Australia sadly lost a quiet giant of intensive care on 30 January 2022. Andrew Hilton was deputy director at the Austin Health Department of Intensive Care and made major contributions to the practice of critical care at an international level for over three decades.
Andrew was born 30 May 1959 at Albury Base Hospital to Kent and Lorraine Hilton. During his early childhood the Hilton family lived in Albury, Sydney and Canberra, and he commenced at Downer Primary School in the Australian Capital Territory at the start of 1964. As the eldest of three children, Andrew developed a near insatiable interest in just about everything, but especially music, sport, astronomy, space exploration, science, literature and film. In 1975, Andrew commenced secondary schooling at Watson High School in Canberra, moving to Albury High School for the last two years of secondary education in 1976. During these teenage years, he established a long term love affair with fast cars (preferably performance BMWs) and commenced many close friendships that would endure for the rest of his life.
In 1978, Andrew started as a medical student at the University of New South Wales. During the holidays he would head back to Albury to stay with family and work in the Haberfield Cheese factory. By 1983, he commenced at the old Canberra Hospital as an intern. Andrew's professional interests were focused on critical care, and he embarked on anaesthesia training, gaining his fellowship in 1990. For several years, Andrew advanced his skills and experience at Duke University Hospital in North Carolina and became widely recognised for his cardiac anaesthesia and echocardiography skills. Ultimately, he returned to Australia and commenced intensive care specialist training at The Alfred, progressing to a consultant appointment there in 2003. Over the following years, Andrew became established as a highly regarded intensivist and global authority on both critical care echocardiography and extracorporeal membrane oxygenation (ECMO).
In 2011, Andrew came north of the Yarra to join the Austin Health intensive care unit (ICU). He established an ICU-based echocardiography program, set up ICU-led ECMO, and contributed enormously to the life of Austin Health. During the subsequent decade, he was appointed to the role of deputy director of ICU, became an Associate Professor with the University of Melbourne, was Censor of the College of Intensive Care Medicine, was elected to the Australian and New Zealand Intensive Care Society’s (ANZICS) honour roll and received the ANZICS President’s medal for lifetime services to intensive care.
While Andrew’s appointments, achievements and awards speak for themselves, the many of us who knew and loved him have all lost much more than a highly regarded professional colleague.
Andrew was the consummate intensivist, operating at the highest level of clinical judgment, skill, knowledge and expertise. He demonstrated what was possible with detailed planning, exquisite execution, inspired leadership, and teamwork. His ability to calmly determine the best approach during a complex crisis was without peer. In addition, his use of echocardiography to rapidly diagnose and tailor therapy in the critically ill patient helped shift ultrasound from a peripheral role in the ICU to a central element of modern practice. While he insisted on the highest and most exacting standards of echocardiography, he was also always encouraging and supportive of anyone who wished to learn.
Andrew was a born teacher, but not just in terms of didactic teaching or lectures. His practice, his conversations and his leadership were eloquent demonstrations of how to provide care with great technique, extensive knowledge, and kindness. In many ways, he was rarely instructional, preferring to draw out the best from trainees and colleagues by providing suggestions, pointers or recommendations on how they might best achieve their full potential. Through his mentorship and guidance, Andrew was instrumental in shaping the careers of junior colleagues who now work across the whole of Australia and beyond.
Andrew had a strong interest in clinical ethics and enjoyed complex philosophical debate. He was instinctively driven to side with the underdog and abhorred the abuse of power, exploitation of anyone vulnerable, and the ugliness of prejudice. Andrew was expert at exploring extremely complex and challenging issues to find a way forward that afforded fairness, consistency, and compassion. He had the courage to speak truths that could sometimes be uncomfortable. He was very much able to recognise the ”right” way ahead, even when this might conflict with self-interest, and while strongly committed to collaboration wherever possible, he also understood the need to take a tough principled stance when there was no other way. He was comfortable adopting the contrarian’s view when it was essential to contest key ideas, and wonderful conversations would inevitably ensue. Occasionally, disagreeing with Andrew could be an exhilarating experience and it was always definitely a learning opportunity. Andrew reminded us that acknowledging our own humanity is central to our role of caring for others. His moral compass would never waver.
As a person, Andrew had the rare gift of seeing and appreciating people exactly as they are. While he was quietly spoken and not especially extroverted, people of all backgrounds would be drawn to him and discuss literally anything and everything. He was genuinely interested in people — their stories, their ideas, their differences and their similarities. In turn, he was not just appreciated or respected: Andrew was loved by those who came to know him.
We have lost a great colleague, mentor and friend, but his family have lost something far more precious. Andrew preferred to deal with his cancer diagnosis quite privately; however, when it was the right time for him and his family, there was an opportunity to celebrate and share what he meant to so many of us. During the last several weeks of his life, Ingrid, Sam, Max and Ethan extended remarkable warmth and kindness to all who came to visit and farewell Andrew; we are all grateful that they could share him with us during this most challenging time. Their loving care for Andrew during his final days was both humbling and inspiring to all who visited and will leave an indelible impact.
Farewell Andrew. You have left us too soon, but we are forever better for having had the privilege to work with you, learn from you, and call you our friend.