06-03-2025
‘I'm a surgeon – but my son being an NHS patient changed me'
'Nothing thrills me more than the human body,' writes Gabriel Weston in her new book. Alive is a gripping and lyrical tour of the major organs – heart, liver, bone, lungs, brain, kidneys, womb, skin, gut, genitals – which began, she says, with a desire to explore anatomy through 'a more human prism'.
Well, that was the general idea. A sort of love letter to the body. But what she didn't realise was how personal the project would become. 'The original plan was that it would be a very blithe sort of book,' she tells me now, 'a sort of enthusiastic feminist romp through the organs, and then as life continued to derail the writing, it all got merged.'
Alive has taken 10 years to complete because her work was constantly interrupted: during this time, Weston, a doctor herself, also became a patient, and a patient's parent – through her own medical problems, and her then teenage son's terrifying diagnosis. And on top of all that, aged 43, she had given birth to twins.
We meet in January, in the house in south London that Weston shares with her husband Ander (Alexander) Cohen, a physician, and their now 11-year-old twins Emily and Miranda. Their son Sam, 21, is at university in Toulouse; their daughter Hetty, 18, is working in Honduras for a year.
Weston is composed and articulate, but avidly curious. 'I am not the same person I was when I started writing this book and my body isn't the same body,' she writes in Alive. 'I was still a young mother with a spring in my step, a doctor enthralled by a future treating other people's diseases. A decade later, I'm menopausal, haunted by memories of my child's illness, and with an ongoing heart condition.'
'My heart not working properly is just part of my identity'
She did not grow up wanting to be a doctor. The daughter of a barrister and a former British ambassador to Nato, she studied English at the University of Edinburgh. In her final year, she was at a friend's house one evening when his father, a surgeon, told them stories of hospital life which enthralled her. A year later, while working for a publisher, she heard about a course being pioneered by a professor who thought that maybe the students with 'perfect science scores weren't the only ones who could make good doctors'.
She went to medical school in London, and the years of study that followed were, she says, some of the happiest of her life. Her progress was fast and she became a member of the Royal College of Surgeons only three years after qualifying as a doctor. But writing was also in her blood, and the memoir that came out of it, Direct Red (2009), was an exceptional, award-winning book; among the first – and I think the best – of a spate of 'medical memoirs'. A novel, Dirty Work, followed in 2013, and she became a presenter on the BBC Two series Trust Me, I'm a Doctor while continuing her work as a surgeon.
What distinguished Direct Red was not only the brilliant writing but the tone: self-deprecating but not annoyingly so, and poetic. Being a junior doctor was tough but Weston saw beauty everywhere. In Direct Red she writes lovingly about the drama of the operating theatre, and in Alive she returns to that, with an almost comical touch: 'Even now, I sometimes think that meeting a person in normal circumstances, with their skin intact, is a moribund business compared to how it could be if only they were supine on the slab, laid open to display the very best of themselves in the rainbow heaven of the operating theatre, fat a garish custard-yellow, arterial red hitting my retina like a mistake, veins blue under sinuous cover, the ice-white of bone in the deeps.'
She describes the zone that all surgeons must enter – 'the mechanical obliterating the personal' – but reading it, I couldn't help wondering at how liberating it would feel to be that objective, and that un-squeamish. Each chapter includes some hands-on experience – so for the 'Genitals' section, she watches a woman who was assigned male at birth having a vaginoplasty; for 'Bone', she watches a leg amputation; and for 'Liver', she attends a meeting at which it is discussed who will be eligible for transplant, and who – effectively – gets written off.
The book is filled with fascinating facts. Who knew that the liver of a large dog, transplanted into a small dog, will shrink to fit the abdomen of the recipient? Or that every year, 10 per cent of your bone is replaced? Or that the sex of painted turtles is decided by the temperature of the nest at a key point of egg incubation, with cold conditions making males? Or that labiaplasty surgery – 'in which the adult vulva is nipped and tucked to look more like a child's' – is one of the fastest-growing cosmetic procedures in the world?
Weston trained as an ENT (ear, nose and throat) specialist, but spends much of her operating time doing skin-cancer surgery. Despite the fact that her book contains sentences such as, 'The ear is great fun to operate on, but bleeds like buggery,' there is a lot of tenderness too – for example in the chapter 'Skin', when she describes returning home and going into the room of her baby twins, burying her nose in their soft skin and inhaling their perfect scent, 'testing out how much sniffing, snuffling, stroking, squeezing and kissing I can pull off without waking them up'.
And then there is the flip side. Weston's first inkling that there was anything wrong with her came when she and her then boyfriend, both first-year medical students, were trying out their stethoscopes by listening to each other's hearts and he detected a murmur. (It was, she says, also an early moment of realisation that the relationship wasn't going to last.) At 24 she was diagnosed with mitral valve disease, which progresses with age, and she is awaiting the time when one of her echocardiogram scans indicates that she's crossed the threshold into being a 'severe' case – making her eligible for surgery.
The book is scattered with emails she has sent to the NHS – mostly chasing appointments, like the rest of us. It is both reassuring and slightly jarring to discover that even a surgeon has similar problems with bureaucracy. Weston was keen to get the surgery done and over with; the surgeons were reluctant and wanted to wait.
'When I originally found out about it, it was not an issue as it was completely quiescent, I just had to have follow-up checks every three or four years. It was only while I was writing this book that things suddenly got much more serious, and I was worried. It looked as if surgery was going to happen quite soon, and when it became clear that it wasn't, I tried as hard as I possibly could to expedite it, including finding this amazing surgeon and driving to Liverpool to try and persuade him.'
She was acutely aware of the irony while she was working on the book that, 'Despite being a doctor, I can't get the system to do what I want it to do.' The surgeon, Paul Modi, said she wasn't ready yet.
'When I told my husband that Modi was not prepared to operate, he said, 'You're very persuasive, but I would have been alarmed if you had convinced them to do that operation just by being persuasive.' And there was something weirdly calming about that. He knows that I have a tendency to over-intervene in a situation.'
She has come to terms with the circumstances. She suffers from occasional palpitations, which come in phases, or not at all for months. 'The fact that my left atrium is 'severely dilated' and that I'm aware more than half of my blood is going back in the wrong direction through the left side of my heart, combined with the waiting indefinitely for the day when I will eventually have surgery, used to worry me more than it does now,' she says drily. 'My heart not working properly is just part of my identity. So weirdly it's sort of OK.'
Writing in Alive, Weston admits that however devoted she is to science, 'the only way I can breathe life into it is by making it personal'. And the personal event that dominates the book is what happened to her son Sam, which she describes as the defining experience of her life.
She and Cohen (a consultant at Guy's and St Thomas' and a world expert in blood clots) were circumspect about their children's ailments when they were little, as doctors often are. When I interviewed Weston 12 years ago, she explained, 'In our family, if the children tell me they've got a funny pain, I don't even look up from my book. If they are bleeding I might look up, but they have to be bleeding quite a lot.'
But when it was serious, Weston could tell. Sam, then aged 14, started getting headaches, and 'I just knew, because he's not a whinger at all. He's one of those kids who's never ill and is eternally optimistic about everything and doesn't complain.'
Weston was away researching the book at the time. When she got home, Sam had had headaches for a week and her husband had taken him to the doctor, who had said it was probably a viral infection. But after another week, and having established that he was experiencing a specific kind of headache that got worse when he stood up, Weston phoned the GP.
'I remember her laughing and saying, 'Well what do you think's wrong with him – a brain tumour?'
'And I said, 'Yes – that's exactly what I'm worried about.''
Despite his reluctance, Weston took Sam to A&E. 'Within an hour I was phoning my husband and saying, 'You need to come in.''
They had given Sam a CT scan and found something. 'Then I had that awful experience of seeing the doctor walking into the cubicle with a face that I just knew meant terrible news.' The doctor explained that Sam had a four-centimetre mass in his brain that they thought was cancer. Weston remembers the doctor saying that 'nearly all things are fixable', even as she herself was thinking, 'This doesn't sound very fixable to me.'
Sam was admitted to Great Ormond Street. 'And I remember this man there,' says Weston, 'who had a really, really sick-looking kid who obviously had something very serious – lots of tubes sticking out of him – and the father came up to me and asked if I wanted to talk, and I looked at this poor man who was being so kind to me, and his child, and thought, 'I don't want to be in your club. I don't want to be near you and I don't want to talk to you…''
Unwittingly, Weston was swept up in the momentum of what was happening, and all the confused feelings that came with it – including the totally illogical sense that by taking action, she had inadvertently set things in motion. 'And that it would end with someone telling me something I don't want to hear. I was almost cursing myself for being too on the case.'
'Every doctor or nurse in the NHS is doing double the workload in half the time'
It wasn't cancer. It was established that Sam was suffering from a cavernoma, a cluster of abnormal blood vessels (occurring in one in 600 people in the UK) which in rare cases (one in 400,000 each year) can cause symptoms including bleeding. In order to decrease the swelling in his brain and make the inevitable surgery much safer, he was treated with steroids and sent home.
'It was between Christmas and New Year,' says Weston, and one night 'he started vomiting. And it was the only time of my life where I had a proper panic attack. I literally couldn't get out of bed; I was just shaking and totally unable to manage my own body.'
They took him to A&E at Chelsea and Westminster Hospital, which kept him overnight and called Great Ormond Street, but again he was sent home. It made Weston very nervous. 'He could only lie on one side because turning him on to the other side made everything so much worse, and I remember him quietly saying, 'I feel like my body isn't working any more.'' Somehow Weston got hold of the consultant at Great Ormond Street and they readmitted him. 'On 2 January they took one look at him and he was in theatre that morning.'
Does she feel that because she was a doctor, she was taken more seriously than if she had been seen simply as a panicky mother? 'It's hard to know – there were a couple of occasions where I agitated in a way that I think made a difference; whether it made a difference in a life or death way, I can't know, but I definitely feel that the fact that I was a doctor gave me confidence.
'It's a fine line, isn't it? I've been in the situation a couple of times since, as a doctor, where I've been advocating for family members, and I also know – as a doctor – how irritating it can be when someone does that; you have to be careful to gently make your presence felt but kind of keep your mouth shut a bit as well.'
Simultaneously, she is acutely aware of how lucky it was that she did take action. She is overwhelmed with sympathy for Merope Mills, whose daughter Martha died following failures in treating her sepsis a few years after Sam's illness, and whose campaigning for the right to a second opinion has resulted in Martha's Rule, which provides for just that. 'If the NHS wasn't so under-resourced, if hospitals weren't so strapped, these things wouldn't happen so frequently, and I think it's remarkable that Merope has managed to put in place an actual policy to try and protect people from what happened to her. Every doctor or nurse in the NHS is doing double the workload they should be doing in half the time.'
Sam is fine now. He has a big scar down the back of his head – 'I wouldn't say it's something he wears with pride, but he's definitely not hiding it.'
The experience has defined Weston's life. 'With a happy ending. When I revisit that time, I revisit it with all the truth of not having known where it was going to go. And when I was writing about it, I was really conscious of the fact that when you tell someone about a devastating thing, but they already know that the ending is going to be OK, you can't possibly convey just how scary it was at the time.
'And given how many stories there are when the ending is not OK, you have to be really careful not to be prurient in how much you're using emotion. Sometimes I've had to justify why I don't write in a more explicitly emotional way. Part of it is a stylistic thing, but part of it was that it just doesn't feel right to me – to squeeze emotion out of stories when you had the good fortune to come out the other end of it well.
'Obviously there's different styles of writing but I think I've always had – and still have – a bit of a feminist sense that it's not my job to be emotionally soft and explicit because I'm a woman. Sometimes I think we accept a level of holding back in male writing that perhaps we're not so keen to see in female writing.'
Writing Alive gave Weston a lot of access to sophisticated hospital procedures – a liver transplant, gender reassignment – but even as a doctor, that access was difficult to arrange. What she saw gave her incredible insight into the NHS. 'You hear about all the dreadful – and true – stories of people's experiences with the NHS, and then you walk into somewhere like the liver unit at King's hospital, and it's hard to imagine anywhere in the world where people would be treated better.'
She is cautiously hopeful about the future of the health service; though she is critical of some attitudes. 'For all our technical advances, there is no opportunity in the UK for doctors to think creatively any more,' she says. 'As I keep saying in the book, we're not selected for a questioning mindset, and original thinking is not encouraged at all.'
But there has been progress, and she was also reassured when the assisted dying bill passed its second reading in the House of Commons. 'Even though I wouldn't need it to [be legalised] to persuade me, I am relieved that the bill has been passed. Even as a 54-year-old, I will live my life feeling happier and safer knowing that it is there; that if necessary, it would be possible to take control of my death, with my family around me, and not to have to absent myself to do it. I understand the arguments against it, but in my heart I can't properly inhabit why someone would feel that way.'
Her experience with Sam has made her a different kind of doctor, she says. 'My doctoring changed from that point onwards. For example, patients started telling me stuff – when I was operating on them under local anaesthetic, say. I felt like I had a mark on me that wasn't there before. I mean as a woman, once you hit your 50s people start telling you s—t all the time anyway, because you have a kind of benign, ruined look about you that invites that, but I think that before Sam's illness, I was a fortunate person to whom nothing awful had happened, and my ability to understand other people was limited by that. Since then, I feel like I have a range that I didn't have before, to do with having been through something really painful. I wouldn't say I'm softer, but I find patients much easier to approach and care for.'
Despite being on the path of the benign and ruined, Weston is perfectly happy with life, and stoic about the future. 'I'm getting better at living,' she says, 'not thinking I have to achieve something to feel alive. I think middle age is a very underrated season.'
