Trauma Surgeon’s Memoir: Hope, Horror & The NHS Frontline
The operating theatre demands a peculiar balance: a capacity for detached precision alongside profound empathy. For Shehan Hettiaratchy, a trauma surgeon at St Mary’s Hospital in London, this duality isn’t a professional requirement, but a deeply held philosophy forged through years of confronting life and death in its most raw forms. From the immediate aftermath of the 2017 Westminster attack to surgical missions in Ukraine and Gaza, Hettiaratchy’s career has been defined by bearing witness to unimaginable suffering – and a resolute belief in the enduring power of hope. His new memoir, The Careful Surgeon, offers a candid reflection on this calling, and the emotional toll it takes.
The Weight of Westminster
On March 22, 2017, Hettiaratchy was overseeing medical student exams when news broke of the terror attack near the Houses of Parliament. Within minutes, he and a colleague were en route to St Mary’s, preparing for the arrival of casualties. Three men had driven into pedestrians on Westminster Bridge before launching a stabbing attack. While the hospital team routinely handled critical injuries – Hettiaratchy describes a typical Saturday night presenting similar challenges on paper – the context was profoundly different. “There was a collective fear that we’re under attack – there are people on the streets of London trying to kill our fellow Londoners,” he recalls in an interview with The Guardian. The BBC series Hospital documented the events of that day, offering a glimpse into the controlled chaos of the emergency response.
Fifteen patients were treated at St Mary’s, including the perpetrator, Khalid Masood, who later died from police gunfire. While most of those injured survived, five others succumbed to their wounds. Hettiaratchy himself performed surgery on a man named Stephen, whose leg, skull, and chest had been damaged when struck by Masood’s car. The immediate focus, he explains, was methodical triage: “This represents patient A, patient B, patient C; what are the injuries, what needs to happen, what needs to go on?” This detachment, he believes, is crucial for sustained focus, but also carries a risk.
The Human Cost of Detachment
Hettiaratchy is a vocal advocate for addressing the emotional wellbeing of healthcare workers. He emphasizes the importance of acknowledging the psychological impact of trauma, rather than suppressing it. “If you’re able to detach from your feelings completely, you’ve lost your humanity,” he states. He worries that a complete emotional shutdown can hinder a surgeon’s ability to provide truly compassionate care. “If I’m not emotionally connecting to them, can I really understand what they need?”
This concern prompted him to initiate team meetings after the Westminster attack, facilitated by the hospital’s counselling team. Remarkably, he even invited Stephen and his wife, Cara, to share their experiences with the medical staff. The gesture was met with gratitude – a simple “thank you” that Hettiaratchy notes is often taken for granted in the demanding world of emergency medicine. This experience reinforced his commitment to fostering open communication and reflection within his teams, moving away from the “stiff upper lip” culture that historically characterized the profession.
A Career Shaped by Conflict
Hettiaratchy’s attraction to “life and death situations” dates back to his teenage years in Hampshire, where he considered a career in the military or medicine – ultimately choosing both. He served a year in the army before beginning medical school, and later deployed as an army doctor in Afghanistan. Today, he balances his role as a consultant surgeon at Imperial College Healthcare NHS Trust – where he is the trauma lead and a specialist in plastic, hand, and reconstructive surgery – with his position as the national clinical director of armed forces healthcare. His profile on the Imperial College Healthcare NHS Trust website details his extensive training and qualifications, including fellowships in microsurgery, hand and wrist surgery, and aesthetic surgery.
He acknowledges a degree of ego in his decision to operate in conflict zones, but also a deeper need to confront the realities of war. He suggests that a certain level of self-belief – perhaps even a touch of “wrongness” – is necessary to perform the act of surgery itself. “You couldn’t walk into an operating theatre and cut somebody open unless there was something a little bit wrong with you,” he observes. “Our brains are literally programmed against doing violent things and seeing violent things.”
The Surgeon’s Paradox: Compassion and Control
Hettiaratchy describes the surgeon’s role as a paradox: requiring both a degree of emotional detachment during the procedure and a profound reconnection with empathy afterward. He notes that some surgeons struggle with this transition, becoming overly focused on technical skill at the expense of human connection. He believes that medical training needs to explicitly address this emotional “switch,” equipping surgeons to navigate the complex interplay between clinical precision and compassionate care.
One particularly challenging case involved a 12-year-old girl named Helena, who suffered severe leg injuries in a banana boat accident. Amputation was considered a viable option, but Hettiaratchy opted for a complex reconstructive surgery, driven by a desire to push his own limits. But, he ultimately reframed his motivation, asking himself: “Who are you doing this operation for? Is it for you or is it for the patient?” He ultimately succeeded in saving Helena’s leg after two lengthy operations, but deliberately downplayed the risks involved when informing her parents, prioritizing their relief over his own professional accomplishment.
Looking Ahead: Preparedness and Prevention
Hettiaratchy’s experiences have underscored the importance of preparedness in the face of unforeseen crises. He believes healthcare systems must proactively plan for the consequences of major incidents, including terrorist attacks and natural disasters. “It will happen again,” he states. “That’s just the way it goes.” He also emphasizes the need to support and invest in the healthcare workforce, ensuring that nurses and doctors are adequately compensated and equipped to handle the emotional demands of their jobs. He supports recent strike action by nurses and resident doctors seeking improved pay and working conditions, arguing that attracting and retaining top talent requires a genuine commitment to their wellbeing. His research interests, as outlined on his Imperial College London profile, include outcomes after major trauma and tissue engineering for trauma reconstruction.
While acknowledging the darkness he has witnessed, Hettiaratchy remains fundamentally optimistic. He believes that “the lightness” of the job – the moments of healing and connection – “will always outshine the darkness.” This enduring hope, he suggests, is what sustains him and drives his commitment to providing compassionate care in the face of unimaginable adversity.