Interview with Dr Joan Hester

Dr Joan Hester is a retired consultant, working in the NHS for over 45 years.

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Dr Joan Hester is a retired consultant, working in the NHS for over 45 years. She was a consultant in anaesthesia and pain management at Eastbourne from 1976-2004 and spent the final 12 years of her career as a consultant in pain medicine at King’s College Hospital London and St Christopher’s Hospice, Sydenham. She is past president of the British Pain Society and was involved with many distinguished organisations throughout her career.

The Villages Music Festival of Ripe, Laughton and Chalvington in East Sussex is a biennial festival launched in 2012. I dreamed up the idea together with a close friend. We shared a love of music and a desire to reach out to our communities and beyond, to involve local people in performing or participating as a committee member or volunteer helper and in listening and enjoying music of different genres.

We also wanted to bring people in our villages together as historically they have been socially isolated, and we wanted to share our beautiful corner of Sussex with people from elsewhere. We also decided to raise money for our local community to enhance music in the local schools, to contribute to the development of the two village halls, two community led village stores, and the ongoing restoration of three local medieval churches that are in the centre of our villages.

This year will be our third festival and the programme is very varied. We have an exciting opera workshop for children aged 7-11 years, led by the Mahogany Opera Group which performs in Aldeburgh and London. We also have an opera evening in a beautiful Sussex garden, a fifties night, a piano quintet performing music by English composers, including locally born Nathan Waring, who has written a lovely setting of Blake Songs of Innocence for tenor, keyboard and cello. There is a folk evening with the Askew Sisters at a local pub, two Downland walks, a tour of Farley Farm (the home of surrealism) and a demonstration of how to prepare a Banoffi pie by the original chef from the Hungry Monk restaurant which created the dish. The grand finale includes the Laughton village choir and friends singing Zadok the Priest and Vivaldi’s Gloria.

Attendees can expect a warm welcome, an intimate venue and refreshments are served at most performances. The difference is the personal touch that comes when volunteers are in charge, there is a most pleasant atmosphere of friendship and goodwill.

My role is to bring together the committee, which includes local musicians, to construct an interesting programme, working with a sponsorship and publicity manager, honorary treasurer and secretary and a website manager. Much of the day-to-day work falls on my shoulders which makes me wonder how I managed to do it while still working! The remarkable thing about the Festival is the immense support and goodwill given by members of the local community, both with financial support and the giving of time and expertise.

Probably the opera evening with two singers from Glyndebourne – which is fairly near to us. A soprano and a tenor sang at close range, moving between the tables where the audience was sipping champagne, on a calm June evening in a lovely garden. It was electrifying! Another great pleasure was the return of three local lads who have been through music college and are now professional musicians playing piano, violin and French horn. They gave a stunning performance of two trios by Brahms and Lennox Berkeley.

This year, I am looking forward to seeing the audience and players interact and respond to each other. I am particularly looking forward to the opera workshop for children, to witness how the professionals work to inspire the children and to see their faces light up. If it inspires one or more children to learn more about music, or to aspire to become a musician our work is done. I also enjoy the guided walks in good company in the South Downs National Parks. Really I enjoy it all, I will even go back to my youth in a flared skirt and stilettos for rock’n’roll!

I don’t know why I chose medicine, it was not a vocational calling. My two older brothers had both studied physics, one at Oxford and one at Cambridge and I wanted to do something different and chose medicine in London. There were no doctors in the family, I come from generations of London shopkeepers, publicans and my father was a life assurance agent in the City. Medicine is a pseudoscience really and suited me very well. I have never regretted the choice.

Pain management was thrust upon me after I had become a consultant in anaesthesia at Eastbourne at the age of 30. I should have been a physician but chose anaesthesia as a quick route to the top. There were shortages of anaesthetists in the 70s and quick progression was quite possible with determination and hard work. I also wanted to have a family which I achieved after becoming a consultant. Unbelievably now there was more than one male colleague resentful of appointing a woman. I had been given the sound advice that if I wanted a consultant post I had to show that I was better than the men! After I took up the challenge I rapidly became interested in pain management as I was able to practise as a physician with real talking patients and was delighted when it became a speciality in its own right and I was able to call myself a consultant in pain medicine.

In the 70s and 80s the speciality was developing rapidly and we believed we would find ‘an answer’ for curing pain. We could inject nerves with toxic chemicals and obliterate pain pathways, not understanding that pain would find another way around, we did more harm than good. Sadly, pain management has not fulfilled its promise, pain is as prevalent now as it was then and often remains intractable. The brain is all powerful. Its plasticity is phenomenal, science has made great leaps in our understanding of pain mechanisms but the hopeful ‘cures’ have all been disappointing, we must learn new ways of harnessing the power of the brain to do the work for us.

tarting the first Macmillan service in the community in Eastbourne and drawing attention of professionals and the public to the need to improve symptom management in advanced cancer. Eastbourne general practice was still suffering from the aftermath of Dr Bodkin Adams, the ”Shipman” of the fifties. Doctors were reluctant to prescribe strong opioids. I acquired the funding for the first Macmillan post and then after a few years was the catalyst that led to the founding of St Wilfrid’s Hospice, Eastbourne, which has gone from strength to strength.

I am proud of my time as clinical director and medical director, as I built up a respected anaesthetic department and a thriving hospital, that is until merger and politics changed everything. Getting a new job at the age of 58 was an achievement and I loved my last 12 years working in London; there is huge stimulus in a busy London teaching hospital from colleagues, students and trainees, a richness of interesting medical conditions and the eternal fascination of medicine. Being president of the British Pain Society was hard work but at the same time rewarding, being able to help and support colleagues and uphold standards.

The greatest achievement is to have been able to pass on knowledge and to have positive feedback from trainees. I have also found brief spells of teaching and clinical work in Africa both edifying and humbling.

When I started training much more was expected from us, responsibility started as a medical student, when I acted as a locum for a houseman colleague. I removed an appendix solo as a houseman, I performed a neurolytic sympathetic block in a private clinic at the request of a cardiac surgeon when I was a senior registrar. I anaesthetised tiny babies without doubting my abilities. We lived and breathed the job, the hospital was our home. We had fun though and the job was sociable. Ice cream and toast on the wards, a hospital bar….. Then doubt crept in and we were made to feel we should be much more cautious. Team working changed, medical appointments were no longer personal, the “Firm” disintegrated, places for doctors to commune together disappeared, we became more isolated, scared of litigation and complaints and were told what we must achieve in terms of targets. It didn’t seem to be what we had been trained to do. Hours may be easier, but the work remains difficult and is more frightening than it used to be.

The NHS has moved from being an organisation that preaches “yes we can” to one that says “no we can’t”; we don’t want any more customers, customers cost money and we don’t have any. Artificial barriers have sprung up to prevent patients getting where they need to be, hoops that doctors, infinitely inventive, have to find ways around. The doctor is not the focus of attention, the patient should be but is often ignored, decisions are made from “on high”, wherever that may be. Investigations are miraculous, accurate, speedy, amazing and elucidating, but are they all necessary? False positives abound. MRI of the spine for instance; friend or foe? NHS treatment can be amazing, but if you have a condition that is difficult to diagnose or a psychological or mental health issue, who knows? It has become disconnected, a matter of luck, and common sense plays little part.

My role has been that of compassionate physician, managing complex cancer pain with interventions such as intrathecal drug therapy in complex cases where standard management has failed, a surprising 10 per cent of patients with advanced disease. As chemotherapy has advanced people are living longer with their disease and specialist pain management has become more important. An excellent relationship exists between the palliative care teams at St Christopher’s Hospice and the pain team at King’s. I continue to teach on a course at St Christopher’s entitled the Sharp End of Pain Control. Such teaching is very necessary and worthwhile.

I am busy still after retiring, but do have some time to myself. I can read a newspaper and do the crossword, which seems luxurious. I am gardening; we open our garden for charities several times a year, I indulge in choral singing, in a choir in the City and in various cathedrals. I conduct a small church choir, I am a churchwarden, I organise an annual choral workshop in addition to the music festival, and other local fund raising events. I am volunteering as a mentor for an Eastbourne-based trust for the homeless, and I volunteered as a doctor for Crisis at Christmas. I am learning German and practise hot yoga to try and beat the stiffness of ageing. Busy? Yes, but I love it all and am looking forward to becoming a grandmother in June. Now that is the most important thing of all.

My mother said I should ‘marry a man who makes you laugh’ – and I did!

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