In safe hands
Some doctors say a delicate pair of hands is half the secret of being a good surgeon. But the head of the University of Hong Kong's liver transplant team, Fan Sheung-tat, does not accept that theory.
'I don't find anything special about my hands,' said the veteran surgeon as he tucked them out of sight during an interview at the Queen Mary Hospital.
It is now a year since Professor Fan, dubbed the 'father of liver transplants', sent ripples through the medical community when he cited long hours and a heavy administrative workload for his decision to resign.
But 12 months on, Professor Fan, 55, appeared at ease as he talked about his subsequent commitment to stay on in the demanding field, after patients, colleagues and senior health leaders lobbied him to reverse his decision. He also outlined his vision for the future and spoke of how he combined fatherhood and family life with his duties as one of the city's leading surgeons.
When he was asked to list the characteristics of a good surgeon, Professor Fan said there were two key elements: a good attitude towards patients and a clear mind that was ready to handle any 'surprises' that might arise inside the operating theatre.
'Doctors' attitude to their patients matters the most. You have to understand patients' feelings, what will be the best for them. You can't treat them just as another paper file.'
Professor Fan agreed with the assessment of the former dean of medicine at the Chinese University, Sydney Chung Sheung-chee, who once said a good surgeon had to act like a swimming duck: looking calm on the surface while paddling furiously below.
'A surgeon cannot panic no matter what happens inside the operating theatre. Your mind has to be decisive, your eyes sharp, and your hands quick,' Professor Fan said.
He cited the example of operations where patients suffered non-stop bleeding, with one patient needing more than 60 bags of blood during surgery, six to seven times the blood circulating in a human body. 'Internal bleeding is a major risk during an operation. If you panic, you can never save the patient.'
Professor Fan also said a good surgeon knew how to recover from the guilt and sorrow of failing to save a human life. He said the key was to recognise that although doctors often were regarded by patients as a saviour, they had their limitations.
'Yes, I have also had to see a patient die on the operating table. We all make mistakes, doctors are not perfect. Of course, I feel very sad about it but, more importantly, I learn from the mistakes. Doctors always face great pressure when a patient dies; to face their teammates and the patient's family. It is hard.'
Over the past two decades, Professor Fan has been credited with developing the University of Hong Kong's liver transplant team to the stage where it is recognised as one of the best in the world. 'I like working in the public sector where I can treat patients from all walks of life,' he said. 'We have a very good team here. In the private sector, most of the time you have to work on your own and the resources you can mobilise are limited.'
As the only liver transplant team in Hong Kong, they work closely with other clinicians at the Queen Mary Hospital, including intensive care experts, anaesthetists and nurses.
Professor Fan said one of the team's greatest achievements was the development, in 1996, of a procedure known as adult-to-adult right lobe live donor liver transplantation. Conventionally, liver grafts from a living donor are taken from the left lobe, which is too small for most adult recipients. The breakthrough eased the problems of organ shortage in adult patients and graft-size limitation in live donor liver transplants. Since then, the method has saved more than 220 patients, with an in-hospital death rate of 5 per cent.
Transplant centres abroad have adopted the technique and surgeons from around the world now visit the Queen Mary to learn these skills.
Following the ground-breaking procedure, Professor Fan was elected as a member of the Chinese Academy of Engineering. In 2005, the team was also awarded the first-class State Science and Technology Awards by the National Office of Science and Technology Awards in Beijing.
But to many people's surprise, the surgeon announced his resignation in October last year, citing an overwhelming administrative burden that left him little time for patients. The team was then carrying out about 80 liver transplants a year.
His colleague and teammate Lo Chung-mau has also complained about the heavy workload placed on surgeons. He said many surgeons had to work 90 to 100 hours a week, carrying out three to four transplants a week.
When Professor Fan's resignation came to light, e-mail, letters and cards flooded into his office. Senior health sector officials also lobbied him to stay on.
'I was very moved,' he said. 'I decided to stay on after knowing so many people think I am needed here. I told myself to push aside my personal feelings and continue to serve people who need me. After that, our team has been given more donations and resources. Now more people share my work and I have more time for patients.'
Professor Fan said liver transplants were among the most stressful tasks for surgeons, and he quipped that it explained why he looked older than his actual age. 'We have to stand next to the operating table for more than 10 hours, with only short breaks. I always have to keep my energy levels up with Coca-Cola and coffee.'
During his precious leisure time, Professor Fan said he resorted to the most basic of pastimes. 'Hiking is the best way to relax. It is a good exercise and you can enjoy good views.'
He has joined Oxfam's gruelling fund-raising Trailwalker race five times. 'The race is good training,' he said. 'It trains your strength and resilience.'
Looking back on his professional career, Professor Fan said his path to becoming a surgeon was indirect. Graduating from the University of Hong Kong medical school in 1976, surgery was not his first choice. In 1977, after a one-year internship, he applied for a physician's post at the Queen Elizabeth Hospital's department of internal medicine. His application, reasons for which he's unaware, was rejected.
But the rejection proved a blessing in disguise. Professor Fan joined the then government surgical unit at the Queen Mary Hospital where he worked for about 10 years.
'At that time, the resources allocated to the governmental surgical unit were very little. But the development of the university surgical unit was very good. With this thought in mind, he approached the university's professor of surgery, John Wong, in 1986 and the following year joined the university's surgical department.
Professor Fan paid tribute to the courage of his patients as one of the reasons for his team's success and worldwide recognition. 'Our patients are willing to take a risk to try new technology,' he said. 'They trust us, they forgive our mistakes.'
Among his patients, he remembered a teenage girl who he described as brave and loving. The girl's mother at the time was in critical condition and urgently needed a liver transplant.
The girl returned from Canada to Hong Kong but was legally barred from donating her liver to save her mother because she was then only 17 years old. 'Our law only allows people aged over 18 to donate organs. The girl waited for her 18th birthday so she could donate part of her liver to save her mother,' he said.
In a dramatic twist, a day before her birthday - the day the transplant was scheduled for - her mother received a liver from a deceased patient from another hospital. 'It was a happy ending, we were all happy about it,' Professor Fan said.
Despite an obvious devotion to his work, Professor Fan steers his two daughters, both in their 20s, away from medicine. His elder daughter is taking a non-medical doctorate degree at Stanford in the US and his younger daughter is a lawyer trainee in Hong Kong. His wife is a private doctor.
'Being a doctor is too stressful, you have patients on your mind every minute. You never have enough time for your own family. As a father, I don't want my daughters to be doctors, I don't want them to be so stressed.'
He plans a 'complete retirement' at the age of 60, to pursue life outside medicine.
'I don't know how to write a book or do special things. In fact, I don't know much about other things apart from being a doctor,' Professor Fan said.