Study suggests why some women have a lower risk of stroke
Averil Mansfield was an ambitious and talented young doctor when she announced, to a senior surgeon, her plan to marry her architect boyfriend.
“What a pity,” he replied. “You had such a promising career as a surgeon.”
Fortunately for the thousands of patients whose lives Mansfield went on to save with her pioneering vascular surgery, she was undeterred by his response.
Such a reaction was, sadly, very much in keeping with the general attitude – that women must choose between marriage and career – within the medical profession at the time.
Despite marrying her first husband Jonathan in 1960, these discouraging words ringing in her ears, Mansfield reached the very top of her game, becoming a consultant surgeon in 1972, aged 35, and the first female professor of surgery in Britain in 1993 when she was 55.
“I didn’t want any special treatment, just for those around me to acknowledge that I could do the job”
“It simply never occurred to me that it might be difficult to become a surgeon,” says Mansfield, now 85, who retired from the NHS 20 years ago. “I didn’t want any special treatment, just for those around me to acknowledge that I could do the job, and I’m grateful that most of my colleagues were exceedingly helpful.”
Mansfield’s reputation was such that Estée Lauder and John Mortimer, of Rumpole of the Bailey fame, were among her celebrity patients. She had the honour of being a guest on Radio 4’s Desert Island Discs in 2020, which led to her being asked to write her new autobiography, Life In Her Hands.
She was also awarded a CBE by the late Queen in 1999 for services to surgery and to women in medicine and, in 2018, presented with a Lifetime Achievement Award by Queen Consort Camilla, who was then Duchess of Cornwall, at the televised NHS Heroes Awards.
“Camilla was full of good humour and we spent time together in a studio afterwards, talking to TV channels, until she suddenly said: ‘I think I’d better go home now. We’ve got rather a busy week’. It was the week of Harry and Meghan’s wedding!”
Mansfield’s gratitude to the supportive colleagues and superiors she encountered – first at Liverpool’s Broadgreen Hospital and later at Hillingdon Hospital and St Mary’s Paddington, in London – was magnified when she heard evidence given to the Royal College of Surgeons Working Party on discrimination in surgery in 2021.
The independent review was commissioned to help address a lack of diversity in the profession, as only 17% of surgeons are female, despite the fact that 50% of today’s medical students are women.
Baroness Helena Kennedy QC, who led the review, heard shocking evidence of ‘locker-room talk of a sexually explicit nature in surgery’ and of a female surgeon referred to as ‘a pretty girl with an empty head’ in theatre.
One outcome is the setting up of a working group, Parents in Surgery, to come up with ways to support surgeons with children, given the anti-social hours many are expected to work, as well as frequently being on call.
Mansfield believes such support is long overdue and readily acknowledges that not having children, while not a choice she actively made, was likely a factor in her own considerable success.
“I would have liked children but I wasn’t able to with my first husband, so I just focused on the other things in my life,” says Mansfield.
“Then along came my second husband, Jack, who already had three children, and suddenly I was a stepmother. I was approaching 40 when we met and, understandably, Jack didn’t want more”
Far from being the sort of trailblazer who wants to pull the ladder up after her, Mansfield used her position to support others by setting up the organisation Women in Surgical Training in 1991, which later became Women in Surgery. “I get lovely messages from women surgeons who tell me I have inspired them,” she says.
In 1991 Mansfield was invited to set up an organisation, through the Royal College of Surgeons, called Women in Surgical Training, which later became Women in Surgery, to ‘encourage, enable and inspire’ other females to follow her lead.
Just 2% of surgeons in the UK were women when Mansfield qualified in the early Seventies. By the Nineties, when 97% of surgeons were male, not much had changed.
Today, 17% of surgeons are women, although male consultant surgeons still outnumber females by a ratio of 8:1. Membership of Women in Surgery, which also welcomes medical students, has grown to 6,000.
“Although we were producing lots of female medical students, we were not producing lots of female surgeons,” says Mansfield.
“Not that women necessarily make better surgeons, but if it’s a career that appeals to women, then we should make sure it’s possible for them to pursue it.
“There’s still a feeling that it’s a boys’ game, which is a shame, because it isn’t.”
“Women in Surgery is not about positive discrimination, but giving support that can help women on their way and make sure they get the advice they need.
“Unfortunately, there’s still a feeling that it’s a boys’ game, which is a shame, because it isn’t.”
While she says she experienced little discrimination within her profession, patients would often react with surprise at discovering the gender of ‘Professor Mansfield’.
“There was one man in my clinic at St Mary’s with an aortic aneurysm who stripped naked and laid on the couch for me to examine him,” recalls Mansfield. “Afterwards I said: ‘Put your clothes on and we’ll have a chat’ and he said: ‘When will I see Professor Mansfield?’
“And I remember explaining to a man in my clinic what was wrong with him, the operation he required, the pros and cons and then he said: ‘So who’s doing this operation, doctor?’ I replied: ‘Well, I am,’ and he said: ‘Bloody hell, a woman’.”
‘A woman cannot be a surgeon’
A male visitor at St Mary’s was even more blunt, after asking Mansfield what job she did: “‘A woman cannot be a surgeon,’ he replied, and I said, ‘Well, I am,’ with a laugh. He said, ‘Then you must be very good.’”
At 5ft 10in, Mansfield was certainly an imposing figure in the operating theatre. She excelled at every stage, scoring top marks in her surgical exams.
And gender had certainly not been the only hurdle she had to overcome. Raised by her welder father and stay-at-home mum in a council house in Blackpool, she was also among a tiny minority of working-class students reading medicine at Liverpool University in the mid-1950s.
“I was very aware of a support network of old boys from certain schools operating behind the scenes,” says Mansfield. “While I knew nobody when I arrived at medical school.”
She received little encouragement from her teachers, either, and is amused by the memory of one school report that said she was ‘no good at sewing’, given what an expert in suturing she became.
Her parents spent years trying to deter their headstrong daughter from pursuing an ambition sparked at the age of eight as she thumbed through medical books in her local library.
“My mother thought I was being ridiculous, that the daughter of a housewife and a welder living in social housing could not enter the medical profession, but finally came round to the idea when she saw I wasn’t giving up.”
Mansfield was born 11 years before the advent of the NHS – she recalls her parents saving money in a jar on the mantelpiece to pay medical bills – and witnessed the many benefits it provided as well as huge advances in technology during her years in practice.
“I’ve lived through the advent of ultrasound, CT and MRI scanning, and all have made diagnosis more reliable and help plan for surgery,” she says.
“When I started, in 1960, anaesthesia was not nearly as sophisticated as it is now, and there was no such thing as an intensive care unit.”
A lifelong pianist
Mansfield is passionate about her chosen field of vascular surgery, which included stroke prevention operations. Still, she recalls with amusement how she recently told a visiting plumber that their jobs were the same: “Arteries are like pipes, and can either be falling to bits or blocked so you either put a new bit in or clean out the old one. That’s it.”
While sad to retire – it was a requirement of the NHS in 2002 when Averil reached 65 – she has certainly made the most of retirement. A lifelong pianist, she has since learnt to play the cello and is part of three amateur orchestras, through which she has built a busy social life.
Her one sadness is that Jack, a general surgeon who was ten years her senior, and died from heart problems in 2013, only got to spend the first decade of retirement with her.
However, she is enormously grateful to him for giving her three step-children and six step-grandchildren, to whom she is “very close”.
“One of the reasons I enjoyed writing the book is that it will be a memento for them,” says Mansfield.
Reflecting on her remarkable career, she adds, “As surgeons we’re sometimes operating on people who are on the edge of life, and don’t always succeed in saving them, which is the very worst part of the job. But knowing I have helped save thousands of lives – I still receive letters from people who wouldn’t be here without the surgery I performed – is a very special feeling.”
That, together with inspiring thousands of female surgeons to follow in her footsteps, means Mansfield will leave a great legacy .
Life in Her Hands: The Inspiring Story of a Pioneering Female Surgeon (Ebury, £20) is out on 23 February.
Written by Helen Carroll