From Carefree to Critical: The Burn That Changed Cameron's Life

Cameron – a graphic designer in his mid-20s – had a life that was the epitome of carefree: working hard in the week, living it to the full at weekends. One Friday night, he came back to his London flat after one too many and fell asleep in his bed smoking a cigarette. I met him the next morning when he was admitted to the burns unit I was working in as a senior house officer (SHO), the most junior member of the team. He had been virtually incinerated when his mattress caught light – he didn't wake up, either because of the alcohol or carbon monoxide from the smoke that had built up in the room – and we fought for days to keep him alive.

When we first took Cameron to the theatre, I could see the whole of his lower body had been affected by the burns, and the muscles in his legs had been slowly cooked. He was young and fit but, despite all we did – cutting away the dead tissues, replacing the fluids he had lost, amputating his legs below the knee – he started fading. His mother spent most of the day and night by his bed. She would slip into our conversations snippets about her son, what he'd been like as a boy, what he hoped to do with his life. For some reason I didn't really process what she said, or connect it with the body on the ventilator in front of me. For me, Cameron was just a problem to be solved.

Ten days in, things started to go wrong. His temperature rose and he stopped producing much urine, a sign his kidneys were failing. His one final chance was if we now amputated both his legs as high above the knees as we could. The surgery took a few hours. As we wheeled him back to the ward, his mother was waiting, a haze of desperation hovering around her. In the gung-ho world of doctors and surgeons, we never discussed feelings or emotions, says Shehan Hettiaratchy. The sense was we were foot soldiers in the war with death and disease, and shouldn't have time to stop, think or feel.

The consultant plastic and reconstructive surgeon says that how vital it is to care was one thing I was never taught in medical school. As she saw the remains of her son she wept, then tried to compose herself, thanking us for doing the surgery, hoping this sacrifice would save him. At first, it seemed to work. Then, out of the blue, his pulse went up and his blood pressure dropped. His heart was failing. In resuscitation (resus) mode, we pumped his chest for 30 solid minutes. Then, the consultant said to stop. It was over. Cameron lay there as he had for the last ten days, oblivious, unchanged outwardly – but now he was dead. The silence was broken by his mother, who saw everything, and now for the first time let her grief be heard. She broke down into a series of unsuppressed sobs.

I had tried to stay disconnected from Cameron – and other patients I had treated, who were in similarly awful situations – but it was becoming an increasingly difficult task. I would dwell on those last frantic moments of trying to save him, or dream about his burnt skin. Somehow I felt caught by him, by the horror of his death and injuries. There was, however, little time then to understand my feelings. Within hours there was a new patient and Cameron and his mother were gone. Yet whenever I was where his bed had been, the dark memory of his death seemed to emerge.

Three months later, his mother returned for a visit. When I saw her, I could immediately feel all the emotions I'd been suppressing rushing to the surface. His mother asked me: 'Can I give you a hug?' I had never been hugged by a patient or their relative before. And as we did, I could feel the weight of the burden I hadn't even known I had been carrying lighten. Her thanks and warmth seemed to dispel the darkness and pain I felt about how her son had died. The moment Cameron's mother hugged me was one of the most important lessons I had in my journey to become a good surgeon: it taught me I couldn't deny my humanity. I couldn't control my emotions and it was dangerous to think I could. The flashbacks I was having, the dark thoughts – they would never vanish if I didn't deal with the events that were causing them. Because being emotionally disconnected can damage a surgeon – unless we are actually psychopaths.

But how vital it is to care was one thing I was never taught in medical school. No one ever spoke to us about caring; what it was and how you did it. Nor did they tell us how you related to your patients. In our gung-ho world we never discussed feelings or emotions. The sense was we were foot soldiers in the war with death and disease, and shouldn't have time to stop, think or feel. While caring wasn't on the curriculum when I did my surgical training, there wasn't an inch of the human body I didn't learn about: every bone, muscle, blood vessel, organ, tendon. Emotions, though, were never mentioned.

After 14 years of intense training I became a consultant surgeon in 2008 and today am the major trauma director of St Mary's Hospital, one of the busiest trauma centres in London, as well as being a consultant plastic and reconstructive surgeon at Imperial College Healthcare NHS Trust. Reconstructive surgery, skin grafts, amputations and urgent life-saving care after traumatic events are, for want of a better phrase, my bread and butter. Shehan says that in the process of gaining an increasingly detailed knowledge of the human body, the human form loses some of its mystique, slowly becoming literally flesh and blood.

Again and again, I've seen the horrors of trauma incidents like Cameron's. Often they are tragically everyday – the three-year-old who fell out of his flat window to his death; the young biker killed in a collision, the force of the impact tearing his heart off its main veins. And sometimes they make the headlines. I led the trauma team treating victims of the Grenfell Tower fire and the Westminster Bridge terrorist attack (both in 2017) and have been deployed to Afghanistan twice, having served in the British Army since my school days as both a regular and a reservist. Throughout my work, I've constantly increased my detailed knowledge of the human body. In the process, the human form loses some of its mystique, slowly becoming literally flesh and blood; its mysteries stripped away. Patients can become more anatomy than actual people.

Doctor banter – dark and callous – encourages you to move on without getting attached. When patients who went down to surgery didn't re-emerge we would say they had gone to 'level ten' – code for the mortuary; a weak medical joke as there were only nine floors in the hospital. 'Don't worry if you lose a patient,' my SHO [senior house officer] told me when I was a junior doctor. 'They're like buses. Another one will be along in a minute.' But this approach never felt right. And today I know, to be a good surgeon, I have to connect emotionally with my patients. If you care about someone you are operating on, you are less likely to make decisions for bravado, for ego – something surgeons are occasionally guilty of. Seeing your patient as a human being means you are more likely to make the correct clinical decision for them – whether or not to amputate; whether or not to try that tricky bit of microsurgery.

And so, after 30 years of being a surgeon, every time I stand in the resus room [the intensive care area in A&E] and see someone come in, I still have that pang of sorrow, that fleeting moment of wishing whatever had happened hadn't happened to that person. That small flash of humanity is all that's needed. That's not to say caring for your patients like this is an easy thing to manage as a surgeon. Shehan says the moment a patient's mother hugged me was one of the most important lessons he had in my journey to become a good surgeon. Because another thing we were never taught when training was how the physical process of surgery makes a surgeon feel – and what effect it has on their relationship with their patient. Taking a knife to someone and slicing them open is an inherently unnatural and, in most circumstances, illegal act.

Surgery, no matter how sophisticated, remains a brutal act with more in common with a butcher's skills than a concert pianist's – sawing bones, slicing skin. Because as I was trying to figure out how to care, I had also learnt to cut. And in theatre, I had to try to put aside any connection formed with my patients and try to reduce them to a simple anatomical structure. When you enter theatre, everything in your brain is programmed not to make that first incision. The skin looks perfect, untouched. You are aware that you cannot rub out an incision once it is made. It is there forever, a permanent mark and connection between you and the patient. Even now as I operate, just before I make that first cut, a shiver of self-doubt passes through me – is this the right thing to do? Part of me is screaming out not to do it, to get out, to not destroy this untouched body in front of me.

Little wonder so many surgical preparations are almost ritualistic, a way of distancing yourself from the reality of what you're about to do. Even the language is deliberately coded. Washing hands becomes 'scrubbing up', the patient cleaning is 'prepping'. Surgical coverings are placed on the patient, hiding everything except that area of flesh to be operated on. Now they are literally just a patch of skin, illuminated by bright lights. All pretence they are a person is gone. I admit I do find instantly going back into caring mode once the operation is over very difficult. It requires you to be a Jekyll and Hyde, and I'm not sure all surgeons manage it that well. The critical part is being able to do the surgery, so many surgeons never fully transition out of the semi-psychopath role, retaining a degree of disconnection from their patients. But if they don't really connect with their patients, how do they build the trust needed between surgeon and patient?

The patient is letting the surgeon loose on their body and often whatever is done cannot be reversed. The bond required is strong, stronger than in many other areas of healthcare. The patient has to believe in the surgeon, believe they can do the operation, believe they can make them better. Perhaps the patient who showed me this most is Helena, a 12-year-old girl, who had been in a terrible accident, while on holiday in Mauritius. A speedboat ran over her while in the sea, almost cutting off her right leg. The only tissue keeping her leg connected to the rest of her body was a small strand of skin. Surgeons there had managed to reconnect the blood supply to her leg. But when I saw her, there was no doubt: she had one of the worst injuries I'd ever seen. As with any accident involving youngsters, I instantly thought of my own four children. Meeting her – fragile, with long dark hair and big round glasses, which amplified her bright eyes – only intensified this.

Still, I had to raise the idea with her devastated family that I might have to amputate her leg, to prepare them for what might come. Her father instantly said it wasn't an option. I knew with such severe injuries she needed the engagement of a range of professionals and I had to pitch her as a case, poke people's egos, entice them with the complexity, engage them with the horror and pain of the situation in order to get them involved. Some responded; others didn't. Many were negative. 'She'll be better off with a clean amputation, surely?' said one surgeon. But some of the specialists hadn't seen as many of these injuries as I had and didn't know Helena and her family. There was no obvious infection. And Helena had age on her side – children have better nerve recovery than adults. I took a sense check with one of my colleagues, Jon – a steady, thoughtful surgeon. I asked Jon if we should try to save Helena's leg. 'Of course we should,' he said. 'She's young, she could do really well. Besides, it'll be fun.' Fun? In that one word he had captured another element any surgeon has to factor in when faced with complex decisions – our egos. Amputating Helena's leg would be easy, there would be no challenge to us as a surgical team. Reconstructing it, trying to get that to work – now there was a fun challenge. But was I doing this for her or for me? I kept coming back to one of my earliest thoughts: 'What would I do if this was my child?' I knew I would be hoping desperately for someone to do what I was proposing. And it meant that saving her leg was about her, not me.

There were setbacks on Helena's journey – but I eventually discharged her, aged 18, with a functioning leg. Those six hard years had melded us together; we keep in touch to this day, and treating Helena helped make me into the surgeon I am today. Today, I warn my surgical trainees they will see some of the most upsetting things they may ever encounter in their lives. They will see young people die, and endless pain and suffering. But they will also see recovery, laughter and hope. I tell them as long as they do what's right for the patient, they will finish the job with no regrets and no guilt. The most important thing I say to them is that they must keep caring. It's the only way to keep going, to keep treating people. It's the only way to be a good surgeon.