I think we now have a recording of this just to say that this is Peggy Frith interviewing Derek Hockaday and it's Thursday, the 24th of September 14.
Thirty five. And we're doing this on Zoome because of the covid pandemic that restricts us from getting together face to face.
But this is a Zoome recording.
Now, I'm very keen to interview Derek because Derek has done a lot of interviews himself for the recording Recollecting Toxic Medicine Project,
for which we're extremely grateful. And I do have some briefing notes about what I'd like to talk to about with Derek, but perhaps we could start off.
Can I just say, Derek? What? What? What do you feel about the interviews in general?
What do you see before we start on you? What do you feel about your involvement with your own project so far?
Well, I found it very pleasant and interesting, very interesting on a personal level.
But how interesting it is generally.
But it is very warming that often people who read the interviews like them and, you know, get something out of them.
The whole purpose really was to back up the archives the Bodleian were collecting of really eminent
people in great detail and just to provide a bit of the literary background to the whole thing.
I certainly find it exciting to actually hear people in person, as it were, and maybe who knows, perhaps we may have also video from today.
So your story seems to start with a patient in 1946.
Tell us about that. Well, it was during the aftermath of the war, everything was very restricted.
But the school I was at, Merchantable, which had a long links to its founder, Thomas White, with St. John's.
So we used to play St. John's Second 15 at rugby and we'd come up on the train from the arrangements through time on the railways as time closed.
And I can always remember walking out from the station and coming into St
Giles on Puzey Street next week and suddenly seeing this marvellous building.
I had to. Anyhow, during the rugby match, I strained my knee and consequently got taken to the to the Radcliffe,
the old emergency department where they dealt with it very competently.
I honestly don't know if I was x rayed or not, but they said it was all right.
Alright, it was just strange. And I shouldn't use it very much for a month.
And was it all right? It was fine, yes.
I was absolutely delighted because although we did rugby at the beginning of the spring term as well as the winter term,
it got me out of the boxing I used to do for the second half of the term so that, yeah, I didn't box that suggest you might be a reluctant boxer?
Well, no, I wasn't. I was. I mean, I started because of being really furious at all the people who I knew went to the boxing matches and cheered,
refusing to volunteer the boxing themselves. So I thought I'd have a go.
And then it was immensely satisfying to tea after a boxing match with somebody who had a black eye because of what you've done.
So that leads me to think you were a formidable opponent from the very first time I did.
And then you went to praise those. Yes, because St John's had of scholarships, sorry, Mergenthaler scholarships to St John's.
And then instead of having five at once, they spread them into three and two because of the immobilisation numbers.
And I didn't get one. So I got a scholarship to raise those instead.
And I actually denied it because it meant I wasn't in the summer Mergenthaler clique at St John's,
but was, you know, just by myself at Brazened as well.
Actually, I was. I went because a chap for Grundy who'd been Appraiser's himself, was a master at the school and knew the business.
People like that praised like people who could play games at the box.
It came in handy again. It didn't. But the cricket. And tell us a bit more about your time race days.
You enjoyed it? I thoroughly enjoyed it. In a sense.
Looking back, I had a fairly quiet life. I think there it was, of course, hugely different because we were about 15 percent were straight from school.
The medicks, the physicists, the mathematicians, people who weren't fit and the rest were service.
And that could have been went in the war. 1939 could have been the two years national service.
Forty five to forty seven after the war. So an immense variety of people, really.
So you went in 46 or 47, 47, and I was part of a sort of experiment or the wishes of George Gordon,
who was the BNC preclinical tutor, the neurophysiologist who'd probably given up clinical medicine because of tuberculosis.
I think he had done Cairns's his job.
He had the idea because he was keen on physiology in those days.
The Orthodox thing was to do two years for SBM, which was anatomy and physiology, a year at the School of Animal Physiology.
And then you did your two terms again for being part of the second person back and pharmacology.
And he thought the drug physiology really needed four terms.
So you could do your first two years, then do your two terms of passing back and pharmacology and have four terms of physiology tutoring.
That meant another summer without exams. I thought that was a good idea.
Did you do anything particularly exciting in that summertime? It what?
In the parks in Oxford? Yeah, on the college. And I think it is a cottage ground is down the Abingdon Road.
And so you majored in physiology, did you? Was that your main love?
What did you particularly interested in? I loved physiology, absolutely.
And I did all right. And, you know, I had the chance of doing some research afterwards.
And I remember thinking that if I do one year, that'll be a good test to research.
And then I'll look at clinical medicine, which I really thought I always wanted to do.
But I thought if I do three years of physiology, I feel I'll be caught.
You know, I'll be a researcher for life. Never go back.
I did one year on rats deficient in putting the acid in their diet because of coke and worked on that.
I remember feeding the rats the vitamin deficient that on Christmas Day.
I didn't think that. Just the dedication of the scientists.
That's. What did you think? What do you think reflecting on it drew you strongly towards putting your your your lot in with clinical medicine?
What was it about it that particularly appealed?
Well, heaven knows the thought of working out my own destiny, because from the sort of age of eight or 10,
I'd wanted to be a doctor and I wanted to be a doctor in the Navy, actually, because there's a lot of Navy in the background of the family.
And I combine those two, which they completely disappeared because when I went into the army to do my national service as a qualified doctor,
I went I went into the army for reasons we can come to later.
Then I've got I've got a note about ABC in 51 52, that was Carter was my supervisor and I saw him twice in the living room.
So it was fairly it was you doing the project, really.
And he gave me the project. But after that, it was very self-propelled.
Yes. And there was some very helpful people in the biochemistry department.
There's a chap called Stockman who wasn't medically qualified, but he helped me a lot with the,
you know, experimental backgrounds and outrageous things and approach things.
I always remember sorry that I was setting up the phosphate analysis method and I was getting what they call distilled water.
To me, distilled water was what you pumped over with heat and condense and it was water.
And this desert was in fact silk and very kind and told me after three weeks was a product and an exchange product.
So it was very different. So your healthy scepticism about scientific method was heard fairly,
but probably was something about the lab and maybe even those rats in the diet and the whole sort of biochemical methods that appealed to you.
I mean, we'll come on later to you on chemistry. Always got me more than physics.
You know, I like chemistry, biochemistry, more than physical things.
And in medicine, I always think people like physics to neurology because of electrical conduction and cardiology.
Well, the biochemist people, they do endocrinology and gastroenterology.
That's really interesting. I always in my days at the medical school,
I would suggest to those people who liked evidence that nephrology and technology were both
quite good subjects because they were based on trends and measurements of blood in particular,
but so that you've got something to go on, as it were. But maybe that's just my.
You can go on. You can. So one of the headings you have here is medical finals in nineteen fifty five.
Do you have what happened with your clinical training. Did you do that.
Which tell me tell us about your hospital chain. That was a the hospital in London which was an excellent hospital in those days.
It really was. And there was a lovely administrator, Brigadier Holly Roberts,
and he went round half the beds in the hospital every day now except weekends ago as well.
So it is not all that impressive.
Do you know are you still in touch with anyone else who trained at the Middlesex in that time?
Not really. Most of them are dead.
Michael Ashkenazic, as happened, David Hamilton's dead, rosewoods dead.
I was talking yesterday about Stand Shoulder, who was who is the great introducer of home dialysis and was a phenomenon himself.
He was a kind of plastic dwarf and had a Napoleonic complex and didn't get on in British medicine and ended up in Montpellier.
But he was very, very good with British medicine, couldn't cope with him, one of his little habits with Oxford,
but eventually she was the royal free would then put him in charge of the renal thing where he was a sort of senior registrar lecturer.
They did it to sort of our patients and organs, and he used to drive out there and there was a heart,
you know, that delivering that message with a lot of technicians. And there were three parking places with consultants.
And Stan, who wasn't a consultant, if when he got there, if they were all full up, he got the technicians to help the consultants go sideways.
So it could be hard to get on in British medicine.
And Venizelos and the many people have tales of their actual medical files.
Do you have anything you know, is there anything in your clinical student career that sticks out as an amusing
anecdote or something that illustrate what it was like to be a student in those days?
Gosh, I mean, I can remember going to the mental hospitals and, you know,
we went to Coney Hatch and used to see these people rocking in chairs and generally not behaving sensibly.
And we really were taught very little about schizophrenia or manic depression.
And then the other thing I remember is going industrial medicine.
We went to the Vauxhall factory at Luton and I remember seeing the people coming off the production line, absolute zombies.
I've never forgotten that, you know, their eyes were glazed, as it were, and they were like automatons.
And it was a very striking in prison. I mean, it was modern times.
Charlie Chaplin's Modern Times plus plus interesting what a sort of hooter went.
And they all left the lights. Yeah, yeah.
I remember patients later in Oxford who works on the lines of British Leyland, you know, used to be demonises and and the luxury they had.
I mean, they were to have another man standing by in case they wanted to go to the lavatory, take their place on the line,
that if the whole shift and the night shift could do their work in about four or five hours and then played cards.
And I remember as a student here going to the paint workshop at British Leyland, as it was then, as you say,
and for me is a rather sort of sheltered middle class grammar school girl, is the first time I'd ever been in a real big factory.
And I was quite shocked actually by the scale of the whole thing, sort of acreage, people working.
Quite extraordinary.
Yeah, two things I really remember from finals I won in those days, people at large, but thin enough for you to feel the RAPEX beat.
They've all got too fat nowadays. And anyhow, I couldn't feel this way.
They'd make speed. He was a sort of man of twenty five, I mean,
so I went over to the other side of the chest and felt it and I dug the Dexter card without a stethoscope.
And that was when I was doing the lung case.
I was writing about this, that and the other and I was over time it wasn't vengeance and it was Invigilator very kindly.
Let me have another five minutes, which is very nice of.
There's a small but significant things one doesn't think, though.
That's absolutely right. I like the texture. Khadir, though you're obviously on the case with Teddybears.
Then you had a spell at the Wheatly military hospital. Tell us about that.
Well, I think the thing to realise is the way the military hospital is part of the practise.
I mean, that almost should be remembered.
But I did it in neurology as my second test job at the Middlesex after a surgical, you know, one and a half years.
And I was being programmed to be a neurologist in those days.
And I think one of my chief screamo.
The other was Giddyap Wangled, Me and Wheatly, which was the hospital for the all the forces, all three forces nervous and neurosurgery.
And he was part of the Cairo lobby because Richard Russell and Kramer and Dennis Williams and others had been in Cairo in the war doing neurology.
And there was a real British Cairo lobby in neurology, all linked to Buchanans and the Oxford Hospital,
to which, of course, was the origin of the Haddington Illo.
And anyhow, I went there and thoroughly enjoyed it.
You had interesting work from as there were nine to five and that was it.
I mean, and a bit you see the it was the only military hospital there that had civilian consultants coming from the neighbouring NHS hospital,
Sir Richard Russel Honore Smith Lewitinn Charles, which they all went out there.
Fascinating. If you were a national serviceman, if you kept in with your consultant, you could tell the majors, the colonels.
You know, Dr So-and-so says how fascinating,
because it Oxford did have a strong streak in sort of post military rehabilitation, particularly of head injuries.
But that was Kans.
Isn't used, as you know, where the patients coming round from being unconscious would think that it was called interviews after you can.
I haven't heard that. But that's lovely out because he was, as I understand it, not knowing a huge amount about the detail of it.
But his pioneering idea is that you could actually open the cranium relatively safely.
And do things to relieve pressure and to take out clots and all those sorts of things
in a way that in an interventional way that hasn't really been done very much before,
I would resist that statement. People have been trepanning, the Sculpey centuries, millennia.
But did he did he take out more so that he could see what he was doing better?
Well, probably, I expect yes. I don't know, but I expect to.
Yes. Well, that is fascinating because people started to get a bit alarmed about whether we were rehabilitating military injuries.
Would they lead on to a good sequel of life?
But I suppose he built up around him meant that they got the very best sort of holistic management, really with the word neurology because rituals,
etc. But they got fewer patients than they thought they would because they fear of ambulances and so on,
dealt with everything better than was expected. But they had plenty of patients.
Yes. Yes. That is fascinating. Thank you. And then I see the word Pickering appears.
Tell us about George Pickering. Well, first of all, I was aiming to do neurology.
I got my membership while I was doing my national service.
Then I thought I'd do some paper chromatography on CSF amino acids because I loved chromatography and.
After about six or seven of these, I decided there was no way to study the brain, which is correct, and.
You know, there was interest,
and then one morning I was driving down to going to drive down to the to play cricket and I got rung up just before I left by Ian Bush,
who worked for Peck in Pickering's department and was a very skilled chromatography
liquid chromatography who'd done real pioneering work on the adrenal steroids.
And then he said he wanted to set up.
A chemical investigation set can be investigations into psychiatric patients,
and this is the time of, in one sense, phenylketonuria, metabolism, brain function,
and now that the pink spots in schizophrenia, which was a bogus blind alley,
but anyhow, it was all in there, that chemistry could affect the brain and.
When I was me, as I read the nineteen hundred Foster's textbook,
A Physiology in which Cherington wrote the section on the nervous system and quite rightly says that neurology and psychiatry one subject,
you know, and I always sort of fundamentally believe that. So I'm driving down through the leaf lines, all the shot.
I really thought London, the [INAUDIBLE] with that. You know, it's much nicer to be in Oxford with Richard had real legs.
And so I accepted the job offer.
And in a sense, I mean, obviously, Bush didn't know me from Adam.
I think the contract with Pickering had been that when we played, we'd go to the what was called the Widgery,
which was a Thursday afternoon case presentations, you know, and listen and learn.
And and I used to go on occasional ward rounds of the Radcliffe.
Well, if I had spare time and and I'll tell you something else in a minute and then hour.
And also we would present cases and I had a marvellous patient.
Who intrigued Pickering, who was interested in body temperature regulation, and this was a lady from Army forces wife that should be out in Singapore,
and I think she had benign hydrocephalus, intracranial hydrocephalus,
and they needed her to get the ventricular pressure and they stirred up the hypothalamus.
And consequently, she didn't regulate the temperature except by gaining weight and wearing a lot of clothes.
And she ran at about 95 degrees. Know, but there she was functioning.
And I had the bright idea that it would be interesting to know what happened if she got 98 degrees.
So I put her in a hotel room and seemed to do a lot and she went blind because I think there was then a vascular still has a bit of optic atrophy.
Also, there was a vascular still when she warmed up and lack of vision, which luckily returned, she cold.
And anyhow, I presented all this and then Pickering's people, that was Cooper as well, was very interested in body temperature.
They did lots of experiments on thermo reflexes which weren't there, and they were absolutely fascinating patient.
So that's in a way why I got into Pickering's orbit and we had chemistry.
Wilson Patient two with copper troubles and I.
Aplysia ring is liver damage, gosh, what was what was I going to tell you about the rest of you?
I know we used to have patients who needed angiography and.
We would have one that morning, a week in which we could take them in and we were getting a backlog.
And I said to shown that, you know, couldn't we do more?
And he said the blockage was the anaesthetics that, you know, you needed anaesthetist.
Then in those days I didn't hear it because they had to be intubated.
Some of them they could. That's right. And they were somehow they felt they needed it in these in case they needed intubation.
And I said, well, look, we can bring this to this because we had very good, again, the National Health Service,
you know, temporary, highly competent young people, inexperienced people and like me.
And he agreed to that. It was very open, very helpful.
I remember. Yeah. And then we went in and.
The anaesthetise, they couldn't intubate this patient from Wheatly and all [INAUDIBLE] was breaking loose and, you know,
so then I rushed and got another anaesthetist in the in the hospital and all was well, but and he said it was a particularly difficult larynx.
You know, it wasn't this chap didn't know what he was doing.
It was a very, very rare that indeed that bright idea, they didn't fancy that anymore.
But I always remember how cooperative Philip was generally with garrotted angiogram, a particular thing at Oxford.
I didn't know how Oxford would compare. I mean, any of the big hospitals might be doing carotid angiography of the brain.
That and it was the time when they were changing with ventricular encephalogram putting in 30,
40 an elevator to just five seven because they learnt how to manipulate their arm.
Yes, I remember in the pre CT scan days because actually I was the first person to order a CT scan of any sort in Oxford when I was say to myself,
because we had to Bristol at first they had a scanner at Frenchie, but then we got one in Oxford.
So just to remind those people who are who might be listening to this in the future,
that this was, of course, pre scanning and that you had to sort of.
It's indirectly, yes, either way from the inside or looking at the tumour blush on the angiogram or the displacement of the cerebral vessels.
Yes, it was a highly specialised thing. And of course, I suppose doing angiography,
all patients with very severe cranial pressure and tumours wrapped in strategic
parts of the brain was actually was quite challenging and supposedly must be.
And do you have memories of Sir George Pickering himself? Oh, yes, certainly he was.
I mean, I think his great strength, the many wouldn't agree with this man.
He ran a very Catholic department with a lot of interests.
I know about four little subgroups now. I think it's a very good way for future physicians to get an idea of clinical research or about research.
It's not a good way to find out things when you need a whole department going on one theme.
But as far as education went, I thought it was very good. That's very interesting that the breadth rather than the focus,
because you could go on to focus when you knew what it was that you were good at focussing on is he was a fearsome sort of character.
You know, he would express himself fairly forcibly, but he always had a wry twinkle.
And he was a crafty old boy, too, I think, on a shrewd politician in that which is an absolute.
Yes, but I always felt he was on the side of the angels eventually.
Yes. I think many people, people people would agree would agree with that on that.
And I feel that he was the fundamental reason for getting the Cambridge preclinical students to do their clinical in Oxford.
I mean, people talk about this and I know John Ledingham was involved and Mike down there, but it was really George was pushing it.
And there's a marvellous picture, you know, they have in your picture the clinical students.
Yes. And in those days, you know, Oxford was getting about 10 a year, if you're lucky.
And there's one picture of George in the middle and the administrator and another administrator and about six students.
And George's face is clearly saying, I'm going to get out of here if it doesn't change.
I mean, it is a marvellous expression of disgust at the position, but he changed it.
And probably was shrewd enough to spot that Cambage was not likely to get its own technical school, which he didn't do for decades,
and the only bright people were going off to London to and they could his father in law was head of the Cambridge College.
Oh, how fascinating. Right. Probably that probably explains partly the link and the opportunity.
Now, you had a year out in Boston, Massachusetts, is a little bit about that.
Well, it was generally in those days you did the BGA being to America,
it was almost an essential thing to get a consulting job with a good hospital in England.
And George was very thick with the job,
who was the co-author of the textbook and lab used to come over and spend a week or two with George and he would come to the labs.
And he thought that the one of the vapour chromatography setups I had will be very useful to Holly Smith,
who was Lloyd Smith Junior, who was running the intra-community of the mass general.
So I think it was on a lot of the committees and knew all about the research background and knew that Hollingsworth's was working on.
He inherited hydroxyurea, familial, hydroxyurea,
and that depended on Clark's late metabolism and oxalate forms by natural females as to the Ketan bodies.
I was working on and so that sort of chromatographs could be adapted and.
I got on with the job and there was one time that I always thought was I had lots of amazing strength of luck, really.
And this was a stroke of luck because some either deliberately or not, you never knew with George he was going to do a ward round and didn't turn up.
I mean, he sent a message saying he couldn't come. Would I take the order?
Because I was you know, the registrar would only lecture. And then LA turned out and said it was going on the water and there's water, is it?
So I had to say, well, George wasn't there. Won't you take water?
Because really will sense, you know? And he said, no, no.
And there was an American patient who was a sort of businessman of 60,
and he'd come back on the ferry from France the day before and then had a considerable central nervous upset.
I mean, he had a brain stem trouble. And I argued to myself that if he hadn't, it was either a stroke or neoplasm.
If it had been an aeroplane, it would have been on the threshold of getting in trouble and going up and down.
And the ship would have pushed him over the stretcher because he had vomiting and misstatements and sort of bias.
What I said to the family, the fact it was a stroke, can sort of reassure them that he'd get substantially but not completely better and.
And there was a thought that there'd be no harm, no,
he could see that you could handle the complexity of it and thinking through all the possible differential diagnosis and also the patient,
because no doubt the patient was pretty descriptions of him certainly is now true.
And so I'm sure that although one was put into committees and was a Rockefeller committee,
so may have even been on edge in America, but I'm sure that helped in that getting to the mass general.
And then it was the integrity unit, which was a superb unit, although a bit anomalous in a way.
And Holly Smith, who is the best guy across the board I've ever worked with, and he was a first rate clinician,
first rate Lattman, first rate administrator, first rate fundraiser raiser, first rate lecture.
You know, you really right. You may not have been a genius, but he was right across the board.
And so he was really inherited. Inborn errors of metabolism rather than medical knowledge,
but there were enough of the old school from Albright's time for it to be a very good thing to consider traditionally.
And Holly was a first rate clinician, and I know it was a most interesting, exciting years to learn.
And again, a bit like the Army because you really weren't in it for what, full on has jobs, etc. You stopped at five o'clock.
So it was all very pleasant.
There was fairly gentlemanly compared with within the NHS, life is, yes, how safe is a theme that's emerging for me that you started off in London,
you then came to Oxford, you then went back to London, then you came back to Oxford for Mergenthaler.
Right. Is that pretty radical London? No, I had one spell spend only one Amanda and Mergenthaler.
I suppose you wouldn't maybe count as London was saying. No, no, no.
That's okay. You have the time came after your BTA and you were looking around for a consultant post.
And what did you have a family at that point? Because, I mean, yes, we married in sixty and had children and sixty to sixty four and sixty six.
So we went to America. Sixty two to sixty three had one child in Boston.
Wow. Yes. I mean the child was born before we got that, but only three months looking after what little one with another one in tow with it.
With you know just one and only one is one. Yeah.
So tell us about that decision of coming to Oxford.
As a consultant from Wheatly, do you mean as a consultant?
Well, I mean, I was thinking along and George, you know,
with his sort of foresight engineer that I worked in the diabetic clinic with Eric Cook
and went on pademelons ward rounds because that man was the stated endocrinologist.
Though he was fairly general physician, really. I suppose I was just getting along, but I'm beginning to think of consulting jobs,
and it was obvious that, yes, everybody knew that ALICO compatible and were going to retire and that,
in fact, they were going to be three consulting jobs, one contract and two general medicine with interest in metabolism and technology.
So I knew that was on the horizon.
Holly Smith had said that there would be a possibility of because by that time Holly Smith left Boston and was running medicine in California.
He was the head of California, the San Francisco Medical School, and which virtually meant he was head of.
So I would have had a chance of a job in La Hoya if I hadn't got the Oxford job.
No, I didn't want to go to America. I mean, that's quite definite.
I didn't apply for any other jobs in England, I think, because I wanted to the Oxford job and I might have thought about it afterwards.
And then there was the great two days. Peter Slide was appointed cardiologist one day and the next day there was the great Pickering, you know,
kept them going because I don't know how much you know about this,
but there were these two jobs and the ten candidates and we were all put in that Calcutta.
And I really heard that kind of Calcutta next to the border, which was a great big interview while we were on it.
Well, in a sense, I knew about that and it was all alphabetical, so I knew I wouldn't be called for a bit.
And I went down to Forest Hill where I was, and walked up the hill and back,
and then they sort of came about about 3:00 when the pieces started to fall.
The others are already toxified, the noxious gas, any of that.
And what happened was there were two jobs and I think there were three of us left of interest.
And Pickering just kept talking and talking because I think he was backing me up for lots of reasons.
But one, I'm sure he just wanted it shown that people would come through Oxford and get a consulting job.
It wasn't just the London hospitals.
And I'm sure he wanted John Ledingham because John had done renin with Darah and Pickering was interested in hypertension.
And anyhow, he got what these committees always say.
They always say, well, any of not any of the candidates, but the final few, any of them would do the job perfectly adequate.
So and then they said, right, that's the case. You can all go to London.
Well, certainly in the morning I was just there and it was just living on me.
And then, of course, the renal business came because I was going to split the.
The diabetic clinic with John Ledingham, you know, we both going to do it and I do the technology that wasn't diabetes, thyroid, pituitary, etc.
And then after only about three or four months, the analysis came along,
it was obvious we at Oxford had to have a dialysis centre and John went off with with the result of that to do that.
Yeah. And went on doing hypertension, even a hypertension.
So the diabetes side of it. How did that splice in to the original plan?
Because you think a lot of are completely at odds with the original plan, first of all.
So that had been a bit disruptive, but.
I worked with them in a clinic, and one thing I did I remember was at that time you had four and a half minutes on average with
each patient and you write down what you gathered in a very stereotyped format that I set out.
And Ali wrote the letters on any of the patients that he thought needed veterans writing on.
I mean, not just the patients he'd seen, the patients everybody would see.
So I after a bit of it, I said to it was, OK, I've seen the patient, you haven't anything.
I want to write a letter. And after a little reluctance, he very kindly said I could, providing he saw the letters,
which of course was fine because I learnt a lot then on his feedback on my letters.
So, I mean, it was a much better.
And then there's something about inpatients and outpatients. How is it all organised at that point?
And did you bring people in for metabolic investigation? We never had a real metabolic unit.
I mean, you could get somebody and obviously to do 24 year olds and that sort of thing.
We never had what I would call a nutritional special unit, which you knew what they ate and you knew what came out of them.
We never had that sort of facility, a metabolic lab in that way.
Everybody did take you know, everybody was a general physician.
And there were the medical wards, the medical firms, which were in pairs in bed, not necessarily in that.
And so it doesn't slide. And then the two professorial units, Pickering's and Whit's.
So there were five firms with suits at the weekend. And then you did sorry, you did the weekdays and then you did the weekend five.
And so obviously your partner did as much, you know, that that was the amount you were doing.
And if you want to take your looked after those patients and they were in your beds and then also
there would be patients from the diabetic clinical forever who came in from a waiting list.
And you were in the hotted wards, which no longer exists. Correct, yes.
And Rowney, would it have been for you? It was Rowney.
Victoria was the women's ward, which was in the main hospital, and running was the men's ward, which is in the Hudson River.
Sorry, Alex. And that's right. They were both out. They were the two heads next door to another election right now because I did slight hold in line.
It was by then, but it was positon slight. I remember Teddybears.
I don't think I was one of the last group of students before he retired because he had something to.
It's how fascinating takes me back as well to those that did you enjoy take?
Oh, absolutely. No, I enjoyed general medicine.
Yes, I did. Mm hmm.
And did you enjoy teaching? I think you did. Yeah, I did.
We used to do a little lecturing and then, of course, bedside teaching.
And I enjoyed them both. Mm hmm. So you would teach both sort of raw recruits once Oxford got clinical school was thriving as well.
You'd have either the people in their first year or the people in their third year.
It would change three months and three months old.
So you were always part of that sort of general, the induction of the new clinical students and then finishing off before finals,
like you actually see them at both ends, as it were, that they learnt time.
And you were medical tutor at Reasoners? Well, for a year, not till 1980.
They didn't have medical students at the colleges until, say, the 70s.
And then prisoners caught up and invited me to be the clinical tutor, which I say I didn't.
Do as assiduously as they do now, because that I always recommend, you know,
major revelations and nobody looked after me when I was a kid student, I didn't see this just anything.
I used to see them sort of three times a term, but I didn't see of them weekly or anything like that.
Yes, I suppose the patterns changed, but I think in my day, certainly when I would have been a student under the care of you and others like you,
it was very important that you were part of a firm and you felt you were part of a sort of learning family.
And in a way, it was quite well there. It always changed with a different group of students.
There was still a very strong idea that this was your team that you would learn from.
And with this and I think one of the great thing to be one of the great things was the number of students was relatively low.
So each student had access to, say, three, four or five patients.
I mean, we're directly clocking them. Well, nowadays, you know, you might be only doing one or two.
And I think that was why. Working on the walls was the best place, and in your time, you must have had quite a lot of.
Trainee's that is post student level, but maybe even from student days,
because I think about almost here who is my particular half year, as it were, because she came from London when I came from Cambridge.
And Jim, whom she married, came back from from his divil.
I thought that was his textbook of pharmacology.
I didn't realise he is the leader of a big pharma that would be Ritters or something or other somebody and somebody had been the main man.
But you must have nurtured a number of diabete ologists who had a sort of diaspora beyond Oxford.
Can you think of certain ones over the years that have.
There was the Georgia Virgin, Frank Woods, amongst others, and then an Indian, and naturally, I would certainly remember.
And where did they go, Derek? For those who who know the field, Alberta want to tell you the story of.
I think it's not important in showing what Besom contributed because George was a
very bright guy and he'd done preclinical at Paleo and then his clinical in Oxford.
And there was an American photoplay who was a big man in New York,
came over again for a year off in Oxford because it was very common for American
consultants to spend a year in Oxford either with grapes or with Pickering or whatever.
And Tapley was taking these clinical students on diabetes.
And he was a thorough radiologist, actually, but on diabetes.
And he said George knew more about diabetes than he did, which may not have been literature.
He was very impressed then Georgia defo with Crib's.
And he has jobs and so on, he and Frank Woods were there, has jobs at Intel together,
HHS and the patients were never better after fibroid or endocrine surgeon.
Indeed. And then George went to America and he was there quite a long time.
But Beissinger, meanwhile, become Professor Darfield, professor at Oxford,
and he thought the trouble with the British system was that if you were going to be a clinical researcher,
you spent too much time in gathering wealth of knowledge about medicine.
And what you wanted to do was to know the clinical aspects of your speciality with know the bitter medicine you began researching,
but you didn't need the whole lot. And he created these jobs, a couple of them, which were for that purpose.
You could be appointed to them without your membership, which before that was sort of essential to get any decent senior lectureship.
And McLeland, who went to the immunologist to come to Birmingham and George was appointed from Boston to Oxford,
and I had met George in Boston, you know, I and a little out there and.
George and I linked up with the crib's team and so on, and it was very fruitful.
And then after Oxford and the various goings on there, he went to Southampton and then Newcastle.
Newcastle? Yes, I sort of had him placed in Newcastle. Yes.
And Frank once went to Sheffield.
Yes. As chair of therapeutics or whatever.
But it was a clinical post and he was very interested. Metformin, which was a big one.
A diabetic drug. Mm hmm.
Interesting as John Kennedy is also when he was interested in bones,
but he also went from Oxford to Sheffield, had a very big renal calcium stirring of bones.
So it's a very good. Yes, interesting. Does that continue to this day that it's not show continued for about about one hour, whether it still does.
I don't know. That is interesting. And then Ranjana Adenike, who was that teenager, was also crashin when, you know, that kind come along.
He has become very influential in Indian diabetes and tinged with a certain hospital pony, and he's on all sorts of international committees and so.
Fascinating to have somebody who's got a sort of global view of diabetes to then go somewhere like India where there must be huge numbers of patients.
I mean, when he came here, he said that he wanted to do a degree like the film and he said, no, I want to spend the two years learning about diabetes.
That will be and that would be valuable in India. He knew absolutely he was going back to India.
He wasn't going to stay on in the States. I had mistakenly thought that he might have been a student here.
But you. And so then is to do with the research within the NHS and leading on to the Sheikh Rashid
diabetes unit and how that whole thing evolved because Oxford became very big in diabetes,
didn't it? Did I mean, there were three sort of themes we had.
David Jenkins was. Well, first of all,
what's pretty amazing was the first student I had and I wish he'd done his membership in
Newcastle and he was from the Middle East and he was the best general practitioner in Kuwait.
I mean, he really was a very good doctor. And when he was about 40, he decided to do some research, sort of have a holiday for two years.
So there was this application, a picture of a rather pudgy Sikh for the turban and, you know, middle aged.
And I remember wondering about I took him on. He was the best researcher. Never had, I think, well, you know, one of the best.
And he was devoted and we ran a trial of glucose, insulin and cardiac infarction,
which, you know, was very good, wasn't really and wasn't big enough to be determined.
But it was a very interesting little study. And then David Jenkins was working in Physiology on Fibre, Burgum and Fibre and so on, dietary fibre.
And I teamed up with him and there was a whole spate of dietary interest with Jim Mann coming along and The Simpsons, and we had several.
Papers on dietary fibre and diabetes in diabetic diets and really got fibre going as a subject.
And then there was the diabetic coma treatments. Tell us a bit about that.
I got rung up one morning. And said, would I give a talk at the coming British Diabetic Association meeting in Birmingham?
Because somebody had dropped out. I don't know who this was, something I really couldn't do.
So I think Derek Williamson, who was in Crib's lab. Suggested me, and by that time, we were already because the Krebs lab had a.
A spectrophotometer against the magic method for analysing ketones so we could do blood ketones in a way that virtually nobody else could,
and we were beginning to do blood, Keita and some people. And that was in the background.
So I started reading up about diabetic coma more than I had before.
And two things struck me when I know people didn't do very well in it.
And to that everybody had a different recipe and the fact that they all had these different recipes and nobody knew what they were doing.
So I went up and gave that talk, which is 20 minutes, and went really well.
And I always remember the next day getting on the train back to Oxford from Birmingham, George insinuates himself into the same compartment.
And we were talking about this and that and.
That time, Frank Woods was also interested in electric incidences, and again, he'd done a deal with Krebs, had been measuring Lactaid and so on.
So, again, it was easy, as it were, in Oxford, to measure that fate and of and.
And you have George and I were talking, we said, well, we got to sort of sort this out, let's start measuring what actually happens.
So we and the point was that George had set up a enslin really I acid incident.
So that was going. And he did this with two, as it were, girls straight from school.
But also there was a middle European for Auvinen,
but very kind the lady who looked after these two and getting Masek and she had all the trips, you know, backgrounders, method and attitude.
So George could do in the Nazis. And the thing that held up a lot of people that time was that there were a lot of antibodies to the insulin used in
treatment and people had been measuring insulin by the fact you were getting a number corrupted by the antibodies.
So the. So we thought these measurements and you can see where the ketones were, but the insulin levels were just sky high.
I mean, they were absurd and it didn't matter if they were 10 percent wrong.
They were absurd. And I think George, with some computer help from South Park Road, whatever would be a reasonable dosage,
and also we were looking at similar Andres's papers on the forearm metabolism and,
you know, 200 million units, four litre of insulin with maximum, you didn't need more.
And at that time, there was a thought because people did drive diabetic coma, particularly with infection,
despite all the insulin being given, that a sort of feeling that was a mystery around.
And there was a thing called insulin resistance, that is I mean, it's very important.
But there was a completely wrong. Interpretation of it that.
If you plotted the disappearance of glucose, the rate of all of the glucose against the insulin given it went up.
And I went up and up and up, and the reason was that you only needed a certain amount of insulin.
So obviously once you got beyond the mines and you gave you got the same full of glucose and it looked as though
there was huge resistance and they didn't realise the difference between a sigmoid curve and a linear curve,
really, that was the fundamental point. And there was this sort of fear of giving us all this.
I always remember, so we decided to run a.
Yeah, and I'm very as it were, marriage is not scientific method.
We have the measurements from, let's say, 15 people and then we said we'll treat the next 15 with a new regime,
which was the small amount of insulin given regulators, you know, sort of five units, five and.
We did that again, not randomised, but sequentially, I think I think that's right, and compared to lots, you know,
the ones before and after, and they were just the same, the fall of the blood glucose and the ketones, exactly the same regime.
Now, in retrospect, though, we didn't quite think it at the time, because there are slight differences in potassium and so on foods.
But I don't think we did the patients a lot of good, but we did the doctors a lot of good because instead of wondering what those events and again,
they had a certain regime and they could just relax. What needs investigating now?
Much more, I think, is the response to infection in patients with uncontrolled diabetes.
And I would love to see all the, you know, these factors like PSP.
And in my case, it would be to try and say, you know,
these immune factors done at the bedside of people with infection and hypoglycaemia, because that's still an important.
Problem in medicine? Well, that's really interesting, I remember as a house s H.O. of writing up, writing up a sliding scale insulin,
and that depended on point of bedside testing of the blood sugar levels until I was little.
When you were just mentioning them. Yes. Yes. When you had to get them back on track or even before the newly diagnosed diabetic would,
where you weren't quite sure what their capacity to respond was relied on point of contact, testing of sort of bedside testing.
Did that come in? I mean, was that fairly widespread through much of your career?
Yes, I would have said it was then when I started. Really, that was.
But the idea of actually giving people it was the early days of what you might call a protocol,
what you managed to determine in terms of how to manage these coma patients.
That's true. Yeah, that's really interesting because it needs large with with a heterogeneous but urgent problem like that.
It probably needs quite a lot of numbers to put together to make a coherent picture of handling each one individually,
but then coming up with something that sort of broadly works across the spectrum of different responses.
That's really, really interesting. Tell us about the shape Rashied Diabetes Unit.
How much did that affect your your working life and your research life?
You personally feel tremendously. It's kind of happened with it because it's.
So, Jeffrey, how was the last British resident to the church, 11 states?
And he was foreign office and he was a great Arabist and he was really in with these guys who became the rulers of the Gulf States,
and he was selecting them as people he thought were good.
And they were obviously friendly to him because he had selected them and.
He had a strong belief he became an September because he was a great classicist and foreign office and they thought he would bring them oil money,
which he did until after his death. They got some because of that, but.
Sheikh Zayed of Abu Dhabi, when Jeffrey Arthur got liver trouble,
he went to Roger Williams and Roger Williams was up in Edinburgh somewhere at the time when.
Jeff was given a liver biopsy, whether he needed a biopsy or not, it could be debated, but he had a liver and he went septic.
So Roger Williams thereafter looked after him immensely closely.
So Jeffrey Hoffman was very grateful to Roger Williams and.
He got the shakes, I probably said,
I want to give money to charity in England and Jeffrey Arthur got the money to the liver unit at
Kings and Jeffrey believed in grants going to NHS research units rather than university ones.
Interesting.
And I always admired Roger Williams is the chap I knew who got big grants from both Israel and the states and probably to keep up with the Joneses.
Sheikh Rashid of Dubai said, I'd like to give money to British medicine.
And at that time, Jeffrey, as I think with real shrewdness,
thought cancer didn't need money because the breakthroughs in technology that led to it was sort of ten years ahead, all the changes in cancer.
And he said, Shukrallah, you know, this is diabetes, which was already rising in the Gulf and becoming a problem.
And at some stage take why?
Well, I've got diabetes now, whether she already had it anyhow. And by that time, Jeffrey Arthur had come to Oxford and he'd known my brother,
who was at the administrative fence when he was a young man of the Admiralty.
So they knew one. And the other thing was that the bursar Canberra, who was really a classicist,
was the chap, in a sense, who Jeffrey Arthur worked with when he came to the college.
And I said, I don't have a good time in that he has to suffer really severe migraines.
And they would knock him out for the whole morning, once a fortnight, once a month.
And he came to see me and then he started talking to him, I said, you know what happens?
On the the night before the migraines, and he sort of came out of that, well, quite often he would wake for sort of only a quarter of an hour,
half an hour in the night before the migraine, and he'd be feeling hungry and he'd turn and go to sleep.
So slightly facetiously. I said, why don't you?
That is just a biscuit and that kind of thing.
You see, as ever, it's in a sense of the bad mind because already there was.
There was the idea that migraine could be precipitated by hypoglycaemia, incorrect,
but there is a real possibility that it's precipitated by the time you turn your metabolism from carbohydrate.
It was the last meal to your stores. I mean, do you know?
Because that must be a big change, Gundam.
With Derek Williamson, myself and Judith, who's interested me migraine, we've been looking to see if you've got migraine,
if you had a look at someone's chest, you went out and you went down and with it that when you were down, you tended to get a migraine.
And that was slightly informative. So I didn't have that sort of idea in my mind.
But I must say, I was really slightly facetious.
I said it was a great supporter of mine and you had come then and would have recommended me because of the diabetic coma stuff, I'm sure.
And I mean, the money was a lot in those days.
It was one and a quarter million, which was quite a lot of money.
Yes, we built a new unit in the area that Alison had left.
When Alison left, it was where his surgical empire was before it all went up the hill because it had with Peter Morris with it now.
Gosh. And we did various of the thing I'm proudest of was not me at all.
It was Keith Frain who came from an emergency unit up in Manchester.
He started in London and done a nice bit of work,
got a good job with a burns unit up in Manchester where the clinicians had maltreated him or they just didn't get on.
And Keith had a real apprehension about.
And it took me about two years to resolve this.
But Terry Williamson, I'm sure, knew about this very when they recommended Keith to me as a sort of third main clinical assistant.
So I metabolic assistant in the unit.
And Keith wanted this very definitely to apply the principle to adipose tissue.
And we thought, well, let's have a go. And it took about a year and a half to two years to get the combination of the small
veins in the anterior abdominal wall that are draining the adipose tissue there.
And, you know, we would look and say, should we get this project up or not?
And because I didn't have to apply for grants, I mean, I did a lot and got money.
But because of the backing of the Sheikh Rashid and had enough steady income that no one could go for something like that.
And I always thought that, you know, every now and then you do need long term backing, irrespective of results,
because Keith had this very clear idea and once it all worked and dying was the first person who did it.
Who is a splendid person? The results they got were really, you know, top of the class, you have to remind me briefly about the fifth principle,
because I can't remember clearly about that pick applied at the lungs.
I think it's very simple. You measure the concentration of whatever light going in.
You measure the concentration. It's like going out and, you know, the blood flow and so you can work out what the tissue took up or without.
Oh, thank you. Okay.
It was in Stebbings textbook. A physiology gave me back a bit, but we did also.
We had a prospective study of diabetes which set off about a year and a half before you gave it to me.
On the conceptual thinking around that, I must have been I think a lot of the conceptual thinking came from Richardo, which, you know,
very much wanted to have a randomised trial of diabetic treatments,
as other people did in a sense, but don't have a very persistent vision, as he put it.
And in fact, I was sort of knocking around and going up to the MRC with him and trying to get money for this and.
Probably sort of temperamentally, I didn't ask for enough, you know,
I didn't see the big vision that Rob Turner had, but what I did do when we got the shake, which money I had one,
I got it on the one proforma that didn't really work out because I was very interested in temperature
and always have been measured in body temperature and have ideas still about the interaction of that,
possibly, possibly with metabolism, diabetes. But we had worked at the top that made alcohol flushing.
Sorry, I don't know if you ever came across that with a side effect of top of mind was
that people flushed if they drank alcohol and it was socially embarrassing.
And the Kings people came up with the idea that if you were to provide alcohol flusher, you tended to be.
Liable to diabetic tissue damage, more liable, and they thought there was some link and exploited that, but I think.
And we measure the plasma concentrations and the body temperature, and it was all the two things that determine the flushing,
the plasma concentration and the temperature of the skin at the beginning when you gave the alcohol that we thought of that.
And did that in a little room. You know, the winds lecture theatre every day is the room the patient had behind the actual lecture theatre.
We did it all with our rolling hills and in temperature, too.
So in a sense, the money that I thought is really important in diabetes, to know for sure if it was the.
Glucose levels that caused the tissue damage, but we had the opportunity to do two things.
In fact, three things really we could measure a lot of the other metabolites, like lactate Perovic ketones.
In other words,
the sort of Crabb's across the board and the fatty acids and so on to see if any of them were more important for tissue damage than glucose.
And we could have had a lot of dietary thought and we could look at low fat against low carbohydrate.
Was one diet better than the other? And so we had a observational study because I thought the important thing was to look at diabetics as
they were treated in the clinic by anybody who was doing it and then just see what happened to them.
It was a very observational study,
but it did have a randomised element of the two diets because that was randomised by law and always refused to regard it as a randomised study,
which it was. And and I think he thought I should have put the same money to his study with the political feelings about,
well, my penultimate note has the dreaded single word administration.
What was that to do with it? Sounds as if it was did you enjoy administration or was it something that you did because it had to be done at the last
night and then demonstrated a few little early stories about administration and my thoughts about administration,
really. I remember I was on a thing called the Regional Consultation Board or something.
We met every month, two months, and I always remember two things from that,
one was that Rosemary Rose, an excellent person, and I really did a lot of good.
But they were introducing she wanted to put money to some guy's job,
which is to explain that although things were going wrong, the NHS were trying very hard.
And I said, wouldn't it be better put the money to stop the things going wrong like that?
And of course, it wouldn't have done very much to stop going wrong.
And she had the big message. But nonetheless, the and the other thing was, I would just like to go to the cardiac unit gang at the directive.
And, you know, he was obviously doing good. It was a very good thing to have a devoted cardiac unit for coronary thrombosis.
I thought and I remember trying to say Elmas Regional Committee to these other guys from,
you know, segmental over what they needed was a cardiac unit and there was some money.
And this should be put to the cardiac units. And they all thought that this was some Oxford scheme to, you know, take them over.
So we had nothing to do with it at all. I just thought it was so obvious and I thought, well, you know, you silly, paranoid people.
And then there was an appointment to come into.
And I was on a committee for secretary country, I mean, there, and they is to do this sort of thing and there was a nice, uh, lay person in the chair.
He was a sort of typical of nature. And there's a cartoon and the bowler hat.
You're a lovely man, but. With six candidates, they came down to two.
But before that, one of the candidates was a woman as well.
And when she came in, this late lady said what he said to no one else.
Are you a serious candidate for this post?
Well, I didn't say anything until she left the room, but then I struck up and said, you know, so that went down like that.
And then there were the two candidates left her and one of them.
Everybody said he was from the one fellow, you know, the psychiatric world.
If one of their relatives was sick, was sick, they would ask this chap to see them and the other chap was obviously regarded as an administrator
who would bust the loonies around from one place to another in a competent fashion.
And the majority went to the administrator and I said no at that point.
And then they come to this business that we would like a unanimous verdict.
And I said, no, I mean, that's your opinion. That's my mine. And find there's a majority.
OK, but in the end, I wasn't a natural administrator at the time and he used to come around.
And you're the chairman of the Medical Staff Council.
And if you on that, you were on a weekly committee that met up with the at the area as it was to my mind,
which was up at the John Radcliffe that and I earlier,
because when the medical firms went up to the John Radcliffe, only four could go and one had to stay behind and for one reason or another,
quite suited us obesity and diabetes and technology to stay behind with Facebook.
Best thing I ever did because you were out of the way of a lot of kerfuffle, peace and quiet.
And we had new outpatient facilities at the John Radcliffe.
And I used to love bicycling between the two because you're absolutely free.
Nobody could get you. The administrators know and I used to go up to this committee and.
I'm not a good administrator.
Fundamentally, I need to match them in the way all these papers are, the mistakes that I support anyhow, but I didn't have the big vision.
I thought you and I would say that I was just beginning to have a feeling of what it was all about after two years when you changed.
And I've always regarded that as a very crafty thing of that time that the administrators
got the conditions to change once they began to understand and bamboozle another lot.
I mean, John Spencer was very good. I thought he was a very well directed administrator.
You know, he was on the side of the angels, but very difficult job.
Yes. And I gather he was around, of course. And I always remember one time he was trying, I suppose,
to sort of limit medical expenditure because they were always worried about the money going on,
overtime payments, not to consultants, but to medicks in general.
And then for some reason, they wanted to find out just how much the conditions were doing.
And it was all to do with limiting the activity, either limiting medical activity which costs money, or limiting consultants pay, which costs money.
But anyhow, we had to say what we were doing and it was the same for everybody, physicians and surgeons.
Everybody was in those days you did half the sessions and you did it in half days a week.
And Pickering's time, the people were appointed in 66,
actually were nine NHS plus to university people and even appointments, which is a real help to getting some research going.
And back in those days before Christmas came, I set up in here and make another trip,
a terrific essay, which I used to do with the neurosurgeons for pituitary tumours.
And that was all great fun. And I have to come back with my mother to the administration late perhaps Mr. Scarborough, who was little.
Yes, that's right. He was getting the clinical there. And everybody, if you can, what they did at home was doing about 14 1/2 days a week.
It was quite clear. And that sort of collapsed. I remember you couldn't go any further with that idea.
He, to my mind, was overruled by the university.
You didn't think he stuck up for the NHS? The. Typically, there is always this business of knock for knock.
I don't know if you know that phrase I used to say one, the university people are very clever.
I bet they're doing well, too. Who is knocking whom for what?
And nobody would ever answer that question. And I don't know if you remember.
You remember see, it wasn't a seed payment or something. It was the surplus payment because of a teaching hospital.
And that was meant to give the conditions a bit of extra backup so they didn't hurt our patients or on the wards,
if they were spending time teaching, you know, they would have some support when it all went into laboratory research.
Absolutely disgraceful. Yes. Yes. No, I can't imagine that it would be.
And that general slide away from exactly what you were talking about earlier, which is teaching students on ward rounds and in clinics.
And that was very precious. I think it was irreplaceable, really.
Gosh. Well, the final thing on the list that you've given to me, Derek says cricket and football at the moment.
Tell us about cricket and football. But there used to be stuff.
Student games in the old days are bad.
But let me tell you, in those very small firms, I had one firm, a consultant early on, three Cambridge firsts and a Czechoslovak refugee batsman.
I heard it was a privilege to be teaching about.
And the is Rugby Football Association says rugby football, the year I got my consultant job, you know, one got it in, let's say, March.
And took it up in June of.
And Jim Hadfield's and if you remember him, a surgical tutor.
I do. He'd been in business with me and he knew I played a little bit.
Yes. So as he did, so am I.
He said I was paying the students, which I hadn't played in before I come back to the Soviet Union.
And I always remember playing that we did quite well.
I think I think we were there's all over who was an all black would never play in that game because he would say,
you know, if I play rugby, I play rugby. And there'd be a few scattered injuries around.
But he didn't play with John Reid, did he was there.
He was with the students there. Anyhow, just after that, I'd set it up with a tutor and I were going on a week's holiday,
just sort of motoring around in the home with one of the home countries in Somerset, that sort of area.
And I couldn't drive after this game because I'm in the front hooka and my neck was so stiff I couldn't get her to do the driving.
I always remember that. And then the soccer, they used to get up a team occasionally.
And we play we used to play on the ground at the top of south parks or sometimes out of the Morrises.
But anyhow, coming up at halftime, the score was something like the students nine consultants.
One said it was obvious our goalkeeper wasn't very good.
And so I got ready to go. And let's remember him.
I do indeed. I do remember he was a really good soccer player.
I remember seeing Les shaping up to shoot and it was obvious it was going to go to the right hand half of the go.
So I flew to my to my right and the ball stuck between my legs.
I mean, I was expecting to catch my legs. I just got stuck between my legs.
Brilliant save. But the cricket was interesting because I used to play a role for the students.
Get to you on and off, you know, and then there's the staff.
Students came in there. And by this time, you know, I was a sort of lecturer in Arizona and the staff wasn't all consultants.
And they form that team, which I wasn't there. And I thought I could be Jim Hall, for instance.
And I went on my way into the students, James and.
Pickerington got Basant to vampyre not the best and knew the rules that anybody who has a fancy al-bassam was a scumbag like.
But Jim was with Jim who was bowling and he was military.
And if you know that phrase, military media is sort of innocuous, fairly regular military base or semi fast, but not very fast.
And I always remember hitting gym for four square leg piece and had to jump to get out of the way, and that's my point.
But and the other thing, I was still not out of time and came from from down, you know, to have to do this.
And the children were watching, but separate from the pavilion.
So I went off to see them. And I don't know whether it was disabled or not.
But you this release the children who came rushing out of this, not out, but fantastic.
So brilliant when that sort of brings us full circle back to your days that Mergenthaler and your sporting things,
the sport, just run through your life like a thread through in a way.
Is there anything we haven't talked about that, you know, you can think of that you want to mention?
At this point. Um. Not very obviously, we've certainly done the clinical research, the oh,
always I know one thing I would like to say to get out of this business of four and a half minutes per patient in the patient diabetic clinic,
it seems to be the only way to get out if they have more doctors,
because it was before the time when the diabetic lurve got so big it had to be unloaded onto the general practitioners.
I mean, in the old days, some did, some didn't. And you'd get all the diabetic clinics from a practise.
All the diabetic patients were given practise. So it seemed to me you had more doctors.
And one of the reasons, you know, I used to write research project was to get somebody appointed a Medick appointed who would research,
you know, two thirds of its time that would do clinical research, which is what, in fact, the doctors wanted to do.
And that's always been a major aim to get the daughters up from, you know, four to six or seven if the research people because I think.
It gives you a bit of flexibility as well. If you've got work, is there any way to get enough doctors there in mind?
And just to remember, they have extremely good the nurses have been all through, I think our patients and in patients.
I mean, the nursing profession is a tremendous boon and a blessing.
Yes. And particularly with the long the long term conditions where they can get to know
over a period of time particular patients and particular ways of treating them.
Yeah, and the other thing, as a consultant, you need a good senior registrar.
It's absolutely vital that a good senior registrar and you have some really good ones.
And I think it was the best, but I've had a lot of excellent and happy days.
I always remember actually the first ward round I did as a consultant where they kept this patient to the last,
I don't know, but deliberately or whether it was just the geography that it was a woman of about 25, 30.
And she was obviously ill because she had a great anaemia, because she had both haemolytic and hypoplastic anaemia.
She was producing the cells and she was losing some muscle.
And in those days, I mean, I always remembered Cook's aphorisms, many of them,
and one of his arteries was never let anybody die without benefit of steroids.
So I thought we must give this woman steroids. And we thought of every blood test we could think of to send off.
First of all, she started the steroids and the steroids did bring her back.
And she had seven lupus. Wow.
And also the LDS church to 200 billion was the old place.
And the thing was, well, when we returned to to the Ishani.
Her sister was in the big house. It's just incredible coincidence because the patient herself lived for about 20 years but then died.
Wow. And yes, that ability to make a difference to somebody's life in that sense.
Yes, it's very memorable, you know. Yeah.
Gosh, thank you, Derek. That's been me. It's been a pure pleasure.
I really enjoyed doing it, Jessica, over night. But not at all.
No, exactly. But memories are good just by definition.
Exactly. Thank you very much. Well, thanks for interviewing me.
It's a pleasure. I will press stop the recording.