President of the College David Tolley was in Christchurch, New Zealand in February when he was caught up in the devastating earthquake. He reflects on the experience in this edition's column

220211-1251. Ten digits which I shall remember as easily as I remember my phone number for the rest of my life. We were just two people visiting Christchurch on 22 February 2011: the events that followed will remain vivid in our memories for ever.

At 12:51, the earth moved. The roar of a rapidly-approaching express train was followed by a sharp crack and the conference centre (the venue for the USANZ meeting) rolled and shook. My instinct to get to the edge of the room and find shelter was made impossible by the severity and power of the movement. I fell to the floor and lay prone as the building continued to shake violently. I clutched my laptop tightly over my head – my only protection from falling objects.

"My instinct to get to the edge of the room and find shelter was made impossible by the severity and power of the movement"

The incessant movement continued for an eternity (although I later learned that it was, in reality, little more than a couple of minutes), before we were running to escape from the building. The structure appeared unscathed but it was obvious, through the dust cloud, that the building next door had collapsed. As we ventured towards it, we were turned back by reports of a gas leak.

I looked over towards the Crowne Plaza Hotel where we had been staying and prayed that my wife, Judy, was not trapped inside – or worse... As I moved towards the hotel, there appeared to be total chaos. A normally quiet intersection was gridlocked with police already on the scene, ordering people away, fearing that the neighbouring hotel was about to go down (in fact it had been damaged in the previous earthquake last September).

As I took in the surroundings, someone shouted my name and, as I turned, I saw Judy sitting on the kerb, her face covered in blood, a large pressure dressing on her head, aided by two friends. None of us had any idea of the extent of the damage nor the serious loss of life that had occurred in that brief period.

A car stopped and the driver, a young woman, took us to the Christchurch Hospital. I have hazy memories of leaping out and asking other drivers to move over to allow us through. I never learned the woman’s name but we shall be forever in her debt.

When we arrived, we discovered that the Emergency Department had been evacuated temporarily and a reception area had been established outside, where patients were triaged. The contrast between the ordered calm there, and the disarray just half a mile away, was striking. Ten minutes later, now inside the Emergency Department and with the bleeding from a large scalp laceration controlled with the aid of a large dressing and Presidential pressure, the assessment was thorough, compassionate and rapid.

While we waited for the wound to be sutured, I took stock of what was happening around me. I listened to the unruffled voice of the clinical director, Dr Jan Bone over the PA, leading the assembled team. This was a virtuoso performance by an expert in complete control of the situation; speaking calmly and quietly, she directed resources where they were most needed. The list of injuries which she called in the first 10 minutes alone was sufficient to fill a trauma textbook: a second volume followed rapidly as the extent of the carnage became apparent. The severity and number of the injuries increased rapidly: it was not long before there was a shortage of O negative blood.

As I ventured outside the cubicle to offer my services, I noticed those unoccupied were standing quietly, waiting for instructions. The direction over the PA continued – updates on availability of imaging, instructions on patient disposal – all the time comprehensively appraising all of the current situation while anticipating the next requirements. I am in little doubt that many more people would have died in the hospital that day without the skill and leadership displayed in the Emergency Department.

We spent the night at the home of the USANZ Nurse convener and her husband. The lack of power and water and the arrival of heavy rain did little to dampen Kiwi spirits as we cooked on the barbeque and dined by candlelight. Many others were less fortunate and spent an uncomfortable night in Hagley Park in the Civil Defence marquee.

Sleep was impossible because of the aftershocks. Their strength varied; many were minor but their effect was magnified as the city effectively lay temporarily on a water bed of slurry created by the liquefaction caused by a mixture of water from the high water table and the sandy substrate which rises to the surface. Others were significant and of sufficient force to shake the foundations of the house, bringing (irrational) fears of collapse. Imagine a long haul flight which flies constantly through turbulence from take-off to landing in darkness.

We were fortunate to leave the city the next day for the peaceful mountains 100km away – thanks to the generosity of another Kiwi urologist. I cannot begin to imagine the effect that the aftershocks (which still continue) had on those who had lost their homes – or worse their loved ones – earlier that day; I have considerable respect for the fortitude of the citizens of Christchurch, who had already lived with similar aftershocks for six months since the previous earthquake.

As we lay there that night, I realised that I had experienced all of the emotions ever described and had probably discovered some new ones too. I had moved on rapidly from my initial disbelief, through fear and anxiety for the safety of my wife, to admiration for the work of the countless rescue workers and the medical teams, and sorrow for the victims and their families.

There were many other feelings too, but my overriding memories are of the bravery and skill of those who worked night and day to free and treat those trapped in the rubble. I was humbled by the generosity, concern and the care shown by our local hosts, as well as by everyone we met in the immediate aftermath, despite the devastation and the personal loss and discomfort that they had experienced. The urologists played their part too. Many rushed to the Central Business District to assist in the rescue work; two young Queenslanders saved a man’s life by amputating both his legs in the field, operating in a confined space with only a Swiss army knife and a rescue worker’s hacksaw. A senior British urologist donned a hard hat and went with a rescue team into the partly-collapsed Press Building and onto the unstable roof to help save a woman who was trapped by fallen masonry.

As the scale of the disaster became apparent, so outside help arrived. Experienced international rescue teams provided much-needed aid but I was also struck by the work of the ad hoc army comprised of university students, who engaged in many tasks including clearing up the slurry of liquefaction and supporting the elderly, many of whom were temporarily rendered homeless because of a lack of water or power.

The outstanding care which I saw delivered in the Emergency Department that day did not simply happen by chance. It is a standard which has been achieved as a result of training across many different disciplines and when it mattered most, it stood up to the most robust challenge imaginable. That reminded me that, above all else, the College exists for the purposes of maintaining the highest standards of surgical care and invests heavily in surgical training – an ethos which we must maintain irrespective of any other outside pressures which threaten those standards.

The New Zealand people have exhibited a striking degree of resilience and resourcefulness: strengths, which as a profession, we need in plentiful supply, as we face the huge task of maintaining professionalism and standards at a time of the largest fundamental change in the delivery of care that the NHS has ever seen. As a College, we intend to support those in training by utilising the successful prize-winning ESSQ programme to develop further our distance learning programme in collaboration with Edinburgh University (see pages 18-19). Successful completion of a two-year course will result in the award of a Ch.M. The development of a Faculty of Surgical Trainers, established initially through a pilot project in Scotland (and open to Fellows of all Colleges), will further support the delivery of high quality surgical training.

I also witnessed the effectiveness of co-operation on a massive scale. Closer to home, we must develop closer collaboration with other surgical colleges wherever possible, and must include the specialty associations through the Surgical Forum, which I now chair, so that we can provide effective solutions to the challenges ahead at a time when the need for a unified approach has never been greater.

 David Tolley

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