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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.

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Thirty five. And we're doing this on Zoome because of the covid pandemic that restricts us from getting together face to face.

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But this is a Zoome recording.

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Now, I'm very keen to interview Derek because Derek has done a lot of interviews himself for the recording Recollecting Toxic Medicine Project,

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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.

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Can I just say, Derek? What? What? What do you feel about the interviews in general?

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What do you see before we start on you? What do you feel about your involvement with your own project so far?

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Well, I found it very pleasant and interesting, very interesting on a personal level.

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But how interesting it is generally.

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But it is very warming that often people who read the interviews like them and, you know, get something out of them.

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The whole purpose really was to back up the archives the Bodleian were collecting of really eminent

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people in great detail and just to provide a bit of the literary background to the whole thing.

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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.

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So your story seems to start with a patient in 1946.

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Tell us about that. Well, it was during the aftermath of the war, everything was very restricted.

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But the school I was at, Merchantable, which had a long links to its founder, Thomas White, with St. John's.

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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.

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And I can always remember walking out from the station and coming into St

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Giles on Puzey Street next week and suddenly seeing this marvellous building.

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I had to. Anyhow, during the rugby match, I strained my knee and consequently got taken to the to the Radcliffe,

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the old emergency department where they dealt with it very competently.

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I honestly don't know if I was x rayed or not, but they said it was all right.

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Alright, it was just strange. And I shouldn't use it very much for a month.

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And was it all right? It was fine, yes.

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I was absolutely delighted because although we did rugby at the beginning of the spring term as well as the winter term,

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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?

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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,

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refusing to volunteer the boxing themselves. So I thought I'd have a go.

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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.

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So that leads me to think you were a formidable opponent from the very first time I did.

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And then you went to praise those. Yes, because St John's had of scholarships, sorry, Mergenthaler scholarships to St John's.

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And then instead of having five at once, they spread them into three and two because of the immobilisation numbers.

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And I didn't get one. So I got a scholarship to raise those instead.

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And I actually denied it because it meant I wasn't in the summer Mergenthaler clique at St John's,

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but was, you know, just by myself at Brazened as well.

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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.

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People like that praised like people who could play games at the box.

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It came in handy again. It didn't. But the cricket. And tell us a bit more about your time race days.

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You enjoyed it? I thoroughly enjoyed it. In a sense.

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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.

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The medicks, the physicists, the mathematicians, people who weren't fit and the rest were service.

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And that could have been went in the war. 1939 could have been the two years national service.

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Forty five to forty seven after the war. So an immense variety of people, really.

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So you went in 46 or 47, 47, and I was part of a sort of experiment or the wishes of George Gordon,

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who was the BNC preclinical tutor, the neurophysiologist who'd probably given up clinical medicine because of tuberculosis.

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I think he had done Cairns's his job.

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He had the idea because he was keen on physiology in those days.

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The Orthodox thing was to do two years for SBM, which was anatomy and physiology, a year at the School of Animal Physiology.

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And then you did your two terms again for being part of the second person back and pharmacology.

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And he thought the drug physiology really needed four terms.

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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.

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That meant another summer without exams. I thought that was a good idea.

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Did you do anything particularly exciting in that summertime? It what?

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In the parks in Oxford? Yeah, on the college. And I think it is a cottage ground is down the Abingdon Road.

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And so you majored in physiology, did you? Was that your main love?

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What did you particularly interested in? I loved physiology, absolutely.

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And I did all right. And, you know, I had the chance of doing some research afterwards.

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And I remember thinking that if I do one year, that'll be a good test to research.

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And then I'll look at clinical medicine, which I really thought I always wanted to do.

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But I thought if I do three years of physiology, I feel I'll be caught.

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You know, I'll be a researcher for life. Never go back.

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I did one year on rats deficient in putting the acid in their diet because of coke and worked on that.

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I remember feeding the rats the vitamin deficient that on Christmas Day.

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I didn't think that. Just the dedication of the scientists.

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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?

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What was it about it that particularly appealed?

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Well, heaven knows the thought of working out my own destiny, because from the sort of age of eight or 10,

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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.

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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,

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I went I went into the army for reasons we can come to later.

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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.

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So it was fairly it was you doing the project, really.

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And he gave me the project. But after that, it was very self-propelled.

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Yes. And there was some very helpful people in the biochemistry department.

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There's a chap called Stockman who wasn't medically qualified, but he helped me a lot with the,

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you know, experimental backgrounds and outrageous things and approach things.

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I always remember sorry that I was setting up the phosphate analysis method and I was getting what they call distilled water.

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To me, distilled water was what you pumped over with heat and condense and it was water.

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And this desert was in fact silk and very kind and told me after three weeks was a product and an exchange product.

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So it was very different. So your healthy scepticism about scientific method was heard fairly,

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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.

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I mean, we'll come on later to you on chemistry. Always got me more than physics.

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You know, I like chemistry, biochemistry, more than physical things.

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And in medicine, I always think people like physics to neurology because of electrical conduction and cardiology.

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Well, the biochemist people, they do endocrinology and gastroenterology.

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That's really interesting. I always in my days at the medical school,

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I would suggest to those people who liked evidence that nephrology and technology were both

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quite good subjects because they were based on trends and measurements of blood in particular,

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but so that you've got something to go on, as it were. But maybe that's just my.

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You can go on. You can. So one of the headings you have here is medical finals in nineteen fifty five.

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Do you have what happened with your clinical training. Did you do that.

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Which tell me tell us about your hospital chain. That was a the hospital in London which was an excellent hospital in those days.

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It really was. And there was a lovely administrator, Brigadier Holly Roberts,

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and he went round half the beds in the hospital every day now except weekends ago as well.

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So it is not all that impressive.

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Do you know are you still in touch with anyone else who trained at the Middlesex in that time?

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Not really. Most of them are dead.

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Michael Ashkenazic, as happened, David Hamilton's dead, rosewoods dead.

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I was talking yesterday about Stand Shoulder, who was who is the great introducer of home dialysis and was a phenomenon himself.

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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.

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But he was very, very good with British medicine, couldn't cope with him, one of his little habits with Oxford,

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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.

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They did it to sort of our patients and organs, and he used to drive out there and there was a heart,

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you know, that delivering that message with a lot of technicians. And there were three parking places with consultants.

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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.

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So it could be hard to get on in British medicine.

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And Venizelos and the many people have tales of their actual medical files.

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Do you have anything you know, is there anything in your clinical student career that sticks out as an amusing

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anecdote or something that illustrate what it was like to be a student in those days?

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Gosh, I mean, I can remember going to the mental hospitals and, you know,

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we went to Coney Hatch and used to see these people rocking in chairs and generally not behaving sensibly.

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And we really were taught very little about schizophrenia or manic depression.

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And then the other thing I remember is going industrial medicine.

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We went to the Vauxhall factory at Luton and I remember seeing the people coming off the production line, absolute zombies.

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I've never forgotten that, you know, their eyes were glazed, as it were, and they were like automatons.

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And it was a very striking in prison. I mean, it was modern times.

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Charlie Chaplin's Modern Times plus plus interesting what a sort of hooter went.

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And they all left the lights. Yeah, yeah.

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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.

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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,

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that if the whole shift and the night shift could do their work in about four or five hours and then played cards.

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And I remember as a student here going to the paint workshop at British Leyland, as it was then, as you say,

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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.

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And I was quite shocked actually by the scale of the whole thing, sort of acreage, people working.

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Quite extraordinary.

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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.

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They've all got too fat nowadays. And anyhow, I couldn't feel this way.

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They'd make speed. He was a sort of man of twenty five, I mean,

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so I went over to the other side of the chest and felt it and I dug the Dexter card without a stethoscope.

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And that was when I was doing the lung case.

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I was writing about this, that and the other and I was over time it wasn't vengeance and it was Invigilator very kindly.

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Let me have another five minutes, which is very nice of.

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There's a small but significant things one doesn't think, though.

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That's absolutely right. I like the texture. Khadir, though you're obviously on the case with Teddybears.

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Then you had a spell at the Wheatly military hospital. Tell us about that.

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Well, I think the thing to realise is the way the military hospital is part of the practise.

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I mean, that almost should be remembered.

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But I did it in neurology as my second test job at the Middlesex after a surgical, you know, one and a half years.

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And I was being programmed to be a neurologist in those days.

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And I think one of my chief screamo.

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The other was Giddyap Wangled, Me and Wheatly, which was the hospital for the all the forces, all three forces nervous and neurosurgery.

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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.

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And there was a real British Cairo lobby in neurology, all linked to Buchanans and the Oxford Hospital,

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to which, of course, was the origin of the Haddington Illo.

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And anyhow, I went there and thoroughly enjoyed it.

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You had interesting work from as there were nine to five and that was it.

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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,

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Sir Richard Russel Honore Smith Lewitinn Charles, which they all went out there.

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Fascinating. If you were a national serviceman, if you kept in with your consultant, you could tell the majors, the colonels.

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You know, Dr So-and-so says how fascinating,

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because it Oxford did have a strong streak in sort of post military rehabilitation, particularly of head injuries.

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But that was Kans.

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Isn't used, as you know, where the patients coming round from being unconscious would think that it was called interviews after you can.

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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.

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But his pioneering idea is that you could actually open the cranium relatively safely.

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And do things to relieve pressure and to take out clots and all those sorts of things

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in a way that in an interventional way that hasn't really been done very much before,

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I would resist that statement. People have been trepanning, the Sculpey centuries, millennia.

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But did he did he take out more so that he could see what he was doing better?

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Well, probably, I expect yes. I don't know, but I expect to.

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Yes. Well, that is fascinating because people started to get a bit alarmed about whether we were rehabilitating military injuries.

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Would they lead on to a good sequel of life?

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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,

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etc. But they got fewer patients than they thought they would because they fear of ambulances and so on,

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dealt with everything better than was expected. But they had plenty of patients.

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Yes. Yes. That is fascinating. Thank you. And then I see the word Pickering appears.

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Tell us about George Pickering. Well, first of all, I was aiming to do neurology.

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I got my membership while I was doing my national service.

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Then I thought I'd do some paper chromatography on CSF amino acids because I loved chromatography and.

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After about six or seven of these, I decided there was no way to study the brain, which is correct, and.

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You know, there was interest,

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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,

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who worked for Peck in Pickering's department and was a very skilled chromatography

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liquid chromatography who'd done real pioneering work on the adrenal steroids.

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And then he said he wanted to set up.

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A chemical investigation set can be investigations into psychiatric patients,

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and this is the time of, in one sense, phenylketonuria, metabolism, brain function,

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and now that the pink spots in schizophrenia, which was a bogus blind alley,

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but anyhow, it was all in there, that chemistry could affect the brain and.

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When I was me, as I read the nineteen hundred Foster's textbook,

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A Physiology in which Cherington wrote the section on the nervous system and quite rightly says that neurology and psychiatry one subject,

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you know, and I always sort of fundamentally believe that. So I'm driving down through the leaf lines, all the shot.

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I really thought London, the [INAUDIBLE] with that. You know, it's much nicer to be in Oxford with Richard had real legs.

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And so I accepted the job offer.

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And in a sense, I mean, obviously, Bush didn't know me from Adam.

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I think the contract with Pickering had been that when we played, we'd go to the what was called the Widgery,

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which was a Thursday afternoon case presentations, you know, and listen and learn.

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And and I used to go on occasional ward rounds of the Radcliffe.

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Well, if I had spare time and and I'll tell you something else in a minute and then hour.

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And also we would present cases and I had a marvellous patient.

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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,

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and I think she had benign hydrocephalus, intracranial hydrocephalus,

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and they needed her to get the ventricular pressure and they stirred up the hypothalamus.

194
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And consequently, she didn't regulate the temperature except by gaining weight and wearing a lot of clothes.

195
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And she ran at about 95 degrees. Know, but there she was functioning.

196
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And I had the bright idea that it would be interesting to know what happened if she got 98 degrees.

197
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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.

198
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Also, there was a vascular still when she warmed up and lack of vision, which luckily returned, she cold.

199
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And anyhow, I presented all this and then Pickering's people, that was Cooper as well, was very interested in body temperature.

200
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They did lots of experiments on thermo reflexes which weren't there, and they were absolutely fascinating patient.

201
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So that's in a way why I got into Pickering's orbit and we had chemistry.

202
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Wilson Patient two with copper troubles and I.

203
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Aplysia ring is liver damage, gosh, what was what was I going to tell you about the rest of you?

204
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I know we used to have patients who needed angiography and.

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We would have one that morning, a week in which we could take them in and we were getting a backlog.

206
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And I said to shown that, you know, couldn't we do more?

207
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And he said the blockage was the anaesthetics that, you know, you needed anaesthetist.

208
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Then in those days I didn't hear it because they had to be intubated.

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Some of them they could. That's right. And they were somehow they felt they needed it in these in case they needed intubation.

210
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And I said, well, look, we can bring this to this because we had very good, again, the National Health Service,

211
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you know, temporary, highly competent young people, inexperienced people and like me.

212
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And he agreed to that. It was very open, very helpful.

213
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I remember. Yeah. And then we went in and.

214
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The anaesthetise, they couldn't intubate this patient from Wheatly and all [INAUDIBLE] was breaking loose and, you know,

215
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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.

216
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You know, it wasn't this chap didn't know what he was doing.

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It was a very, very rare that indeed that bright idea, they didn't fancy that anymore.

218
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But I always remember how cooperative Philip was generally with garrotted angiogram, a particular thing at Oxford.

219
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I didn't know how Oxford would compare. I mean, any of the big hospitals might be doing carotid angiography of the brain.

220
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That and it was the time when they were changing with ventricular encephalogram putting in 30,

221
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40 an elevator to just five seven because they learnt how to manipulate their arm.

222
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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,

223
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because we had to Bristol at first they had a scanner at Frenchie, but then we got one in Oxford.

224
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So just to remind those people who are who might be listening to this in the future,

225
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that this was, of course, pre scanning and that you had to sort of.

226
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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.

227
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Yes, it was a highly specialised thing. And of course, I suppose doing angiography,

228
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all patients with very severe cranial pressure and tumours wrapped in strategic

229
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parts of the brain was actually was quite challenging and supposedly must be.

230
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And do you have memories of Sir George Pickering himself? Oh, yes, certainly he was.

231
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I mean, I think his great strength, the many wouldn't agree with this man.

232
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He ran a very Catholic department with a lot of interests.

233
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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.

234
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It's not a good way to find out things when you need a whole department going on one theme.

235
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But as far as education went, I thought it was very good. That's very interesting that the breadth rather than the focus,

236
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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.

237
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You know, he would express himself fairly forcibly, but he always had a wry twinkle.

238
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And he was a crafty old boy, too, I think, on a shrewd politician in that which is an absolute.

239
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Yes, but I always felt he was on the side of the angels eventually.

240
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Yes. I think many people, people people would agree would agree with that on that.

241
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And I feel that he was the fundamental reason for getting the Cambridge preclinical students to do their clinical in Oxford.

242
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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.

243
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And there's a marvellous picture, you know, they have in your picture the clinical students.

244
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Yes. And in those days, you know, Oxford was getting about 10 a year, if you're lucky.

245
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And there's one picture of George in the middle and the administrator and another administrator and about six students.

246
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And George's face is clearly saying, I'm going to get out of here if it doesn't change.

247
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I mean, it is a marvellous expression of disgust at the position, but he changed it.

248
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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,

249
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and the only bright people were going off to London to and they could his father in law was head of the Cambridge College.

250
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Oh, how fascinating. Right. Probably that probably explains partly the link and the opportunity.

251
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Now, you had a year out in Boston, Massachusetts, is a little bit about that.

252
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Well, it was generally in those days you did the BGA being to America,

253
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it was almost an essential thing to get a consulting job with a good hospital in England.

254
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And George was very thick with the job,

255
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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.

256
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And he thought that the one of the vapour chromatography setups I had will be very useful to Holly Smith,

257
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who was Lloyd Smith Junior, who was running the intra-community of the mass general.

258
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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.

259
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He inherited hydroxyurea, familial, hydroxyurea,

260
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and that depended on Clark's late metabolism and oxalate forms by natural females as to the Ketan bodies.

261
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I was working on and so that sort of chromatographs could be adapted and.

262
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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.

263
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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.

264
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I mean, he sent a message saying he couldn't come. Would I take the order?

265
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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?

266
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So I had to say, well, George wasn't there. Won't you take water?

267
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Because really will sense, you know? And he said, no, no.

268
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And there was an American patient who was a sort of businessman of 60,

269
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and he'd come back on the ferry from France the day before and then had a considerable central nervous upset.

270
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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.

271
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If it had been an aeroplane, it would have been on the threshold of getting in trouble and going up and down.

272
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And the ship would have pushed him over the stretcher because he had vomiting and misstatements and sort of bias.

273
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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.

274
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And there was a thought that there'd be no harm, no,

275
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he could see that you could handle the complexity of it and thinking through all the possible differential diagnosis and also the patient,

276
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because no doubt the patient was pretty descriptions of him certainly is now true.

277
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And so I'm sure that although one was put into committees and was a Rockefeller committee,

278
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so may have even been on edge in America, but I'm sure that helped in that getting to the mass general.

279
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And then it was the integrity unit, which was a superb unit, although a bit anomalous in a way.

280
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And Holly Smith, who is the best guy across the board I've ever worked with, and he was a first rate clinician,

281
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first rate Lattman, first rate administrator, first rate fundraiser raiser, first rate lecture.

282
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You know, you really right. You may not have been a genius, but he was right across the board.

283
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And so he was really inherited. Inborn errors of metabolism rather than medical knowledge,

284
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but there were enough of the old school from Albright's time for it to be a very good thing to consider traditionally.

285
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And Holly was a first rate clinician, and I know it was a most interesting, exciting years to learn.

286
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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.

287
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So it was all very pleasant.

288
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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,

289
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you then came to Oxford, you then went back to London, then you came back to Oxford for Mergenthaler.

290
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Right. Is that pretty radical London? No, I had one spell spend only one Amanda and Mergenthaler.

291
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I suppose you wouldn't maybe count as London was saying. No, no, no.

292
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That's okay. You have the time came after your BTA and you were looking around for a consultant post.

293
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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.

294
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So we went to America. Sixty two to sixty three had one child in Boston.

295
00:35:44,180 --> 00:35:53,020
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.

296
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With you know just one and only one is one. Yeah.

297
00:35:57,440 --> 00:36:04,060
So tell us about that decision of coming to Oxford.

298
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As a consultant from Wheatly, do you mean as a consultant?

299
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Well, I mean, I was thinking along and George, you know,

300
00:36:14,290 --> 00:36:22,210
with his sort of foresight engineer that I worked in the diabetic clinic with Eric Cook

301
00:36:22,210 --> 00:36:29,140
and went on pademelons ward rounds because that man was the stated endocrinologist.

302
00:36:29,140 --> 00:36:39,290
Though he was fairly general physician, really. I suppose I was just getting along, but I'm beginning to think of consulting jobs,

303
00:36:39,290 --> 00:36:46,880
and it was obvious that, yes, everybody knew that ALICO compatible and were going to retire and that,

304
00:36:46,880 --> 00:36:56,750
in fact, they were going to be three consulting jobs, one contract and two general medicine with interest in metabolism and technology.

305
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So I knew that was on the horizon.

306
00:36:59,510 --> 00:37:08,780
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.

307
00:37:08,780 --> 00:37:17,840
He was the head of California, the San Francisco Medical School, and which virtually meant he was head of.

308
00:37:17,840 --> 00:37:23,180
So I would have had a chance of a job in La Hoya if I hadn't got the Oxford job.

309
00:37:23,180 --> 00:37:27,470
No, I didn't want to go to America. I mean, that's quite definite.

310
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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.

311
00:37:35,870 --> 00:37:51,200
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,

312
00:37:51,200 --> 00:37:54,050
kept them going because I don't know how much you know about this,

313
00:37:54,050 --> 00:38:05,240
but there were these two jobs and the ten candidates and we were all put in that Calcutta.

314
00:38:05,240 --> 00:38:14,360
And I really heard that kind of Calcutta next to the border, which was a great big interview while we were on it.

315
00:38:14,360 --> 00:38:22,510
Well, in a sense, I knew about that and it was all alphabetical, so I knew I wouldn't be called for a bit.

316
00:38:22,510 --> 00:38:27,100
And I went down to Forest Hill where I was, and walked up the hill and back,

317
00:38:27,100 --> 00:38:31,780
and then they sort of came about about 3:00 when the pieces started to fall.

318
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The others are already toxified, the noxious gas, any of that.

319
00:38:40,390 --> 00:38:49,090
And what happened was there were two jobs and I think there were three of us left of interest.

320
00:38:49,090 --> 00:38:58,420
And Pickering just kept talking and talking because I think he was backing me up for lots of reasons.

321
00:38:58,420 --> 00:39:04,300
But one, I'm sure he just wanted it shown that people would come through Oxford and get a consulting job.

322
00:39:04,300 --> 00:39:06,940
It wasn't just the London hospitals.

323
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And I'm sure he wanted John Ledingham because John had done renin with Darah and Pickering was interested in hypertension.

324
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And anyhow, he got what these committees always say.

325
00:39:21,580 --> 00:39:29,770
They always say, well, any of not any of the candidates, but the final few, any of them would do the job perfectly adequate.

326
00:39:29,770 --> 00:39:34,720
So and then they said, right, that's the case. You can all go to London.

327
00:39:34,720 --> 00:39:43,100
Well, certainly in the morning I was just there and it was just living on me.

328
00:39:43,100 --> 00:39:51,260
And then, of course, the renal business came because I was going to split the.

329
00:39:51,260 --> 00:40:03,640
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.

330
00:40:03,640 --> 00:40:07,840
And then after only about three or four months, the analysis came along,

331
00:40:07,840 --> 00:40:16,180
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.

332
00:40:16,180 --> 00:40:22,700
Yeah. And went on doing hypertension, even a hypertension.

333
00:40:22,700 --> 00:40:29,500
So the diabetes side of it. How did that splice in to the original plan?

334
00:40:29,500 --> 00:41:54,380
Because you think a lot of are completely at odds with the original plan, first of all.

335
00:41:54,380 --> 00:41:59,400
So that had been a bit disruptive, but.

336
00:41:59,400 --> 00:42:10,020
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

337
00:42:10,020 --> 00:42:17,520
each patient and you write down what you gathered in a very stereotyped format that I set out.

338
00:42:17,520 --> 00:42:22,680
And Ali wrote the letters on any of the patients that he thought needed veterans writing on.

339
00:42:22,680 --> 00:42:26,580
I mean, not just the patients he'd seen, the patients everybody would see.

340
00:42:26,580 --> 00:42:32,760
So I after a bit of it, I said to it was, OK, I've seen the patient, you haven't anything.

341
00:42:32,760 --> 00:42:40,140
I want to write a letter. And after a little reluctance, he very kindly said I could, providing he saw the letters,

342
00:42:40,140 --> 00:42:45,490
which of course was fine because I learnt a lot then on his feedback on my letters.

343
00:42:45,490 --> 00:42:51,210
So, I mean, it was a much better.

344
00:42:51,210 --> 00:42:56,790
And then there's something about inpatients and outpatients. How is it all organised at that point?

345
00:42:56,790 --> 00:43:03,840
And did you bring people in for metabolic investigation? We never had a real metabolic unit.

346
00:43:03,840 --> 00:43:09,960
I mean, you could get somebody and obviously to do 24 year olds and that sort of thing.

347
00:43:09,960 --> 00:43:18,450
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.

348
00:43:18,450 --> 00:43:24,450
We never had that sort of facility, a metabolic lab in that way.

349
00:43:24,450 --> 00:43:28,350
Everybody did take you know, everybody was a general physician.

350
00:43:28,350 --> 00:43:35,400
And there were the medical wards, the medical firms, which were in pairs in bed, not necessarily in that.

351
00:43:35,400 --> 00:43:45,000
And so it doesn't slide. And then the two professorial units, Pickering's and Whit's.

352
00:43:45,000 --> 00:43:54,510
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.

353
00:43:54,510 --> 00:44:00,300
And so obviously your partner did as much, you know, that that was the amount you were doing.

354
00:44:00,300 --> 00:44:06,690
And if you want to take your looked after those patients and they were in your beds and then also

355
00:44:06,690 --> 00:44:13,710
there would be patients from the diabetic clinical forever who came in from a waiting list.

356
00:44:13,710 --> 00:44:19,030
And you were in the hotted wards, which no longer exists. Correct, yes.

357
00:44:19,030 --> 00:44:22,600
And Rowney, would it have been for you? It was Rowney.

358
00:44:22,600 --> 00:44:31,390
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.

359
00:44:31,390 --> 00:44:40,680
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.

360
00:44:40,680 --> 00:44:43,890
It was by then, but it was positon slight. I remember Teddybears.

361
00:44:43,890 --> 00:44:49,920
I don't think I was one of the last group of students before he retired because he had something to.

362
00:44:49,920 --> 00:44:55,770
It's how fascinating takes me back as well to those that did you enjoy take?

363
00:44:55,770 --> 00:45:01,050
Oh, absolutely. No, I enjoyed general medicine.

364
00:45:01,050 --> 00:45:06,570
Yes, I did. Mm hmm.

365
00:45:06,570 --> 00:45:11,790
And did you enjoy teaching? I think you did. Yeah, I did.

366
00:45:11,790 --> 00:45:16,410
We used to do a little lecturing and then, of course, bedside teaching.

367
00:45:16,410 --> 00:45:26,820
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.

368
00:45:26,820 --> 00:45:31,020
You'd have either the people in their first year or the people in their third year.

369
00:45:31,020 --> 00:45:36,600
It would change three months and three months old.

370
00:45:36,600 --> 00:45:45,960
So you were always part of that sort of general, the induction of the new clinical students and then finishing off before finals,

371
00:45:45,960 --> 00:45:51,810
like you actually see them at both ends, as it were, that they learnt time.

372
00:45:51,810 --> 00:45:57,630
And you were medical tutor at Reasoners? Well, for a year, not till 1980.

373
00:45:57,630 --> 00:46:02,190
They didn't have medical students at the colleges until, say, the 70s.

374
00:46:02,190 --> 00:46:10,870
And then prisoners caught up and invited me to be the clinical tutor, which I say I didn't.

375
00:46:10,870 --> 00:46:15,620
Do as assiduously as they do now, because that I always recommend, you know,

376
00:46:15,620 --> 00:46:24,070
major revelations and nobody looked after me when I was a kid student, I didn't see this just anything.

377
00:46:24,070 --> 00:46:30,440
I used to see them sort of three times a term, but I didn't see of them weekly or anything like that.

378
00:46:30,440 --> 00:46:40,550
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,

379
00:46:40,550 --> 00:46:47,320
it was very important that you were part of a firm and you felt you were part of a sort of learning family.

380
00:46:47,320 --> 00:46:52,460
And in a way, it was quite well there. It always changed with a different group of students.

381
00:46:52,460 --> 00:46:57,860
There was still a very strong idea that this was your team that you would learn from.

382
00:46:57,860 --> 00:47:08,870
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.

383
00:47:08,870 --> 00:47:13,400
So each student had access to, say, three, four or five patients.

384
00:47:13,400 --> 00:47:18,860
I mean, we're directly clocking them. Well, nowadays, you know, you might be only doing one or two.

385
00:47:18,860 --> 00:47:32,470
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.

386
00:47:32,470 --> 00:47:37,300
Trainee's that is post student level, but maybe even from student days,

387
00:47:37,300 --> 00:47:46,120
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.

388
00:47:46,120 --> 00:47:51,500
And Jim, whom she married, came back from from his divil.

389
00:47:51,500 --> 00:47:55,720
I thought that was his textbook of pharmacology.

390
00:47:55,720 --> 00:48:09,280
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.

391
00:48:09,280 --> 00:48:15,730
But you must have nurtured a number of diabete ologists who had a sort of diaspora beyond Oxford.

392
00:48:15,730 --> 00:48:19,270
Can you think of certain ones over the years that have.

393
00:48:19,270 --> 00:48:29,320
There was the Georgia Virgin, Frank Woods, amongst others, and then an Indian, and naturally, I would certainly remember.

394
00:48:29,320 --> 00:48:36,610
And where did they go, Derek? For those who who know the field, Alberta want to tell you the story of.

395
00:48:36,610 --> 00:48:44,680
I think it's not important in showing what Besom contributed because George was a

396
00:48:44,680 --> 00:48:53,200
very bright guy and he'd done preclinical at Paleo and then his clinical in Oxford.

397
00:48:53,200 --> 00:48:57,670
And there was an American photoplay who was a big man in New York,

398
00:48:57,670 --> 00:49:04,750
came over again for a year off in Oxford because it was very common for American

399
00:49:04,750 --> 00:49:11,680
consultants to spend a year in Oxford either with grapes or with Pickering or whatever.

400
00:49:11,680 --> 00:49:16,510
And Tapley was taking these clinical students on diabetes.

401
00:49:16,510 --> 00:49:20,020
And he was a thorough radiologist, actually, but on diabetes.

402
00:49:20,020 --> 00:49:25,600
And he said George knew more about diabetes than he did, which may not have been literature.

403
00:49:25,600 --> 00:49:31,130
He was very impressed then Georgia defo with Crib's.

404
00:49:31,130 --> 00:49:37,880
And he has jobs and so on, he and Frank Woods were there, has jobs at Intel together,

405
00:49:37,880 --> 00:49:47,510
HHS and the patients were never better after fibroid or endocrine surgeon.

406
00:49:47,510 --> 00:49:54,950
Indeed. And then George went to America and he was there quite a long time.

407
00:49:54,950 --> 00:50:00,110
But Beissinger, meanwhile, become Professor Darfield, professor at Oxford,

408
00:50:00,110 --> 00:50:08,000
and he thought the trouble with the British system was that if you were going to be a clinical researcher,

409
00:50:08,000 --> 00:50:13,520
you spent too much time in gathering wealth of knowledge about medicine.

410
00:50:13,520 --> 00:50:21,650
And what you wanted to do was to know the clinical aspects of your speciality with know the bitter medicine you began researching,

411
00:50:21,650 --> 00:50:30,950
but you didn't need the whole lot. And he created these jobs, a couple of them, which were for that purpose.

412
00:50:30,950 --> 00:50:38,930
You could be appointed to them without your membership, which before that was sort of essential to get any decent senior lectureship.

413
00:50:38,930 --> 00:50:49,490
And McLeland, who went to the immunologist to come to Birmingham and George was appointed from Boston to Oxford,

414
00:50:49,490 --> 00:50:55,430
and I had met George in Boston, you know, I and a little out there and.

415
00:50:55,430 --> 00:51:00,230
George and I linked up with the crib's team and so on, and it was very fruitful.

416
00:51:00,230 --> 00:51:08,420
And then after Oxford and the various goings on there, he went to Southampton and then Newcastle.

417
00:51:08,420 --> 00:51:13,550
Newcastle? Yes, I sort of had him placed in Newcastle. Yes.

418
00:51:13,550 --> 00:51:18,010
And Frank once went to Sheffield.

419
00:51:18,010 --> 00:51:22,820
Yes. As chair of therapeutics or whatever.

420
00:51:22,820 --> 00:51:28,180
But it was a clinical post and he was very interested. Metformin, which was a big one.

421
00:51:28,180 --> 00:51:32,300
A diabetic drug. Mm hmm.

422
00:51:32,300 --> 00:51:35,330
Interesting as John Kennedy is also when he was interested in bones,

423
00:51:35,330 --> 00:51:43,380
but he also went from Oxford to Sheffield, had a very big renal calcium stirring of bones.

424
00:51:43,380 --> 00:51:54,590
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.

425
00:51:54,590 --> 00:52:05,870
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.

426
00:52:05,870 --> 00:52:18,040
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.

427
00:52:18,040 --> 00:52:27,370
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.

428
00:52:27,370 --> 00:52:40,450
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.

429
00:52:40,450 --> 00:52:46,180
That will be and that would be valuable in India. He knew absolutely he was going back to India.

430
00:52:46,180 --> 00:52:54,130
He wasn't going to stay on in the States. I had mistakenly thought that he might have been a student here.

431
00:52:54,130 --> 00:53:02,470
But you. And so then is to do with the research within the NHS and leading on to the Sheikh Rashid

432
00:53:02,470 --> 00:53:08,320
diabetes unit and how that whole thing evolved because Oxford became very big in diabetes,

433
00:53:08,320 --> 00:53:12,550
didn't it? Did I mean, there were three sort of themes we had.

434
00:53:12,550 --> 00:53:15,720
David Jenkins was. Well, first of all,

435
00:53:15,720 --> 00:53:27,010
what's pretty amazing was the first student I had and I wish he'd done his membership in

436
00:53:27,010 --> 00:53:34,690
Newcastle and he was from the Middle East and he was the best general practitioner in Kuwait.

437
00:53:34,690 --> 00:53:42,640
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.

438
00:53:42,640 --> 00:53:51,190
So there was this application, a picture of a rather pudgy Sikh for the turban and, you know, middle aged.

439
00:53:51,190 --> 00:53:57,670
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.

440
00:53:57,670 --> 00:54:05,500
And he was devoted and we ran a trial of glucose, insulin and cardiac infarction,

441
00:54:05,500 --> 00:54:11,510
which, you know, was very good, wasn't really and wasn't big enough to be determined.

442
00:54:11,510 --> 00:54:23,200
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.

443
00:54:23,200 --> 00:54:34,530
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.

444
00:54:34,530 --> 00:54:43,650
Papers on dietary fibre and diabetes in diabetic diets and really got fibre going as a subject.

445
00:54:43,650 --> 00:54:52,580
And then there was the diabetic coma treatments. Tell us a bit about that.

446
00:54:52,580 --> 00:55:05,260
I got rung up one morning. And said, would I give a talk at the coming British Diabetic Association meeting in Birmingham?

447
00:55:05,260 --> 00:55:10,450
Because somebody had dropped out. I don't know who this was, something I really couldn't do.

448
00:55:10,450 --> 00:55:23,850
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.

449
00:55:23,850 --> 00:55:33,690
A spectrophotometer against the magic method for analysing ketones so we could do blood ketones in a way that virtually nobody else could,

450
00:55:33,690 --> 00:55:38,910
and we were beginning to do blood, Keita and some people. And that was in the background.

451
00:55:38,910 --> 00:55:44,430
So I started reading up about diabetic coma more than I had before.

452
00:55:44,430 --> 00:55:50,610
And two things struck me when I know people didn't do very well in it.

453
00:55:50,610 --> 00:55:59,820
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.

454
00:55:59,820 --> 00:56:05,190
So I went up and gave that talk, which is 20 minutes, and went really well.

455
00:56:05,190 --> 00:56:15,150
And I always remember the next day getting on the train back to Oxford from Birmingham, George insinuates himself into the same compartment.

456
00:56:15,150 --> 00:56:20,350
And we were talking about this and that and.

457
00:56:20,350 --> 00:56:31,390
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.

458
00:56:31,390 --> 00:56:39,670
So, again, it was easy, as it were, in Oxford, to measure that fate and of and.

459
00:56:39,670 --> 00:56:48,730
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.

460
00:56:48,730 --> 00:56:59,140
So we and the point was that George had set up a enslin really I acid incident.

461
00:56:59,140 --> 00:57:05,560
So that was going. And he did this with two, as it were, girls straight from school.

462
00:57:05,560 --> 00:57:11,200
But also there was a middle European for Auvinen,

463
00:57:11,200 --> 00:57:24,010
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.

464
00:57:24,010 --> 00:57:34,900
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

465
00:57:34,900 --> 00:57:42,690
treatment and people had been measuring insulin by the fact you were getting a number corrupted by the antibodies.

466
00:57:42,690 --> 00:57:54,020
So the. So we thought these measurements and you can see where the ketones were, but the insulin levels were just sky high.

467
00:57:54,020 --> 00:57:58,370
I mean, they were absurd and it didn't matter if they were 10 percent wrong.

468
00:57:58,370 --> 00:58:08,920
They were absurd. And I think George, with some computer help from South Park Road, whatever would be a reasonable dosage,

469
00:58:08,920 --> 00:58:15,910
and also we were looking at similar Andres's papers on the forearm metabolism and,

470
00:58:15,910 --> 00:58:22,210
you know, 200 million units, four litre of insulin with maximum, you didn't need more.

471
00:58:22,210 --> 00:58:29,440
And at that time, there was a thought because people did drive diabetic coma, particularly with infection,

472
00:58:29,440 --> 00:58:34,330
despite all the insulin being given, that a sort of feeling that was a mystery around.

473
00:58:34,330 --> 00:58:38,920
And there was a thing called insulin resistance, that is I mean, it's very important.

474
00:58:38,920 --> 00:58:47,620
But there was a completely wrong. Interpretation of it that.

475
00:58:47,620 --> 00:58:56,520
If you plotted the disappearance of glucose, the rate of all of the glucose against the insulin given it went up.

476
00:58:56,520 --> 00:59:05,220
And I went up and up and up, and the reason was that you only needed a certain amount of insulin.

477
00:59:05,220 --> 00:59:12,870
So obviously once you got beyond the mines and you gave you got the same full of glucose and it looked as though

478
00:59:12,870 --> 00:59:19,860
there was huge resistance and they didn't realise the difference between a sigmoid curve and a linear curve,

479
00:59:19,860 --> 00:59:29,330
really, that was the fundamental point. And there was this sort of fear of giving us all this.

480
00:59:29,330 --> 00:59:36,230
I always remember, so we decided to run a.

481
00:59:36,230 --> 00:59:40,130
Yeah, and I'm very as it were, marriage is not scientific method.

482
00:59:40,130 --> 00:59:51,050
We have the measurements from, let's say, 15 people and then we said we'll treat the next 15 with a new regime,

483
00:59:51,050 --> 01:00:01,210
which was the small amount of insulin given regulators, you know, sort of five units, five and.

484
01:00:01,210 --> 01:00:08,860
We did that again, not randomised, but sequentially, I think I think that's right, and compared to lots, you know,

485
01:00:08,860 --> 01:00:19,990
the ones before and after, and they were just the same, the fall of the blood glucose and the ketones, exactly the same regime.

486
01:00:19,990 --> 01:00:28,810
Now, in retrospect, though, we didn't quite think it at the time, because there are slight differences in potassium and so on foods.

487
01:00:28,810 --> 01:00:37,930
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,

488
01:00:37,930 --> 01:00:44,260
they had a certain regime and they could just relax. What needs investigating now?

489
01:00:44,260 --> 01:00:51,340
Much more, I think, is the response to infection in patients with uncontrolled diabetes.

490
01:00:51,340 --> 01:00:58,510
And I would love to see all the, you know, these factors like PSP.

491
01:00:58,510 --> 01:01:01,210
And in my case, it would be to try and say, you know,

492
01:01:01,210 --> 01:01:11,610
these immune factors done at the bedside of people with infection and hypoglycaemia, because that's still an important.

493
01:01:11,610 --> 01:01:20,100
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,

494
01:01:20,100 --> 01:01:28,950
and that depended on point of bedside testing of the blood sugar levels until I was little.

495
01:01:28,950 --> 01:01:36,090
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,

496
01:01:36,090 --> 01:01:47,130
where you weren't quite sure what their capacity to respond was relied on point of contact, testing of sort of bedside testing.

497
01:01:47,130 --> 01:01:51,250
Did that come in? I mean, was that fairly widespread through much of your career?

498
01:01:51,250 --> 01:01:56,820
Yes, I would have said it was then when I started. Really, that was.

499
01:01:56,820 --> 01:02:01,350
But the idea of actually giving people it was the early days of what you might call a protocol,

500
01:02:01,350 --> 01:02:07,230
what you managed to determine in terms of how to manage these coma patients.

501
01:02:07,230 --> 01:02:16,740
That's true. Yeah, that's really interesting because it needs large with with a heterogeneous but urgent problem like that.

502
01:02:16,740 --> 01:02:24,810
It probably needs quite a lot of numbers to put together to make a coherent picture of handling each one individually,

503
01:02:24,810 --> 01:02:30,660
but then coming up with something that sort of broadly works across the spectrum of different responses.

504
01:02:30,660 --> 01:02:36,150
That's really, really interesting. Tell us about the shape Rashied Diabetes Unit.

505
01:02:36,150 --> 01:02:40,980
How much did that affect your your working life and your research life?

506
01:02:40,980 --> 01:02:52,060
You personally feel tremendously. It's kind of happened with it because it's.

507
01:02:52,060 --> 01:02:59,860
So, Jeffrey, how was the last British resident to the church, 11 states?

508
01:02:59,860 --> 01:03:09,040
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,

509
01:03:09,040 --> 01:03:13,630
and he was selecting them as people he thought were good.

510
01:03:13,630 --> 01:03:21,890
And they were obviously friendly to him because he had selected them and.

511
01:03:21,890 --> 01:03:31,400
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,

512
01:03:31,400 --> 01:03:37,670
which he did until after his death. They got some because of that, but.

513
01:03:37,670 --> 01:03:44,600
Sheikh Zayed of Abu Dhabi, when Jeffrey Arthur got liver trouble,

514
01:03:44,600 --> 01:03:52,680
he went to Roger Williams and Roger Williams was up in Edinburgh somewhere at the time when.

515
01:03:52,680 --> 01:04:02,190
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.

516
01:04:02,190 --> 01:04:07,830
So Roger Williams thereafter looked after him immensely closely.

517
01:04:07,830 --> 01:04:13,470
So Jeffrey Hoffman was very grateful to Roger Williams and.

518
01:04:13,470 --> 01:04:17,610
He got the shakes, I probably said,

519
01:04:17,610 --> 01:04:25,620
I want to give money to charity in England and Jeffrey Arthur got the money to the liver unit at

520
01:04:25,620 --> 01:04:34,020
Kings and Jeffrey believed in grants going to NHS research units rather than university ones.

521
01:04:34,020 --> 01:04:36,240
Interesting.

522
01:04:36,240 --> 01:04:48,780
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.

523
01:04:48,780 --> 01:04:53,760
Sheikh Rashid of Dubai said, I'd like to give money to British medicine.

524
01:04:53,760 --> 01:04:57,330
And at that time, Jeffrey, as I think with real shrewdness,

525
01:04:57,330 --> 01:05:07,710
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.

526
01:05:07,710 --> 01:05:14,100
And he said, Shukrallah, you know, this is diabetes, which was already rising in the Gulf and becoming a problem.

527
01:05:14,100 --> 01:05:17,810
And at some stage take why?

528
01:05:17,810 --> 01:05:29,820
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,

529
01:05:29,820 --> 01:05:33,480
who was at the administrative fence when he was a young man of the Admiralty.

530
01:05:33,480 --> 01:05:41,970
So they knew one. And the other thing was that the bursar Canberra, who was really a classicist,

531
01:05:41,970 --> 01:05:47,370
was the chap, in a sense, who Jeffrey Arthur worked with when he came to the college.

532
01:05:47,370 --> 01:05:56,160
And I said, I don't have a good time in that he has to suffer really severe migraines.

533
01:05:56,160 --> 01:06:02,140
And they would knock him out for the whole morning, once a fortnight, once a month.

534
01:06:02,140 --> 01:06:09,390
And he came to see me and then he started talking to him, I said, you know what happens?

535
01:06:09,390 --> 01:06:20,700
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,

536
01:06:20,700 --> 01:06:27,360
half an hour in the night before the migraine, and he'd be feeling hungry and he'd turn and go to sleep.

537
01:06:27,360 --> 01:06:30,810
So slightly facetiously. I said, why don't you?

538
01:06:30,810 --> 01:06:36,480
That is just a biscuit and that kind of thing.

539
01:06:36,480 --> 01:06:45,740
You see, as ever, it's in a sense of the bad mind because already there was.

540
01:06:45,740 --> 01:06:53,290
There was the idea that migraine could be precipitated by hypoglycaemia, incorrect,

541
01:06:53,290 --> 01:07:01,640
but there is a real possibility that it's precipitated by the time you turn your metabolism from carbohydrate.

542
01:07:01,640 --> 01:07:05,420
It was the last meal to your stores. I mean, do you know?

543
01:07:05,420 --> 01:07:10,340
Because that must be a big change, Gundam.

544
01:07:10,340 --> 01:07:17,750
With Derek Williamson, myself and Judith, who's interested me migraine, we've been looking to see if you've got migraine,

545
01:07:17,750 --> 01:07:25,490
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.

546
01:07:25,490 --> 01:07:30,680
And that was slightly informative. So I didn't have that sort of idea in my mind.

547
01:07:30,680 --> 01:07:34,660
But I must say, I was really slightly facetious.

548
01:07:34,660 --> 01:07:48,860
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.

549
01:07:48,860 --> 01:07:52,640
And I mean, the money was a lot in those days.

550
01:07:52,640 --> 01:07:57,810
It was one and a quarter million, which was quite a lot of money.

551
01:07:57,810 --> 01:08:04,490
Yes, we built a new unit in the area that Alison had left.

552
01:08:04,490 --> 01:08:13,760
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.

553
01:08:13,760 --> 01:08:21,200
Gosh. And we did various of the thing I'm proudest of was not me at all.

554
01:08:21,200 --> 01:08:28,550
It was Keith Frain who came from an emergency unit up in Manchester.

555
01:08:28,550 --> 01:08:31,850
He started in London and done a nice bit of work,

556
01:08:31,850 --> 01:08:42,230
got a good job with a burns unit up in Manchester where the clinicians had maltreated him or they just didn't get on.

557
01:08:42,230 --> 01:08:47,710
And Keith had a real apprehension about.

558
01:08:47,710 --> 01:08:52,820
And it took me about two years to resolve this.

559
01:08:52,820 --> 01:09:03,320
But Terry Williamson, I'm sure, knew about this very when they recommended Keith to me as a sort of third main clinical assistant.

560
01:09:03,320 --> 01:09:07,820
So I metabolic assistant in the unit.

561
01:09:07,820 --> 01:09:14,540
And Keith wanted this very definitely to apply the principle to adipose tissue.

562
01:09:14,540 --> 01:09:27,800
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

563
01:09:27,800 --> 01:09:33,500
veins in the anterior abdominal wall that are draining the adipose tissue there.

564
01:09:33,500 --> 01:09:37,310
And, you know, we would look and say, should we get this project up or not?

565
01:09:37,310 --> 01:09:42,650
And because I didn't have to apply for grants, I mean, I did a lot and got money.

566
01:09:42,650 --> 01:09:51,350
But because of the backing of the Sheikh Rashid and had enough steady income that no one could go for something like that.

567
01:09:51,350 --> 01:09:58,220
And I always thought that, you know, every now and then you do need long term backing, irrespective of results,

568
01:09:58,220 --> 01:10:07,340
because Keith had this very clear idea and once it all worked and dying was the first person who did it.

569
01:10:07,340 --> 01:10:19,720
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,

570
01:10:19,720 --> 01:10:23,800
because I can't remember clearly about that pick applied at the lungs.

571
01:10:23,800 --> 01:10:29,860
I think it's very simple. You measure the concentration of whatever light going in.

572
01:10:29,860 --> 01:10:38,950
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.

573
01:10:38,950 --> 01:10:42,820
Oh, thank you. Okay.

574
01:10:42,820 --> 01:10:54,310
It was in Stebbings textbook. A physiology gave me back a bit, but we did also.

575
01:10:54,310 --> 01:11:04,500
We had a prospective study of diabetes which set off about a year and a half before you gave it to me.

576
01:11:04,500 --> 01:11:16,570
On the conceptual thinking around that, I must have been I think a lot of the conceptual thinking came from Richardo, which, you know,

577
01:11:16,570 --> 01:11:22,240
very much wanted to have a randomised trial of diabetic treatments,

578
01:11:22,240 --> 01:11:28,660
as other people did in a sense, but don't have a very persistent vision, as he put it.

579
01:11:28,660 --> 01:11:39,090
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.

580
01:11:39,090 --> 01:11:44,100
Probably sort of temperamentally, I didn't ask for enough, you know,

581
01:11:44,100 --> 01:11:53,820
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,

582
01:11:53,820 --> 01:12:01,050
I got it on the one proforma that didn't really work out because I was very interested in temperature

583
01:12:01,050 --> 01:12:07,380
and always have been measured in body temperature and have ideas still about the interaction of that,

584
01:12:07,380 --> 01:12:14,400
possibly, possibly with metabolism, diabetes. But we had worked at the top that made alcohol flushing.

585
01:12:14,400 --> 01:12:21,540
Sorry, I don't know if you ever came across that with a side effect of top of mind was

586
01:12:21,540 --> 01:12:27,630
that people flushed if they drank alcohol and it was socially embarrassing.

587
01:12:27,630 --> 01:12:38,730
And the Kings people came up with the idea that if you were to provide alcohol flusher, you tended to be.

588
01:12:38,730 --> 01:12:56,250
Liable to diabetic tissue damage, more liable, and they thought there was some link and exploited that, but I think.

589
01:12:56,250 --> 01:13:05,400
And we measure the plasma concentrations and the body temperature, and it was all the two things that determine the flushing,

590
01:13:05,400 --> 01:13:17,070
the plasma concentration and the temperature of the skin at the beginning when you gave the alcohol that we thought of that.

591
01:13:17,070 --> 01:13:28,810
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.

592
01:13:28,810 --> 01:13:35,800
We did it all with our rolling hills and in temperature, too.

593
01:13:35,800 --> 01:13:47,570
So in a sense, the money that I thought is really important in diabetes, to know for sure if it was the.

594
01:13:47,570 --> 01:13:53,030
Glucose levels that caused the tissue damage, but we had the opportunity to do two things.

595
01:13:53,030 --> 01:14:00,860
In fact, three things really we could measure a lot of the other metabolites, like lactate Perovic ketones.

596
01:14:00,860 --> 01:14:01,290
In other words,

597
01:14:01,290 --> 01:14:10,640
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.

598
01:14:10,640 --> 01:14:18,050
And we could have had a lot of dietary thought and we could look at low fat against low carbohydrate.

599
01:14:18,050 --> 01:14:29,600
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

600
01:14:29,600 --> 01:14:36,020
they were treated in the clinic by anybody who was doing it and then just see what happened to them.

601
01:14:36,020 --> 01:14:38,150
It was a very observational study,

602
01:14:38,150 --> 01:14:47,300
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,

603
01:14:47,300 --> 01:14:59,900
which it was. And and I think he thought I should have put the same money to his study with the political feelings about,

604
01:14:59,900 --> 01:15:05,750
well, my penultimate note has the dreaded single word administration.

605
01:15:05,750 --> 01:15:15,080
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

606
01:15:15,080 --> 01:15:22,730
night and then demonstrated a few little early stories about administration and my thoughts about administration,

607
01:15:22,730 --> 01:15:30,160
really. I remember I was on a thing called the Regional Consultation Board or something.

608
01:15:30,160 --> 01:15:35,550
We met every month, two months, and I always remember two things from that,

609
01:15:35,550 --> 01:15:40,800
one was that Rosemary Rose, an excellent person, and I really did a lot of good.

610
01:15:40,800 --> 01:15:45,870
But they were introducing she wanted to put money to some guy's job,

611
01:15:45,870 --> 01:15:53,580
which is to explain that although things were going wrong, the NHS were trying very hard.

612
01:15:53,580 --> 01:16:01,440
And I said, wouldn't it be better put the money to stop the things going wrong like that?

613
01:16:01,440 --> 01:16:05,250
And of course, it wouldn't have done very much to stop going wrong.

614
01:16:05,250 --> 01:16:16,320
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.

615
01:16:16,320 --> 01:16:26,370
And, you know, he was obviously doing good. It was a very good thing to have a devoted cardiac unit for coronary thrombosis.

616
01:16:26,370 --> 01:16:35,250
I thought and I remember trying to say Elmas Regional Committee to these other guys from,

617
01:16:35,250 --> 01:16:41,370
you know, segmental over what they needed was a cardiac unit and there was some money.

618
01:16:41,370 --> 01:16:49,860
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.

619
01:16:49,860 --> 01:16:57,620
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.

620
01:16:57,620 --> 01:17:02,060
And then there was an appointment to come into.

621
01:17:02,060 --> 01:17:16,010
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.

622
01:17:16,010 --> 01:17:21,290
He was a sort of typical of nature. And there's a cartoon and the bowler hat.

623
01:17:21,290 --> 01:17:27,830
You're a lovely man, but. With six candidates, they came down to two.

624
01:17:27,830 --> 01:17:31,730
But before that, one of the candidates was a woman as well.

625
01:17:31,730 --> 01:17:36,470
And when she came in, this late lady said what he said to no one else.

626
01:17:36,470 --> 01:17:39,710
Are you a serious candidate for this post?

627
01:17:39,710 --> 01:17:47,690
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.

628
01:17:47,690 --> 01:17:52,250
And then there were the two candidates left her and one of them.

629
01:17:52,250 --> 01:17:59,030
Everybody said he was from the one fellow, you know, the psychiatric world.

630
01:17:59,030 --> 01:18:08,720
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

631
01:18:08,720 --> 01:18:14,630
who would bust the loonies around from one place to another in a competent fashion.

632
01:18:14,630 --> 01:18:20,870
And the majority went to the administrator and I said no at that point.

633
01:18:20,870 --> 01:18:24,950
And then they come to this business that we would like a unanimous verdict.

634
01:18:24,950 --> 01:18:29,390
And I said, no, I mean, that's your opinion. That's my mine. And find there's a majority.

635
01:18:29,390 --> 01:18:38,570
OK, but in the end, I wasn't a natural administrator at the time and he used to come around.

636
01:18:38,570 --> 01:18:42,860
And you're the chairman of the Medical Staff Council.

637
01:18:42,860 --> 01:18:50,330
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,

638
01:18:50,330 --> 01:18:53,510
which was up at the John Radcliffe that and I earlier,

639
01:18:53,510 --> 01:19:03,410
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,

640
01:19:03,410 --> 01:19:10,610
quite suited us obesity and diabetes and technology to stay behind with Facebook.

641
01:19:10,610 --> 01:19:16,340
Best thing I ever did because you were out of the way of a lot of kerfuffle, peace and quiet.

642
01:19:16,340 --> 01:19:20,870
And we had new outpatient facilities at the John Radcliffe.

643
01:19:20,870 --> 01:19:25,610
And I used to love bicycling between the two because you're absolutely free.

644
01:19:25,610 --> 01:19:38,730
Nobody could get you. The administrators know and I used to go up to this committee and.

645
01:19:38,730 --> 01:19:40,680
I'm not a good administrator.

646
01:19:40,680 --> 01:19:50,730
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.

647
01:19:50,730 --> 01:20:00,000
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.

648
01:20:00,000 --> 01:20:05,010
And I've always regarded that as a very crafty thing of that time that the administrators

649
01:20:05,010 --> 01:20:11,940
got the conditions to change once they began to understand and bamboozle another lot.

650
01:20:11,940 --> 01:20:18,450
I mean, John Spencer was very good. I thought he was a very well directed administrator.

651
01:20:18,450 --> 01:20:24,120
You know, he was on the side of the angels, but very difficult job.

652
01:20:24,120 --> 01:20:32,760
Yes. And I gather he was around, of course. And I always remember one time he was trying, I suppose,

653
01:20:32,760 --> 01:20:38,250
to sort of limit medical expenditure because they were always worried about the money going on,

654
01:20:38,250 --> 01:20:43,020
overtime payments, not to consultants, but to medicks in general.

655
01:20:43,020 --> 01:20:49,080
And then for some reason, they wanted to find out just how much the conditions were doing.

656
01:20:49,080 --> 01:20:59,250
And it was all to do with limiting the activity, either limiting medical activity which costs money, or limiting consultants pay, which costs money.

657
01:20:59,250 --> 01:21:06,570
But anyhow, we had to say what we were doing and it was the same for everybody, physicians and surgeons.

658
01:21:06,570 --> 01:21:13,470
Everybody was in those days you did half the sessions and you did it in half days a week.

659
01:21:13,470 --> 01:21:18,390
And Pickering's time, the people were appointed in 66,

660
01:21:18,390 --> 01:21:28,950
actually were nine NHS plus to university people and even appointments, which is a real help to getting some research going.

661
01:21:28,950 --> 01:21:34,490
And back in those days before Christmas came, I set up in here and make another trip,

662
01:21:34,490 --> 01:21:39,140
a terrific essay, which I used to do with the neurosurgeons for pituitary tumours.

663
01:21:39,140 --> 01:21:51,740
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.

664
01:21:51,740 --> 01:22:00,710
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.

665
01:22:00,710 --> 01:22:08,400
It was quite clear. And that sort of collapsed. I remember you couldn't go any further with that idea.

666
01:22:08,400 --> 01:22:12,540
He, to my mind, was overruled by the university.

667
01:22:12,540 --> 01:22:21,120
You didn't think he stuck up for the NHS? The. Typically, there is always this business of knock for knock.

668
01:22:21,120 --> 01:22:29,940
I don't know if you know that phrase I used to say one, the university people are very clever.

669
01:22:29,940 --> 01:22:34,260
I bet they're doing well, too. Who is knocking whom for what?

670
01:22:34,260 --> 01:22:39,960
And nobody would ever answer that question. And I don't know if you remember.

671
01:22:39,960 --> 01:22:48,970
You remember see, it wasn't a seed payment or something. It was the surplus payment because of a teaching hospital.

672
01:22:48,970 --> 01:22:58,810
And that was meant to give the conditions a bit of extra backup so they didn't hurt our patients or on the wards,

673
01:22:58,810 --> 01:23:06,280
if they were spending time teaching, you know, they would have some support when it all went into laboratory research.

674
01:23:06,280 --> 01:23:11,260
Absolutely disgraceful. Yes. Yes. No, I can't imagine that it would be.

675
01:23:11,260 --> 01:23:19,320
And that general slide away from exactly what you were talking about earlier, which is teaching students on ward rounds and in clinics.

676
01:23:19,320 --> 01:23:23,800
And that was very precious. I think it was irreplaceable, really.

677
01:23:23,800 --> 01:23:30,940
Gosh. Well, the final thing on the list that you've given to me, Derek says cricket and football at the moment.

678
01:23:30,940 --> 01:23:36,400
Tell us about cricket and football. But there used to be stuff.

679
01:23:36,400 --> 01:23:39,340
Student games in the old days are bad.

680
01:23:39,340 --> 01:23:51,400
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.

681
01:23:51,400 --> 01:23:58,130
I heard it was a privilege to be teaching about.

682
01:23:58,130 --> 01:24:10,800
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.

683
01:24:10,800 --> 01:24:15,450
And took it up in June of.

684
01:24:15,450 --> 01:24:20,220
And Jim Hadfield's and if you remember him, a surgical tutor.

685
01:24:20,220 --> 01:24:25,820
I do. He'd been in business with me and he knew I played a little bit.

686
01:24:25,820 --> 01:24:31,020
Yes. So as he did, so am I.

687
01:24:31,020 --> 01:24:40,590
He said I was paying the students, which I hadn't played in before I come back to the Soviet Union.

688
01:24:40,590 --> 01:24:43,200
And I always remember playing that we did quite well.

689
01:24:43,200 --> 01:24:49,080
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,

690
01:24:49,080 --> 01:24:53,690
you know, if I play rugby, I play rugby. And there'd be a few scattered injuries around.

691
01:24:53,690 --> 01:24:59,100
But he didn't play with John Reid, did he was there.

692
01:24:59,100 --> 01:25:07,590
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,

693
01:25:07,590 --> 01:25:14,370
just sort of motoring around in the home with one of the home countries in Somerset, that sort of area.

694
01:25:14,370 --> 01:25:24,450
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.

695
01:25:24,450 --> 01:25:30,510
I always remember that. And then the soccer, they used to get up a team occasionally.

696
01:25:30,510 --> 01:25:38,340
And we play we used to play on the ground at the top of south parks or sometimes out of the Morrises.

697
01:25:38,340 --> 01:25:45,960
But anyhow, coming up at halftime, the score was something like the students nine consultants.

698
01:25:45,960 --> 01:25:50,410
One said it was obvious our goalkeeper wasn't very good.

699
01:25:50,410 --> 01:25:57,700
And so I got ready to go. And let's remember him.

700
01:25:57,700 --> 01:26:01,450
I do indeed. I do remember he was a really good soccer player.

701
01:26:01,450 --> 01:26:09,180
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.

702
01:26:09,180 --> 01:26:15,210
So I flew to my to my right and the ball stuck between my legs.

703
01:26:15,210 --> 01:26:21,900
I mean, I was expecting to catch my legs. I just got stuck between my legs.

704
01:26:21,900 --> 01:26:30,180
Brilliant save. But the cricket was interesting because I used to play a role for the students.

705
01:26:30,180 --> 01:26:35,010
Get to you on and off, you know, and then there's the staff.

706
01:26:35,010 --> 01:26:44,040
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.

707
01:26:44,040 --> 01:26:50,130
And they form that team, which I wasn't there. And I thought I could be Jim Hall, for instance.

708
01:26:50,130 --> 01:26:58,230
And I went on my way into the students, James and.

709
01:26:58,230 --> 01:27:06,810
Pickerington got Basant to vampyre not the best and knew the rules that anybody who has a fancy al-bassam was a scumbag like.

710
01:27:06,810 --> 01:27:12,150
But Jim was with Jim who was bowling and he was military.

711
01:27:12,150 --> 01:27:24,490
And if you know that phrase, military media is sort of innocuous, fairly regular military base or semi fast, but not very fast.

712
01:27:24,490 --> 01:27:32,680
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.

713
01:27:32,680 --> 01:27:44,320
But and the other thing, I was still not out of time and came from from down, you know, to have to do this.

714
01:27:44,320 --> 01:27:49,090
And the children were watching, but separate from the pavilion.

715
01:27:49,090 --> 01:27:52,900
So I went off to see them. And I don't know whether it was disabled or not.

716
01:27:52,900 --> 01:28:02,290
But you this release the children who came rushing out of this, not out, but fantastic.

717
01:28:02,290 --> 01:28:10,120
So brilliant when that sort of brings us full circle back to your days that Mergenthaler and your sporting things,

718
01:28:10,120 --> 01:28:14,860
the sport, just run through your life like a thread through in a way.

719
01:28:14,860 --> 01:28:21,670
Is there anything we haven't talked about that, you know, you can think of that you want to mention?

720
01:28:21,670 --> 01:28:32,110
At this point. Um. Not very obviously, we've certainly done the clinical research, the oh,

721
01:28:32,110 --> 01:28:41,740
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,

722
01:28:41,740 --> 01:28:45,370
it seems to be the only way to get out if they have more doctors,

723
01:28:45,370 --> 01:28:52,600
because it was before the time when the diabetic lurve got so big it had to be unloaded onto the general practitioners.

724
01:28:52,600 --> 01:28:58,780
I mean, in the old days, some did, some didn't. And you'd get all the diabetic clinics from a practise.

725
01:28:58,780 --> 01:29:05,650
All the diabetic patients were given practise. So it seemed to me you had more doctors.

726
01:29:05,650 --> 01:29:15,970
And one of the reasons, you know, I used to write research project was to get somebody appointed a Medick appointed who would research,

727
01:29:15,970 --> 01:29:23,820
you know, two thirds of its time that would do clinical research, which is what, in fact, the doctors wanted to do.

728
01:29:23,820 --> 01:29:35,680
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.

729
01:29:35,680 --> 01:29:43,300
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?

730
01:29:43,300 --> 01:29:51,790
And just to remember, they have extremely good the nurses have been all through, I think our patients and in patients.

731
01:29:51,790 --> 01:29:58,690
I mean, the nursing profession is a tremendous boon and a blessing.

732
01:29:58,690 --> 01:30:04,780
Yes. And particularly with the long the long term conditions where they can get to know

733
01:30:04,780 --> 01:30:10,540
over a period of time particular patients and particular ways of treating them.

734
01:30:10,540 --> 01:30:15,400
Yeah, and the other thing, as a consultant, you need a good senior registrar.

735
01:30:15,400 --> 01:30:21,640
It's absolutely vital that a good senior registrar and you have some really good ones.

736
01:30:21,640 --> 01:30:28,840
And I think it was the best, but I've had a lot of excellent and happy days.

737
01:30:28,840 --> 01:30:36,760
I always remember actually the first ward round I did as a consultant where they kept this patient to the last,

738
01:30:36,760 --> 01:30:46,720
I don't know, but deliberately or whether it was just the geography that it was a woman of about 25, 30.

739
01:30:46,720 --> 01:30:56,680
And she was obviously ill because she had a great anaemia, because she had both haemolytic and hypoplastic anaemia.

740
01:30:56,680 --> 01:31:00,460
She was producing the cells and she was losing some muscle.

741
01:31:00,460 --> 01:31:07,240
And in those days, I mean, I always remembered Cook's aphorisms, many of them,

742
01:31:07,240 --> 01:31:13,030
and one of his arteries was never let anybody die without benefit of steroids.

743
01:31:13,030 --> 01:31:19,060
So I thought we must give this woman steroids. And we thought of every blood test we could think of to send off.

744
01:31:19,060 --> 01:31:24,610
First of all, she started the steroids and the steroids did bring her back.

745
01:31:24,610 --> 01:31:31,090
And she had seven lupus. Wow.

746
01:31:31,090 --> 01:31:36,520
And also the LDS church to 200 billion was the old place.

747
01:31:36,520 --> 01:31:44,720
And the thing was, well, when we returned to to the Ishani.

748
01:31:44,720 --> 01:31:56,480
Her sister was in the big house. It's just incredible coincidence because the patient herself lived for about 20 years but then died.

749
01:31:56,480 --> 01:32:02,300
Wow. And yes, that ability to make a difference to somebody's life in that sense.

750
01:32:02,300 --> 01:32:07,110
Yes, it's very memorable, you know. Yeah.

751
01:32:07,110 --> 01:32:12,380
Gosh, thank you, Derek. That's been me. It's been a pure pleasure.

752
01:32:12,380 --> 01:32:17,270
I really enjoyed doing it, Jessica, over night. But not at all.

753
01:32:17,270 --> 01:32:23,360
No, exactly. But memories are good just by definition.

754
01:32:23,360 --> 01:32:27,380
Exactly. Thank you very much. Well, thanks for interviewing me.

755
01:32:27,380 --> 01:32:36,510
It's a pleasure. I will press stop the recording.