by the Hospital Senses Collective
In Fragile Lives, Stephen Westaby’s memoir of his 35-year career as a heart surgeon, he reflects on an occasion from his early medical student days. In 1966 he snuck into a surgical viewing gallery at Charing Cross Hospital to watch an operation on a young woman’s heart: ‘It was an old operating theatre viewing gallery respectfully separated by glass from the drama on the operating table no more than ten feet below…I sat clutching the hand rail, just me and Grim Reaper, and peered through glass hazy with condensation … I moved to find the best view, settling for a position directly above the surgeon’s head.'[1]
Nicknamed ‘the ether dome’, Westaby describes a now outmoded viewing gallery, illuminating the distinct viewpoint, emotive power, and detailed experience of this observing position. His image of the space cannot shake off the theatrical essence of the operating theatre. Before turning on the intercom to hear what is being said below, the scene is like a silent movie. It is drama which plays out before him, each player with a distinct role. Later, actions are in ‘slow motion’, as if in a film. Once the patient is lost, and each of the clinical roles fulfilled, each of the players, the senior surgeon, the anaesthetist, and the perfusionist, separately exit stage right. As an audience member Westaby’s view remains static: once the staff are out of frame he can no longer see them, but his view, looking down upon the patient’s body, persists.
Viewing galleries have long been components in modern surgical spaces in varying forms from amphitheatres to balconies, to tiered seating. The viewing gallery provides exactly what it suggests: views. It provides opportunities to observe surgeries, and for the operation to be narrated by the surgeon in order to give insight into the embodied practice of surgery. Westaby’s position, high above, looking down, offers an unnatural viewpoint, but one engrained in medical teaching: this viewing gallery is old and already barely used. Westaby alludes to the legacy of the surgical viewing space, often treated as or appearing as ‘a gladiatorial amphitheatre’, previously allowing anyone ‘to gaze down on a spectacle of life and death.’[2]
The separating glass screen is a newer addition, an emblem of evolved surgical teaching, demonstrations, and patient safety. The screen that separates the observer from the observed is critical, ‘respectfully’ separating the surgery from the observation of the would-be surgeons. Smell cannot penetrate. Sound only does once the intercom is switched on, and the drama given its soundtrack. Sight remains the critical sense; while it cannot take in every aspect of the surgery, cannot always see what the surgeon, anaesthetist, or nurses are doing, the position of the birds-eye view gives a broad idea of the overall room.
Throughout Westaby’s text, we see the different processes in surgery. The patient has already been brought in and the surgery started by the time Westaby arrives, but we then see the surgery, and the consequences of the patient’s death: one nurse remains behind and is joined by another; medical students come in to clean the body; cleaners come in to clean the room; porters come to take the body to the mortuary. Westaby observes the private rituals of death. He observes a life cycle of the operating room, himself hidden away, unnoticed and unobserved, while he can take in the changing scene before him.
During the surgery, blood had spurted leaving an unseen spot on the back of the lighting fixture: only Westaby from his unique position sees it. Once the theatre is cleaned, and all traces of the patient and their death removed, only Westaby knows about the residual spot of blood on the back of the light. This spot becomes a memory to Westaby which he takes with him throughout his career.
References
- S. Westaby, Fragile Lives: A Heart Surgeon’s Stories of Life and Death on the Operating Table, (Harper Collins, 2017), pp. 5-6
- Westaby, Fragile Lives, p. 11.
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