Keeping the region in good heart
After years working for the British armed forces, it appeared cardiologist Dr Nick Fisher was opting for the quiet life by moving to Nelson. Not so, reports Sarah Dunn .
Nelson cardiologist Dr Nick Fisher has worked for the armed forces during the Bosnian War, the Falkland Islands conflict and the second Gulf War, but now he is relishing a different kind of action at Nelson Hospital.
Growing up in England, Fisher dreamed of being a pilot like his father. He learned to fly before he could drive thanks to a programme initiated to encourage high-achieving students to enter the armed forces as soon as they finished school, but on his mother's advice, he entered medical school instead of the air force. Once he was a doctor, the navy beckoned.
"With no idea what direction I wanted my career to take, and severely broke after five years at medical school, I was persuaded by the Royal Navy to join them as a doctor rather than as a pilot."
Fisher said all doctors in the navy had to spend three years deployed with active forces as a general or trauma doctor. He spent time on frigates deployed to defend the Falkland Islands, to the Adriatic Sea during the Bosnian War and served with a rapid reaction force of the Royal Marines, pushing himself so hard that he now anticipates the need for a hip replacement.
Speaking about his standard arrival to a patient via a rope dangling from a helicopter, Fisher said: "I've taken off in a helicopter a lot more times than I've set down in one."
He returned to the navy for the second Gulf War in 2002. Following his time as a trauma doctor, Fisher went on to further medical training and discovered cardiology. He spent two years of research at the University of Virginia in the United States, and three years at London's Royal Brompton, a world-famous cardiology hospital.
Cardiologists operate by looking at a TV screen as they work, not at their hands. Fisher said he liked it because it was similar to the co-ordination tests used for pilots.
"Landing a stent in a moving artery uses the same skills as landing a plane on a windy day. You also don't have time to ponder decisions - when someone is having a heart attack, you have to think fast, come up with a plan of action and get on with it in a very military manner."
He went on to become a consultant cardiologist working for the armed forces of the United Kingdom, reaching the rank of surgeon commander. Fisher said many people asked why the forces needed a cardiologist, but with a fit, largely male population, cardiac arrhythmias and coronary artery disease was common. His training in stent insertion allowed servicemen to keep their careers and the military's investment in their training.
"I was demonstrating that, rather than retiring a young helicopter pilot suffering from angina due to a narrowing in his coronary artery, why not return it to normal with a stent and keep him flying?"
By 2005, Fisher decided he was ready for a change. When he spoke of his plans to establish an interventional service to insert stents in people's hearts in New Zealand to a Kiwi colleague, they wrote down "Nelson, Napier-Hastings, Tauranga" on a scrap of paper for him. "On a whim, I sent my CV to these centres, and received positive responses from all."
Fisher said Nelson seemed to be the most ready for his service, so in 2006, he joined the medical department. A year later, he established the first interventionist centre outside a surgical centre in New Zealand.
"Starting an interventional service in Nelson has been rather an uphill journey," Fisher said. "On reflection, it was like clearing a field long enough for a 737 to land, buying the plane, and assuming we had an air service."
He said he had to create a cardiology department before introducing the service, but Nelson Hospital's cardiology team now delivered some of the highest-quality heart care in the country. Fisher works there with cardiologist Dr Sam Wilson, the pair make sure their rosters dovetail so that they can provide close to a 365-day service.
His wife Tammy Pegg, also a cardiologist at Nelson Hospital, specialises in cardiac MRIs and advanced care planning. She regularly deals with people who have advanced heart failure, and is passionate about "giving people the truth, enough knowledge so that they can make decisions about what they want" when they have a condition with the same mortality rate as cancer.
"Intervention kind of gets the glamour," said Fisher. "It doesn't matter how many you save in the cardiac catheterisation lab, some are going to get heart failure."
Pegg said she was pleased to see the Nelson Marlborough District Health Board had just agreed to find a specialist heart failure nurse, and she was keen to see the nurse "owned" and directed by local GPs. She was interested in technology such as video links which would allow her to interface with patients over longer distances, and was involved with a closed Facebook group called "Shock Absorbers" which was for patients with implantable defibrillators.
"It's all about keeping them at home and out of the hospital," said Pegg.
She said her cardiac MRI service was the only publicly funded one in the South Island - although she currently devoted her Friday nights to running it.
"I always have to do all the cooking on Fridays," said Fisher.
Between them, Fisher, Wilson and Pegg use the cardiology's public equipment out of hours to run their private cardiology service, Top of the South Cardiology. Run by Fisher's mother, a former nurse, the service makes use of the same publicly employed staff and premises in order to treat private patients. Fisher said it earned the NMDHB upwards of $500,000 each year in fees, which were used to support the public health system.
Back at home, Fisher's father supervises the family's vineyard and winery, Mahana Hills, which focuses on "natural" winemaking with no finings, blending, chemicals or filtration.
"Remembering how we started the cardiology department, we thought, ‘How hard can it be?"'
The Nelson Mail