Dr G's Blog

There is a photograph I will treasure for the rest of my life.

It is black and white. It shows two pairs of hands - held together. It was taken in a hospice, in the final chapter of a friendship that began seventeen years ago in an operating theatre, and that became one of the most important relationships of my professional and personal life.

I have written recently about how we die - about my mother's peaceful death at home, and about the quiet dignity afforded to our beloved Betsy by a veterinary team who understood that the environment of death shapes the experience of it. This post continues that thread. But it is also something different. It is about what happens when loss arrives not at the end of a long life, but in the middle of one -  and what it means to sit beside someone who has given so much of themselves to others, and simply be present as they near the end.

We began as locum consultants together in 2007 -  he a plastic surgeon, I an anaesthetist - in Theatre 1, West Wing, John Radcliffe Hospital.

It is worth pausing on that word: locum. It is a role that carries its own particular pressures, ones that those who have done it will recognise immediately. Arriving into an established team. Finding your footing. Earning trust without the safety net of a permanent post. There is an uncertainty to it - a particular kind of professional vulnerability - that never quite makes it into job descriptions or appraisals. We both felt it. And navigating that together, from the beginning, created a bond that a more straightforward start might never have forged.

From that uncertain beginning, something remarkable grew.

The particular intimacy of a shared operating theatre is difficult to explain to those outside medicine. You work in close proximity, under pressure, with another person's life quite literally in your hands - both of you, simultaneously, responsible and accountable. Trust is not given. It is built, slowly, across hundreds of cases and thousands of hours, through the quiet competence of someone who never meaningfully lets you down.

Over the years, that trust deepened into genuine clinical partnership. We built our experience, our confidence, and our skills together - and that collaboration produced work we were both proud of. Chief among it was the development of the Enhanced Recovery After Breast Reconstruction Pathway at Oxford: a programme that improved outcomes, reduced recovery times, and reflected the very best of what close anaesthetic and surgical teamwork can achieve. It is a particular source of pride that this work has since travelled beyond Oxford, beyond the NHS, and has most recently been delivered in Malta - a small but meaningful marker of what can grow from two people simply committing to do things better.

Theatre 1 was also, over those seventeen years, a place of teaching and formation. Anaesthetic and surgical colleagues passed through - trainees, fellows - people at the beginning of their own careers - and absorbed something of what we were building together. Many of them are now consultants -  pioneers in their own specialty areas, building on foundations laid in that theatre in ways that neither of us could fully have anticipated. That quiet, distributed legacy is something I thought about a great deal as we held hands.

What began in theatre became something much more.

Over seventeen years, our professional lives wove into our personal ones in the way that only the deepest working relationships allow. Our wives became friends. Our lives  became shared.

He and his wife were a remarkable partnership: no children by choice, entirely devoted to one another, inseparable in life and in everything they loved doing together. Cycling. Skiing. City breaks that seemed to multiply with the years.  All undertaken with the same quiet enthusiasm he brought to everything outside work.

Because here is what defined him professionally, and what those of us who worked alongside him will carry forward: he understood, instinctively and completely, the importance of balance. Work hard. Be efficient. Bring the best from the people around you. Respect the theatre team. Finish on time. Go home. Live your life.

In a culture that can quietly glorify overwork and burnout, that ethos was not just admirable -  it was quietly radical. And it inspired the teams around him more than he perhaps ever knew.

He fought multiple myeloma with the same discipline and determination he brought to everything. It is a cruel disease, and he met it without self-pity and without surrender.

The NHS - at its best - -surrounded him with everything modern haematological oncology could offer: novel treatments, pioneering approaches, the full commitment of a multidisciplinary team that understood what was at stake. He was not a passive patient. He engaged with his treatment with the same informed, purposeful energy he had brought to his surgical career.

And when the fight reached its final stage, the NHS offered something equally important: compassionate hospice care. The comfort, the dignity, the unhurried presence that I have come to understand - through this year more than any other - is not the absence of medicine but its highest expression.

There is a particular poignancy, I think, in watching the healthcare system care for one of its own -  someone who has spent a career in devoted service to others, now on the receiving end of that same devotion. It is humbling. And it is, in the truest sense, what the NHS is for.

I sat beside him and held his hand.

I am not sure I have the words for what that moment contained. Seventeen years of operating theatres and shared cases and late conversations and the particular shorthand of a long friendship - all of it present, and none of it needing to be said.

We have worked together with some of the finest surgical and anaesthetic technology available. We have been part of procedures that would have been unimaginable a generation ago. We developed pathways that have reached beyond our hospital, beyond our country. We contributed, between us, to the training of colleagues who are now forging their own paths in medicine and surgery.

And yet.

All there was, in that room, was two pairs of hands. The security of that. The friendship. The trust - the same trust that had been built across seventeen years, now present in its simplest and most essential form.

I am writing this as the third in a series of reflections on loss and end of life care - a series I did not plan to write, and that this year has made necessary.

What these experiences share is something I keep returning to: that how we accompany people through the end of life - whether as professionals, as friends, or as family - matters enormously. The environment. The presence. The willingness to set aside everything that is not essential and simply be there.

We are privileged in medicine to build relationships forged not on convenience but on shared purpose  - the daily commitment to do our very best for other people's lives and families. Those relationships carry a weight and a warmth that is genuinely rare. They are one of the things that make a career in healthcare, for all its difficulty, something worth being grateful for.

He devoted his professional life to the care of others. He did it with skill, with efficiency, with balance, and with a generosity of spirit that made him a finer colleague than most people are lucky enough to encounter.

It was a privilege to sit beside him. It was a privilege to hold his hand. It was a privilege -  the right word, however painful -  to be present as someone who gave so much returned, at last, to rest.

Work hard. Be efficient. Go home. Live your life.

He did all of that. 

And more.

Recently, I’ve reflected on how that we *experience* death matters for patients and families. This perspective has sadly extended into another deeply personal space.

We recently said goodbye to our beloved bulldog, Betsy. She was 12, and remarkably well until the final few weeks. Her decline, in many ways, echoed my mum’s: a short period of deterioration after a long life well lived.

What resonated strongly was not just the loss - but again how that loss was experienced.

Betsy's end of life care was not at home but at the vets - but we were able to bring important aspects of her world with her: her bed, her blanket, and, most importantly, us.
The team Medivet & Partners Woodstock created a calm, unhurried space where she was held, comforted, and surrounded by familiarity.

There are, of course, differences. Betsy’s death was assisted - carefully and humanely - whereas my mum’s was natural.

But the environment… the peace… the presence of love ......those things were strikingly similar.

The first two images shared here were taken hours apart: one while Betsy slept peacefully at home and one at the end of her life. Without context, it is almost impossible to tell the difference.

That, in itself, says something important about how she died.

Again, moments like this reinforce something fundamental: how end of life care is delivered, and the environment in which it happens, shapes the experience just as profoundly.

My respect for veterinary professionals has deepened enormously. They carry a unique responsibility: guiding both animal and family through one of life’s hardest moments with compassion, clarity, and dignity.

Betsy was a huge part of our family.

There is real comfort in knowing her final moments were peaceful, surrounded by love - and shaped by people who understand that how they die matters too.