This is Derek Hockaday interviewing Chris Reynolds on the fourth of March 15.
Chris, I think you qualified in Cape Town in 73.
I did. And what did you do then? Did you come over to Australia?
Well, I did. It's embarrassing story.
My school had been the test bed for scholarships.
So when Cecil Rhodes wrote his will, he said that the school would have a scholarship in perpetuity, although it was just a school.
Everybody else had to compete in a rather wider field. And the year of 1972, there was a shortage of candidates.
My headmaster asked me whether I would be kind enough to become a runner in the race,
but I was to come second because he'd already chosen the person that he wanted.
And as a favour to him, I went to the interview and found that the favoured candidate fell over in the in
the race and he was in the embarrassing situation of having to give it to me,
which he didn't like at all, and he couldn't bring himself to phone me. So I actually only found out because the because the the local newspaper,
which called itself The Cape Times, rang me up and said, and what are you going to read at Oxford?
Which was a bit of a shock to me because I had absolutely no plans to read anything at all.
And I was only a fifth year medical student. And Oxford insisted that I didn't do my house jobs in South Africa, that I come up the next year,
which was would have been Michaelmas term nineteen seventy three, which I couldn't because I was taking my finals.
So they said I would have to come the next term and and they said I couldn't do my house jobs and I would probably read a PPP.
And this was all completely confusing for me.
And I was asked what college I was going to go to and I hadn't even thought about that because I had no thought that I was coming to Oxford.
So I have to really have a crash course in Oxford.
When I got here, the warden of Rhodes House, Willemse, said, he says yes, Williams, what was his first name?
He called me and and realised this was all a bit of a bit of a mess.
So he phoned the then postgraduate. It was a Mr Potter.
He was the neurosurgeon whose book on head injuries I had read as a medical student.
So, you know, when was things the authors of books must be dead. Yeah.
So I went to I went to see him and he said, this is ridiculous. You need to walk the wards.
And he found that there was an Oxford student who'd failed his not only his finals, but also cancer, said Edgar Williams was his name.
Right. Monty Montgomery's chief of staff. Yes, indeed.
Cartographer's, that is he said there was there was a job.
And because there was a medical doctor, medical student who'd failed, not only had he failed, Oxford failed.
Wilson said failed the the exam to take down in London.
So he sent me off to Northampton to meet an X reader in surgery called Kevin Cronin.
Yeah. And I went for the so-called interview.
He just chatted to me and he said, well, I must be going now. So I said, do I have the job?
And he said, Oh, dear boy. He said, anyone is good enough for Oxford, it's good enough for me here in Northampton.
So I was going to start with him. And then I was sent to interview to be interviewed by John Badenoch,
who was all a bit he's trying to do his clinic and he assured me into a side room, didn't make me lie down to examine it.
And he sort of looked at my CV. And I think that there was a problem because there wasn't going to be anybody.
And then I met you, Derek, and you said it was all going to be OK.
So I did six months and six months in in Northampton and six months at the Radcliffe Infirmary.
And actually it was great fun. And I had a I had a wonderful time.
And then I met Peter Morris because I wanted to do nephrology and he offered me a place in his in his lab to do the field of transplantation.
And I've also got to know that John Ledingham and Desmond Oliver and with some nephrology and the transplantation defo, which I finished in 1979.
So when you set out from South Africa, did you see yourself staying in England or not?
I didn't, but I was actually asked that at the interview because they said, will you come back?
Because South Africa was in the grip of totalitarian apartheid and there was
absolutely no prospect of the national government ever being voted out of power.
They had an. Entrenched majority. And things were getting worse and worse and worse.
I mean, the White House had a pretty good standard of living, but the the political temperature was going up and the well,
the way they were then calling all young white males up into the army for two years.
And but the thing that I found when I went back there is that I when I tried to to reason with people,
even people for my own language group, I found that either they were completely out of sympathy with me.
And I mean, they felt that Slavka would have to evolve in its own way and that apartheid will just have to be modified.
And I was told that I was an idealistic fool for believing that apartheid was destined to fail.
And I'm proud to have been involved in it because it turned out that I was correct.
Yeah. So after three or four years, I felt out of sympathy.
My wife's family had left South Africa and I felt comfortable here.
And so I elected to stay and I eventually got my British citizenship in nineteen ninety.
But I do feel bad about not having gone back because the idea of the Rhodes Scholarship is to come to Oxford
University and take the what the opportunities you've had and take them back and put them back into the country.
But there are quite a lot of Africans who didn't do that then.
So you did, you did feel we were doing a bit of clinical during that time.
I did with this. And and I worked on the.
So the transplant is interesting for the medical school point of view is that I arrived here and there was no professor of surgery.
He had just died. Remind me, Derek, what his name was Alison.
Yes. He was apparently a very famous thoracic surgeon one time, apparently some Martorell bellbottoms.
And I think he operated on the oesophagus. And yes, he was a great for the oesophagus, but apparently he was unwell anyway.
He died. And so the Department of Surgery, there wasn't anyone here.
And Peter Morris was recruited as a vascular surgeon and as a transplant surgeon and to run immunological research and transplantation.
So it was quite good timing, really, because he didn't he was setting up his lab and didn't have research fellows and because I came with a salary.
So I met him at the Rhodes Trust Scholarship.
Coming up, dinner. Right. Of course, this is all completely new to me because I wasn't really familiar with with the university and the sort of thing.
And I was quite a bit abstemious individual.
But at this particular meal, there was rather a lot of wine and then a drink, which I hadn't wasn't familiar with, called port.
And then cigars were passed around. And the next day I thought that I'd had a subarachnoid.
But anyway, Peter Morris invited me to and I've been registered for it.
And do you feel. So he then used me as a as a locum working on the on the transponding from time to time.
And um, I also helped in the with all of the data systems and then got the NHS job.
So I got my early training and in taste of nephrology,
in transplantation from from the professor of surgery and from from from all over and John Nottingham.
And what was your day feel on what were you researching? We were testing a hypothesis that if you did that,
you could make an animal tolerant to its kidney transplant if you blocked its immune
response early on by giving the recipient animal an antibody against the donor antigens.
And the certainly worked in animal models.
And it was probably a bit like rhesus that you could that you could mop up immunogenic cells when it worked perfectly in the animal model.
And I did not you'd have a 600 renal transplant, not as quickly as the laboratory technicians who could do them in about 12 months.
My personal best was about 17, but anyway and it worked very well.
But unfortunately, the antibody was going to fix complement.
So I had my next part of my experiment was to lop off the C section of the antibody so that it wouldn't fix complement.
Would it then work because the fact the fraction would be rapidly stabilised.
So I made to fractions and they didn't fix the complement and gave them and they worked but less well.
And that work was then supposed to go on into larger animals.
But in fact it never progressed. And that particular. That particular.
Models seem to be one that worked in rodents, but it didn't work in higher mammals and so and so it never went in.
But what I learnt I think the interesting thing about it being a field is,
is that I learnt to be disciplined intellectually to read every paper that I quoted, to know the whole subject.
I learnt, I think, to write systematically. I learnt statistics and fatality statistics from Richard Peto, who was the and I'm quite sure what he did.
But he was Mr. Richard. We were sent to see him.
And I've still got his lecture notes because he told us the principles of statistics before he told us the methods.
So we understood why we were doing what we were doing and why we couldn't compare things in a particular way in a very logical way.
I think he must have you know, I think he knew that he was talking to non mathematicians, but that really set me up to understand that statistics,
not just plugging numbers into a computer, you have to know what you're why you're doing what and what's legitimate.
And so I didn't and I didn't have to work in a laboratory, which I think is a tremendous discipline.
I learnt the terrible disappointments that you have when experiments don't work, because I think Alan Island uncertainty.
I learnt disappointment. I learnt hard work.
I talked to right. And I think I learnt how to criticise in a constructive way.
Who told you to write? Did you just learn by experience?
I think I was a bit of a mimic because I read good papers and I thought this was the other thing I,
I think I learnt was by reading what I do and back to myself out loud.
Very good, because, you know, I could scan it and Cassandra.
Right. But in fact the grammar would would jar if it wasn't written correctly or the sentence was too long.
And I was told to summarise the sentences for far too long.
So it would be a bit of a game where I would write the paper and he would lengthen the sentence with adding another several phrases on.
And then I would put a fullfil that I thought I could only carry a C.
So what I, I mean, I think I write reasonably well and and so prepared me for editing textbooks.
Yeah. And what have you. So, so I had, I felt enormously privileged to be here, but of course it was, it wasn't the place it is today.
It was quite a small medical school.
I found the medical students quite enchanting because they were they were I think, almost picked for their for their characters.
They were many of them were very interesting human beings in other ways.
And I've followed some of them. And what's happened to them subsequently?
Um, and the other thing I enjoyed was very much like what we had in Cape Town was that when they were members of Thurm, they were there all the time.
And, uh, they joined in on the takes.
And when you got to chat to them, you find many of them, you know, were accomplished in many other fields.
And they I have to say that contrary to to what I had expected, they had a good work life balance.
You know, they did their sport and what have you. And they they would turn up for the Waldron's having quietly got themselves ginned
up so that if doctors paid not Hockaday or driven and shot them a question,
they would be able to be able to handle it.
I didn't I mean, I, I did a little bit of teaching of them, showing them cases and what have you, but they were mostly seem to be very well taught.
And what did you think of the nurses compared to Capetown? I thought they were better.
They were they the nurses in South Africa tended to be much more function is doing as they were told.
The nurses here took much more of a leadership role.
The interesting thing was the way I watched how they handled junior doctors and the more mature they were,
the better they handled us because they wanted to get the best out of us.
But they knew that we were rather inexperienced. And I actually had a I had some very nice nurses.
I wonder whether you remember Megan on little the Scottish.
Yes, yes. Yes. So when I was you know, if I was doing a lumbar puncture and I was making heavy weather of it, she would,
which wasn't often, I'm pleased to say, but she would just quietly come along and get the patient into a better position.
A position is a yes. And she was you know, she would help me tidy up afterwards.
And I mean, it was just a I thought they handled the junior doctors. Very well.
And who is the senior registrar, Alan Beven it?
No, it was Bob Simpson behind the Bob Simpson told me a lovely story when he was your senior registrar.
He he was very supportive of the junior staff. And he really got him on the tape, not just about midnight, having kind of mock things up.
And he was never, never got disappointed if you asked him for some advice.
And I remember being very frightened one night because I was called down to Ronnie
Ward and where there was a man who had several metastases from the cancer of the
lung and he was in status epilepticus and it was four o'clock in the morning and it
was the long ward and just his light was on and the other patients were all awake.
And I was having some difficulty. And in in, first of all, getting Evenflo in to give him the diazepam.
I then got in and then I gave him a modest pace and he didn't didn't help.
And so we kept starting up again.
And so I rang Bob and he just took me through it. And the following day I said, I want to tell you how grateful I am because I was very frightened.
I felt completely inadequate. And and, you know, I you know, you gave me reassurance and whatever you say said think nothing of it.
I said, you know, because it wasn't traditional for somebody. Registrars left.
Their duty is a little bit high and dry. So he said, well, you know why?
I said, well, why do you why have you sort of made it a point to keep you advised against it?
Well, you see, when I was a junior doctor, I think he might have been in Southampton. He said we had a diabetic ketoacidosis come in,
which in those days was a pretty terrifying presentation because it was treated in a different way in those days.
And I know that just was changing just as I came here, the small that sort of incident.
And he phoned his senior registrar who said to him, incidents the stuff and slammed the phone down.
And and Bob said that wasn't much help. And so I had a bit of a baptism by fire.
Yeah. Of managing this patient. And he said, I thought that was a horrible thing to do to a junior doctor.
So maybe I mean, that example made me vow that I would never leave the junior doctor high and dry.
Not that I mean, I probably hadn't thought about it, but I but I, um, because I was a junior doctor,
but having been supported by him and he was he was he went off to be a consultant at Chichester.
Yes. And I've never seen him again. But I gather he's retired. But he looked after us very well.
He was a good guy who was sensational. Steve O'Keefe.
Oh yes. And I think became a nutritionist. And I think he actually went to South Africa.
Right. He was a because he was very lovely to them.
And it was always that was the interesting thing about Oxford is you found the people done these fields
and things and were really world experts in some particular area while they were beavering away.
So there was a huge mixture of of, I think, remarkable people.
I, I don't want to name drop, but but I did feel a sense of of all when Sir Peter Medawar came to the department to give a seminar,
he'd had you straight by then and he had an anonymous hemianopia.
So his wife, who apparently worked in the dance school, actually moved the lectern round.
And he gave this wonderful talk on the immunology of cancer.
And he made a whole lot of self-deprecating jokes, which I wasn't used to because it's not as an African thing.
So he said, you can tell this experiment has been honestly performed because I got exactly the opposite result.
I was in my hypothesis, the [INAUDIBLE] and the and James gowns.
I heard James gowns and you lady went in the MRC giving seminars at the dance school.
And my the technical supervisor took me over to to the dance school where there was a wonderful seminar.
The this is the discovery of the of of the function of histocompatibility antigens,
which we thought had been put on human beings to frustrate transplant surgeons.
But suddenly it was discovered that it was the mechanism for cells or recognition and killing virally infected cells.
And the people who did that work at Dockerty and Zinkernagel. But someone from their lab came and presented the data and we were tipped off that this
was going to be stuff that was good when she got the Nobel prise that we would listen.
So we all trooped off to the dance school and crept in the back and one of the little seminar rooms was there.
And this beautiful seven of which I understood about seventy five per cent and it was twenty five per cent that I didn't understand.
And I decided that under no circumstances would I put my hand up and ask the question where a hand went up at the front of the.
Of the. Of the. Seminar room and asked the question, implying that the question had also not understood the same 25 percent,
and I was very relieved, but I didn't know who it was.
So I turned to my supervisor, technical supervisor John Faith, and I said, I am not in a stage whisper spat.
And he said, That's Rodney Porter. And he got the Nobel prise for discovering the structure of antibodies.
So I felt that I was in good health right now. Technical supervisor, was he a clinician or a scientist?
Yes, working with Peter Morris is he had qualified as a doctor.
And he and he went and he actually did he did some postdoctoral work in the Dunn school.
And he was really an immuno chemist. So he taught me how to.
He taught me the sort of techniques of preparing antibodies and what have you.
And he went off later to work at the Institute of Child Health.
So maybe Demorris, being the professor of surgery, wasn't going to have a chance to buy that books every day.
So he was he kind of he supervised my day to day work.
And, you know, if I didn't know the method he taught me and I think it's good to be true.
And he was he was a very skilled laboratory. And so then you go to different field, say seven.
Did and did you go straight to the reading unit?
Well, I got the registrar job, which in those days was as six months, three or six months gerontology with Leo Walnut and somebody else's name.
I've got to went off to New Zealand. Sean McCarthy. Yes. And Gordon Willcock was about.
And so I did the six months in the in the unit and then I did six months of geriatrics and then at Colorado nervously that it was very traumatic.
And I was very fond of. Well yes.
But he would make me do the thyroid function tests on every little old lady.
I'd come in. So I once had the temerity to ask him. I said, Dr. Welner, are you anticipating that this patient might be hyperthyroid or hypothermia?
And he said to me, well, it could be I said I never kept a book,
but he wasn't quite so quick to ask me to do thyroid function tests after that, because I think he was just kind of diminishes me.
And then there's all of us said to me, we've had enough time.
He had been here for six, six years, seven years.
And he said, I know nothing of you.
Here is the time you went out and did something else.
And I had thought about going to Australia and my parents and all lived and had an interview with the famous Priscilla Kinkaid Smith.
But she she didn't offer me a job and is all over, then turned around and he said bad news, said all the best there.
Not many training person around you. They're all taken. Guys was taken.
Newcastle was taken. Um, Cardiff was taken.
And the days were the best ones.
But I've run the Hammersmith Hospital and at the Hammersmith Hospital er they just closed applications, but they'll take one from you.
And so I applied and I was appointed. Right. Yes.
So it was days. Who did that sort of thing not. Yes.
John Ledingham had withdrawn a bit from the from the reading at that stage I think they got on but there was
there was a certain tension between them and and I mean there's John getting a mad general medicine to do this.
Didn't do. Have you had the clinical school to do? We had new college.
And for him to be on call for the day to day problems, kidney that was really not plausible suggested most.
And I think he does. I think he looked after his his juniors and he knew I wanted to nephrology.
And he was worried about the sort of Oxford phenomenon of people never leaving.
There's to need to go somewhere else. Yeah. Anyway, I got the job and then that was nineteen eighty and eighty one.
I started eighty two and and then six years later it was agreed that they needed a second consultant,
but that he was a consultant because he was old and getting older and it had a very tough time,
a case that they turned off dialysis and got into the newspapers and they've been
accused of er euthanasia and General Medical Council and all sorts of horrible.
His morale was quite low. So I came in in eighty eight and started as a second consultant.
Right. And have you done six years and then have to go into business with.
Yes, yes. I've been, I've been the senior registrar and then I've done some post-doctoral research and then I.
Become the baby to senior lecturer, and then I have this fantastic opportunity of working on the testing in man of recombinant human growth research,
but that's where you tend to refer to them as well.
I mean, I did the curious thing was that I was asked my interview what was a tractable problem in renal disease that was the right solution.
So I said the treatment of anaemia,
because these patients are transfusion dependent and these were young people dragging themselves along with the Enflames five.
And I could see they hadn't I mean, they thought this was interesting, but not that not all of them.
They were all immunologists.
And then, I mean, it's just the most amazing piece of luck that the the British expert on another person was a scientist called Mary Curtis,
who did the assays. She wasn't a clinician and she persuaded the company that had produced Recombinant Rippert
and that because she had the assays and she worked with a very good team of hepatologist,
including a man called Martin Picard, who was one of David Wetherall fellows,
who was an expert on metabolism, that that she was the right place to test this material.
And she had another haematologist who was very good at looking at bone marrow function,
in vitro, taking bone marrow and looking at that red cell production, what have you.
But you didn't have read it.
So she phoned up Professor Peters, who was not a man interested in dialysis or anaemia, and said he said, I got just a check for you.
He works now, renal unit, and he's interested in this. So she came to you and we got we were given the second batch to put in to test.
The other was tested in Seattle and a very famous reading unit by a very famous team.
But when we got our first test results, Keith, Peter said to me, you should publish.
I said, well, it's not really in my data belongs as much to Mary Kate. So he said, rubbish.
She said Scoop said so. He said, I'll phone up the editor of The Lancet.
And I've seen the work and I see he said it's fantastic. So I mean, it was straightforward.
So he phoned and the editor of The Lancet said, well, if you'll send me a manuscript by the middle of next week, we'll get it in in the fortnight.
So with Mary, I sat and typed out myself. Mary Kate looked at it.
It was very simple study just before and after.
And what you put any of the kinetics and things like that.
And it came in a later paper and The Lancet and appeared in The Lancet,
I think it was in 1985 scooping the New England Journal of Paper by the Americans.
Infuriated, very good. Absolutely infuriated. And it was met with you described as deafening silence.
No one seemed to know the significance at all up here. I mean, I I was asked to give the talk on the face, but I really I didn't know what happened,
but no one seemed to know this was this was a complete game changer.
And we just completely abolished transfusion problems in renal patients.
And anyway,
then Washington eventually got into the newspapers and I got onto the onto the radio where I was television where I was interviewed by Jeremy Paxman,
who, needless to say, asked me very testing questions. And I was I was the observer came to interview me.
It was quite funny because they'd been to see somebody else about growth factors and said, well,
you know, don't talk to me because my growth factors don't do anything for man at the moment.
But there's a guy down at the Hammersmith.
He's got this growth factor that seems to be working to the Gerba came to see me and I said, you know, this is not I'm just a small cog.
Here's the day's what I want to photograph and what have you.
Anyway, the photograph, as they said, to separate the bottom line, I say, well, this is fantastic.
This is an idea that's fulfilled its promise. And so, unfortunately, they put a picture of me in the in the in the Observer,
which said fulfilling its promise in particular paper was stuck up on boards saying, C.G., when I was fulfilling his promise.
Extremely embarrassing. Yeah. But anyway, it was a it was a game changer.
Quite a lot of work on it since. So that and that happened.
And then I applied for the job here that you probably published several other papers from the industry and the story then you applied up,
which of course was quite a big risk because I was in a protected academic environment at the Hammersmith
with as an adequate but not overwhelming amount of clinical work and lots of time for the research.
But it was a pretty tough environment. And it wasn't it wasn't a it was a kidney.
It was struggling with inadequate facilities. And I'd be very.
Here in Oxford, and I thought I would get on reasonably well with Oliver and Peter Morris,
and so when, yes, all of us would be put in an application, I put in an application,
I was told at the Hammersmith, and if I put in an application,
they would not renew my senior lectureship GPA, which I thought was a bit rough, very rough.
So I, I spoke to my wife and she said, well, I think you said Oxford because I know the people.
Then I get home from to be my declassifies and there's been a mentor.
So I applied and I was appointed and have had eighty eight.
That's twenty six, 27. And happy is coming from the heavens.
How did you find the two compared.
I think the Hammersmith had a broader range of research than it was a pretty tough environment, unforgiving environment.
Failure was not accepted. I mean they used to say that no one ever got stabbed in the back.
So it was always in the front end.
But there's a lot of very exciting stuff.
Are they the good thing about the place was that it was quite iconoclastic and you took no one's word for anything.
So if someone got up and made an ex cathedra statement, they would get challenged.
And there were some outstanding departments that were present and the standard of the discussion and the questioning was really very good.
And I mean, some of the work that was coming out of that, you know,
the work on practise nocturnal haemoglobin area and the cardiologist's on coronary interventions,
I mean, there was the bone marrow transplant unit, but it it was it was exhausting because it was very demanding.
You were expected to work very hard clinically and keep up your research when you were a junior doctor.
And when I got here, I was much softer place. I mean, it was clearly very good work going on.
And it wasn't quite so much clinical science going on here of working with patients.
A lot of stuff going on, you know, in in laboratories that was of interest.
But it wasn't I didn't see much of what's called translational medicine at that particular stage,
whereas, you know, the iPad stuff was going at the lab to into the testing the patients.
So I suppose that's the big difference is, was that there wasn't as much other clinical research here.
I also thought that people were a bit politer.
They may have been thinking things I'm not saying, but the Hammersmith was a very brittle, sort of abrasive, abrasive environment.
I mean, I had several unhappy humiliations, um, one of which, if you've got time of the I I had a patient had a kidney transplant.
He was a musician from San Francisco who wasn't gay,
but he was British and he got rid and come back and we put him on status and gave him a transplant.
And he's in the 80s and and he fell to bits.
He got cytomegalovirus in his eyes. He got pneumocystis pneumonia.
He got terrible thrush.
And I said that he's he's having a far west on the patient. He must have he must have some immunodeficiency.
So HIV had been AIDS and be describe it, HIV hadn't been identified.
So there was no viral testing. So I presented him on the Grandstanders page transplantation immunodeficiency syndrome and got booted out
of the lecture theatre as being someone who'd had catastrophically over immunosuppressed this individual.
I said I said not not true. I said he got the standard treatment.
Anyway, um, about nine months later, the first test for what was called the three came out at St Mary's Hospital.
And I went to the serum bank and I took it down to Saint Mary's Hospital and he was HDB three positive.
So in fact, we had transplanted an HIV positive individual unknowingly because we didn't have a test and no show anyway.
He was written up. And needless to say, many of the people who thought that I was talking through my hat were very pleased to be on the paper.
So it was a pretty abrasive, really abrasive environment.
And when you came back here after six years, how at this place changed or how did the kidney unit.
Yeah. It hasn't changed much, and that was I think was the was was maybe why I was appointed,
it was just doing the same things and the registrars were kind of carrying a lot of the work.
But there was a little bit of research going on and not much teaching and, um, no seminars.
And and so I think. But I mean, it was still working pretty well.
So it was a good, safe, sound kidney unit. But it was it it was not it was punching well below its weight.
And I mean, it should have and I think it was because there hadn't been an investment in in stock.
But in fact,
the interesting thing was that quite a lot of very bright Oxford graduates and registrars had for some reason got interested in the colleges.
That much of the frustration of David Wetherall. I think a lot of them enjoyed working with John Ledingham.
So I'm thinking of people like Peter Rateliff was a registrar and did a lot of clinical research, some of it very perceptive stuff.
Nothing, nothing to do what he's doing at the moment. And a lot of his lab work had been very demanding, but not brought him any interesting results.
He worked on hypoxia in the kidney and there was heavy rain and there was John first.
So there was there was a very busy bunch of people around here. And so we try to build it up into into an academic unit.
And Peter Bingo got a chair. So I said, this is really gonna sound like namedropping.
But because I went to the Hammersmith and because I've worked here, I've worked with some really interesting people,
most of whom have now, of course, the stratospheric while I'm at my feet on the ground say so.
Let's check Barzeh, which is the vice chancellor of Cambridge University, was the senior registrar when I was down.
Sir Robert Leclair, he's now head of Kings, was massively distraught as a Peter Radcliffe was Sir John Saville.
He was the head of the MRC. He was son as a senior lecturer. So I think they've probably forgotten who I am.
But I do. I was it was great fun.
Oh, Peter Matheson is now going to be Vice-Chancellor Hong Kong University.
He was a senior registrar that the professor of medicine at at at Brighton was the registrar.
Patrick Maxwell was say so I've it's been great fun working with some extremely talented people.
So when you came as a consultant, you weren't swamped by the clinical work.
He could get some research. Yeah, I did. But in fact, I drowned eventually.
Right. And it was just this was, I think, exhausted and burnt out.
And we were going through the crisis.
I mean, Derek, he would remember when we used to ration dialysis. Yes.
Such the diabetics were not favourably thought about.
And now thirty percent of the patients starting dialysis are diabetics.
There was there was a kind of almost prejudice against diabetics and prejudice against the elderly.
And that and Des had a day fix that everybody had to go into home dialysis, which was going to break because not everybody could put up with it.
Yeah. And it was it was it was pretty tough.
I worked one in two nights and weekends and then things improved a bit in 1995.
But so I became a collaborator. I collaborated with the team on polycystic kidney disease, which we had a lot of polycystic disease here.
And that was that was fun because they found the gene hajee.
Yes. They found the fact they found the major underlying chromosome.
The the original author of the paper, um, called Steve Reed, has actually been headhunted to Yale.
Yeah. To finish the job they found. Yeah. They found they'd found here, Steve, and found the more place where the gene was but didn't find the gene.
So Yalgoo recruited him and he went over there and they were going to find it in six months.
But the gene is duplicate and they didn't find it. And the man he left behind, Peter Harris,
had a lucky break because there was a family where there was a crossover and Peter found it and got the got the paper.
It was an Oxford family contribution contributed to that. I've collaborated with him.
And then I just got a new interest, actually, which was one of two things,
is that people with myeloma can develop acute kidney failure because they're like Chanes, some of them about 10 percent in the light chanes.
Will find covalently to timbales for protein and form superglue in the tubules, and so the kidneys will just go off like that.
And we saw cases like this and we had a very good pathologist to stain the kidneys beautifully
and showed me the almost what I call red protein in the wrong peptide in the wrong area.
And then I was a very big, very big state of patients here.
And I was asked by the International General Assembly to give what was called a kidney forum,
which was named by somebody to give a lecture on a case which is then recorded.
And they invite the great and the good to hear it. And then it's published.
And I offered the military personnel have done this because I'd seen leptospirosis.
I said we've done that. So I said, well, I see a lot of my limited knowledge about it.
They said, we'll do that, but learn about it. So I went dry for five months and read everything on on myeloma and gave this case.
And it's been an enormous milestone. We've done two clinical trials here on trying to improve the prognosis.
And interestingly, we can now pretty well stop the disease in its tracks because there are better drugs for turning off the light gene synthesis.
But in the laboratory in America discovered which like Chanes who caused this catastrophe,
we don't have a peptide blocker for it yet, but we've improved the prognosis.
But so I've become the the person that people chatter about difficult cases of myeloma.
And the nice thing about having worked in Oxford is watching my subject go from depressing to to quite optimistic big changes.
When did transplantation come in to change the clinical scene?
1974. Peter Morris arrived in 1974 and he had they were about 140 home dialysis patients who were young and otherwise fit.
And he brought the Melbourne Royal Melbourne Hospital expertise here and started in 1974.
We've not done they've done over 3000 transport must be getting on nearly 4000 now.
So we do about 150. And it meant that there was not such a need for dialysis.
But what it meant is that we were then taking on other people.
And then Peter Friend arrived about 12 years ago and brought kidney pancreas transplantation, which when it's good, it's fantastic.
I mean, you see these people's lives, the diversity activity transplant,
if you do a great deal for the long standing tissue injury, in my view, the autonomic neuropathy, the disease.
But it it it certainly stabilises. Yes. But that's been a very exciting event to hear.
Now, that's fascinating that because I always think really the tissue damage is at least two stages.
And if you go to the second stage, you're never going to reverse it, let alone stop it completely, but reduce the rate of progress,
because it reminds me of another wonderful moment in my time as a working here is that angiotensin converting enzyme inhibitors,
which we were told would not would not really fly. And I was the one and there was a woman with a bad blood pressure.
It was had renal failure and undergone it again. And we couldn't control it except with drugs that made it very symptomatic.
Mithal Dopa and Minoxidil, which made her hair. And she said she was in terrible way.
And John Ledingham said, we've got to give her this new squibbing drug, which I think was need to think about it all.
So he got on the phone and asked them all see blood pressure in Glasgow to send him a packet and they sent him packing and leaving with.
Absolutely. So he said, oh, they said, no, no, we can't do this.
This the drugs under way. So he said, but if you send us the patient, Sir John Ledingham turned to me Friday afternoon about three 45 said,
Chris, get this weapon on the shuttle up to Glasgow due tomorrow and get her sent to the MRC blood pressure.
So I said to John Hughes, Doctor, I think you've got a slightly optimistic idea of my powers of influence here.
I think you better phone the House governor and see whether you can fix up a taxi to Heathrow and pay for the air ticket.
So he said yes. Suppose he said, but what you have to do is do a very good discharge.
I mean, I don't want to a poor discharge summary going. It's not by now that quarter past four and the secretary's gone.
So I went into the office and there was Molly, who was the home dialysis organiser, and I said, Molly, I have a favour to ask you.
Molly typed on a golf ball typewriter. My. That went up there and this woman went up to Glasgow and they put her on Captopril
and it works and she came back and she's still the patient mine right there.
Just terrific. And she's in The Lancet. That's terrific. Yes.
Was there any connexion, apart from oxygen between your Ripperton work and the oxygen sensing were?
Absolutely. But I thought I must say what Sir Peter Radcliffe, I come here as the consultant director to senior registrar and I get invited to a
basic science meeting on hypoxia and the risk ripperton and I said to the organisers,
I don't think I'm the right person to go to this meeting because I would love to go.
But I would be a spectator because I've got nothing to contribute. And could I give my place to Peter Ratcliffe, who's interested in regional hypoxia?
So they said, no, you can't, but you can go with him and you can share the travel money and the hotel room.
So if we went and it set him off and he's kind enough to admit that, that's what I mean.
So he went and he heard all the best basic scientists. And then he came back and he taught himself molecular biology.
TAUTOU He said, I want to understand what turns the other person on.
And as you know, he discovered the mechanism, which I think you'll probably get recognition other than his fellowship, the Royal Society.
And he he took on the registrar, Chris Pugh.
He'd also been a student here, and he took on Patrick Maxwell, who'd been a student here.
And and the rest is history. So it was he said, I'm not interested in hiring reposing works name.
It works, but I'm interested in I'm interested in in how it's controlled.
Yes. And his wonderful experiment was everyone thought the kidney was the only organ that had an oxygen sensor.
So you get a whole lot of experiments in which he transected cells with reporter Jean and he found that they all seem to switch on.
And he thought he must have missed his experiments,
that he'd found the phenomenon of widespread oxygen sensing death, which he had some trouble getting published.
But of course, it led into understanding of of of possible Lindahl disease.
And he did into the understanding of tumours and all sorts of things.
So it was it's a it's a been a major biological discovery.
I didn't take I didn't take an iota of credit, but it was rather nice that he was interested in kidney hypoxia and I was interested in the right spot.
And it just happened that there was this wonderful little meeting in Paris that we both went to.
So his labs were in the main job.
They were in the erm and I think actually how much of the church do you feel sort of bit isolated from the German general?
Fairly. I think it's I think we would have been a bigger and a better kidney unit if we'd been on the mainland side,
because I think we would have collaborated with cardiology and chronology and everybody else.
I think we would, yeah. I think I could imagine that we would have seen research projects.
But because because there was this London road between us, we didn't have an intensive care unit.
We I think we were a little bit the the country cousins in that, which I think is a pity.
I mean, we have we only wanted to be down. We wanted to not aged or a coronary angiogram.
The patients had to be shipped over there. The other thing we didn't have the we didn't you know, you didn't have that sharing of ideas and chatting.
You know, we were a bit isolated. We had the best ideas is always in the gaps. And so that wasn't a good time.
Did you go to the Thursday afternoon round round, for instance? Yes, I doubt I the they were kind of slightly the high point of the of the week.
I set up our own renal runs here on a Tuesday afternoon for the biopsy meeting with the grand rounds.
I made a point of getting to and I just had the standard of the presentation was excellent.
The sad thing is that they're not very well attended anymore.
I don't know what it is. I mean, they were almost a three line with medical students to be there and the junior doctors would be present.
And it was considered, you know, it was a thing you did. They didn't seem to be taken quite seriously.
But the stand is extremely high. And Peter Radcliffe is a fantastic, fantastic chairman.
He always asks very searching questions. David, whether it was a very good one.
Wonderful occasion.
Tim Littlewood presented a case of thrombotic TGP and they treated the patient and they got better with infusions of fresh frozen plasma.
Never knew how this worked. So did Wetherall knew that work, but he was too embarrassed to meet with.
And so he said, Doctor, what is it? Dr Littlewood, do you know how plasma infusions work in TCP?
Latimers would said yes, yes, yes.
I guess so. They were. Are you going to tell us?
No, it's a secret. Which I thought was a nice way of saying, you can mock me, but I could get my neighbour to, in fact, as you know,
and I discovered that actually it's because these patients lack of approaches that breaks down one valbrun factor.
So we knew that she knew how it worked. Now, you mentioned pathology.
How important is that? And the back up to the original. What I said is we we we we would be incapable of doing our jobs.
We've had three excellent pathologists. We've had Michael Dunn.
He was of course, he's a fellow American and he was one, but he was also a director of clinical studies.
And I was told when he came, he came as a lung pathologist and there was no such thing as a pathology.
And John Ledingham said to him, you have to take this on as an aside. And he did.
And he wrote Donal's textbook of renal pathology to be up there somewhere and gave us a fantastic service.
And then when he retired, we managed to recruit the reader in pathology in St. Thomas's, who David Davis.
And he was wonderful, very supportive.
And when we were doing talks or writing book chapters, they would always come up with the illustrations, very loyal to the kidney unit.
And and then when he retired, we'd been even luckier because we recruited one of the top four pathologists in the world.
And a chap called Ian Roberts, who is has a fantastic reputation, is a brilliant teacher,
a fantastic diagnostician and and a good researcher and very loyal to us, too.
So he's not somebody who's sort of absent without leave. I mean, he's here for the meetings and that.
The trouble is that and this does worry me a bit as the NHS university divide,
is that if I wanted to make a suggestion to people, I would in fact have no university hospital divide.
I would have a set of salaries. And the clinical director could say, you're doing good work.
I think what we're going to do is to reduce your clinical work a bit, give you more time. But people are stuck in a rather rigid job description.
So he has a huge workload. And I think he would say, well, he was one example.
A lot of people, I think, where you could see early in your career,
you could flex the amount of of clinical and research work you doing in someone's research work was going well.
You I think you could ease off on that. Someone was an excellent teacher. You know, you could flex things, but people look.
So anyway, pathologies been pretty good.
So the aspects you have. Bacteriologists Yes.
Interestingly, the great change in in in in microbiology and microbiology used to be a place we sent samples.
We went in there. You could smell the ego. Now they are out amongst us.
So terrific and everything. And you can find them up and say, what should I do?
You can say, I've got this job. What should I do?
Then I on the wards, in fact, they come to our transplant meetings, they help us diagnostically and they've got new diagnostic methods.
Say, for example, cytomegalovirus, which is diagnose in retrospect from seroconversion,
is not diagnosed today by PCR test on the number of CMB copies.
And they can tell you straightaway, they can tell you how the patient can help us with the patient's treatment.
So there was a lovely virologist. She was you started that his name is going to go to my head at the moment who died some years ago?
John Tobin. Oh, yes, Sir John was lovely because he would come to the meetings and say,
I've got some results here, and he would tell you what the significance of the results were.
But he wasn't really a clinical microbiologist. And now we've got Derek Crook and Chris Conlon, who will have very strong infectious disease.
So the good collaboration between them.
So, I mean, John Kerry and I particularly remember because he was supportive on the virology front, that we've got good,
good virologists and they all got a clinical trial, some of them new clinics, and they do stuff on John Walker.
And I would say that's true. Never we never lonely now. And there's any of the bacteriological genetic now.
Yes. As you probably know, they did a beautiful piece of work on Castrillon difficile, which proved that it's not in intra hospital.
It actually is coming in from outside. And given the thrashing that we got from the Daily Mail and in Parliament, from the Department of Health and,
you know, we were Macchi doctors, you should have learnt from what was his name in Austria, you know.
Some of them, obviously, and, uh, when this piece of work, it was not as simple as that, are a lot of organisms, actually it's not much inside.
It's it's coming in. I don't remember seeing any of that in the Daily Mail or on the Today programme.
So that was work done by, I think, Derek Crook, Peter Panopto heavily involved there.
Now they've been tracking the MRSA. Is that looking at the tuberculosis?
We had one fantastic example of a woman who became hepatitis B positive on the dialysis unit.
And the assumption is immediately that we've given to her by the dialysis needles or blood transfusion.
And anyway, she they took her hepatitis B virus away and they and they sequenced it.
And actually, one journey found in Indonesia. And she migrated from there about 40 years ago and it must have been dormant in her.
And so we were let off the hook as not having been the the criminals.
So watching molecular microbiology. So cytomegalovirus, hepatitis C, I mean, we can even call B.K. virus that infects kidneys.
Did you talk to anyone then? It's like now because just, you know, you just get the test,
whereas we had to work on it on the basis of this is clinically likely, but we can't be sure.
Yeah. And dietitians well, renal units can't function without dieticians.
The interesting thing was that we really needed was the dietetic service that was prohibitive and we stopped people eating.
Yes. And now actually they're completely different. Now they are nutritionists rather than less than that.
So we have our own team have their own offices here. They got all our patients.
We refer to those that are malnourished.
They they're pretty on to us. They track the ward patients and their caloric intake.
And if they're not feeding, they're the first ones to start telling us it's time to set up the initial feeding.
And they're very good at constructing the central feeds based on so interesting example of
multidisciplinary working because nephrologists alone wouldn't really be able to do anything.
So we have the first I mean, our nurses are have a lot of independence,
so we have no specialists and they come to us, they say, I've done this much, done three quarters the job.
I just need to know whether we going to go left now right or stay the same nurses, dieticians, the two I can think of.
And the other thing is quite a lot of social support.
Yes, I'm sure because of the with the families, because I mean, renal disease is not a kind of thing to a family and physiotherapists.
Yes. We don't have enough of them there. They're the ones that stop up,
get our patients mobilising because they're tough with them and have difficulties once again with this example of being on the wrong side.
You know, we have kind of strokes. And what we need is straight medicine is completely different from what it was when I was a junior doctor.
I mean, it was it was a sort of Didden phenomenon. So there that we can't do without them occupational therapists as well,
because the occupational therapists will suss out a person's abilities and their suitability for home pretty quickly and courteously.
They seem to have the wherewithal to say, give me five days and I'll get the wherewithal.
And then here you are in Oxford.
But you went after the region probably. Yes. So Oxford is a it's got a hospital for a big city in a small way, essentially.
What is a small town, really? And I was very keen that we should not lose out.
Ah, just to general hospitals. Not only do they teach our medical students, they are junior doctors go out to rotate out there,
but also our clinical our clinical referrals come from there.
And Oxford couldn't justify being a big kidney unit if we only looked after the city of Oxford or 600000 people.
So we took off. We are really in it for for about one point eight million and the transplant unit for about 2.5 million because we do wedding.
So quite early on, I offered to go to Northampton.
I used to go to Northampton, where I met the famous Charles Fox who worked with him on his diabetic nephropathy patients.
And we set up a dialysis unit there. So that was quite a lot of travel.
So I used to look after that. And then somebody in Whitehall decided to redraw the map and created something called Northampton,
Leicestershire and Rutland Water and confiscated Northampton Practise that we took on the whole of Buckinghamshire.
So we run a big kidney into Milton Keynes, a big kidney unit in Stoke Mandeville and had been kidney unit in.
We can and we've always lived up to Swindon. And after much fighting, we have a big kitchen unit in Swindon.
We never looked after reading and we used to look after lost by referral, but then they go to Bristol.
So I'm in favour of a hub and spoke model because it's good for our referral.
Practise is good for patients too, because the patients are getting difficult for just a general hospital and not being patronising.
It's nice to know they can go in and have the registrars get good experience and it means we have a lot of throughput.
What it means is a good team working for the patients and go back there and we need
the number of beds in our transplant unit transplants for later reading as well.
So they've got a very big catchment area. So you do have patients in Banbury and er and I do the mistake and the mistake madam, but I'm the only one.
Northampton was confiscated. I lost my clinics there, so I became peripatetic so I would go to any unit that was under pressure.
So I worked in Milton Keynes, I worked in Swindon, I worked in Sacramento.
I would just get in the car and go and do the clinics out there because like when you're a bit older, you can work a bit faster and take a registrar.
But it wasn't ideal. What they needed, I think, was a consultant there who the the the general physicians could come and talk to.
So we're trying to set that up. We've set that up in Milton Keynes and and in and in Swindon.
But these two doctors, both of whom were registrars of ours, you are teaching the students out there and the registrar.
So it's a it's a it's virtuous. How often do you get up to London for the conferences or, you know, government bodies?
I used to be quite a lot of that. I was a sense of the Royal College.
I had, um, I was secretary of the association and I was a clinical vice president.
I was asked to stand for president, but then a colleague of mine rang up and said, I understand, are you standing?
And I said, if you're standing, I'm going to nominate you. And he was brilliant.
So I never became president. I found that.
Yeah, I. I find that really exciting being in the middle of your speciality when you thought you could make a difference.
And we did make a difference. We wrote persuasive public policy documents.
We argued our corner on things. We revitalised our national society.
We made it really buzzy. We didn't make it London centric. We made we had one meeting a year.
We met round the country. We got the young consultants on board and we gave them jobs to do.
We set up a registry of all the patients, the renal failure. So it was really fun being in the middle of that.
I did a bit of advising of the Department of Health occasionally, but they then got their own person.
I've done a few things for the BBC and the BBC came here and was talking about great
engineering discoveries and some of the college that I go up to Oxford and not.
We discovered the kidney machine was discovered in Holland at the Second World War.
And in Sweden we had some of the original one, one of the original ones here.
And John, let me say, this chap came up, Porter came up to interview me and he was wonderful.
He's very good looking man. And all the nurses were sweet. He came along and he talked to a patient that I talked to him through the day.
And he was a very nice programme. He I gave him the history, whatever.
It was a really nice programme. And I was fed up into Wednesday afternoon.
Here it is. But I have a sister in law who quite a long time find me a rather annoying brother in law and quite annoyed,
I think, because she's very close to my wife. And when we came here, she didn't have any contact with her.
So we got all right. But I think she try me a bit irritating. Anyway, she was travelling on the outback of America, of Australia in a four by four,
and the Australian Broadcasting Corporation buys presents from the ABC.
Say she rang my wife and said, here am I in the middle of the outback?
And I turn on the radio and he said, Oh, yeah, but your bloody husband and you were writing textbooks about subjects.
Yeah, we've done I've edited the fourth edition of the Oxford textbook of Clinical Neurology.
But, uh, when does the first, uh, first was the first time in the in the in the late 80s,
I was an associate editor and, um, especially a clinical textbook, the American textbooks, a very theoretical, um, um.
And this book is. Supposed to be for the practising the Folger's, a squad of illustrations.
It's good, but I actually think the days of textbooks are numbered because you can't you produce it.
It's out of date. And I think actually people are going to do everything online.
Yeah, I read a textbook on Earth Ripperton, which was not textbook, but what I refer to not as quite quite fun.
No, I mean, I think that's the lovely thing about being in Oxford is I've had a nice mixed life of clinical and research.
And about 10 years ago, I was asked to take in the Peter Redcliffs role as the clinical trial Jesus college girl that introduced me to college life,
which is quite different from anything else one can possibly experience,
because they're are people with very different interests and some of them are broad minded and some of them are rather narrow.
And they don't have extraordinary traditions like, for example, that when a fellow retires,
the most recently appointed fellow makes the farewell speech because he's the person you know,
she's the person most least likely to to have any grudge.
Exactly. So I had to do a speech on retiring, but his name was Bill.
So I said, well, when I Googled it, I said I got rather more than a bug.
And I have asked me to be a bit more specific. And so I teach the medical students I've been involved in student.
You know, the GMC requires a clinician to be involved in in interviewing students and they have to be for the colleges.
So they get there, that they get in, but they have to be interviewed by more than just the preclinical scientist.
And I find I've actually written about not shaji, I've written about because I find it I quote,
I guess they're called discomfit in December because you meet 30 remarkable young people and you can choose for.
Yeah. And you don't know how the interview ends and you look at their at their personal statements and what have you.
And of course, I, you know, I'm always pleased with the ones that have come here,
but I was worried about the ones that didn't and and this whole business.
But I think Oxford has a very tough time trying to balance a fairness agenda and and and equality attract the best people.
But that's been been fun and I must be supervised and so on.
The pastoral tutor for four students in each year.
So I must have I've taught them about I think I've done about 60.
Some of them are consultants and and that come and talk to me about how things were going.
And most of them are fine, but a few of them are not. You'd be the field supervisor to the University of NSW.
One of these is actually what I would mostly supervise.
I mean, I would be I think they used to call them up to the pastoral tutor, most of them all right, actually.
But every now and then you have someone who runs into into choppy water and you just need an avuncular figure to talk things over.
And I've been examined. The other thing was nice was the thing that was really one of the most exciting
things that I was made an examiner and then had the temerity to criticise the exam.
Yeah, yeah. As I said, I said, you know, you can spot just three essays.
I said I said, well, what would you do differently?
So then I found myself with a job and they made me senior principal examiner in medicine, which I found really great fun.
Yeah, it did. So we we restructured the exam. So we did lots of stations.
We did short questions rather than just three essays.
We did some laboratory medicine. Um, we carried on doing physician surgeon.
I said what I what I like about it. Well the, the wonderful thing was that most students were outstanding and the good thing
was that the students that had lost their way were picked up by the exam.
And either many of them, some of them repeated, but some of them were then had their electives lost and had to be put back on the straight and narrow.
So I did that for for about eight years,
actually setting the exam and having great fun looking to see how various questions correlated with the art of ventriloquism.
But I, I used to come back after the exams and we do the honours fibres as well.
And I would say to my wife, I've had the same as I used to call it, interviewing in December,
services to call it, sort of know what I say does come discomfit in December.
And I said Joy in January. I mean, when I examined it, I say, you know, we've done something right.
These are bright. Someone would pass membership, actually, and.
And and they're going to be housemen in six, seven months time and they're going to be looking after you and me.
So, yeah, all this doom and gloom, I was rubbish.
That's what I didn't ask about. Biochemists, how much did you have to do with them?
We didn't have a great deal to do with them.
Actually, we we we developed a good relationship with when a a really interesting bomb was dropped on us about two thousand and seven.
And it went something like, this is not a criminal affair out there and it's not being diagnosed,
it's not being treated properly or people are getting to see somebody too late.
And it's because people can't interpret plasma crack.
The plasma cracklin is determined not only by renal function, but by muscle mass and and age and race.
So some guys in the states had done a study of dietary treatment, of renal failure,
but that actually measured kidney function using a direct method and fellow made an injection and decay that they had all the plasma cracked.
So they gave all the data to some mathematicians and said, what are we to the crack?
And we tell you the the the actual GFR, which are you?
The gender and the race and the age come up with the formula which saves us injecting Filaret.
And they called it the indictee form. So all you have to then do was plug your crap and just plasma craton and you'll get a GFR.
And this was like magic. So they did this, but of course the only patients that studied were patients renal failure and they hadn't got the upper end.
And they and the and and it wasn't particularly accurate. But then they decided that anybody had a GFR, less than 60 had chronic kidney disease.
And then the government decided that everybody chemistry department would have to say the craton was such and such.
And this is a GFR of such and such. And then tell the doctor that this meant the patient either did or didn't have kidney failure.
So, of course, a muscular man with the Craton 140 would be told that he had kidney failure because his GFR,
he like these craton, it was high and take into account his muscle mass and they didn't take count of age.
And the GP's getting these letters saying a patients got chronic kidney disease.
So we talked to the the biochemists about this. They they they did the formula and we set up a system of warning, the GPS.
It has to be interpreted based on mammograms and what have you.
And they basically said Jonathan Kay was very supportive of Dr. Wilkinson, was very helpful,
you know, with difficult cases where you had to measure things like Aluminium's and what have you.
But I didn't we didn't do any sort of what I would call collaborative work with him.
And of course, the imaging people, the radiologists will not be friend.
Right? Well, I saw Fred died recently, so I arrived here and this was a one man band.
And he was very hardworking, very helpful, but a bit idiosyncratic.
He was he was very helpful. Very good. And I think he is an equal raise the money through the end of the give away his babies first to.
Yeah. Which, you know, it's unbelievable because he kind of felt that it was his personal fiefdom, but he was pretty supportive.
And then we got Fergus Gleason, who is a wonderful radiologist,
and he's the sort of man you can go there on a Friday afternoon to try to fix the
problem and find him thinking he's getting to the end of his week and he says,
hello, how can I help? I think that's a wonderful thing to say to a colleague on Friday.
I would say he was very good. And we had a radiologist called Nigel Cowan who left under a bit of a cloud, unfortunately.
So, um, but we now have two other two other radiologists, and the other thing that we we we got we had what he Fletcher,
he was a great doctor, scenography, and we have very good interventional radiologists.
They and these guys can do the most magical things going up arteries.
So they did our best to do our parathyroid sampling stuff. They would occasionally do our adrenal sampling.
We didn't to do very often. They would plug holes in the kidneys that we biopsied that were bleeding.
They would not very large restenosis. And, uh, I mean, as colleagues, there are they're pretty special.
They're like the areas of these days that they've done is they do they.
So actually, Nigel continues to do that. He used to he used to do these.
Did they put the idea,
that sort of thing they do to deal with obstructive eurocracy now is not the nightmare it used to be with Joe Smith trying to get something.
And now as long as we can fix the patient not hyperventilating, not thrombocytopenic uraemic,
these guys will pop up and degrade cafetorium and they consider it pretty routine.
So we we take the obstructive Shomron. So interventional radiology and then MRI is come along,
which has transformed our lives in terms of diagnosing kidney diseases because they very specific appearances in polycystic and lithium toxicity.
Gosh. And and now we've got functional MRI, which helps us to diagnose the patients.
We have patients transplants. You get you get Evvie driven lymphomas, but they are not in lymph nodes.
Very often they're in the tissue lymphoma and they use this bluecoats.
Yeah. UPD and and they said, yes, it's there and then we cannot track them so that we don't have the CT scans.
They tell us it's getting smaller. This is all on the church because I mean, the cancer imaging here is pretty special.
Yes. Yes. I mean. And how much cricket did you manage to play?
I played a fair bit, um, but I couldn't do it when I was working one in two because I couldn't I couldn't get the weekends off.
I used to play for the United Oxford Hospitals team.
And, um, and he was the senior technician who's been here as long as I have used to be the used to be the groundsman.
He used to do the ground at the other side and, um, and but now they've built a building to live.
Yeah. I think a lot of people felt that it wasn't what it was supposed to be for. I people know where do they play just for interest.
I think it's the clubs going around the city.
Played a little bit of that sentence, John. I think it, uh, there was a ground up.
Yeah. And of course, the last question, nobody can answer how to do it.
It's all in, but nobody can answer that. Now, is there anything I should have asked you about Chris that I haven't?
Come to me, I probably want to. But I can't think of anything except to say that I consider myself to be very lucky to have landed up here,
and the thing that I find if I were to write my own obituary,
I would I would wonder whether I would say that luck it favoured me or whether I'd actually made made the best of what I've got.
But I have to pinch myself occasionally to think that that I was just going to be a I think, an academic physician in Cape Town.
And then all these extraordinary accidents occurred. The accidents of getting I call myself an accidental Rhodes Scholar and then coming here.
And I've been lucky enough to get a house job, which I wasn't because I wouldn't have had a house job otherwise.
So that was a, you know, a little gift.
And then meeting Peter Morris and getting a position in his life and being welcomed by the as Oliver and then getting that job at the
Hammersmith and then being given the opportunity of working on the Metropolitan Museum of Art to give them their right hand to do that.
Yeah. And then getting this job. So I every time I like I happened, I thought was it was it was lucky.
But I hope that that I, I didn't.
And I did something with the luck. But you never Garriock said that I practise.
I find the luckier I get. Now you must have heard.
I've heard that straightaway. So I just was one thing.
If I, if I, when I talk to the students, I'm invited to go and talk to them before finals now that I'm no longer the principal
examiner because I was incredibly nervous and they all decided they're going to fail.
So I said, if you're sitting in this room for this tutorial, you're probably not going to fail.
One of the failures are not here today because they're not not engaged.
I said, can you just do me a favour and remember that in clinical medicine, you have to abide by clinical method.
And clinical method starts with taking a history. And then you examine the patient and then you plan your investigations and then you
interpret and then you're trying to make a diagnosis and then you plan treatment.
You don't start slamming treatment into people as they come through the door.