John McCall has come a long way since he was a medical student stitching his first wound.
On that occasion, he fainted and woke up on the floor of the Wellington Hospital A and E department.
"It was the situation - having to put a needle through someone's flesh," he said, laughing.
"It's an unusual thing to do. Obviously, you get desensitised to it to some degree."
But Prof McCall says while there is an aspect of surgery which is compelling, he never forgets he is "physically performing an assault" on patients.
Brought up in various parts of Southland and Otago, the closest John McCall got to the medical profession was his mother's work as a nurse. His father was a farm manager, stock agent and shopkeeper and John planned on being a farmer.
Neither did he have much involvement with tertiary education; his older brother was first in the family to attend university.
Prof McCall entered the Dunedin School of Medicine in the late 1970s and discovered his niche, although had no burning desire to be a surgeon.
"You become exposed to different things and surgery was one of the things that interested me. At first, the tussle was between [specialising in] surgery, general practice or internal medicine."
So why surgery?
He says he enjoys the technical and personal challenges and the ability to give patients often life-transforming treatment.
"The medical care of surgical patients is also interesting and rewarding and just as important as the surgery itself. Then there are the personal interaction aspects. Often people think surgeons don't interact with patients because the patients are anaesthetised during the operation, but it is not like that at all."
Prof McCall was specialising in liver surgery when he was invited to become one of the founding surgeons at this country's only liver transplant unit, established at Auckland Hospital in 1998.
Liver transplants had been performed in other parts of the world for decades, but in New Zealand there were few options for patients before the mid-1980s. Between 1986 and 1996, about 100 New Zealanders went to Australia for transplants, a major undertaking for patients and their families, including a heavy financial and emotional burden.
Eventually, the New Zealand Government called for proposals to run a unit in this country and Auckland won the contract.
Prof McCall was asked to go overseas and train in transplantation techniques. Despite mixed feelings about leaving his family behind he did so, spending most of 1997 at Kings College Hospital, London.
The New Zealand unit performs between 35 and 40 transplants annually, using mainly livers from deceased donors.
In a carefully-timed exercise, often outside usual business hours, a team of surgeons travels anywhere in the country to collect livers - and usually other organs as well - from people who have died as a result of severe brain injury but whose organs are able to be maintained for some time on life support.
Livers are flown back to Auckland where recipients and surgeons are on standby for a transplant.
New Zealand, like most countries, is short of donor livers. After a few years, Prof McCall introduced two new techniques used overseas - splitting one donor liver between two people (a child and an adult) and taking part of a liver from a live donor.
The first live donor transplant was carried out in 2002, five years before the procedure was established in the UK.
Live donation is controversial because of risks for donors, Prof McCall says.
"You hear about people donating a kidney to someone else, but with kidneys you are born with two and you can take one out and the other manages quite well. With the liver you are born with one. It can be separated, along with blood vessels and bile ducts . . . but it is much more major surgery for the donor and there is a small but real risk of death for the donor."
So far, 30 live donor transplants have taken place in this country, with no donor deaths and good results for recipients.
Receiving a new liver is life-changing for patients and their families, and satisfying for the surgeons, Prof McCall says.
"All those having a transplant are facing very serious illness or death without it. We give them a new lease of life. As a surgeon, it is very satisfying. That's why we do it.
"The long-term success rate is very high. People send us photographs of their kids and holidays and lots of other things, which is great. There is also lifelong contact with transplant patients to monitor them and deal with problems which can crop up later."
Five years after a transplant, about 90% of New Zealand patients are alive and well.
"People do die occasionally and that's devastating, of course. Families usually realise we have done the best we can and it's not possible to guarantee the outcome of any medical intervention, particularly one as complex as a transplant."
Prof McCall has resigned from the unit, but will still perform some transplants in Auckland.
He made the move south mainly for family reasons. After three years at the University of Otago part-time, his wife, Prof Jennie Connor, was recently appointed head of the preventive and social medicine department.
The couple have three children, a son who has started at the University of Otago, a daughter studying dance in Auckland and a son "who has gone to Germany to follow his girlfriend".
Prof McCall's position was made possible through a bequest from the F. and J. McKenzie Charitable Trust which, among other things, aims to recruit and retain staff at the Dunedin School of Medicine.
PROFESSOR JOHN MCCALL
• Age: 52.
• Born: Southland.
• Educated: Southland Boys' High School.
• Graduated: Dunedin School of Medicine, 1982; graduated as Doctor of Medicine (research degree similar to a PhD) 1993.
• Career: Trained as a general surgeon in Auckland and Dunedin, qualifying in 1991; fellow positions in colorectal and liver surgery Australia 1992-94; senior lecturer Dunedin School of Medicine and surgeon at Dunedin Hospital 1994-96; fellow in liver transplantation surgery, Kings College Hospital, London, 1997; surgeon with New Zealand Liver Transplant Unit, Auckland 1998-2009; University of Auckland medical school 1998-2009, clinical professor from 2007.
• Career highlights: Surgeon at New Zealand's first liver transplant unit; pioneered split liver transplants (where one liver is shared between two recipients) and live donor transplants.
• New position: McKenzie professor of clinical science, University of Otago.
• Roles: 50-50 position with Dunedin School of Medicine and Southern District Health Board teaching surgery, convening professional development course for 4th-6th year medical students, research, and carrying out general and liver surgery at Dunedin Hospital.
• Interests: Tramping, climbing, keeping fit, reading, gardening.
