Elaine Griffiths is the only female heart surgeon in the country. There are 119 male heart surgeons. Why is this?

Elaine Griffiths, now 37, laughs. 'Cardiac surgery is a bit like a gold standard in medicine. It's the top notch; a high-earning speciality with a lot of political clout. People who do hearts can earn a lot of money, especially in private practice, and so the men try and keep it for themselves. Plus, it is a more life-and-death area of surgery than anything except perhaps the brain. It's got the glamour, and there's a certain amount of power associated with that.'

Although the balance between the sexes at the stage of entry to medical school now tips roughly 45:55 in favour of women, barely 4 per cent of surgeons are female. Attitudes elsewhere are less sexist: in India, surgery is a favoured option for women. 'It is specifically a white Caucasian problem,' says Ms Griffiths.

She is one of a team of surgeons at the spanking new pounds 6m cardio- thoracic centre at Broadgreen Hospital in Liverpool, a modern building on an old hospital site. The unit is a centre of excellence serving Merseyside, Cheshire and beyond, an area of some 2.5 million people.

Elaine Griffiths takes a mischievous pleasure in confounding the expectations of patients and their families when she first meets them to explain the procedures. They often ask, 'When do we get to see the surgeon?' They don't expect a woman, and they certainly don't expect a young, glamorous woman. 'They think a woman surgeon must be an old battleaxe.'

So she sweeps along the unit's corridors in short skirts and high heels, fair hair flying. Some patients fall in love with her. Others send poems - 'quite good poems' - and one proposed marriage. 'You have already handled my heart,' he wrote, 'now take the rest of me.'

Elaine Griffiths believes she was born to be a heart surgeon. 'I don't come from a medical family - my father was a civil servant - but for as long as I can remember, I wanted to be a doctor. As a Brownie and Girl Guide I was always best at first aid. Once I got to medical school I knew very quickly that I wanted to be a surgeon.'

She did her initial training at King's College Hospital in London. 'There is a lot to learn: you have to be very motivated, and it's not enough just to be there because you father was a doctor.

'Very few medical schools nowadays have arrogant, high-handed consultants - that was a bygone era. All the same, when I went to see the postgraduate dean he said, 'Don't be so silly, dear, you're far too pretty to be a surgeon]' He wasn't being malicious; he genuinely thought it wasn't appropriate for a woman.'

She took him seriously for a while and decided to become an anaesthetist. But when she did her elective year in Cape Town, 'the more I watched surgery, the more I knew I was on the wrong side of the drapes. I found myself in Christiaan Barnard's operating theatre and saw him do heart transplants and by the time I came back to England I knew I had to be a surgeon.'

Ms Griffiths has little time for surgeons who throw implements across the operating table, strut and fret and crave star treatment. 'I learned a lot from Magdi Yacoub, who's such a wonderful person. He never gets angry in theatre. If you've made a mistake he lets you know, but he doesn't hurl things about or throw tantrums.'

Ms Griffiths has a long-term relationship (with another heart surgeon) but no children. Was this a necessary sacrifice?

'When you're a young doctor it is difficult to settle down into a stable relationship. At one stage of our training we used to move with our jobs every six or nine months, which was hard on married doctors. Every single one of my friends who was married at medical school is now divorced. The training was very hard on your social life in those early years.

'The new training programme proposed by the Calman Report would restrict higher surgical training to just one geographical area, as well as reducing junior doctors' hours. That should place less strain on relationships. The divorce rate is appalling.'

How difficult is it to come to terms with the death of patients?

'Death is always very painful, particularly when you're just starting out. I didn't lose patients in the very early stages because then I was only doing very straightforward operations. But the first time a patient died I took it as a personal insult.

'It is only later, in advanced training, that you do the high-risk cases, and you always save more than you lose. But it's a hard thing to cope with, always.

'If a patient dies on the operating table - which fortunately is extremely rare - I would always go and talk to the relatives myself. You've taken on a patient; you have a contract with them, in a way. If we're having trouble in theatre we get the intensive care staff to warn the family that things aren't going too well.

'I used to operate on children, but I don't any more because I found it too heart-breaking. I got much more personally involved in the whole family trauma. I always felt it was part of my responsibility to take the child out and give it to the mum - and I've been there crying with the best of them. I couldn't leave it behind: and you have to be able to shut yourself off and go home.

'I'm almost frightened to say this (she touches wood) but I have never lost anybody who I didn't know was a high risk. You do what you can, you do your best, but sometimes they don't make it.'

How much say do patients have in the surgery they receive, and the measures taken to prolong life?

'I always discuss treatment with them. I believe very much that the patient has a right to be involved, and should have all relevant information. They almost always want me to operate. Often they've reached such a low ebb that the chance of a new lease of life is usually one they're willing to go for.

'If you talk to people as sensible human beings and explain exactly what is going to happen without medical jargon, they do understand. I think they do find it easier to talk to me because I'm a woman. My colleagues often say, 'But people don't ask those things.' and I'll say, 'Oh yes they do.' I'll go into as much detail as a patient wants. Some can't bear to think of the open chest cavity, or the blood.'

What does it feel like, knowing you hold someone's life and the symbol of life, their heart, in your hands? (Ms Griffiths has small, curved hands. She wears a number of silver rings, with which she fiddles as she speaks.)

'The basics are always the same: it's very repetitive surgery and you know what to expect. The only time I've felt emotional about it was when we did heart-lung transplants and took everything out of the chest cavity. You look at this person who's alive, although there's nothing in there - and that is momentous.'

Does she ever worry that modern medicine can do too much, push life too far beyond its natural boundaries? 'I think we have the ability to keep people alive for too long, and as a profession we don't necessarily respect their wishes not to be kept alive. I have patients saying to me, 'If I have a big stroke please don't try and keep me alive.' I think that's reasonable, and you have to be guided by them. On the other hand I don't think you can let people say, 'Please turn my relatives off.' That is unfair. But it's very hard - especially if it's a young child.'

So what are the essential qualities a surgeon needs? 'It is necessary to be dextrous; you have to be able to think on your feet; and you need a three-dimensional mind.'

She escorts me back down the stairs, along vinyl-floored corridors, past patients in dressing gowns. Everyone seems to know her and everyone greets her. At the entrance she gives my hand a strong, three-dimensional shake and sends me out into the sunshine.

(Photograph omitted)

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