On 22 March 2017, trauma surgeon Shehan Hettiaratchy was running end-of-term exams for his medical students when his phone buzzed. There had been a terror attack near the Houses of Parliament. Three men had driven into pedestrians on Westminster Bridge, then started stabbing people on the street. Within minutes, Hettiaratchy was in a car with a colleague and heading to St Mary\u2019s hospital near Paddington, west London, where he is the lead surgeon. Victims injured in the attack were due to arrive.<\/p>\n
Though Hettiaratchy and his team were used to treating patients with life-threatening injuries \u2013 on paper, he says, what they were facing was no different from \u201ca busy Saturday night\u201d \u2013 this felt different. There was \u201ca collective fear that we\u2019re under attack \u2013 there are people on the streets of London trying to kill our fellow Londoners\u201d.<\/p>\n
On the day itself (documented in the BBC series Hospital<\/a>) Hettiaratchy was in charge and had to think practically and methodically: \u201cThis is patient A, patient B, patient C; what are the injuries, what needs to happen, what needs to go on?\u201d Detaching yourself is \u201cprobably why you can stay locked in\u201d, he thinks \u2013 and ultimately how you get the job done. That day, staff at St Mary\u2019s treated 15 people who had been injured in the attack, including the perpetrator, Khalid Masood, who, later died, having been shot by a police officer. While all of the other patients treated at St Mary\u2019s survived, five of Masood\u2019s other victims died.<\/p>\n double quotation markThere was a collective fear that we\u2019re under attack \u2013 there are people on the streets trying to kill our fellow Londoners’<\/p>\n But that evening, after all the patients had been seen and emergency surgery performed (Hettiaratchy himself was tasked with operating on Stephen, who had been out celebrating his birthday with his wife when he was hit by Masood\u2019s car, damaging his leg, skull and chest), the trauma surgeon felt a \u201cgut punch\u201d of emotions. Hettiaratchy is passionate about making sure healthcare workers are equipped to deal with the emotional side of the job, as well as the clinical one. The \u201cmost important thing\u201d he says to his medical students, he writes in his new memoir, The Careful Surgeon, \u201cis that they should stay horrified by what they see \u2013 they need to stay shocked\u201d.<\/p>\n If you\u2019re able to detach from your feelings completely, \u201cyou\u2019ve lost your humanity\u201d, he tells me when we meet in a part of St Mary\u2019s that was meant to be rebuilt \u201cabout 30 years ago\u201d. It may finally get done in another 30 years, he jokes. But while he clearly sees the need for improved material resources in the NHS, \u201chumanity is really the thing that we cannot afford to lose in healthcare\u201d. To disconnect from what a patient has been through and how they must be feeling would mean to become \u201cinhuman\u201d, he says, which, in addition to not being \u201cgood for me as an individual\u201d, is also bad for the patient. \u201cIf I\u2019m not emotionally connecting to them, can I really understand what they need?\u201d<\/p>\n \u2018Surgeons should stay horrified by what they see \u2013 they need to stay shocked\u2019 \u2026 Hettiaratchy at St Mary\u2019s. Photograph: Hannah Cauh\u00e9p\u00e9\/The Guardian<\/p>\n Clearly, it takes a certain kind of person to handle a job in which you are required to think compassionately and methodically in the face of horror. But Hettiaratchy has always been attracted to \u201clife and death situations\u201d, he says \u2013 as a teenager in Hampshire he narrowed his career options down to joining the military or following in his psychiatrist parents\u2019 footsteps and becoming a doctor. In the end, he did both: joining the army for a year before starting medical school and, later, taking time out from his work in London to serve as an army doctor in Afghanistan. These days, as well as his work as a consultant surgeon in London, he is the national clinical director of armed forces healthcare, and has worked with the frontline medical aid charity UK-Med on surgical missions in Ukraine and Gaza.<\/p>\n \u201cI\u2019m not sure what I was trying to prove\u201d by entering war zones, he says. \u201cBut it felt like something I needed to do for me.\u201d He says that there was a certain amount of feeding his own ego involved, but to some extent working as a surgeon requires that anyway, he thinks. \u201cYou couldn\u2019t walk into an operating theatre, take a knife in your hand and cut somebody open unless there was something a little bit wrong with you,\u201d he says. \u201cThat\u2019s a deeply unnatural act. Our brains are literally programmed against doing violent things and seeing violent things.\u201d To overcome that natural revulsion and survival instinct, \u201cyou have to back yourself \u2026 Is that self-confidence? Is that ego? It\u2019s a fine line.\u201d<\/p>\n double quotation markYou couldn\u2019t walk into an operating theatre and cut somebody open unless there was something a little bit wrong with you<\/p>\n Though the calling requires, he believes, being a bit of a sociopath, after a patient has woken up \u201cyou have to be opposite. You have to be caring, you have to be empathetic.\u201d Hettiaratchy is candid about the fact that not all surgeons are able to strike this balance. \u201cI think we get it wrong,\u201d he says. \u201cWe\u2019re not trained to come and do that switch on, switch off, that change of emotion \u2013 we don\u2019t even talk about it.\u201d Often surgeons can do the \u201cswitch off\u201d from the emotional side and perform surgery competently; \u201cbut sometimes they\u2019re not so good at doing the second part, which is switching on human emotions again\u201d. Things are getting better \u2013 you\u2019re less likely to find \u201cold style\u201d surgeons these days, he thinks, whose attitude is \u201cI\u2019m always right\u201d and who are \u201cegotistical, arrogant, unemotional\u201d. According to Hettiaratchy the need to be empathetic and honest about your own performance is acknowledged much more within the profession now, but surgeons should still \u201cproperly be critical about what we do\u201d.<\/p>\n