Living up to expectations

January 4, 2002

What do you get when you combine old-style doctoring with 21st-century obstetrics? Harriet Swain meets King's College London's 'miracle maker' Kypros Nicolaides.

The knock at the door comes just as Kypros Nicolaides has been explaining his reasons for allowing the BBC to film his foetal medicine unit at King's College Hospital, concluding with a rant against government health policies. A doctor operating the ultrasound scan tells him she is worried about one of his patients. The baby has stopped moving.

Nicolaides beckons me to follow. The ultrasound room is full of people all staring at a foetal blur on a screen. Lying in front of them is a pregnant woman, sobbing quietly.

"Your baby is very sick," Nicolaides tells her after tracing the monitor over her belly and watching the screen. "You have two choices." One of these is to deliver the baby that day. The other - and the one eventually chosen - is to try a medical procedure and see what happens after 24 hours. "Kypros?" says the pregnant woman's partner and then asks a complicated question about the placenta. It turns out he has misunderstood something and is reassured. The woman just continues to sob.

I can see why Nicolaides has invited me to witness this scene. It shows in microcosm everything he later talks about - the medical and ethical dilemmas he works with all the time, the highly charged atmospheres, the need for information and the importance of parental choice. In addition, as he is careful to point out, it shows the way he works. He tells me to note the way they use his first name, the way nobody wears white coats, the way he tells them directly that their baby is ill. He even employs an odd bit of jarring banter at the end - his way, he explains, of getting through to people in tense situations.

Afterwards, though, Nicolaides says he is not sure if I can write in detail about the case. At first I think this is because of the sensitivities of the people involved. Then, I realise, it is because he does not want to spoil the suspense of the television series. Nicolaides has a shrewd understanding of many things, including how the media works.

The two-part BBC series Life Before Birth follows a handful of families attending the pioneering Harris Birthright Research Centre for Fetal Medicine, of which Nicolaides is director. Nicolaides agreed to take part because he wanted to show the importance of the unit's work at the forefront of medical developments and, particularly, to show it in a balanced way.

But just as strong a motive was the desire to inform. "I feel these programmes can produce major reforms," he says. "We introduce things in medicine and we need, more now than at any other time in the history of medicine, to carry the population with us."

Nicolaides's respect for the powers of publicity comes despite several brushes with its downsides. He was the specialist treating Mandy Allwood, who signed a deal with a national newspaper after discovering that she was expecting octuplets - all of whom eventually died in the womb. Nicolaides, advised her, in vain, to abort at least some of the foetuses to try to safeguard the others, but came into conflict with her publicist Max Clifford, since he believed the media pressure was bad for her health.

More damaging were complaints by a former patient, Jenny Sabin, about alleged sexual remarks made by Nicolaides. Sabin had been pregnant with twins who had a rare condition and lost both of them. Following her complaints, Nicolaides had to appear before the General Medical Council and was told, he says, to modify his behaviour.

"The very high profile as a miracle-maker raises the expectations of people that when they come here they will have a miracle made and therefore things will work out," he says. "And if things do not work out, then somebody must have done something wrong. You can take a type of behaviour out of context and focus on that."

Nevertheless, he can see why his behaviour may sometimes be construed as inappropriate. Not only will he often ignore "political correctness and mass hysteria about how people must behave" to put his arm around a patient after breaking bad news, but he often makes unexpected comments to try to lighten the tension. This way he can help them "loosen up suddenly, begin to communicate, begin to make decisions that are life-and-death decisions".

As for changing his behaviour: "You are a product of your life, aren't you?" he says. "You evolve and develop a certain style. That style is a product of your own background, your own teachers, your own observations and your own experiences."

His own background is medical through and through. His father was "one of these old-style doctors in Cyprus", who would go by donkey from village to village to visit the sick. "He would sit with them, sleep with them and eat with them for days until they died and then he would go to their funeral or they recovered. He would deliver a baby and he would become a godfather - he had thousands of godchildren."

But his father was also deeply political. He was one of the leaders of the Cypriot revolution against the British, and when Nicolaides was two was put in a concentration camp for four years. He was then brought to England to sign the agreement for independence for Cyprus and quickly became an Anglophile. As a result, Nicolaides was sent to England after his A-levels to continue his education, studied medicine at King's College London, and has remained there since.

When he was still studying, in the late 1970s, King's took delivery of its first ultrasound machine and Nicolaides was hooked.

"Looking through the mother into the foetus opened up a new area which was satisfying all sorts of different aspects of my life," he says. "It was satisfying the medical curiosity, it was bringing in a whole philosophical perspective of what is life and where does it begin, and a minefield of ethical dilemmas." What is more, it was all new.

For him, obstetrics has married his two interests of politics and medicine and has succeeded in continually offering new intellectual and emotional challenges. The "playing God" aspect of it is both an attraction and a source of fear, but really, he says, he is just doing what medics have always done - intervening to try to cure the sick.

Like his father, he tries to keep to the "old-style" doctoring: he allows patients to contact him - at home or at work - whenever they are worried and does not attempt to stay emotionally detached. He offers "my complete and absolute involvement with medicine. I am very, very one sided. I have hardly any social life, hardly any other interests. I am absolutely committed to medicine. I become part of that family." If a baby dies, he will cry with them.

Yet the decisions about whether to terminate or continue with a pregnancy, whether to go ahead with a medical procedure or let nature take its course are finally down to the patients. His absolute emphasis on parental choice sometimes forces him to carry out procedures with which he disagrees and, while he has never refused, he confesses to feeling "personally traumatised" by the choices that some of his patients make.

How does he cope? He points to his coffee and cigarettes - he chainsmokes throughout our conversation. What about his own family? He has a boy and girl, aged eight and five. Does he have time for them? "Not enough," he says quietly.

But there are also the "constant rewards" of seeing life go on, of seeing a woman who suffered tragedy a couple of years ago giving birth to a healthy child, of teaching, of developing new medical methods, of giving good news, cushioning trauma. "This is the energy which moves you along," he says. "It is what completely takes over within me."

Life Before Birth , starts on January 16 on BBC1 at 9pm.

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