Dr Andrew Norton - Obituary

Posted By Grant Forrest |  last update 14-Jun 2022

Dr Andrew Norton, Past President and an early member of SCATA, was diagnosed with a malignancy some months ago. Initially, he'd responded well to radiotherapy and had begun a course of chemotherapy but subsequently had a sudden deterioration and died on the 12th May 2022.
Martin Hurrell and I attended his funeral in Alford in Lincolnshire on the 9th June 2022, and then at Woodhall Spa Golf Club where Andrew was a member for many years.

I'm very grateful to Martin, to Andrew's brother Roger, to Andrew's colleague Dr Gurdip Samra, consultant in Anaesthesia and Intensive Care Medicine at Pilgrim Hospital, and to Andrew's widow, Pippa for their eulogies. The following draws to a great extent on their words from the service.

Andrew Carey Norton

24th May 1955 to 12th May 2022

Andrew graduated from the London Hospital Medical College in 1981. His first house surgeon post was at the Royal East Sussex Hospital in Hastings, before returning to London for his second house physician post at Queen Mary’s Hospital in the East End. Now fully qualified, Andrew’s first post in anaesthesia was at Leicester Royal Infirmary, followed six months later by his first visit to Pilgrim Hospital in Boston. At the age of 26, he was embarking on a medical career that spanned four decades. After a 6-month post in Peterborough, he moved north, first to Glasgow, and ultimately to Aberdeen. Gaining the FFARCS in 1985, Andrew continued his post-fellowship career until 1990, when he was appointed to his first consultant post, returning south to the Pilgrim Hospital in Boston, Lincolnshire where he remained for 31 years. He held leadership roles in United Lincolnshire Hospitals NHS Trust, when it was formed by merger in 2000. He was an active member of the British Medical Association. In 2011, Andrew was awarded the FFICM and in 2012, he led the 4 million pound refurbishment of the ICU at Pilgrim Hospital, having the foresight to budget for and implement the Metavision digital care record system.

Andrew joined the UK Society for Computing and Technology in Anaesthesia (SCATA) in 1991, just four years after its formation in 1987. Not one to hang about, just three years later he became Secretary. He subsequently occupied pretty much every position, Treasurer, Membership Secretary, Chairman and President. The current president, Grant Forrest, remembers how Andrew, while President, “… kept me in good spirits during my simultaneous tenure as Chairman, helping me with points of order in committee meetings and making every resource that he could available to me so that together, we could further the interests of the society as a whole”. 

It was in his first years in SCATA that Andrew’s nascent and abiding interest in medical terminologies began. In 2001 the US Anesthesia Patient Safety Foundation (APSF) set up a Data Dictionary Task Force, chaired by Terri Monk. Its mission was to create a “Data Dictionary” for the specialty of anesthesia and Andrew, with his passion for terminology, joined as Content Director. 

It became apparent that if the work of the group was to have wide impact, it would need to align with an international standard. The obvious choice was SNOMED CT, the leading international controlled terminology designed for use in IT systems, comprising over 350,000 concepts. Each concept has a unique identifier that allows a receiving system to know what information is represented, regardless of language.

The task for the group was to identify, from this huge pool of concepts, those with specific relevance for anesthesia and to organise them in a way that anesthesiologists would find useful. To say that this was not completely straightforward would be an understatement. It was painstaking work: long hours in windowless rooms, hammering out seemingly endless details. By the end of each day most of the team were more than ready for something cool in a long glass but Andrew, being made of sterner stuff, would often head for his hotel room to put in a couple more hours so that everything was ready for the next day. He also made notes on new terms that the group felt were needed, and put them forward as candidates for inclusion in a future SNOMED release. 

In recent years, this work has passed to the Anaesthesia Clinical Reference Group of SNOMED CT which Andrew led, jointly, with Patrick McCormick and Andrew Marchant. Andrew was usually the anchor on the regular Zoom calls. He applied his huge expertise with patience and a dogged tenacity to get things right. Andrew Marchant recalls “Andrew's kindness and generosity of spirit” and says of him “He had quite a professional profile and you always wonder whether such people will be approachable - once you met him, you very quickly knew that Andrew was going to be a sympathetic and encouraging listener”. Ian Green of SNOMED remembers Andrew as “A quiet, unassuming, knowledgeable leader”. 

Andrew was an active member of the HL7 Anesthesia Working Group. The HL7 work focuses on structural models  and communication, relying on terminologies for detailed content. Andrew’s clinical experience was of great help in defining use cases and how content should be organised. Somehow, he persuaded his wife Pippa to attend some of the meetings and to record the minutes. Pippa set a standard that hasn’t been equalled subsequently.

Perhaps even more significant than the universal respect that Andrew enjoyed was the great affection in which he was held.  John Walsh from Massachusetts says  “He always seemed kind … I was impressed by his helping out in his ICU after he had retired. He also appeared very non-judgmental when correcting us in our errant ways”. Ellen Torres, who lives in Oregon describes Andrew simply as “… a wonderful, special person!” 

One of Andrew’s habits was to taunt the group by always finding himself a cheaper and better alternative to the official hotel in which each HL7 meeting was held. He seemed to be able to find places with Olympic-sized swimming pools and super-fast broadband for about $20 a night. Naturally, these were often some distance from the actual meeting but for Andrew, making the journey using complex combinations of public transport was just part of the challenge. He had an amazing gift for navigating strange cities and we found that the best way to avoid getting lost was to keep Andrew in sight at all times.

His dry humour, his appetite for doing work rather than seeking credit for it, and above all, the kindness and patience to which so many of his friends have referred will be missed. Isaac Newton said : “If I have seen further, it is by standing on the shoulders of Giants” and that perhaps implies that progress in science and medicine is founded on a sort of pyramid of genius. At least as important, possibly more so, is the quiet foundational work of people like Andrew who, so-to-say, lay the rails on which the trains run, and without which progress would be impossible.

Recently, Andrew received the SNOMED CT Long Service Award which was richly deserved. Monica Harry, Director of Content and Mapping at SNOMED International said of Andrew: “He showed passionate dedication, over many years, to improving SNOMED CT for the benefit of his colleagues. Steadfast in his resolve, always gentle in his demeanour, yet politely persistent in his drive to get things right. Through his leadership, Andrew inspired others to take up the challenge”. 

It's been a 20 year journey, but I’m sure Andrew would be pleased to know that, largely owing to his contributions, SNOMED CT has a comprehensive set of terms that will be invaluable to the digital system builders of the generations to come.

In addition to being a keen amateur golfer with a handicap of 10, Andrew was a music lover. At his memorial service, the attendees were treated to the distinctive vocals of John Fogerty and Credence Clearwater Revival (CCR) and their 1971 hit "Have You Ever Seen The Rain". In their eulogies, his widow Pippa and brother Roger both made mention of Andrew's wide-ranging musical tastes, from classical to modern ambient electronic and all stops between. Once, in answer to the question "what kind of music do you like?", Andrew answered: "Everything, from Rock to Baroque". If asked to pick a favourite, Andrew might have pointed to the Dutch band Golden Earring.  Whilst the majority of us could name their hit "Radar Love", their entire discography could be found in Andrew's collection, along with a similar repository of the works of CCR.  If he had a favourite genre, it would undoubtedly have been progressive rock, whether it was bands, supergroups, album covers or personnel, the breadth and depth of his knowledge was encyclopaedic. He and Pippa travelled widely, often to gigs in Europe and further afield, but the Skegness Embassy Theatre was their favourite spot for tribute bands.

Pippa recalls their wedding in Jamaica in 2003, specifically their return to Heathrow Airport where they paused in the arrivals hall for a quick coffee before attempting to locate their car. Having left Andrew seated in the cafe, she returned from a quick visit to a nearby store to find him missing, albeit with his suitcase still next to his chair. Alarmed by the absence of her new husband, concerned that he may have had a change of heart, her attention was drawn to a commotion in the area upstairs and to her right. An unfortunate soul had collapsed, and there was Andrew, administering CPR. 

This was typical of Andrew - his selfless care, compassion, kindness and willingness to help others.

Andrew and I were colleagues in SCATA for 25 years. I was struck by his modesty in relation to his personal achievements, his warm and gentle manner in both our business and social discourse, but above all, his genuine passion for the thornier aspects of clinical modelling and terminology. He never wavered in his desire to "get it right", always leading by example. 

andrew norton

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