Episode 6: Professor Jane Somerville

Oli Lewington

Following on from our previous episode for International Women's Day, where we heard from 3 incredible women and the barriers they faced in the modern workplace, we wanted to take you back in time to an era where women in medicine were even rarer than they are now and where every step was a fight to be recognised. As part of Women's History Month 2024, it seemed only right to hear from a woman who was a true and integral pioneer in medicine in this country, who went against the grain to succeed in a male dominated era, and who fought successfully against a huge array of challenges and obstacles at every stage of her career. She's also just the 2nd woman to enter the pediatric cardiology hall of fame. This is the story of professor James Somerville. 

JINGLE 

During a career that spanned more than 40 years, professor Jane Somerville was a leading paediatric cardiologist and consultant physician. She's also a British Emeritus Professor of Cardiology at Imperial College. Jane was part of Britain's first ever heart transplant in 1968, where she acted as a physician working under the great Donald Russ.

And later, she developed the concept and sub speciality of grown ups with congenital heart disease, otherwise known as GUCH, and helped to realise the unmet needs of adolescents. She practiced her medicine at the National Heart Hospital, Great Ormond Street, and of course, the Royal Brompton, where she built and established the GUCH unit, which was later renamed the Jane Somerville Unit in 1996. Among other things she established during her impressive career, she founded the GUCH Patients Association, later renamed, against her wishes, to the Jane Somerville Foundation, and also founded and organised the First World Congress of Pediatric Cardiology in 1980, which is still going strong today. I sat down with Jane in her London flat to find out what it was like to be part of the first ever heart transplant, who inspired her to go into medicine, and how she felt constantly having to fight battles and build hospital units. But first, I asked her why she decided that going into medicine was for her, despite there being no visible women role models at the time. Can we go back to the start of your career and the start of your training? Because I imagine at the time you first went into training at Guy's, no was a very common response to women in medicine.

What was it that made you want to go into medicine in the first place?

Jane Somerville

That's a story. Reading medical books in the holidays when I was staying with my aunt, because my mother was a working woman. So I was often with my aunt and she was married to a hopeless doctor. The place was full of medical books. I think he took 16 years to qualify, so there were plenty of medical books and I thought, oh, that looks interesting. I'm going to do medicine. So I never had any doubts, so there wasn't a long romance with anything.

So I came down and went to Queen's College which had good science. So I was able to do the 4 sciences and was exempted from 1st MB. So I went into 2nd MB in medicine, and that's great help. And I went to Guy's. I got accepted which was great. And, off I went in into 2nd MB and I think it was the 2nd or 3rd year that Guy's took women, but medical schools were made to take women. Otherwise, they couldn't get their grants.

They had to have 9% of their had to be women.

Oli Lewington

It seems like a ridiculous number now, doesn't it, to enforce 9%?

Jane Somerville

Well, that's what they got. They were made to take women. They didn't want to take them at all. They were just sprinkled before that.

Oli Lewington

Was there any resentment among the men at Guy's having to take on board these women?

Jane Somerville

Oh, yes. There was amongst the senior staff. Absolutely. Didn't want it at all. I mean, and the great Guy's men who were noisy and had been Admirals or whatever during the war or whatever in the medical services, the senior physician, yeah, didn't want them at all. [Paraphrases a senior member of Guy's Hospital] "In guys? A woman? In Guy's?!"

Yes, of course, and I don't think the boys really resented it unless you showed you were cleverer than they were or you were competing for what they wanted. No. I don't think you were counted in that way.

They were all fun. But 9% is well, there's enough to have girls around.

You can see them. You know, it's not just a sprinkle occasionally. We weren't kind of odd bodies. I think I'd been there a month. I was walking across... Guy's Hospital has a very nice little park. You walk across the medical school in the corner and, coming out of the medical block was a senior physician and his entourage of boys and, all walking in order of seniority and he sees me walking across and says, oh, that's another bloody woman, at the top of his voice.

Wouldn't be allowed now and, it's quite funny. I, born with a turned up nose, turned it up more and walked on. I think I was meant to burst into tears because it did occur not with me, but I was used to boys. Why would I why would I care?

Oli Lewington

So was there anyone that you saw within medicine who gave you that aspiration to become a medic or to believe that you could excel within medicine?

Jane Somerville

No. I believed in me. I knew I would excel, I knew. I didn't know how difficult it would be because I had no idea and there were a few things that I had not thought of that were rather basic and fundamental with my childhood dreams. If you're asking me, did I have people who inspired me? Yes, I did and I name them to this day and I think of them. I had, Sir Russell Brock, brilliant teacher, just brilliant, demanding.

Paul Wood, unbelievable teacher of cardiology. The dean of guys, Sir Rowan Boland, who I think was probably my sort of lord protector, and I think I was untouched in all senses because I was the Dean's protege.

Oli Lewington

Jane, you were the first female registrar at Guy's. Did that feel groundbreaking to you at the time?

Jane Somerville

Oh, we didn't have groundbreaking. I thought it was exciting. I was pleased. I thought it was special. I got a lot of plaudits for it. I thought, oh, goody, goody, goody because I hadn't done. Oh, that's nice, I thought.

Oli Lewington

Was that the first time when you felt recognised as an exceptional medic?

Jane Somerville

Well, I didn't think of it in those terms. If you think back now, I suppose it was the first time. I think people spend far too much time contemplating their navels and their wonderfulness and their recognition or their lack of it or whatever. We didn't think like that. We just went on with life and got on with it.

Oli Lewington

You defined the concept and the subspeciality that you called grown ups with congenital heart disease or GUCH as it's otherwise known. Why did you think it was important to establish this service for people transitioning from childhood to adulthood?

Jane Somerville

Surgeons talked about total correction, and it became very clear to me because I was a house officer for a year, there was no such thing as total correction except the very occasional, but I also realised with the changing experience and advances that patients could survive. But who is going to look after them? There was the service of paediatric cardiology. There were adult cardiologists who did see congenital heart disease but did not understand anything about the complex conditions. So who was going to look after all these people? And there was no provision within any country, other than Canada was the first. And the reason there was provision in Canada, by John Keith, great children's heart doctor, was because he was worried about the rheumatics because rheumatic heart disease is classically continues on into adult life.

There was loads of rheumatic heart disease, loads and loads. So he started services in the Toronto General with some difficulty for his rheumatics because they needed it. They were adults with bad Louvela disease and so that's how it started in Canada and the Canadians are much more sensible than most people. We didn't have that amount of rheumatic heart disease although we had it, but it was all centered in Taplow where that's where they went. So, all our cardiologists would manage rheumatic valvular disease with no problem. So the concept of adult congenital heart disease was neither accepted or worried about, and if you met it, well, perhaps you knew it or you sent it to your pal down the road who might know something about it, holes in the heart with the things you might meet. Whereas now we were having all sorts of odd blue things, funny, funny diseases.

We're surviving by the mid seventies, plenty of them. And Bonham Carter, Dick Bonham Carter in Great Ormond Street, which had massive amount of survivors because they had excellent surgery and they were operating on babies for about 15 year, 20, 15, 20 years. Very, very good surgery, lots of survivors. What was he going to do with them in Great Ormond Street? So he sent them to me.

I was working there. He sent them to me because I had adult beds by then. And I was crying out for them. Nobody else would send me any patients, so but Dick did. Dick Bonham Carter did. So I had these oncoming patients from Great Ormond Street. Quite a lot too.

Oli Lewington

So at what point during your training did the cardiothoracic surgery side of things become a focus of yours?

Jane Somerville

It became a focus when I heard, Alfred Blalock lecture. And I was a medical student and a senior medical student, and I wanted to become a senior cardiac surgeon then without any knowledge, by the way, or any calculated thought of what that meant. It was words. And I can almost take you to the place in Guy's Hospital where I had this feeling. That is for me!

Oli Lewington

And did you understand how difficult it would be to get to a point of being able to do that, or were you sort of blissfully ignorant at the time?

Jane Somerville

Oh I was told it wouldn't be possible at the time. Yes. I I vaguely understood. I've always understood it's difficult to do whatever. But those words don't put me off anything. It will be difficult for you to go down the road. Well I'm going down the road.

So, that is not something that I've ever spent time worrying about. Difficulty, that adds to it. Doesn't detract from it.

Oli Lewington

So take me to the first time you saw any cardiac surgery.

Jane Somerville

In Guy's at that time, I don't know whether it is anymore, but your 12th assignment, 12th period of 3 months on the wards, you can do what you like, and I chose to do cardiac surgery, And I also shared it with neurology. I didn't do very much neurology, but I used to say when they said, what are you doing? I spend my I spend my time between 2 nights. 1 was Sir Charles Simons, the other was Sir Russell Brock, so I'd be running between the medical block and the surgical block, but where I realise liked to be was in in the cardiac surgery, so I saw it watching all the blood. You have no idea how bloody it was. It was like a battlefield, in his theatre. It was not nice.

So I did 3 months before I qualified in in the time I was taking my qualifying exams, so I'd seen plenty of cardiac surgery. Most exciting.

Oli Lewington

You obviously didn't become a full-time cardiac surgeon, but you did work as a surgeon for a while, didn't you?

Jane Somerville

I was a surgeon for a year. I did cardiac surgery for a year after my first period of general medicine as a house officer. I I did it as a house I was Brock's house surgeon, which was extremely exciting, never a dull moment. And, Donald Ross was the surgical registrar and he had to deal with my misdemeanors or my meddles and whatnot misses, of which were plenty because you really didn't know what was going on. Not too many people knew what was going on. I wasn't the only one, but it gave me a very good training. Very good training to be a a cardiologist and I think that it's one of the things they miss now.

I think 6 months cardiac surgery, although it's not quite the same anymore, would not hurt cardiologists and it put me at a great advantage compared to my fellow colleague's registrar when I went to train.

Oli Lewington

Why is that? Why would it be good for cardiologists?

Jane Somerville

Well, because you know anatomy. You know what you're talking about. Instead of talking about abstract things, you've actually seen them. I know what the heart looks like. I know what a mitral valve looks like. I know where it is in the chest. It's a tremendous advantage to know what something looks like, what the pathology is living, what the surgeon has to face so you can be close to a surgeon because you understand actually what sort of case you're giving them, what is troublesome.

Instead of just writing, please see and treat, you know, get on with it and do the operation, you have some understanding of what they're going to face. Most physicians, cardiologists have no idea and had no idea. In fact, the senior cardiologist who's a distinguished chap, they'd come into the wards at the end or the next morning and say, everything all right? And you say, no, the patient died. Oh, really? You know, all of that. They'd have no idea.

And you'd say, well, sir, it was a bit it was very difficult operation. Oh, really? What's the problem? Well, the diagnosis wasn't right or something. You know, all those sort of things. No idea. The surgeon had a hard time.

I mean, he may be full of bravado as they are, you'd have to be, but he had to have courage and belief in himself. In fact, Brock gave a very interesting talk in Montreal, I think, talking about the trials of a surgeon and what it means and how you sometimes just feel you can't go on and you must.

Oli Lewington

So you're at the National Heart Hospital at this point.

Jane Somerville

Yes, which is a great hospital. Small. It's where we did the first heart transplant, 1968. I was the physician to the first heart transplant.

Oli Lewington

What does that involve, being a physician to a heart transplant?

Jane Somerville

Well, you have to find out what's the matter with them. Every day, twice a day, because we didn't know anything. There's a lot of medical, there's a lot of medical parts to post operative care anyway and, we didn't know about rejection. We didn't know how to diagnose it. We didn't know what to do about it, and I was like the surgeon's handmaiden which suited me anyway because Donald Ross came to the National Heart Hospital in 1965 first and so we were doing all sorts of things and he he wanted to they like surgeons like handmaidens. What's the matter with this and what has this one got pink spots and what's the matter, you know, all this, so I could be a diagnostic physician and be with the surgeons. So he asked me he needed a physician nominally, he always liked to have a physician anyway, so he said would you like to be the physician to the first heart transplant?

The most exciting thing on earth. It really was, very exciting and somewhat shocking. Somewhat shocking to look into the chest with the heart taken out of a so called living patient. It really was a shock when you don't quite know what is life and what is death. For the first time, you're faced, I was faced with the reality. So exciting when it started beating again, the heart inside the, oh, inside the recipient's chest.

What a moment. Oh, Very sweet chap called Fred West. Very sweet, terrible coronary disease, dying from coronary disease. It really was a great moment but there were a few shocking things. And then suddenly, again, all this new medicine, things you'd never envisaged. We had a lot of help from a very nice chap called the Mowbray who came from Mary's who came over every morning to discuss as it was very difficult to diagnose, if you've never seen it before, what is rejection. Most rejection is not acute. It isn't.

It's sort of subtle. So there's a lot of medicine to be learned and a lot to be done, and not very easy with 3 children, not a lot of sleep. Crisis a minute, you know, but it was so wonderful to be there.

Oli Lewington

And were you a consultant at this point?

Jane Somerville

I became a senior lecturer and it carried consultant status. You were a second class consultant, and I remember the Dean, who was a famous cardiologist called Aubrey Leatham, when I was asking why, although I was a consultant and giving consultant lectures, why I wasn't on the same list of lecturers as the other consultants. He said, you cannot be one of us. And I said, flounced out, I remember very close to tears one of the few times. I said, I don't want to be one of you. I'm better than you are.

Oli Lewington

You've been part of a lot of firsts in your time. Can you tell me a bit about how you managed to build the GUCH unit at the National Heart Hospital?

Jane Somerville

That was given to me by a patient of my husband's and we were having lots of champagne one Saturday morning, as we often did, in Fortnum and Masons, and along comes the owner, starts talking to me and he because he was a patient of my husband's. And he said, and what do you do? So I said told him what I did. And I think, if my memory is certainly right, he'd had a child with bad congenital heart disease who had left the planet. And, anyway, he said, oh, how very interesting. And he said, can I help you? I said, yes, you can.

You can give me some money to build a ward. He said, I'll send 2 people along and let's see if you're ready to build a ward and I'll see if I can help you.

So that's how I got the money. I built it. I was the only person that had to build my own facilities but then, you know, that's how it always has been and so on. And so we got to a ward and we got an adolescent unit and so that was good. And then I had to build again in the Brompton.

Oli Lewington

Yeah. Can you tell me a little bit more about that and and how that came about?

Jane Somerville

Well, when I first went to the Brompton, I had no beds, but that's alright. No challenge. No response. Plenty of response from me. A lot of growling and carrying on. Anyhow, in the new hospital, I got beds and, but I didn't get anything special and we had to build it. Unfortunately, we got a new chief executive who thought that grown up congenital heart disease was something special that other hospitals didn't have and that the Brompton could make its name, which I think it did, if it had this.

So he encouraged me. Physician's complained. Why should she have a development? Why should she have new beds? And he said, she can have new beds because she has raised the money to get them. And they're going to be in the current corridor. If you want to develop a corridor, come along with your project.

So that was, bless him, Bill Bain, really nice Canadian. Anyhow, so we built the unit there and got it. And so that was good.

Oli Lewington

How frustrating is it to have to fight the same battles over and over?

Jane Somerville

Well, I don't know that it's frustrating. It's very annoying sometimes. It's very frustrating when you see so and so gets it and other ones don't. But you kind of get used to it after a while. After all, I've always been a girl, out outnumbered by the boys, and one has always had to fight for something. I was at school. When I was I was at school with boys, there were 70 boys and 6 girls.

Oli Lewington

I just want to pick up on something you said earlier. No challenge, no response. There are some people, when they're faced with a challenge, they shy away from it. And there are some people like you who respond to it. What do you think it is that is kind of inbuilt in you that makes you respond positively to a challenge?

Jane Somerville

I like challenge. I like somebody telling me you can't do it. I like somebody saying it's not possible. All those things excite me. Now don't ask me that trail through my brain what that's about, but I get very easily bored. I'd I suspect I don't have a very long concentration time and, therefore, there's a bit of excitement or I can needle somebody or something or I'll think of something new or when they say, I can't, I will. I was that sort of little girl, I will or I won't.

It was always quite clear to me, I think, from quite a young age. Why can't I do that? I think there's a reason why I can.

Oli Lewington

There must be something innate, in as you say, in responding in a certain way to when people say you can't do something. Do you think it's a response that can be learned, do you think people can understand that and, become that sort of person? Or do you think it's just an innate quality that you have?

Jane Somerville

I think you've got to have the courage to respond very often. You've got to have an innovative brain, so you have to have that. Or you have to have a degree of obstinacy which says, well I am going to do that and I'm not going to tell you I'm going to do it until I've done it. But all of those bits of a personality, it's a question of whether you have it or whether you don't. So there are all sorts of things that make you rise to a challenge, of which anger is one of the things, but it's best I've learnt over years not to do it in anger. If you really want to rise to the challenge, and I have said this to many people who come for advice about something or other, don't do it now. Just let it go for a week and then let's come back and think about it and we'll discuss it because you can't always think straight if you're very angry.

Oli Lewington

You've achieved a lot of different things over the course of your career. Is there anything that you would say you're most proud of?

Jane Somerville

My family. I've got 4 great children and stayed in a marriage. I think that current day living is the most difficult. But, we and we had reasonably happy family and they're great, great people, all of them. So in that sense, I'm very lucky. They're very nice to me and I love them very dearly. But if in my career is what you want to hear about - lots of people achieve a good family - I was very lucky, very fortunate, very good husband, put up with a lot, and I think it's because he was a mature man who wanted to live the life of a bachelor and be married, and it suited us all fine.

We could both do it. What have I achieved? Well, we did the World Congress. I invented the World Congress and they said I couldn't have that. That was good. We got the ward open. What else did we do?

We got the patient association. I think that was important for the patients. And one of the reasons for that, there was all these patients all around and there was only me dealing with that and actually I couldn't be dealing with it.

They had a problem a minute. It was enough, I used to say, it's enough to diagnose what's the matter with you without asking why you can't get to school or why you can't be a farmer or why you can't do something else. So I thought if they had a their own organisation, they could talk to each other and stop nattering at me. So that was the start of the GUCH Patient Association and, I'm pleased with that. I'm pleased they've got each other now. It's a good organisation and I think it'd be great if people and doctors would support it more. It needs help, but it is the only organisation that supports the huge number of needs of the patients, which are huge.

Medicine does not supply all the needs of a patient. They've got a lot of, as you know, a lot of needs. There's all sorts of things we in life take for granted and enjoy. They want to know can they have it too? And they all want to live forever, so it's enough to look after them medically, plus their needs.

Oli Lewington

I think it's really important, I think, that sort of system of setting up a patient association so people can support each other. But I think, as you say, the medical support and support from the medical community is also really, really important.

Jane Somerville

It's very important. Well, now I don't I I mean, I I just wonder if the medical community is ever going to examine a patient again. Our patients need to be examined because they've got all sorts of odd things. It's still some of it is new medicine even though that. Oh, another good thing I did was I established the working group in the European Society of Cardiology. That was very important. It's working group number 22.

Working group GUCH number 22. So the specialties in Europe could be recognised and then they could all talk to each other. You know, the French could talk to the Belgians and the Scandinavians are very good about patient association.

They really are. And so this has been a help. So that was a good thing to do.

Oli Lewington

You talked about one of your proudest things being your family and having 4 children and a marriage that survived. How do you manage the career that you've had with a large, young family?

Jane Somerville

I think I was very lucky. One thing about children is they don't know there are better mothers around fussing about whether they got name tapes or odd socks or things. I didn't worry about things like that. There were dramas over nannies and helpers, but I had the most wonderful Irish housekeeper who came every day called Maggie, and I always thought the wrong Maggie was in charge of the country, actually. She was the most wise, important person you could ever meet in your life and the children still speak in admiration of her. And she was wonderful and I couldn't have done it without her because Maggie was there and I also had help on Saturdays and would draft in anybody to help me and I was lucky all around. And Walter, my late husband, encouraged me in my career.

I think that was one of the attractions. Women were falling about wanting to marry him, but I think one of the attractions was a here as a woman who knew which way where she was going and was going to do it, that suited his philosophy.

Oli Lewington

You talk about someone who supports your career as being being important there. You've supported the careers of several younger physicians coming through the ranks over the years. I wonder if you could talk to us particularly about, Dr Wei Li, who I know you helped very significantly in her career.

Jane Somerville

Well, first of all, did I support peoples, I tried to. And my fellows, this was a problem within my home also because my fellows were almost as important as my children and they had to come home too and the whole place was a sort of carry on, you know. And I did help. I tried to help support people because I felt in my own way I'd been very lucky and I, they came from abroad usually. I didn't particularly support any English. They didn't come to near me, but mostly from abroad, which is why I can travel everywhere around the world and find somebody to love and love me, which is gorgeous and I've seen the world. But, so I did try, I did try and had some great people with me beginning with the first fellow I ever had very I was very junior then, very early seventies, was called Rosa Barbosa who was a paediatric cardiologist of Rio de Janeiro and actually built a hospital almost with her own hands, got money and built the Children's Hospital of Rio for cardiac surgery because everything was done in Sao Paolo.

I mean, amazing with a very tough upbringing. Some of these people have such a tough time. Very special people and another very special person is Wei Li. How lucky was I to have Wei Li in my life? I met her in China, she interpreted for me and I thought she was marvelous. Highly intelligent, awful start, had been, you know, persecuted as part of the Mao persecution and sent to Mongolia and all that. Excellent English. Really. She's the most trustworthy, solid person you could ever have, and anybody who has Wei Li is blessed.

And she lived with us for a bit here and I was very glad to have her and Walter loved her very much and we helped Wei Li get on her feet, but she is a strong, strong woman and by far the best, I think, remarkable, absolutely remarkable. Made her in life that I didn't make for her. She very strong.

Oli Lewington

How important is it for women to help other women in the medical profession?

Jane Somerville

I think it's extremely important. Extremely important. I've always regarded it as very important, and I've always been available as much as I can. I don't think that women like me very much, so that's I don't know whose problem that is mine or theirs, but, I always have helped women. In fact, I would prefer I would go out of my way to help women that I wouldn't go and help men, but that's, you know, we all have our choices. I think it's very important and I think I have been blessed. I mean, I have been lucky.

Not everybody's lucky. Awful things happen to everybody, boys and girls, so to speak. But I think you've got to help people and if you don't help people, it will come back on you.

Oli Lewington

You don't strike me as a woman who just sits around and and doesn't occupy yourself with something that you're passionate about. So what have you been doing since you left medicine?

Jane Somerville

Well, one of the things that happens is that I do see my own children and the naughty grandchildren much more now, so that's good. I that occupies a certain time. And then as a sort of daytime activity, I'm deeply involved in whistleblowing, whistleblowing of doctors because it is a huge scandal. We've been at it 4 years with my colleague David Ward, who's another cardiologist without enough to do, and together we're with a interesting organisation called Justice For Doctors. We're desperately trying to get another conference to air the problems and there are people, good consultants as well as non-consultants who have lost their jobs and their livelihoods. Recently, this last year, lost Maxfax surgeon, obstetrician and gynaecologist, general surgeon, neurosurgeon. I mean it's a disgrace. Why? Well it matters like speaking up for the safety of a patient which is our duty as a doctor, it's the duty of candor.

You have to if you see something unsafe. Anyhow, you get punished for it and it has to stop.

Oli Lewington

Jane, thank you so much for giving us your time today. 

Jane Somerville

Welcome. 

Oli Lewington

The conversation with Jane really gave me a sense of how incredible her career was as a standalone thing, let alone when you consider it in the context of the world she was living in and operating in, and the adversity and the challenge that she faced from the beginning. It feels like we've come on leaps and bounds, and we have we have come on leaps and bounds since she first started training in the 1950's when it was kind of seen as progressive just to have women. And there were plenty of senior male doctors criticising the fact that they had to take 9% of women in a cohort. But I think we found in the last episode that there is still stereotyping and still stigma and still a lack of women in medicine and still a lack of women in senior positions in medicine. And all of these things still need to be addressed.

And I think it's important that we hold those two things in our minds at the same time. Yes. We've come a really long way, but we are not there yet. And I'm not even sure we know where there is. I really hope you enjoyed listening to this episode, and we would love you to subscribe to us wherever you get your podcasts. And I'll see you next time.