Loss 52/101: Loss of life for a cardiac surgeon: Mark Field

#104. What's it like to handle a human heart? Or to operate in that small space between life and death? And is there grief for a surgeon when a patient dies during, or after, surgery?

This is The Silent Why, a podcast on a mission to open up conversations around grief, to see if hope can be found in 101 different types of loss.

Loss #52 of 101: Loss of a life for a heart surgeon

Meet Mark Field, a cardiac surgeon from Liverpool (in the north of England) who joined me (Claire), in-between commitments at work, to talk about life, death and loss in heart surgery.

Now, this isn't a subject that's discussed much with surgeons, and you'll hear Mark say that even he had reservations talking about it, but it's such an important area to highlight. Just because you work in a career that encounters death, doesn't that mean you find it any easier to face than people in other jobs. And, like many other careers we've covered on the podcast, it's once again surprising how little training is provided to medical professionals when it comes to delivering the news of a patient’s death. Especially when people's responses to bad news are so varied.

I was introduced to Mark through the Aortic Dissection Charitable Trust, and knew this was a man I wanted to speak to when he sent me the best excuse for being late to a Zoom call ever. I received an email just after the start time had passed that simply said: “Sorry Claire. 5 minutes! Trying to prevent death!!”

In this conversation you'll hear about how hard it is when major operations don't end with a healthy recovery, how surgeons control (or don’t control) human emotions, the privilege of working with such a valuable organ, and why hope plays such an important role in Mark's job.

And because trying to co-ordinate the diaries of a journalist and a heart surgeon got really tricky, Chris wasn't able to join me in this episode, so I was flying solo for the first time in 53 losses.

If you want to hear how other careers handle dealing with death, visit www.thesilentwhy.com/letschat and scroll down to 'Jobs working with loss, grief and death' for a full list.

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Episode Transcript

Mark Field (00:02):
Hi, my name is Mark Field. I'm a cardiac surgeon,
and I'm here to talk about lossin heart surgery.

Claire (00:10):
Welcome to The Silent Why, a podcast on a mission to
find out if hope can exist in101 different types of loss, and
to hear from those who haveexperienced them. I'm Claire.

Chris (00:20):
And I'm Chris. And in this episode, well, I'm pretty
silent.

Claire (00:23):
Yeah, sadly, Chris had to sit this one out. It turns
out the diaries of journalistsand heart surgeons are just
really tricky to coordinate. SoI was solo on this joint mission
for the first time.

Chris (00:33):
So in this episode, Claire meets Mark Field, a
cardiac surgeon from Liverpoolin the north of England, who
joined her in betweencommitments at work to talk
about operating in that verysmall space between life and
death in surgery, especiallyaround such a vital organ.

Claire (00:50):
I connected with Mark through the Aortic Dissection
Charitable Trust, and I knewthis was a man I wanted to speak
to when he sent me the bestexcuse for being late to a zoom
call ever. I received an emailjust after the start time had
passed, that simply said,'Sorry, Claire. Five minutes.
Trying to prevent death.'

Chris (01:07):
Brilliant, I might try that one myself some time. I've
already heard this conversationand you're in for a real treat.
It's so rare you hear surgeonsspeaking like this.

Mark Field (01:16):
As I've said to you before, I've had some hesitancy
in talking about this, becausemostly surgeons do not talk
about these things, it's a sortof unspoken truth.

Claire (01:27):
We'll hear how hard it is when one of those major
operations doesn't end with ahealthy recovery.

Mark Field (01:32):
I'm not sure if it's a morbid thing. But I have a
list of patients who have died.
And every single one of them, Ican look at their names. And
remember every single detailabout what happened

Chris (01:43):
And how surgeons control or don't control their human
emotions.

Mark Field (01:46):
The patient did die, and I remember that surgeon
crying tears rolling down hiseyes. And at the time, I didn't
really understand it. Why wouldhe cry in front of the whole
team once I became a consultant.
I always regretted that becauseI personally have had many
occasions where it's happened tome.

Claire (02:03):
Mark also tells me about what it's like working
with such a valuable organ inour bodies, and what a privilege
his job is.

Mark Field (02:10):
Having the heart in your hand is very special every
time you did it. And somehowit's so beautiful and atomically
beautiful. I'm sure everycardiac surgeon will tell you
every time you hold a patient'sheart in your hands, you do
acknowledge to yourself that itis a privilege.

Chris (02:27):
And it's really surprising how little training
is provided for delivering thenews of a patient's death,
especially when the reactions tobad news vary so widely,

Mark Field (02:35):
You can witness the relative crumbling in front of
you short of shouting andscreaming and people may run out
of the room. And sometimes itcan be quite aggressive. And
sometimes the response is sodeep and so visceral that it is
almost shocking to you.

Claire (02:51):
It was a real privilege to interview Mark. And I think
this might be one of the bestloss interviews we've ever done.

Chris (02:58):
Because I wasn't there?!

Claire (02:59):
Not at all!

Chris (03:00):
We did wonder if this had happened occasionally, my work
being what it is, and now it has- the loss of a co host.

Claire (03:06):
Although one out of 53 episodes isn't really that bad.

Chris (03:09):
Hm I'm still going to grieve.

Claire (03:10):
You'll get over it.

Chris (03:11):
What happened to 'feel the feelings'?

Claire (03:13):
Okay, well, you crack on with that. And we'll head
into the episode. Annoyingly,when we recorded this I had a
weird dry throat coughing goingon after our holiday. So
probably something I got off theplane. But if you're thinking my
voice sounds a bit weird. That'swhy. So here we go. I began by
asking Mark to describe anaverage week.

Mark Field (03:35):
So my name is Mark Field. I live and work in
Liverpool. I'm a heart surgeonwith an interest in aortic
surgery. I guess my typical weekstarts on a Monday with a clinic
on Tuesday. I have an operatinglist on Wednesday, I have a
clinic Thursday have anotheroperating list. And then Friday

(03:56):
is meetings. I also have anencore commitment as well for
emergencies.

Claire (04:01):
So is it quite a tricky job to balance like the home
life work life? It sounds likeit's one of those ones that
would be tricky.

Mark Field (04:05):
Yes, it is. There is a commitment to the job and a
commitment to the patients. AndI guess I'm on call really 24/7.
So I will get called on any dayat any time whether I'm on call
or not about my particularpatients and and quite often I
need to drop things and come in.
And quite often that extends toholidays as well. And sometimes

(04:28):
even when you're outside thecountry, you may get a call in
the middle of the night becauseat the time, the time
differences but yeah, it is it'sa huge commitment, but I guess
it's hugely rewarding as well.
You have the opportunity to savea patient's life and you know
sometimes quite frequentlyparticularly when I was a

(04:48):
registrar I had a really a drovea bit of a jalopy and I used to
drive drive to work and stuck ina traffic jam and I'd look
across at the guy in his Porschenext door and think well, that's
fine. You know, I don't knowwhat you do, but I'm going to
work and I'm going to opensomeone's chest I'm going to
stop their heart and operate onthem and save someone's life.
And that's enough and that'sthat's very rewarding.

Claire (05:10):
I mean, I think people hear heart surgery brain surgery
you know the the vital organslike you said, huge amount of
risk, life and death stuff, youknow, mistakes cost lives. So
what on earth made you want tospecialise in hearts?

Mark Field (05:21):
I guess it's different for every person. And
I guess for me, I did a I didsome research and a PhD before
going into medicine. So I was amature student in medicine. And
so that the time I did researchin Oxford was it was all about
hearts that I always wanted tobe a doctor was a bit of a sort
of failed medic didn't quite getthe A levels to get into medical

(05:43):
school went and did a degree andthen the PhD and then finally,
after the third or fourthattempt got into into medical
school, and then it just, I wentthrough medical school and kept
coming back to two hearts andcardiac surgery and and the more
I saw it, the more that I justsaid, Yeah, that's what I wanted
to do. I was funnily enough I doremember when I was a medical

(06:05):
student listening to twoorthopaedic surgeons talk about
cardiac surgery. And thebasically said, you know, what,
why would anyone want to be acardiac surgeon, your patients
die. And I guess it struck me atthe time, and I didn't really
understand it at the time, all Iknew was that, you know, I was
interested in hearts and I wasinterested in in fixing things

(06:27):
back in the day, you know, youdid house jobs, and your first
six months was in medicine, sixmonths in surgery. And I
remember doing six months inhealth care, the elderly, which
was difficult, difficultspecialty, and then my second
six months was in urology. And Ijust thought I was in my element
here, because it's like, youhave a blockage, and you unblock
it. And I thought, you know,even though I was research

(06:48):
orientated, so this is great.
You're literally unblock things,patient gets better, it's very
rewarding. It's sort of verydefined. And so I thought, well,
I like to unblock things. I'minterested in the heart, I'll
put the two together. Anddespite many people telling me
not to do it, I eventually foundmy way here.

Claire (07:08):
Wow. Because the heart is, you know, it's there's
something romantic about theheart almost, it's got this
symbolic thing from so manylovely aspects of life. You
know, it's in art, literature,love pain, it's so integral to a
lot of what we say even butseeing an actual human heart is
not something that many of usget to do in life, I suspect a
lot of people wouldn't want to,but I think it must be
fascinating to be so close tosomething that's just the centre

(07:30):
of life. Is there somethingspecial about the heart to you
in that way? Or is it more justthat this is a part of the body
I work on, and it's kind of abit more technical? No,

Mark Field (07:38):
it's really very special. Like, you know,
although I do it twice a week,it's every single time you open
up someone's breastbone, and youopen up the sack, the
pericardium that surrounds theheart, and you suddenly faced
with a heart, it's very special,you know, sometimes you you put
your hand around the heart andhave to lift it up to do various

(07:59):
things. Because there arevarious bits on the operation
where you pause to give fluidsto protect the heart when it
stopped. And so you have two orthree minutes every 20 minutes
to stop. And mostly that timeyou just reflect sometimes I
look at myself and you know,just stood around waiting for
this fluid to go in. And you Ijust think you know, how on
earth did I get to this point,what a privileged position it

(08:21):
is. And you're having the heartin your hand is very special
every time you do it. And somehearts are beautiful,
anatomically beautiful. You justlook at the structure, because
obviously, we spent a lot oftime learning anatomy and you
just look at them. They'reabsolutely beautiful. And then
sometimes you look at them, andthey're not so beautiful. No

(08:41):
reflection on the patient. Butthey've suffered a life's worth
of things abuses, events. Andobviously, those are the hearts
that need fixing. But yeah,every single time I'm sure every
cardiac surgeon will tell youevery time you hold a patient's
heart in your hands, you doacknowledge to yourself that it
is a privilege. Wow,

Claire (09:01):
I love that some of them are beautiful. I love the
idea. I hope my heart. I'd liketo think I haven't got it. But
yeah, obviously you're handlingsomething that could just end
someone's life. And when you dosomething wrong with that it's
literally life and death. Solike you said, you can't avoid
patients dying. That's people'sfirst opinion when you want it
to go into it. So I assume thatthis can happen, maybe during an

(09:22):
operation. But I know there'snot just one way for a patient
to die in your kind of line ofwork. So what are the types of
things that can go wrong? Thekinds of circumstances where a
patient might die? And at whatstage? Does that tend to happen
the most?

Mark Field (09:33):
Yeah, I mean, that's the circumstances. I mean, for a
patient and their family. It'sobviously the circumstances may
be quite irrelevant. Andobviously they've suffered a
death. But I think for a surgeonand the team, the justice and
the team around because thereare a group of probably eight
people involved in every heartoperation. And so I think the
circumstances do have an effecton how it's managed or the

(09:57):
impact it has for certain The wehave a group of patients who
come in as elective so that youknow that they're at home
they've been seen in the clinic,and you've agreed to do after,
after various discussions andconsent, you've agreed to do a
particular operation, you'veexplained to them what the risks
are. And then, and then thatpatient comes in from home
relatively well, usually, somepatients have no symptoms at

(10:19):
all, yet, they're having a lifethreatening operation to make
them live longer. Other patientshave really bad symptoms of
breathlessness and chest pain.
And it's more obvious to themthat they're coming in for an
operation. And they will acceptthe risks to get rid of those
symptoms. But those are aparticular cohort of patients,
which are different to patientswho come in as emergencies. And

(10:40):
those patients have baddiseases, acute diseases, which
are life threatening, and, youknow, the suddenly out of the
blue, something has happened tothem on any given day, and they
come in for an emergencyoperation and, and they are
going to die without anoperation. And so effectively,
those patients have no choice.

(11:03):
And I think as a surgeon, and asa team, you may feel that in all
you can do is good in thatsituation. And if it doesn't
work out, then it is sad. Andyou will still reflect on how
you manage things. But you know,that's a different circumstance,
those two groups of patients, Iguess, like you say, it's
interesting the perception thatsome patients or family have

(11:25):
about the risks of heartsurgery. So quite often, when
you see patients in the clinic,and you say, Well, you know,
your risk of dying from thisoperation is three or 4%, or
your chances of survival aren't97 98%. They're very happy with
that. And sometimes we tellpatients that they are they're
going to have high risk surgery,which maybe 10 or 20% risk of
survival. But and quite often inin the lay public's mind, heart

(11:49):
surgery is still 5050, you know,whether you're going to come
through it, whether it'selective or emergency, so that
quite often the risks that weperceive as high risk are not
the same as what patientsperceive as high risk. So it's,
it's not often that a patientwill die in the operating room,
it does happen. And it happensto probably every surgeon a
couple of times a year. Andthose are particularly difficult

(12:12):
things to deal with. Becauseusually, either the patient has
come in and extremists, andreally death's door and you draw
your can or there's been somedifficulty in the operation of
possibly a technical issue,possibly something that could
have been different withdifferent decision making. And
those although they're rare,those hit the team the hardest.

(12:35):
And having a patient die on thetable at the end of an operation
is very difficult. Mostly thedeaths that we face, patients
that we have got throughsurgery, and then they go to
intensive care, a typicalpatient would just spend one
night on intensive care and goto a normal Ward afterwards.
Some patients spent weeks somepatients spend months and have a

(12:57):
tracheostomy in their, in theirwindpipe to help them breathe.
And they may end up with otherorgan support like dialysis,
things like that. And those,those patients may die many
weeks or months down the line ofa complication such as a stroke
or or some issue with theirbowels or their liver or
kidneys. And quite often withthose patients as there's a lot

(13:21):
of warning, and there's there'san expectation that things are
going in a particular direction.
And sometimes it's time to talkto the patient about what's
going on. And but often, it's aconversation with the relatives.
And then I guess the third groupis a patient who's gone through
itu through the intensive careunit and no particular issues
and they've gone to a normalWard, and they usually stay in
hospital for about a weekrecuperating. And then once when

(13:43):
we once or twice a month in aunit of Liverpool size, there
will be somebody who who has asudden cardiac arrest on the
ward and dies. And again, thosethose are difficult to take
because the patient's survivedthe operation got through
intensive care gone to the wardis really just sort of waiting

(14:04):
to go home and and then it justseems even more of a tragedy
that they were so close. So Iguess it definitely the
circumstances of the patientpresentation and the
circumstances of the surgery andthe circumstances of of the post
operative period or impact on onhow deeply a surgeon and the

(14:25):
team because I must emphasisethat it's the team, you know,
everyone's impacted by it. Butit impacts differently. And as I
said before, I think from apatient or relatives
perspective, whatever happenedto the patient has happened and
their relative has died and thecircumstances may not be that
important to them as it is tothe surgical team. So yeah, it's

(14:46):
it's very different.

Claire (14:50):
He mentioned that you might have to go through this a
couple of times a year maybe onthe table. So you know it
follows that there must besomebody somewhere keeping a
close eye on the stats and whenpeople Die and how they die and
how often they die. So how issuccess measured in your job?
Because I'm guessing on paper,it's very different from what
you're actually making decisionsfor in real life. How does that

(15:11):
work?

Mark Field (15:11):
So I Yes, this is a difficult one, because I mean,
it's important that surgeons aremonitored in all specialties.
And so that was, we've all seenon the media that some rogue
doctors, rogue surgeons, andit's important that the patients
are kept safe from suchdeviations in activity or in
performance. And in heartsurgery, it's easier than then

(15:35):
probably any other surgicalspecialty to measure quality,
because the frequency with whichpatients die following heart
surgery means that theperformance measure for a heart
surgeon is the number ofpatients who die. So over a
three year period were monitorednationally. And it's a very
stark and that simple graph thatthey present to us, which is

(15:57):
essentially the number ofpatients which you've operated
on over that three year period,versus the number of patients
who have died. And that's quitestark, and you can't, you can't
argue with that as an endpoint.
Because other endpoints such asquality of life, you can, you
can argue with, but for acardiac surgeon, you really
can't can't argue it againstmeasuring a death, because it's

(16:18):
obviously just black and white.
And it's not something to beinterpreted. And there are some
scores that allow for risk. Soif I operate on calm, very
complex patients, those patientswill be scored according to
their age and other otherthings. And I will have have a
certain allowance for that inhow they measure my performance.

(16:40):
But if after a three year cycle,it's found that my mortality as
it as we call it, is more than acertain percentage, then I will
be challenged by the medicaldirector of my hospital, and
then I'll be challenged by, byour society who monitor
performance. And so that isdifficult because it it does

(17:05):
affect the way you behave. Andalthough as a doctor, you want
to give every patient the bestchance and, and the best option,
and you want to be consistent inthat it can be difficult,
because we're all human. And ifsomebody's measuring your
outcomes, and you're in asituation where your outcomes

(17:27):
are borderline, difficult to, toseparate that in your head, and
but you have to at the end ofthe day, but it's difficult,
because once you once you becomesort of performance managed, as
we call it, then that's it's aguess as a source of
professional embarrassment, thatyou're being performance
managed, it has an impact oneverything in your life. Because

(17:50):
you know, that is what you'vetrained to do this job for 20
odd years, you've beenpractising for, whatever, 10 or
20 years, and there is a riskthat you may lose your job and
your livelihood, and there's notmuch else you can do. Highly
trained cardiac surgeons don'treally have much else to do. But

(18:12):
that affects, you know, thatjust it clouds clouds your mind
a little bit, but you have tovery consciously think, you
know, I'm making decisions basedon what I think is right and
what I think is wrong, and whatmy opinion is. And so
performance management comeswith a package of measures, and
it comes with that you're toldthat you you may have to operate
within other surgeons forsafety, or you may have to only

(18:35):
do patients with a certain riskprofile. And there are various
other supportive sort ofwraparound things that are put
in place. So you hope that itdoesn't affect the patient
outcome. And that's keepingpatients safe. And so, I mean,
all these measures are designedto keep patients safe. And it
all came out of the Bristolchildren's inquiry that went on

(18:56):
some decades ago now whereperhaps the mortality was higher
than expected for a certainoperation. And that led on to
measuring surgical performance.
But you would hope thatmeasuring performance keep keeps
patients safe. On the otherhand, on the other side of it,
you need to be careful that itdoesn't prevent patients from
having an opportunity. And it'simportant for us as leaders that

(19:17):
if you have a surgeon that's indifficulty, and has been
performance managed, that thetemptation I guess maybe to not
offer patients high riskoperation, and those are the
patients that actually benefitmost from it. So it's for us as
an institution as as as leadersto take that away from them. Let
the more senior surgeons or thesurgeons with better outcomes

(19:39):
manage those patients. And inthe end, the patients and
relatives don't suffer fromthat. And the institution
managers that risk so it'sreally a balance. They do
measure us, but it's a balancebetween keeping patients safe
and giving patients opportunityand not letting all those things
In this cloud, your judgement inwhat you do is difficult. And

(20:02):
it's probably, I don't thinkit's like that for any other
surgical specialty because it'snot so black and white in terms
of measuring outcomes. Yeah,

Claire (20:12):
I can see how that would be difficult just by, you
know, human nature and justnormal workplaces. Or you can
see how there would be somepeople who would naturally
think, Well, I'm not going totake on any high risk cases,
because that's going to affectmy stats. And then you can see
other people who'd be like,well, I want the high risk
cases, because actually, that'swhere the interest is. For me,
that's where the opportunity is,that's where I could potentially
do something amazing. But if Ionly take on those kinds of

(20:33):
cases, then I'm risking my statsbeing bad. So yeah, I can see
that it'd be very difficult tobalance.

Mark Field (20:38):
Our last Society president was Richard Paige who
was a thoracic surgeon,actually, but he, I think he had
the the insight and theforesight to see that patients
were perhaps losing out becauseof the way we measure things.
And, and so he introduced asystem where we call it it's
called a Nightcore exclusion.
Essentially, it means that ifyou if you have a very high risk
patient who is going to diewithout an operation within a

(21:00):
couple of weeks, and not anemergency emergencies are
excluded from all thesemeasurements, which is good. But
if you have a patient that needsa third or a fourth time
operation and infection, and therisks are very high, we can go
to an MDT a multidisciplinaryteam meeting and providing the
the surgeons all agree that thisshould be excluded from the

(21:20):
statistics, then you can have anexclusion, it's a great benefit.
That means that two surgeons aremandated to scrub and operate.
So you got two senior surgeonsat the table during the case.
And that doesn't count onanyone's statistics as it were.
So it allows it we're trust toprevent all those things coming
in to stop patients havingopportunity.

Claire (21:43):
That's really good. And I think, I'm guessing, going
into something like this whereyou know, someone's gonna die
one day, you probably didn'tcome into this thinking, I'm
going to be the first cardiacsurgeon that's never going to
have a death. What happens whenyou have that first death? Do
you remember that first death?
And are you prepared in yourtraining for that?

Mark Field (22:00):
So I guess, and I haven't been to medical school
for some time, because my agemay have changed a little bit.
But when I went to medicalschool, there was no training
around how you manage a patientdying. And I think it's
obviously probably different fordifferent doctors, because of
the level of investment inpossibly, maybe a GP, say, as a

(22:24):
patient in the community, in acare home that dies, and they
may have seen once or twice overa period of 10 years that may
have a different impact to asurgeon. It's just one single
patient that you have donesomething to. And so I guess in
medical school, they neverreally taught us because I guess
medical school is GeneralTraining, certainly where I went

(22:45):
to medical school, they nevertaught us about or gave us any
tools for managing a patient whodies, or how to how to process
it, and how to how to reflectand how to be able to continue
practising after a patient dies,I guess. I mean, I know, you

(23:08):
know, over the course of mycareer, there probably have
probably had 30 patients whohave died. And I, I mean, I'm
not sure if it's a morbid thing.
But I'm sure every surgeon isthe same because every every
cardiac surgeon keeps a veryclose eye on their own data and
their own outcomes. And so Ihave a list of patients who have
died. And I, every single one ofthem, I can look at their names

(23:28):
and remember every single detailabout what happened. And and I
guess partly, you know, that'spersonally for me to reflect on
whether whether I could havedone something different whether
the decisions that were madecould have been different
whether and I guess every everydeath that happens in in I guess
in any hospital and particularlycardiac surgery gets a review

(23:51):
called on mortality review. Andso, so your case gets
scrutinised by another doctor,surgeon or an East test, and
it's rated as avoidable orunavoidable and you get various
feedbacks. And if there areparticular issues, then it's
discussed on an audit day whereall sorts of the hospital are in
a third lecture theatre and, andthere's open discussion.

(24:15):
Sometimes obviously, that can bedifficult. Sometimes you have to
take criticism, sometimes youhave to accept that you could
have done things differently.
Perhaps the outcome would havebeen different. Quite often.
It's just it's grey, really.
It's never really very rarely isit? Is it clear cut that there
has been a technical issue orthere's been something you made
a bad decision much more. It'susually much more grey,

(24:38):
thankfully. But yeah, thereisn't a lot of preparation for
it. And in terms of how it'smanaged I've seen as a junior
doctor, I've seen it managedvery well. I've seen it managed
very, very poorly. And when Isay that I mean about personally
how you how you process thatinformation. And I remember

(24:59):
particularly vividly oneconsultant surgeon who patient
had had a cardiac arrestfollowing a heart operation on
the following day. And as it iswith cardiac surgery, you know,
once if a patient has a cardiacarrest after they've had an
operation, and usually it endsin the chest been reopened to

(25:19):
make sure there's not acollection of blood around the
heart, and that can easily befixed. And, and quite often,
sometimes that can be on anormal Ward, which is quite
extreme. Sometimes it's inintensive care. And but I
remember vividly watching apatient just been reopened in a
consultant surgeon had done theoperation the day before
appearing, and did all he could,there was no obvious cause as to

(25:42):
why the patient had a cardiacarrest and what the patient did
die in intensive care. And Iremember that patient that
surgeon crying.
And I can remember, it tearsrolling down his eyes. And at
the time, I didn't reallyunderstand it and have to be

(26:04):
honest, because I was a surgicaltrainee, and you don't really
have as much insight, or youdon't have as much understanding
of the personal investment youhave when you operate on
someone. So as a little bitdismissive. I just, you know,
why would he cry? Like, youknow, why would he cry in front
of the whole team, like Iremember, but I always regretted

(26:26):
once I became a consultant, Ialways regretted that because I
personally, I've had manyoccasions where it's happened to
me. And you know, tears come toyour eyes, either, either at the
operating table, or wherever youare on the ward, or when you're
speaking to relatives, becausecan be very, very difficult,
just the rawness of the emotionspeaking to relatives, and, and

(26:49):
it's just about how you processthat. what's just happened and
how you gather your thoughts andhow you how you manage yourself,
the team, the family, and thenhow you come in the next day.
And so quite often, it's, youjust have to muddle your way
through. And I know from myobservation of younger surgeons

(27:10):
coming through the system, Idon't especially think they've
been trained in a different wayto manage these things. Because
it's just hugely, hugelypersonal. When you've seen a
patient that clinic, you'vetalked to them, you've chatted
with a family and know them,you've agreed to do an
operation, the expectation isthey're going to get through the
operation. And so it's a massiveinvestment. It's a bond between

(27:33):
two humans, I guess. And thenwhen it goes wrong, that leaves
you, it just leaves you withwith a massive sense of you
failed that patient. Andsometimes it's sometimes you
genuinely feel you have and onother occasions, it's you know,
it's just circumstance and thedisease that has just been too
extreme, and yet you haven'tbeen able to, and no, probably

(27:54):
no one, you know, no surgeonanywhere would have been able to
get that patient through and,but it's trying to process all
that information, to try andunderstand what's happened, how
it happened, you know, whetherthere was any learning or
reflection, anything, you canshare anything, and then
managing the family, but thengoing on there, and then quite

(28:16):
often, you may have an operatinglist the next day. That's
difficult. But I mean, I'mhoping something like this may
help patients and relatives andhopefully other professionals as
well, because mostly we don'ttalk about these things. And as
I've said before, I've had somehesitancy in talking about this

(28:37):
podcast, because mostly,surgeons do not talk about these
things. There are that sort ofunspoken truth, I would

Claire (28:46):
say. There seems to be this assumption, with a few
different areas of work wherewe've spoken to people who deal
with death, especially on adaily or weekly basis. Like
whether it's, you know, murderdetectives or paediatric
intensive care. Now, as we spoketo a funeral directors, there's
this assumption that you're acertain kind of person that can
deal with that kind of thing alot easier than other people.
Which is a shame because it'sgot nothing to do really, with a

(29:09):
human dealing with death anddealing with loss. It's all
about your skill sets, andyou've got skill sets and all
these different areas. But thatdoesn't mean you're any harder,
cordoned off, when it comes todealing with loss and grief and
relatives of people. And it wassimilar. When we spoke to the
funeral directors, they said,you know, people don't really
talk about it much. And they youknow, they admitted we've we've
got PTSD from some of the stuffwe've seen, it doesn't mean we

(29:30):
were any stronger at dealingwith these things. And that does
seem to be a shame, because itdoesn't impact the training that
you go through. And I thinkyou're probably right, and
assuming the training hasn't gota lot better in helping people
deal with that side of it. Howdo you deal with the degree from
the loss? It's a bit more sortof technical and education based
and this is what happens andmaybe here's some practical
steps, maybe you need todebrief, maybe you need to talk

(29:51):
to someone else. Maybe you needsome counselling, but there
isn't that kind of maybe settingpeople up for saying you know
what, you're human. You mightcry when one of your patient
dies and that's okay, you mighthad a week to reflect on it at
home, or it might impact yourpersonal life. That's okay,
you're human. And I think thatwould help a lot of people. I
think that's why this is animportant conversation because I
want other people in these sortsof professions to hear it, that

(30:13):
it's okay. If you struggle withhuman emotions connected to your
job. And I know you've mentionedthere are a lot of different
human emotions, when it comes tosurgeons and responses to stuff
and they vary a lot. What arethe sort of different ones
you've seen? And what's yourwhat's your go to? Or you're
kind of to get angry, do you getupset,

Mark Field (30:29):
so I've seen a range of things, you, and it's depends
on people's personalities. And,you know, the classic range of
responses. I mean, some peopleget very surgeons, I would say,
can get very angry, they getvery crossed, they start
shouting, they're frustrated,things are not happening. And,
and you know, they have a lifein front of them, which is

(30:51):
slipping away. And it'sunderstandable that if things if
the team around them doingthings before they're even
asked, and they get frustratedand start shouting, that's
probably the worst response.
Because what you need in thatcircumstance is you need your
team, you need you need help,you need an East US to
supportive you need aperfusionist, the person who

(31:11):
runs the heart lung machine tobe supportive. You need everyone
to be on on their A game at thatmoment. And quite often, you
need surgeons to come into yourtheatre and to and to look at
things afresh and offer advice.
And so at that moment, you needyour team around you, if you can
get the patient through and youneed to work through the

(31:33):
problems, and forget abouteverything else. It doesn't
always happen. Other people gocompletely introvert. And I
guess that's me. my niece'swould tell you, I have been a
lifelong project for myAnaesthetist, Justin, who I
think has worked on me to tryand get me to communicate during

(31:54):
those episodes, because in mymind when I get into those
situations, and it's wrong, butyou can't see like a day in
those circumstances. But in mymind, the only way to get this
patient through is somethingsurgical. And in my mind, the
only person who can do that isme. And it's wrong. But in that

(32:18):
moment, it's all going throughmy head. And it's you know, what
are my options, sometimes doingsomething can make things worse,
sometimes, sometimes you can geta patient out of the operating
room alive, that perhaps in someway harmed by that I mean, you
know, possibly a heart attackduring the operation and but you
can get the patient out aliveand you can live to fight

(32:40):
another day as it were. And ifyou have to something you
haven't done or something you interms of operation that you that
you're leaving terms of thedisease to decision, shall I
accept the situation I'm in, getthe patient out of theatre
alive, and then come back totheatre down the line to address
the issue? Or can I not get thispatient out of theatre and I

(33:01):
have to do something and butdoing something may actually you
may lose that position you're inand it may be a worse position.
And in my mind in that moment,it's you know, it's just a
decision for me. And so I justgo quiet. And I think normally,
we have music playing. Sousually asked for the music to
go off. That's when usuallypeople know something's wrong.

(33:21):
And then I stopped talkingbecause usually we're talking a
bit and then and then I thinkeveryone's hit the marks gone
quiet, something's wrong. Andthen usually just another sort
of, okay, what's the problem,and then we'll try and work
through it together. Anothersurgeon who used to play music,
I remember one of the surgeonswho trained me, he used to turn

(33:43):
up the music when bad thingswere happening. I don't know if
that was to drown out the badthoughts on. But mostly, I would
say people are in the middle. Sopeople used to get a bit
frustrated because things aren'thappening quickly. They go a bit
quiet because they are actuallythinking about what all the
problems are. But then they'reable to dispassionately and I
think those are the probably thesurgeons who handle it best.

(34:05):
They're actually very matter offact, and they go okay, I've
done this, it didn't work. I'vegot options. ABCDE what are we
going to do? And then there's adiscussion and then it happens
on from the outside on the faceof it, you may think well, that
person doesn't really seem tocare. You know, they're not
shouting, they've not gonequiet. They really seem
completely detached from thewhole situation that just got

(34:27):
some options. And you may lookat that and go Well, they didn't
really seem to care what theoutcome is here. But I think
that's misunderstanding what'sgoing on. I think those are
probably managing the situationbest then managing it
objectively. And then all theother issues like cloud your
head around the death thatsurgeon will process on another

(34:51):
day. I think so. Yeah. There'sthere's a huge range and room
for improvement on for all ofus, I think. Yeah.

Claire (34:58):
And ultimately, when someone's offered Hang on your
heart, you don't really wantthem? Well, I don't know, if
people think about this, Iwouldn't want them thinking
about, you know, the situationof oh, this is a young man with
three kids, and who am I goingto do and you know, all those
sorts of things, bringing in theactual personal circumstances of
that person, it's not going tohelp you. It's just going to
cloud things and make it moreemotional. So ultimately, you do

(35:18):
want somebody that's not reallywell, they're caring. But like
you said, it probably looks likethey're not caring, but you kind
of want you want them to be ableto compartmentalise all that for
the right time, because theremust be a lot of other things
that you're having to deal with.
And there must be some fear thatstarts to come in at this point.
And I know I've heard you talkabout how that fear helps you
focus the mind, but sometimes itcan be misconstrued as
arrogance. In your professional,I can see how that would happen.

(35:41):
Do you actually, do you findthat hard? Do you have to try
and convince people in any waythat you're not arrogant? And
that you do care at times? Or doyou just have to let that go?
What other people might thinkand just get on with your job?

Mark Field (35:52):
Yeah, I think you'd have to let it go people, I
mean, people around, you knowwho you are. And you can't hide
it. I mean, one thing about thisspecialty is you can't hide your
personality, because you're,you're quite often functioning
in extremes of a situation whereyou can't control the narrative
about who you are and what youare. And so people over a course
of many years, becauseobviously, we're, we're a close

(36:15):
knit team, and there isn't ahuge turnover of staff. And so
we you know, we all know eachother, we socialise a lot
together. And so you can't hidethat aspect of yourself and the
team around you know, generallyknow who you are, know what
support you need, they know yourskill set, and they know what
you can do what you can't do,they'll know how you're going to

(36:37):
react. And quite often the needsjust is pivotal in that because
their needs just, even thoughthe surgeon may be in denial and
go, I don't need any help, I'llsort this out, I'm fine. The
ministers will office to be ontheir phone texting a friend so
and so who's got a problem? Canyou come into theatre? And and
even though you may, you may notthink that you need help,

(36:58):
someone will appear? It'susually because someone has
texted someone say there's aproblem here. And we have a very
supportive Hospital. I'm notit's not the same in every
hospital, I would say butcertainly Liverpool, you know,
once you have a problem, two orthree surgeons will appear in
your theatre. And that's reallyimportant that there are a

(37:21):
couple of people because, as yousay, you may I often you know,
these patients well, and you'vemet the family, and it Yes, it
is hard if if the patient hasyou know, three children, and
you've met the children,sometimes I think it's difficult
to meet the children of someoneyou're gonna operate on because
it, it's nice, but it alsoaffects you. And it makes it

(37:44):
very difficult to be objectiveand to be dispassionate and to
do what you need to do. Becauseyou're right, when when you see
something going wrong in frontof you, your thoughts will
automatically go to well, hecan't die, he's got or she you
know, they've got three childrenand they've got this and they've
got that and and there's allthis history and and then that

(38:05):
feeds into clouding up all theissues and making it difficult.
Like you say the the best thingis to compartmentalise
everything, and just workthrough the problem and get the
patient out. And then speak tothe relatives along the way.
Even though we're cardiacsurgeons, we are human. And
people, I think sometimes forgetthat. And but it does affect us

(38:28):
enormously, even surgeons who itmay appear are not connected or
in some way detached from fromit, or often it's just their way
of processing the tragedy.

Claire (38:39):
What have you sort of seen when it comes to things
like coping strategies, becauseagain, speaking to different
kinds of areas of work, like thepolice, they've got quite a dark
sense of humour. That's part ofhow they cope with a lot of what
they see. For other industries.
They're quite famous for maybepeople drinking too much or
getting into other addictionsthat are very unhealthy. If
you've seen good copingstrategies in your line of work,
I feel like I want to say I wantto assume that you haven't. I

(39:01):
don't know why. I don't know ifit's because my mum was a
theatre nurse just having seenbits and bobs and heard them
talking and I don't feel likethe medical world is is
brilliant with great copingstrategies for how to deal with
what they deal with. But thatmight be a huge generalisation.
I've got wrong. No,

Mark Field (39:16):
I think you're absolutely right. I mean, I
don't think anyone has specificcoping strategies. I mean, there
there are issues around yourperformance, which we discussed,
and those are all managed and,you know, hopefully managed
well, but and then maybe if youhave a run of deaths in a short
period of time, I guess I can'tsay that I've ever seen or heard

(39:39):
about sort of surgeon, you know,taking to substance misuse or
anything like that to cope. I'veseen them become a bit withdrawn
and I've seen them becomedetached from the department.
I've seen them start to becomeaccusatory maybe perhaps a
little paranoid. You know all orhuman traits. But more acute

(40:03):
when you're in a situation whereyou, you need to keep working.
And you need to be convincedthat the reason one or two or
three patients died is notbecause of you, or anything
you've done. You need torationalise it in your mind and
come to some decision whetheryou whether you think this is
something you've done wrong, andyou need some retraining or some
support or whether you think no,this is just three things that

(40:25):
have happened in short space oftime. But I just hesitate
because I don't think I've seena surgeon go off the rails as it
were, I think there is supportthere particularly, I think in
Liverpool anyway, we have a, wehave an early warning system, it
means that we will intervene,there are various points that
the national body may interveneon your performance. In our

(40:48):
hospital, we try to trigger thatsooner so that we can, we can
correct things before it becomesa national issue. I mean, I
didn't mention it. But youroutcomes, as it were, are
published in the internet, like,you know, you can log into the
society and you can see what myoutcomes are. There's no hiding
from that. So hopefully, thingsare corrected. And Liverpool,
certainly before you get to thatpoint. So I guess when you ask

(41:11):
about coping strategies, a lotof it's very personal, a lot of
it is hidden away, you may getsome hint of it, you know, a
surgeon may say, Well, I've hada death today, I'd rather not do
the list for the for tomorrow,I'd rather not operate for the
rest of the week, or can I notdo this case, because I just
don't feel up to. And those aresubtle, subtle things that you

(41:33):
know that someone isn't copingthat well with what's going on
and said, that is asking for abit of space. But apart from
that, I don't have a good answerfor you, other than you're
right, it's probably not wellmanaged. There are no good
strategies, and it's sort ofhidden away. And people are left
in a dark room as it were tocope with whatever they need to

(41:55):
cope with, and then come backwhen they're ready.

Claire (41:59):
So you obviously deal with the losses of life and
death. But are there otherlosses that come with a job like
this, that maybe other peoplearen't aware of other kind of
secondary losses maybe or thingsthat you've faced or others have
faced around you? Absolutely.

Mark Field (42:11):
And as we talked about earlier, patients dying
are actually quite rare. They'realso traumatic when they happen.
But you know, overall, heartsurgery is quite safe, mostly
what happens, othercomplications. And that is quite
often a form of loss, becauseit's a loss of, it's a loss of
quality of life. And sometimesit can be a loss of function. So

(42:34):
one of the main issues, althoughwe operate on the heart, the
main issues are around thebrain, or around the spinal
cord, or around other organs inthe body, the lungs, the
kidneys, the bowel, the liver.
And so cardiac surgery is quiteunique in that, although we're
very focused on fixing theheart, to fix the heart, you
have to stop it mostly, notalways. But mostly, you have to

(42:57):
stop the heart. And it's theheart lung machine, that you
connect to the patient. And thatwill keep the patient alive.
While you've stopped the heart.
The consequences of that is thatyou will affect lots of the
other organs of the body. Andthat's why these patients go to
intensive care afterwards.
Mostly, it's not, sometimes it'sfull support of their heart with

(43:17):
various drugs and variousdevices. But also, it's to
support the kidneys sportdelivered about the brain,
spinal cord, all the otherorgans of the body. So quite
often we are when we talkedabout patients dying down the
line after a couple of weeks onintensive care, it's quite often
as to what we call multi organsupport, or multi organ failure.

(43:39):
And so other organs start toshut down. And other things are
required to try and supportthem. And so it's it's the
complications of, of operatingon the heart that lead to loss.
And one of the, I guess one ofthe biggest issues is of stroke,
it can be very, very hard to goand see a patient

(43:59):
postoperatively on day one,because quite often, they're
kept asleep for a few hours, andthen they're woken up and
they're taken off theventilator. And then they're
awakened. And surgeontraditionally comes around in
the morning on a ward round tosee the patient and then you go
and speak to the patient, andthey can't move one side of
their body because they've had astroke. And sometimes patients

(44:20):
with particular operations canget paraplegia and they can't
move their legs and these arepermanent things paraplegia if
it's there, it doesn't getbetter stroke can get better,
sometimes it doesn't. But youfeel personally responsible
again, and those circuits couldhave done the operation in
different ways such that theycouldn't have they wouldn't have
had a stroke and it's adevastating thing because they

(44:41):
just look at you from their bedand they can't move their their
arm or their leg and and they'relike What to do now and and
there is very little you can doapart from get them into stroke
rehabilitation and get as muchfunction back as you can. But I
think for cardiac surgeons, it'sstroke, that is the biggest

(45:01):
thing really, because it's muchmore common than death. It
really affects the quality oflife. And it affects the outcome
of the whole operation. Youknow, I remember One patient in
particular, who was in his 80s.
And he was quite fit and active.
He was loved his garden, he hada huge garden. But he had this
big aortic aneurysm, which isthe aorta is the main blood

(45:25):
vessel that comes out of theheart. And it was quite big, but
seven centimetres from memory.
Normally, we would operate whenthey were about five and a half
just to prevent them rupturing.
So he was in his 80s. And thesuggestion was that he should
have an operation to get rid ofthis aneurysm, he had no
symptoms from it, patients havethis idea, it's a ticking time
bomb, that it's going torupture. And he couldn't really

(45:45):
live with that knowledge that hehad this aneurysm in his body
that could disrupt your anytimehe decided you want to have an
operation, I think between us,we met each other a couple of
times, and I had somereservations for patients in
their 80s, the outcomes aredifficult for heart surgery. And
you have to be very clear thatyou're doing the right thing for
the right reasons in someone'sin their 80s. And essentially,

(46:06):
this is an operation to make himlive longer, or to treat some of
the issues he had when copingpsychologically coping with the
knowledge of this aneurysm, theaverage life expectancy in UK
maybe around 83. And so doing anoperation on someone at 83, to
make them live longer. Itdoesn't make a whole lot of

(46:27):
sense, unless there are goodreasons. And he just couldn't
live with this. So we took himto theatre and the operation
went perfectly well and came into see him in the morning. And
he'd had a stroke, and hecouldn't move his left side. And
you just think, Gosh, I alwaysremember that patient because he
had a good quality of life. Hewas in his garden, you know,
operation to make him livelonger. Yes, he may live longer,

(46:48):
but he's lost his quality oflife, he did make a good
recovery. Actually, in the end,he went back to driving me he
wasn't perfectly normal again.
But it is sort of one of thosepatients that affects you during
your whole career in terms ofdecision making. And whenever I
come across an octogenarian andthe proposal is that they're

(47:09):
going to have an operation don'talways think back to that
particular patient, don't youknow, really, is this the right
thing to do. And those are thesort of difficult decisions that
you have to live with. It'sdefinitely a form of loss. And
it's quite often with the typeof operations we do, which are
very large, there is a trade offsometimes between you're doing

(47:30):
an operation to make someonelive longer, particularly in the
younger age group. You know, inthe 50s, and 60s, you can do an
operation to make them livelonger for prognosis, but the
operation is so large, that theynever fully recover from it. So
they lose some of their longterm quality of life in exchange
for prognosis for living longer.
You never quite know what thattrade off is, in essence, COVID

(47:53):
we have this term new normal.
And I think that it was some ofthe operations that we do that
are so huge, that is a realthing that you, yes, we can do
this operation to get rid ofyour aneurysm that will make you
live longer, but in return,you're going to lose some of the
great quality of life that youhave. And those are very
difficult, difficultconversations.

Claire (48:15):
Yeah. And, again, do you get any preparation or
training to have conversationslike that? Because I'm guessing
there's times when you have totell people someone's died as
well, I'm guessing it depends onwhat stage they died as maybe
two is involved there. Butyou're facing a lot of very raw
grief, even if it was, you know,that people thought, well, it
might be a little bit expected,you're still facing that initial

(48:36):
response. And those sorts ofskills for those sorts of
conversations almost couldn't befurther away from the technical
surgery that you're doing on theother side. So do you get help
with how to do that?

Mark Field (48:47):
No. There's a theme here. But it's it's very, I can
tell you it is very traumatic togo and tell someone that their
relative has died is verytraumatic, some of their
reactions are so visceral, Iremember again, I just go back
to my training because Iremember a particular example of

(49:07):
where it was done really, reallypoorly. And that a patient had
died following surgery, and thesurgeon sort of appeared and in
his backpack on jeans and sortof pushing the relatives room,
the door open and sort of said,well, sorry, if I just died, and
there's nothing I could do. Andand then, you know, almost

(49:29):
immediately just left him withwith a nurse. And I remember
thinking at the time, it wasjust, I mean, probably he'd had
no training in it, or noguidance or how to do it well.
And, and it was it just alwaysstuck with me that was so bad in
terms of how you can go andspeak to relatives. In cardiac

(49:51):
surgery as a little bit uniquein that quite often you have
warning and even when a patientis going to die on the table in
the operating room thatHeartland machine will keep them
alive, and it may keep themalive while you're trying to fix
things. But deep down, you knowthat there is a problem that you
may not be able to get out of.
And quite often we know inintensive care patients are kept
alive artificially. So quiteoften, there is some warning of

(50:13):
things, but families just likesurgeons react differently,
although we only have to go andspeak to families, you know,
probably most five times a yearto give them that news, it can
be extremely dramatic. And Iguess it depends on the family
dynamics, and how close therelatives are, and all those
human things. And sometimes,it's quite sort of dislike some

(50:34):
surgeons a bit detached and, andbecause people react
differently, and they may notreact in that moment, they may
go away and react later on downthe line. But in some, you can
witness the relative crumblingin front of you. And they may be
short of shouting and screaming,and people may run out of the
room. And sometimes it can bequite aggressive as well,

(50:57):
because, you know, they maythink you're personally
responsible. And sometimes theresponses stay deep, and so
visceral that it is almostshocking to you, and you're
almost like you just don't knowwhat to do, you definitely need
a mechanism to manage thatsituation you need, you need
some sorts of tools, whichunfortunately, you learn through
experience some sort of tools asto how to how to prepare or, or

(51:19):
to have the thought to preparesomeone for that if you can, if
you have time, and in some way,in part that information. And
I've seen again, just anotherexample, I've seen a doctor,
when I was a junior watching,and the doctor went through,
spent about 15 minutes goingthrough what had happened, what

(51:41):
had happened, what had happened,and the end stopped and looked
at the relatives. And then therelatives sort of said well, as
he did. And, you know, it's likethe doctors tried to go through
the pathway tried to explain itall, but not got the key
information out at the front. Sothat's certainly one thing I've
learned is that, you know, youyou can't go in and blurt out

(52:01):
that, but you need to get tothat point very quickly. You
know, it's, it's a matter ofluck. I'm really sorry, we've
tried everything, but they'venot survived. And you need to
get that thing out reallyquickly. And you need to be very
clear about it can't leave anyambiguity there. There will be
questions, and they may havequestions immediately. But those
questions, even if you give theanswers, they're probably not

(52:23):
going to take it in. Anotherthing I've learned is to write
to them, I think it's reallyimportant that as a surgeon, you
write to the relatives in acouple of weeks, and just offer
them an open appointment to comewhenever they like at any point
in the future. And quite often,some relatives will will take
you up on that, and they'll cometo clinical to see you in

(52:44):
sometimes six months, whenthey've had time to process it
and they've got questions, somepeople will find it very
traumatic and never want to comeinto the hospital again and
can't really face it. Somepeople were happy to do it on
teams, and some people will,will come in face to face and
their, their entire family aswell. And, and sometimes that
can be a rewarding experience.

(53:08):
You can explain to them quiteoften relatives may not know how
poorly the patient was, or theymay not have understood the
risks the operation, or whatexactly it happened. Because
sometimes patients will just notreally tell their family what
the risks are and tried to hideit from them. And sometimes
those meetings are played out ina Coroner's Court. And it's

(53:30):
difficult, but there is notraining for it. You learn
through observing it being donebadly. And it's been done well,
and through learning what worksfor you. Because every every one
is very different in terms of inthat moment. It's one of those
things that we discussedearlier, you may think that the
more of it that happens, thebetter you get at it, but

(53:51):
probably the more of it thathappens, you just become more
traumatised by and you don't getbetter at it really. It's just
cumulative trauma that you needto somehow process or channel
away in a different way. I don'tthink you can ever get used to
or you don't want to become goodat it getting away. But you can
you're never desensitised to it.
Because all the time just humannature, again is that you

(54:14):
reflect on your own family. Andyou know, how would you react if
you're in that situation so, andall the investment you've had
with the patient and the family,it becomes very personal. So
it's it's really very, verydifficult, but it's definitely
something I would suggest isnever delegated to a junior
doctor, take one along with youso that they can see. Never
delegate it and you shouldalways find all nurses are

(54:37):
compassionate, but you shouldfind especially compassionate
nurse to go with you becausesurgeons are surgeons and they
can do what they can. Some aregood at it. Some are not so good
at it. Some may have more of ahuman touch than others. But one
thing that I've foundconsistently is that the nurse
that you take along quite oftenThat's correct thing to say. But

(55:00):
quite often they just have moreof a human touch, they have more
ability to relate. And thenquite often, when the news has
been given, the surgeon canleave. And usually the nurse
will stay and do all those otherthings that are important in
managing what's going

Claire (55:16):
on. They've got that bedside manner. Surgery
sometimes. Yeah, and hopefully,that's really encouraging to
people that are, you know, sortof behind you earlier in the, in
their career that are reallystruggling with doing those
first few and thinking, Oh, myword is this me and we're not
cut out for this, why can't I dothis part of the job to hear
that you still struggle withthat, and it's something you
never really get used to. Butthat's okay. Because there are

(55:38):
other people that you can putaround you to help with that. I
think that's, that's reallyimportant for people to know,
one of the questions we ask allour guests is around the
question, why? Just to find out?
Is that something that peoplebattled with? Have you ever
questioned why you got into thiskind of work? Or why you're
doing this? Or is that neverreally been something that
you've thought about?

Mark Field (55:56):
I mean, I think, to me, it's, it's clear, like,
actually, it's extremelyrewarding specialty. And as I
say, mostly, these things don'thappen in 97 98% of the time,
the outcomes are excellent. Youknow, you you meet up with a
patient at a particular point intheir life, they've suddenly got
heart disease, they thinkthey're going to die, usually,

(56:18):
they're convinced they're goingto die, and you're able to offer
them options to treatment, andthen agree with them, and then
take them, take them to theatreand fix their heart. And from a
technical point of view, that'san amazing thing to do, as we
discussed, it's an amazing thingto be allowed to take someone to
an operating room and open theirchest and fix their heart, that

(56:41):
is an amazing thing on a dailybasis. And then it's very
rewarding, because, you know,there's patients you meet them
postoperatively, and you meetthem in, in clinic, and some of
them, you, some of them quiteoften, in the type of operations
I do in aortic surgery, theyneed repeat interventions over
the course of their lifetime.
And, and you get to know them,and you get to know their

(57:01):
families. And, and so it'sextremely rewarding,
technically. And it's extremelyrewarding on a personal
perspective in, you know, therelationship you have with these
patients and how you're able tohelp them and, you know, I
think, I can't sink when I thinkyou know, what, if I hadn't done
cardiac surgery, what would Ihave done? I mean, the answer I
often give my children as Iwould have been a farmer. I

(57:24):
can't think of any other, likemedical specialty, that would
give me what I get. And if Iwasn't going to be doing this,
then I'm happily chase a fewpigs around the farm.

Claire (57:35):
And I guess what you're talking, people play so much
hope in you, they come to youwith the hope that you can make
somebody better, or you can keepthem alive, which is quite a
pressure in a lot of ways. Butthere's obviously a lot of hope
in other ways, because like Isaid, the statistics are really
good for what you do. So isthere any other ways that hope
plays a part in what you do?

Mark Field (57:57):
Well, you know, I often have this banter with my
nieces. Because I sort of have abit of an academic background, I
often say, you know, everythingI do is, is based on science and
research. And they just go offand laugh at me, because most of
it pseudo science, and it's notbased on any science at all. So,
I mean, it's not quite at thestage where we keep our fingers

(58:18):
crossed, hope for the best. Butthere is hope in all aspects of
it, I guess there is, you know,there is hope that you can from
the patient perspective thatsomething can be done for them.
And it's hoped from, from asurgeon's perspective that you
can do something from theoutcomes, as we've discussed,
can be along a broad range ofthings from success to failure.
And some of those things you cancontrol as much as you can. And

(58:42):
the more experienced you are,the more things you can control,
because you've been stoppedyourself getting into trouble
rather than trying to getyourself out of trouble. And
it's not just about delegating,or just imparting that
information. So you can say Itold them, I told them, I told
them, it's also about givingthem some hope and, and saying
to them, Look, this is asituation, it really doesn't

(59:03):
look that good. However, thereare certain things we can try
certain things we can do. We'regoing to do that and see if we
can change things around.
However, we may not be able togive them some time to think it
gives them some time to processand gives them some hope. But
yes, there is hope. You know,every day, I drive into work to
do an operation. I mean, I dostill imagine myself driving

(59:25):
home at the end of the day, andI don't know what the outcome
was going to be, you know, I, Ioften think I really, really,
really hope that I'm drivinghome reflecting on on every
single aspect of the operationand how well it went and how the
patient's done so well. Andthat's like so, so pleasing.
Sometimes you can't really sleepthat night is just focused on
replaying the operation and thenyou're and then when the patient

(59:46):
does well, you're so happy withthe outcome. Other times it's
not like that and you're drivinghome thinking what the hell just
happened. And you wake up thefollowing day going Was it a
dream Was it a nightmare? Youknow? No, it's real it happened
and having to live with, withwhat happened. And, and so when
you go to work, definitely thereis there is hope that the

(01:00:08):
outcome is going to be good fromthe surgeon and the patient and
the family. And and there's,there's hope as well, I guess in
the team, because the team,we've not talked much about the
team, but the team are reallyimportant. And they're all
obviously, humans as well. Andthey all like to work with
successful surgeons and inoperating theatres, where the

(01:00:33):
outcome is good, because whenit's not good, it's so traumatic
for everybody. There is hopefrom everyone at every point in
the pathway that things aregoing to go well, and mostly
they do go well.

Claire (01:00:46):
Okay, so our last question is, what's your Herman?
Which is what kind of whatthings would you want to give to
others to kind of help them inthese kinds of situations? And I
know, with a scientific brain,it's a bit trickier for you. So
yeah, looking back overeverything you've done, and you
know, everything you'veaccumulated, what sort of things
would you want to share withothers about what you do? So

(01:01:08):
what's your Herman?

Mark Field (01:01:10):
So I thought a lot about this, tried to understand
it and try to come up with a,with a good answer. And, and I
think it is around how we managedeath, but not around a patient.
A patient dying is a tragedy foreveryone. But one thing that
I've learned is that if youmanage that death badly, you can

(01:01:34):
affect the quality of the lifeof the entire family, for a
generation. If you manage itincorrectly, there can be so
much bitterness, and so muchresentment in the family, for
their entire lives. And it's soimportant to get that right, and
to avoid not just the patientdying, but in a way the family

(01:01:58):
dying, or the family sufferingthat loss for an entire
generation. So if I if I was togive advice to someone coming
behind me, it was yes, the deathis tragic, and and there be all
sorts of things and issues tocope with around that. But your
focus has to be on the family.
You know, certainly if it's ifit's during during an operation,
and you have an opportunity toget out when you know things are

(01:02:19):
going wrong, and go and speak tothe relatives, or if it's on the
intensive care on a ward andthen speak to voters give them
for wanting but also gives themsome hope. I think hope is
really important.

Claire (01:02:39):
I've heard it said that 'if you have nothing to be
grateful for, check your pulse'.
And I suspect this has an extraspecial meaning for those who
have survived life savingsurgery at the hands of surgeons
like Mark. So thank you to allsurgeons who are taking on the
risks and duties of dealing withhuman lives every day. I'm sure
you don't get half the thanks.
You deserve all that areprobably said behind your backs.

Chris (01:03:00):
And a big thank you to Mark for being willing to
venture into a subject thatother surgical professionals
might not know how to broach.
It's such a brilliant andinsightful conversation that we
know will help many others insimilar vocations. Know that
they're not alone in having tohandle loss and grief on a
regular basis. And of course,it's okay to not find it easy.
To hear more of our episodesinto other careers. Visit our

(01:03:20):
website,www.thesilentwhy.com/letschat.

Claire (01:03:25):
Yep, on that page, I've got a list of all the
conversations we've had withpeople who have jobs that
involve working with death andgrief on a regular basis. This
includes a Scotland Yard murderdetective who's everywhere at
the moment is even on TV, apaediatric intensive care nurse,
funeral directors, policechaplains funeral celebrant, an
end of life coach and many more.

Chris (01:03:44):
And for more on Claire and myself, visit
www.thesilentwhy.com or followus on social media
@thesilentwhypod for more aboutHerman you can go to the
www.theHermancompany.com Orfollow him on Instagram
@TheHermanCompany. He's evenbeen travelling recently.

Claire (01:03:58):
If you know someone that just needs a boost at the
moment, maybe they're goingthrough hospital treatments,
chemo exams grief loss or atough time. Why not send them a
Herman he's the perfect handmadeby me companion to help people
know they're not alone inwhatever tough situation they're
going through. If you have noidea what we're talking about
when we mentioned a Herman, justhead over to the website in the
show notes. UK shipping is free,but I can ship him anywhere in

(01:04:21):
the world for you. I know thatyou know somebody right now that
just needs a smile.

Chris (01:04:25):
We're finishing this episode with a quote from
Christiaan Barnard who is aSouth African cardiac surgeon
who performed the world's firsthuman to human heart transplant.

Claire (01:04:35):
"I realised all of a sudden that life is the joy of
living. That is what it is. Itis really a celebration of being
alive. You see, what they taughtme was that it's not what you've
lost. That's important. It'swhat you have left. That's
important, but I qualify this.
There must be a joy in living.
There must be still enough leftso there can be a celebration.

(01:04:58):
You can't celebrate nothing inThere must be something to
celebrate. So I think one mustrealise that as a doctor, if you
value life, your goal must notbe to prolong life. Your goal
must be always to providesomething for that patient that
he can celebrate. Providesomething so that life can be
the joy of living."