Gerald Keen was a cardiothoracic surgeon at Bristol Royal Infirmary, Bristol Royal Hospital for Sick Children and Frenchay Hospital from 1964 until 1991. His most enduring achievements were the introduction of cardiopulmonary bypass to Bristol in 1965 and the enlargement of the facilities for open-heart surgery, which permitted the volume of work carried out in Bristol to increase from a little over 60 operations each year in 1964 to over 900 when he retired. He was born on 9 February 1926 in London, the son of Myer Keen and Rachel Mary Keen née Waller, who had a grocery store in Lambeth, the family living above the shop. He was awarded an entrance scholarship to Westminster Hospital, where he qualified in 1949. After two years of National Service in the jungles of Malaya from 1950 to 1952, which he considered a ‘maturing’ experience, he embarked upon a surgical career. Specialising in thoracic and cardiac surgery, the latter very much in its pioneering stages, he trained with Russell Brock at the Brompton Hospital and with Charles Drew and Price Thomas at Westminster Hospital. During this time he worked in the laboratory under Drew’s direction, developing the technique of profound hypothermia and circulatory arrest, one of the methods which permitted open-heart surgery to begin. Later he had the opportunity to work for a year in San Francisco with Frank Gerbode, the noted American heart surgeon, who contributed to the training of a number of British heart surgeons. Keen’s practice was originally thoracic and cardiac, both adult and paediatric, but over the years he concentrated increasingly on adult cardiac surgery, predominantly valve replacement and coronary artery bypass surgery. Cardiac surgery was an evolving specialty during his working life, and he incorporated successive developments into his own practice. Except in his final years of work, he had just one cardiac surgical colleague, with whom he had an excellent working relationship; they both maintained an immense commitment to the care of their patients. He found time to publish several papers, to become a Hunterian Professor of the Royal College of Surgeons of England (from 1971 to 1972), to write a textbook on chest injuries (*Chest injuries: a guide for the accident department* Wright, 1975) and to edit one entitled *Operative surgery and management* (Bristol, J Wright, 1981). His introduction of cardiopulmonary bypass and the development of the unit required considerable determination and was achieved in the face of some resistance. He lived many years after retirement and had the satisfaction of seeing his unit working to the highest standards and the equal of any in the country. His legacy also includes many patients enjoying a good quality life after successful treatment and those young doctors whose training was, for a longer or a shorter time, under his supervision. He was an ideal colleague – loyal, supportive and cooperative. His sense of humour was mischievous, and, on his day, he was a great raconteur. In retirement he maintained a medico-legal practice for many years and enjoyed golf and bridge as well as being an avid reader. Marion (née Goodwin), his beloved wife of 61 years, predeceased him in 2016 and he was survived by their two sons, David, a dentist, and Richard, an industrialist. James D Wisheart **Gerald Keen also wrote his own obituary, which he sent to the Royal College of Surgeons of England in November 2020:** Gerald Keen was born in London above his parents’ grocery shop, which his father opened in 1920 after returning from the First World War. He was educated at Coopers’ Company School, one of several City of London ancient grammar schools. He entered King’s College London in 1944 and Westminster Hospital in 1946 with an entrance scholarship in anatomy and physiology. Following qualification, he was called to military service, and served for two years as a regimental medical officer to the Scots Guards and Malay Regiment in the jungles of Malaya during the Emergency, a very maturing and worthwhile experience for a young man. He trained in general and later cardiac surgery at Westminster and Brompton hospitals and in San Francisco. Modern open-heart surgery in the 1950s, apart from one or two centres in London, was totally undeveloped in the rest of the UK. In the 1950s and early 1960s a number of young surgeons, including Keen, went to the USA for training in this new specialty, where it was well established as a result of huge financial investment, helped by the American determination to succeed. His year in San Francisco with Frank Gerbode was very rewarding professionally and a very happy time for his wife Marion and their sons, David and Richard. He was appointed to Bristol Royal Infirmary in 1964 as the first and only full time cardiac surgeon in the southwest of England, caring for 3.2 million people. At that time chest surgeons undertook all types of cardiac surgery at all ages, together with lung surgery, oesophageal surgery and chest injuries, whereas today the modern cardiac surgeon restricts their practice to cardiac surgery. There was no intensive care unit for a further four years. In 1964 diagnostic ultrasound, CT scanners, MRI scanners and coronary angiography were for the future and appeared at least five to 12 years after his appointment. The underfunding and general lethargy of the system at the time, coupled with the poor understanding of modern cardiology, were important obstacles to progress. There were no trained cardiologists or paediatric cardiologists in Bristol until 1974 and much of the anaesthesia was conducted by GP anaesthetists. For the next ten years he and a younger colleague were faced with a huge pool of patients with advanced and often terminal heart failure, so far treated with the inadequate drugs of the time, who were offered for surgery as a last resort and with a consequent high mortality. This early experience was typical of most embryonic cardiac surgical centres, which were under resourced, under trained and under staffed, and consequently cardiac surgery in the UK was hazardous. It was some years before cardiac surgery in the UK became a safe and routine specialty. A new modern hospital building was built in 1971 and the top floor was planned as a nurses’ sick bay. Fortunately he was able to persuade the management that the idea of a nurses’ sick bay was antiquated, and it was agreed that this ward of 20 beds should become the new cardiac surgical ward. Eventually the unit with eight consultant cardiothoracic surgeons and a large team of cardiologists, anaesthetists and nurses was housed in its own building and over 2,500 operations were performed annually. Further units were opened in Exeter and Plymouth, a total of 15 cardiac surgeons for the same 3.2 million population served initially by one surgeon in the southwest. He regarded his cardiac surgical life as a journey from the Wright brothers to Concorde. He brought back his American training to the UK and developed this with Russell Brock, Clement Price Thomas and Charles Drew, with whom he developed the technique of profound hypothermia, particularly useful in the open-heart surgery of infants when cooling to 15°C allowed the surgeon prolonged periods of total circulatory arrest for operating on the still open heart. For this work he was awarded the degree of master of surgery. He developed a special interest in the traumatic rupture of the aorta and published on a large series of successfully treated patients (usually motor cyclists), the basis of his Hunterian Professorship at the Royal College of Surgeons of England (‘Closed injuries of the thoracic aorta’ *Ann R Coll Surg Engl*. 1972 Sep; 51[3]: 137-156). He found time to produce textbooks on chest injuries (*Chest injuries: a guide for the accident department* Wright, 1975) and operative surgery (*Operative surgery and management* Bristol, J Wright, 1981). His contributions to cardiac surgery and its development in Bristol were generously acknowledged by the Department of Health. The family were very happy in Bristol. Sons David and Richard were educated at Clifton College, David becoming a dental surgeon and Richard chairman of a national construction company. Marion, his beloved wife of 61 years, spent 30 years as a volunteer, teaching juniors in deprived areas to read – she was rewarded with an invitation to a garden party at Buckingham Palace. During his sometimes early disheartening career he was strongly supported by Marion, who sadly died in 2016. In his final few years he found companionship and comfort with Isabel Norris. Gerald Keen