Jonathan Sackier

Professor Jonathan Sackier (Class of 1975) is an internationally renowned surgeon and technology innovator. He was involved with developing both AESOP, the first commercial surgical robot and the first hands-free exoskeleton, allowing paraplegics to walk unaided. Jonathan has served as  Visiting Professor of Surgery at Oxford University’s Nuffield Department of Surgical Sciences and when not innovating is co-host of the Join the Docs podcast – and a longtime  aviator.

If we met you at a wedding, how would you describe your current activities?

I try to divide my time in quite a disciplined way. Every day I will do some work on my projects, which are all healthcare related, and then spend some time doing something for the world – a charity I’m involved with or just something nice for other people; and also I try to do something nice for myself every day.

People think having a To-do list is onerous – but I’m hugely grateful that people give a damn what I think about stuff, so I love having a to-do list. I’m constantly learning.

I also have a discipline that every week I want to enrich my soul or my brain by going to see a new play or a poetry reading or an opera, or a dance show or try a new recipe – all that kind of stuff.

What was your first experience of work?

I had a Saturday job at Dixon’s in Kilburn where I lasted about three hours before being fired! They had all the speakers in one area, all the record-players in another area… I went up to the manager and suggested we set them up as complete systems, which might make them easier to sell. The manager told me to go and get my things and leave!

But I had other jobs that were fantastic. I worked as a weekend milkman during Med school. I’d come down from University from Liverpool on a Friday and they would tell me whose round I was filling in for that weekend. Each milkman had a book with the orders and what time he was intending to get to each customer. Sometimes there would be a gap in the times. I always wondered why that was. There was one time where I opened the porch door and a lady came out and she was, let’s say, ready for the regular milkman!

But another customer, a little old Polish lady called me in and gave me coffee, cake and a glass of vodka. And it turned out that the usual milkman would usually go in and chat to her. It was her social connection for the day. I loved doing it. It was great fun and very well paid. When I qualified and got my first cheques as a junior doctor, I just laughed – I got paid less for a month as a doctor than I had been paid for a weekend as a relief milkman!

Were you always as organised in planning your week as you are now?

No, I don’t think so. It’s that thing: experience stops you doing stupid things, but you only get experience by doing stupid things. And I did a lot of stupid things. I made a lot of bad decisions in my life but, as Nelson Mandela said: I never lose; I either win or I learn. And I’ve learned a lot.

I was not a naturally gifted student by any stretch of the imagination. For me to get into CLS was a struggle. My father had left school at 12. My mother went to secretarial school. No-one in my family had been to university or anything. My father worked in the rag trade – some design and some middle management. He was a lovely man. He and my mum had very strong values and that was hugely helpful for me. They were very keen on education and conversation was very important to them.

I wish I could say my life had been very organised and planned but really I think it has been about being in the right place at the right time and having the willingness to take opportunities when they present themselves.

I had the privilege of meeting the great American baseball player Yogi Berra. He was such a sweet man. We became friends. He had all these famous, great expressions: ‘When you come to a fork in the road, take it!’

Meaning: just make a decision; any decision?

Yes. Do something! Accept there’s no good or bad decisions – accept where you are and do something!

Your parents’ valuing conversation – how have your personal or social qualities helped you in your career?

I think I have learned what works – and what works is treating people kindly. I have had the great good fortune to lead a very interesting life and meet some wonderful people. Not just in medicine and business but also in the performing arts. And those who have ongoing success usually have one unifying characteristic: they are very nice. They treat people very nicely. There are exceptions, of course! But you do see that those people can hit a brick wall in their careers…

I have been friends with [American pop-soul hitmaker] John Oates for many years. I see how he treats everyone respectfully and warmly. People are always coming up and asking for photos and autographs. He’s lovely to everyone.

In medicine, there used to be a thing called ‘trial by sherry party’. If you were being promoted to a senior position, they’d take you to a dinner first and see how you behaved in that setting over a few drinks. When I was interviewing people to join our Faculty, you’d go to dinner and see whether, when it came to it and it was midnight and you needed to call someone to help with a patient, whether the candidate was someone who you’d dread having to call. Would it be pleasurable to have a cup of coffee with them while we’re waiting for the X-rays to come back; or would you be waiting for the torture to be over? Everyone wants to work with nice people. It’s not complicated!

You must have a method to stop the pressure of the work from living with you 24/7…

Well, when you find out what it is, please tell me! Being a surgeon is a humbling experience. Whenever we have a bad outcome, it’s devastating. People say you become inured to it. Rubbish. You never get used to it. If you do get used to it, you should stop immediately.

There is great pleasure in the achievement of performing an operation well and seeing a patient recover from a hernia, sebaceous cyst or major cancer resections. A job done well. There’s satisfaction in that. But the main thing is knowing you’ve helped someone live to see their next birthday. That personal connection. Many of my patients have become friends. We had a close personal connection because I was there at a very difficult time for them. And that’s the big privilege of working in medicine.

When did it first occur to you to go into medicine?

It was when I had my appendix out in St Mary’s Hospital, Paddington, when I was 11.

Firstly, the family doctor Dr Antoniou who came to our house and said I had to have the operation, and I was struck by how kind and gentle he was. And then at the hospital, the surgeon David Levy came to us and I was struck by how confident he was that he knew why I was in pain and what he should do to make it better and that he talked to me – not to my parents. He talked to me and explained what he was going to do. And then when I woke up and he was there and all the nurses and other people, I was so impressed by his control of the situation. He was so confident – I wasn’t a confident kid, so it really struck me.

I was a very shy, nervous kid. But at CLS, I got to really love being involved with drama and the debating society and that helped me enormously. Pete Coulson and Ted Gordon and other teachers encouraged me to push myself – I didn’t want to do it. I mean: I wanted to do it but I doubted I had the skills, I thought I was going to embarrass myself and everyone else. ‘I’m not good enough’. And they gave me the confidence that I was.

What did you play?

I was in lots of plays in the end. My favourite? In 6th form I co-directed Tom Stoppard’s Rosencrantz and Guildenstern are Dead, with my friend Martin Ward.

Going on stage gave me the confidence to do scientific presentations and to teach. I love teaching. And every time I teach or give a presentation I always think of my teachers – Richard Price , David Blake, Frank Gregory, all these people who taught me. I could see they had prepared a lesson. They didn’t just make it up. They knew their subjects and they delivered the lessons with great humour and made you feel like you were a part of something.

Did you find the CLS school culture friendly and inclusive?

I look back largely with great affection. I felt very privileged to be part of this school. I didn’t come from an academic family and I didn’t think I was very clever but I was hungry to learn. I came to see that everyone else had the same insecurities as me and I made friendships that have lasted until this day. Steven Isserlis, the cellist. David Silk, who died during Covid, was very dear to me. He was there for me at a very difficult time in my life. He also moved to America as a lawyer. He played Hamlet in our Rosencrantz and Guildenstern – I wrote on his obituary page, ‘Good night sweet prince’. Robin Gott, who still collaborates with me today – an actor and a wonderful cartoonist. I’m still in touch with a lot of the guys.

I didn’t realise it at the time but later it dawned on me: the character of the people I’d known at school and how the school had shaped our lives.

So the idea to be in medicine was forged early on – but when did you get into the more specific branch of robotics and innovation?

My dad had this thing about always talking to everyone. When I was going through my training, I knew all the porters at the hospital. I took my time to get to know everyone. Surgery is like any other manual task using tools – you can never find quite the right spanner or pair of pliers. And I had an idea for a particular phase of a given intervention but I didn’t have the right instrument – so I took one of the instruments from the theatre (which you definitely wouldn’t do today) and took it to the bloke at the hospital who fixed stuff. He had a workshop with spot-welders and lathes to repair hospital beds and I asked him if he could help me. And I stood there and he put holes and grooves in this instrument and at the end I sterilised it and then started using it in operations.

So I always had that instinct to try new things, to try and improve what I had. But then everything else I did just kind of happened: the robotics thing happened because I gave a lecture at the American College of Surgeons on the future of surgery. As an illustration, my friend Robin had done a cartoon of me having a Martini while using a Nintendo controller to operate on a patient in the next room. Someone in the lecture told a friend about this and that friend rang me up on the basis that I was an expert in robotic surgery!

Which I certainly wasn’t! I mean, there was no such thing at that point! But this guy, Yulun Wang, had built a robot for defence purposes and had just lost his funding and wanted to find a new use for it. He asked me to help and we built the first surgical robot. It was all an accident, a case of mistaken identity.

But Yulun was an illustration of what I tell people. He was an engineer, a brilliant bloke, a PhD, but his every sentence ends with a laugh. We got on like a house on fire. I learned about engineering and CAD and how to fund things and what a patent was. And I subsequently did loads of other projects including a few with Yulun. We are still friends and we still have some ongoing collaborations.

Everything that happened has just been a circumstance arising and I am just curious – I’m fascinated by everything, literally everything and constantly thinking: how could that work in medicine? Could that make things better for people?

I happened to meet [legendary US talk show host] Larry King once. A friend of a friend. Larry was giving a talk to medical students about his heart disease. We went for lunch afterwards. We got on like a house on fire and became friends and I ended up being involved with his cardiac charity. I met his ninth and tenth wives!

The noticeable thing was how engaged he was with everything he did. Like the actors I’ve met – they don’t do it to make money. They do it because they love doing it. John Oates is still touring and collaborating. He just loves music.

Can you compare working in the US and British health systems?

Patients are patients. I didn’t change the way I practised when I went to America. I did see a different spectrum of disease there – my first night on call I saw five gunshot injuries. I thought, What the hell’s going on?!

During my early career in the UK, there were problems in the system but they were solvable. Since coming back, I’ve needed to use healthcare here and some has been a good experience but mostly it has been terrible. The NHS is not fit for purpose and I don’t think, in its current form, it can be fixed, even by throwing money at it.

The NHS was structured 75 years ago for a much smaller population than we have now – and when there was far less complexity in both known diseases and available treatments. Life expectancy is much greater now; we have a much more diverse population than we had then…

And the delivery of care – I ran a practise in the US with a superb office manager. We got stuff done. If I got a call on a Friday from a colleague who needed specialist support with a patient, I would go over there straight away. No waiting list. If someone needed an operation, someone in terrible pain, I’d do it straight away. Here, you can’t do that. The administration and everything moves at a snail’s pace. A two-week target to see someone with a possible cancer? How about a two-hour target?

In America, there are problems too: the leading cause of bankruptcy is medical expenses and the leading cause of bankruptcy among doctors is unpaid bills. But if you are a caring doctor who wants to deliver high quality care, you can do it. You don’t have to make people wait. I was hearing in Edinburgh there’s an eight-year waiting list for hip replacements. That is unconscionable.

Working in areas that seem, to outsiders, so emotionally intense, are there still moments you can actively enjoy?

I enjoy all of it. I wouldn’t do it otherwise. Exclude difficult people from your life and things that don’t improve the world or bring you pleasure. Whether you think you’re going to succeed or fail, you’re right. If you think you’re going to be happy or unhappy, you’re right. Helping other people should bring you joy!

We have a medical school reunion at least once a year. I was sitting next to a guy named Mike – he said I had been a real inspiration to everyone at Med School. I had no notion of that – I’d thought Mike was Mr Cool and I was a nobody. He said he was insecure as hell at Med  School – I thought that was just me. But we were all finding our way, putting on a bit of a mask… you need to get to the moment where you can drop that and accept yourself for who you are, warts and all…

I choose to live my life in a certain way. I do a lot. I’m reliably informed that this isn’t a rehearsal and we’re a long time dead. I used to volunteer at the Red Cross hospital in Tijuana. I’ve done teaching missions in China and India many times; surgery in rural hospitals in the United States. Teaching others and sharing what I’ve been blessed with. It’s a rich tapestry and I’ve enjoyed it all

You can hear Jonathan’s podcast using the links below:

Spotify
Apple Podcasts
www.jointhedocs.com

And on Tiktok, Instagram, Facebook and YouTube @jointhedocs

(c) Robin Gott