Continuing the tape, continuing the tape. Yes, John Wilkinson had been involved with managing some patients with disease in Oxford.
We had quite a few families just by chance, and this new drug had been developed by Roche.
It was the first of the oral retinoids and they were trying it out in lots of different disorders of characterisation.
And one suggestion was that they should try and Daria's disease.
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.
So I was the fool girl, never thinking this would prove to be of any interest at all.
Of course, it was fantastic because it worked. And this disease, what happens to the patient roughly?
Well, I get this horrible disfiguring brown warty, malodorous skin condition,
which in its worst form, you can smell the patient in the outpatient clinic.
It's horrible. It's milder forms. Well, and the treatment can be worse than the disease.
So it's highly variable. It's dominantly inherited. Right.
And it's got really interesting pathology and was one of the few conditions that I could actually easily recognised on the microscope,
because I've never all that good at pathology. But that is a yes, because the correctness lies in the epidermis they separate.
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.
The patients instead you get hyper keratosis, dis keratosis.
So it's very interesting what it does. It's a very interesting, says Renana, the genetic basis.
But it hasn't changed the treatment. It's a single genetic side as well.
Yes, it's a fascinating. Yes. And which was rather unexpected.
Yes. Everybody thought it might be a structured protein, but it isn't. Yes, but it hasn't changed our management yet.
So I'm waiting now. There is you know, there have side effects. Yes.
And so the side effects can be worse in suicide. No, no, no.
That's a branch of retinoids. So that's loss of trust. No, no.
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.
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?
Yes. This was John Bell who helped with that in the eyes.
And yes. So well, I didn't you know, I was just the the phenotype.
I didn't do genotyping. And actually, they need they need good intelligence collected.
Yes. But you didn't do West and lots of votes. No, I did not know that.
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
to London in London on the crack of dawn and another family in Wales going well into a Welsh farm.
Yeah. So we were based in the I am in principle. No, no.
But you had one year and early research. Did you find it?
I did. And I, I think that was more, more facilities, wasn't it.
Yes. Other is the other area I was interested that was Canellos interest.
You wanted somebody to take for the dentist because she was concentrating on the Minneapolis diseases and her other interest had been this.
And she was very keen that somebody else would continue to keep doing patients.
Yes. Yes. I think hand and yes. And then these days, you know, I used to be able to get off services.
Do you remember the regional health authority you gave the registrar also?
Yes. Yes. And that's all gone. Yes. And I really benefited from that and hugely benefited from training part time.
I mean, I was a registrar for ten years, metastatic about the years.
But what was that? Oh, hey, Hayley,
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.
It's very blistering as opposed to the washiness. But down the microscope can look almost identical.
So you need you rely on the clinician to help but different genes.
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.
Yes, but a different side chromosomally. Yes, yes.
Yeah. Very, very interesting. Yes. Sharded. Quite a lot of work on both of them.
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.
So so I had to just run it over. Said, oh, he said there's lots of private practise, you'll be fine.
A consulting job will come up because nature of course, was established. So I couldn't move.
And I think I'm probably the only dermatologist who made a loss from private practise.
I you did. What did you do?
I did it and there was centre called bio planned centre or something in Oxford, um, completely different from the right people,
the one opposite that was set up within within the Oxford Hospital that was in the Churchville.
I say, well, I hated it. I just was not. No, I was no good at that.
But they gave me an honorary consulting contract.
So I was able to continue doing teaching and a bit of research and then supposedly getting my income from this clinic,
which is which never unfortunately, you're running ahead of and surviving.
Oh, yes. Yes. And I said followed me. Right. And so then we had a consult in Stigman.
Yes. John finally came up, thank goodness for which in the end, I think I was the only applicant.
My predecessor there was Margaret Walsh, who had been trying to cover both Milton Keynes and Stoke Mandeville.
You know, extraordinarily difficult things to do. Yeah. And she finally retired, completely exhausted.
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.
So I arrived in Stoke Mandeville to a department where Margaret had just she'd been rammed into the ground, I think.
And so it was waiting redevelopment. And I was able to bring in change that.
And it was great. I was on my own, so I didn't have to ask anybody what changes did you made?
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.
But certainly you need the light. There was nothing. It had all been done.
And I had to discuss this with management and where it was going to be sited and so on and so forth.
And the physiotherapist apparently remember this, they wrote a letter saying, doesn't Dr Birgeneau that ultraviolet light causes skin cancer?
Yes, I did know that. So we finally got our ultraviolet light up and running in the department.
There was a very good clinical assistant there. Was there Brownsburg who'd been there for years?
She hadn't, I think. Yes, I think she was clinical assistant.
We managed to get her upgraded eventually to associate specialist because she was extremely able and she like surgery.
I hated surgery. So that for me was fantastic. It was at that stage that I shared the surgery.
Well, you know, there's, of course, Derek Forsight surgery. I did write a book on it, you know,
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.
So the only thing to do was to write the books. So I got a plastic surgeon for surgery to do it with me.
Was that your first book? Yes, yes.
But you've had a lot of papers, but then I'd had some papers. Yes, yes.
No, that's the challenge was actually getting a plastic surgeon to do it with me, because back then,
for a plastic surgeon to do a book for a dermatologist and the surgery was a no no.
Right. Um, so it was very interesting.
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.
Yes. Yes. From her plastic surgery colleagues. And give me a way to get encouraging dermatology.
So extraordinary because I could use a change.
So yes is no. I did believe they would have understood that, but ran two, three, three editions, I think just a little bit.
They've told me about you to do that compared to what wonderful Indic,
the residency programme was focussed on getting the residents through their board examinations.
Yes. In Oxford you learn by osmosis, in dermatology, you were left just to get on with the clinic's huge clinics.
But I don't remember much structure and it was very structured.
So we went to do very early on in my career as a dermatologist trainee and it was a fantastic year for me.
I was the only part time trainee that ever had and do because we still had we had two small children, three and five.
When we went back, she was doing a pan fellowship. And yes, it was a wonderful year, such fun.
I didn't think I was going to get any money because there wasn't a job officially.
But I had a phone call from Gerry Lazarus, who was the head of the department, who phoned the outpatient clinic in Oxford.
Well, I don't know how he got hold of me. It must have been about two months before we left.
Antisepsis not find you some money. Isn't that wonderful? Yes, because again, it worked out because somebody had.
Or they had a gap, somebody was going into research and he suddenly found a pocket of money.
This is America. So I was a part time resident.
Fantastic. So was that structuring? Well, it really made you so keen on structure, probably.
And, you know, teaching. Yeah, I'm full progress.
Yes, I think it probably was, but it certainly helped me because our technology is completely different from all the other specialities.
So you're starting with a blank sheet. And it helped me that you helped me make sense of looking at skin.
It really gave me the tools that I needed to progress. Now, in your instrument, was Jemmy Savile raising the money?
Jemmy Savile? Yes. I met him going down the corridor once in a shell suit with gold bangles and.
Oh, yes. Did you have any thoughts?
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.
But then you were you two men who looks at the same time?
No, it was a full time consulting job in Stoke Mandeville. I was the only consultant.
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.
But actually, I found out from Vaneta it must have been about six months or nine months into the job.
I had to make called. And she said, Do you know that statement was calling our registrars to do you know,
are not that because there used to be a 10 mile route and they did this.
So you came back to Oxford? I eventually came back to Oxford. Or did they just retired?
Right. So I did five years and Stoke Mandeville and they were a wonderful five years.
You don't really learn how to you don't really learn, but especially to yourselves and taking responsibility.
Yeah. And it was a great five years and I had huge support from my colleagues in amission.
So I used to take my difficult patients to that clinic ratings.
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,
we look at people with Lagos's and Lagos's are actually hugely challenging.
Yes. No, I agree that it just absolutely, really difficult.
And I had an Tarrant's has a huge interest in Lagos's vascular problems.
And I have this cohort of really tricky patients in statement.
And I wasn't getting anywhere and I was losing confidence because I just didn't know what to do.
So I decided I talk to terrorists. I would you come to Stoke Mandeville and do an ulcer clinic with me?
So I brought in I suppose it must be ten difficult patients.
And Terence came and Terence looked so senior and important to me.
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.
I felt so much better. I mean, I it was the most expensive we were able to continue that.
Know Stuart Hamilton, does that mean no alternative but to run it?
And who was doing the pathology and the stoke?
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.
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?
Yeah. Yes. Well, it was a very good working relationship. Absolutely.
Yes. That yes. Just as good. Yes. The meeting is a bit of a sham you into.
I mean, that's a great thing, I think, because I used to say, oh, yeah, yeah.
The whole region was it was it was very well not Oxford. It was the Amersham.
Hi. Yeah. I'm actually working on one department.
It would have been Milton Keynes, the project would have come and I think Windsor came to us as well.
So I would bring my difficult patients. I must tell you this funny story about the past apartment.
I had this patient and I didn't know what the problem was. So you're quite right. You take a biopsy.
So and it looked to me as if we might need frozen sections as well.
He was a a patient, an Indian patient. And he had this bizarre rash.
He'd been through a whole lot of other departments.
So I took the frozen sections and as well as the order pathology and they cut the frozen sections on the cross.
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.
And did you take the patients in your car to these meetings so no patients found themselves?
Yes, but yes. Yeah. So then you came back to Oxford.
And what were your particular interests in the Oxford Department apart from your teaching?
And actually, I'd continued the you're quite right.
I had actually maintained a link. John Bell had asked me to come.
Or to start an A.M. specialist dermatology clinic,
so I have been coming back to Oxford to do the clinic with the rheumatologists, with Heidi doing eyes, with the real physicians.