He has separated twins from all over the globe, but the Benhaffaf story captivated the world and, indeed, Edward Kiely himself, writes JOANNE HUNT
EDWARD KIELY has been a paediatric surgeon at London’s Great Ormond Street Hospital for 27 years, but last year, his name jumped from medical journals to the newspaper headlines – all thanks to two Cork babies.
In April, conjoined twins Hassan and Hussein Benhaffaf underwent surgery to separate them. It was Kiely, a fellow Corkonian, who led the 14-hour operation. Their story captivated the nation.
Kiely has done 21 such operations but this one, he admits, was different. “It was sort of personal,” says the quietly spoken medic.
“I was born and brought up in Cork city but we moved outside to a place called Gleantain, just down the road from where they live,” he says. “This wasn’t just Cork, it was somebody down the road. That was as close as you can get really.”
Apart from this proximity, there was the media attention to contend with too.
“It was different because most of the twins we’ve done, it hasn’t been announced until afterwards. We’ve done plenty that nobody has ever heard about,” he says. But he didn’t let the attention faze him.
“In the end you think, this is what has to be done, this is what we are going to do, and we will just get on with it,” says Kiely.
With a father a surgeon, aunts, uncles and three brothers and a sister who all did medicine, there was plenty of medical talk around the kitchen table, says Kiely.
“No one suggested I did it, no one said don’t do it – in the end I couldn’t think of anything else to do,” he says.
While studying medicine at UCC, Kiely played rugby for Munster, a team he still follows avidly.
While training at Mercy hospital in Cork, his interest in paediatric surgery grew. On moving to Dublin, however, a job at Trinity providing pathology services to hospitals was chosen with the oval ball in mind.
“I wanted to do something that would be useful to a surgeon, but also it was nine to five with weekends off,” says Kiely, who went on to play for Lansdowne, captaining the side to win the Leinster Senior Cup.
Despite two separate breaks to bones in his hand, Kiely’s passion for the game was undimmed, and he played for a further year while working at the Mater before moving to London in 1973 to earn his surgical stripes.
“I just thought, you have to go somewhere the population is large to get the practice.” It was always his intention to come home.
“I met somebody at Mass and he said, ‘If you’re here eight years, you’ve had it,’ and I thought, nonsense, I’m going home.” But then the job at Great Ormond Street, the epicentre of paediatric medicine, came up.
Kiely has practised there for nearly three decades. Most of his patients are under five years old. So what is it like for this huge Munster man to work with such tiny anatomies?
“You wear glasses, so they look quite big. But I’ve been doing it so long now, it’s just what I do,” says Kiely. “Then I see a seven-year-old child and I think, my goodness, an adult!”
For many seriously ill children, this hospital and Kiely may be their only chance. How does it feel to have such hope vested in him?
“People come, often from abroad, and they don’t know you from Adam. They meet an Irishman and maybe they weren’t expecting to meet an Irishman. They thought the name was Indian,” says Kiely.
“They are handing over their beautiful child to this person . . . a total stranger who is going to do something frightful to their child. I have no idea of what that is like on their side, and actually that doesn’t matter. It’s not emotion they need from me, what they need from me is that the job will be done and done properly, the ability to do it and get a decent result.
“I think if you get too wound up in what they are expecting, and just how awful it is for them, and it is truly awful, I think you would be just paralysed by indecision.”
Kiely describes paediatric surgery as “the surgery of uncommon conditions” and says he has tried not to have one area of expertise.
However, he has become a world authority in the treatment of neuroblastoma, a cancer of cells in the nervous system affecting one in 10,000 children. Chemotherapy can tackle it, but removing the remaining abdominal tumour, often wrapped around vital organs, is another matter.
A solution came to Kiely while in Cork. “I was home on holiday and just gave my brother [a vascular surgeon], a hand one day,” he says. Seeing how he went about dissecting blood vessels, Kiely wondered could it be applied to children. “The answer is, it could,” he says.
So how did it feel to perform such a technique for the first time? “It felt like it feels now, absolutely terrifying. It’s still terrifying,” he says with deprecation.
“The best surgeons I’ve seen frighten very easily. I think the bad ones don’t understand. The good ones understand what might happen.”
The outcome of any surgery is never a certainty, as Kiely knows well.
“No matter how good you are and how careful you are, you don’t get good results all the time,” he says quietly.
“Some of the results will be truly terrible and, inevitably, some of your patients are going to die, but mostly the result is okay.”
When things go well, he says, “you think yes, you’ve done it, the tumour is out of the child . . . you’re delighted to hand the child back to the parents, alive and looking okay . . . and you think, that was very interesting, I’d like to do another one please.”
And when a child doesn’t make it, how does he process that? “I’m not sure, I’m not sure, because you don’t remember success, you remember disasters. They are the things that stay with you. All surgeons are like that, successes just fade away, but the disasters never do.
“You’re not a machine, I have children of my own, but I’ve not had to hand my child over like that, to have something frightful done, so I don’t know what it’s like and it’s unimaginable.”
Kiely cites developments in anaesthesia and intensive care as the biggest advances in his lifetime. But is our ability to keep the seriously ill alive for longer always a good thing?
“Will everybody be delighted in five years’ time that you have kept this child alive? The answer is ‘no’,” says Kiely.
“There are young children you look at and think, I wonder was it a great idea, but you don’t know that at the time. You are just doing your very best and you’re not quite sure how it will be.”
While in Dublin last week, Kiely was awarded an Honorary Fellowship by the Royal College of Surgeons – though you get the impression that it’s the gratitude of the children and parents he has helped that touches him most.
“They send you cards now and again, and pictures, ‘Here she is, getting married’ or ‘He’s just graduated’. Yes, that really is fantastic.”
Does he keep in touch with the Benhaffhaf boys?
“I keep in touch with their progress, yes,” he says with a smile. “I’ve seen them since and they are doing just fine. It’s great.”
Dr Edward Kiely delivered the 86th Colles Lecture at the Royal College of Surgeons in Ireland annual Charter Day last weekend
