After 52 years, remarkable surgeon and professor Les Bokey is retiring
When Les Bokey arrived in Australia as a refugee in the 1960s, few could have predicted the indelible impression he would leave on medicine and cancer surgery. Now, at the end of his career, he reflects on a fulfilling life.
When Professor Les Bokey arrived in Australia as a teen from a refugee camp in Alexandria, Egypt, he was mesmerised by his new-found freedom and knew he wanted to “put lives back together” in the country that had provided him and his family with safety and a place to call home.
“When you haven’t felt free, to be free is just quite beautiful,” Bokey says.
“The main impetus of being a migrant then, which was in the ’60s, was to contribute back to your community; there’s such a privilege to come to a country where you had freedom.”
He was drawn to medicine early and never looked back, becoming a world-renowned colorectal surgeon and bowel cancer specialist who has saved countless lives, hastened the introduction of surgical advances, and served as a mentor to thousands of medical students as a respected lecturer.
“Medicine was about putting lives back together again and I wanted to contribute to that,” he says.
“As a migrant, your life is fractured in many ways. Your past is fractured, your memories are fractured, and so putting things back together again is a way of dressing that fractionation.”
It’s a purpose that has driven his life’s work.
He recalls with a laugh that his mother was so mortified by his subspecialty as a “poo doctor” that she used to tell her friends he was a plastic surgeon.
“She couldn’t come to say that her son was a bowel surgeon. Poor Mum, she was so proud, she just couldn’t bring herself to say bowel surgeon!”
Dressed in a sharp black suit topped off with one of his signature bow ties, Bokey cuts a striking image as he shows off some of the futuristic machines that have come to redefine medicine.
He’s at the Ingham Institute’s Centre for Robotics and Health Technology, where he has served as institute director. The institute has been instrumental in the development of robotic surgery and health automation.
The institute, in western Sydney, was created with the help of philanthropy and a partnership between South Western Sydney Local Health District and affiliations with Western Sydney University and the University of NSW.
Its goal is to achieve health equality by providing world-class technology and medical care directly to some of the country’s most diverse and disadvantaged communities. It’s a mission that aligns with Bokey’s philosophy on contributing to the community.
Now, after 52 years in medicine, he is retiring. Though the way he tells it, he is yet to work a day of his life.
Instead, he describes it as a wonderful five-decade learning experience where his patients and colleagues (as he refers to the students he has trained) have helped him understand important lessons.
One of the most poignant moments of his career happened when he was still a medical student. A young woman who had inflammatory bowel disease ended her life because there was no treatment available for the painful condition. It helped to define him as a doctor.
“That was a moment of maturity and an understanding that every person you deal with has got fears and insecurities and that dealing with illness is not a technical matter, but it’s dealing with those insecurities and anxieties and family matters as well. As a young doctor, you’ve got to learn and have to mature into that.”
Another moment came when he met a Holocaust survivor at St Vincent’s Hospital’s casualty ward. She was unlikely to live and wanted to donate her eyes so other people could see.
“These are memorable moments of being introduced to so many different echoes and tears of human frailty and learning from that, at the same time as developing the technical skills that are required to become a surgeon.”
Since those early days, Bokey has worked all over the world including at St Bartholomew’s Hospital in London, Sahlgrenska University Hospital in Sweden. and the Cleveland Clinic Foundation in the US. He is also a former head of surgery with the faculty of medicine and associate dean of surgical sciences at the University of Sydney.
But his career has also provided him with a front-row seat to some of the most extraordinary advances in medicine that have been nothing but lifesaving.
“It’s just been a hoot! It’s been fantastic,” he says.
“It’s like driving a super duper whooper car. It’s gone from a Ford Model T car to an electrically monitored, fully automated one.”
Cancer surgery in the early days of his career was far more invasive. It was open surgery where doctors would use their hands to prod the cancerous area to remove it in the crudest of manners. It carried the risk of high blood loss, poor patient outcomes and low long-term survival rates.
Then came a breakthrough realisation that would change the way surgery was conducted.
“There was a wonderful thesis at the University of Paris written by a Romanian surgeon who’d done his thesis on the anatomy of the rectum,” Bokey says.
“This gentleman described in detail that the rectum was enveloped in a fascial envelope almost like a plastic bag. And it’s evident that every other organ in the body is wrapped in a plastic bag, and that if you stayed just outside of that plastic bag and in the right anatomical plane, you could do a bloodless procedure. By not disturbing the cancer and not putting your fingers through it and so on and so forth, you would reduce the risk of local recurrence.”
Bokey and his colleagues applied the same principle to their work and found they could avoid blood vessels and nerves and remove the cancer as an enclosed tube.
“We did that for the rectum and we did that for the colon, and lo and behold, we found – by we, I mean myself and colleagues at Concord Hospital and the University of Sydney – we found that the survival rate was significantly improved and the local recurrence rate was significantly down.”
Similar work was happening in other parts of the world too, with positive results. According to Bokey, the long-term benefits were astounding, with local recurrence dropping from around 30 per cent to less than 2 per cent.
The other breakthrough has been thanks to the evolution of robotics, which gave rise to the concept and then reality of minimally invasive surgery, with Bokey’s work being instrumental in the introduction of keyhole surgery for bowel cancer. He also introduced robotic surgery as an academic discipline at Liverpool Hospital in Sydney.
In 2005 he was made a Member of the Order of Australia for his service to medicine as a colorectal surgeon and for his creation of education and research programs that are still having an impact.
For Bokey, robotics are vital for closing health gaps in Australia where distance and clinical outcomes can depend on a patient’s postcode, and he sees a bright future.
“Now we’ve got the concept of robotic surgery, which is the same as laparoscopic surgery, except that the operating arms, instead of being chopsticks that can only go up and down and to and fro, they can swing around like your own little hands inside the body. But this is still being researched.”
It’s a future he’s excited to witness, this time from afar, and at a time when rates of bowel cancer are on the rise; the reasons for which, he believes, will be found to be varied but likely to include environmental factors, diet, and genetics.
As retirement arrives, Bokey says he is feeling “liberated and happy”. He and his wife have grand plans of spending their days tending to their beloved horses and dogs on their farm in the Southern Tablelands of NSW.
For future medical students, he has some words of wisdom to share.
“Learn to be an understanding human being,” he says. “Every day of your career means that you learn something from your patients. Your patients are your greatest asset, because they teach you how to be humble, they teach you how to fail, they teach you how to make mistakes and how to say ‘I’m sorry’.
“Be equipped for the future in terms of technicalities. Don’t be trained for the 1990s, be trained for the 2050s. Always be curious.”
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