The Making of a Surgeon: Professor Anthony Mundy

Edna Astbury-Ward

Disclosures

April 14, 2020

Becoming a top surgeon is a lifetime's journey, composed of hard work, exams, gruelling dedication, exhausting shifts, practical know-how, and academic excellence. Surgeons are trained to make life and death decisions in the blink of an eye, they're confident and capable people. They are often depicted in dramas, soaps and films as heroic characters. They’re the subject of endless fascination. But what is it really like to have spent your life as a surgeon in the dedication of your profession to your patients and their families? And what toll does such sacrifice take on the surgeon and their families?

One person who knows only too well is Professor Anthony Mundy. Professor Mundy is professor of urology and consultant urological surgeon at UCL Hospitals, London, and is also the  medical director responsible for quality and safety, research and development and education and training. Prof Mundy is especially looking forward to 2021 and the countdown is on to celebrate a number of significant milestones in his medical career. Celebrating such achievements will be all the sweeter after coronavirus locked down the world in 2020.

Prof Mundy was born in London in 1948 and said: "2021 will be my 50th anniversary as a doctor, my 40th year as a consultant, my 30th year as a professor and my 20th year as a medical director. Sadly it will only be my 9th year as a responsible officer - which rather spoils the mathematical progression!" 

Gearing up for such noteworthy anniversaries can often be a time of significant reflection on what you have achieved, what you would like to have achieved, and perhaps what you could have done differently. Medscape UK talked to Prof Mundy about his achievements and how his life as a surgeon has moulded him. He didn't hold back.

Q&A

Did you have a plan of what you wanted to achieve almost 50 years ago?

No, no I didn't. I was too busy working towards qualifying to think about where I wanted to go or what I wanted to do in the future. The nearest thing to planning in those days was whether to go out for a curry that evening.

Mostly things have worked out well but not in the way I would have imagined or anticipated. I've discussed with a number of people 'why are we like we are, in medicine?' Basically, I spent most of my early career taking exams. In those days you just drifted into whatever specialty you drifted into, and I enjoyed all the jobs I did whether they were medical or surgical. I decided eventually that I was more a surgeon at heart than a physician and I drifted around until I found I liked urology.

Why was that? What drew you to urology?

Mainly because I thought cardiac surgeons I met were bastards and neuro-surgeons were bastards.

Can I quote you on that?

Yes you can.

So what then?

As much as I enjoyed general surgery and vascular surgery, the vascular surgery patients all dropped dead within a year or so and many of the general surgery patients died of cancer, but in urology… they didn't. Most of the patients you saw and treated in urology survived, they weren't all 150 years old, and the urologists I worked for were all nice people. So I thought, if I become a urologist, I might become a nice person too. So I became a urologist!

Did you become a nice person?

No, I failed that. We don't get everything we want in life!

So, tell us about your most exciting times as a surgeon

I don't get excited. I get interested and I get involved but I'm not somebody who gets either dreadfully excited or dreadfully depressed. I just take life as it is.

Is that part of a surgeon's persona?

Oh, now we're opening a box of snakes.

What are you most proud of then, if you've never been excited about stuff?

When I was quite young, I realised that I was extraordinarily lucky, because, bearing in mind that I was born in 1948, and brought up in the early post-war era while rationing was still widespread, I was born white, Anglo-Saxon, Protestant, European, middle class, with parents who earned enough money to put me through school and university. Then I realised at about 16 that, by contrast, for most people on this planet, 'life's a bitch and then you die', and indeed, I hold that as my personal philosophy. People ask me what do I believe in and I tell them that the reality is that, for me, life has been a long round of getting pretty much everything I wanted and when I wanted it. Hence I don't get depressed. Every morning I wake up and thank whoever it is up there for being so lucky. 

But you must have worked towards that?

I don't know that one consciously does that. When one goes through a system as I have, courtesy of being middle class, northern European etcetera, it just gives you a fantastic start in life, especially when challenged by life events such as, in my case, being sent away to boarding school at 9.

Did being sent to boarding school at 9 have an effect on you?

Oh yes, it is very 'character forming'.

Tell us about those effects

Boarding school is all a bit frightening. In the early days I used to wonder whether I would remember what my parents looked like when/if I ever saw them again, things like that. I did actually settle in quite quickly and make friends but one day the school bully targeted me. I remember it was a Sunday afternoon. I don't know why he started bullying me but he started prodding me, prodding me, prodding me until eventually I just turned round and hit him back. We started to fight and I left him on the ground. I never had any trouble after that, ever again, from anybody. Even when I went on to senior school my reputation had preceded me. So, I learnt a life lesson early on.

A second different type of lesson was when the headmaster brought my parents into his office at school and told them, "Listen, your son is quite bright but he's a lazy bastard." My father took that to heart and he said: "Look son, if you come first in any exam from now on, I'll give you a pound, if you come second, I'll give you 10 shillings [50p], and if you come third I'll give you five shillings [25p]." From then on I came first in everything.

What would you tell your 25-year-old self?

Don't take advice from a 72-year-old!

Why would that be, why wouldn't people take your advice?

Well why would they? Why would they listen to advice from someone whose got all of the cards stacked up in his favour by race, by gender, by background and everything? And so consequently, I think you are probably shaped by circumstances and events not by advice.

What would you say has been your greatest achievement in and out of medicine and surgery?

Three lovely kids, being a Professor of urology at one of the leading hospitals in the world, and having done pretty much everything I've wanted to do.

What haven't you done that you would have liked to?

Nothing really.  Actually, my greatest achievement is the fact that its 2020 and I'm still here.

Do you think medicine is still the career it once was?

No, not by any stretch of the imagination. Medicine now is very much the product of British party politics, like education. That's the thing I dislike about it most of all. I've never had a great love of politics or politicians of any stripe. The NHS and our state education system are the two main political playthings and most politicians couldn't care less about either beyond the way they can use them to manipulate people to vote for them. I don't think the system of care is as good as it was and nor is the system of teaching and training. The 'firm' system worked well for 100 years or more in keeping teams together and supporting them in both clinical practice and in training and education, but it has completely gone by the wayside, and so we struggle to do all of the things required of us by our political masters whether it's hours of work, conditions of work, terms of service or whatever.

What do you think we do better in medicine and health now?

The development of medical science, especially drugs. My father was a GP in the 1940s, 50s and 60s and he could only have dreamed of such things as we have now. Indeed, I can remember getting tonsillitis when I was a boy and having injections of penicillin four times a day for a week, which were absolute bloody agony. These days they mix it up with procaine so it doesn't hurt, but then of course nowadays you take it by mouth anyway. There were hardly any drugs then compared with now. If you look at the National Compendium, which is a compendium of the pills and potions that are available for pharmacological treatment, it's about 500 pages long. When my father qualified, it was about 25 pages long.

Has there been a toll on your personal life as a consequence of being a surgeon?

Oh, well I've been through a couple of marriages and divorces. Often as young doctors we were exhausted and never saw our families. We thought love was forever but actually it was well, see you in 6 months, and it was very difficult. I remember in particular being chronically short of cash and halfway through my training my bank manager phoned me up to tell me that I had a £40,000 overdraft. This was just before I was going to go and do research at Johns Hopkins in the States on duodenal secretions in frogs, and so rather than do that I did a stint abroad working in the Middle East as a surgeon in a surgical field hospital during the war with the Yemen. So I didn't do a PhD but I did pay off my overdraft.  I am entirely familiar with the difficulties of being a junior doctor – albeit with the occasional unusual solution. 

In my training there was a strong element of expectation from my (much) better half(s) that when I became a consultant, rather than a senior registrar, I would become less busy, rather than busier, whereas in fact the reality is, it just goes on and on and on and on and on. But I couldn't say it was the job that did it. To be honest, I'm probably just not very good at being married.

Do you have gut reactions to people?

Yes, I hate everybody!

I don't believe that for a minute. So, how do you manage your gut reactions?

Simple. I realise they are gut reactions. So, for example let's talk about the 'woke' generation as that's a useful generalisation. I walk down the street every morning to the station on my way to work and I think, why is every single person wearing the same woolly hat on their head? Why are they all wearing puffer jackets? The women, without exception, are all wearing jeggings. Everybody, male and female is wearing plimsolls, trainers you call them now. Everybody is identically dressed and as you sit there on the tube looking at people opposite you, they are all playing on their iPhones. It's just the whole homogeneity of it all I find strange. I don't like it but I realise it is entirely irrational behaviour and I remember that when I was young it was all jeans and Chelsea boots, and at the time I was probably being looked at by a gentleman with a bowler hat and rolled umbrella who was despairing of me!

Do you find your gut instinct is often right, or have you been proven wrong?

Oh yes, I make mistakes all the time about people.

When you retire, what do you want to be remembered for?

I am somewhat cynical. I think that there'll be a huge sigh of relief from a lot of people saying thank God he's gone. I just remember over the years, people say, oh gosh wait until so and so goes, who's going to replace him? Who's going to take over doing that sort of work because nobody else can do that and the reality is that 3 months later they're forgotten about. So, I think the answer to your question is, I don't think I'll be remembered for anything and I have to say I'll be bloody surprised if I was.

If you had your time again, what would you have done differently?

I really couldn't think what I would have done differently, because, as I say, these things just happen. There isn't a great deal that I've done in a positive sense.

But look at all those lives you've saved and all those lives you've made better with your skills. How can you possibly say that?

I can't cure cancer. I don't bring the dead back to life. I put some people back together again who've got into difficulty, but sometimes it's only temporary. And in the end, 'life's a bitch and then you die!'

There must be something?

Well yes, looking after spina bifida patients in my early years as a urologist. I remember talking recently to a particular lady I had treated 30 odd years ago when she was a 14-year-old. She had an ileal conduit and wanted her waterworks reconstructed so that she could get rid of her urinary stoma bag, which I did. All was fine until recently when she developed a new problem. She was now coming up to 45 and I was having to redo her ileal conduit, and I said to her somewhat philosophically, it must be awfully disappointing that you started off life with an ileal conduit, and now you're going back to an ileal conduit? And she said, 'Oh no, no!' She grabbed me by the hand and squeezed it and said, "No, no, no - just when I was getting into my teens and twenties, when it really mattered, you got rid of the bag for me and made me as near normal as possible," and then I thought… 'Well, you know, maybe it has all been worthwhile after all.'

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