1
00:00:01,560 --> 00:00:09,010
This is Peggy Frith being interviewed by Derek Hockaday, 15th of September, 1915, Peggy.

2
00:00:09,010 --> 00:00:14,380
Well, they were in Cambridge early seventies. What made you want to come to Oxford?

3
00:00:14,380 --> 00:00:24,780
Hmm. Well, I. I just decided fairly late to change the medicine as I went to Cambridge to do natural sciences.

4
00:00:24,780 --> 00:00:28,080
And one of the big problems was I was very squeamish.

5
00:00:28,080 --> 00:00:33,150
So I had to convince myself that I could overcome that which I did by going to the open heart surgery.

6
00:00:33,150 --> 00:00:38,220
Anyway, I decided to change the medicine because it seemed more pragmatic.

7
00:00:38,220 --> 00:00:41,880
And in those days there was no teaching hospital at Addenbrooke's.

8
00:00:41,880 --> 00:00:47,820
So you could either go to London or come to Oxford and Oxford seemed more my cup of tea.

9
00:00:47,820 --> 00:00:55,510
I didn't really want to plunge into the rigours of living in London and I thought Oxford was an appealing place.

10
00:00:55,510 --> 00:01:04,050
Did you listen? I ever hear one of the Oxford ambassadors, I mean, like Pickering or Mike Penhaligon, that erm did you hear any of them in Cambridge?

11
00:01:04,050 --> 00:01:09,570
I didn't actually, although it seemed that there was an interesting crowd of medicks who were going to go over to.

12
00:01:09,570 --> 00:01:20,100
Yes. But I was dislocated from my ear because I spent having done biological natural sciences and a part time in physiology at Cambridge,

13
00:01:20,100 --> 00:01:23,130
working with the likes of Martin and Brindley.

14
00:01:23,130 --> 00:01:31,890
And I remember Hodgkin coming to lecture to us and Adrian and people of that sort and James Fitzsimons and Simons.

15
00:01:31,890 --> 00:01:39,330
Indeed, I was very fond of of James because he was the most human, if I can put it that way, and that I loved it.

16
00:01:39,330 --> 00:01:47,070
And also I thought his work on first was fascinating and there were very good teacher, very clear picture.

17
00:01:47,070 --> 00:01:51,930
So I enjoyed physiology, but I didn't think I would enjoy being a physiologist.

18
00:01:51,930 --> 00:02:00,990
So I had to spend a year doing anatomy, which nearly drove me crazy. So just one year doing all that because I hadn't done any anatomy at all.

19
00:02:00,990 --> 00:02:04,410
And what was the admissions procedure like to Oxford?

20
00:02:04,410 --> 00:02:12,540
It's very interesting, fairly informal, but I think I was the only person because it was an irregular time of year and I rather,

21
00:02:12,540 --> 00:02:22,710
in desperation, contacted probably Messrs Tidey and Messa, and it was towards the end of Michael Daniel's directorship.

22
00:02:22,710 --> 00:02:27,750
And he interviewed me and I can remember we had a very jolly time and laughed a lot.

23
00:02:27,750 --> 00:02:33,420
And again, I can most vividly remember talking about something about the art of Picasso.

24
00:02:33,420 --> 00:02:38,310
So it was not exactly a medically orientated interview,

25
00:02:38,310 --> 00:02:46,410
although perhaps he moved on from medical questions or physiological questions, or if so, there was no written paper,

26
00:02:46,410 --> 00:02:54,060
there was no formal interview by a board, or does the one man know anything about and you know,

27
00:02:54,060 --> 00:03:01,350
roughly how many were coming from Cambridge a year then? I know you at the time, but how many would you think we were?

28
00:03:01,350 --> 00:03:05,940
Twenty eight. And we were the Cambridge intake.

29
00:03:05,940 --> 00:03:11,340
Not all of the 28 came from Cambridge. There were a few people. And Bornhorst from London.

30
00:03:11,340 --> 00:03:23,430
Yes. People like Jim Ritter who'd done a deal here, and a few other assorted people from different premedical schools.

31
00:03:23,430 --> 00:03:26,880
But the majority were from Cambridge and there was a similar number.

32
00:03:26,880 --> 00:03:30,910
I think the total in the year was 52, 54.

33
00:03:30,910 --> 00:03:37,620
Yes. And of course, we were at Cambridge. We were one in ten women.

34
00:03:37,620 --> 00:03:46,080
And I should note also, my students are now aghast at the fact that at Cambridge I could only go to one of three colleges because it was just prior,

35
00:03:46,080 --> 00:03:49,740
about six years prior to the first men's colleges.

36
00:03:49,740 --> 00:03:53,850
Yes. Taking women at Cambridge. So I was at Newnham. Right.

37
00:03:53,850 --> 00:04:08,100
Um, now that slightly got off the subject. Yeah, there were six girls in our half intake, so six of the 28 were women got a fifth the quarter one.

38
00:04:08,100 --> 00:04:14,670
And then when you went on the firms, how many clinical students will there be an affirmative time?

39
00:04:14,670 --> 00:04:18,480
I seem to remember there were five or six. Those were the days and those were the days.

40
00:04:18,480 --> 00:04:23,010
And what did you think of the clinical student period?

41
00:04:23,010 --> 00:04:24,600
For me, it was wonderful.

42
00:04:24,600 --> 00:04:32,670
It was quite daunting because I wasn't sure I could do it in the sense of would I have the technique, would I have the personality?

43
00:04:32,670 --> 00:04:36,120
Would I be it? Would I would I enjoy the actual medical work?

44
00:04:36,120 --> 00:04:42,330
I found it quite taxing. I found it quite upsetting, dealing with people who were really very ill.

45
00:04:42,330 --> 00:04:46,800
But I found that the level of support, although it varied enormously,

46
00:04:46,800 --> 00:04:52,410
some people didn't seem to understand what it was like to be starting as a student all over again.

47
00:04:52,410 --> 00:04:59,510
But there were others beacons of understanding who were very supportive, in particular a young.

48
00:04:59,510 --> 00:05:08,210
Canadian NATO senior house officer whose name I can't remember, sadly, but he was very humane and very understanding,

49
00:05:08,210 --> 00:05:14,400
and I think he prevented me from running further than running off the ward, which was here.

50
00:05:14,400 --> 00:05:18,240
And I was on slight hold and.

51
00:05:18,240 --> 00:05:23,570
Yeah. And of course, there were an ledingham, which I did is my second. I don't think I did now.

52
00:05:23,570 --> 00:05:29,090
Renowned for being an organ. Hockaday I don't think they did well though I,

53
00:05:29,090 --> 00:05:36,230
I remember vividly all of those who taught me and I thought it was the most wonderful apprenticeship system.

54
00:05:36,230 --> 00:05:43,070
I particularly remember when I was a student in my final year of clinical

55
00:05:43,070 --> 00:05:49,100
studies being on tape with John Ledingham and admitting a very unusual thing,

56
00:05:49,100 --> 00:05:55,170
a man with lupus. We really did think he had lupus. We didn't have the sophisticated, serological testing.

57
00:05:55,170 --> 00:06:01,070
Then we had to defibrillate blood with paper clips and look for lupus cells.

58
00:06:01,070 --> 00:06:06,170
I remember doing that, but the man was very ill and he had lots and lots of physical signs.

59
00:06:06,170 --> 00:06:16,070
I remember being completely transfixed by how this systemic disease was creating so many problems in different organs of the body.

60
00:06:16,070 --> 00:06:21,560
So I suppose I was naturally always felt that I was a physician and probably a

61
00:06:21,560 --> 00:06:26,900
specialist because I really enjoyed the detective work of making a diagnosis.

62
00:06:26,900 --> 00:06:33,500
And I was I was too squeamish to be a surgeon, although I think I would have made quite a good surgeon if I hadn't been squeamish,

63
00:06:33,500 --> 00:06:38,090
because I'm quite neat and dextrous in small hands and all that sort of thing.

64
00:06:38,090 --> 00:06:44,870
But I'm rather glad I wasn't a surgeon, actually, because I think I think it's more interesting,

65
00:06:44,870 --> 00:06:55,580
more challenging to be to to think through the twists and turns of medical diagnosis and treatment, which, of course, you would understand.

66
00:06:55,580 --> 00:06:59,060
And what about Furneaux? But what do you think of that? Oh, well, fine.

67
00:06:59,060 --> 00:07:06,320
It was interesting because by then Jim Holt had taken over as director of clinical studies and he called all the Cambridge crew and he said,

68
00:07:06,320 --> 00:07:13,160
and of course, we'll all be doing Oxford finals. And we looked at each other and said, actually, we hadn't thought about this.

69
00:07:13,160 --> 00:07:17,600
So we said, so, Dr. Holt, what's the difference between Oxford and Cambridge finals?

70
00:07:17,600 --> 00:07:25,010
And he said, oh, the Oxford finals are much easier than Cambridge. So the five of us,

71
00:07:25,010 --> 00:07:29,180
because I remember we all piled into Jerry Marston's mini or was it a Hilman

72
00:07:29,180 --> 00:07:37,250
name in order to go to Cambridge to to to sit said exams because we rebelled.

73
00:07:37,250 --> 00:07:43,130
And Peter Millard was brilliant because there wasn't a pathology component of finals at Oxford.

74
00:07:43,130 --> 00:07:51,410
And he drilled us in pathology, having been a but he'd been at Cambridge and he was also he was a rebel as well in that

75
00:07:51,410 --> 00:07:55,730
he thought that what we were doing was quite right and that we should stick to our guns.

76
00:07:55,730 --> 00:08:01,320
So I don't actually think I was ever an undergraduate or clinical student member of a college at Oxford.

77
00:08:01,320 --> 00:08:07,910
I went back to Addenbrooke's to do find I suspected something to do with this odd dates and so on.

78
00:08:07,910 --> 00:08:18,710
But you got your badge, many of them due to my complete ineptitude, because I didn't realise that you had to apply for both of those.

79
00:08:18,710 --> 00:08:24,290
It took a year for me to realise I actually hadn't got my qualification in surgery.

80
00:08:24,290 --> 00:08:28,340
Well, I had, but I hadn't applied for the letters after my name.

81
00:08:28,340 --> 00:08:33,410
So we had to go through another hoop and send another message to the Senate, House or wherever.

82
00:08:33,410 --> 00:08:37,980
But that didn't delay taking over Halstrom. No, no, no.

83
00:08:37,980 --> 00:08:46,250
Fine. I do I do remember finalise surgical finals in Addenbrooke's.

84
00:08:46,250 --> 00:08:50,390
It was that old Addenbrooke's. Yes. He also told Addenbrooke's.

85
00:08:50,390 --> 00:08:58,730
But I remember that we had Harold Ellis and a very large Scottish professor from possibly Glasgow.

86
00:08:58,730 --> 00:09:01,670
I don't know. And I was sitting,

87
00:09:01,670 --> 00:09:10,850
waiting my turn somewhat nervously for my surgical vivir and my the person who'd been over the head of me came out white as a sheet and I said to him,

88
00:09:10,850 --> 00:09:17,630
Are you okay? You look a bit. He said, Gosh, Harold parallelise jumped up and lay on the floor and said, Do something.

89
00:09:17,630 --> 00:09:24,810
I've had a heart attack and lay there pretending to be dead. So I said, well, I hope you gave him a jolly good thump on the chest.

90
00:09:24,810 --> 00:09:30,590
I said, I didn't know what to do anyway. This rather distracted me from feeling nervous,

91
00:09:30,590 --> 00:09:39,530
and I didn't think they'd repeat that particular performance next stewarded, you know, and then and talking to people.

92
00:09:39,530 --> 00:09:44,420
Do you think it was true that the Cambridge exam was more difficult than the Oxford?

93
00:09:44,420 --> 00:09:49,490
It's very difficult to know. It it's very difficult to know because one doesn't get the opportunity to do both

94
00:09:49,490 --> 00:09:53,510
as a sort of let alone the control or the standard of which they're marking here.

95
00:09:53,510 --> 00:09:59,470
I mean, if it was a funny mismatch, because I remember that we did orthopaedics, whereas the.

96
00:09:59,470 --> 00:10:02,650
Didn't seem to do much orthopaedics, and they were terribly impressed.

97
00:10:02,650 --> 00:10:12,250
I remember diptheria got prise in orthopaedics at Cambridge because she'd been well drilled by the all and got an orthopaedic patient in her finals.

98
00:10:12,250 --> 00:10:14,740
So I don't think they specialised in orthopaedics.

99
00:10:14,740 --> 00:10:21,790
It was rather sort of an also ran subject was indeed there was sort of mismatches of that sort, but.

100
00:10:21,790 --> 00:10:29,290
Oh, I think I think we did OK. And Dayna got the prise in surgery.

101
00:10:29,290 --> 00:10:34,050
So did you get the jobs you wanted? I did.

102
00:10:34,050 --> 00:10:41,950
I, I got the SDM job much to my surprise, because there was only one professorial unit there.

103
00:10:41,950 --> 00:10:51,680
And as you will remember and therefore I was Paul Beasley's, one of four housemen lost and Wetherall first one.

104
00:10:51,680 --> 00:10:55,480
So David came in the New Year, I think the calendar year.

105
00:10:55,480 --> 00:11:01,410
So we had August, September, October, November, December with Paul, who was delightful.

106
00:11:01,410 --> 00:11:07,040
Yes, a man of few words, a man of great charm and understanding and a very good clinician.

107
00:11:07,040 --> 00:11:18,190
Yes. And what he do takes in the evening or not, he would appear on the round if asked.

108
00:11:18,190 --> 00:11:26,500
Yes, I was with Roman Gokul, who was out, and he was hugely efficient and effective.

109
00:11:26,500 --> 00:11:32,670
And therefore I know I am distressed. He would be I mean, there was a problem that Roman couldn't sort out.

110
00:11:32,670 --> 00:11:37,540
Indeed. Yeah. And you said and then Wetherall.

111
00:11:37,540 --> 00:11:42,340
Oribe. So how frightened was he?

112
00:11:42,340 --> 00:11:54,340
Well, we were sure it was quite a big change in personality between Beeston and Wetherall, but he was he was very fair and quite strict.

113
00:11:54,340 --> 00:11:58,840
I do remember now this was when I was in S.H. So I remember taking the rap for my

114
00:11:58,840 --> 00:12:02,950
house officers who had not done something that I had suggested should be done.

115
00:12:02,950 --> 00:12:10,240
And I was roundly ticked off, but not for having failed to get this particular test done.

116
00:12:10,240 --> 00:12:14,170
And I rather gallantly, I thought, didn't blame these young chaps afterwards.

117
00:12:14,170 --> 00:12:17,710
I had I had quite a stiff word. Yes.

118
00:12:17,710 --> 00:12:24,240
And I did not burst into tears on the road, although, I mean, you would be ticked off on the ward round in front of the patients.

119
00:12:24,240 --> 00:12:27,850
I mean, I'll come back to that. I will come back to listen to you.

120
00:12:27,850 --> 00:12:32,290
That's very, very interesting. That was still happening. Yes, I actually would have been.

121
00:12:32,290 --> 00:12:40,670
Yes. Because I can remember standing there at the trolley is thinking, well, I don't take the rap here, but I'm going to have words.

122
00:12:40,670 --> 00:12:47,830
Oh, yes. And then you said, Kujo, that was Tim to that I'd been I'd been a student with Tim,

123
00:12:47,830 --> 00:12:54,620
but I actually did the paediatric surgical job with Nick Dudley, who'd be newly appointed, and Malcolm Gough.

124
00:12:54,620 --> 00:12:57,940
Yes. And I actually found surgery fascinating.

125
00:12:57,940 --> 00:13:07,600
I find watching an experienced surgeon, particularly, I remember Malcolm Gough operating on a a chap who was sixteen,

126
00:13:07,600 --> 00:13:10,900
I think, who'd collapsed on the rugby field at Bradley.

127
00:13:10,900 --> 00:13:20,650
And it turned out that he'd had a volvulus of his small intestine because he got some peculiar sort of mental problem.

128
00:13:20,650 --> 00:13:30,580
And this boy would have undoubtedly died if he had not been in the hands of such an experienced and bold and skilled surgeon.

129
00:13:30,580 --> 00:13:42,910
Yes. And I remember Malcolm Gough operated to undo the tangle and he said if he's going to lose as much, God seems to be infected, he won't live.

130
00:13:42,910 --> 00:13:46,390
And therefore, we will put hot I'll stitch his abdomen together.

131
00:13:46,390 --> 00:13:51,790
We'll put towels on his abdomen, send him to intensive care, and I'll operate tomorrow.

132
00:13:51,790 --> 00:13:57,430
I couldn't be there on the following day, but he said that he'd only had to resect a couple of feet of small.

133
00:13:57,430 --> 00:14:03,550
But that's interesting because the arterial supply had got tied up in the volvulus and as he done.

134
00:14:03,550 --> 00:14:14,200
But I remember the moment where he had to make an educated guess as to how much he had to clip of the omentum in order to undo the problem.

135
00:14:14,200 --> 00:14:18,130
And I had huge respect for the ability to keep calm.

136
00:14:18,130 --> 00:14:21,700
He would say, oh, well, this is sort of fairly standard procedure.

137
00:14:21,700 --> 00:14:31,930
But as a junior trainee watching someone with that degree of experience now, you've been in no doubt that you were working very hard.

138
00:14:31,930 --> 00:14:37,810
Did you realise how hard he was working in this in the operating theatre?

139
00:14:37,810 --> 00:14:38,390
Well, know that.

140
00:14:38,390 --> 00:14:49,660
Erm I mean they and yes I think, I think particularly in paediatrics as well as try to think about it and whether it was even more unpredictable,

141
00:14:49,660 --> 00:14:59,980
what you would have to operate on a lot of appendicitis then, of course. But also they had a speciality in I remember a lot of spinal bifida children.

142
00:14:59,980 --> 00:15:08,590
They did a lot of chumped work, right? They didn't actually do primary repairs on the spine that would have been done by neurosurgeons or orthopod.

143
00:15:08,590 --> 00:15:17,560
They think I see there may well have been a urinary diversion work for those children who didn't have bladder control or bladders.

144
00:15:17,560 --> 00:15:19,840
I mean, you know. Yes.

145
00:15:19,840 --> 00:15:29,680
And there was this incredible dilemma as to what the quality of life of those children would be, because if you didn't operate, they would die.

146
00:15:29,680 --> 00:15:35,200
And if you did operate, some of them would do quite well, but others would not have such a good quality of life.

147
00:15:35,200 --> 00:15:41,500
And it was terribly, terribly difficult to know. And that's fascinating because I'd always imagine the neurosurgeons were doing that.

148
00:15:41,500 --> 00:15:47,500
But in fact, the paediatric surgeon now, I didn't even know they had a separate house.

149
00:15:47,500 --> 00:15:52,240
I mean, there wasn't a firm of paediatric surgery in the sense they wouldn't have had separate

150
00:15:52,240 --> 00:15:56,240
beds or that they both did general surgery as well as the paediatric surgery.

151
00:15:56,240 --> 00:15:59,440
And I remember it was as they were building up the service that Nick Dudly came

152
00:15:59,440 --> 00:16:04,330
on board and gradually probably did more of paediatric surgery than others.

153
00:16:04,330 --> 00:16:08,440
But he also took on Tim Taylor's thyroid surgeries. But I mean, yes, they did.

154
00:16:08,440 --> 00:16:13,890
The husband of just a paediatric surgery not to go for it.

155
00:16:13,890 --> 00:16:20,770
All right. I was just the paediatric surgeon and I over the beds, they were on Liow surge.

156
00:16:20,770 --> 00:16:30,430
Right. So the Leopold wards, which were sort of out in one of the wings on the main Picadilly corridor corridor from Picadilly,

157
00:16:30,430 --> 00:16:35,090
Leo made, I think it was on the ground floor and the search was on the first floor.

158
00:16:35,090 --> 00:16:39,800
Presumably it could then get to taller. No, we didn't have dollar theatres or did we?

159
00:16:39,800 --> 00:16:45,670
I remember Tim Tebow operating on the ground floor in the Oval Office is.

160
00:16:45,670 --> 00:16:50,440
But I can't envisage. And did you have another husband?

161
00:16:50,440 --> 00:16:59,740
I mean, you're a pair of people. I seem to remember that as paediatric housemen, I was the only housemen and that we cross covered with the outcome.

162
00:16:59,740 --> 00:17:05,980
Yes, that was made sense. I remember Cross covering. I remember taking over from Alan Spannaus.

163
00:17:05,980 --> 00:17:09,370
So I think there probably was only one paediatric.

164
00:17:09,370 --> 00:17:18,260
So I think they I think Gough and Dudley had to housemen, but one of them was adult and the other was and we swapped overall a bit.

165
00:17:18,260 --> 00:17:22,030
Right. I think we may have swapped a part of the firm. You did?

166
00:17:22,030 --> 00:17:29,620
Yes, because I remember being and now I come to think of it, I remember being in the operating theatres with Malcolm Gough at that juncture.

167
00:17:29,620 --> 00:17:35,320
So then you go back to a on the national parliament.

168
00:17:35,320 --> 00:17:41,130
I went back to the said yes. The weather not forgiven you.

169
00:17:41,130 --> 00:17:49,840
Yes. And we looked up to these really very old leukaemia patients, lymphoma patients as well, even more hair raising.

170
00:17:49,840 --> 00:17:52,900
I occasionally looked up to some of his private patients who were usually

171
00:17:52,900 --> 00:17:57,340
crusty old bachelors from the university who were holed up on the private ward.

172
00:17:57,340 --> 00:18:01,570
And they were which was right at the top above the Indian wards.

173
00:18:01,570 --> 00:18:07,750
Yes. I remember going there at weekends and trying to cheer up these rather well.

174
00:18:07,750 --> 00:18:14,380
They were pretty ill, many of the patients, and finding that quite difficult because they were quite, quite scary.

175
00:18:14,380 --> 00:18:19,960
So now it was very interesting.

176
00:18:19,960 --> 00:18:23,290
And to me then, I mean, it was Wetherall with say,

177
00:18:23,290 --> 00:18:29,670
Jim Hoge was the senior editor because John Ledingham hadn't come in yet, but he buzzed off somewhere else.

178
00:18:29,670 --> 00:18:35,980
He was. He was. Because we had Roger Smith and David Graham Smith during the time.

179
00:18:35,980 --> 00:18:42,800
Was that when I was asked Joe, was that when I was housemen? I remember, but I worked with both of them and we had a lot of fun.

180
00:18:42,800 --> 00:18:53,680
Yeah, cheerful physicians and interesting, interesting cases where today's close to saying, oh, well, I wondered whether I might become a neurologist.

181
00:18:53,680 --> 00:19:04,990
Yes. So I did a year of neurology working with the likes of Charles withI Brian Matthews,

182
00:19:04,990 --> 00:19:11,170
Charles Warlow at the church, at the church, and indeed on the specialist board there.

183
00:19:11,170 --> 00:19:15,640
And Brian Matthews was the most remarkable clinician. I don't have to say.

184
00:19:15,640 --> 00:19:19,060
I remember him walking onto the ward one morning and he said to me,

185
00:19:19,060 --> 00:19:26,890
Whose patient is that p pointing to a young woman who is propped up in a bed with the cot sides up with a nasogastric tube.

186
00:19:26,890 --> 00:19:33,760
I said, Well, not yours, Professor. I know that you haven't got a torch.

187
00:19:33,760 --> 00:19:37,630
Patients got Wilson's disease. Good Lord. And he went to the bedside.

188
00:19:37,630 --> 00:19:45,140
I produced my torch and I had got you of luxury. So he didn't say another word, but I mean, he couldn't have seen the kinds of the rings.

189
00:19:45,140 --> 00:19:50,200
No, I've got courage afterwards to say to him, how did had he made the diagnosis?

190
00:19:50,200 --> 00:19:56,830
Is there anything that causes a spastic Tatra paralysis with nasogastric with all problems?

191
00:19:56,830 --> 00:20:05,200
So are the petina. To me that this was how you might make a spot diagnosis of autism.

192
00:20:05,200 --> 00:20:09,790
But ever a fascinating disease, sorry. Why is neurology?

193
00:20:09,790 --> 00:20:14,230
I then decided I wanted to work part time because we had two sons.

194
00:20:14,230 --> 00:20:19,210
Well, actually, I decided I wanted to work part time before Tom was born.

195
00:20:19,210 --> 00:20:23,900
And I did not think that part time neurology would be feasible in Oxford if you were a woman.

196
00:20:23,900 --> 00:20:26,380
I think I was probably right.

197
00:20:26,380 --> 00:20:34,120
So I said I was or had always been interested in ophthalmology, although I knew I was very unlikely to want to be in isolation.

198
00:20:34,120 --> 00:20:38,710
But if the eye hospital was interested in employing someone who had a physician's background,

199
00:20:38,710 --> 00:20:45,640
I would be very interested to do some homology with a view to becoming a physician with an interest in what I wanted to,

200
00:20:45,640 --> 00:20:51,730
partly because I knew from my neurology that neuro ophthalmology was very interesting.

201
00:20:51,730 --> 00:20:59,200
But equally, there wouldn't have been such characters around whether in fact and what was their response.

202
00:20:59,200 --> 00:21:02,560
Jondaryan was a great hero. He was very, very supportive.

203
00:21:02,560 --> 00:21:08,680
I don't think he quite knew what it was that I was going to do because he hadn't done much theology.

204
00:21:08,680 --> 00:21:16,060
But he realised the fascination of the I use the ophthalmoscope and all sorts of how the I could help in diagnosis.

205
00:21:16,060 --> 00:21:20,650
And he was he sent me to see the censor.

206
00:21:20,650 --> 00:21:25,690
I think it must have been at the Royal College of Physicians involved.

207
00:21:25,690 --> 00:21:37,600
So I put on my best frock and went to it was in the Georgian buildings on the right hand side at the college and is slightly elderly.

208
00:21:37,600 --> 00:21:44,620
Man said. Oh, he said, you've come to see me about was it being an eye physician, he said doesn't exist, you know?

209
00:21:44,620 --> 00:21:48,790
And I said, no, I realise that, but I'm very interested in it. And he said, well, I'm a diabetic allergist.

210
00:21:48,790 --> 00:21:52,270
And he said, You've been sent by John Ledingham. He said, I work for Una Ledingham.

211
00:21:52,270 --> 00:21:55,720
What a formidable lady and what a wonderful clinician. He said.

212
00:21:55,720 --> 00:22:02,030
So I I understand, you know, what he was trying to say was that women could make reasonable physicians.

213
00:22:02,030 --> 00:22:06,430
So he put on his glasses and he said there's no syllabus.

214
00:22:06,430 --> 00:22:13,510
You know, I don't quite know what you have in mind. So of course, I'd gone with this thing in my handbag, which I produced and handed it to him.

215
00:22:13,510 --> 00:22:17,410
And he looked at it. He said, oh, he said, oh, it's obviously going to take a bit of time to have a look at this.

216
00:22:17,410 --> 00:22:22,840
Would you like a cup of tea? I said, thank you. He said, you haven't just come from Oxford to talk to me about this.

217
00:22:22,840 --> 00:22:27,500
How are you? And I said, yes, I have. So he started to leave his way through the syllabus.

218
00:22:27,500 --> 00:22:31,510
We looked over his glasses at me and he said, oh, he said, would you like a chocolate biscuit?

219
00:22:31,510 --> 00:22:36,670
Then I thought to myself, I think I might be in with a chance. Yes.

220
00:22:36,670 --> 00:22:43,510
So in the end, he said he could see what he could do and he realised that it was actually much broader spectrum than he had supposed.

221
00:22:43,510 --> 00:22:48,100
There was not only diabetic eye disease and neural homology as inflammatory disease,

222
00:22:48,100 --> 00:22:56,800
and it's overlapped with rheumatology the and diagnosis with things like Willson's disease and neurofibromatosis, lots of inherited diseases.

223
00:22:56,800 --> 00:23:05,950
I mean, the sky's the limit really. Anyway, I went home and said to Robyn, my husband, hmm, not sure everything's going to happen.

224
00:23:05,950 --> 00:23:11,020
It wasn't real for the plane, but it might have been. You know, I wonder he was a diabetic.

225
00:23:11,020 --> 00:23:14,810
Oh, yes. Yes. Oh, I ought to remember this.

226
00:23:14,810 --> 00:23:19,270
No, no, it doesn't matter. But he was at the vintage that might have been called Wilfred.

227
00:23:19,270 --> 00:23:23,200
Anyway, about a month later, this thing plopped through the letterbox here.

228
00:23:23,200 --> 00:23:26,710
Actually, we were living here and it said Royal College of Physicians.

229
00:23:26,710 --> 00:23:34,330
I opened it thinking it was going to be a no. And it said we have the training committee has decided to award you an ad hominem training post.

230
00:23:34,330 --> 00:23:37,330
I looked at this and I said to Robyn, hold on a minute, shouldn't that be?

231
00:23:37,330 --> 00:23:44,740
And feminism, he said he said, shut up and just write back and say thank you very much.

232
00:23:44,740 --> 00:23:46,990
So that was exactly what happened to me then.

233
00:23:46,990 --> 00:23:53,200
Those days you had to get their registration permission then to go to work because you've got membership already.

234
00:23:53,200 --> 00:23:58,720
I have got membership if it was in order to pursue an accredited training programme.

235
00:23:58,720 --> 00:24:00,430
So it I think it was the training.

236
00:24:00,430 --> 00:24:07,630
They were both accreditation that they had given me and then ticket to let other people should think of following in my tracks.

237
00:24:07,630 --> 00:24:13,870
But that meant it's fascinating because it's the positions extending their orbit into their hospital.

238
00:24:13,870 --> 00:24:21,190
Yes, but what were their hospitals saying? Um, well, I did a rather this is a rather PEGI thing to do.

239
00:24:21,190 --> 00:24:27,700
I wasn't sure whether medical terminology would be a goer and whether anybody would want to follow in my footsteps.

240
00:24:27,700 --> 00:24:34,600
So I had two tasks. One was to conduct a training programme, which I'll come back to later, if I may,

241
00:24:34,600 --> 00:24:38,330
and the other was to find out whether this was a reasonable idea or not.

242
00:24:38,330 --> 00:24:47,170
So I hit on this this idea, which was my idea that I would write to all thirteen of the professor of epidemiology in the United Kingdom.

243
00:24:47,170 --> 00:24:48,790
So it was in pre email days.

244
00:24:48,790 --> 00:24:59,230
So I typed out a letter and did my best to that exact lick stamps and addressed it to all these professors and of the thirteen eleven replied.

245
00:24:59,230 --> 00:25:04,690
I thought was pretty good, but three of them said, what a brilliant idea, go for it.

246
00:25:04,690 --> 00:25:11,950
I don't know how you're going to do it. Three or four of them said this is a really interesting idea and I would fully support it.

247
00:25:11,950 --> 00:25:18,460
But it's very difficult because, of course, there are no jobs, so maybe you'd be foolish to do it.

248
00:25:18,460 --> 00:25:23,050
Three of them said, I like the idea, but there's no way this is going to work.

249
00:25:23,050 --> 00:25:27,220
And two or three of them, too, I think, wrote back and said, What on earth are you talking about?

250
00:25:27,220 --> 00:25:34,780
Stop being so stupid. And one of them said, I shall be nameless where I went, but it was a fairly high ranking institution.

251
00:25:34,780 --> 00:25:38,450
Would I go and see him, which I did.

252
00:25:38,450 --> 00:25:46,360
And when I got rid of him, in a way I was in a way. But when I got back, in essence, I said to Robin said, So how did it go?

253
00:25:46,360 --> 00:25:49,890
I said I was making a case. He simply did not want to hear this.

254
00:25:49,890 --> 00:25:58,150
And so there were those who felt very strongly that I could only be done by an ophthalmologist as I'm breaking up the managers.

255
00:25:58,150 --> 00:26:06,220
Well, that was a very interesting question, because what I had to do was to set out to win my spurs and be a good general opthamologist,

256
00:26:06,220 --> 00:26:17,260
astute at diagnosing and understanding what surgery implied for the patient without hurtfully doing any operating myself because I'm being squeamish.

257
00:26:17,260 --> 00:26:21,260
ISIS, one of the things that really makes it difficult for me and in fact,

258
00:26:21,260 --> 00:26:24,460
it's the only time that I have actually passed out in the operating theatre,

259
00:26:24,460 --> 00:26:29,950
although I think I was pregnant at the time, so that might have had something to do with it.

260
00:26:29,950 --> 00:26:38,080
What I had to try and do is to maintain my credentials as a physician and possibly capitalising on my neurological training.

261
00:26:38,080 --> 00:26:43,300
So I built up links with neurology and set up, in fact, a neuro theology clinic,

262
00:26:43,300 --> 00:26:48,670
which I think was I certainly remember having a succession of neurology, senior registrars.

263
00:26:48,670 --> 00:26:56,620
This was to, as I got more senior with my medical training and I also had to know what I was doing ophthalmological.

264
00:26:56,620 --> 00:27:03,370
Because if you if you if you were foolish or if you didn't know what you were talking about, ophthalmologist didn't think that,

265
00:27:03,370 --> 00:27:08,590
of course, because they felt that you were trespassing into their territory without really understanding what you were talking about.

266
00:27:08,590 --> 00:27:12,370
I mean, you'd have to be able to dive in Stockholm and say exactly, exactly.

267
00:27:12,370 --> 00:27:19,330
Because if you diagnose glaucoma as any old optic neuropathy, you that that was culpable.

268
00:27:19,330 --> 00:27:26,200
There's absolutely no way to do that. But actually, the overlap in the quality was very, very interesting.

269
00:27:26,200 --> 00:27:36,340
And I was quite clear in the end, John Illston came and didn't Hongchang did the diabetic work and therefore I was doing their very work.

270
00:27:36,340 --> 00:27:42,460
You know, I had to train in diabetic work and I had to train in using the laser, which was not my favourite thing,

271
00:27:42,460 --> 00:27:47,140
because I was terrified that I was going to do harm instead of good with the laser,

272
00:27:47,140 --> 00:27:51,070
which, of course, is very difficult to do if if you're if you're trained in a good way.

273
00:27:51,070 --> 00:27:56,410
It's difficult not it's difficult to say exactly.

274
00:27:56,410 --> 00:28:04,090
There's the fixing beam and then there's the firing beam. So I did all of that and I went for part of my training.

275
00:28:04,090 --> 00:28:08,680
I was working under Rosemary Roof scheme, which used to be called the part time married women scheme.

276
00:28:08,680 --> 00:28:15,580
But there were lots of jokes about that. You know, were you part time when you the other part time or whatever?

277
00:28:15,580 --> 00:28:18,640
Yeah. So training flexibly.

278
00:28:18,640 --> 00:28:25,720
One of the great things about the scheme was that they would pay for you to go to get training outside Oxford if you couldn't get it in Oxford.

279
00:28:25,720 --> 00:28:27,820
And neuropathology was an example.

280
00:28:27,820 --> 00:28:35,380
So again, put on the best frock and went to see the wonderful Mike Saunders, who lives under the name of Saunders like Winnie the Pooh.

281
00:28:35,380 --> 00:28:41,860
He was not Saunders, but some years ago. And he was he was quite intimidating when you first met him.

282
00:28:41,860 --> 00:28:47,320
And he was a highly regarded clinician. He was a neuro ophthalmologist at Queen's Square.

283
00:28:47,320 --> 00:28:58,090
And I went with my CV and I knew that he was training Elizabeth Graham, this Graham, who is my exact counterpart at St Thomas's Hospital.

284
00:28:58,090 --> 00:29:07,000
But she was ahead of me in her training because she trained full time and in fact, I think went less than full time.

285
00:29:07,000 --> 00:29:13,270
She she certainly postponed having a family until she had a consultant post in London.

286
00:29:13,270 --> 00:29:16,180
So he had experience of training.

287
00:29:16,180 --> 00:29:24,310
He knew that she was an excellent physician and knew that she'd made an excellent ophthalmologist as well within the neuropathology field.

288
00:29:24,310 --> 00:29:30,430
And I went to him with my CV and he said, I'd love to employ you, but I'm afraid I can't pay you.

289
00:29:30,430 --> 00:29:39,590
And I said, that's fine, Mr Saunders, because I come with my with my funding from Oxford, which he said, oh, well, when can you start?

290
00:29:39,590 --> 00:29:47,170
Yes, but the previous week when I think about, you know, a few weeks time.

291
00:29:47,170 --> 00:29:52,300
So every Friday, every Thursday evening, I would go to London, stay with a friend of ours overnight,

292
00:29:52,300 --> 00:29:55,930
and then go to a full day clinic at Queen's Square on Friday.

293
00:29:55,930 --> 00:29:59,010
Outpatient clinic, outpatient clinic. And he had very little.

294
00:29:59,010 --> 00:30:08,310
Inpatient work, although we would work at patients who had to come in for the neurosurgeons now, I suppose in essence you asked why ophthalmology?

295
00:30:08,310 --> 00:30:11,820
I've always found the I fascinating because it's visual and I'm very visual.

296
00:30:11,820 --> 00:30:16,980
It's detailed and I'm very detailed. It's neat. And I love neat and tidy and orderly things.

297
00:30:16,980 --> 00:30:28,200
I could never made a gut person, although the technique is there tidiness and you didn't have to get out of bed in the middle of the room,

298
00:30:28,200 --> 00:30:36,540
which you did occasionally in neurology. And suddenly you might have to see sick patients in neurology on the ward if they were.

299
00:30:36,540 --> 00:30:39,750
Yes, if there were medical problems that needed to be sorted out.

300
00:30:39,750 --> 00:30:47,010
So it actually combined quite well with with wanting to look after children and helping support Robin in his career.

301
00:30:47,010 --> 00:30:55,560
There was this hectic six years where I was mother to 52 children because we went into the Dragon school.

302
00:30:55,560 --> 00:30:57,840
You ran the house? We ran the house at the Dragon.

303
00:30:57,840 --> 00:31:07,530
Indeed, with fifty 10 to 11 year old boy there expected you to do better because I was the first house master's wife at the Dragon who had worked.

304
00:31:07,530 --> 00:31:11,400
There was only one house that we could take over because it was a big house with

305
00:31:11,400 --> 00:31:16,590
fifty and we had two Matron's and my job was to appoint and support the matrons,

306
00:31:16,590 --> 00:31:22,680
but I didn't have to be there in the day because they would cross with each other and they used to look after our two boys who were little.

307
00:31:22,680 --> 00:31:24,120
Then they were three and five.

308
00:31:24,120 --> 00:31:36,390
When we moved in to the house, when they had things like they said her, the Oxford Hospital reacted because there who was there?

309
00:31:36,390 --> 00:31:44,520
Was it turn on the television was very concerned that I might sort of might not mesh

310
00:31:44,520 --> 00:31:49,950
into the way that the eye department ran because I wasn't a I wasn't a surgeon.

311
00:31:49,950 --> 00:31:52,380
I didn't spend time in the operating theatre.

312
00:31:52,380 --> 00:31:58,110
And I suppose my allegiances were very much to the sort of physician side of whatever it is would have been.

313
00:31:58,110 --> 00:32:06,190
You'd have thought. I mean, I know he operated, but you'd have thought running the academic institute, he would have an hour.

314
00:32:06,190 --> 00:32:10,500
Yes. Yes. I think I think he found it difficult for one reason or another.

315
00:32:10,500 --> 00:32:21,480
He did when he retired. He did write me a delightful letter which said, I admire many things that you have achieved, many of them against.

316
00:32:21,480 --> 00:32:29,910
No, some of them against opposition. And then there is a little sort of, Tony, broad caveat, which I said to him, thank you very much for your letter,

317
00:32:29,910 --> 00:32:36,420
because and it was acknowledging that what I had set out to do had actually brought something to the hospital,

318
00:32:36,420 --> 00:32:43,620
whereas he was worried, I think, that it might take something away from the hospital and take it into the medical domain.

319
00:32:43,620 --> 00:32:52,950
But I enjoyed training juniors. I set up a medical clinic which was mostly uveitis to treat inflammation and infection.

320
00:32:52,950 --> 00:33:00,120
And one of the things that was instrumental in setting up the post because they weren't exactly growing on trees at that time,

321
00:33:00,120 --> 00:33:03,120
was the fact that I was invited by John Brazier,

322
00:33:03,120 --> 00:33:10,620
who was a surgical colleague at University College in London, to set up a new service for HIV patients.

323
00:33:10,620 --> 00:33:21,120
Yes, I remember it started in 93, which was actually almost at the peak of the epidemic of HIV AIDS.

324
00:33:21,120 --> 00:33:26,520
And I had an average of one new patient with cytomegalovirus, retinitis,

325
00:33:26,520 --> 00:33:35,130
which was the main site threatening infection of the highly immunosuppressed end of AIDS patients would get.

326
00:33:35,130 --> 00:33:43,050
And it was a race between them dying and going blind if they had seen the retinitis, which often became bilateral.

327
00:33:43,050 --> 00:33:48,840
So I and we had a rough incidence of one new case every fortnight in Oxford.

328
00:33:48,840 --> 00:33:54,210
This was in London University College, one new case every fortnight and a death every fortnight.

329
00:33:54,210 --> 00:33:59,040
So at any one time I had about 30 patients, three zero patients.

330
00:33:59,040 --> 00:34:08,500
And we it was a battle and we fought it using intravenous drugs with Heckmann lines because there were no oral medications at that time.

331
00:34:08,500 --> 00:34:13,210
So who is putting in the Heckmann and the husband, the HIV team would do that?

332
00:34:13,210 --> 00:34:16,950
Yes. We then started to inject eyes.

333
00:34:16,950 --> 00:34:24,450
And I have to say that we were told that this was crazy because we would detach the retina, there would be bleeding, there would be infection.

334
00:34:24,450 --> 00:34:29,580
If particularly if we did repeated injections of antiviral gansett be forced on it,

335
00:34:29,580 --> 00:34:35,520
there might be uveitis as a result of the injection of the medication. And of course, I was squeamish.

336
00:34:35,520 --> 00:34:42,570
So I had to learn how to give these injections. They came in tiny insulin syringes and they were two drops.

337
00:34:42,570 --> 00:34:47,090
Wow. So I think it's 100 microliters 50 microliters job job.

338
00:34:47,090 --> 00:34:59,310
Got that wrong. I'm not sure. And I had to get my registrar to teach me how to do these injections, but I had to steel myself to do them.

339
00:34:59,310 --> 00:35:03,120
And once at a conference, I was asked, does the patient need a sedative, Dr. Breath?

340
00:35:03,120 --> 00:35:10,650
And I said, no, the doctor needs to know that providing explain to the patient what you're doing.

341
00:35:10,650 --> 00:35:16,270
You're using days apparently know. So it was sort of.

342
00:35:16,270 --> 00:35:22,110
But then who decided to do these injections? You said people were saying you can't do that.

343
00:35:22,110 --> 00:35:30,000
So where did the where did the impetus come from? One of the extraordinary things about CMB retinitis was that we could see the relentless

344
00:35:30,000 --> 00:35:34,110
progress of the retinitis by looking and by photographing and by mapping it.

345
00:35:34,110 --> 00:35:38,790
And it was often the last thing that AIDS patients developed before they died.

346
00:35:38,790 --> 00:35:40,890
So with this race against the virus,

347
00:35:40,890 --> 00:35:47,760
we we the people in the states had injected and they had shown that you could get much higher concentrations of antiviral,

348
00:35:47,760 --> 00:35:50,880
all the static, of course, nothing biocidal,

349
00:35:50,880 --> 00:35:57,360
but that you could halt the retinitis by injecting in a way that you could never achieve with systemic levels of the drug through a human life,

350
00:35:57,360 --> 00:36:01,300
even giving twice daily infusions with big peak levels.

351
00:36:01,300 --> 00:36:09,480
Actually, I remember all the toxicity. I remember from George roaring around London on his motorbike with these sort of the

352
00:36:09,480 --> 00:36:14,090
refrigerated equivalent of a pizza delivery thing in the back of his motorbike with all the.

353
00:36:14,090 --> 00:36:20,820
Clearly a hospital which was tailor made to the weight and real function of each of the patients anyway to see the pharmacologist.

354
00:36:20,820 --> 00:36:24,540
He was a palliative care doctor, but he was a man. He's rather like more grey.

355
00:36:24,540 --> 00:36:29,040
He was a great sort of doer and a great visionary irregularity.

356
00:36:29,040 --> 00:36:37,140
I mean, oh, yes, he would. There was nothing that Robert George couldn't overcome, hence the motorbike to weave through the London traffic.

357
00:36:37,140 --> 00:36:41,850
Anyway, we injected eyes and we showed that it was relatively safe.

358
00:36:41,850 --> 00:36:49,230
And these brave men who died, who had the courage to accept the injections,

359
00:36:49,230 --> 00:36:57,030
paved the way to finding out that they were acceptable and indeed that they were efficacious for macular degeneration patients.

360
00:36:57,030 --> 00:37:02,450
So I think without the pioneering work that these patients accepted,

361
00:37:02,450 --> 00:37:06,990
you see the extraordinary thing in the eyes that the patients could see that they were going blind, literally.

362
00:37:06,990 --> 00:37:11,730
They could see the visual field encroaching week by week, sometimes even day by day.

363
00:37:11,730 --> 00:37:19,170
And they knew when you injected that it would stabilise things for maybe a fortnight.

364
00:37:19,170 --> 00:37:27,900
But I do remember one of the early patients I injected, he was blind in one eye, had some vision in his second eye.

365
00:37:27,900 --> 00:37:34,630
And in those days, 20 years ago, we would say that the worst possible side effects from the injections,

366
00:37:34,630 --> 00:37:39,960
but we perhaps made light of them because we began to realise it was relatively safe.

367
00:37:39,960 --> 00:37:44,070
Anyway, he was German, this patient, and he's lying there on the couch.

368
00:37:44,070 --> 00:37:49,770
And I injected the eye and he said, it's black. I said, What did you say?

369
00:37:49,770 --> 00:37:58,440
He said, it's black. I said, Your vision is black. He said, I can see nothing big intake of breath.

370
00:37:58,440 --> 00:38:05,730
I said, it'll be because the pressure's gone up to a very slight extent and the eye is struggling with the blood supply.

371
00:38:05,730 --> 00:38:10,290
Let's wait and saying a prayer under my breath, almost literally.

372
00:38:10,290 --> 00:38:14,610
And I bet you in a minute or two hoping that this would be right.

373
00:38:14,610 --> 00:38:19,650
It'll come back a minute, went by another half minute.

374
00:38:19,650 --> 00:38:23,850
He said it's back. I said, is that you say it's still black?

375
00:38:23,850 --> 00:38:28,240
He said, no, it's back. My vision has come back. Hmm.

376
00:38:28,240 --> 00:38:38,370
Well, so before you end the AIDS, I mean, how part time were you, six sessions away from the AIDS off.

377
00:38:38,370 --> 00:38:41,790
So this get back to my story, which I had gone off being with,

378
00:38:41,790 --> 00:38:50,730
came before I had a consultant post in Oxford and I was working half time in Oxford, which I mean five, six months.

379
00:38:50,730 --> 00:38:59,850
I think it must have been six sessions. Yes, that's right. So we sort of when you said but I'm off for a day in London, what do they say?

380
00:38:59,850 --> 00:39:05,580
Well, I had some sort of because I was, as it were, supernumerary in our department,

381
00:39:05,580 --> 00:39:12,570
providing I could fit round the arrangements that were made in London that was acceptable to the department.

382
00:39:12,570 --> 00:39:18,960
I made sure that I think the only patients for whom I had nominal responsibility

383
00:39:18,960 --> 00:39:23,910
under Tony Brown's supervision were in the neuro ophthalmology clinic.

384
00:39:23,910 --> 00:39:29,040
But when did I start the inflammatory clinic? I must have majored in inflammatories.

385
00:39:29,040 --> 00:39:36,480
But we always we were always careful to see that other trainees actually had exposure to inflammatory disease as well.

386
00:39:36,480 --> 00:39:40,360
And was that in the hospital or in the Drumright? It was in the old hospital.

387
00:39:40,360 --> 00:39:46,890
Yes, we were the one of the last. Because, I mean, did you run a germ clinic with direct with John Ledingham?

388
00:39:46,890 --> 00:39:55,530
Yes. And that was in order to keep up my physician's credentials because I didn't know whether this wild card was going to come off.

389
00:39:55,530 --> 00:40:01,340
And if it hadn't done, I think I would have gone. Will work as a general physician.

390
00:40:01,340 --> 00:40:10,310
I didn't quite know how that was going to work. I do remember going to talk to Andrew Marcus in time about whether I would be able to qualify as a GP.

391
00:40:10,310 --> 00:40:16,190
And there was this window of opportunity after which I would lose all the training I had ever had in general medicine,

392
00:40:16,190 --> 00:40:21,680
and I'd have to go back to square one to train as a GP. So that was a bit of a wake up call.

393
00:40:21,680 --> 00:40:31,430
Anyway, I did eventually get a job in Oxford, which was crafted on the back of having already set up the London clinic for HIV patients.

394
00:40:31,430 --> 00:40:40,520
And although we never had many HIV patients at any one time, HIV AIDS patients in Oxford proportionately far fewer.

395
00:40:40,520 --> 00:40:45,170
But Tim Pito in particular said, But with this patient choice, Peggie,

396
00:40:45,170 --> 00:40:53,600
we will have to pay for those patients that you're already looking after and future patients with Kotva retinitis because

397
00:40:53,600 --> 00:41:00,110
we wouldn't actually find anybody else who could look after them in the way that you can with your London expertise.

398
00:41:00,110 --> 00:41:04,010
The trust will have to pay for those patients to go all the way to London to see

399
00:41:04,010 --> 00:41:09,860
you regularly so I can make a case to show them that it's not cost effective.

400
00:41:09,860 --> 00:41:18,620
And indeed, that is what happened. And the chief executive asked to see me, David Wilson, I remember he said, who are you and what do you do?

401
00:41:18,620 --> 00:41:23,720
And unbeknown to me, I had told the patients I must have been running an inflammatory clinic at that time.

402
00:41:23,720 --> 00:41:28,490
I told them that the clinic was coming to a halt because I was no longer going to be working in Oxford

403
00:41:28,490 --> 00:41:34,760
because my training programme had come to an end around the time I remember Dulci Goodings saying to me,

404
00:41:34,760 --> 00:41:41,570
We think it's in your interest. Or perhaps it was Shirlee able. It was whoever was the dean of the part time trading scheme.

405
00:41:41,570 --> 00:41:51,500
We think it will force the question of whether you will be best deployed, which was whether there would be a job in Oxford or not.

406
00:41:51,500 --> 00:41:55,880
We think otherwise it would kind become like an endless piece of elastic. You might never get a consultant post.

407
00:41:55,880 --> 00:42:00,080
Indeed they would. Yes. So I was sort of homeless, as it were.

408
00:42:00,080 --> 00:42:06,440
But my little unbeknown to me, three of my patients, I think, wrote to the chief executive and said,

409
00:42:06,440 --> 00:42:12,410
we don't know what we're going to do when we go back to the general clinic, which is very good, very good of them.

410
00:42:12,410 --> 00:42:14,960
So you saw David Wilson. I saw David Wilson.

411
00:42:14,960 --> 00:42:23,390
And I remember Alex Gatherer was the head honcho managerially, and I had to go and talk to him best from time again.

412
00:42:23,390 --> 00:42:25,820
And he was very helpful and very genial.

413
00:42:25,820 --> 00:42:35,660
I think he'd been briefed by senior colleagues who knew me well and also the way that the funding was that they came over a with them.

414
00:42:35,660 --> 00:42:42,110
I think there was more of support from general medical side, including the infectious disease.

415
00:42:42,110 --> 00:42:44,330
By this time, because of the HIV,

416
00:42:44,330 --> 00:42:51,710
also the rheumatologists were very supportive because I had developed with John Adams help and his expertise in the clinic,

417
00:42:51,710 --> 00:42:59,270
I developed a particular interest in Sakiewicz and veganism. Beginners in particular can drill holes in the eye very quickly because you get a

418
00:42:59,270 --> 00:43:03,980
vasculitis which cuts off the blood supply to the sclera and it can be very painful,

419
00:43:03,980 --> 00:43:09,230
can be painless in rheumatoid arthritis. And you get this black hole appearing on the on the skin.

420
00:43:09,230 --> 00:43:12,860
The real challenge is that Roger Smith said it would have been yes.

421
00:43:12,860 --> 00:43:18,260
Yes, he would have been very supportive. And I asked him estimate. Yes, he had taught me when I was their opportunity.

422
00:43:18,260 --> 00:43:27,410
They were up at the end of the clinic that I didn't because I went to Liz Graham to do inflammatory diseases and Thomases.

423
00:43:27,410 --> 00:43:35,720
And I had the experience from John Ledingham, who had a lot of eagerness. Yes, I could patients and I believe and lupus patients indeed,

424
00:43:35,720 --> 00:43:42,650
although they were by then pretty well managed with with steroids and brain and other immunosuppression cyclophosphamide,

425
00:43:42,650 --> 00:43:46,370
that they didn't often develop vascular complications in the eye.

426
00:43:46,370 --> 00:43:50,960
But I have seen optic neuropathies and skywriters in in lupus.

427
00:43:50,960 --> 00:43:58,130
Now, you said you were, as it were, under Tony Bronzewing, but you were NHS not being correct.

428
00:43:58,130 --> 00:44:03,020
I only came on the scene as far as university was concerned when I took up the post at the medical school.

429
00:44:03,020 --> 00:44:13,490
Right. When we come to that later. The other question, during the Howard Williams deal, I know Howard Williams, Julia John Howard Williams diabetes.

430
00:44:13,490 --> 00:44:21,000
Yes. Yes. When she was going through the same troubles as the combat.

431
00:44:21,000 --> 00:44:25,130
Yes, I do know her name. I didn't know her personally.

432
00:44:25,130 --> 00:44:28,610
I don't think she would have been in the eighties, you know.

433
00:44:28,610 --> 00:44:33,740
Yes, she'd probably been a bit younger than me who she must have been around at that time.

434
00:44:33,740 --> 00:44:43,460
She would be attached to further Vaudrey. I think about to say how interesting, though, because he was preheating, of course.

435
00:44:43,460 --> 00:44:48,620
So it could have been at a time when I happened to be doing other things elsewhere.

436
00:44:48,620 --> 00:44:53,990
Yes. And I'm not sure what happened when he came on the scene and took over from Philip.

437
00:44:53,990 --> 00:44:57,590
Well, the diabetes diabetic. Well, he didn't me. I'm sure he did.

438
00:44:57,590 --> 00:45:09,670
And he didn't. But in a sense, Filipov, he went on, as well as who and who was say that talked to him, that he got immersed in the new contract.

439
00:45:09,670 --> 00:45:15,910
Yes, you know, that took a tremendous amount. I mean, he'd done a tremendous amount of damage is in London.

440
00:45:15,910 --> 00:45:20,710
Yes. The vicuña. Yes. But in Oxford, I mean, until.

441
00:45:20,710 --> 00:45:28,270
Well, I mean, he did a lot of calculation on this, but, you know, until as it were finished, when he wouldn't have done it all by any means.

442
00:45:28,270 --> 00:45:34,160
No, I suppose all the trainees did their share of diabetic work.

443
00:45:34,160 --> 00:45:38,410
Whom did the operative Laza.

444
00:45:38,410 --> 00:45:44,920
Right. Which was where you had to use blunderbuss treatment for really resistant proliferative disease,

445
00:45:44,920 --> 00:45:47,800
particularly if they'd had a vitreous haemorrhage which had cleared,

446
00:45:47,800 --> 00:45:56,440
they would often anaesthetise them and put on big on bones, which is very painful, I think, to do in the unanesthetized patient.

447
00:45:56,440 --> 00:46:00,000
So they would come in for quite major sessions.

448
00:46:00,000 --> 00:46:07,510
And, you know, you could add more than at what time did you, in fact, move to the university.

449
00:46:07,510 --> 00:46:13,180
And that's where it doesn't matter that they took it from Joan Trull.

450
00:46:13,180 --> 00:46:16,420
David asked whether I was interested in the directorship of clinical studies,

451
00:46:16,420 --> 00:46:21,850
and I felt that that would have meant giving up some of the clinical work that I'd established in Oxford.

452
00:46:21,850 --> 00:46:28,300
And I didn't want to do that because I wanted the continuity with patients. But I said I'd be very interested if there were a deputy position.

453
00:46:28,300 --> 00:46:32,050
And Sue, of course, who became director of clinical studies.

454
00:46:32,050 --> 00:46:37,120
And we made a team together. That's four times when you were half and half, as it were initially.

455
00:46:37,120 --> 00:46:43,540
I mean, I did two sessions, which later went to three sessions, which meant that I went up to I had three jobs.

456
00:46:43,540 --> 00:46:47,350
I had a weekly clinic in London on Friday, which was all day.

457
00:46:47,350 --> 00:46:51,670
And was Helter-Skelter absolutely beginning to end?

458
00:46:51,670 --> 00:46:55,570
Because I didn't I didn't I was just making out the case for having someone to help me in

459
00:46:55,570 --> 00:47:00,580
the clinic when in fact combination therapy came on the scene and AIDS incidence declined.

460
00:47:00,580 --> 00:47:07,390
And in that clinic, would you still be injecting people? Busy, busy times?

461
00:47:07,390 --> 00:47:16,000
Yeah, I think 1998, three jobs. So I had three jobs, which was sort of made up a full time number of sessions, but was over and above.

462
00:47:16,000 --> 00:47:18,670
I became quite good at compartmentalising. Sure.

463
00:47:18,670 --> 00:47:23,050
And saying, well, if you don't mind, I'll deal with that on Tuesday or Wednesday or whatever it may be,

464
00:47:23,050 --> 00:47:29,320
depending on which day I was in that particular place. So what were you doing as director of clinical studies?

465
00:47:29,320 --> 00:47:34,650
As deputy director of clinical studies, my brief became the pastoral care of the student.

466
00:47:34,650 --> 00:47:37,590
I mean, I was supporting ASU, yes.

467
00:47:37,590 --> 00:47:44,670
And the first thing we had to face was this first major inspections and I remember Sue helping everybody and cajoling

468
00:47:44,670 --> 00:47:50,310
everybody and cracking the whip in the end to get all these blasted filing cabinets full of all this paperwork,

469
00:47:50,310 --> 00:47:54,570
which had never existed, literally a room full with these filing cabinets.

470
00:47:54,570 --> 00:47:59,220
It was like something out of Kafka. And she was brilliant. I remember her phoning up.

471
00:47:59,220 --> 00:48:02,940
She may have told you this story about phoning up Peter Morris in Australia. Yes.

472
00:48:02,940 --> 00:48:08,670
And he was saying it's not my problem. And she said, oh, please send somebody to I think, you know, in the nice way.

473
00:48:08,670 --> 00:48:15,540
She's very proud of it. And it is. Absolutely. And I shouldn't tell this story, but maybe I will.

474
00:48:15,540 --> 00:48:19,530
The day before the inspectors were due to give their report, she called me to her office and she said,

475
00:48:19,530 --> 00:48:23,820
Betty, I have one problem you might be able to help me with. I said, was that so?

476
00:48:23,820 --> 00:48:28,650
She said, When people say nice things about me, I tend to burst into tears.

477
00:48:28,650 --> 00:48:33,480
And I said to her, well, that's going to be difficult then, because they're bound to say nice things about.

478
00:48:33,480 --> 00:48:38,430
So what can we do? I said, treating it as if she might be one of my pastoral students.

479
00:48:38,430 --> 00:48:40,860
I said, I see three possibilities.

480
00:48:40,860 --> 00:48:46,920
Number one, you burst into tears and they wait until that settles down and then you explain no to you burst into tears.

481
00:48:46,920 --> 00:48:53,130
And I explain that this might have happened and you can decide whether to leave the room or whether to not.

482
00:48:53,130 --> 00:48:57,930
Number three, we tell them pre-emptively that this might. Oh, No. Four is we just tough it out.

483
00:48:57,930 --> 00:49:03,810
And I do remember being there when the report was given and I was catching her eye.

484
00:49:03,810 --> 00:49:11,700
She didn't know sort of began. And then we sort of.

485
00:49:11,700 --> 00:49:21,420
So that was that was yes. She was terrific at that it pastoral care was necessary or was were you doing.

486
00:49:21,420 --> 00:49:24,660
Because when I was a medical student there wasn't any public health.

487
00:49:24,660 --> 00:49:28,800
So when did it come in and how did you find it?

488
00:49:28,800 --> 00:49:34,290
Joan Troell had blazed the trail because she was with John Cyr.

489
00:49:34,290 --> 00:49:38,100
Yes, he was director and she was deputy director and she had made pastoral care.

490
00:49:38,100 --> 00:49:43,290
Big thing. And she told me when I took over, she said, Peggy, you will be surprised at two things.

491
00:49:43,290 --> 00:49:50,100
One is the incidence of serious illness and indeed bereavement in the families of medical students because being in their twenties,

492
00:49:50,100 --> 00:49:59,820
their parents in their 50s have a kind of blip in their mortality rate and heart attacks and cardiovascular disease in particular.

493
00:49:59,820 --> 00:50:04,240
And she said the other is the level of mental ill health amongst students, medical students,

494
00:50:04,240 --> 00:50:13,020
stress job, I think probably talented, quite high achieving, high attaining students.

495
00:50:13,020 --> 00:50:16,470
There's quite high incidence as the incidence, particularly of women.

496
00:50:16,470 --> 00:50:23,370
Rose, I'm not a sexist comment, but it's well known that eating disorders are much commoner in women.

497
00:50:23,370 --> 00:50:32,370
So she said anorexia depression, which might well the stress of being a medical student might have contributed to.

498
00:50:32,370 --> 00:50:36,450
So I thought she was absolutely right.

499
00:50:36,450 --> 00:50:43,080
Of course, the fact that she was at the GMC, that it was quite easy to talk to her about fitness, to practise questions.

500
00:50:43,080 --> 00:50:50,670
And in my mind, very early on, teasing out fitness to study as being very distinct from fitness to practise,

501
00:50:50,670 --> 00:50:59,700
because fitness to study meant that, say, a student with eating disorders had to stop studying for their own health reasons.

502
00:50:59,700 --> 00:51:07,740
That did not mean that they were not going to qualify as a doctor and that they would therefore be deemed less fit to practise.

503
00:51:07,740 --> 00:51:12,760
But we were saying to them as students that they were not fit to study at that time.

504
00:51:12,760 --> 00:51:18,030
Yes, just as if they've broken limbs or whatever.

505
00:51:18,030 --> 00:51:20,400
And we worked with the College Doctors Association.

506
00:51:20,400 --> 00:51:27,300
I was chair of the College Doctors Association for can't remember how many years, certainly more than ten.

507
00:51:27,300 --> 00:51:33,690
And I think their provision for mental health in in students and medical students in particular is good.

508
00:51:33,690 --> 00:51:38,280
We're very lucky these characters were coming to you or you in anyway.

509
00:51:38,280 --> 00:51:46,470
So I decided in view of the time that I had and the fact that there were 150 each year by that,

510
00:51:46,470 --> 00:51:53,540
it grew to that number quite rapidly with the GMC reforms and being asked to take more.

511
00:51:53,540 --> 00:52:02,130
So it had already started under John Ledingham, but under John Seah and then on to see the numbers road,

512
00:52:02,130 --> 00:52:07,140
I decided that I would appraise each of them once during their time,

513
00:52:07,140 --> 00:52:14,280
the medical school, because it would be possible for someone with my timetable to do that if I was fairly efficient doing it.

514
00:52:14,280 --> 00:52:17,430
So I asked the secretary if she could sort of call them up one by one,

515
00:52:17,430 --> 00:52:23,050
not alphabetically, but at the same stage or with a potluck with her third year.

516
00:52:23,050 --> 00:52:24,750
I would do it in year five.

517
00:52:24,750 --> 00:52:31,500
So that would be the middle year of their clinical studies, because at that point they understood what it was to be a clinical student.

518
00:52:31,500 --> 00:52:36,630
And as it developed, I actually focussed on what? Their career choice might be,

519
00:52:36,630 --> 00:52:42,900
but it also gave me an opportunity to honour those who were actually thinking of leaving medicine or who had become disillusioned or who

520
00:52:42,900 --> 00:52:51,750
actually were subliminally unwell in some way they might be depressed or they might be struggling with some undisclosed medical problem,

521
00:52:51,750 --> 00:52:58,350
which they hadn't wanted to declare. So I had to tread a fine line between things on the record, off the record confidentiality,

522
00:52:58,350 --> 00:53:02,370
often saying, would you like me to make an appointment for this person,

523
00:53:02,370 --> 00:53:11,850
which might be their GP with them in the room so that they would know what I'd said, which was just can we make an appointment for this person?

524
00:53:11,850 --> 00:53:18,510
Because left to their own devices, they might might not find the will to do that,

525
00:53:18,510 --> 00:53:22,830
whereas they had agreed that I would do up to them whether they kept the appointment or not.

526
00:53:22,830 --> 00:53:28,050
So it was treading that fine line between not being a nanny to them, but doing strategy with them.

527
00:53:28,050 --> 00:53:32,350
Yes. And could you would you talk to the consultants?

528
00:53:32,350 --> 00:53:32,970
They were working.

529
00:53:32,970 --> 00:53:46,770
And at the time, sometimes I tried very hard, particularly with Tim Lancasters help to build up the cadre of clinical tutors within the colleges.

530
00:53:46,770 --> 00:53:53,310
Some were excellent and some were dormant, weren't actually interested in doing this pastoral stuff.

531
00:53:53,310 --> 00:54:01,560
They thought the medical school should do that, whereas we always felt that to have another string to the bow for the students to turn to

532
00:54:01,560 --> 00:54:05,880
through their college was a very good idea and some of the college tutors were excellent.

533
00:54:05,880 --> 00:54:13,590
And we set up training days. I remember Basil Shepstone Blessin departing because we had a role to play.

534
00:54:13,590 --> 00:54:19,680
He didn't do role play, so he got up and left, which of course, he was quite entitled to do.

535
00:54:19,680 --> 00:54:25,770
But Chris Bulstrode was very helpful in setting up certain things from the.

536
00:54:25,770 --> 00:54:35,730
Yes, he was very interested in education. He said, as you probably know, he may have mentioned as well the educating the educators, the Unicon course,

537
00:54:35,730 --> 00:54:44,010
right where we went away to some frightfully nice place like what's the place where the National Westminster Bank is now?

538
00:54:44,010 --> 00:54:47,440
And he probably was and will be put up for a weekend.

539
00:54:47,440 --> 00:54:56,610
And we do sort of quite intensive stuff to do because, I mean, in my time, which goes up to 92, the most they were doing was videoing people.

540
00:54:56,610 --> 00:55:00,120
They just began to video teaching. Yes.

541
00:55:00,120 --> 00:55:04,620
And there was nothing else. And it was very interesting because Chris was very good.

542
00:55:04,620 --> 00:55:11,790
Intuitively, the courses were small enough that he would sort of have have a some idea of how each tutor

543
00:55:11,790 --> 00:55:17,880
worked and he would try and show them that there were things greater than their horizons.

544
00:55:17,880 --> 00:55:21,810
Mine was extempore teaching, which I would never do. I would always be well prepared.

545
00:55:21,810 --> 00:55:26,430
And I said, but I'd have to have slides. I show them something. No, Peggy, these are not farmers.

546
00:55:26,430 --> 00:55:34,980
Go teach them how to do ophthalmoscope. And that actually was quite an eye opener because you could see that if you if you if you took a deep breath,

547
00:55:34,980 --> 00:55:42,150
you could use teaching methods that you wouldn't normally have felt comfortable using.

548
00:55:42,150 --> 00:55:47,820
And so there was definitely. And then you became the director.

549
00:55:47,820 --> 00:55:53,310
No, I didn't. I stayed deputy. But Sue became Tim Lancaster took over.

550
00:55:53,310 --> 00:56:06,090
Right. Um, and he he was he was his great strength is in organising things and delegating things to people to get things done.

551
00:56:06,090 --> 00:56:14,220
He also has a very strong suit in teaching himself and is much beloved by the students for being a very good hands on teacher.

552
00:56:14,220 --> 00:56:20,130
He's also brilliant at remembering their names, which I absolutely hope is that that's just the way my brain doesn't work.

553
00:56:20,130 --> 00:56:25,050
But I think it was very good for me to see each student once it ended up being an

554
00:56:25,050 --> 00:56:29,130
a half hour slot because there was some work they had to do before they came.

555
00:56:29,130 --> 00:56:36,560
And then we would go through the work that they had done to see how their profile stacked up with what they thought they might do.

556
00:56:36,560 --> 00:56:42,750
Right. And often it was quite congruous. Sometimes it was other things would suggest themselves.

557
00:56:42,750 --> 00:56:46,410
So it became a sort of career counselling when I was thinking that.

558
00:56:46,410 --> 00:56:53,500
And in fact, I mean, second clinical year, many of them would change their minds after that.

559
00:56:53,500 --> 00:56:59,400
And I mean, that's fine. And when they come back for reunions, they often say, do you remember?

560
00:56:59,400 --> 00:57:04,770
I always say yes. And they said, you said to me that I might enjoy anaesthetics.

561
00:57:04,770 --> 00:57:10,320
And I never thought it. And I said, well, I thought it was boring. But then I went, I did a special study module.

562
00:57:10,320 --> 00:57:14,340
I realised this is exactly what I wanted to do. I'm not always that story.

563
00:57:14,340 --> 00:57:18,570
I did meet I meet some who've left medicine right and they looked slightly sheepish.

564
00:57:18,570 --> 00:57:28,170
They're always wearing very smart suits. They come back to the come, you know, they're so good in the lawyers or the city or what.

565
00:57:28,170 --> 00:57:34,650
I am cheeky enough to say, Oh man, con, which is management consulting.

566
00:57:34,650 --> 00:57:43,570
Yes, Dr. Frist, we're coming back to tell you how to run the children's hospital, and I say, oh, really good luck.

567
00:57:43,570 --> 00:57:54,330
Good luck. And is that the thing you guys enjoyed most or what would it be, the clinical words going on or both of those?

568
00:57:54,330 --> 00:58:02,620
I'm pretty chuffed that I broke into a sort of nonexistent clinical word and set up a clinic and that we kind of triumphed in the eye.

569
00:58:02,620 --> 00:58:05,040
It wasn't me that triumphed over blindness in AIDS,

570
00:58:05,040 --> 00:58:14,000
but I do working in conjunction with brave patients who are in the most extraordinary I mean, AIDS was the most ghastly.

571
00:58:14,000 --> 00:58:22,230
Yeah, yeah. And working alongside HIV physicians was what I really did enjoy doing and felt very pleased about it.

572
00:58:22,230 --> 00:58:29,250
And I wish that they kept that on. After I retired from the Inflammatory Disease Clinic at Oxford,

573
00:58:29,250 --> 00:58:34,170
I came to find because the field is quite narrow and because I wasn't working full time,

574
00:58:34,170 --> 00:58:41,100
that the actual conditions that presented were less of a diagnostic challenge.

575
00:58:41,100 --> 00:58:44,850
So it sort of closed in on me a bit to the inflammatory disease.

576
00:58:44,850 --> 00:58:53,310
But then we had novel therapies with the mono therapies, so it was exciting to see those becoming effective.

577
00:58:53,310 --> 00:58:57,600
But I wasn't on the crest of that wave. I was in the sort of power wave of setting that up.

578
00:58:57,600 --> 00:59:02,820
So I missed the dramatically. Yes, we'd moved by then. I was lead clinician at the hospital when we moved.

579
00:59:02,820 --> 00:59:06,090
My goodness me. That would, you know, stories to tell about that.

580
00:59:06,090 --> 00:59:08,640
Like none of the phones worked and all the bleeps worked.

581
00:59:08,640 --> 00:59:15,210
What we're trying to run a seamless 24 hour emergency service for the whole of Oxfordshire and beyond here.

582
00:59:15,210 --> 00:59:18,390
And none of it none of the phones worked and the bleeps didn't work.

583
00:59:18,390 --> 00:59:24,570
Well, we were in some electronic black hole, so I had to jump up and down, get that sorted out pretty quickly if I could.

584
00:59:24,570 --> 00:59:35,190
Anyway, they said there's hope stories associated with that. Um, I think that the most fulfilling thing probably has been working with students

585
00:59:35,190 --> 00:59:41,890
and helping them get alongside their struggles and acting as an ally in that.

586
00:59:41,890 --> 00:59:49,260
It's very like the work that one does clinically. Joan Child told me that she's just like another outpatient clinic patient.

587
00:59:49,260 --> 00:59:53,850
So there were some students I got to know really well because they often had challenging problems.

588
00:59:53,850 --> 00:59:59,130
And it was a we didn't lose many in the sense of leaving medicine,

589
00:59:59,130 --> 01:00:08,330
all the eating disorders students came through and many of them have made brilliant doctors.

590
01:00:08,330 --> 01:00:40,200
All but one of the depressives.

591
01:00:40,200 --> 01:00:47,520
And I think even of those I chatted around who were thinking of leaving medicine, I would say, well, get your qualification,

592
01:00:47,520 --> 01:00:52,200
think about GMC and then and then have another thing,

593
01:00:52,200 --> 01:00:56,220
because otherwise you're turning your back on something that you will not be able to get back to.

594
01:00:56,220 --> 01:01:00,000
Yes, that's very good advice. But they can put it in your back pocket.

595
01:01:00,000 --> 01:01:09,060
Yes. And it's only a year or two. And you've got that for always, particularly if you've got your GMC registration, Camerata or whatever.

596
01:01:09,060 --> 01:01:16,650
Exactly. Exactly. But I mean, in fact, in the 60s, I mean, bullying was a fact on the roads.

597
01:01:16,650 --> 01:01:20,910
And in 2000, was it still happening? Yes.

598
01:01:20,910 --> 01:01:31,260
Is the answer to that. But I think that the students are more open, particularly if asked directly, and that tends to be a domino effect.

599
01:01:31,260 --> 01:01:34,560
I think they're more supportive of each other.

600
01:01:34,560 --> 01:01:41,880
And I had a particular whether it's because I'm a woman and whether because there are proportionately more women students.

601
01:01:41,880 --> 01:01:52,830
Now, I had a particular interest in helping to address sexism in medicine as it applied to students,

602
01:01:52,830 --> 01:01:58,860
actually, the chaps that the male students who are often amongst the most supportive of the women's eyes.

603
01:01:58,860 --> 01:02:05,490
And they were pretty indignant when they had been teaching me there was one particular teacher who shall be nameless,

604
01:02:05,490 --> 01:02:13,730
who would pretty well exclude the women from his teaching as they all go away.

605
01:02:13,730 --> 01:02:22,170
And I went to see Sue with this, and I had asked the students just to give me a sort of verbatim idea of what he'd been saying,

606
01:02:22,170 --> 01:02:28,140
which made it clear that he wasn't really interested in teaching the student, the women students, his subject.

607
01:02:28,140 --> 01:02:32,490
So she said to me, said, what do we do now? I said, Sue, either you go or I go.

608
01:02:32,490 --> 01:02:37,890
We go together, I think. And in the end, she went and he said, But you have no evidence of this.

609
01:02:37,890 --> 01:02:43,530
And she said, well, these are the things that some of the students have said, handed it to him.

610
01:02:43,530 --> 01:02:47,160
And he went very quiet and he stopped the behaviour.

611
01:02:47,160 --> 01:02:55,360
And I don't think she had to be pretty heavy handed with him, just became aware of the fact that that he'd lost his anonymity.

612
01:02:55,360 --> 01:02:59,780
Yes. But there was also bullying of both sexes going on.

613
01:02:59,780 --> 01:03:07,460
Yes. Yes. I think particularly when people are under pressure and they I think some people use pretty fruity language.

614
01:03:07,460 --> 01:03:14,460
And I think the bullying associated with I won't give you a good reference has gone because they demolished

615
01:03:14,460 --> 01:03:23,760
that system of patronage is so that that fear of blotting your copy book and of somebody saying,

616
01:03:23,760 --> 01:03:29,160
I wouldn't employ this person if I were you for good or bad.

617
01:03:29,160 --> 01:03:40,650
Yeah. And now no longer teachers. I think overt bullying harassment is actually now rarer than it was.

618
01:03:40,650 --> 01:03:45,180
Well, I would guess it now it's gone to 12 there.

619
01:03:45,180 --> 01:03:48,150
Is it still happening?

620
01:03:48,150 --> 01:03:56,940
I would say that a senior people treat more junior people in a way that I would not countenance more often than I would feel comfortable with that.

621
01:03:56,940 --> 01:03:59,910
I can't say that there's an epidemic. No.

622
01:03:59,910 --> 01:04:07,080
And that the students are getting a bit better than the students, I think are getting better at saying, oh, I,

623
01:04:07,080 --> 01:04:12,960
I don't know that somebody they need somebody to come to and they know that there will be

624
01:04:12,960 --> 01:04:21,480
a system whereby without there being an inquisition or a sort of crucible sort of effect,

625
01:04:21,480 --> 01:04:29,370
that if they say that somebody has said something, if they have a contemporaneous record of what's being said, that this may come to light.

626
01:04:29,370 --> 01:04:33,510
And so I think that there is less of it as a result.

627
01:04:33,510 --> 01:04:39,720
Of course, we don't know what's under the tip of the iceberg, but having seen the iceberg for nearly 20 years,

628
01:04:39,720 --> 01:04:43,800
I think it did become smaller, but it didn't disappear completely.

629
01:04:43,800 --> 01:04:47,330
Now, let's go back to work. All this time you would be writing papers,

630
01:04:47,330 --> 01:04:55,950
something if that was one of my problems in being I don't feel I sometimes say

631
01:04:55,950 --> 01:05:01,200
to people I'm not an academic by nature because I don't like writing things up.

632
01:05:01,200 --> 01:05:09,060
My ideal combination would be to be the gofer who found things out, but get somebody else to write the paper.

633
01:05:09,060 --> 01:05:12,390
I think I may be dyslexic in some way.

634
01:05:12,390 --> 01:05:18,030
I find it very difficult to crystallise my thoughts in print.

635
01:05:18,030 --> 01:05:28,260
I don't find it difficult to crystallise my thoughts when I'm teaching because you've got images in and that is true of handwriting.

636
01:05:28,260 --> 01:05:36,090
As a typing on a PC, I still type with two fingers and I found it very difficult to learn the piano because I can't.

637
01:05:36,090 --> 01:05:40,410
To me, it's a mystery that Angela sits there with these things in her ears.

638
01:05:40,410 --> 01:05:45,630
I know it's already Carolyn who's done transforming jobs, fixing all our translator,

639
01:05:45,630 --> 01:05:50,520
translating the audio to what comes out of their fingers to me is a miracle.

640
01:05:50,520 --> 01:05:53,730
Yes, I can't see myself ever doing that. So I do.

641
01:05:53,730 --> 01:05:59,620
It's always been a bit of a slog writing things. And you'd be going to national meetings.

642
01:05:59,620 --> 01:06:03,150
Oh, yes. Yes. And we did. Yes.

643
01:06:03,150 --> 01:06:12,780
I have spoken internationally on HIV and on pemphigoid, which was the subject of my M.D. thesis, again, with my dermatological links.

644
01:06:12,780 --> 01:06:16,560
Sorry, I haven't picked this up when they developed.

645
01:06:16,560 --> 01:06:24,330
Well, I joined I became an honorary dermatologist, so with a wonderful trail of of mostly women.

646
01:06:24,330 --> 01:06:29,940
So there was there was Superjet, Vanessa Van Halen, mostly vanilla from your Oscar?

647
01:06:29,940 --> 01:06:35,760
Yes, she was very influential, but I had no idea she was brilliant at writing papers.

648
01:06:35,760 --> 01:06:40,140
She was this, you know, this drive to get things published.

649
01:06:40,140 --> 01:06:45,480
And so she was an expert in blistering disorders of the skin.

650
01:06:45,480 --> 01:06:54,180
And we knew that secretaryship pemphigoid, which is rare but tends not to produce much in the way of skin blisters, if at all.

651
01:06:54,180 --> 01:07:00,720
But this was akin to bullous pemphigoid, which is a blistering disease, which Cicatrice pemphigoid.

652
01:07:00,720 --> 01:07:06,450
The scarring pemphigoid does have potentially blinding repercussions because it affects the cornea.

653
01:07:06,450 --> 01:07:12,210
Bullous pemphigoid did not appear to affect the cornea and then was a whole host of absolutely fascinating,

654
01:07:12,210 --> 01:07:20,110
really rare, blistering conditions related to things going on at the basement membranes in skin dermatitis.

655
01:07:20,110 --> 01:07:24,870
Pettifor Miss herpes gestation, as it was called.

656
01:07:24,870 --> 01:07:32,780
It's got another name now, but we're pregnant. Women would get blistering in the skin and the deposition of immunoglobulin at the base membrane.

657
01:07:32,780 --> 01:07:44,100
And then a whole fascinating group of children, some of whom would make it into adult life, who had genetic.

658
01:07:44,100 --> 01:07:53,490
Programmed disorders of the basement membranes. So I studied hundreds of these patients, 400 and something, and I went to Great Ormond Street,

659
01:07:53,490 --> 01:08:00,480
to the skin clinic there with David Atherton to see these children with blistering disorders, some of them very severely affected.

660
01:08:00,480 --> 01:08:04,360
We found a higher incidence of corneal disease than we had suspected,

661
01:08:04,360 --> 01:08:15,190
a higher incidence of symptoms in very little babies who were having corneal erosions where the corneal surface had blistered often at night anyway,

662
01:08:15,190 --> 01:08:23,160
because they yes, they wake up screaming and rubbing eyes with a lot of watering and were inconsolable because it is very painful.

663
01:08:23,160 --> 01:08:31,020
It's like having your eyes scratched and then they would often get an erosion that would wake them up for several nights in a row.

664
01:08:31,020 --> 01:08:33,970
And often that wasn't realised, very often wasn't realised.

665
01:08:33,970 --> 01:08:38,760
We came up with a very simple regime for the parents to use with lubricants and putting it pad over

666
01:08:38,760 --> 01:08:47,520
the eye and it reduced the length of these episodes significantly induce an antibiotic ointment.

667
01:08:47,520 --> 01:08:52,300
And I followed up some of those children in Birmingham. I went to Celia Moss's clinic in Birmingham.

668
01:08:52,300 --> 01:08:55,200
She was a blistering specialist as well.

669
01:08:55,200 --> 01:09:06,270
And I once had to give a talk at the Dowling Club, which is the dining club for dermatologists throughout the UK.

670
01:09:06,270 --> 01:09:10,860
So that was very fascinating because we and I was looking at the conjunct over clinically and I was

671
01:09:10,860 --> 01:09:16,770
also taking small samples of conjunctiva from the surface of the eye with forceps and little snip.

672
01:09:16,770 --> 01:09:23,640
And we do immuno fluorescence on these tiny, tiny about the size of a pin, his right arm.

673
01:09:23,640 --> 01:09:29,430
Anyway, I crunched together this theset. I remember saying to Robyn, I don't need to write this thesis.

674
01:09:29,430 --> 01:09:32,640
I just can't do it. And he was saying, come on, Peggy,

675
01:09:32,640 --> 01:09:44,670
think of that wonderful gown that you can wear as a nobody is doing that in the skin clinics in the in the Churchill.

676
01:09:44,670 --> 01:09:53,210
And I went to Kettering in Northampton and I sort of moonlighted all over the southern U.K. I'm freezing these pieces of conjunctiva and you say,

677
01:09:53,210 --> 01:09:56,850
yeah, so who's doing the immuno fluorescent and all that?

678
01:09:56,850 --> 01:10:04,290
That was done by Peter Mylord. Right. Coming full circle back to my student days and what the really, truly wonderful person was,

679
01:10:04,290 --> 01:10:10,140
the technician who used to cut the sections because dead easy to lose this pin before, you know, say there's nothing there.

680
01:10:10,140 --> 01:10:14,910
And I would say there is. You've dropped it off and it's fallen into.

681
01:10:14,910 --> 01:10:19,020
Yes. And then you just did the international you talk.

682
01:10:19,020 --> 01:10:23,400
But did you go to many conferences abroad? I'm not a great conference person, I'm afraid.

683
01:10:23,400 --> 01:10:30,780
I found it was a very small field and much as it was quite fun to hobnob with ones,

684
01:10:30,780 --> 01:10:38,100
that meant we were very small group who would get together by referring patients occasionally clinically.

685
01:10:38,100 --> 01:10:43,800
So I would often send my if I had really difficult patients, I would send them to Les Graham at Thomas's,

686
01:10:43,800 --> 01:10:49,800
sometimes to John Darte, who'd been a trainee of mine who became also interested in Pemphigoid Warfield's.

687
01:10:49,800 --> 01:10:54,390
So I thought it was a bit of a slog preparing papers.

688
01:10:54,390 --> 01:11:05,120
And you know what? I'm not. For me, the thrill is in finding things out rather than in getting them out there.

689
01:11:05,120 --> 01:11:10,790
I could be taken and was taken to task for that. When Martin Black looked at my thesis.

690
01:11:10,790 --> 01:11:21,200
Who's he? He's a dermatologist, but he's another expert in blistering diseases at St. John Hospital in London that used to be in Chinatown.

691
01:11:21,200 --> 01:11:24,810
He said there's so much interesting work in here, you should have published it.

692
01:11:24,810 --> 01:11:29,180
And I thought, this is what this is. There it is.

693
01:11:29,180 --> 01:11:35,570
I'm sure you me read it in the library, you know, gave permission because in a sense, I mean, you have it, but I know what you mean.

694
01:11:35,570 --> 01:11:39,200
Yes. And what happened? I asked you about that.

695
01:11:39,200 --> 01:11:43,880
I should have asked you don't think of March.

696
01:11:43,880 --> 01:11:49,430
I'd rather rather anecdotally rambled on about a number of things.

697
01:11:49,430 --> 01:11:59,720
Um, I have a position at New College because Alan, when John Ledingham retired from New College, Alan Townsend became the clinical fellow.

698
01:11:59,720 --> 01:12:03,500
But because new college has always had a relatively large number of clinical students,

699
01:12:03,500 --> 01:12:11,180
they asked whether I would help him to look after the students because they might pass by then was fairly well honed.

700
01:12:11,180 --> 01:12:21,060
And that's been very interesting. So I do admissions and I enjoy that trying to spot candidates who are with the bema.

701
01:12:21,060 --> 01:12:29,240
Now, all of them, I think, would be takeup, but it's trying to find a group who will hang together as five students who

702
01:12:29,240 --> 01:12:35,600
will bring something extra without wanting them to be in a particular mood.

703
01:12:35,600 --> 01:12:44,600
So I find that quite interesting. I mean, you really it's another group when you're admitting it's very to begin with,

704
01:12:44,600 --> 01:12:49,400
the four of us, there are two preconditions to see of the students.

705
01:12:49,400 --> 01:12:53,690
Is that what do you mean the group of five students? Yes. Yes.

706
01:12:53,690 --> 01:12:57,640
I never thought of that because I always thought, you know,

707
01:12:57,640 --> 01:13:02,420
the people who most would be good to come or you thought they did and then had to get on with it.

708
01:13:02,420 --> 01:13:04,880
But yes, they were very interested, I suppose.

709
01:13:04,880 --> 01:13:10,340
I suppose there was something sort of tacit I don't know whether it was ever made explicit between the four of us who were hunting,

710
01:13:10,340 --> 01:13:14,190
as it were, that we were looking for a fairly convivial people who.

711
01:13:14,190 --> 01:13:18,140
Oh, that's true. I mean, only one people. I enjoyed teaching. Yes.

712
01:13:18,140 --> 01:13:24,860
And that they would have that human spark, which would mean that they would relate to each other as individual human beings.

713
01:13:24,860 --> 01:13:29,810
Occasionally we would take a wild card and sometimes it didn't work out as well as we might have hoped.

714
01:13:29,810 --> 01:13:38,690
But isn't that that's true? I'm sure everybody I guess that so I suppose the overall challenge of having had an

715
01:13:38,690 --> 01:13:45,440
effect over the years by virtue of having been clinging on here for so many decades,

716
01:13:45,440 --> 01:13:54,020
I suppose that I understood some of the players who were playing. The other thing I have been involved in is the dreaded Athena Swan.

717
01:13:54,020 --> 01:14:01,760
Women in I say dread it because it's an awful lot of work which was foisted on departments by our wonderful chief medical officer,

718
01:14:01,760 --> 01:14:06,560
Sally Davis, who said, where are all the senior women when it comes to allocating money?

719
01:14:06,560 --> 01:14:11,000
And there was a sort of some people thought she was crazy and some people

720
01:14:11,000 --> 01:14:14,900
thought she was meddling and interfering and other people thought she was dead. Right.

721
01:14:14,900 --> 01:14:19,160
And so it has turned out, for instance, at Oxford, but it was fascinating going round.

722
01:14:19,160 --> 01:14:24,590
I tried to sort of strike the match, as it were,

723
01:14:24,590 --> 01:14:32,180
with heads of clinical departments for them to be enthused by the goods that might come from this rather than seeing it as a yes,

724
01:14:32,180 --> 01:14:39,560
a troublesome, time consuming, annoying sort of diversion which they had to go through in order to get their their funding.

725
01:14:39,560 --> 01:14:44,380
Yes. And I think actually it has been very informative.

726
01:14:44,380 --> 01:14:49,220
And what you have spoken about is Gingery. Oh, oh, my goodness.

727
01:14:49,220 --> 01:14:53,540
I mean, to my mind, the people, they changed Indrek,

728
01:14:53,540 --> 01:14:59,690
but much for the better over the Cambridge people because they came in with the footlights and that sort of idea.

729
01:14:59,690 --> 01:15:04,790
But what are your memories of my memories, Anthony? Well, I was a senior member, yes.

730
01:15:04,790 --> 01:15:09,140
But most of the time last year I was. But I was member of quite a long time.

731
01:15:09,140 --> 01:15:14,300
And I brought in the idea of getting the script right.

732
01:15:14,300 --> 01:15:18,020
And David Smith did that for a time when may have done right.

733
01:15:18,020 --> 01:15:24,140
He may have done I don't think the scripts were being vetted very vigorously when I took over.

734
01:15:24,140 --> 01:15:27,740
That one would be talking. It would help. I haven't done it for many ten years.

735
01:15:27,740 --> 01:15:34,130
I would have done it for the time in 2001 after 2000, probably would have I think I was already doing it.

736
01:15:34,130 --> 01:15:40,070
When I say that was 1998, because I think it was around 1990, said yes.

737
01:15:40,070 --> 01:15:50,090
Oh, well, maybe I wasn't the first, but I might. I did a number of stories that you can't divulge, but I do.

738
01:15:50,090 --> 01:15:59,270
And what do I do remember saying to them? Because they left it very late to send me the script and I took advice from people fairly high.

739
01:15:59,270 --> 01:16:05,510
Administration and I smelled a rat, something that was going to be politically very sensitive,

740
01:16:05,510 --> 01:16:12,020
so we had to change the identity of a particular nationality. One of the consultants portrayed in Tingeing.

741
01:16:12,020 --> 01:16:19,010
Right. Who is in trouble and the sensitivities around that the students simply hadn't understood.

742
01:16:19,010 --> 01:16:24,940
No, no. So do the admin. People would bail out of anything. But nonetheless, you know, I do understand.

743
01:16:24,940 --> 01:16:30,620
Yeah. Yeah. And then another, you know, more scurrilous things to do with the personal lives of certain senior members of staff,

744
01:16:30,620 --> 01:16:33,860
which I had to point out to them that this might be in the student's imagination.

745
01:16:33,860 --> 01:16:38,240
But just suppose that it wasn't entirely clear what should happen here.

746
01:16:38,240 --> 01:16:43,430
Oh, my goodness. This look of horror came over their face. You mean this is actually happening?

747
01:16:43,430 --> 01:16:49,430
I suppose it might be. How are you going to feel and how is the other person going to feel?

748
01:16:49,430 --> 01:16:56,900
But we managed to smooth that one out with a bit of fancy footwork. Is I mean, way back you took part in it?

749
01:16:56,900 --> 01:17:05,600
No, I sold the story. I was a part of the firm, but I sold the tickets, did the backroom stuff.

750
01:17:05,600 --> 01:17:12,320
No, see, Sue was a great actor, Sue, but. Right. I would have like to be a good actor, but I never had the courage.

751
01:17:12,320 --> 01:17:14,720
My courage failed me. I think.

752
01:17:14,720 --> 01:17:21,860
Well, I've been on stage a number of times to be lampooned, usually as a goody goody, as a senior member, often against Michael Donaghy.

753
01:17:21,860 --> 01:17:29,480
I think they used to find that was funny. No, I mean, you went to quite a few hospitals while you were also in Oxford.

754
01:17:29,480 --> 01:17:33,470
And I know it's very difficult and probably the answer's fairly obvious.

755
01:17:33,470 --> 01:17:42,210
How did Oxford compare to the other hospitals to do think as a hospital and medical school?

756
01:17:42,210 --> 01:17:47,760
And I sort of thought specifically about that, I think it was very well run actually,

757
01:17:47,760 --> 01:17:56,310
compared with those hobnob places like Green Square, which were very specialised, I reckon that we did as well clinically.

758
01:17:56,310 --> 01:18:03,990
And and we often would send particularly difficult diagnostic cases to them.

759
01:18:03,990 --> 01:18:10,680
But I think that acumen was pretty. You know, if we found we were puzzled as to what it was often they were.

760
01:18:10,680 --> 01:18:20,190
On the whole, I think Oxford did a remarkably good job of combining its district hospital aspect with its specialised aspect,

761
01:18:20,190 --> 01:18:22,950
because I think it did both remarkably well.

762
01:18:22,950 --> 01:18:35,470
Certainly in the days that I was treading the boards on the wards, which was when I was more junior, I think that's quite remarkable that we had.

763
01:18:35,470 --> 01:18:45,550
A cadre of very talented consultants who taught us and who worked clinically alongside and I think that's the unique thing about medicine,

764
01:18:45,550 --> 01:18:53,710
even more than law, probably, that you actually analyse in detail as it happens on a live person,

765
01:18:53,710 --> 01:19:01,180
a patient with someone who's more experienced than another pair of eyes that knows what's going on here.

766
01:19:01,180 --> 01:19:07,840
I find this absolutely fascinating. And so I think Oxford did that as well as well as any other place.

767
01:19:07,840 --> 01:19:14,860
Hey, what about the nursing home? That's hard to say because most of the places that I went were outpatient days.

768
01:19:14,860 --> 01:19:24,190
So I had very little exposure to inpatient nursing in the London hospitals and a lot of backup investigation, pathology.

769
01:19:24,190 --> 01:19:27,290
Biochemistry, again, probably isn't quite.

770
01:19:27,290 --> 01:19:34,510
I think one of the things about Oxford was this close association with the people who were doing the specialised work.

771
01:19:34,510 --> 01:19:39,220
So someone like Peter Mylord, who was doing skin pathology,

772
01:19:39,220 --> 01:19:43,180
the people who were doing renal pathology and actually going and looking down a microscope.

773
01:19:43,180 --> 01:19:49,870
So I'm John Ledingham was very keen on that when I did the renal unit, that if you had a biopsy and it was a difficult diagnostic case,

774
01:19:49,870 --> 01:19:56,590
we'd all troop off to the pathologist and Michael Dumbell or David Davis would have the slides there forced the renal unit.

775
01:19:56,590 --> 01:20:03,130
Oh, yes. Yes. For the people who were doing renal pathology and actually going and looking down a microscope.

776
01:20:03,130 --> 01:20:09,790
So I'm John Ledingham was very keen on that when I did the renal unit, that if you had a biopsy and it was a difficult diagnostic case,

777
01:20:09,790 --> 01:20:16,540
we'd all troop off to the pathologist and Michael Daniel or David Davis would have the slides, therefore, the renal unit.

778
01:20:16,540 --> 01:20:23,140
Oh, yes, yes, yes, yes, yes, yes, yes.

779
01:20:23,140 --> 01:20:29,530
In the days when we didn't dialyse, anyone over 60 or so, because, of course,

780
01:20:29,530 --> 01:20:35,110
they went blind on their first or second dialysis with the heparin because they were with diabetic,

781
01:20:35,110 --> 01:20:41,110
they they had high incidence of proliferative retinopathy and the strategy that they would begin dialysis sited.

782
01:20:41,110 --> 01:20:47,620
Right. And very often get haemorrhaging one eye because Victa persons at Kings, that got them going.

783
01:20:47,620 --> 01:20:53,440
But it it's interesting, but I don't know what you did, but, you know, I know it was a big influence peddling.

784
01:20:53,440 --> 01:20:58,840
I'm about to close you down. Anything else you want to say? So I'm in a super interview.

785
01:20:58,840 --> 01:21:02,000
Thank you very much. Yeah.