I’m a heart surgeon. The NHS is failing because it was designed for a world that no longer exists

Wells has been based at the Royal Papworth Hospital in Cambridge for 40 years. His repetition of da Vinci’s dissections and the observations he made formed the basis of his book, The Heart of Leonardo (Springer), written with the support of the Royal Library staff at Windsor Castle, where the original drawings are housed, and for which King Charles III wrote the foreword.

Here, in his own words, Wells talks about matters of the heart.

I originally wanted to be an artist, not a doctor

I grew up in a tiny Shropshire village, my father was a butcher (hence my familiarity with the ox heart, the subject of Leonardo’s studies in that organ) and my mother developed multiple sclerosis in middle life, making home life difficult for the family. My parents worked incredibly hard to send me and my two sisters to boarding school. I somewhat let them down by being more interested in music, art and sport than academia.

I scraped through O-levels, then flunked my A-levels the first time around. When it came to leaving school in 1967, I told my mother I wanted to be an artist. “That won’t pay very well,” she said. I said I’d be an architect instead, then. But as we were talking, Christiaan Barnard came on television having just performed the world’s first successful heart transplant. “Ok, I’ll do that,” I said rather flippantly to my mother, to which she agreed.

I eventually successfully re-sat my exams to earn a place at medical school in London, where I helped Sir Terence English with the UK’s first successful heart transplant in 1979, even getting to know Professor Barnard a little, eventually.

The human heart bewitched me

Standing in the gallery watching open-heart surgery for the first time was spellbinding. Heart surgery combines anatomy, physiology and surgery; it’s unique. It’s the only organ in the body that never stops moving; if it’s not working at the end of surgery, the patient dies. Surgeons have to be like conductors, coordinating the team of professionals, perfusionists, nurses and anaesthetists, without whom the procedure would simply not be possible.

Surgeons need to have a creative streak

Despite not pursuing art as a career, the artistic impulse never left me. Surgery, especially heart surgery, rewards the same things: observation, hand-eye coordination, imagination and a respect for form. After every operation I draw the patient’s heart in a leather-bound sketchbook. I’ve performed around 16,000 operations in total, with over 10,000 being heart surgery, so there are many notebooks stored in my loft.

It only takes me about 10 minutes, and it matters enormously. Seeing the picture instantly takes me right back into that moment in time; I know what worked, what didn’t and what I might have done differently. If you want to keep improving, reflection is critical. Every operation should teach you something new. At 75, I still find the work absorbing. The human heart holds all the secrets.

I learned more about the human heart from Leonardo da Vinci than at medical school

Surgeons should understand where their craft comes from because history deepens understanding; without that, medicine becomes shallow and technical. I despair of students today, they seem to have so little curiosity. You can’t learn everything from text books. I began studying Leonardo da Vinci’s anatomical drawings over 40 years ago and his intricate, centuries-old medical sketches changed my life – along with my patients’ lives – by showing me how the heart really worked.

My life’s work has been the mitral valve, the most complex valve in the heart. For decades the default response was simply to replace it, and this was often wrong. The valve is not just a flap; it is an integrated apparatus of “leaflets” which act as one-way doors to regulate blood flow, moving beautifully like leaves do, flowing with the pressure of the body, along with chords, papillary muscles and ventricles. If you understand the problem properly and take time to analyse it, you can usually repair it.

When I open the heart, I sit down. You’d sit down to write or draw, why should you always stand to operate? I call it the “golden five minutes”. I look. I think. I work out exactly what is wrong and solve each problem in turn. Repair preserves life far better than replacement, especially in young patients.

The NHS is badly struggling, I’m sorry but it’s true

Training in my day was brutal by today’s standards. I worked relentlessly – house jobs, registrar posts, casualty shifts – often on call every night for months. I loved it. By the time I became a consultant, I had spent close to a decade immersed in surgery. That depth no longer exists. While we still have wonderful trainers, training has been shortened, so we now have doctors finishing with far less experience, and some of them can’t even handle tools.

From a surgeon’s point of view (and not my hospital’s), the NHS is failing, not through a lack of goodwill but because it was designed for a world that no longer exists. When it was created, people died younger, treatments were few, and training could be simpler because medicine itself was simpler.

Today I operate on conditions that were untreatable even a generation ago, yet we fund and organise the system as if nothing has changed. We have shortened training to fill rota gaps, producing doctors who are asked to take responsibility before they have had time to acquire judgement. Surgery is the one discipline where judgement cannot be hurried.

The solution is obvious but politically uncomfortable. The NHS must be properly funded through a mixed model: general taxation supplemented by compulsory insurance for those in work, with children, the unemployed and the chronically ill protected. It’s time to accept that modern medicine costs real money, and training excellence cannot be delivered on the cheap.

Medical knowledge needs to be shared to help the masses

Alongside my NHS work, I’ve conducted medical missions to many countries where rheumatic heart disease remains devastatingly common. In many parts of sub-Saharan Africa, valve replacement is effectively a death sentence because reliable anticoagulation and follow-ups aren’t available.

From 2010 I became involved with the charity Chain of Hope. In Ethiopia – unlike here, where we take valve repair for granted – hundreds of children are left with little or no access to cardiac care. In Addis Ababa I didn’t just operate, I’ve helped train local teams to understand that mitral repair, when anatomically possible, yields a life far closer to normal than replacement.

It makes my own heart sing when I see that children I operated on over a decade ago are still alive with their own valves working normally.

It is possible to die of a broken heart, I’ve seen it happen

The heart is not just a pump, it has its own nervous system, its own intelligence. I have seen people die of grief, it’s surprisingly common that when one half of a long-married couple goes, the person left quietly slips away soon after. Hearts can fail when the will to live disappears. The interaction between emotion and physiology is still poorly understood, yet certainly real.

You can survive with half a brain, a fraction of a liver or kidney. You cannot survive without a heart. If there is one thing I’ve learned about hearts and about life, it is this: look carefully, think deeply, and never rush what matters most.

I may know all about the heart from a medical perspective, but I’m no expert in romantic matters. I am with a lovely woman now, but I’m sad to say that, like so many of my colleagues from those previous times, I’ve had failed marriages, but have been endowed with three wonderful children and five grandchildren for which I will always be grateful.

Some people think surgeons feel as though we are gods at times, but most of us know that we’re only human, albeit with a huge responsibility in our hands every day.

[Source: Daily Telegraph]