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Continuing the tape, continuing the tape. Yes, John Wilkinson had been involved with managing some patients with disease in Oxford.

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We had quite a few families just by chance, and this new drug had been developed by Roche.

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It was the first of the oral retinoids and they were trying it out in lots of different disorders of characterisation.

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And one suggestion was that they should try and Daria's disease.

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And John had a cohort on St. Thomas's where he rotated to and he wanted somebody in Oxford to do the other half of the study.

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So I was the fool girl, never thinking this would prove to be of any interest at all.

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Of course, it was fantastic because it worked. And this disease, what happens to the patient roughly?

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Well, I get this horrible disfiguring brown warty, malodorous skin condition,

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which in its worst form, you can smell the patient in the outpatient clinic.

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It's horrible. It's milder forms. Well, and the treatment can be worse than the disease.

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So it's highly variable. It's dominantly inherited. Right.

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And it's got really interesting pathology and was one of the few conditions that I could actually easily recognised on the microscope,

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because I've never all that good at pathology. But that is a yes, because the correctness lies in the epidermis they separate.

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It doesn't sense that held together. So you've got this phenomenon called a council ISIS, but you don't get blisters very often.

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The patients instead you get hyper keratosis, dis keratosis.

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So it's very interesting what it does. It's a very interesting, says Renana, the genetic basis.

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But it hasn't changed the treatment. It's a single genetic side as well.

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Yes, it's a fascinating. Yes. And which was rather unexpected.

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Yes. Everybody thought it might be a structured protein, but it isn't. Yes, but it hasn't changed our management yet.

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So I'm waiting now. There is you know, there have side effects. Yes.

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And so the side effects can be worse in suicide. No, no, no.

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That's a branch of retinoids. So that's loss of trust. No, no.

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With Torgeson, as it was called or treat tonight, you get try mucosal dryness was the big problem and you can get that energy with it, too.

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But lots of mucosal dryness and that can be sometimes worse than trying to sort out the skin, as did you do in genetics yourself?

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Yes. This was John Bell who helped with that in the eyes.

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And yes. So well, I didn't you know, I was just the the phenotype.

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I didn't do genotyping. And actually, they need they need good intelligence collected.

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Yes. But you didn't do West and lots of votes. No, I did not know that.

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I went around the country finding people, families and collecting samples and going off on and 25 early in the morning and arriving with the milkman

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to London in London on the crack of dawn and another family in Wales going well into a Welsh farm.

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Yeah. So we were based in the I am in principle. No, no.

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But you had one year and early research. Did you find it?

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I did. And I, I think that was more, more facilities, wasn't it.

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Yes. Other is the other area I was interested that was Canellos interest.

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You wanted somebody to take for the dentist because she was concentrating on the Minneapolis diseases and her other interest had been this.

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And she was very keen that somebody else would continue to keep doing patients.

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Yes. Yes. I think hand and yes. And then these days, you know, I used to be able to get off services.

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Do you remember the regional health authority you gave the registrar also?

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Yes. Yes. And that's all gone. Yes. And I really benefited from that and hugely benefited from training part time.

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I mean, I was a registrar for ten years, metastatic about the years.

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But what was that? Oh, hey, Hayley,

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was this disease that was very similar to Daria's disease and sometimes it was used to be a debate about whether they were the same conditions or not.

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It's very blistering as opposed to the washiness. But down the microscope can look almost identical.

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So you need you rely on the clinician to help but different genes.

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It's turned out to be another cancer mateparae. It's in the biology apparatus as opposed to the as the independent or absolute fascinators.

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Yes, but a different side chromosomally. Yes, yes.

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Yeah. Very, very interesting. Yes. Sharded. Quite a lot of work on both of them.

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So and then you became a consultant. So I fell off the ladder if I was trying so long and I couldn't spin it at any point.

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So so I had to just run it over. Said, oh, he said there's lots of private practise, you'll be fine.

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A consulting job will come up because nature of course, was established. So I couldn't move.

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And I think I'm probably the only dermatologist who made a loss from private practise.

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I you did. What did you do?

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I did it and there was centre called bio planned centre or something in Oxford, um, completely different from the right people,

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the one opposite that was set up within within the Oxford Hospital that was in the Churchville.

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I say, well, I hated it. I just was not. No, I was no good at that.

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But they gave me an honorary consulting contract.

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So I was able to continue doing teaching and a bit of research and then supposedly getting my income from this clinic,

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which is which never unfortunately, you're running ahead of and surviving.

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Oh, yes. Yes. And I said followed me. Right. And so then we had a consult in Stigman.

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Yes. John finally came up, thank goodness for which in the end, I think I was the only applicant.

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My predecessor there was Margaret Walsh, who had been trying to cover both Milton Keynes and Stoke Mandeville.

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You know, extraordinarily difficult things to do. Yeah. And she finally retired, completely exhausted.

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And then, of course, as they often do realise, that actually they needed to pass. So they pointed me and Stoke Mandeville from Project or Latin Kings.

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So I arrived in Stoke Mandeville to a department where Margaret had just she'd been rammed into the ground, I think.

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And so it was waiting redevelopment. And I was able to bring in change that.

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And it was great. I was on my own, so I didn't have to ask anybody what changes did you made?

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Well, one of the first things we did, there was no ultraviolet light treatment and which is key for dermatology, that's psoriasis and other things.

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But certainly you need the light. There was nothing. It had all been done.

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And I had to discuss this with management and where it was going to be sited and so on and so forth.

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And the physiotherapist apparently remember this, they wrote a letter saying, doesn't Dr Birgeneau that ultraviolet light causes skin cancer?

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Yes, I did know that. So we finally got our ultraviolet light up and running in the department.

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There was a very good clinical assistant there. Was there Brownsburg who'd been there for years?

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She hadn't, I think. Yes, I think she was clinical assistant.

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We managed to get her upgraded eventually to associate specialist because she was extremely able and she like surgery.

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I hated surgery. So that for me was fantastic. It was at that stage that I shared the surgery.

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Well, you know, there's, of course, Derek Forsight surgery. I did write a book on it, you know,

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simple skin surgery after the ER and do because I did lots of surgery and there was nothing to look up for us people who didn't like it.

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So the only thing to do was to write the books. So I got a plastic surgeon for surgery to do it with me.

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Was that your first book? Yes, yes.

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But you've had a lot of papers, but then I'd had some papers. Yes, yes.

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No, that's the challenge was actually getting a plastic surgeon to do it with me, because back then,

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for a plastic surgeon to do a book for a dermatologist and the surgery was a no no.

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Right. Um, so it was very interesting.

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Finally, I found Ruth Raymond, who was a trainee here, agreed to do it, and she got a lot of stick for having done it for him.

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Yes. Yes. From her plastic surgery colleagues. And give me a way to get encouraging dermatology.

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So extraordinary because I could use a change.

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So yes is no. I did believe they would have understood that, but ran two, three, three editions, I think just a little bit.

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They've told me about you to do that compared to what wonderful Indic,

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the residency programme was focussed on getting the residents through their board examinations.

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Yes. In Oxford you learn by osmosis, in dermatology, you were left just to get on with the clinic's huge clinics.

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But I don't remember much structure and it was very structured.

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So we went to do very early on in my career as a dermatologist trainee and it was a fantastic year for me.

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I was the only part time trainee that ever had and do because we still had we had two small children, three and five.

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When we went back, she was doing a pan fellowship. And yes, it was a wonderful year, such fun.

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I didn't think I was going to get any money because there wasn't a job officially.

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But I had a phone call from Gerry Lazarus, who was the head of the department, who phoned the outpatient clinic in Oxford.

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Well, I don't know how he got hold of me. It must have been about two months before we left.

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Antisepsis not find you some money. Isn't that wonderful? Yes, because again, it worked out because somebody had.

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Or they had a gap, somebody was going into research and he suddenly found a pocket of money.

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This is America. So I was a part time resident.

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Fantastic. So was that structuring? Well, it really made you so keen on structure, probably.

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And, you know, teaching. Yeah, I'm full progress.

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Yes, I think it probably was, but it certainly helped me because our technology is completely different from all the other specialities.

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So you're starting with a blank sheet. And it helped me that you helped me make sense of looking at skin.

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It really gave me the tools that I needed to progress. Now, in your instrument, was Jemmy Savile raising the money?

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Jemmy Savile? Yes. I met him going down the corridor once in a shell suit with gold bangles and.

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Oh, yes. Did you have any thoughts?

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I mean. Well, I remember as a child not liking Jemmy Savile, and I remember finding him slightly sleazy as he walked down the corridor.

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But then you were you two men who looks at the same time?

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No, it was a full time consulting job in Stoke Mandeville. I was the only consultant.

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So on call we decided the definition was a phone call, was if they could find me, I was on call and if they could.

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But actually, I found out from Vaneta it must have been about six months or nine months into the job.

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I had to make called. And she said, Do you know that statement was calling our registrars to do you know,

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are not that because there used to be a 10 mile route and they did this.

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So you came back to Oxford? I eventually came back to Oxford. Or did they just retired?

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Right. So I did five years and Stoke Mandeville and they were a wonderful five years.

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You don't really learn how to you don't really learn, but especially to yourselves and taking responsibility.

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Yeah. And it was a great five years and I had huge support from my colleagues in amission.

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So I used to take my difficult patients to that clinic ratings.

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And I remember I must tell you this, before I came back to Oxford, one of one of the areas that we practise in dermatology,

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we look at people with Lagos's and Lagos's are actually hugely challenging.

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Yes. No, I agree that it just absolutely, really difficult.

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And I had an Tarrant's has a huge interest in Lagos's vascular problems.

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And I have this cohort of really tricky patients in statement.

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And I wasn't getting anywhere and I was losing confidence because I just didn't know what to do.

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So I decided I talk to terrorists. I would you come to Stoke Mandeville and do an ulcer clinic with me?

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So I brought in I suppose it must be ten difficult patients.

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And Terence came and Terence looked so senior and important to me.

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So he stayed at the end of each couch and he sort of like back with his arms folded and he would not his head and he'd say, yes, very difficult.

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I felt so much better. I mean, I it was the most expensive we were able to continue that.

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Know Stuart Hamilton, does that mean no alternative but to run it?

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And who was doing the pathology and the stoke?

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We had Andrew Tabbouleh, I think was the pathologist with two young and was a younger pathologist, Adam Fadell, who'd actually trained in Oxford.

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And I used to go and look at the slides myself as well. And that was as good as what you go to Oxford, would you say?

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Yeah. Yes. Well, it was a very good working relationship. Absolutely.

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Yes. That yes. Just as good. Yes. The meeting is a bit of a sham you into.

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I mean, that's a great thing, I think, because I used to say, oh, yeah, yeah.

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The whole region was it was it was very well not Oxford. It was the Amersham.

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Hi. Yeah. I'm actually working on one department.

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It would have been Milton Keynes, the project would have come and I think Windsor came to us as well.

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So I would bring my difficult patients. I must tell you this funny story about the past apartment.

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I had this patient and I didn't know what the problem was. So you're quite right. You take a biopsy.

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So and it looked to me as if we might need frozen sections as well.

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He was a a patient, an Indian patient. And he had this bizarre rash.

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He'd been through a whole lot of other departments.

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So I took the frozen sections and as well as the order pathology and they cut the frozen sections on the cross.

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And then they did their ordinary staining and it was leprosy. And they had to and it was heaving with and they had to defrost the cross several years.

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And did you take the patients in your car to these meetings so no patients found themselves?

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Yes, but yes. Yeah. So then you came back to Oxford.

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And what were your particular interests in the Oxford Department apart from your teaching?

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And actually, I'd continued the you're quite right.

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I had actually maintained a link. John Bell had asked me to come.

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Or to start an A.M. specialist dermatology clinic,

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so I have been coming back to Oxford to do the clinic with the rheumatologists, with Heidi doing eyes, with the real physicians.