A Time to Heal
This week I came across Hugh McLeave’s biography of Professor Ian Aird entitled ‘A Time to Heal’. In it Aird is described as having been ‘a brilliant surgeon, an inspired teacher and one of the great medical personalities of his generation’.
He was also, if I have my family tree correct, my grandfather's cousin.
Born in 1905 in Edinburgh he attended George Watson’s College where school certificates record he never achieved anything less than ‘Excellent’ and where contemporaries described him as one who ‘could not help himself, being a perfectionist’. He subsequent studied medicine at Edinburgh University and embarked on a career which, in time, saw him rise to become Professor of Surgery at the Hammersmith Postgraduate Medical School. Here he became best known for separating Siamese twins, most notably the Nigerian pair of Boko and Tomu. Dying in 1962, five years before I was born, meant I never met him but photographs of him are strangely familiar as, in appearance, he bore a striking similarity to my Uncle John.
Few, despite his pioneering work, remember him today and I have only once in my own career come across anybody for whom his name meant anything. My first house job was in Bristol, working as part of a urological firm in Southmead Hospital. The consultant under whom I worked, Mr Roger Feneley, had himself studied from Aird’s Textbook of Surgery, and he took some delight in imagining he was nurturing ‘the young Aird’ to become a fine surgeon in his own right. Disappointingly, I suspect, for Mr Feneley, I was in no way cut out for surgery and happily chose instead an equally satisfying career as a GP.
That textbook of surgery was not the last thing that Ian Aird wrote. His final words were found in a notebook alongside a Bible opened at Ecclesiastes 3 where he appeared to have been reading these words: ‘To everything there is a season, and a time to every purpose under the heaven: a time to be born and a time to die’. This is what, in a ‘bold and unequivocal hand’, he had written:
‘To the Hammersmith Coroner: I have taken a fairly substantial dose of barbiturates. I have never taken a drug before in my life. I have passed my apogee. My skill is going and I am in deep despair. I find myself in unmitigated gloom. Although I am a sincere and practising Christian, I cannot continue. I have burnt myself out. There is too much to do. I cannot write my book again. My department has produced the electronic control of patients in operating theatres, done the first intra-cardiac operations, transplanted the first kidney homografts in Britain, shown the connection between blood groups and disease - and there has been no distinction given to us...Ian Aird’
McLeave, who knew Aird well, interpreted that final comment, not as an embittered comment at the lack of personal recognition, such was not his nature, but rather as a reflection of the struggles he’d long had in attracting funding for his work and the active discouragement he’d experienced from within the medical profession.
The frustration that he was not achieving all that he could, together with his own excessively high standards that fuelled that frustration, culminated in producing the emotional distress with which he no longer felt able to cope. The conclusion McLeave drew was that ‘Had [Aird] taken a holiday, sought medical advice or resigned himself to living at a slower tempo, he might have lived - but he demanded nothing less than perfection in himself’.
Though I never knew Professor Aird, I recognise, both inside and outside of medicine, that same perfectionism that demands of individuals more than they are able to give and renders them both guilt ridden and unhappy. As expectations increase, both from within and without, what Atul Gawande describes as our ‘inevitable fallibility’ leaves us imagining we are moral failures simply because of our inherent ordinariness. We, and those with whom we live alongside, need to be kinder to one another, acknowledge our humanness, and stop insisting that we are more than we could ever become. There are many reasons that drive individuals to take their own life, and none but those who follow this drastic course can fully understand those reasons, even indeed if they themselves can ever understand them - but amongst those reasons lie unhelpful and unrealistic demands and expectations. Hannah Arendt had it right when she said ‘In order to go on living one must try to escape the death involved in perfectionism’.
In life, Ian Aird was fond of quoting Shakespeare’s words spoken by Cardinal Wolsey in Henry VIII:
And, when I am forgotten, as I shall be,
And sleep in dull cold marble, where no mention
Of me more must be made of, say I taught thee.
A fitting memorial for my long forgotten relative would be that he did indeed teach, and that we learnt, that perfectionism, and the demand for it, kills, just as it surely, at least partly, killed him.
Written by Dr Pete Aird General Practitioner.
This blog was originally posted on Resilent GP a closed facebook forum that aims to support GPs 8/6/19