As a Paediatric Cardiac Anaesthesia Fellow at Great Ormond Street Hospital, Dr Andrew Selman (RGS 1990-1997) is familiar with working under pressure to treat the very sick. During the first wave of the coronavirus outbreak, however, Andrew was working in the Intensive Care Unit at St George’s Hospital, Tooting during his final year of training in anaesthetics. As one of our RGS Heroes, we were honoured to catch up with Andrew to reflect on the challenges of the last year.

Tell us what the last year has been like.
The last year has been a challenging year both at work and home, as I expect it has been for most people. In February 2020, I started my last six months of training in Anaesthesia at St George’s Hospital in Tooting and was expecting a pleasant time split between doing subspecialty anaesthesia in cardiothoracic and neurosurgical theatres.

Instead, I found myself seconded to an intensive care unit (ICU) in the hospital as the ICU capacity was expanded by almost three-fold in the space of a few weeks. Working in ICU is a core part of anaesthesia training, but nothing could have prepared us for how many critically ill patients we were to look after.

The team work, professionalism and dedication of all the staff I worked with was amazing and the work was intense and relentless. There were many deaths in the ICU on a daily basis and we were put onto an emergency staffing rota, working many more hours than usual.

At home, my wife was on maternity leave with our third child, but then she also became a teacher to our older two children who were now being home schooled. How she managed this juggling act for several months, I’ll never know, but I know she had the tougher job of the two of us.

A brief respite during summer to see friends and family was very welcome, as was the return to school for our older two children in September.

Now that I work at Great Ormond Street Hospital (GOSH) on the Cardiac Intensive Care Unit, I’m more removed from the Covid-19 work of the first wave, but we’re still busy with referrals for unwell children who are transferred from all over the country.

What have you found most challenging?
Talking to families on the telephone to tell them that a loved one had passed away, especially when they weren’t allowed to visit them in hospital, was a very difficult experience for all involved. Doing this on a daily basis took its toll on many staff and maintaining our professionalism during this time was extremely challenging.

And most rewarding?
In ICU, working with so many dedicated and selfless doctors, nurses, healthcare professionals and volunteers from all areas of the hospital and beyond was an experience that made me feel incredibly lucky. Having my wife and children there to welcome me home each day, when some colleagues where going home to empty houses, made me feel the luckiest man alive. Coming through one of the most challenging years that any of us are likely to experience, has been humbling and a lesson in not taking things for granted that I’ll never forget.

Paediatric cardiac anaesthesia is an incredibly specialist field – how did you come to work in this area?
It’s been a long journey! Before I started my training in anaesthesia I did four years of general paediatric training. During that time I spent six months working in anaesthesia with a view to eventually work in paediatric intensive care, but I enjoyed anaesthesia so much that I changed specialities in 2012.

In my penultimate year of anaesthesia training, I spent a year at GOSH and really enjoyed my time in paediatric cardiac theatres and cardiac ICU. GOSH has an 18-month fellowship for further training in cardiac anaesthesia which I successfully applied for and I’ve been working in the cardiac ICU for several months, which will be followed by a year in cardiac theatres. Hopefully, there will be a permanent post to follow the fellowship.

What’s the most fascinating case or piece of research you have been involved with?
At Great Ormond Street we look after children with an enormous array of different heart problems and the treatments available to patients are improving all the time. Children undergoing heart transplants are one such group who have benefitted from recent advances in technology. Donor hearts normally only come from a small group of organ donors, but a recent collaboration between The Royal Papworth Hospital and Great Ormond Street using a mobile heart by-pass machine means that we can now transplant hearts from a much larger population of potential donors. Read a recent BBC article about them.

By the nature of the very poorly children you treat at GOSH, it must be incredibly emotional at times. How do you switch off after a difficult day?
Spending time with my family is an important part of switching off from work. We have three children and my wife is a Paediatric Oncologist at University Hospital Southampton so life at home is never dull. I also keep in touch with a number of my RGS friends and we meet up at least a couple of times most years. I’ve never stopped being active since playing rugby for RGS, so I include a bike ride or a run in my commute to work every day. I do a couple of triathlons every year and play five-a-side football most weeks too. Doing some exercise is a great way to unwind at the beginning and end of a busy day.

How do you balance work and family life?
I think this has been a huge challenge for all families in the last year and we’re no different. With coronavirus restrictions in place, we’ve spent much more time at home together as a family and making the most of this with the children has been really important. We have a themed party for the children most Saturday nights and getting out of the house to visit new places together has been a regular event. We’ve enjoyed keeping in touch with friends and family via zoom, however different it is to normal socialising and I’ve had lots of messages for support from my RGS friends too.

What advice would you give current students considering a career in paediatric medicine or anaesthesia?
Working with children is a real privilege. They’re such vibrant characters, say the most unexpected things and have the most vivid imaginations. They’re adaptable and positive, even at their most unwell and I couldn’t think of any better job when I’m singing nursery rhymes, reading Where’s Wally or watching something on YouTube as part of giving an anaesthetic.

Working in anaesthetics appeals to my childhood memories of reading Roald Dahl’s George’s Marvellous Medicine, so being able to administer mind-altering drugs to people and watching the effects on a daily basis, is a proposition I found difficult to resist! I should add that you must have a firm grounding in the physiological and pharmacological basis for what you’re doing before embarking on giving an anaesthetic, but I haven’t made anyone grow enormously large or small as a result of my efforts so far, to the best of my knowledge!

If you could go back in time, what advice would you give your 16-year-old self?
Don’t let anyone tell you that you can’t do something you want to in life. If you really want to do something, hard work, dedication and perseverance can get you there. But if you don’t get there, you may well find something you like better along the way. Disappointments often open up as many opportunities as the challenges we overcome easily and you’re the only person who can stop yourself excelling at what you love doing. Don’t forget your friends and family who will support you on your journey. Mine have been amazing.