patient simula-
         four years time, the golden jubilee edition is printed “I’ve had     tors. But developments like these have come too late; while in
         to change it over the years,” he tells me, “You wouldn’t think       surgical practice he and his peers worked crazy hours because
         anatomy changes, but the clinical anatomy aspects change.            as he says, “That is what you did then.” Touchingly he adds
         If you look at the first edition, there was lots about spread        that he couldn’t have managed without his wife, who brought
         of tuberculosis along the intercostal bundle, and where cold         up their children and managed the home. Since retiring from
         abscesses appear, because that’s what the kids saw. That’s all       surgery and becoming an anatomist, reading Dickens, Hardy,
         gone now and is replaced by where you put laparoscopic               and Trollope has replaced keeping on top of medical journals.
         equipment into the abdomen, avoiding major structures.”
            He has seen enormous changes since he started: “One
         thing I’ve learnt in a long career is there’s no going back.         Passing thoughts
                                          I’ve never in 59 years of the       Before I left I asked him about the future and as ever he was
                                          N H S seen people saying            refreshingly candid. “Well I’m 81 so I have to say it’s downhill
                                           ‘we made a mistake; let’s          all the way from now. I’ve been blessed with good health
                                            go back to what we did six        and I’m compos mentis. I know exactly what I’m going to be
                                            years ago, 10 years ago,          looking like in a few years time. I’m not going to donate my
                                            15, 20 years ago.’ We were        body to anatomy, I regret to say. I don’t want my students
                                             wrong. The change that           to say ‘silly old so and so, look at him. That little shrunken
                                             we brought in was wrong.         walnut was his brain.’ I’m not going to let anyone laugh at
                                             When we had regions              me. I’m enjoying life, I love the teaching. I’ve always enjoyed
                                             and areas and districts,         life, there hasn’t been a time when I’ve been miserable. I’ll
                                              they abolished the area.        keep going as long as I can. But I do enjoy the work and
                                              And then there were just        the teaching. Once I can’t cope with the students and the
                                               areas and districts and        postgraduates—that’s the time to pack it in.”
                                               they said that was wrong,
                                                                              Peter Cross former editor, BMJ Careers
                                               but they never said let’s      pcross@bmj.com
                                                bring the areas back or       This article was first published in BMJ Careers (2007;335:197-9; doi: 10.1136/
                                                anything like that.”          bmj.39390.630567.7D).

         160                                                                                                           STUDENTBMJ | VOLUME 16 | APRIL 2008

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