Gabriel Weston (London, 55 years old) lives in a house in the London neighborhood of Lambeth. Identical to the neighboring houses on the outside, inside it is an explosion of color. In the attic, there is a bed next to her work desk. “As soon as I start writing, I get sleepy,” she explains. She warns that her 12-year-old twins will arrive at any moment. She is restless. The public school has alerted about a possible gang fight. “One is very curious and will want to stay and watch,” she says. She speaks enthusiastically and without pause. She offers tea.
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Is medical education backward?
It disconnects the physical part from the emotional. A good doctor needs bifocal vision: to observe the body from its humanity as much as from its biology.
What led you to do it?
I think studying literature. Being a surgeon, I suffered from impostor syndrome. I thought that coming from a literary background delegitimized me. I hid that side. I knew that if I showed any emotion, my teachers would say surgery was not for me. Today, as a mother of a son with a brain cavernoma, and as a patient with heart disease, I am living another truth that alters my discourse.
Has illness made you bold?
It has dissolved the boundary in front of my patients. When I operate, it must exist. But I can reassure someone. There is so much we cannot solve, that what we do achieve encourages us.
To take care of patients, should doctors distance themselves?
It comes from that teaching that separates the physical from the emotional. I tell them: I am going to take care of you. You can cry, sweat, fear… I only ask that you don’t move. Then the best I can do is concentrate. Then emotional care passes to the nurse. I learned this as an intern doctor: there is a time for emotion and another when emotions will be a disaster.
What a lesson.
In my life, there have been areas, like surgery, where it has been very useful. In others, not. Our strengths are often our weaknesses. As a mother, I am too categorical: I love being with my children only up to a point.
Doesn’t that happen to all of us?
If you say it, you are the bad mother. Throughout motherhood, I have lived this paradox: when I am with the children, I wish they were at school, and as soon as they leave, I miss them. [As if by magic, the twins Weston had at 43 years old knock on the door]. My husband comes from a large family. He wanted many children. I agreed to have one more thinking I wouldn’t get pregnant because I was too old. Two arrived.
Have the most humane doctors been sick?
No. But those who have been sick become more humane. The good thing is that there is room for different types of doctors. An autistic person can be a genius in the laboratory.
Are doctors more aware of their mortality?
I came to medicine because I was concerned about death. I don’t remember a day in my life when I haven’t thought about it. Not with fear, but with the awareness that everything can end in a moment.
Memento mori.
Yes. Remember that you are mortal and don’t postpone what is important. But it is not generalizable. My husband is an angiologist, specialized in arterial obstructions. He works on the preventive side. He is logical, optimistic, and prosaic. He is 69 years old and never thinks about death.
Did you meet him in the hospital?
Of course. Today young people — my children among them — wouldn’t date someone 15 years older. But… putting limits on love seems like a loss to me.
You discovered your heart condition when he hugged you.
Not him!, my previous boyfriend. We were studying Medicine. He heard my heartbeat and said: “Something in your heart isn’t working.” Today he is a cardiologist. He remembers the moment enthusiastically; for me, it meant realizing that I would need care all my life.
How are you?
Fine. The public health system [NHS] has so few resources that they pay little attention to my problem. With an annual test, I have to assume I am fine. At some point, they will have to operate on me…
You tried to bring it forward.
Five years ago it worsened. I looked for a surgeon. He listened patiently. He said he would operate when I needed it. My ex-boyfriend, who now works in Hawaii, says the same: every year you delay the operation is a year gained: technology advances rapidly.
Fewer resources but better ones?
It is a political decision. Spain has a good public health system.
The question is how long it can be maintained.
Here everyone says that for unimportant things private medicine is better, and for important things you have to go to the public system. But… not everyone defends the public system. How is that understood? It is business above health or humanity.
“I thought being a doctor would protect me.”
At 30, I was so happy with my white coat… I was young and arrogant. When they told me about my son’s cavernoma, a nurse gave us a locker for our things. Instead of thanking her, I looked at her distantly: “No way. We are not staying here.”
How is your son?
Fine. He must have periodic MRIs. And… he is not good at remembering it. As a mother, I have gone from getting angry and reminding him to accepting that at 28 he must take care of his body.
You came to medicine late.
I am from the humanities. But… while studying in Edinburgh, the surgeon father of a friend, who like all surgeons had a big ego, brought photos of his operations. Everyone was horrified. I was fascinated. He told me that when I returned to London, I should go see him operate. I went. After three operations, I discovered that my interest in medicine was not what he had in mind. He said his wife didn’t know he was there, and I knew I couldn’t go back.
Does this happen in all professions?
We have gotten used to dealing with harassment as if there were no other way to go through the world. Once, upon landing, a man put his hand on my inner thigh. And left it there. I froze. If you slap him, you become violent. If you scream, hysterical. You end up staying silent and leaving. I was 46 and didn’t know how to react.
Are all surgeons egocentric?
They are egocentric, and I include myself. You have to have a high opinion of yourself to cut someone. Of course, the wound you cause is therapeutic, but we need a useful coldness that I certainly have. My husband is too kind a man to be a surgeon.
Where did you get the coldness?
I think from the internship. We only went home one weekend every two months. Saturday afternoon made me sad. My father told me that he, who was also an intern, learned a trick: to think that Saturday night was Sunday night and to release sadness and anger at home before returning to the internship.
Having felt that, you were interned.
He was a diplomat. The Ministry of Foreign Affairs paid two-thirds of the cost. And… there were three of us.
What did your mother think?
My mother was a lawyer, but she married a diplomat. She never worked and became a resentful woman. She was a great mother, but lived at my father’s service. I tell my daughters: even next to the most wonderful person in the world, the couple will only be equal if that person knows you can leave. Even if you choose not to.
Are independent women scary?
My husband had many girlfriends who idolized him. I also had boyfriends, and he is the only one for whom I was not… too much.
Much of your medical learning has been fieldwork: in ambulances, in morgues…
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The curiosity that makes me go to places where life and death meet. I think I like observing more than operating.
Do you need it to write?
Writing is an unstable profession. Almost no one reads anymore. I keep operating to make sure I will have work. Also, writing is capricious. In one week, everything you write may be bad. That’s why operating a couple of days a week makes me feel I do something useful.
You specialized in ear, nose, and throat.
In general surgery, I had a boss as good a surgeon as she was tyrannical. I wanted to avoid working with her. In this very masculine world, the abuse came from a woman.
Does writing change your perspective as a surgeon?
If I see a breast in pathology, I imagine the woman it belonged to. Bones are alive. We are born with 360 fragments. We end with 206. The humerus appears at eight weeks, the shoulders finish joining in adolescence. Every 10 years, our bones are different. They repair, grow, and shrink. As a doctor, you see moments of crisis, people facing the reality of their body. We think little about that until something doesn’t work.
You relate medicine and sociology.
In 2019, doctor Hanno Tan published that the probability of women surviving cardiac arrest was 50%. Not due to lack of defibrillators, but because we downplay symptoms.
Do patients expect more empathy from a woman?
They expect more empathy from a female doctor and trust male doctors more. But it is changing. My daughters and their classmates are smarter than most boys in their class. One day I talked to them about the great mysteries of life: in 10 years, those boys will be in charge and you will work for them. We still live in patriarchies. MeToo made us think that if we all talked about problems experienced instead of looking the other way, things would improve, but… it is hard.
You have written about your mistakes.
It is essential to deserve credibility. A while ago, I cut an artery unnecessarily. The person is fine, but I realized I was being decisive to impress. Another time I removed the wrong melanoma.
How can that happen?
I was responsible, but a nurse noticed by checking the paperwork. We called the patient. I apologized and operated again. I remember when the manager called me, my instinct was to try to deny it.
Blaming others.
Denial is a way to protect ourselves. It is in the child when he says “it wasn’t me” in front of the broken vase.
Why did you write about abortion?
I don’t like the idea of the doctor-hero. Every year, 23,000 women die from poorly performed abortions. A society in which a woman has no control over her reproductive rights is not a free society. In the United Kingdom, as soon as you have children, you live imprisoned. I don’t mean that I don’t love my children. But there is no equality in who takes care of them, and if we complain… we are hysterical.
Hysteria disappeared from the mental illness manual in 1980.
And only in 1991 did the demand for sex from a man to his wife become illegal.
Does the woman’s demand not exist?
Sexual appetite is like hunger. It is managed. To men who feel discriminated against by their wives’ lack of sexual interest, I would say: who owes you sex? Take a shower, read a book, become someone interesting, and maybe someone will want to sleep with you.
Does reading increase sexual attractiveness?
Any clean man, who is kind and interested in something outside himself will find a partner. Look, I have a Dutch sister-in-law and I think equity is more developed there. If my husband and I couldn’t have afforded domestic help, I would have had to give up my job. Like my mother. Because he wouldn’t have given up his. It is wonderful, but without another woman at home, I wouldn’t have been able to work. Now we distinguish between good and bad weeks. The good ones are when one of us can leave the house three mornings and one night. When we were raising four children, we argued a lot.
Passion and shame coexist in the body.
Look, I have some urinary incontinence. Because of menopause and because I always have something better to do than go to the bathroom. If it ever escapes me, I tell the twins so they can laugh. I didn’t talk about these things with my mother. Now, when we finish the interview, they will come and say: “I bet you talked about the clitoris.”
Shall we talk?
It is the female sexual pleasure organ, not the vagina. The vagina is a void. Until the 13th week, the penis and clitoris are the same, which is why sex change operations are possible, because there isn’t much to change.
For Freud, clitoral orgasm was for neurotics.
Urologist Helen O’Connell considers vaginal orgasm unlikely. What happens is that a non-external part of the clitoris surrounds the vagina. The anatomy of the genitals should be rewritten because not all sex is genetic. For turtles, it is decided by the incubation temperature of the eggs.
What is the boundary between neglecting the body and obsessing over it?
The answer defines us. With my children, I tend to downplay pains without other symptoms. With patients, I can feel impatience or irritation towards those obsessed with their body, but I don’t show it. Being professional is controlling emotions.
Do you achieve that patience with your children?
Not at all. I think that as long as I am willing to apologize when I am wrong, I can let slip some swear words or lose patience. It prepares them for life.
It took eight years to research Alive.
It was fascinating to learn that Aristotle believed the heart was the thinking organ.
Are more breast implants done for therapeutic or aesthetic reasons?
For breast augmentation surgery. I don’t judge. I remind myself that we live in a patriarchy and each has better or worse tools to deal with it. But cosmetic surgery pursues eternal youth, an impossible goal. We might do better preparing to age well.
No organ works harder than the kidneys.
I accompanied a patient to dialysis for a week. I felt alone and experienced a bit of what she went through three times a week to try to extend her life.
Can life be extended by taking care of oneself?
Of course: exercise, little red meat, little sugar, few ultra-processed foods, no alcohol…
None?
Nothing better than little.
Many doctors drink a lot…
It is so. We are people. I believe in pleasure. A middle-aged woman has seen so much pleasure disappear from her life that anything that gives it to us, we have to take it. I say women because women and pleasure don’t have a good relationship.
Can the liver regenerate in a day?
Not from a paracetamol or alcohol overdose. I spent a month with the transplant professor at King’s College Hospital. To choose whom to transplant, he defended those who had learned the lesson and didn’t drink. He said bad biology was one thing and bad character another. I am not interested in books about doctors that don’t talk about patients. I think the right way to deal with a disease is by knowing it. And discussing it: we need to talk about what we have in dark areas.
