AN ANESTHETIST’S REPORT. On an old air force pilot, a Liverpool Football Club hat, and the dangerous business of getting to know your patients.

I met a remarkable old man today. He was ninety-four years old, and I was about to give him what might be the last anaesthetic of his life.

A retired RAF pilot. He’d flown missions involving nuclear weapons, and subsequently worked in major incident investigation, including the infamous Hillsborough disaster during which tragedy 96 Liverpool FC fans had died.

A lifetime of extraordinary experiences, most of which I could only begin to imagine.

As his anaesthetist, I discovered our shared allegiance to Liverpool Football Club. This might not sound remarkable until you remember that this was happening in Western Australia, some fifteen thousand kilometres from Anfield.

Two strangers, meeting by chance on the opposite side of the world, discovering they supported the same football club. He even had the same Liverpool FC hat as mine in his bag.

And this, as it turned out, was going to be a problem.

He had come to us with an abdominal aortic aneurysm, a dangerous swelling of the body’s main artery. Except this wasn’t simply an aneurysm.

It had already ruptured locally, the bleeding temporarily contained by the surrounding tissues and clot. We were attempting an emergency repair in a man whose heart, kidneys and cardiovascular system had already endured rather more than their fair share of life.

The estimated chance of passing to the other side dying on the operating table was one in four.

And yet here he was. Ninety-four, still engaging, still talking, still very much himself. He reminded me very much of my own father: softly spoken, quietly charismatic, and carrying a formidable collection of medical problems that seemed entirely at odds with how well he was still functioning.

One of the curious privileges of anaesthesia is that we get to meet people at extraordinary moments in their lives. Sometimes the encounters are brief and transactional. Sometimes, almost without meaning to, you get to know somebody.

And today I made the mistake of getting to know somebody.

The ward interaction was all too brief. We talked about his flying, his career, his own doctor son, his football. Somewhere along the way, he stopped being a high-risk emergency vascular case and became an old fellow I desperately wanted to get through the day.

And then I made an even bigger mistake.

Down in theatre, as he charmed everybody, I asked him if he liked the music I was playing. He didn’t. It was Taylor Swift. I told him not to worry; I had something I knew he’d like for when he drifted off.

You’ll Never Walk Alone

And as we prepared to put him to sleep, I played You’ll Never Walk Alone. For anyone unfamiliar with Liverpool Football Club, this isn’t simply a football song. It is something closer to a collective expression of loyalty, grief, hope and belonging.

It carries an extraordinary emotional weight, particularly for supporters who have lived through the club’s history.

For a man who had been involved in investigating Hillsborough, I can only imagine how many layers of meaning it might have held.

I hope I never forget the look of delight that spread across his face as he slowly recognized the song. Then he broke down.

And then so did the theatre team.

And, for a moment, I came perilously close myself. Not quite, obviously. I’m still a double-hard bastard. But close.

There was something almost unbearable about the juxtaposition. This extraordinary old man, who had spent a lifetime doing extraordinary things, lying in front of us at perhaps the most vulnerable moment of his life.

He knew the odds were against him

His own mortality was no abstraction. We had discussed it. We all knew the odds. And now we were playing him a song about never having to face the darkness alone. It was beautiful. And absolutely bloody awful.

As his eyes closed, perhaps for the final time, the song came to its glorious conclusion, and I allowed myself a sigh of relief.

The emotional charge of the room could dissipate. Time to compartmentalise our feelings and get the job done. But the playlist, randomly selected, decided we hadn’t suffered enough.

Straight into Let It Be by the Beatles.

Nobody had even begun to recover. To get their acts together. To compose themselves.

Then, while I was still managing one of the most physiologically demanding inductions of my career, Somewhere Over the Rainbow came floating through the theatre.

Not just any rendition. The impossibly tender Hawaiian version, with the ukulele.

For God’s sake.

At this point I was occupied keeping a very fragile ninety-four-year-old alive. My hands, my attention and my thoughts were all spoken for. I couldn’t simply wander over and change the music.

The entire operating theatre appeared to be trapped in an increasingly elaborate emotional ambush.

Eventually I was able to reach my phone.

Gorillaz. On Melancholy Hill.

Not exactly the emotional reset I’d been hoping for, but I was desperate. I’d simply hit the first playlist that wasn’t the one currently trying to destroy us. Mercifully, it worked.

The spell was broken

The room returned to something resembling its normal state. We could all get on with the rather serious business of repairing an aorta.

The life-saving operation had gone well. In fact, remarkably well, considering what we had been anticipating. The old man had tolerated it beautifully.

And when my surgical colleague, Mahmoud, finally walked into theatre, I was able to offer the reassurance that seemed most appropriate.

‘Right. I didn’t kill him. Now it’s your turn not to kill him.’

Which, in our particular corner of medicine, is practically a declaration of affection.

I’ve thought quite a bit about what happened in the hours since. Anaesthetists are trained to be calm, technically proficient and emotionally composed.

We’re a little like pilots ourselves. There are good reasons for this. When the situation becomes critical, somebody needs to remain capable of making decisions.

But composure isn’t the same as detachment.

I could have conducted the entire encounter differently. A polite introduction. A careful assessment. A clear explanation of the risks. A technically competent anaesthetic.

A SEA VENEER OF LIVERPOOL Michael Walsh. A fascinating, illustrated and story-filled insight into the maritime city, its old pubs, and the personalities of the past. Click the picture to access.

All entirely appropriate.

But I would never have known about the RAF, the nuclear weapons flights, the investigations, the Liverpool Football Club hat. I would never have seen the person behind the formidable list of diagnoses.

And I wouldn’t have understood what that song meant to him.

There is a temptation, especially in high-risk medicine, to protect ourselves by maintaining a certain distance. We see suffering, uncertainty and death often enough that emotional detachment can begin to feel like another piece of protective equipment.

Sometimes it is. Sometimes it has to be.

But I don’t think the answer is to stop allowing patients to matter to us.

THE LEAVING OF LIVERPOOL: Ex-Liverpool seaman Michael Walsh Bestseller. A first-hand account of the British ships, seafarers, adventures and misadventures (1955 – 1975). Click the picture to find out more.

I suspect that old man knew perfectly well what was at stake. I also suspect that, for a brief moment before losing consciousness, he felt surrounded by people who cared about him as a person rather than simply as a surgical problem.

If I were ninety-four, facing odds like his, I think I’d want that. I don’t know whether I’ll ever forget the sight of him listening to that song.

And I rather hope I don’t

Because amid all the machinery, the monitors, the drugs, the numbers and the extraordinary technical business of keeping somebody alive, there remains something wonderfully simple about what we do.

A human being places his life in the hands of other human beings. Sometimes, if we’re fortunate, we remember just how extraordinary that is. You’ll never walk alone. Today, at least, he didn’t.

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