1 00:00:01,320 --> 00:00:10,620 This is the 22nd of May two, and for the record today, interviewing Andrew Friedman. 2 00:00:10,620 --> 00:00:14,460 Andrew worked well. When really did you come to Oxford? 3 00:00:14,460 --> 00:00:31,020 First, I was appointed an essay show on December the 1st, 1968, and it was the same as an essay show in EMT surgery, 4 00:00:31,020 --> 00:00:36,120 having come up from Cornwall on the train, having missed EMT as a student. 5 00:00:36,120 --> 00:00:43,560 But in Cornwall, I worked as a as I host opposition to a most wonderful person down there who 6 00:00:43,560 --> 00:00:47,820 convinced me the D.A. was the way forward because he didn't get up at night. 7 00:00:47,820 --> 00:00:52,860 And anyway, I applied for this job totally unqualified for it. 8 00:00:52,860 --> 00:01:03,420 And at the same time, when I eventually got appointed in under some of the first 2000 and is very nineteen sixty eight, 9 00:01:03,420 --> 00:01:08,040 Billund started his first day as a consultant in the hospital on the same day, 10 00:01:08,040 --> 00:01:14,760 and a person who later became a great friend, Jack Freedberg from Canada, became a visiting senior registrar. 11 00:01:14,760 --> 00:01:37,840 So there were three of us starting on that same day and Gavin Livingston was still alive and working. 12 00:01:37,840 --> 00:01:44,560 And he was just a remarkable man. He is losing weight all the time, but he would insist on coming to work with pethidine tablets, 13 00:01:44,560 --> 00:01:51,880 sitting next door to this useless surgeon of me and getting me to take a tonsils out. 14 00:01:51,880 --> 00:01:56,510 And then I got it wrong. He took over and took the rest of it out or whatever. So it was a very generous man. 15 00:01:56,510 --> 00:02:08,110 Yes. And where did you train? Well, I was I was trained at guys, you know, and run Macbeth, the Macbeth retard, I think, in about June 68. 16 00:02:08,110 --> 00:02:13,180 But when Gavin died, he came out of retirement to do it alone. 17 00:02:13,180 --> 00:02:19,930 So at that stage, there was a Coleman who was appointed in 1964. 18 00:02:19,930 --> 00:02:27,370 He'd been a senior registrar in Edinburgh and then had been appointed consultant in Coventry. 19 00:02:27,370 --> 00:02:33,640 And then the job came up in Oxford and Livingston Macbeth appointed him as a full time consultant, 20 00:02:33,640 --> 00:02:37,580 not allowed to do any private practise, but to do research. 21 00:02:37,580 --> 00:02:46,360 So he came in 64, having had an amazing reputation actually in one of the original people to do the operation of state. 22 00:02:46,360 --> 00:02:50,540 That to me. Right, done. Which he did with a chuckle. 23 00:02:50,540 --> 00:02:55,090 How shot nicked in Boston where they trained and then he bought it. 24 00:02:55,090 --> 00:03:01,360 He bought the first operating microscope to Edinburgh and then the second operating microscope came to Oxford. 25 00:03:01,360 --> 00:03:07,270 So it was the beginning of microsurgery of the ER and he was very much involved in that. 26 00:03:07,270 --> 00:03:09,280 And would you say did much research? 27 00:03:09,280 --> 00:03:23,050 I mean, did you know he had a programme Gang of cats, which I think most and he was trying to look at the stability of the operation in cats, 28 00:03:23,050 --> 00:03:28,570 but looking at all the specimens later he decided that most of them had got cat flu, which I don't know what that was. 29 00:03:28,570 --> 00:03:38,410 But the thing was in infected. He did, but he did do some very good early research in the states, which is still actually quoted. 30 00:03:38,410 --> 00:03:43,540 As, you know, it's not a great paper. But anyway, so he he was there. 31 00:03:43,540 --> 00:03:48,040 Bill loved and come from the Middlesex is where he was also a consultant for 32 00:03:48,040 --> 00:03:52,180 a couple of years and then having been a senior registrar regent in Oxford. 33 00:03:52,180 --> 00:03:59,290 So he went to the Middlesex consultant and he was appointed in 68 when I was a brand new asset. 34 00:03:59,290 --> 00:04:08,800 So, I mean, to my mind, the feeling that the empty Oxford and its original name that they did or developed 35 00:04:08,800 --> 00:04:15,880 new things from Macbeth was a remarkable man and quite a tricky chap to work with. 36 00:04:15,880 --> 00:04:22,660 But he was appointed, I think, in 1934, somewhere around there, didn't go to the war, 37 00:04:22,660 --> 00:04:27,340 but was very much involved in things going on in the war and kept a lot of the road running. 38 00:04:27,340 --> 00:04:31,750 He used to start operating at 5:00 in the morning and finish at 2:00 in the afternoon 39 00:04:31,750 --> 00:04:39,460 so everybody could go home to their families and get the blackouts organised. So he ran the department and he was singlehanded. 40 00:04:39,460 --> 00:04:47,530 He came with no beds in the hospital with an ER syringe in 1934. Gavin Livingston joined in 1946. 41 00:04:47,530 --> 00:04:54,160 And I think having been a society doctor from St Thomas's with huge private practise and a large Bristol 42 00:04:54,160 --> 00:05:00,190 motor car that used to whiz up and down to Holland Street from Oxford to Hollis's practise on for a bit. 43 00:05:00,190 --> 00:05:09,910 Yes. And he he started and wrote Macbeth and in the meantime realised that there was he knew Florey quite well. 44 00:05:09,910 --> 00:05:18,190 And I know the stories always of the policeman and the I think the brain abscess, as far as I can remember. 45 00:05:18,190 --> 00:05:26,650 But he started to work with all the chronic mastoid disease of putting this penicillin powder into the mastoid cavities. 46 00:05:26,650 --> 00:05:30,820 So he was highly Motherwell. Lots of little stories that I don't know how true they were. 47 00:05:30,820 --> 00:05:38,320 Basil Floran, you know, using the stuff until it ran out and had to be recycled in the urine and all that sort of business. 48 00:05:38,320 --> 00:05:44,740 But it worked, but it seemed to be better than the sulphonamide, which was the other alternative at that stage. 49 00:05:44,740 --> 00:05:53,170 And that was all written up to and but he then invented this operation for chronic sinuses, 50 00:05:53,170 --> 00:06:02,110 which is very common in those days where he did it was called an austere plastic flap where the great big scar that ran from ear to ear, 51 00:06:02,110 --> 00:06:11,530 the scalpel forward, the front wall of the frontal sinus removed and the whole thing cleaned out right down to brain has exposed and then replaced. 52 00:06:11,530 --> 00:06:18,160 And he undoubtedly was quite a major advance on what is a dangerous disease that, you know, pre antibiotics. 53 00:06:18,160 --> 00:06:25,780 People were dying very commonly of Simon's disease and there was a lot of osteomyelitis in the skull. 54 00:06:25,780 --> 00:06:34,150 And he decided that the way forward was radical excising to get around the osteomyelitis and to do this flap. 55 00:06:34,150 --> 00:06:37,220 So is always actually known, still is known as Macbeth's. 56 00:06:37,220 --> 00:06:45,650 Operation in some textbooks that's been modified and it's hardly needed now with all the modern chemistry that's available. 57 00:06:45,650 --> 00:06:51,020 And meanwhile, Gavin Livingston had got involved with the thalidomide disaster, 58 00:06:51,020 --> 00:06:57,980 which not only caused tetraplegic of these children, but many of them were born without is right. 59 00:06:57,980 --> 00:07:02,390 And we got a grant and this is before I knew anything about it. 60 00:07:02,390 --> 00:07:07,430 But they got a grant in the Radclyffe from The Lady Who Thalidomide Trust. 61 00:07:07,430 --> 00:07:12,110 And nearly all the thalidomide is done by cabbing Livingston Oxfords. 62 00:07:12,110 --> 00:07:19,040 And he became a congenital er abnormality in the country and extensively lectured 63 00:07:19,040 --> 00:07:24,790 and he became president of all sorts of children's foundations of things. 64 00:07:24,790 --> 00:07:30,570 When you say they were born with that, is that the artery after the area of the artery was missing? 65 00:07:30,570 --> 00:07:36,680 So was that it is all of the bronchial WFA there, but the middle ear was missing. 66 00:07:36,680 --> 00:07:43,460 The obstacles were often missing. But the inner ear, the doctors developed some Mureta was there, so there was no side. 67 00:07:43,460 --> 00:07:46,850 The potential for hearing was there, but there was no sound getting in. 68 00:07:46,850 --> 00:07:52,190 You think the piano would be the plastic surgeons? Yeah, well, he worked very closely with St. Pete. 69 00:07:52,190 --> 00:08:00,200 Mm hmm. And they did the they did all the piano work and Eric Peter the piano work and Livingston did all the middle ear, 70 00:08:00,200 --> 00:08:05,360 the middle ear and trying to reconstruct an ear canal because that was missing. 71 00:08:05,360 --> 00:08:11,750 And indeed, when I came in six days, we had a garden in the Oriente department where we we used to keep a pump. 72 00:08:11,750 --> 00:08:17,900 That was the exercise for the laryngectomy patients was putting tar on the bottom of the pond. 73 00:08:17,900 --> 00:08:21,710 So it would float that. Yeah, but there were always children having tea parties. 74 00:08:21,710 --> 00:08:27,470 All there is bandaged up and their limbs. And I still got some photographs somewhere of all this that's in there. 75 00:08:27,470 --> 00:08:34,520 And so he he got a huge reputation in community there and even well, you know, it happens today. 76 00:08:34,520 --> 00:08:41,240 But even when I was retiring, we still were referred a lot of congenital er abnormalities or different ways of doing things now. 77 00:08:41,240 --> 00:08:46,580 Yeah. So bathmat is a huge influence of this sort of thing. 78 00:08:46,580 --> 00:08:51,830 And he became president of the section of the RASM R7. 79 00:08:51,830 --> 00:08:55,580 Livingston did the same. Did they meet in Oxford. Yes. 80 00:08:55,580 --> 00:09:00,800 I don't think they knew each other until they took those two, but they say, oh, I'm sure they did. 81 00:09:00,800 --> 00:09:04,490 Yes, we have something called the back, 82 00:09:04,490 --> 00:09:14,030 which that sample of the British Association of it's a it's a four yearly mega meeting that we have international meeting the Brits put on. 83 00:09:14,030 --> 00:09:23,690 I've got actually what it's about. But the very first one was organised by Ron Macbeth in oral grade in about 68, I think was the very first one. 84 00:09:23,690 --> 00:09:28,220 And it's progressed. And so he was a very much a national figure. 85 00:09:28,220 --> 00:09:34,610 Yes. And known in Canada a lot, too, for some reason. I'm not quite sure why, but he went off there a lot. 86 00:09:34,610 --> 00:09:41,000 Did you apply for Oxford on the advice, this chap in Cornwall or could he'd heard about the work? 87 00:09:41,000 --> 00:09:47,630 We just know because I heard about the work. I just thought that he and D I wanted it to be a paediatric surgeon until I 88 00:09:47,630 --> 00:09:55,230 met one who said he was up all night and I didn't like eyes because I agree. 89 00:09:55,230 --> 00:10:04,430 So I said, well, I went to as a student, I remember going and goes to watch my operations and all you could see was his eye looking at you. 90 00:10:04,430 --> 00:10:10,490 And I didn't mind blood, but just one eye looking good, right? 91 00:10:10,490 --> 00:10:14,960 Well, somebody was to him. Once you've come, you're in a stage in Oxford always. 92 00:10:14,960 --> 00:10:19,930 I did. A researcher in Canada right there was then in Toronto. 93 00:10:19,930 --> 00:10:23,900 I worked in the Banting Institute actually with all the. Yeah. 94 00:10:23,900 --> 00:10:27,980 Banting and best. So close to your heart in College Street. Yeah. 95 00:10:27,980 --> 00:10:35,090 Where did you work. I was at that stage I was doing laryngeal cancer work. 96 00:10:35,090 --> 00:10:41,000 It was nineteen seventy four when I was at the seventy three to seventy five. 97 00:10:41,000 --> 00:10:48,230 And 1974 was a hundred years since Bill Roth in Vienna had taken the first larynx out of. 98 00:10:48,230 --> 00:10:56,090 So my boss Douglas Brice at that said we're going to have the centenary conference laryngeal cancer work. 99 00:10:56,090 --> 00:11:00,500 You're going to do the work my lad, and I'm going to present all the papers which is carried out. 100 00:11:00,500 --> 00:11:02,300 You're quite frank. 101 00:11:02,300 --> 00:11:12,380 If I were a lovely man, then I was stuck and they had this wonderful pathologist out there who taken an interest in the cancer work. 102 00:11:12,380 --> 00:11:16,520 When he got a larynx, he did these very fine sections all the way through the larynx. 103 00:11:16,520 --> 00:11:21,970 And so these big slides and it was to look at the growth and spread of laryngeal cancer. 104 00:11:21,970 --> 00:11:28,760 So that's why we were quite heavily involved, actually classifying, you know, these TNM classifications, 105 00:11:28,760 --> 00:11:37,110 which you could do from the pathology of that you couldn't see is by naked eye, in other words. 106 00:11:37,110 --> 00:11:41,220 A small tumour might have spread somewhere, and that's really what we were doing. 107 00:11:41,220 --> 00:11:44,880 So there are about 10 papers that came out that year and a half. 108 00:11:44,880 --> 00:11:50,730 And that's what I did. But I am not quite sure why. 109 00:11:50,730 --> 00:12:01,560 But then I got back to Oxford and then I was very much and dealt with all the children with congenital airway problems that got me up at night. 110 00:12:01,560 --> 00:12:10,050 And before they invented the surfactant stuff that stopped the halah membrane to street disease or respiratory distress syndrome, 111 00:12:10,050 --> 00:12:17,370 because up to then I was up there quite often sucking out the right main bronchus, which always got blocked up with its gunk in this country. 112 00:12:17,370 --> 00:12:23,880 All babies. Yeah, yeah, yeah, yeah. In the neonatal intensive care unit. 113 00:12:23,880 --> 00:12:28,560 And then and then I did a lot of the airway work. 114 00:12:28,560 --> 00:12:39,550 In fact, when I was president of the larynx section, I my my presidential address was on trauma to the larynx because in Canada, the farmers. 115 00:12:39,550 --> 00:12:46,740 That's exactly right. Well, in Canada, the farmers did not like snowmobiles going over the fields, 116 00:12:46,740 --> 00:12:52,530 compressing the snow which wrecked the winter wheat so used to street piano across. 117 00:12:52,530 --> 00:12:58,140 It was a snowball. They were almost garrotted, some of them, but that was one of them. 118 00:12:58,140 --> 00:13:05,040 Apart from the cancer, that was the main clinical thing that I was taught about in Canada when I got back. 119 00:13:05,040 --> 00:13:13,230 It was just before they had a proper seatbelts. They were still the lap belts and people were being injured by the dashboard. 120 00:13:13,230 --> 00:13:22,020 And because I've done this in Britain, one or two things, a lot of patients, not nationally but regionally, came to Oxford. 121 00:13:22,020 --> 00:13:27,600 So we had got quite an experience of laryngeal injuries. So you went to Canada, which is a senior registrar? 122 00:13:27,600 --> 00:13:38,790 That's right. Came back and I came and I came back to see the registrar within about two or three months, two or three months, three to three. 123 00:13:38,790 --> 00:13:45,420 I waiting still have retired. And for some reason or other, there was a decision made that they didn't need. 124 00:13:45,420 --> 00:13:51,570 And I think that Dudley was already imposed and they didn't need another thyroid person. 125 00:13:51,570 --> 00:13:57,060 The money and it may be something to do. Beth, although he retired by then I transferred to EMT. 126 00:13:57,060 --> 00:14:05,250 So I think I was funded from Tim Tilse, pot of money as a third and consultant because I was. 127 00:14:05,250 --> 00:14:13,830 But Beth Livingston is my Beth originally that Livingston joined him and then Coleman came. 128 00:14:13,830 --> 00:14:19,320 So were three. Then Levingston died and none was appointed, so there were still three. 129 00:14:19,320 --> 00:14:29,340 And then Beth retired. So we were left with London Koban and in nineteen I was appointed like seventy five years. 130 00:14:29,340 --> 00:14:34,830 And then in 75 they decided they really need a third because the work was building up 131 00:14:34,830 --> 00:14:41,940 and both London were busy and away quite a lot and they need a ladder on the ground. 132 00:14:41,940 --> 00:14:45,300 And I was the devil they knew I. Yeah. So I wasn't that great. 133 00:14:45,300 --> 00:14:55,180 I'm sure there were many but some within the senior editor of the students technical students, they would be attached for one month, three months to. 134 00:14:55,180 --> 00:14:59,280 And, you know, I think they were they were much less than that. 135 00:14:59,280 --> 00:15:02,130 They came I think we had them for two weeks. 136 00:15:02,130 --> 00:15:09,510 It was never unfortunately was never really until it was realised how common E.A. was in general practise. 137 00:15:09,510 --> 00:15:16,660 It was never considered terribly important to the core teaching. 138 00:15:16,660 --> 00:15:23,310 And I think there were so many other calls clinically on the medical students that I 139 00:15:23,310 --> 00:15:27,330 think EMT was also quite difficult to teach with a very different look down orifices. 140 00:15:27,330 --> 00:15:33,330 It's so much easier when cameras came on and then the scopes that you could project images, 141 00:15:33,330 --> 00:15:41,850 but actually to watch somebody not passionately looking on air and saying something or other, it wasn't terribly impressive to a student. 142 00:15:41,850 --> 00:15:46,230 But we used to do we had I know we had a two week course that I used to run that and we should 143 00:15:46,230 --> 00:15:52,320 try and do it fairly methodically to equip them for what they might expect in general practise. 144 00:15:52,320 --> 00:15:58,290 But it wasn't as practically as it could have been. And you when say you ran it, was that as a consultant? 145 00:15:58,290 --> 00:16:03,930 Yes, yes, yes. That was one of my jobs that was handed on to me right in front a bit. 146 00:16:03,930 --> 00:16:05,610 Who then ran to do the teach. 147 00:16:05,610 --> 00:16:13,830 Erm you personally or the senior registrar or that we had to see the registrars in those days and they were, they were always very good. 148 00:16:13,830 --> 00:16:23,370 Yes. I think it was, I suspect it was a senior registrar who did most and never learnt he had a sort of invention to build. 149 00:16:23,370 --> 00:16:29,200 And was it his arms on the pharyngeal puch and the formation of the financial part. 150 00:16:29,200 --> 00:16:36,760 So he, he, he, he did a lot with that. And then he really got took over Gavin Livingston's work on. 151 00:16:36,760 --> 00:16:44,470 Genitalia, surgery, right, but Kelmann also did that and there was always a bit of jealousy between the two. 152 00:16:44,470 --> 00:16:50,740 But you've stolen my patient, that's all. But yeah, that's what happened. 153 00:16:50,740 --> 00:16:55,210 And then. Yes, and that. 154 00:16:55,210 --> 00:17:00,820 But I think there were three of us and two senior registrars, two registrars and a couple of researchers. 155 00:17:00,820 --> 00:17:09,610 And actually, it was a very close knit community. When I first came as a researcher, we were housed where plastics is now, Kilner Ward, 156 00:17:09,610 --> 00:17:17,950 and we go down the corridor on the right and we had a little outpatient room rooms upstairs, a tiny library. 157 00:17:17,950 --> 00:17:21,820 And Bhathal is always upset. 158 00:17:21,820 --> 00:17:29,620 We were never a university department and he thought we ought to be more academic and so did Colbourne. 159 00:17:29,620 --> 00:17:34,180 And when Macbeth was chairman of the Medical Staff Council, 160 00:17:34,180 --> 00:17:39,190 and I'm not sure quite one that was there was the maternity unit was being built at the John Radcliffe. 161 00:17:39,190 --> 00:17:45,640 And I think that was opened, too, because my number three son was born there, the other two in the attractive. 162 00:17:45,640 --> 00:17:51,190 And when they knew they were moving, but Beth said we will have he was chairman of the medical staff. 163 00:17:51,190 --> 00:18:00,610 We will have the maternity block. So E.A. moved to the Wolfson's Street site of the Nuffield maternity home, as it was then called it. 164 00:18:00,610 --> 00:18:05,260 And which is absolutely wonderful because we had two operating theatres upstairs. 165 00:18:05,260 --> 00:18:08,740 We had large that's the second floor. 166 00:18:08,740 --> 00:18:18,760 The first floor was two or three wards, one children and two adults that had a lot of space and then a down below and a lovely outpatient facility. 167 00:18:18,760 --> 00:18:22,150 And we had an academic unit with a very nice library. 168 00:18:22,150 --> 00:18:30,040 And in fact, it was one of the best, best libraries in the country from, you know, old journals going back to when Macbeth was appointed. 169 00:18:30,040 --> 00:18:37,120 And we all used to contribute a bit of our salary into providing one journal and it was kept up. 170 00:18:37,120 --> 00:18:40,660 And now I think it's all what the council library, I don't know. 171 00:18:40,660 --> 00:18:44,510 But with all this, electronic journalism has changed. But we were quite proud of the libraries. 172 00:18:44,510 --> 00:18:52,210 They're great. And then when the general surgeons went up the hill, I mean, did you feel bereft of them? 173 00:18:52,210 --> 00:18:59,710 No, we didn't, because we had plastic's neurosurgery as an EMT and there was a huge amount of cross referral. 174 00:18:59,710 --> 00:19:06,910 So we didn't. And I think that they were the natural link somehow because E.A. often used to stray into 175 00:19:06,910 --> 00:19:13,060 neurosurgery and some of the brain abscess were caused by either the nose or the ear. 176 00:19:13,060 --> 00:19:23,830 So it was very useful to have them. And I mean, I first exploits for that was with Joe Pennypacker and it as a very junior registrar. 177 00:19:23,830 --> 00:19:30,940 He was upset and sorting out the odd cockup would end teaching and teaching is, oh, he's wonderful, man. 178 00:19:30,940 --> 00:19:40,690 His father, my very first paper ever was he was the well, he was the main author, but he told me to do it and he corrected it all. 179 00:19:40,690 --> 00:19:46,120 He was he got published and I was very proud of it and started as a very junior doctor. 180 00:19:46,120 --> 00:19:50,620 And and then the plastics became more and more important. 181 00:19:50,620 --> 00:19:55,150 I gave up doing head and neck cancer surgery and became purely Airds after a bit. 182 00:19:55,150 --> 00:20:03,640 And my main interest had been children's deafness. And I we started our cochlear implant programme and one of the first ones in the country 183 00:20:03,640 --> 00:20:09,220 then and still present to the deaf children to such and not they do very much great. 184 00:20:09,220 --> 00:20:14,500 But I still keep a hand in it. The implants now, what is that? 185 00:20:14,500 --> 00:20:19,000 Is that a mechanical bit of outrageous or biological bit? 186 00:20:19,000 --> 00:20:27,820 No, it's mechanical and mechanical. Electrical. What happens is it's but children who are largely Emmies adults as well. 187 00:20:27,820 --> 00:20:32,530 But it started really with profoundly deaf children with no hearing. 188 00:20:32,530 --> 00:20:42,610 But, you know, hearing. And what happens is that a tiny electrode is winkled into the cochlea, which stimulates the nerve. 189 00:20:42,610 --> 00:20:52,150 And since there are 32000 nerve endings in the cochlear and one's got a maximum of about 16 to 20 channels, how it works, you know. 190 00:20:52,150 --> 00:20:59,740 But somehow at the end of very clever idea to get these things into a nine month old children, by the time they're three, 191 00:20:59,740 --> 00:21:03,550 their speech and language development is almost the same as a normal three 192 00:21:03,550 --> 00:21:08,500 year old having in the past when I started being defined to sign language or, 193 00:21:08,500 --> 00:21:13,600 you know, special education or that sort of thing. So it is actually it's been a remarkable advance, 194 00:21:13,600 --> 00:21:22,240 but it's nothing to do with the surgeons is actually to do with a very clever electronics industry where they invented this kind of thing. 195 00:21:22,240 --> 00:21:30,880 There was a single Channel one done in the hospital in Los Angeles, probably in about nineteen eighty two or something. 196 00:21:30,880 --> 00:21:36,470 And then the vast the bottom was rolled on in Melbourne, in Australia and. 197 00:21:36,470 --> 00:21:46,670 Still the one where one of the two models we still use, I mean, it's been upgraded to normal, but so did the negativity due to the pituitary. 198 00:21:46,670 --> 00:21:50,530 It didn't lead me to the pressure, which it did with Bill. He did a lot of work. 199 00:21:50,530 --> 00:21:56,540 And then Chris Adams took it out when he found that by sticking a crime probe in the side of the nose 200 00:21:56,540 --> 00:22:02,720 with reasonable with much less trauma than we because we had we were always very sceptical about that, 201 00:22:02,720 --> 00:22:06,950 because we record if you're going to free something with the huge blood vessels around the 202 00:22:06,950 --> 00:22:12,530 outside of the of how you actually froze the bit of the adenoma or whatever it might actually be. 203 00:22:12,530 --> 00:22:19,990 But anyway, he seeing it. I mean, this would, I think two days and I think it's on x ray screening. 204 00:22:19,990 --> 00:22:28,010 Yes. Yes. But I never I did want it to as a you as a trainee, but I, I didn't really do that. 205 00:22:28,010 --> 00:22:35,120 But Bill Londoner's, Byron externalise mind approach when you did actually see it very well. 206 00:22:35,120 --> 00:22:44,900 But there was the occasional problem with the transverse sinus went in front of the dura between the two cabinets on the right side. 207 00:22:44,900 --> 00:22:54,230 And I don't know why, because I didn't seem to ignore that, but he seemed to get in there and it came and but we were very close to Chris Adams. 208 00:22:54,230 --> 00:22:58,460 But he was a powerful man and a very, very, very good surgeon. 209 00:22:58,460 --> 00:23:04,280 Yes. And, you know, if I was a patient, I think I'd be quite happy to have been handling it. 210 00:23:04,280 --> 00:23:17,480 Then how does private practise interact with all this? I think private practise was I mean, it was always done over the road in the åkerlund. 211 00:23:17,480 --> 00:23:24,170 And originally Billund was a big private man and Levingston and McBeath before him and they all worked, 212 00:23:24,170 --> 00:23:28,040 took five Barberot, which was a little bit further up the road. 213 00:23:28,040 --> 00:23:34,310 And then when 23 Bonbright became available, the rent's much cheaper than 85. 214 00:23:34,310 --> 00:23:37,370 So I think everybody move. That is such an easy thing. 215 00:23:37,370 --> 00:23:44,630 And although I did a bit of private practise, it was so easy being more or less on site all the time. 216 00:23:44,630 --> 00:23:50,390 And Joe Smith taught me when I first appointed Subdivides to come and do a private clinic with I'll show you how you treat 217 00:23:50,390 --> 00:23:56,510 private patients are the first thing I realised it had students in there teaching them how to behave and how to talk to patients. 218 00:23:56,510 --> 00:24:02,720 And I often had students in my private rooms, I thought come over the road and you could just see how, 219 00:24:02,720 --> 00:24:07,280 you know, I was always very against people calling patients by their Christian name. 220 00:24:07,280 --> 00:24:12,230 And I always like people to look like doctors and shake hands properly and able. 221 00:24:12,230 --> 00:24:16,790 And they were silly things. But Joe Smith taught me a lot of that might be slightly old fashioned, 222 00:24:16,790 --> 00:24:25,970 but the first bloke I worked at the Middlesex and he told me that the more important the private patient, 223 00:24:25,970 --> 00:24:31,760 the route that you get, you've got to get on top of that. 224 00:24:31,760 --> 00:24:35,840 But I don't think I saw anybody very thin. 225 00:24:35,840 --> 00:24:39,530 And then I say, what did you feel about the nursing nuts? 226 00:24:39,530 --> 00:24:46,010 Oh, gosh. But we knew exactly when we when I first started who was in charge. 227 00:24:46,010 --> 00:24:55,970 Yeah. And there was Sister Jean Buie who ran the the the wards, an EMT, absolutely superb mission. 228 00:24:55,970 --> 00:25:08,360 And there was Sister Montoya, who still lives in Wantage, who's still alive, who ran the theatres and somehow all the nurses, they were different. 229 00:25:08,360 --> 00:25:15,530 I think we had some very, very good devoted nurses that stayed for years and years and years. 230 00:25:15,530 --> 00:25:24,680 And we had some wonderful scenes that looked after patients, but thumping that pillows up and they were always around and talking to them. 231 00:25:24,680 --> 00:25:34,790 And in my opinion, I'm sure a lot of people's opinions, things changed a bit when some degree nursing came on and see Adamsville got rid of. 232 00:25:34,790 --> 00:25:39,470 Yeah, but I never actually I never that must have been a major directive, 233 00:25:39,470 --> 00:25:44,390 but I don't ever seem to remember meeting her didn't seem to matter very much because we knew 234 00:25:44,390 --> 00:25:50,870 who Matron was in all those years and they seem to be permanent structures till they retired. 235 00:25:50,870 --> 00:25:55,100 And then when they did retire we had yes to one became of third. 236 00:25:55,100 --> 00:25:58,790 One of our nurses got upgraded to take out the system. 237 00:25:58,790 --> 00:26:01,400 They stayed much the same. Right. 238 00:26:01,400 --> 00:26:08,870 And one of them actually still a health hazard, I think in the Abbington practise, one of the Abbington practises, then the handling of wax. 239 00:26:08,870 --> 00:26:15,740 And is that go with this is a one time you had a sort of wax clinic. 240 00:26:15,740 --> 00:26:20,450 We did walk in. We had a wonderful website and it said, I mean, not you personally. 241 00:26:20,450 --> 00:26:22,880 That was started in we had well, 242 00:26:22,880 --> 00:26:30,380 I think there was a problem with GP rejiggered out is that they were bursting eardrums every now and again with a bit of extra pressure. 243 00:26:30,380 --> 00:26:36,730 I think nowadays it's all done with Hooven or vacuum cleaners in use of oil, the ER with grease. 244 00:26:36,730 --> 00:26:41,230 For a couple of days, and then it stuck it out under a microscope, 245 00:26:41,230 --> 00:26:46,060 but we did have a wax cleaning, I can't remember too much about it run by the nurses. 246 00:26:46,060 --> 00:26:52,790 Right. And the other clinic we had was a hearing aid clinic, which is absolutely wonderful, this huge old hearing aids. 247 00:26:52,790 --> 00:27:01,180 But code, the Medical Research Council, Elektronik hearing, it was called redress against what it was always called big box. 248 00:27:01,180 --> 00:27:08,050 It was. But we used the registrars when I was I used to love doing that because it needed no brain power. 249 00:27:08,050 --> 00:27:12,130 They were fabulous. People had all been through the war. They were all different through the war. 250 00:27:12,130 --> 00:27:18,070 They all had wonderful stories. And we have sweepstake on the average age. 251 00:27:18,070 --> 00:27:24,580 But but it was great fun just talking and it sounded overcast, boring with hearing it. 252 00:27:24,580 --> 00:27:29,980 But actually, what none of us made are doing it because we knew there wasn't going to be major decisions to be made. 253 00:27:29,980 --> 00:27:37,190 I'm grateful talking to the people. Was there a lot of interference with those hearing aids over the trial? 254 00:27:37,190 --> 00:27:43,990 Yeah, nearly all hearing aids spent that time in the top right hand drawer of the dressing table. 255 00:27:43,990 --> 00:27:50,290 And they they I mean, I think in those days, almost the only reason for wearing a hearing aid is that you could see someone 256 00:27:50,290 --> 00:28:00,560 was deaf and therefore you made a little bit more effort to speak clearly, but electronically, they were pretty useless. 257 00:28:00,560 --> 00:28:05,410 And what would you do? I mean, how many patients who would you be doing? 258 00:28:05,410 --> 00:28:16,080 What I started as a consultant. I did I did have three operating and four outpatient sessions a week, and there was one teaching session. 259 00:28:16,080 --> 00:28:19,420 And I'm not sure what I suppose there was on call. 260 00:28:19,420 --> 00:28:27,310 I don't know how it was divided. I mean, I was what they called 911 is I, I was telling them when I started and I became nine on that. 261 00:28:27,310 --> 00:28:31,400 And the one 11th was that nothing was happening. That was private practise. 262 00:28:31,400 --> 00:28:33,370 Yes. Right there something. 263 00:28:33,370 --> 00:28:43,390 And then we did because we went to university departments and we although we were attached vaguely, we came under the Nuffield Department of Surgery. 264 00:28:43,390 --> 00:28:48,680 Yes. So that that was our universities side, if you like, and you live in our area. 265 00:28:48,680 --> 00:28:57,100 I was on a relationship with ordinary and very angry and I wasn't terribly good at that sort of thing. 266 00:28:57,100 --> 00:29:00,820 But the students had great, you know, had great fun with them. 267 00:29:00,820 --> 00:29:06,610 We always, for some reason, rather EMT course, always was just before generic. 268 00:29:06,610 --> 00:29:13,810 So they were usually absent practising. And I mean the number of students who change the laws. 269 00:29:13,810 --> 00:29:23,590 Do you think that altered anything? Read I yeah, I don't there was much more two or three people around the bedside that you could get to know. 270 00:29:23,590 --> 00:29:31,720 I knew that names that was, that was that actually when you saw them in the corridor six months later, you knew their names. 271 00:29:31,720 --> 00:29:41,260 And I think that was very nice now. Well, when I left, I find it very difficult to know who was who, who hadn't turned up. 272 00:29:41,260 --> 00:29:45,700 Now, what I don't know is whether that's a function of the years or the numbers. 273 00:29:45,700 --> 00:29:48,130 I'm sure the numbers were a huge part of it. 274 00:29:48,130 --> 00:29:53,650 It probably was the numbers, but I think there's also a huge increase in the number of teaching staff or potential teaching staff. 275 00:29:53,650 --> 00:30:00,610 I mean, if you look down the telephone directory of psychiatrists, I received some and anaesthetists anaesthetist is. 276 00:30:00,610 --> 00:30:07,500 That's right. How important is it is vital that I work with one of these all my career. 277 00:30:07,500 --> 00:30:13,150 And he retired two years younger, Jacqueline Looch, who I was engaged with, 278 00:30:13,150 --> 00:30:17,920 and the other students were done with Dick Fordham and Toni Fisher, who were both. 279 00:30:17,920 --> 00:30:24,190 And they stayed with we worked together all day and we enjoyed the sessions. 280 00:30:24,190 --> 00:30:33,850 But Robert McIntosh and Ken Boston, like TMT and the Macintosh laryngoscope, 281 00:30:33,850 --> 00:30:41,380 which is still in use today, was designed because Rollerball said, come and have a look at this. 282 00:30:41,380 --> 00:30:45,880 He was put in one of those tonsil gags and they were boil Davis gags. 283 00:30:45,880 --> 00:30:50,110 I thought he was a cracked it open and you could see the lyrics. 284 00:30:50,110 --> 00:30:59,080 And so the blade of the tonsil gag is exactly the same shape as the Macintosh laryngoscope because Macintosh had a technician called Salt. 285 00:30:59,080 --> 00:31:07,750 I remember him and he said, Salt can have a look at this, make me one of those Anabasis that people have intubated using a Macintosh laryngoscope. 286 00:31:07,750 --> 00:31:18,040 The blade, which is exactly the same shape as the the Bodanis gag that's used for every tonsillectomy in the world almost. 287 00:31:18,040 --> 00:31:21,550 And can Bostom there were a lot of Boston. 288 00:31:21,550 --> 00:31:31,690 Um, instruments, I can't remember what they were, but they were things that were intubating people and bits of endotracheal tubes and things, 289 00:31:31,690 --> 00:31:40,540 and we also worked very closely with John Lloyd in his pain clinic, but he started the first intensive care unit in transuranic. 290 00:31:40,540 --> 00:31:43,420 Yes. Yes. You remember Cronshaw? I do, indeed. Yes. 291 00:31:43,420 --> 00:31:52,600 And he there was this thing called the Oxford Tracheostomy Tube, which was a right angle, red rubber, 292 00:31:52,600 --> 00:32:00,070 to which a lot of people were allergic to whatever the red rubber was that it was some I and 293 00:32:00,070 --> 00:32:04,760 they were very clever because it was not for tube because they put a magnet in the opening. 294 00:32:04,760 --> 00:32:13,540 So there's a ventilator with magnetically clip into the pipe from the neck that would fit into the tracheostomy tube and they would were Coolac, 295 00:32:13,540 --> 00:32:24,370 the tracheostomy tubes. And I think somewhere they used to be a very good anaesthetic cabinets of old instruments and things. 296 00:32:24,370 --> 00:32:32,970 And there are a lot of things like that design of the Macintosh laryngoscope of sorts, contribution to making them and that go up the hill. 297 00:32:32,970 --> 00:32:38,770 It must be up the hill in the natural department of anaesthetics, whether you'll also see those red rubber right. 298 00:32:38,770 --> 00:32:43,000 Angled tracheostomy tubes. And I had to I was a junior doctor. 299 00:32:43,000 --> 00:32:47,300 I did a lot of the tracheostomy for John Lloyd in the debt. 300 00:32:47,300 --> 00:33:16,690 And he was the. Now, Tunstall's I mean, there used to be a lot of tonsillectomies and then there are a few of these other led to that. 301 00:33:16,690 --> 00:33:20,370 Is it right or completely right. Is this just a fashion. 302 00:33:20,370 --> 00:33:29,040 Yeah, antibiotics. Nothing to do with it. They might have done I suppose, in that I think now you have to earn a tonsillectomy. 303 00:33:29,040 --> 00:33:31,720 You know, GBE has to write from my records. 304 00:33:31,720 --> 00:33:40,980 I've had this child or this adults being six times this year, missed school a few months of school or a few months of work, whatever it is. 305 00:33:40,980 --> 00:33:42,910 And with years, it's not getting better. 306 00:33:42,910 --> 00:33:50,150 But I think before they used to be an awful thing called a tonsil drive where and they were done with a guillotine. 307 00:33:50,150 --> 00:33:51,690 And Beth started this. 308 00:33:51,690 --> 00:34:00,130 But you could do 12 children and about sort of an hour and quickly, Gastón, with Aether as they were covering their tonsils snipped off. 309 00:34:00,130 --> 00:34:03,900 And what stopped the bleeding? As a very good question. 310 00:34:03,900 --> 00:34:10,890 At least one of them came back each night to be properly attired. 311 00:34:10,890 --> 00:34:14,950 And it was all pretty brutal, but I never got involved with that. 312 00:34:14,950 --> 00:34:20,130 That must have stopped actually in about six or seven or 68 because I never saw still drive, 313 00:34:20,130 --> 00:34:32,760 although Beth did make us do Tunstall's on the local anaesthetic on a Friday afternoon, which was you had to be very stoical patient. 314 00:34:32,760 --> 00:34:43,590 You sat up in a chair with a plank but behind you so you could put your head back and you sat in front of the local insight, local knowledge. 315 00:34:43,590 --> 00:34:46,980 Is there any evidence that the time do you any good in later life? 316 00:34:46,980 --> 00:34:53,130 I mean, now, you know, the know, if if you've never I mean, I've never had my top floor adenoids out. 317 00:34:53,130 --> 00:34:55,740 By the time I was 11, I had no adenoids. 318 00:34:55,740 --> 00:35:02,610 They with a completely by the time about 20, you don't have tonsils, you only have tonsils if they've been infected. 319 00:35:02,610 --> 00:35:07,800 And the scarring from the from the healing infection leaves your toxins behind. 320 00:35:07,800 --> 00:35:12,300 But nobody's quite sure what they are. But it's something to do with drug production. 321 00:35:12,300 --> 00:35:29,910 And I think those things, like a lot of medical school now, I was just a very good but and I mean, so Johnson's tonsils are done. 322 00:35:29,910 --> 00:35:34,140 But I think you have to admit that lot and actually just fledgeling. 323 00:35:34,140 --> 00:35:39,240 Make Belrose without the stomach man as well. Exactly right. 324 00:35:39,240 --> 00:35:46,860 Yeah. And there's I think that, um. 325 00:35:46,860 --> 00:35:52,280 And have you been in the new department that I work for? 326 00:35:52,280 --> 00:35:58,890 I retired in agency at 2008, in September. 327 00:35:58,890 --> 00:36:03,990 And I think we moved up there in 2006. I had two years of that. 328 00:36:03,990 --> 00:36:13,960 But the whole thing was so different because we moved from a completely identifiable unit with our academic department, with a lovely library, 329 00:36:13,960 --> 00:36:21,330 the lab and all our private offices and things without patients with ward above, etc., 330 00:36:21,330 --> 00:36:28,320 but to an amorphous big block and shared our ward with the plastics and with the eyes. 331 00:36:28,320 --> 00:36:31,700 And you'd never find your patients. 332 00:36:31,700 --> 00:36:40,500 So I never got used to it as long as the show never, ever got used to it before you VMT moved up the hill, did you have to go up the hill? 333 00:36:40,500 --> 00:36:44,310 Much of it was blandest to the church, right? 334 00:36:44,310 --> 00:36:50,120 No, I would owe it to the respect for people to just stay. 335 00:36:50,120 --> 00:36:55,140 And where we did go up the hill for children. 336 00:36:55,140 --> 00:36:59,080 What got them into the children's intensive care? 337 00:36:59,080 --> 00:37:03,420 You used to ask us to go up there to do tracheostomy, and that's a yes. 338 00:37:03,420 --> 00:37:07,800 And I worked a bit with Steve West a bit, too. At one stage. 339 00:37:07,800 --> 00:37:13,170 We're doing well. Well, Steve was very keen on artificial heart. 340 00:37:13,170 --> 00:37:17,940 Yeah. Call the Jarvik heart. Yeah, the Jarvik heart needs electricity. 341 00:37:17,940 --> 00:37:24,330 And because I've been screwing things into the head for implants and things, I did the wiring for it. 342 00:37:24,330 --> 00:37:33,600 So we had to implant the electronics into the head and then feed a wire through the neck to connect up with the heart. 343 00:37:33,600 --> 00:37:38,100 The thing he stopped inside. So that was my role with that. 344 00:37:38,100 --> 00:37:45,210 What why didn't that succeed in the end, as it were? I know, but it didn't take that with no cardiology. 345 00:37:45,210 --> 00:37:52,710 No, I think I I'm not quite sure because there were other devices, 346 00:37:52,710 --> 00:37:59,580 because I was I went out with Steve Watts twice the Brockton Hospital, where we put them in and worked with the people. 347 00:37:59,580 --> 00:38:02,090 The problem, and they were developing another one. 348 00:38:02,090 --> 00:38:08,590 Now, whether it's one of these things that they were I think it was designed as a temp, the best use was for. 349 00:38:08,590 --> 00:38:13,900 Cardiomyopathy, as far as I remember, and if you gave the heart a rest for long enough, 350 00:38:13,900 --> 00:38:18,910 the cardiomyopathy would sometimes improve and I think that's what it was designed does. 351 00:38:18,910 --> 00:39:16,520 But then I think they found that there were there were complications with the machine and the death rate was a bit high to. 352 00:39:16,520 --> 00:39:24,440 And we're going up to London to committees and things. Yes, I was I wasn't on the College of Surgeons Council, 353 00:39:24,440 --> 00:39:32,090 but I was on and what they are said quite a lot in the presence of the secretary and bit of that. 354 00:39:32,090 --> 00:39:36,800 And would that be the one that was a yes. And you ran the programme? 355 00:39:36,800 --> 00:39:42,230 I ran, but I was I was a few years before I was secretary of the thing. You enjoy it? 356 00:39:42,230 --> 00:39:48,500 I loved it. Loved it. It had 420 consultants. 357 00:39:48,500 --> 00:39:55,790 I was president in 1997 and I knew everybody and most of the trainees I knew because I worked with the College of Surgeons, 358 00:39:55,790 --> 00:39:58,700 all the specialist advisory committee for quite a long time. 359 00:39:58,700 --> 00:40:05,660 And so I used to go around on the interview panels, interviewing people for senior registrar jobs and things, 360 00:40:05,660 --> 00:40:09,560 and also at the College of Surgeons in Ireland, as it was called, Dublin. 361 00:40:09,560 --> 00:40:20,730 And there was a lot of an honorary Irish, whatever I might be added as I go, I still go over there to their annual meeting and you should play golf. 362 00:40:20,730 --> 00:40:26,150 And I don't understand what they're talking about, but it's such a lovely bunch. 363 00:40:26,150 --> 00:40:35,690 I you know. And what would you say had been the big changes in individual time, I think? 364 00:40:35,690 --> 00:40:45,680 Well, apart from the increase in consulting staff, the big changes has undoubtedly been due to the sophistication of micro instruments, 365 00:40:45,680 --> 00:40:53,840 of electronics, of very sophisticated visual equipment, not only microscopes, but also at discos. 366 00:40:53,840 --> 00:40:58,940 So it's very, very rare that you have a science problem. I think this was all done. 367 00:40:58,940 --> 00:41:08,660 Keyhole was and that became a problem because not everybody has good hand eye coordination to look at a television screen and operate down here. 368 00:41:08,660 --> 00:41:14,150 But it sorted a lot of people out about speciality, you know, and people stop doing that. 369 00:41:14,150 --> 00:41:17,960 But the biggest changes in my career have undoubtedly been the microscope, 370 00:41:17,960 --> 00:41:31,580 the very fine instruments usually made in Switzerland or Germany and the the the electronics maybe to do with the ER. 371 00:41:31,580 --> 00:41:37,520 Was there ever any difficulty buying instruments you wanted? A lot, you know, a funding thing. 372 00:41:37,520 --> 00:41:44,450 What would happen. You didn't then. Yes, you did. I mean, what in the end happened? 373 00:41:44,450 --> 00:41:53,870 The one of the girls worked out that actually for me personally, doing a certain number of operations, I was only using four or five instruments. 374 00:41:53,870 --> 00:42:02,630 What was the point of a great try? These instruments were never used and she managed to work out what each of us was using most of the time. 375 00:42:02,630 --> 00:42:07,790 And so we had doubles of those and kept in very good condition and a few extras. 376 00:42:07,790 --> 00:42:11,570 But it was quite a good system because it saved it. 377 00:42:11,570 --> 00:42:17,610 It saved money and it didn't and get damaged because they've always been damaged. 378 00:42:17,610 --> 00:42:24,200 Originally in the old Redcliff, the instruments were looked after by the supporter or a technician. 379 00:42:24,200 --> 00:42:31,090 We had then the beautifully looked after, but then when we moved to the autoclave system, they were put in a box, trundled down the corridor. 380 00:42:31,090 --> 00:42:35,180 This very fine and these little micro scissors and things were getting damaged. 381 00:42:35,180 --> 00:42:39,440 Yeah. And so there was an awful lot of damage going on. 382 00:42:39,440 --> 00:42:40,670 So there wasn't a fire. 383 00:42:40,670 --> 00:42:49,640 There's a huge problem in getting funding for the electronics because the cochlear implants, you know, originally was costing about 30000 per patient. 384 00:42:49,640 --> 00:42:54,050 So you had to be very careful and work out who was really going to benefit. 385 00:42:54,050 --> 00:42:58,070 And that was a bit of a lottery. And is that the administrators? 386 00:42:58,070 --> 00:43:04,400 You'd have to convince your fellow surgeons, though. No, it was the administrators or the funding people. 387 00:43:04,400 --> 00:43:14,750 But then what's happened, nice interfered is and it's become such a cost effective thing and much more cost effective than a hip or a knee. 388 00:43:14,750 --> 00:44:02,060 That money has come from other budgets. Was making who was on the panel? 389 00:44:02,060 --> 00:44:07,120 Do you remember the administrators? There were always two jeeps, right? 390 00:44:07,120 --> 00:44:11,950 And then there was sort of finance people, administrators, but there was always a couple of jeeps. 391 00:44:11,950 --> 00:44:17,710 But I don't think there was anybody there might have been a public health fact. 392 00:44:17,710 --> 00:44:21,380 I think it was one of the public health doctors, somebody like Mulgrave Grey. 393 00:44:21,380 --> 00:44:29,290 But it wasn't me or Grey. It was. But then no, as it were, consultant positions. 394 00:44:29,290 --> 00:44:34,990 No, I don't remember that. That's interesting. So you had to write a pretty good news. 395 00:44:34,990 --> 00:44:42,410 You had to be able to defend what you're trying to do, what the evidence was, but eventually nice of taking it on. 396 00:44:42,410 --> 00:44:47,230 And since I've left, it's become you can you know, you have to get the criteria right. 397 00:44:47,230 --> 00:44:55,780 It's not difficult in your time. Do you think the relationship between consultants and administrators has changed? 398 00:44:55,780 --> 00:45:05,140 Well, I. Yes, I do. I mean, they the right if we always knew who the house gardener who is called. 399 00:45:05,140 --> 00:45:12,490 I like that. Yeah. Yeah. And if there was a problem, if somebody was unhappy, one could always go and approach. 400 00:45:12,490 --> 00:45:18,280 And particularly David Wilson. I've forgotten the chap before that, but they were very good engine Bario. 401 00:45:18,280 --> 00:45:28,270 Yes, I do remember his job is. But I think I mean the awful thing well is now that I was up in the job market for two years and I never, 402 00:45:28,270 --> 00:45:37,600 ever met the chief executive, Michael, whatever his name is, and it's the only time I see him as a charity concert in Dorchester. 403 00:45:37,600 --> 00:45:44,080 I pay for the children's hospital now when he was sitting in front and I sort of said hello and he was not interested. 404 00:45:44,080 --> 00:45:48,460 I just retired. But they used to give a little to the parties. 405 00:45:48,460 --> 00:45:51,370 If you retarded the not that that matters at all, 406 00:45:51,370 --> 00:45:59,520 but there was there was no communication from the what they call medical director now and or the chief executive. 407 00:45:59,520 --> 00:46:06,820 So I think things have deteriorated. And although all those different what we call them there was the regional health authority, 408 00:46:06,820 --> 00:46:13,420 the district health or the area health authority, although they all got sort of amalgamated, it's still one amorphous bunch. 409 00:46:13,420 --> 00:46:17,740 But you quite well. Do you get out into the refugees? 410 00:46:17,740 --> 00:46:22,240 You usually a witness? Well, I did want to join time. Yes. 411 00:46:22,240 --> 00:46:27,160 And I got to know the GP's very well. And I love that I was. And in the region. 412 00:46:27,160 --> 00:46:35,710 Did that Keen's or. No, I didn't when that what's happened now is that Stoke Mandeville, 413 00:46:35,710 --> 00:46:43,240 High Wickham and I think Wex and Park Hospitals have all lost their inpatient beds and they're all being done on the job. 414 00:46:43,240 --> 00:46:46,210 Right. All the emergency workers coming to John regularly. 415 00:46:46,210 --> 00:46:52,060 So the consultants, they are curating day case work at Base Hospital, coming to the inpatient work. 416 00:46:52,060 --> 00:46:58,480 Yeah. So there's so many people knocking around the emergency workers built up. 417 00:46:58,480 --> 00:47:03,520 I mean, it's not you know, it's nosebleeds and other things, but nevertheless, it's keeping people on their toes, 418 00:47:03,520 --> 00:47:08,890 which is really meant because the junior staff nurse have such a short period of training. 419 00:47:08,890 --> 00:47:13,900 They're not the apprentice scheme has database that the consultants are in a lot more. 420 00:47:13,900 --> 00:47:19,840 You know, if you're already on call corner one at an eight or something, as far as I can remember, they are on call. 421 00:47:19,840 --> 00:47:28,570 When you are called, you're often in is enough and there's enough theatre space for these characters around. 422 00:47:28,570 --> 00:47:37,630 I, I would doubt it. I think even all lost lists, you know, and, you know, I it's not I had a very, very good innings, I must say. 423 00:47:37,630 --> 00:47:45,520 I thoroughly enjoyed myself, but I could see the writing on the wall when we left our of the pub that we also used to where we were autonomous, 424 00:47:45,520 --> 00:47:51,580 where if we wanted a bit of help in the neurosurgeon's, somebody Popeye, if we wanted a bit of plastics or they wanted us, 425 00:47:51,580 --> 00:47:57,220 we could just pop over because there was a big link with the cleft palates, for instance, of plastic with us, 426 00:47:57,220 --> 00:48:02,650 because most children were also deaf with a single blue ear, 427 00:48:02,650 --> 00:48:10,090 because a part of the title plate muscle opens the station to station tube doesn't get opened. 428 00:48:10,090 --> 00:48:14,170 You get this fluid in the ear. So we had quite a link with that. 429 00:48:14,170 --> 00:48:22,180 And it was so easy if they were doing a cleft palate and that could somebody just nip over and have a look at these ears while the patient's sleep? 430 00:48:22,180 --> 00:48:25,690 And it was that sort of cooperation that was so easy. 431 00:48:25,690 --> 00:48:34,230 And also, Jeriko became an important the Jerrica Cafe sort of basic place was in the building then. 432 00:48:34,230 --> 00:48:41,770 And that's how it is. Yeah. Yeah. And there's a pub down there called Arachnophobes and then the administrators want to know where you were. 433 00:48:41,770 --> 00:48:51,300 Oh, I think they're in the right club somewhere. But the junior staff, they love that side of it. 434 00:48:51,300 --> 00:48:57,610 Actually being in town, being near that is really the university buildings and everything else. 435 00:48:57,610 --> 00:49:04,320 You needed to go look at something the right to. Sounds like you could do that in your lecture is very easily hit. 436 00:49:04,320 --> 00:49:09,630 Did anybody introduce protocols in their care about working down a scheme? 437 00:49:09,630 --> 00:49:16,170 Yes. No sort of scheme? No. I mean, they tried to impose that on you in any sense. 438 00:49:16,170 --> 00:49:21,690 I think I think it happens now, but it must happen that if, in fact, it's happened, I think with tonsils, you know, 439 00:49:21,690 --> 00:49:29,310 you can't see a tonsil unless it's being referred from a GP and you can't see it unless there is a number of attacks per year. 440 00:49:29,310 --> 00:49:34,620 And that when you get it in, you, you know. So I think there are these protocols. 441 00:49:34,620 --> 00:49:42,120 But you said earlier England, what happened was I was never terribly good on evidence based medicine. 442 00:49:42,120 --> 00:49:49,020 I always thought I knew best. And there's all this bit about your experience, but I've sort of seen it before. 443 00:49:49,020 --> 00:49:56,310 So you think but actually trying to make it scientific, all this Cochrane collaboration, I could never cope with that. 444 00:49:56,310 --> 00:50:01,260 And I couldn't put him down to about that issue. 445 00:50:01,260 --> 00:50:05,130 But, um, I don't know. 446 00:50:05,130 --> 00:50:11,190 I mean, it's difficult to predict the future of medicine, but I sort of I do worry about the future of medicine. 447 00:50:11,190 --> 00:50:16,140 And I think with funding I can see a hospital like that. 448 00:50:16,140 --> 00:50:20,550 You know, we've got an Oxford is a major teaching hospital. It's a major university hospital. 449 00:50:20,550 --> 00:50:29,040 It's a major district hospital. And I think trying to cope with the district and regional referrals and teach and the 450 00:50:29,040 --> 00:50:34,590 university is a very expensive business and I'm not quite sure what's going to happen. 451 00:50:34,590 --> 00:50:41,380 But my feeling with a speciality like mine is that it's I mean, 452 00:50:41,380 --> 00:50:46,050 already what I can see what's happened hearing aids provision has is now 453 00:50:46,050 --> 00:50:52,170 disappearing out of the hospital to go to spectators and things get befogged out. 454 00:50:52,170 --> 00:50:55,270 Yeah. And I can see a lot more work being done in the periphery. 455 00:50:55,270 --> 00:51:03,730 Now, why do you need an outpatient clinic, an expensive hospital, when you could actually go out to the periphery, do it at an outpatient clinic, 456 00:51:03,730 --> 00:51:12,060 but then you've got to think, well, how many patients you see in outpatients have got to come back for your MRI scan and then, 457 00:51:12,060 --> 00:51:18,330 you know, should you be doing that kind of hospital afford with all the expensive stuff that's 458 00:51:18,330 --> 00:51:22,920 now going on in medicine to deal with all the so-called tregear in medicine, 459 00:51:22,920 --> 00:51:28,110 which are terribly important for the patient and but not necessarily life saving. 460 00:51:28,110 --> 00:51:32,820 And it will all be and end up as a really first class emergency service, 461 00:51:32,820 --> 00:51:38,520 which I think it will pass the rest of, if not in some sort of privatisation bit. 462 00:51:38,520 --> 00:51:43,710 But the problem I see with absolute completely destroys cohesion within departments. 463 00:51:43,710 --> 00:51:47,790 You know, I think the Education Department, if it started splitting up somehow, 464 00:51:47,790 --> 00:51:53,850 it would be a different place to what you remember with a lot of joint meetings and cups of tea and well, 465 00:51:53,850 --> 00:52:01,530 they've got this patient can we talk about and all that sort of business. And I think it's going to be difficult to teach doctors. 466 00:52:01,530 --> 00:52:06,130 And I think it's going to be difficult to teach them the sort of, I don't know, 467 00:52:06,130 --> 00:52:12,090 the almost the ethics of medicine and the how to break bad news and all this sort of business, 468 00:52:12,090 --> 00:52:20,280 if it's all tangled up with because we spent a lot of time talking to our registrars and such as they would come and say, 469 00:52:20,280 --> 00:52:24,870 look, you know, I don't know how to approach this patient obviously got horrible cancer. 470 00:52:24,870 --> 00:52:34,410 What do we actually say? And it was it was very important to try to work out how you do approach these things, that it is a time. 471 00:52:34,410 --> 00:52:38,700 But equally, they have counselling in this of the students and they do I mean, 472 00:52:38,700 --> 00:52:44,010 they get more thoroughly taught in those formal ways against their practise way. 473 00:52:44,010 --> 00:52:47,870 I'm sure now it's very clear and I don't know which is best, you know. 474 00:52:47,870 --> 00:52:54,330 Yeah, but I sort of look at my career as being terribly influenced by my bosses. 475 00:52:54,330 --> 00:52:58,200 It's actually as if they're totally rubbish. 476 00:52:58,200 --> 00:53:05,970 I probably still practising. I'm not quite sure I did my my wish for university link ever come about. 477 00:53:05,970 --> 00:53:10,620 I mean, not really. No there isn't one there. Well no I mean no there isn't there. 478 00:53:10,620 --> 00:53:22,500 So I didn't know. And do you think that the NHS in Oxford is short changed at all financially because of the university? 479 00:53:22,500 --> 00:53:28,560 I think so, yes. I mean, if I was going to run a hospital, I would go to somewhere like Swindon. 480 00:53:28,560 --> 00:53:34,680 I wouldn't take on the most incredibly complex work. The cost money, I would do routine. 481 00:53:34,680 --> 00:53:40,290 I mean, we never quite understood by the Daily Radclyffe when it was just left with neurosurgery, 482 00:53:40,290 --> 00:53:47,850 plastic's eyes VMT couldn't have made a fortune just because there was no there was no geriatrics blocking up the beds. 483 00:53:47,850 --> 00:53:54,690 There was no there was a neurosurgical high dependency unit. 484 00:53:54,690 --> 00:54:02,730 I think that's what it was called. But there was nothing terribly expensive about the patients were getting. 485 00:54:02,730 --> 00:54:09,760 And we always assumed that the finance of the racket was going into a black hole for John Richter, but you never quite knew what happened to it. 486 00:54:09,760 --> 00:54:14,430 I know Chris Evans got terribly worried when he wrote that paper called Box Box. 487 00:54:14,430 --> 00:54:19,830 Do you remember that? I didn't make it up to the time he got he, I think, 488 00:54:19,830 --> 00:54:27,360 was seeing a huge number of Greek patients and all the private practise that he was earning was going back into the hospital, 489 00:54:27,360 --> 00:54:34,350 he thought, to provide extra nurses and facilities. But when you looked at the accounts and the medical staff meetings, 490 00:54:34,350 --> 00:54:44,070 it was quite obvious that neurosurgery, it was disappearing completely and they couldn't get anywhere. 491 00:54:44,070 --> 00:54:51,890 I don't know that he would be interesting to talk to. Oh, it's a great way to be. 492 00:54:51,890 --> 00:55:00,230 I think I'll certainly try as I'd like to interview him, because he would know if he would give me some very stern feelings, 493 00:55:00,230 --> 00:55:08,480 I think about finance that he used to get three fifths of these medical is in any condition that as it were here, 494 00:55:08,480 --> 00:55:19,490 it was more common in the end because of increasing ageing and deafness on dust and not noise. 495 00:55:19,490 --> 00:55:23,910 Deafness used to be a major problem. The motor works, but that's been around here. 496 00:55:23,910 --> 00:55:29,810 Yes, it was still there, but with the hammering, with all the banging and hammering and that, 497 00:55:29,810 --> 00:55:32,810 you know, a lot of measuring was done at the same limits. 498 00:55:32,810 --> 00:55:40,730 And a machine's got to be this rigid enforcement on air protection where you are doing these noisy works. 499 00:55:40,730 --> 00:55:45,020 But I mean, I think there's no doubt everybody goes deaf if they live long enough, 500 00:55:45,020 --> 00:55:52,610 like everybody needs a prostate surgery and what frequencies go in the networks that live frequently. 501 00:55:52,610 --> 00:55:56,810 Unfortunately, it's for all the high for business, which is the one where the constant speech, 502 00:55:56,810 --> 00:56:03,050 you know, the days of these F's and the children, I mean, the whole high pitched voices of the. 503 00:56:03,050 --> 00:56:11,250 Yeah, that's right. Yeah. You know, the wife and I think you can't hear it, but it makes it very difficult. 504 00:56:11,250 --> 00:56:16,580 It used to be called cocktail party because when there's a group of people all talking, yes. 505 00:56:16,580 --> 00:56:22,850 It's very difficult to filter out what you're saying with the best and most expensive hearing and it still hasn't got sorted out. 506 00:56:22,850 --> 00:56:24,290 And so I think that's increased. 507 00:56:24,290 --> 00:56:32,220 And I think there's no doubt that I mean, I don't know enough about Katsunobu, but one of the Graeme Cox, you know, but he's just retiring. 508 00:56:32,220 --> 00:56:42,860 But he's coming up a few days. But he undoubtedly has seen a huge change from the laryngeal cancer into the floor of most cancers. 509 00:56:42,860 --> 00:56:50,630 And that is quite sure why that's happening. But, you know, horrific surgery has to be done to get rid of the jaw or the small business. 510 00:56:50,630 --> 00:56:56,120 So cancers have changed and that many more women we've noticed with cancers of the head and 511 00:56:56,120 --> 00:57:00,410 neck problem because women have not stopped smoking as much as men have stopped smoking. 512 00:57:00,410 --> 00:57:07,070 Yeah. And so when they started later, they saw that when I was doing it, I always used to tell the students, 513 00:57:07,070 --> 00:57:15,560 you got ten male laryngeal cancers to one woman, but I believe it's now four or five women to six men, something like that. 514 00:57:15,560 --> 00:57:19,880 So that's changed. Yeah. 515 00:57:19,880 --> 00:57:27,440 So I think cancers change. We're not quite sure apart from the male female and the fact it's changed from the larynx to the jaw. 516 00:57:27,440 --> 00:57:40,250 And the French have got huge jaw problems from rough red wine and smoking cigarettes that hang on their bottom lip Gauloises without any filter tips. 517 00:57:40,250 --> 00:57:47,030 That's where one of the biggest names for this and the red wine does it, red wine and well, that's where it's thought. 518 00:57:47,030 --> 00:57:57,950 And and the Indians get a lot of it from Betelnut, chewing and spitting out the Betelnut and also the reverse cigarette smoking. 519 00:57:57,950 --> 00:58:09,080 I'm not quite sure how you do that, but you put the lighter down in such a way that they do move it. 520 00:58:09,080 --> 00:58:14,960 Right. Well, and that's terrific. Anything else you want to say? No, it's fascinating to talk about these things. 521 00:58:14,960 --> 00:58:20,450 I remember all these people. You know, I never, ever knew Eric, Pete, 522 00:58:20,450 --> 00:58:26,180 but he was a chap that I would love to go back because he had Gavin Livingston used to like each other tremendously. 523 00:58:26,180 --> 00:58:31,190 And, of course, Gavin Livingston's nephews. What is kulaks? And from what did we see? 524 00:58:31,190 --> 00:58:38,240 I didn't know you nailed it. Yes, I know. He said, is there a nephew of that, Mr Livingston? 525 00:58:38,240 --> 00:58:44,600 Does that mean anything to you? Yeah, he was my sort of it was all but a different branch. 526 00:58:44,600 --> 00:58:49,760 But he was vaguely related. It was a yes. But he he went to Australia. 527 00:58:49,760 --> 00:58:53,300 I mean, you write as a surgeon. He was demoted. Right. Right. 528 00:58:53,300 --> 00:58:58,700 But he was up, you know, an undergraduate. Yeah, yeah, yeah, yes. 529 00:58:58,700 --> 00:59:03,050 Yeah. A very interesting and I like the people coming in there. 530 00:59:03,050 --> 00:59:07,880 As brilliant as they used to be, I think much brighter. Yes. 531 00:59:07,880 --> 00:59:13,550 I would never get in. Also multitalented. They've all got the right age at the piano. 532 00:59:13,550 --> 00:59:19,820 And no, I, I originally started to think about doing forestry. 533 00:59:19,820 --> 00:59:25,430 That was because I have no idea. When I left school, I was at the school where most people went to the army. 534 00:59:25,430 --> 00:59:31,130 And then when I left school, I've no idea what I was want to do. 535 00:59:31,130 --> 00:59:36,830 Yeah. Yeah. And then I, and it was also just for A-levels were graded. 536 00:59:36,830 --> 00:59:42,050 So you were the school here and you go to the high court were upset because you had wasted any time. 537 00:59:42,050 --> 00:59:51,590 The sport was very much encouraged. And then and then we lived next door to the man who founded Go Kent Rankin. 538 00:59:51,590 --> 00:59:54,830 Founded the only private first company in this country, 539 00:59:54,830 --> 01:00:00,590 and he went off to work every day in a Land Rover with a gun, a dog and a picnic camp, and I thought that was. 540 01:00:00,590 --> 01:00:04,790 So he advised me when if I wanted to do that, you better come. You can come. 541 01:00:04,790 --> 01:00:08,240 But you must go to Oxford, where we had a full first school this year. 542 01:00:08,240 --> 01:00:12,170 So he gave me this tickets and I went up and I forgot the name of the first forester. 543 01:00:12,170 --> 01:00:18,680 Anyway, he said, Well, yeah, we could take you, but you better get into one of the colleges, take this and run some jobs anyway. 544 01:00:18,680 --> 01:00:29,010 I didn't get in or I didn't do it in the end, but I met Bob Torrance Johns, who later became a patient and he vaguely remembers meeting them. 545 01:00:29,010 --> 01:00:38,060 He says he did. I probably didn't. But he said, Freedgood, there's no way to get to the university beside foresters and geographers of academic life. 546 01:00:38,060 --> 01:00:43,430 And anyway, the only reason he considered is you could run quite quickly out. 547 01:00:43,430 --> 01:00:49,160 So I never did. But because I was my idea suddenly changed. 548 01:00:49,160 --> 01:00:54,110 If I get into jobs, maybe I could persuade me to take you to medicine. 549 01:00:54,110 --> 01:00:58,250 I mean, you always knew you wanted to do medicine as well. No, I didn't know that. 550 01:00:58,250 --> 01:01:07,310 I'd never it came up when I met some medical students who told me to be very high up the Darwinians scale of evolution. 551 01:01:07,310 --> 01:01:11,560 You needed to be dependent on your parents a long time. Why not be a Medick? 552 01:01:11,560 --> 01:01:16,040 Yeah, and I thought and then, of course, when I went to guys, 553 01:01:16,040 --> 01:01:22,080 most of guys was full of South Africans playing rugby had been just like Marius's full of Welsh. 554 01:01:22,080 --> 01:01:26,450 They're just going to train at Paddington and National Service. 555 01:01:26,450 --> 01:01:31,970 I missed that. I missed that by two years. Yeah, yeah, yeah, yes. 556 01:01:31,970 --> 01:01:36,330 I think that finished in fifty nine or thereabouts or something like that. 557 01:01:36,330 --> 01:01:40,700 Yeah. So I left school at 61. 558 01:01:40,700 --> 01:01:45,960 I suppose it was OK and really marvellous. Thank you very much. 559 01:01:45,960 --> 01:01:47,820 What do you think of him and.