Heart Man

Good morning, thank you for coming. OK, let's go please. Papworth, and

a major heart operation is underway. For the patient the outcome is

crucial. It really will make the difference between life and death.

We are now going to stop the heart so we can open it up and have a

look inside and this guy's circulation depends on what is

going on down there. This is what the Cambridgeshire Hospital does.

Every year thousands of people' lives are saved or transformed by

open-heart surgery and transplants. You will see the heart has no

output. Lungs have stopped and we are going to do the operation.

today is more than just another extraordinary day at an

extraordinary hospital. After a career spanning 40 years this is

the last time one of its most accomplished surgeons will ever

perform an operation. His name is John Wallwork and he's probably

done more to put Papworth's name on the map than almost any other

surgeon in its history. Over the past year we've been given

exclusive access to the life of a man affectionately known at the

hospital as 'God'. Heart transplantation has always

fascinated John Wallwork. To think about what the heart does, it beats

something like 30-40 million times a year that's for one year.Then

you've got to work that out for how many over your lifetime and to be

able to replace that was pretty exciting. And back in the 1970s for

a young ambitious doctor wanting to specialise in cardiac surgery, the

place to be was Stanford in California - at that time the

world's leading transplant hospital. The world's first heart/lung

transplant took place in Stanford with Bruce Reitz and I was the

chief resident at the time. So basically the team was him, me and

obviously all the other people around. It was a very exciting time.

I set up the first donor for that operation and looked after the

patients afterwards. At that time the UK was lagging behind - but not

far. In 1979 Keith Castle became the first person in Britain to have

a successful heart transplant. The operation was carried out by Sir

Terence English at Papworth. And now he wanted to build a world-

class team. As someone who had spent a year carrying out

transplants in the United States, he was a good choice. The at my

interview I was asked what my experience of heart transplantation

was. I said my first experience was better than your national

experience. Three years later, Brenda Barber became the first

person in Europe to successfully undergo a heart and lung transplant,

carried out at Papworth Hospital. remember it very well. We had to

bring the donor down from the Midlands and do the operation here.

Two operating rooms and spends a fair amount of the evening and into

the night doing it. There was so many things we did not know. We

have no way of properly measuring drug levels. We did not know about

the rejection of the lung. Celia was one of the nurses who took part

in a ground-breaking operation. When you work in cardiothoracic,

anything to do with the heart and lung, his major anyway. But to take

out a false set of lungs and a heart, the patient dependent on the

machine, was ground-breaking. we did not have any back-ups if

things did not work. It was stressful doing kidneys and livers,

because it just goes pink. There is always an excitement when the heart

of beats and the circulation has taken over and they come off bypass.

Following her transplant, Brendan Barber was able to return to an

active life. I was the first one at Papworth Hospital to be done and in

Britain. I wasn't scared. I only had a fifty-fifty chance and they

knew I was dying. I did not have anything to lose.

She lived 11 years following the transplant, and most of those

extremely well. She saw her daughter grow up. It is a great

pleasure. I think I realised personally when the patient went

home we were part of something special and it wasn't A1 we help

change the quality of life. Harold is one of those whose lives have

been transformed following the first transplant. Born with a

condition that left toe with a hole in the heart and damaged lungs, she

was expected to die young. Young was up to seven. They just kept

moving the goalposts. But the outpost was 30. How are you feeling

today? I am all right. Or we will put the nose pegs on and start with

normal breathing. Take a big breath in and then blow out as hard and as

fast as you can. Like all of its patients, she comes back to

Papworth hospital for regular check-ups. Low as fast as you can.

Keep it going. Carol had co- operation in 1987, three years

after Brendan Barber. I can remember him saying, we would like

to offer you, if we do the operation we would hope to of the

you four healthy years. That sounded great. I will have one of

them. We will do that again. Brenda Barber, the first person, she was

in having tests. And I can remember saying, I don't know who that is,

assuming it was a member of the staff. And they said, she has had

one! It was brilliant. You could ask a real person that was walking

around who had had a transplant are, how they were. She was normal. It

was great! I went through a silly season post transplant. Having

never being allowed out to play or to any sport. I did horse riding,

Badminton, circuit training, I learnt to swim. There was almost

nothing I didn't have a go at. A hospital have invited me back and

we met Princess Diana and I chatted to her for quite a long time. I

felt sorry for her. I think it was meant to be the other way around,

but she was quite shy. All of your tests are done. We have the same

results as last time and your lung function is above 100%. When you

start something you are interested in getting people to survive a year.

And all of those milestones. Then most people survived by five years.

The lungs are particularly difficult for a transplant because

they are prone to infection. All the other organs are neatly inside,

the lungs are a challenge. 24 years after her operation, Carol is

another longer surviving double transplant patient. I work on the

basis that I am alive today, I was a live yesterday, and I will let

you know about tomorrow when it happens. When I saw you were

getting breathless... After more than 3,000 operations, John is

talking things through with his last patient, Colin who needs open-

heart surgery. How have you been since I saw you? It has got

progressively worse. Transplants might make the headlines, but

Papworth hospital carries Alps routine operations such as valve

replacements, more than any other hospital in the country. Around

2000 a year. When your valve is very narrow, you get breathless

quickly. You haven't had symptoms for a while because your heart has

been trying to push blood through a tiny hole. We will fix that for you

tomorrow. We said we will replace your bath, there are lots of things

we can do to hearts that Lee Cook not do. We repair some of them, if

we don't do this you will be in trouble. We can do things to the

heart to make it work better without needing a transplant. And

there will be more efficient mechanical devices.

We will give you an anaesthetic if you are and nice person! I hope so.

In 1986, 35-year-old Davina Thompson was so ill she needed a

new heart, lungs and liver. A triple transplant had never been

attempted anywhere in the world, but John was convinced he could do

it. I think progress in medicine and surgery has to have people who

will pioneer it. You cannot just sit on your backside and wait for

other people to make developments. You have to do it in a responsible

way. We had a patient whose lungs had been destroyed because of liver

disease. People with cystic fibrosis are usually young people.

But they are very ill because of their illness. I suppose you have

to argue, because we were stretching the boundaries of

transplantation, we have the patience and we think we can do

this. It meant two surgical teams working side-by-side. John leading

a heart and lung transplant, while another surgeon transplanted the

liver. We worked out how to do this. The first time it we did it, which

we did not do the second time, we put them in separately. They

connect at the bottom end. So the second time we put them in

connected together to save one junction. It was how many people

were in just for that one person. You see those people working as a

team, and we did work as a team. It was very special. By the time

Davina Thomson left hospital, the press was gathering. The operation

had taken nearly eight hours and involved a team of around 20 beagle.

John had attempted something that had never succeeded before and it

had paid off. It is like being reborn again. His I cannot describe

how much difference it has made to me. One of the most exciting sites

in surgery, what you don't see is looking at an empty chest. A person

who is alive with no heart and lungs. And then the next day that

person can talk to you. It is an interesting experience. When you

get an empty chest and no liver, it is a very big and empty person. It

is quite interesting site. I remember being on the Tube after

doing the heart, lung and liver transplant. And I looked round the

Tube and said to myself, I have seen something you never have. It

is in my Guinness Book of Records. Of all the publications I have come

of the one my children look at is the Guinness Book of Records.

Guinness Book of Records a lot, Papworth Hospital was on the map as

a walled leading cent of the transplantation. For the next few

decades, his feet would hardly touch the ground. When it first

started a lot of us were on call all of the time. It was exciting. I

don't think anybody moaned about it. If anybody did, if the kitchen is

too hot and then you leave. There was a time when we were doing about

100 transplants a year. You would be automatically wide awake. When

the kids started getting phone calls, I ended up getting two lines.

You don't know when it is going to happen, Christmas Eve, New Year's

Day or 6:00pm a night on your white's birthday. So we deal with

it. I have called the ambulance service and they are mobilising a

crew to come and pick you up. its peak in the 80s and 90s, up to

400 Heart, Lung and combined heart, lung transplants took place in the

UK each year. Improved car design and road safety has seen the number

of available donor organs for. In the last year there have been fewer

than 100 transplants in Britain. Both carried out at Papworth will

stop transplantation is a rare thing. Though never be enough donor

organs to go around with people with heart failure and lung failure

who need them. We have a very scarce resource and we need to use

it as wisely as possible. She gets a hard because she is the right

blood group and the right size. Do you transplants somebody who is

actually dying with a very low risk of surviving? Body transplant into

someone who is stable but you know it is going to get worse? It is a

difficult area how you choose. It is a mods form of medical therapy,

in order for someone to live, somebody has to die. We sometimes

forget when people say they are calling for an organ to come

forward, they are saying, we want someone else to die. Combined a

number of transplant years, his 29. John is being reunited with two of

his former transplant patients, Sandy Law and Peter Harte, the

longest surviving heart transplant patient in Britain. You were very

ill. I can remember the first thing when I woke up, I have warm feet

for the first time ever. I could feel my toes. It was incredible.

went for 15 years with no trouble at all after the transplant. What

has it meant the you the 29 years to have a heart transplant? It was

the end of the road for made. was either that or nothing. I had

been told I wouldn't survive until Christmas. It was fantastic fining

out it wouldn't take half-an-hour to take a five-minute trip to the

bus. I could do it in five minutes, I could run with the dogs, I could

go shopping, it was incredible. It It made every difference. My

children have all grown up, I've got grand children, great

grandchildren. I'd have missed all them. Six years ago, Sandy's heart

began to fail. She became one of the very few people and the world

to receive a second replacement heart. She and Peter have strong

views about organ donation. And so glad I have never been in the

position of being denied a transplant, because I know there

are a lot of people who have died waiting for an organ. It should be

compulsory unless you decide not to donate beforehand. Thousands are

dying every year, young people. It is not right. The transplant

community of divided on this, because whichever way you look at

it, even with presumed consent, people are not going to go round

saying that they have the right to take the organ without discussion.

I do not mind the system, as long as the public except that for most

of them, it is a gift and for most of the patients who are sick, it is

a gift that they need. John retires from operating today, but what goes

through the mind of a surgeon as he prepares to undertake open heart

surgery? I am always very interested in watching Formula One

drivers. I would have thought that they should be sitting there for

hours in their cars, but then suddenly they are in the zone. The

same happens with surgery. As soon as you're in the operating room, it

starts and you're completely focused. One of the things we learn

in surgery is how to deal with patients without hurting yourself.

It is similar to the way that people are taught when they go into

areas of deprivation and starvation, the thing you have to remember is

not to give away your emotions. You can have empathy and sympathise and

sometimes you feel hurt. Sometimes you feel hurt for them and

sometimes for yourself. Especially if you think you could have done

things better. But his is important to learn how to have compassion,

but not lose your own emotions, because you can get seriously burnt.

If you get too involved emotionally, you can make bad decisions. There

is a time to leave, there is always that business would people hang on

for too long or they believe they are indispensable. I learned early

on that time not indispensable. That means you have to make sure

that you live as healthily as you can. By stepping down, I allowed

that service to get a younger person in, someone who could grow.

I so of patience yesterday, and he has got a tight valve. We're going

to take it out and put a new one in. We will do that by stopping his

heart on the heart and lung machine. My assistants have opened the chest

and put the pipes in. We do two operations in each room every day.

These gloves never fit. My fingers are too short. It has been like

that for 30 years. Even if he is not in the operation

theatre, he knows what is going on. We have never cottoned on to that -

- how he does it. If something is going wrong, he appears in the

doorway. He has a A6 sense of what is going on. He is fast, but

accurate. He is amazing. Of course, he likes to tell us that he makes

very good pastry. He has very cold hands, which you probably need on

an operating theatre. That is the end of the operation. We're nearly

there, folks. You can see the heart beating again, which is nice.

That's all, folks. Thank you. Goodbye. That is my final day.

Coffee. Enjoy it. Come back in to see it. By Emily coming back in one

it is my operation. Thank you, darling. -- I am only coming back

in when it is my operation. It was difficult to get the new valve in

but we expected that. His heart is working OK and he is off the bypass.

It looks good. I have been thinking about finishing for a while. It is

not as though I have been dragged out of the theatre screaming. I

have known it was going to be happening, so why do not feel any

concern about that. Roger, is this guy asleep? I hope that the system

will continue to work on. Hopefully, we will learn something so that

when I have a heart operation, they will do it properly. He made the

cake? Wow. As John prepares to leave, his legacy continues. -- who

made the cake. Artificial heart by a knowledge -- technology was

pioneers here. Today, artificial hearts are smaller and keep people

alive while they wait for donors. You operations mean that damaged

organs that would have once required transplantation can now be

saved. -- transplantation. But it is not enough. The people die every

day waiting for an organ transplant. John feels that the use of animal

organs is the best way forward. You would get an organ that was

already working, you know what it can do. We got to the stage where

we could transplant other animals with pig organs. And we did that

successfully. At the same time as running the transplant service,

John teamed up with David White, to set up a biotech company to try and

push forward the frontiers of science. It was controversial but

John was convinced it could save more of his patients. I regret we

did not get xenotransplantation through. I think there became a

stage were there was nothing I could do against -- various powers

around, other than the unbelievably brave -- other than be unbelievably

brave and do something inappropriate. In a different era,

we could have got that opportunity but we did not for a variety of it

-- a variety of reasons. I regret that I lost control of the Science

Of Zeno transplantation. To mark an extraordinary career. --

xenotransplantation. Scientists have come to Cambridge to pay

tribute to John's work during his time here. Among best scientists,

Terence English, who operate alongside John during that first

transplant. There is a lot of energy there, he is not constrained

by accepted rules. He is very stimulating to work with.

legacy has extended beyond national boundaries because he has trained

people from all over Europe and other countries, particularly from

Australia. He has single-handedly been responsible for the legacy of

heart and lung transplantation, through training and experience.

John's last-ever patient,: Deadman is a transformed man. -- Colin. He

is able to return to his passion. The changes are unbelievable. I can

walk quite a distance and keep up with most people without getting

out of breath. As time goes on, that will get better. It is already

been down to the Professor. Isn't it clever but I remember this?

may have stopped operating but now he has a new goal. He is working on

a project with Cambridge University to help build a �40 million

research institute which will see Papworth's world-class reputation

continue into the future. We cannot just sit there and say we did this

in the past so therefore we are good, we have to look to the future.

How old is that think? This machine is 12 months old. There has to be a

dichotomy between laps science and medical science. The mantra has

been bench to bed side. I think we can do that better when we are

within the same physical environment. We have our research

institute and scientists and the collisions, and then mix of people

between in the same place, so that they can be with each other. Who

knows what they're going to find to do and what clever ways they will

be able to treat people with heart failure. Who knows whether somebody

will manage to get rid of heart failure and lung failure. A a a or

pie have left the place with the ability to wonder. I hope by leave

it with the ability to contemplate new things and to be brave. -- I