Rhys, forty-two years old
Cause of death: Rugby
Cause of life: Self-forgiveness
The first time I saw Rhys Thomas, he was wearing a blood-red Welsh rugby jersey, playing against Italy at the 75,000-capacity Millennium Stadium in Cardiff. It was his fourth of an eventual seven caps playing for Wales. The second time I met Rhys was at a cafe near his home, only this time he didn’t have a heartbeat.
Born in Johannesburg to his Welsh engineer dad and artist mum, childhood was spent outdoors, climbing trees and playing cricket with his large band of cousins. His early flair for sport took Rhys to the premier government-run King Edward VII School in the Houghton Estate in Johannesburg. The long list of professional sports stars and business leaders it has produced is a testament to the values, discipline and structure it gave to boarders like Rhys. And he needed these boundaries – his wild streak could then be focused on sport rather than crime or drugs.
‘It was like the military just without the killing,’ he told me.
But the school did have plenty of violence. ‘It broke a lot of people, the lashings and the beatings, never from the teachers but from the older boys. And then a few years later you were those older boys, you were giving out the punishments.’ The school made Rhys into the man he would become, but later it would lead to his downfall.
As a cricket-mad 13-year-old, Rhys watched South Africa’s victory in the 1995 Rugby World Cup on a big television with his cousins. The country, still reeling from the apartheid era, was in desperate need of a unifying moment and so was he. The weight of history and the hope of a nation were on the shoulders of the Springboks. When Nelson Mandela stepped on to the field wearing the green and gold jersey, the roar of the crowd was deafening, a sound that seemed to echo the breaking of old barriers.
As the final whistle blew, confirming South Africa’s triumph over New Zealand, Rhys’s family home erupted in jubilation. It wasn’t just a sports victory; it was a symbolic win for unity and reconciliation. People of all races were hugging, crying and celebrating together. But for Rhys, the meaning was different. It made him pick up a rugby ball for the first time, leaving his cricket bat behind as he returned to school after the holidays. Within ten years of Rhys scoring his first try against his school’s arch rival, the nearby St John’s private school, Rhys was wearing that red Welsh jersey in front of a roaring crowd.
The decision to move across the world for sport was a tough one. In the weeks before he signed a rugby contract, Rhys was offered the chance to live on a kibbutz in Gaza. But seeing a Welsh rugby team on tour in Johannesburg playing strip touch rugby, laughing and running around naked as the sun set on the beach, helped seal the decision for fun-loving Rhys. He was soon stepping off a plane wearing shorts and flip-flops into the wet Welsh winter.
Rhys had signed a contract to play rugby for the large, industrial Welsh town of Newport. It was quite a culture shock. He thought there had been a mix-up when he was dropped off at the waterlogged training pitch, covered in a strange substance he had never seen before – mud. Although Newport has a rich history and strong sense of community, the city’s struggles extend beyond just the weather. Newport has several areas that rank among the most underprivileged in Wales and in the top 10 per cent most deprived areas in the UK. The average life expectancy is three years lower than in rural Monmouthshire just 10 miles away. Newport is still the only place I have ever been where I have seen a dog step on a human shit.
Despite the dramatic acclimatisation, Rhys was soon called up for the Wales Under-21 side, helping them win the Six Nations in his final season. He was selected for the World Cup Dream Team as the best tight-head prop, before putting on the Welsh jersey as a professional for the first time against Argentina in June 2006.
‘There is nothing in the world like playing rugby in Wales. My heart pounded as I pulled that red jersey over my head and felt the Welsh crest against my chest for the first time. There were 75,000 people singing the national anthem, flames shooting over the green grass as I emerged on to the pitch into a war of sport for eighty amazing minutes.’
But like so many at the top of their game, with the biggest highs come the lowest lows. Rhys had been injected into Wales as an 18-year-old, rising to superstardom. After the games came the parties, the free drinks, the temptations around every corner. The disciplined walls of his school crumbled, the physical abuse replaced by a brutal training regime, but his wild streak was no longer satisfied by his pitch-time alone. During untamed nights out, Rhys would do things he would regret and say things he didn’t mean. If drinking alcohol is like borrowing happiness from tomorrow, Rhys became overcome by debt – he owed much to his team, his family and himself. He would carry this past behaviour on a long, difficult journey with him until he finally learned to become a better, stronger man. But he would need to be broken first.
The cracks started after a punishing blow to his chest during a very physical game. This sparked a series of events that led to Rhys’s heart stopping twice before he was able to scrape his life back together. But the life Rhys returned to would be unrecognisably good in some way, but unrecognisably bad in others.
It is not just professional sports stars who have their demons – doctors like me rarely live the life they advise. The media had a party when England’s new health secretary, Thérèse Coffey, was photographed smoking a cigar while clutching a flute of champagne. But I’m also certainly not 100 per cent healthy nor 100 per cent moral – on a good day I may hit 50 per cent. Healthcare workers tend to drink to hazardous levels more frequently than the general population, with over 20 per cent also being smokers. I remember feeling guilty caring for a critically injured cyclist after riding to work that morning not wearing a helmet. I’ve spoken to a family about alcoholism while sucking a mint to disguise last night’s afterparty. But is it okay for a heart surgeon to smoke or the hepatologist to drink whisky? More generally, as life becomes overexposed, spilling all of our inner personal lives on the floor of the town square through social media, how should we deal with our own hypocrisy?
David Fleming, a cultural historian and economist, stated in his book Lean Logic, ‘There is no reason why he should not argue for standards better than he manages to achieve in his own life.’ I am no paragon of perfect living but can still be a coach guiding patients to do better than I. José Mourinho played fewer than 100 games in Portugal’s second division. Arrigo Sacchi, despite being one of the greatest ever football managers, never played professionally.
Of course, there may be boundaries to avoid, but we are all complex and multifaceted. To echo Bob Dylan, who was channelling Walt Whitman, we are full of contradictions and many moods. We all contain multitudes. And that is okay. Or perhaps it is even better than perfection, advising on perfection. Carl Sagan, one of the most celebrated scientists of the past 100 years, famously said, ‘We are made of star-stuff.’ That sounds inspiring and it is. We are all recycled from something else, it just depends on how far you want to go back. The iron in our blood was formed inside a giant red star billions of years ago. But since then, it has moved through countless rocks, mountains, trees and butterflies. How beautiful. But your iron has also moved through guns, bullets that have killed, bacteria that have infected others, and steel that has spilt blood. As Fleming aptly concludes in his book, ‘Indeed, it would be worrying if his ideals were not better than the way he lives.’
After the severe impact to his chest, Rhys needed weeks of painkillers and steroid injections to ease the pain. But even when the bruising settled, things weren’t right. Rhys would get pain in his jaw, causing him to grind his teeth at night. During training, his left arm would feel tight and his heart would pound like when he first wore that red Welsh jersey, especially after drinking high-dose caffeine shots that were a standard part of the training regime.
This culminated in a heart attack after a game, needing Rhys to take six months off rugby entirely. But he was then given the all-clear to return to professional sport and by 2012, life was finally looking up. His rugby was the strongest it had been for years, his fitness was back, and his mind was sharp. He was about to sign the contract of a lifetime with French team Biarritz, known for its rich history and strong rugby traditions.
Although life can kick you when you are down, being on top of the world means there is further to fall. Five years after his heart attack, Rhys felt great, at the top of his game. The day before his mum’s birthday, recovery from a minor neck injury meant Rhys needed to be at the gym earlier than the rest of the team. His ‘easy’ warm-up of 1,000 calories on the bike in forty-five minutes was coming to an end. At minute forty-three, the final few calories ticked by when the familiar feelings of neck, jaw and arm pain returned. Rhys’s vision faded as he stumbled off the bike into the team physiotherapist’s office. Crumbling on to the floor, an ambulance was called as Rhys lay still, sweating, his face moist like the grease inside a pizza box, having a massive heart attack.
At the hospital, doctors tried to open up the blood vessels around his heart using wires threaded through the artery in his right wrist. As they did, the blood supply to his heart muscle reduced even further and his heart started to fail. Doctors rushed Rhys to the cardiac theatre, stopping his heart on purpose to perform an emergency quadruple bypass. As Rhys’s chest was opened by the surgeons, they saw the main blood vessel to his heart had split open, caused by the blow to his chest years before, combined with the physical stress of training, caffeine and his lifestyle. Rhys’s heart muscle was severely thinned at the front and could no longer beat. The last words that the muscular, powerful, ‘wild’ sportsman Rhys said to his family, including his children aged between four and eighteen, before having surgery were simple – ‘I love you.’
The phrase ‘all you need is love’ often gets dismissed as a clichéd sentiment. But allowing it to extend beyond the boundaries of a ‘boy meets girl’ romantic love story makes it hit home. Although articles espouse the rise of toxic masculinity, the truth is that even Rhys – a solid, South African rugby player brought up on corporal punishment at school – chose love as his final message before facing his end.
Perhaps the Beatles were pointing towards research showing that married couples do indeed tend to live longer than their single counterparts. This is largely attributed to the social and emotional support inherent in a long-term union. A partner can provide accountability for healthy lifestyle behaviours, resulting in lower rates of substance abuse, lower blood pressure and reduced levels of depression compared to single peers. However, recent studies have shown that these longevity benefits are not exclusive to romantic relationships. Similar advantages can be found in close, non-romantic relationships that offer a degree of emotional support and ‘love’. These findings suggest that the quality of social connections, rather than the specific nature of the relationship, is crucial for fostering long-term health and well-being.
Up until 2013, no human deaths had occurred due to wind turbine accidents. That changed on 29 October 2013, when two of the four mechanics servicing a wind turbine in Ooltgensplaat, Netherlands, were killed. A fire broke out at the top of the turbine after a short circuit. Due to the height of the turbine and location of the fire, the fire department had trouble extinguishing the blaze. A specialised team were called in to use a large crane to battle the raging fire. Two of the mechanics were able to escape but the remaining two, men aged nineteen and twenty-one, became trapped on the top of the turbine. In their final moments they didn’t jump or scream. Instead, an iconic image of Daan Kous and Arjan Kortus showed them hugging before the black smoke and flames engulfed their bodies. Love isn’t all you need, but it is all we think about when there is little else left.
Rhys’s heart remained silent and still for hours as surgeons replaced the blood vessels on its surface during a difficult operation. Blood to his other organs flowed through a large heart-lung machine as the team realised that over half of his heart’s muscle had died after his previous chest injury and the heart attack that followed. His blood pressure was too low to come off the bypass machine and so surgeons needed to insert a balloon into Rhys’s aorta to keep enough blood flowing.
When Rhys woke in the Intensive Care Unit, with his body fighting to stay alive, his brain starved of oxygen, the dreams he experienced were indistinguishable from reality. The ceiling of the ward turned into waves of hot sand, his wife appeared as a figurehead at the front of a pirate ship. Rhys experienced past and possible future lives, while trapped in a cyclical reality that felt like it lasted decades. But even when he was discharged from hospital two weeks later, life would not get much easier.
In a heartbeat, Rhys had been transformed from an elite, professional sportsman into a frail, dependent shell who couldn’t even walk to the toilet. His heart struggled to squeeze; he suffered crippling panic attacks that could only be calmed by breathing techniques he was taught at hospital. But when even this breath work stopped working, the only treatment was one of the world’s most popular, destructive drugs – alcohol. Rhys fell into his self-destructive former ways and rather than alcohol helping him get through the day, it started to make his condition even worse. His heart function was declining day by day and within months, Rhys was on the urgent heart transplant waiting list. He was given twelve months to live, but as the months ticked down, no heart could be found. Instead, after nine months of waiting Rhys was given a stark choice – become a man without a heartbeat and live or keep your own heartbeat and die.
Nearly every mammal, large and small, shares a fascinating relationship between its average life expectancy and its heartbeat. This link gifts mammals roughly 1 billion heartbeats in their lifetime. For instance, a hummingbird’s heart, which races at more than 1,200 beats per minute, gives it a lifespan of merely three to five years. Conversely, the blue whale’s heart, which beats only about six times per minute, supports a life expectancy of more than 100 years. Humans, however, have artificially extended their lifespan through medical advancements, averaging around 3 billion heartbeats over a lifetime.
When you dash to catch a bus or do a workout at the gym your heart rate surges. Even if you are not a fitness fanatic, in a typical six-minute period of sex, your normal 400 beats will rise to more than 1,000. Not only does your heart beat faster, but it also contracts more forcefully, expelling 120 millilitres of blood per beat compared to the usual 80 millilitres. This change boosts the blood volume pumped through your body from 30 litres to more than 120 litres. But when your heart fails like Rhys’s, it can’t adapt to changes. Rhys’s heart struggled to just beat at a normal pace, ejecting only half of the normal amounts of blood. So, activities as minor as walking to the toilet would starve Rhys’s muscles of oxygen.
Medicine has long been captivated by the heart, ever since William Harvey described it as ‘the circuit of the blood’ in 1649. What is essentially a pump is both soft and responsive, yet robust and enduring. Yet, like all pumps, it can fail. Medicine soon came up with options for repair.
The methods designed to repair blood vessels that were used during Rhys’s bypass operation were developed by the Lebanese-American surgeon Dr Michael DeBakey. His life was nothing short of special. He discovered early links between smoking and lung cancer, performed one of the world’s first heart-bypass surgeries and introduced operations still essential to save lives in my hospital today. He even trialled the first mechanical heart device that is now fast becoming a reasonable alternative to a heart transplant for some patients like Rhys. DeBakey continued working until the age of ninety-nine after suffering a catastrophic aneurysm rupture himself aged ninety-seven. His life was saved by a seven-hour operation that he had invented, followed by a prolonged stay in the ICU. He died two months before his one hundredth birthday.
For some patients, simply replacing the pipes that supply blood to the heart is not enough. When heart muscle dies it does not regenerate. While heart transplants offer a lifeline, they are fraught with challenges. Finding a suitable donor match in time can be difficult, and post-transplant life involves a commitment to powerful immunosuppressive drugs that prevent rejection but can cause severe infections and even cancer.
Three hundred years after Harvey described the heart’s wonder, advances in medical technology have produced mechanical devices to help the failing heart that are small enough to be implanted under the skin. The evolution of heart support devices has been groundbreaking. The first heart-bypass operation on a human, in 1951, was unsuccessful, but by 1953, the iron heart machine saved an 18-year-old woman at Thomas Jefferson University Hospital in Philadelphia by closing a hole in her heart. But now, these devices can sustain life for extended periods even in those with minimal heart function. These machines have even been inserted during a cardiac arrest in the Louvre, Paris. The Mona Lisa silently looked on as French medical teams put the patient on a heart-lung bypass machine in the middle of the museum.
Remarkably, it is now possible to live without a heart entirely. Former Czech firefighter Jakub Halik was the first, living for six months with two mechanical pumps instead of a heart, and even managing to visit the gym despite having no pulse. This was the choice that doctors gave Rhys. A transplant could not be found for him in time so he could opt to live with a mechanical pump or not live at all.
In the UK, the shortage of hearts and other organs for transplant is a critical issue, leaving many patients in desperate need. With more than 300 people waiting for a heart transplant, the demand far surpasses the supply. Despite the 2020 implementation of the opt-out donation system across the UK, the gap remains wide, particularly affecting those with urgent needs. The wait can be excruciatingly long, with many patients on mechanical heart support struggling to maintain their quality of life. It is even longer in minority ethnic groups where consent rates for donation are particularly low despite the increased need in those communities. This is due to a combination of factors. Genetic diversity between people means that finding a specific tissue type, the protein fingerprints in our organs, is harder in minority groups under-represented as donors. Hence there are fewer compatible organs. Additionally, historical mistrust of healthcare systems and some cultural beliefs can lower resignation as organ donors in some communities. Socioeconomic challenges, such as limited access to healthcare, also contribute to lower donation rates.
This was why I acted as an ambassador for the ‘Tribute to Life’ project, launched by the NHS Blood and Transplant service, at the 2022 Commonwealth Games in Birmingham. This aims to enhance ethical organ donation and transplantation practices across nations. By fostering international co-operation, the project seeks to improve organ donation rates and save lives through shared learning and collaboration. It was at the planning session at the House of Lords that I sat next to one of the heart surgeons who implanted Rhys’s artificial heart.
But it doesn’t have to be this way. Think about your closest loved one right now – maybe your son or daughter, your mum or your dad. Imagine the feeling when the phone rings offering them another chance at life through the gift of donation. Imagine that same phone call saying that the gift has instead been cremated or buried in a box. Donation is not only the greatest gift that can be given, but it is a gift that is of no value unless it is given. Intensive care facilitates this most selfless human act. We care for the physical body of a patient, even after their soul has departed when their brainstem, the part that makes you legally alive, has died. We protect their organs, ensuring their donation has the maximum benefit to recipients who may live hundreds of miles away. Although these people will never have met the donor, their second shot at life can be a constant reminder to us all of how far humanity and medicine have come.
I hope that Chapter 8 can save a life through teaching you CPR. But I hope this chapter can save even more lives if just one of you considers what to leave behind after your death. Think about how what you no longer need could transform the lives of many others. Once you have thought about this, no matter the outcome, tell your family about your wishes. Death need not detract from the joy of living. Even in death you can leave a legacy of hope for others.
The team explained to Rhys how a mechanical device could be fitted inside his failing heart, attached to a battery pack worn over his shoulder, to give an extra boost to every heartbeat. Although this would improve the health of his organs, Rhys would lose all pulses in his body as the pump would smooth out the blood flow into a continuous stream. With just months left to live, Rhys had little choice. He spent a traumatic six weeks waiting in the cardiac ward, watching many older and younger patients die before or after similar procedures. He became familiar with the ebb and flow of life and of death. First, an emergency buzzer would sound in the bed next to him. Soon, the medical team would rush in and try various treatments. Sometimes they worked, often they did not. When they did not, the patient would die. Curtains were pulled around, families cried, the body moved, the bed wiped clean, curtains opened, ready to receive another patient. Rhys waited his turn to go on the conveyer belt of life.
But the day of his operation did come. He kissed his family goodbye, told them he loved them once again, and was taken to theatre. This time the operation did not go according to plan. The scar tissue from his previous surgery meant it took three heart surgeons over four hours just to get near his heart. But after nearly twelve hours on the bypass machine, a member of the theatre team came to tell Rhys’s family that they hadn’t been able to put the device in his heart. They were going to wake Rhys up and move to end-of-life care. A knock on the family room door mid-conversation interrupted them with news of a breakthrough. They had just managed to divide the delicate, thin muscle remaining in his heart and slip the metal limbs of the device into position.
After two weeks in intensive care, Rhys needed a tracheostomy, meaning he was unable to speak when his eyes finally opened. Instead, a nurse gave him a clipboard to write on. That clipboard still hangs in Rhys’s house today, reminding him what is important and what was at stake. Scrawled in thick black pen are the words ‘I love you’.
We forget how machines, drugs and procedures can fix many parts of a person, but not the whole. I can sometimes save a life, but not fix a life. In the weeks that followed Rhys’s operation, he spiralled to new lows. His purpose in life, his job, his security, his identity had all be taken away. He was living on benefits and the six weeks spent in the cardiac ward watching the supermarket of life and death would return in the early hours of the morning, invading Rhys’s thoughts. He couldn’t sleep, he couldn’t think straight. He only found one effective treatment – alcohol.
Rhys started drinking to blackout levels again. All of the things he had held dear were collateral damage as his relationships broke down. Then he was taken off the transplant list. His behaviour was so self-destructive that he would wake up in police cells to the noise of his new mechanical heart beeping. Its batteries would last only eight hours before Rhys had just fifteen minutes to change or charge the unit once the alarm sounded. If it ran out, Rhys would die.
‘I was angry and bitter. I was a victim, and I didn’t care about anything. I didn’t have the energy even for my emotions. And when I got that low, I could see no way out. I had done so much wrong; how could I ever do good?’
The rock bottom would come in 2019 when a car accident after drinking led to Rhys being taken to a rehab facility in South Africa by his family. We have all had that feeling of being in a stationary car, stopped at green lights. You need someone to honk their horn at you from behind. For Rhys, this was his last chance at his dog-eared life. But can people really change? Should we carry around our old mistakes like baggage, letting them weigh us down as punishment? The question Rhys asked more than any other during his month in rehab was, ‘Who am I?’
I have spoken with many people who have made poor ‘choices’ in life. These choices often end in ICU. The more I listen to their stories, the more I question the role free will has in people’s predicaments. Although my mum and dad are very proud of my achievements, are these really of just my making? I didn’t choose to be born into a loving family, into a household full of books, in a country with free education or in a century when most babies survive. I didn’t mix my personal blend of neurotransmitters in my brain that means I can understand science, avoid addiction and turn away from violence. And any choices I make occur against a backdrop of overwhelming noise and chaos in the world around me, making it feel as though personal decisions are insignificant in the grand scheme of things. Even MRI studies now show that our subconscious processes predetermine so-called choices long before we are consciously aware of making them. If there were any doubt before, this reinforces why medical care should never be allocated based only on the perceived worth of a person. Even if your life is a series of great decisions, should you be judged only by your worst one? If so, who really are you? It seems simple, but does anyone really know who they are?
The Oxford philosopher Derek Parfit spent more than twenty-five years trying to answer this question. The explanation he settled on could help Rhys and millions like him who struggle to walk away from the shadows of their past.
Parfit argued that personal identity is not what really matters when thinking about who we are. Instead, psychological continuity and connectedness are crucial. ‘You’ are not a static entity but a series of interconnected experiences that change and warp with time. We are not even the same person throughout our lives, instead we live life as a series of evolving selves. And while this highbrow notion seems of little relevance to a hard-hitting rugby player with an addiction like Rhys, it can be life-saving. You can let go of the past. You can be someone else. You are someone else. Every day. You can forgive yourself and become anew. Your past self does not define your future.
But shouldn’t identity matter? Yes, I am very different from my 18-year-old spotty, thinner self but still feel responsible for the stupid things I did back then because I am the same person. And I also care about what may happen to me when I am sixty because that’s also going to be me. Parfit agrees that yes, you should care about your past and future selves, but not because you are literally the same person. I will have the same name, the same birthmark on my ankle. I’ve been walking around in the same flesh-bag body since being born and have many of the same likes and dislikes.
But, Parfit argues, it is not these physical things that matter. Instead, his ideas align with the ancient philosophical puzzle known as the Ship of Theseus. Imagine gradually replacing every part of a ship day-by-day. You change all of the wooden planks, swap out every nut and bolt, until one day, decades later, none of the original components remain. Is it still the same ship? In fact, every seven years, each cell in your body has already been replaced. Are you then the same person? Parfit uses this analogy to illustrate his view that identity is not tied to a specific set of components but rather to the continuity and connection between them over time. It also shows how we should consider our actions against what Parfit calls ‘future persons’, the generations that come after us.
Healthcare is responsible for around 5 per cent of all greenhouse gas emissions. If it were a country, medicine would be the fifth-highest polluter, ironic given the impact that climate change has on the burdens of ill health. It’s hard to raise a glass to the next decade while the climate emergency causes more deaths than smoking, Aids, diabetes and vehicle crashes combined. These climate-related illnesses and injuries disproportionately affect low-income communities – another example of the poorest and most vulnerable people bearing the largest burden of ill health.
And within that polluting country, ICU would be the industrial heartland of emissions, a carbon hotspot in the hospital, producing three times more output compared with general wards. Every cardiac arrest patient in this book needs the equivalent electricity of a four-person household per day with over 180kg2 of CO2 produced, the same as burning 80 litres of petrol. The machines used to care for a critically ill patient require three times as much energy per day as the average family home uses per day. We would need to plant over 70,000 trees to absorb our unit’s carbon footprint and wait 80 years for them to reach their maximum carbon uptake. But that is OK. Or put another way, as the Greek proverb tells us, “A society grows great when old people plant trees whose shade they shall never sit in.”
Alarm is all very well, but what about solutions? I spend a lot of my time at overseas medical conferences and as I fly home it’s embarrassing that my talk about respiratory disease was powered by jet fuel, while the calories provided by the conference were delivered through meat. The lights that brought my colourful slides of battered lungs to life took their energy from the coal that coated the insides of the patient I was trying to save.
I want organisers of these events to commit to providing food that doesn’t bloat the atmosphere as well as those eating it. A meat-free lunch would do little to dampen spirits but could hopefully be a start to dampening forest fires over the next decade. A quarter of global emissions come from food production – half of them from animal product emissions, chiefly beef and lamb. Livestock contributes to global warming not only through methane production but through deforestation linked to expanded pastures, and the Intergovernmental Panel on Climate Change is pleading for us to switch to a plant-based diet.
If air travel is unavoidable in allowing human connections at conferences, we should nudge speakers to use honorariums or travel costs to cover ethical carbon offsetting projects, and this should be built into the travel expenses policy.
Organisers could cover travel costs of only the most efficient airlines or advocate train travel for short-haul alternatives. With online streaming and virtual connections, travelling halfway around the world to watch someone present slides and to check your emails at the back of a lecture theatre seems a little odd.
And the venues should be chosen not only for delegates’ convenience but also to improve our lives now and those of future generations. Selecting facilities that commit to renewable energy is a price worth paying for organisers, delegates and the planet.
This is also slowly being tackled for patients in ICU. Simply reducing unnecessary blood tests across Australia has saved $33 million, 4,400 litres of blood and the labour equal to forty full-time staff, not to mention the environmental benefits. My own unit now turns computers off overnight, uses light-emitting diode bulbs, and has stopped fully charging unnecessary electrical equipment. We used to spend more than £100,000 per year on those terrible plastic non-sterile gloves, 100 pairs used every day on every patient – 4,000 pairs a day in total. Reducing inappropriate gloves use by 20 per cent, bringing back human touch and good handwashing instead, has saved more than £20,000 and the burden of 1.5 million pairs of plastic waste from these gloves every year.
Nelson Mandela, like the Ship of Theseus, changed the cells in his body as he aged, changed his views, his knowledge and his relationships as he journeyed from prisoner to president. When he held up that rugby trophy watched by 13-year-old Rhys, he was a testament to profound change. ‘Do not judge me by my successes, judge me by how many times I fell down and got back up again,’ he would later say.
In other words, personal identity is not what matters. What matters is psychological continuity and connectedness. And as we age, we have fewer and fewer psychological connections with our childhood selves. Our distant future selves also become less connected to our present selves. I might even be more connected to other people, my wife and my children, than I am to that 18-year-old Matt Morgan.
This is a powerful realisation. It gives us permission and a logical argument to allow us to move on. You will still drag your flesh-bag body with the scars from your past mistakes but realise now that you are more like the person that you have become than any loser from the past. Or as C. S. Lewis said, ‘You can’t go back and change the beginning, but you can start where you are and change the ending.’
Although Rhys is not an Oxford philosopher, he is living proof of Parfit’s conclusion. His stay in rehab gave him the tools, the time and the humanity to heal. When we met on a sunny Welsh morning in a cafe in his hometown of Caerleon, I was the only one drinking anything. As I sipped a strong coffee, still tired from a colleague’s retirement party that weekend, Rhys was a picture of health. Physically he was the lightest he had ever been, sober for five years and not even drinking coffee. As I shook his hand, I couldn’t resist feeling for his pulse in the wrist still scarred from his procedures. Still nothing. It was an unnerving experience, talking and laughing with someone despite them having no heartbeat. But around his shoulder was the telltale black strap holding his lifeline device making this possible.
Although Rhys was back on the transplant list, he was in a difficult place – too well to be in the super-urgent category, but too unwell to live much longer without a transplant. He is approaching the world record of living with an artificial heart for fourteen years.
‘I’m still training as hard as ever, every day. But this is for the game of my life. I need to stay my best to make it to the starting fifteen to get my transplant. I want to keep living.’
He fitted perfectly into his new skin. He hasn’t forgotten about the past; he owns it and can still look back at that wild Rhys. But he can also gaze forwards, letting his life move on to better things. His website is framed by a widescreen colour photo of a strong, confident man, barefoot and tattooed, standing on top of a Welsh mountain, looking out across the scattered clouds with the sun just breaking through.
The breath work that got him through his panic attacks in hospital has led to a new passion teaching leaders in business and sport this life skill to address their own demons. His work with the charity Sporting Chance, founded by the former England football captain Tony Adams, allowed Rhys to share his journey with other professional athletes, supporting their own emotional and health problems. This lit a flame inside Rhys to set up his own charity, Tidy Butt, that deals with the stigma around mental health in schools, businesses and professional sports teams across Wales.
After we had spent a few hours together, I asked Rhys the last question on my list: ‘If you could press a button right now that would stop you from ever having become ill, would you press it?’
‘No way,’ came Rhys’s answer, without missing a beat. ‘I miss rugby so much and I would love to play again. Perhaps I will after my transplant,’ he smiled. ‘But I have found my sobriety. I found who I really am. Who I can be.
‘The best record I’ve broken is not a sporting one. I’ve broken multigenerational links of addiction in my family. I’ve changed the space between now and the future for me and my family.’
We can all learn from that space. First, we need to find space. There is a big difference between being mindful and having your mind full. Victor Frankl’s spectacular book, Man’s Search for Meaning, that inspired Jack to plant trees in Chapter 2 includes the line ‘Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.’
He also went on to say, ‘When no longer able to change a situation, we are challenged to change ourselves.’
Rhys is now a strong, fit, happy and confident leader. He is one of the most successful people to have ever come from that school in South Africa. Not because of the number of caps he has won, or his bank balance, or his police record. He is a success because of what he has overcome. Because success is like winning a boxing match. Everyone says congratulations but they forget how many times you’ve been punched in the face.