There are blood stains on his white clogs and panoramic photographs of the golf course at Dooks, Co Kerry on the walls of his consulting rooms. Maurice Neligan, cardiac surgeon at the Blackrock Clinic, Our Lady's Hospital for Sick Children in Crumlin and the Mater Hospital, Dublin, and director of the National Cardiac Surgical Unit, seems to wear his two lives easily, living intensely while in Dublin and escaping every six weeks or so to his house at Dooks, on the Iveragh Peninsula, where the River Caragh flows into Dingle Bay. Now 60, he expects to retire in five years, to continue to "play golf badly" with Pat, his wife of 31 years. He plans to spend more time too at his other passions: reading and writing about local history, antiquities and the archaeology of his beloved Kerry. Currently he's reading Sir Jonah Barrington's sketches. "I love Irish history and biography. I grew up feeling history was alive," he says.
It was literature - particularly Axel Munthe's The Story Of St Michele - which led him to become a doctor. He was attracted at the age of 15 to the human interest of medicine rather than the science of it and, while it's a cliche to say it, the truth is that he wanted to help others. In retirement, however, he will focus more on himself and may even write a novel with a medical background. "I'd pay back some debts," he says mischievously. He seems genuinely to fear, however, that he won't last long into retirement. He has seen too many colleagues live rushed, vital lives only to die within months of leaving medicine. Living on a knife edge and using the knife to alter the fates of thousands of others carries a heavy price.
Being called a hero deeply embarrasses him and he plays down what he does, describing it as "routine" and remarking that the great advances in cardiac surgery were made before he entered the field, by people such as Christian Barnard. He stresses that others - Prof Eoin O'Malley and surgeon Keith Shaw - set up the heart surgery department at the Mater Hospital, where Neligan and his colleague, surgeon Freddie Wood, conducted the first heart transplant in Ireland, in 1987.
"I'm not exceptional. I consider myself extraordinarily fortunate to have been where I was at the right time," he says. Many of his patients praise his humanity and warmth. When the poet Brendan Kennelly entrusted himself to Neligan for quadruple bypass surgery, he was impressed at being able to discuss literature with his surgeon. Kennelly says he even introduced him to a poem he had been unaware of - something from Gilbert's history of Dublin, written in the 17th century. Neligan takes the book from the shelf behind his desk and shows me the page. The poem describes the annual bunfight of the Taylor's Guild, a group no different, Neligan suggests, than any gathering of solicitors, accountants or - and here the knife goes in gently - doctors. The poem describes a decorous group of men listening respectfully to a holy sermon before eating and drinking themselves sick. "Now they part with heavy curses. Broken heads and empty purses . . ."
"The message of the poem is nothing changes," Neligan says. "Our ancestors were pathetically similar to us."
HE worries about the strength of the moral core at the heart of the medical profession. It disturbs him that private patients with VHI cover attending the Mater Private or the Blackrock Clinic have no problem getting the heart surgery they need, when they need it, while many public patients are left to die on waiting lists. A lack of facilities and funding means 1,600 people are on the waiting list for cardiac surgery. A recent review of just 250 such patients found 47 died awaiting surgery. "That's 20 per cent. If you extrapolate those figures to the waiting list as a whole, well in excess of 100-150 people have died awaiting treatment over the past five or six years," he says.
"In practice, while the service is free to everybody at the point of use, that does not signify very much if the service is not there when you need it," he says.
"This is the one thing they omitted specifically from the patient charter. Nurses and doctors must be polite to patients and give them their appointments on time, but it omits to say you can have your treatment within a reasonable period.
"One gets the feeling the Department of Health hopes it will go away. Basically, there seems to be some sort of hope that by prevention or some means of treatment that the need for heart surgery would diminish. But this flies in the face of all international experience and the time is here the Department of Health has to accept the responsibility of providing a service that looks after all the community.
"The success of the Celtic Tiger is not percolating down to all levels of the community. Hospitals still have huge problems of funding. We still have patients going 48 hours on trolleys. There's a major problem here and it's something I've been saying for 10 years and the situation certainly hasn't got any better."
Neligan's persistence in advocating the needs of patients has probably earned him an enemy or two in the Department of Health. He's the bad boy of heart surgery, going against the establishment and making headlines for his criticism of the health service. He won't go as far as to say that somebody with specialist knowledge planted Magill magazine's report that operating theatres had been empty for three days while heart surgeons went to a medical conference (in fact, the theatres were being renovated during the surgeons' absence), but he does wonder how Magill got information on the precise number of private patients treated at the Mater, by himself and his colleagues Freddie Wood and John Hurley. Even the surgeons themselves don't have this confidential information, he points out.
"If I asked them for the information, they wouldn't give it to me. I asked Aidan Walsh, the chief executive of the VHI, if the figure had come from him and he said that it had not. I'd like to know where it did come from." Although it may tempt those in power to retaliate, Neligan believes doctors "don't have the right to remain silent". It's no secret that doctors who speak out feel they are taking a big risk. While there's no objective proof, at times hospitals and departments within hospitals have felt punished at budget time for their public candour. So why is it that Neligan has no fear, when so many others do?
"In conscience, one can't shut up. There's a book on morality by a friend of mine, Prof Owen O'Brien, Conscience And Conflict, and it's worth any young doctor or surgeon in Ireland reading it because it brings us back to the title. You can't be afraid and you mustn't be silent about things that have a moral imperative. The medical profession must point to the deficiencies in the health service because who else is going to do it? Who else will be the patient's advocate? "One of the problems is we have been subdivided and we get inter-university and inter-hospital rivalries. We have to rise above this and say where there are people waiting for all kinds of treatment, and where there is the inhumanity of people lying on trolleys for 48 hours, where there are huge and glaring inequalities, you do no favour to anybody by remaining silent and if this offends people, so be it. What is happening is far more offensive."
Neligan has high expectations of the commitment of the current Minister for Health to improving the situation. "I think Mr Cowen is a courageous, sympathetic and tenacious human being and will do something for these problems."
THE role of rebel seems to run in Neligan's blood, although he himself doesn't see the connection. His father, John Neligan, an Army officer from Templeglantine. Co Limerick, fought in the Civil War. His father's brother, Colonel Dave Neligan, was Michael Collins's spy in Dublin Castle. Neligan remembers his father not as a hero, but as a "convivial and a fanatical fisherman". His parents set up home in Booterstown, Co Dublin where Maurice joined two older sisters in a family which was "not well-to-do and not poor". He went to Blackrock College and played rugby - he still takes in interest in the sport. He went to medical school at University College, Dublin and did his residency in the Mater. All his life he has lived in or near Blackrock.
In 1966, Maurice married Pat, also a doctor, and they have seven children. Pat has worked part-time as a GP for much of her career - a sacrifice her husband acknowledges has helped him to devote himself obsessively to his own career. "At times she's been bemused by the intensity of it all. It's not a job you could do unless it riveted your attention all the time and there's tremendous job satisfaction."
The force and vigour of Neligan's career led the couple to send each of their seven children to boarding school. With the telephone ringing all the time, the life or death nature of his work may have been intrusive and Neligan believes it benefitted the children to live outside the home and learn to be independent. All have done well and several are in medical careers or on the way to them.
Maurice (30) is an orthopaedic surgeon in Waterford; John (29) is a film-maker currently working on Amongst Women in Westport, Co Mayo; Kate (26) has recently completed an MBS and works at the Daily Mail in London; Sarah (24) is an intensive care nurse in the Mater Hospital (having his daughter around at work is never awkward, he says, "It's a big place and she's very junior"); David (21) is a fourth-year science student in UCD (while he hasn't expressed an interest in medicine yet, it may be an option for him, too, his father confides); Lisa (19) is a third-year medical student at UCD; and Lucy (15) is a boarder at Alexandra College. Some years ago, David broke his neck playing rugby. Neligan knew as soon as he heard that it was likely his son would be paralysed from the neck down: it was the most traumatic experience of the surgeon's life. "It's almost miraculous that he has no residual disability," he says. "It reflects greatly on the expertise of my colleagues in Beaumont Hospital." The accident gave Neligan a chilling insight into the feelings of families when they hear that a relative has died. He loses between 15 and 20 of the 600 men, women and children he treats each year, and he dreads having to break the news to their families. "It's depressing, particularly if it's a young person and it's unexpected. It's not easy to go to a family and say the husband or the father has just died. But you have to function and go on. You may have two or three more patients to operate on that day. You must detach your personal life from the professional." Whatever happens, a surgeon must never lose confidence. "The only way you can focus yourself is to say, `All I can do is my best'. If you blamed yourself, you couldn't go on."
His dedication is so fervent that it is hard to believe him when he says that on the day he retires, he will just "walk away". "I wouldn't have the feeling that the department would collapse after I go. I think we built a firm basis and we have had our successes. It would give me great satisfaction to see it improve after I go."
Work, family, golf and literature are his only preoccupations. There's very little else he wishes to talk about. "I'm a very simple person, quite honestly. I think that makes your vision clearer. You aim for what you can do and try to achieve some little thing," he says.
