A surgical superstar

Harold Ellis doesn’t seem like someone who’s entered his ninth decade. But he has. Soon it will be 50 years since Clinical Anatomy, the standard anatomy textbook, first appeared. It’s now in its 11th edition, and still going strong. Professor Ellis has slowed down a bit: now he says he works part time—Monday to Fridays—when once he also worked weekends and evenings.

Public lecture

I first chanced across Ellis some years ago at a public lecture at the Old Operating Theatre near Guy’s Hospital, London. His talk was nigh on perfect: engaging, informative, brought alive with vivid word pictures and a peppering of anecdotes and amusing asides. When he isn’t lecturing he is based in the Hodgkin’s Building at Guy’s. You get to his office on the top floor passing en route a collection of marble busts of medicine’s good and great.

Given his passion for the history of surgery, it seems appropriate that his father was a barber. There wasn’t a doctor in the family. He was good at biology at school; the two options were medicine or teaching and his old biology teacher advised against the latter. He studied medicine in Oxford, quickly settling for surgery as it seemed to him that medical patients died whereas a proportion of the surgery cases recovered. He flirted with the idea of going into obstetrics and gynaecology and now feels he made the right decision.

Oxford days

At Oxford he strove to work for surgeons with a reputation for teaching as well as being excellent clinicians, and it seems these qualities are inextricably linked. “I tried to get onto the firms with surgeons who did good ward rounds, checked our notes, and took us into theatre.”

National service was spent in the army. He enjoyed the surgery but the services were not for him and are best summed up by a remark made to him by his colonel: “Ellis you may be a good doctor but you’re a damn poor officer.” He took this as a compliment.

Birth of the NHS

Ellis qualified in July 1948, the month the health service started. For the past nine years he has given a lecture initially called “50 years of the National Health Service; an old surgeon looks back.” There have been some remarkable changes. Diseases are different now. “I tell these young kids that in their lifetime they’re going to see diseases disappear, which they’re seeing every day. And they’re going to see other diseases, which I never dreamt about. When I started, if you saw an obese patient, you’d say ‘what’s this?’ At the end of the war, everyone was skinny. Anyhow, diseases change. Treatments change.” Things that were taken for granted now seem odd, patients with head injuries were kept in a dark room to get over the brain damage; “After a few days you’d say ‘well they must be over the concussion now,’ you’d pull the curtains back, get them to stand up, and they’d faint. You’d say ‘my God, they’re more concussed.’ Back into bed, draw the curtains. The treatment for coronary thrombosis was weeks of strict bed rest ‘to let the heart heal up.’ They would all die of deep vein thrombosis and pulmonary embolism. You’d see young people in their 20s with rheumatic fever, which you never see today. And the wards were full of patients with duodenal ulcer on milk drips.”

In the early 1960s Ellis moved to Westminster as the foundation professor for a newly opened surgical unit. He is proud of the team he was able to select, which included as senior lecturer a “boy genius” called Roy Calne who he considers our greatest living surgical scientist. Calne did the first 13 human renal transplants at Westminster, of which 12 died of every unknown (at that time) medical complication. He also brought on Norman Browse (later Sir Norman), president of the Royal College of Surgeons, and Barry Jackson, also knighted, serjeant surgeon to the Queen.

Teaching methods

For almost six decades teaching has been an important part of his life. He reckons that he was at his best when he had just taken his FRCS (fellowship of the Royal College of Surgeons) and has got progressively worse the further he has got away from being a candidate. Teaching, as far as he is concerned, is something that can’t be taught. You can pass on tips and make a good teacher brilliant but you can’t make someone teach who hasn’t got it. He was teaching postgraduates at the Royal College of Surgeons recently and was chased by an educationalist after the lecture, “I’ve heard about you,” she told him, continuing, “The way you teach goes against everything that I teach. You do the opposite.” Apparently she teaches people not to be confrontational, and that’s what he does: “I say to a girl who can’t point out biceps in the dissecting room, ‘wretched, tedious, idle, peasant girl,’ which you’re not meant to say. But I do it with a smile. Yes I shout at them, and I tell them off, I tell them that patients die because of their ignorance, for things like putting a knife through the aorta. But they’ll never forget that. Fortunately it happens on a cadaver and they’ll never do it again and I’ve saved many lives.”

Yes I shout at them, and I tell them off, I tell them that patients die because of their ignorance, for things like putting a knife through the aorta. But they’ll never forget that

Things have also changed in lecture halls. Blackboards have been replaced by whiteboards, then overhead projectors were introduced and now we have PowerPoint. He can and does use PowerPoint if there is no choice but finds it terribly restrictive, preferring the plasticity he gets from his trusted slides. He is scathing about people who stand in front of an audience and read notes, suggesting better use would be made if handouts were passed around and the speaker took questions afterwards. But he admires technical advances that allow clips of film to illustrate a talk but concludes that nothing can beat blackboard and chalk, especially, as in his case, when you can do so without referring to notes.

Publications

Ellis wrote his first papers during 1953 and 1954 while working on his master of surgery thesis. He managed to get three papers from it before writing an historical account of fractures of the leg. Later he favoured writing papers using a dictaphone but now he hasn’t a secretary he’s learnt to type. So far he has written 25 textbooks and number 26 is coming out next year. His first book came out at the time his first child was born in 1960 while he was a senior surgical registrar. In four years time, the golden jubilee edition is printed “I’ve had to change it over the years,” he tells me, “You wouldn’t think anatomy changes, but the clinical anatomy aspects change. If you look at the first edition, there was lots about spread of tuberculosis along the intercostal bundle, and where cold abscesses appear, because that’s what the kids saw. That’s all gone now and is replaced by where you put laparoscopic equipment into the abdomen, avoiding major structures.”

He has seen enormous changes since he started: “One thing I’ve learnt in a long career is there’s no going back. I’ve never in 59 years of the NHS seen people saying ‘we made a mistake; let’s go back to what we did six years ago, 10 years ago, 15, 20 years ago.’ We were wrong. The change that we brought in was wrong. When we had regions and areas and districts, they abolished the area. And then there were just areas and districts and they said that was wrong, but they never said let’s bring the areas back or anything like that.”

He has something to say about the move to bring back matron. “The matron that I knew will never be the matron that comes back in. The ward sisters that I knew, you’re never again going to have a sister who’s running everything, who will live in the hospital; who will not marry (because if they marry they can’t live in the sisters’ quarters) who’s going to be on duty day and night; who if there’s a sick patient will stay up all night. I’d be called down to change a drip, sister would still be there. ‘Oh sister you still here?’ and, ‘Oh well George was very ill, I didn’t think I could leave him.’ Now you can’t bring that back, things change. So we’re never going to say bring back the 120 hour week.” He talked about a time when he arrived at 3 am in his pyjamas to see a coal miner who’d just been brought out of the pit squashed, and the man asked, “Are you the night shift?” I said, “No, I’m the day shift.”

New ways of working

“We’ve got to work out new ways of training people,” he tells me. Today’s surgeons don’t get the hands on experience they once had. For example, he removed 200 appendixes while still a resident surgical officer. But far from being gloomy he is encouraged, knowledgeable, and enthusiastic about patient simulators. But developments like these have come too late; while in surgical practice he and his peers worked crazy hours because as he says, “That is what you did then.” Touchingly he adds that he couldn’t have managed without his wife, who brought up their children and managed the home. Since retiring from surgery and becoming an anatomist, reading Dickens, Hardy, and Trollope has replaced keeping on top of medical journals.

Passing thoughts

Before I left I asked him about the future and as ever he was refreshingly candid. “Well I’m 81 so I have to say it’s downhill all the way from now. I’ve been blessed with good health and I’m compos mentis. I know exactly what I’m going to be looking like in a few years time. I’m not going to donate my body to anatomy, I regret to say. I don’t want my students to say ‘silly old so and so, look at him. That little shrunken walnut was his brain.’ I’m not going to let anyone laugh at me. I’m enjoying life, I love the teaching. I’ve always enjoyed life, there hasn’t been a time when I’ve been miserable. I’ll keep going as long as I can. But I do enjoy the work and the teaching. Once I can’t cope with the students and the postgraduates—that’s the time to pack it in.”

This article was first published in BMJ Careers (2007;336:197-9; doi: 10.1136/bmj.39390.630567.7D).

       

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