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This is Derek Hockaday interviewing Chris Reynolds on the fourth of March 15.

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Chris, I think you qualified in Cape Town in 73.

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I did. And what did you do then? Did you come over to Australia?

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Well, I did. It's embarrassing story.

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My school had been the test bed for scholarships.

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So when Cecil Rhodes wrote his will, he said that the school would have a scholarship in perpetuity, although it was just a school.

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Everybody else had to compete in a rather wider field. And the year of 1972, there was a shortage of candidates.

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My headmaster asked me whether I would be kind enough to become a runner in the race,

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but I was to come second because he'd already chosen the person that he wanted.

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And as a favour to him, I went to the interview and found that the favoured candidate fell over in the in

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the race and he was in the embarrassing situation of having to give it to me,

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which he didn't like at all, and he couldn't bring himself to phone me. So I actually only found out because the because the the local newspaper,

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which called itself The Cape Times, rang me up and said, and what are you going to read at Oxford?

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Which was a bit of a shock to me because I had absolutely no plans to read anything at all.

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And I was only a fifth year medical student. And Oxford insisted that I didn't do my house jobs in South Africa, that I come up the next year,

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which was would have been Michaelmas term nineteen seventy three, which I couldn't because I was taking my finals.

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So they said I would have to come the next term and and they said I couldn't do my house jobs and I would probably read a PPP.

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And this was all completely confusing for me.

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And I was asked what college I was going to go to and I hadn't even thought about that because I had no thought that I was coming to Oxford.

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So I have to really have a crash course in Oxford.

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When I got here, the warden of Rhodes House, Willemse, said, he says yes, Williams, what was his first name?

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He called me and and realised this was all a bit of a bit of a mess.

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So he phoned the then postgraduate. It was a Mr Potter.

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He was the neurosurgeon whose book on head injuries I had read as a medical student.

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So, you know, when was things the authors of books must be dead. Yeah.

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So I went to I went to see him and he said, this is ridiculous. You need to walk the wards.

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And he found that there was an Oxford student who'd failed his not only his finals, but also cancer, said Edgar Williams was his name.

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Right. Monty Montgomery's chief of staff. Yes, indeed.

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Cartographer's, that is he said there was there was a job.

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And because there was a medical doctor, medical student who'd failed, not only had he failed, Oxford failed.

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Wilson said failed the the exam to take down in London.

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So he sent me off to Northampton to meet an X reader in surgery called Kevin Cronin.

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Yeah. And I went for the so-called interview.

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He just chatted to me and he said, well, I must be going now. So I said, do I have the job?

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And he said, Oh, dear boy. He said, anyone is good enough for Oxford, it's good enough for me here in Northampton.

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So I was going to start with him. And then I was sent to interview to be interviewed by John Badenoch,

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who was all a bit he's trying to do his clinic and he assured me into a side room, didn't make me lie down to examine it.

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And he sort of looked at my CV. And I think that there was a problem because there wasn't going to be anybody.

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And then I met you, Derek, and you said it was all going to be OK.

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So I did six months and six months in in Northampton and six months at the Radcliffe Infirmary.

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And actually it was great fun. And I had a I had a wonderful time.

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And then I met Peter Morris because I wanted to do nephrology and he offered me a place in his in his lab to do the field of transplantation.

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And I've also got to know that John Ledingham and Desmond Oliver and with some nephrology and the transplantation defo, which I finished in 1979.

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So when you set out from South Africa, did you see yourself staying in England or not?

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I didn't, but I was actually asked that at the interview because they said, will you come back?

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Because South Africa was in the grip of totalitarian apartheid and there was

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absolutely no prospect of the national government ever being voted out of power.

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They had an. Entrenched majority. And things were getting worse and worse and worse.

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I mean, the White House had a pretty good standard of living, but the the political temperature was going up and the well,

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the way they were then calling all young white males up into the army for two years.

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And but the thing that I found when I went back there is that I when I tried to to reason with people,

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even people for my own language group, I found that either they were completely out of sympathy with me.

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And I mean, they felt that Slavka would have to evolve in its own way and that apartheid will just have to be modified.

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And I was told that I was an idealistic fool for believing that apartheid was destined to fail.

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And I'm proud to have been involved in it because it turned out that I was correct.

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Yeah. So after three or four years, I felt out of sympathy.

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My wife's family had left South Africa and I felt comfortable here.

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And so I elected to stay and I eventually got my British citizenship in nineteen ninety.

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But I do feel bad about not having gone back because the idea of the Rhodes Scholarship is to come to Oxford

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University and take the what the opportunities you've had and take them back and put them back into the country.

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But there are quite a lot of Africans who didn't do that then.

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So you did, you did feel we were doing a bit of clinical during that time.

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I did with this. And and I worked on the.

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So the transplant is interesting for the medical school point of view is that I arrived here and there was no professor of surgery.

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He had just died. Remind me, Derek, what his name was Alison.

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Yes. He was apparently a very famous thoracic surgeon one time, apparently some Martorell bellbottoms.

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And I think he operated on the oesophagus. And yes, he was a great for the oesophagus, but apparently he was unwell anyway.

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He died. And so the Department of Surgery, there wasn't anyone here.

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And Peter Morris was recruited as a vascular surgeon and as a transplant surgeon and to run immunological research and transplantation.

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So it was quite good timing, really, because he didn't he was setting up his lab and didn't have research fellows and because I came with a salary.

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So I met him at the Rhodes Trust Scholarship.

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Coming up, dinner. Right. Of course, this is all completely new to me because I wasn't really familiar with with the university and the sort of thing.

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And I was quite a bit abstemious individual.

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But at this particular meal, there was rather a lot of wine and then a drink, which I hadn't wasn't familiar with, called port.

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And then cigars were passed around. And the next day I thought that I'd had a subarachnoid.

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But anyway, Peter Morris invited me to and I've been registered for it.

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And do you feel. So he then used me as a as a locum working on the on the transponding from time to time.

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And um, I also helped in the with all of the data systems and then got the NHS job.

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So I got my early training and in taste of nephrology,

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in transplantation from from the professor of surgery and from from from all over and John Nottingham.

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And what was your day feel on what were you researching? We were testing a hypothesis that if you did that,

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you could make an animal tolerant to its kidney transplant if you blocked its immune

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response early on by giving the recipient animal an antibody against the donor antigens.

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And the certainly worked in animal models.

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And it was probably a bit like rhesus that you could that you could mop up immunogenic cells when it worked perfectly in the animal model.

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And I did not you'd have a 600 renal transplant, not as quickly as the laboratory technicians who could do them in about 12 months.

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My personal best was about 17, but anyway and it worked very well.

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But unfortunately, the antibody was going to fix complement.

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So I had my next part of my experiment was to lop off the C section of the antibody so that it wouldn't fix complement.

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Would it then work because the fact the fraction would be rapidly stabilised.

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So I made to fractions and they didn't fix the complement and gave them and they worked but less well.

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And that work was then supposed to go on into larger animals.

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But in fact it never progressed. And that particular. That particular.

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Models seem to be one that worked in rodents, but it didn't work in higher mammals and so and so it never went in.

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But what I learnt I think the interesting thing about it being a field is,

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is that I learnt to be disciplined intellectually to read every paper that I quoted, to know the whole subject.

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I learnt, I think, to write systematically. I learnt statistics and fatality statistics from Richard Peto, who was the and I'm quite sure what he did.

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But he was Mr. Richard. We were sent to see him.

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And I've still got his lecture notes because he told us the principles of statistics before he told us the methods.

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So we understood why we were doing what we were doing and why we couldn't compare things in a particular way in a very logical way.

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I think he must have you know, I think he knew that he was talking to non mathematicians, but that really set me up to understand that statistics,

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not just plugging numbers into a computer, you have to know what you're why you're doing what and what's legitimate.

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And so I didn't and I didn't have to work in a laboratory, which I think is a tremendous discipline.

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I learnt the terrible disappointments that you have when experiments don't work, because I think Alan Island uncertainty.

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I learnt disappointment. I learnt hard work.

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I talked to right. And I think I learnt how to criticise in a constructive way.

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Who told you to write? Did you just learn by experience?

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I think I was a bit of a mimic because I read good papers and I thought this was the other thing I,

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I think I learnt was by reading what I do and back to myself out loud.

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Very good, because, you know, I could scan it and Cassandra.

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Right. But in fact the grammar would would jar if it wasn't written correctly or the sentence was too long.

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And I was told to summarise the sentences for far too long.

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So it would be a bit of a game where I would write the paper and he would lengthen the sentence with adding another several phrases on.

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And then I would put a fullfil that I thought I could only carry a C.

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So what I, I mean, I think I write reasonably well and and so prepared me for editing textbooks.

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Yeah. And what have you. So, so I had, I felt enormously privileged to be here, but of course it was, it wasn't the place it is today.

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It was quite a small medical school.

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I found the medical students quite enchanting because they were they were I think, almost picked for their for their characters.

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They were many of them were very interesting human beings in other ways.

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And I've followed some of them. And what's happened to them subsequently?

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Um, and the other thing I enjoyed was very much like what we had in Cape Town was that when they were members of Thurm, they were there all the time.

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And, uh, they joined in on the takes.

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And when you got to chat to them, you find many of them, you know, were accomplished in many other fields.

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And they I have to say that contrary to to what I had expected, they had a good work life balance.

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You know, they did their sport and what have you. And they they would turn up for the Waldron's having quietly got themselves ginned

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up so that if doctors paid not Hockaday or driven and shot them a question,

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they would be able to be able to handle it.

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I didn't I mean, I, I did a little bit of teaching of them, showing them cases and what have you, but they were mostly seem to be very well taught.

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And what did you think of the nurses compared to Capetown? I thought they were better.

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They were they the nurses in South Africa tended to be much more function is doing as they were told.

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The nurses here took much more of a leadership role.

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The interesting thing was the way I watched how they handled junior doctors and the more mature they were,

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the better they handled us because they wanted to get the best out of us.

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But they knew that we were rather inexperienced. And I actually had a I had some very nice nurses.

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I wonder whether you remember Megan on little the Scottish.

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Yes, yes. Yes. So when I was you know, if I was doing a lumbar puncture and I was making heavy weather of it, she would,

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which wasn't often, I'm pleased to say, but she would just quietly come along and get the patient into a better position.

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A position is a yes. And she was you know, she would help me tidy up afterwards.

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And I mean, it was just a I thought they handled the junior doctors. Very well.

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And who is the senior registrar, Alan Beven it?

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No, it was Bob Simpson behind the Bob Simpson told me a lovely story when he was your senior registrar.

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He he was very supportive of the junior staff. And he really got him on the tape, not just about midnight, having kind of mock things up.

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And he was never, never got disappointed if you asked him for some advice.

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And I remember being very frightened one night because I was called down to Ronnie

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Ward and where there was a man who had several metastases from the cancer of the

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lung and he was in status epilepticus and it was four o'clock in the morning and it

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was the long ward and just his light was on and the other patients were all awake.

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And I was having some difficulty. And in in, first of all, getting Evenflo in to give him the diazepam.

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I then got in and then I gave him a modest pace and he didn't didn't help.

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And so we kept starting up again.

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And so I rang Bob and he just took me through it. And the following day I said, I want to tell you how grateful I am because I was very frightened.

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I felt completely inadequate. And and, you know, I you know, you gave me reassurance and whatever you say said think nothing of it.

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I said, you know, because it wasn't traditional for somebody. Registrars left.

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Their duty is a little bit high and dry. So he said, well, you know why?

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I said, well, why do you why have you sort of made it a point to keep you advised against it?

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Well, you see, when I was a junior doctor, I think he might have been in Southampton. He said we had a diabetic ketoacidosis come in,

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which in those days was a pretty terrifying presentation because it was treated in a different way in those days.

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And I know that just was changing just as I came here, the small that sort of incident.

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And he phoned his senior registrar who said to him, incidents the stuff and slammed the phone down.

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And and Bob said that wasn't much help. And so I had a bit of a baptism by fire.

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Yeah. Of managing this patient. And he said, I thought that was a horrible thing to do to a junior doctor.

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So maybe I mean, that example made me vow that I would never leave the junior doctor high and dry.

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Not that I mean, I probably hadn't thought about it, but I but I, um, because I was a junior doctor,

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but having been supported by him and he was he was he went off to be a consultant at Chichester.

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Yes. And I've never seen him again. But I gather he's retired. But he looked after us very well.

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He was a good guy who was sensational. Steve O'Keefe.

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Oh yes. And I think became a nutritionist. And I think he actually went to South Africa.

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Right. He was a because he was very lovely to them.

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And it was always that was the interesting thing about Oxford is you found the people done these fields

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and things and were really world experts in some particular area while they were beavering away.

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So there was a huge mixture of of, I think, remarkable people.

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I, I don't want to name drop, but but I did feel a sense of of all when Sir Peter Medawar came to the department to give a seminar,

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he'd had you straight by then and he had an anonymous hemianopia.

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So his wife, who apparently worked in the dance school, actually moved the lectern round.

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And he gave this wonderful talk on the immunology of cancer.

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And he made a whole lot of self-deprecating jokes, which I wasn't used to because it's not as an African thing.

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So he said, you can tell this experiment has been honestly performed because I got exactly the opposite result.

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I was in my hypothesis, the [INAUDIBLE] and the and James gowns.

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I heard James gowns and you lady went in the MRC giving seminars at the dance school.

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And my the technical supervisor took me over to to the dance school where there was a wonderful seminar.

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The this is the discovery of the of of the function of histocompatibility antigens,

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which we thought had been put on human beings to frustrate transplant surgeons.

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But suddenly it was discovered that it was the mechanism for cells or recognition and killing virally infected cells.

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And the people who did that work at Dockerty and Zinkernagel. But someone from their lab came and presented the data and we were tipped off that this

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was going to be stuff that was good when she got the Nobel prise that we would listen.

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So we all trooped off to the dance school and crept in the back and one of the little seminar rooms was there.

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And this beautiful seven of which I understood about seventy five per cent and it was twenty five per cent that I didn't understand.

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And I decided that under no circumstances would I put my hand up and ask the question where a hand went up at the front of the.

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Of the. Of the. Seminar room and asked the question, implying that the question had also not understood the same 25 percent,

190
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and I was very relieved, but I didn't know who it was.

191
00:20:10,520 --> 00:20:18,240
So I turned to my supervisor, technical supervisor John Faith, and I said, I am not in a stage whisper spat.

192
00:20:18,240 --> 00:20:25,110
And he said, That's Rodney Porter. And he got the Nobel prise for discovering the structure of antibodies.

193
00:20:25,110 --> 00:20:32,430
So I felt that I was in good health right now. Technical supervisor, was he a clinician or a scientist?

194
00:20:32,430 --> 00:20:36,120
Yes, working with Peter Morris is he had qualified as a doctor.

195
00:20:36,120 --> 00:20:41,040
And he and he went and he actually did he did some postdoctoral work in the Dunn school.

196
00:20:41,040 --> 00:20:45,840
And he was really an immuno chemist. So he taught me how to.

197
00:20:45,840 --> 00:20:50,700
He taught me the sort of techniques of preparing antibodies and what have you.

198
00:20:50,700 --> 00:20:55,020
And he went off later to work at the Institute of Child Health.

199
00:20:55,020 --> 00:21:01,920
So maybe Demorris, being the professor of surgery, wasn't going to have a chance to buy that books every day.

200
00:21:01,920 --> 00:21:06,270
So he was he kind of he supervised my day to day work.

201
00:21:06,270 --> 00:21:10,530
And, you know, if I didn't know the method he taught me and I think it's good to be true.

202
00:21:10,530 --> 00:21:16,590
And he was he was a very skilled laboratory. And so then you go to different field, say seven.

203
00:21:16,590 --> 00:21:20,400
Did and did you go straight to the reading unit?

204
00:21:20,400 --> 00:21:33,270
Well, I got the registrar job, which in those days was as six months, three or six months gerontology with Leo Walnut and somebody else's name.

205
00:21:33,270 --> 00:21:40,450
I've got to went off to New Zealand. Sean McCarthy. Yes. And Gordon Willcock was about.

206
00:21:40,450 --> 00:21:52,500
And so I did the six months in the in the unit and then I did six months of geriatrics and then at Colorado nervously that it was very traumatic.

207
00:21:52,500 --> 00:21:57,060
And I was very fond of. Well yes.

208
00:21:57,060 --> 00:22:00,550
But he would make me do the thyroid function tests on every little old lady.

209
00:22:00,550 --> 00:22:10,380
I'd come in. So I once had the temerity to ask him. I said, Dr. Welner, are you anticipating that this patient might be hyperthyroid or hypothermia?

210
00:22:10,380 --> 00:22:16,110
And he said to me, well, it could be I said I never kept a book,

211
00:22:16,110 --> 00:22:24,030
but he wasn't quite so quick to ask me to do thyroid function tests after that, because I think he was just kind of diminishes me.

212
00:22:24,030 --> 00:22:27,360
And then there's all of us said to me, we've had enough time.

213
00:22:27,360 --> 00:22:31,170
He had been here for six, six years, seven years.

214
00:22:31,170 --> 00:22:34,500
And he said, I know nothing of you.

215
00:22:34,500 --> 00:22:37,350
Here is the time you went out and did something else.

216
00:22:37,350 --> 00:22:46,590
And I had thought about going to Australia and my parents and all lived and had an interview with the famous Priscilla Kinkaid Smith.

217
00:22:46,590 --> 00:22:56,300
But she she didn't offer me a job and is all over, then turned around and he said bad news, said all the best there.

218
00:22:56,300 --> 00:23:00,490
Not many training person around you. They're all taken. Guys was taken.

219
00:23:00,490 --> 00:23:05,580
Newcastle was taken. Um, Cardiff was taken.

220
00:23:05,580 --> 00:23:09,480
And the days were the best ones.

221
00:23:09,480 --> 00:23:18,480
But I've run the Hammersmith Hospital and at the Hammersmith Hospital er they just closed applications, but they'll take one from you.

222
00:23:18,480 --> 00:23:22,680
And so I applied and I was appointed. Right. Yes.

223
00:23:22,680 --> 00:23:26,340
So it was days. Who did that sort of thing not. Yes.

224
00:23:26,340 --> 00:23:35,490
John Ledingham had withdrawn a bit from the from the reading at that stage I think they got on but there was

225
00:23:35,490 --> 00:23:43,120
there was a certain tension between them and and I mean there's John getting a mad general medicine to do this.

226
00:23:43,120 --> 00:23:47,580
Didn't do. Have you had the clinical school to do? We had new college.

227
00:23:47,580 --> 00:23:58,860
And for him to be on call for the day to day problems, kidney that was really not plausible suggested most.

228
00:23:58,860 --> 00:24:05,970
And I think he does. I think he looked after his his juniors and he knew I wanted to nephrology.

229
00:24:05,970 --> 00:24:10,560
And he was worried about the sort of Oxford phenomenon of people never leaving.

230
00:24:10,560 --> 00:24:17,700
There's to need to go somewhere else. Yeah. Anyway, I got the job and then that was nineteen eighty and eighty one.

231
00:24:17,700 --> 00:24:24,480
I started eighty two and and then six years later it was agreed that they needed a second consultant,

232
00:24:24,480 --> 00:24:32,910
but that he was a consultant because he was old and getting older and it had a very tough time,

233
00:24:32,910 --> 00:24:36,630
a case that they turned off dialysis and got into the newspapers and they've been

234
00:24:36,630 --> 00:24:41,730
accused of er euthanasia and General Medical Council and all sorts of horrible.

235
00:24:41,730 --> 00:24:49,410
His morale was quite low. So I came in in eighty eight and started as a second consultant.

236
00:24:49,410 --> 00:24:53,640
Right. And have you done six years and then have to go into business with.

237
00:24:53,640 --> 00:24:59,910
Yes, yes. I've been, I've been the senior registrar and then I've done some post-doctoral research and then I.

238
00:24:59,910 --> 00:25:10,690
Become the baby to senior lecturer, and then I have this fantastic opportunity of working on the testing in man of recombinant human growth research,

239
00:25:10,690 --> 00:25:14,010
but that's where you tend to refer to them as well.

240
00:25:14,010 --> 00:25:29,670
I mean, I did the curious thing was that I was asked my interview what was a tractable problem in renal disease that was the right solution.

241
00:25:29,670 --> 00:25:32,190
So I said the treatment of anaemia,

242
00:25:32,190 --> 00:25:38,640
because these patients are transfusion dependent and these were young people dragging themselves along with the Enflames five.

243
00:25:38,640 --> 00:25:43,050
And I could see they hadn't I mean, they thought this was interesting, but not that not all of them.

244
00:25:43,050 --> 00:25:44,940
They were all immunologists.

245
00:25:44,940 --> 00:25:52,380
And then, I mean, it's just the most amazing piece of luck that the the British expert on another person was a scientist called Mary Curtis,

246
00:25:52,380 --> 00:26:01,260
who did the assays. She wasn't a clinician and she persuaded the company that had produced Recombinant Rippert

247
00:26:01,260 --> 00:26:09,030
and that because she had the assays and she worked with a very good team of hepatologist,

248
00:26:09,030 --> 00:26:15,390
including a man called Martin Picard, who was one of David Wetherall fellows,

249
00:26:15,390 --> 00:26:22,560
who was an expert on metabolism, that that she was the right place to test this material.

250
00:26:22,560 --> 00:26:26,920
And she had another haematologist who was very good at looking at bone marrow function,

251
00:26:26,920 --> 00:26:31,980
in vitro, taking bone marrow and looking at that red cell production, what have you.

252
00:26:31,980 --> 00:26:33,120
But you didn't have read it.

253
00:26:33,120 --> 00:26:41,280
So she phoned up Professor Peters, who was not a man interested in dialysis or anaemia, and said he said, I got just a check for you.

254
00:26:41,280 --> 00:26:51,990
He works now, renal unit, and he's interested in this. So she came to you and we got we were given the second batch to put in to test.

255
00:26:51,990 --> 00:26:58,290
The other was tested in Seattle and a very famous reading unit by a very famous team.

256
00:26:58,290 --> 00:27:04,770
But when we got our first test results, Keith, Peter said to me, you should publish.

257
00:27:04,770 --> 00:27:08,560
I said, well, it's not really in my data belongs as much to Mary Kate. So he said, rubbish.

258
00:27:08,560 --> 00:27:14,130
She said Scoop said so. He said, I'll phone up the editor of The Lancet.

259
00:27:14,130 --> 00:27:19,320
And I've seen the work and I see he said it's fantastic. So I mean, it was straightforward.

260
00:27:19,320 --> 00:27:26,850
So he phoned and the editor of The Lancet said, well, if you'll send me a manuscript by the middle of next week, we'll get it in in the fortnight.

261
00:27:26,850 --> 00:27:30,990
So with Mary, I sat and typed out myself. Mary Kate looked at it.

262
00:27:30,990 --> 00:27:34,380
It was very simple study just before and after.

263
00:27:34,380 --> 00:27:37,910
And what you put any of the kinetics and things like that.

264
00:27:37,910 --> 00:27:41,340
And it came in a later paper and The Lancet and appeared in The Lancet,

265
00:27:41,340 --> 00:27:47,250
I think it was in 1985 scooping the New England Journal of Paper by the Americans.

266
00:27:47,250 --> 00:27:54,960
Infuriated, very good. Absolutely infuriated. And it was met with you described as deafening silence.

267
00:27:54,960 --> 00:28:03,330
No one seemed to know the significance at all up here. I mean, I I was asked to give the talk on the face, but I really I didn't know what happened,

268
00:28:03,330 --> 00:28:07,070
but no one seemed to know this was this was a complete game changer.

269
00:28:07,070 --> 00:28:11,670
And we just completely abolished transfusion problems in renal patients.

270
00:28:11,670 --> 00:28:14,530
And anyway,

271
00:28:14,530 --> 00:28:22,500
then Washington eventually got into the newspapers and I got onto the onto the radio where I was television where I was interviewed by Jeremy Paxman,

272
00:28:22,500 --> 00:28:31,470
who, needless to say, asked me very testing questions. And I was I was the observer came to interview me.

273
00:28:31,470 --> 00:28:36,480
It was quite funny because they'd been to see somebody else about growth factors and said, well,

274
00:28:36,480 --> 00:28:40,200
you know, don't talk to me because my growth factors don't do anything for man at the moment.

275
00:28:40,200 --> 00:28:41,610
But there's a guy down at the Hammersmith.

276
00:28:41,610 --> 00:28:49,740
He's got this growth factor that seems to be working to the Gerba came to see me and I said, you know, this is not I'm just a small cog.

277
00:28:49,740 --> 00:28:53,250
Here's the day's what I want to photograph and what have you.

278
00:28:53,250 --> 00:28:58,050
Anyway, the photograph, as they said, to separate the bottom line, I say, well, this is fantastic.

279
00:28:58,050 --> 00:29:06,660
This is an idea that's fulfilled its promise. And so, unfortunately, they put a picture of me in the in the in the Observer,

280
00:29:06,660 --> 00:29:14,730
which said fulfilling its promise in particular paper was stuck up on boards saying, C.G., when I was fulfilling his promise.

281
00:29:14,730 --> 00:29:21,060
Extremely embarrassing. Yeah. But anyway, it was a it was a game changer.

282
00:29:21,060 --> 00:29:24,390
Quite a lot of work on it since. So that and that happened.

283
00:29:24,390 --> 00:29:32,850
And then I applied for the job here that you probably published several other papers from the industry and the story then you applied up,

284
00:29:32,850 --> 00:29:39,570
which of course was quite a big risk because I was in a protected academic environment at the Hammersmith

285
00:29:39,570 --> 00:29:48,540
with as an adequate but not overwhelming amount of clinical work and lots of time for the research.

286
00:29:48,540 --> 00:29:54,030
But it was a pretty tough environment. And it wasn't it wasn't a it was a kidney.

287
00:29:54,030 --> 00:29:59,630
It was struggling with inadequate facilities. And I'd be very.

288
00:29:59,630 --> 00:30:06,320
Here in Oxford, and I thought I would get on reasonably well with Oliver and Peter Morris,

289
00:30:06,320 --> 00:30:10,850
and so when, yes, all of us would be put in an application, I put in an application,

290
00:30:10,850 --> 00:30:14,390
I was told at the Hammersmith, and if I put in an application,

291
00:30:14,390 --> 00:30:21,290
they would not renew my senior lectureship GPA, which I thought was a bit rough, very rough.

292
00:30:21,290 --> 00:30:30,680
So I, I spoke to my wife and she said, well, I think you said Oxford because I know the people.

293
00:30:30,680 --> 00:30:37,460
Then I get home from to be my declassifies and there's been a mentor.

294
00:30:37,460 --> 00:30:40,970
So I applied and I was appointed and have had eighty eight.

295
00:30:40,970 --> 00:30:47,020
That's twenty six, 27. And happy is coming from the heavens.

296
00:30:47,020 --> 00:30:53,420
How did you find the two compared.

297
00:30:53,420 --> 00:31:06,410
I think the Hammersmith had a broader range of research than it was a pretty tough environment, unforgiving environment.

298
00:31:06,410 --> 00:31:11,150
Failure was not accepted. I mean they used to say that no one ever got stabbed in the back.

299
00:31:11,150 --> 00:31:17,300
So it was always in the front end.

300
00:31:17,300 --> 00:31:20,150
But there's a lot of very exciting stuff.

301
00:31:20,150 --> 00:31:31,880
Are they the good thing about the place was that it was quite iconoclastic and you took no one's word for anything.

302
00:31:31,880 --> 00:31:36,310
So if someone got up and made an ex cathedra statement, they would get challenged.

303
00:31:36,310 --> 00:31:44,870
And there were some outstanding departments that were present and the standard of the discussion and the questioning was really very good.

304
00:31:44,870 --> 00:31:48,350
And I mean, some of the work that was coming out of that, you know,

305
00:31:48,350 --> 00:31:56,150
the work on practise nocturnal haemoglobin area and the cardiologist's on coronary interventions,

306
00:31:56,150 --> 00:32:03,920
I mean, there was the bone marrow transplant unit, but it it was it was exhausting because it was very demanding.

307
00:32:03,920 --> 00:32:11,130
You were expected to work very hard clinically and keep up your research when you were a junior doctor.

308
00:32:11,130 --> 00:32:16,610
And when I got here, I was much softer place. I mean, it was clearly very good work going on.

309
00:32:16,610 --> 00:32:21,170
And it wasn't quite so much clinical science going on here of working with patients.

310
00:32:21,170 --> 00:32:26,270
A lot of stuff going on, you know, in in laboratories that was of interest.

311
00:32:26,270 --> 00:32:31,130
But it wasn't I didn't see much of what's called translational medicine at that particular stage,

312
00:32:31,130 --> 00:32:39,830
whereas, you know, the iPad stuff was going at the lab to into the testing the patients.

313
00:32:39,830 --> 00:32:46,820
So I suppose that's the big difference is, was that there wasn't as much other clinical research here.

314
00:32:46,820 --> 00:32:51,020
I also thought that people were a bit politer.

315
00:32:51,020 --> 00:33:01,760
They may have been thinking things I'm not saying, but the Hammersmith was a very brittle, sort of abrasive, abrasive environment.

316
00:33:01,760 --> 00:33:15,080
I mean, I had several unhappy humiliations, um, one of which, if you've got time of the I I had a patient had a kidney transplant.

317
00:33:15,080 --> 00:33:21,740
He was a musician from San Francisco who wasn't gay,

318
00:33:21,740 --> 00:33:26,450
but he was British and he got rid and come back and we put him on status and gave him a transplant.

319
00:33:26,450 --> 00:33:31,100
And he's in the 80s and and he fell to bits.

320
00:33:31,100 --> 00:33:36,110
He got cytomegalovirus in his eyes. He got pneumocystis pneumonia.

321
00:33:36,110 --> 00:33:42,730
He got terrible thrush.

322
00:33:42,730 --> 00:33:50,360
And I said that he's he's having a far west on the patient. He must have he must have some immunodeficiency.

323
00:33:50,360 --> 00:33:55,170
So HIV had been AIDS and be describe it, HIV hadn't been identified.

324
00:33:55,170 --> 00:34:03,650
So there was no viral testing. So I presented him on the Grandstanders page transplantation immunodeficiency syndrome and got booted out

325
00:34:03,650 --> 00:34:09,980
of the lecture theatre as being someone who'd had catastrophically over immunosuppressed this individual.

326
00:34:09,980 --> 00:34:14,180
I said I said not not true. I said he got the standard treatment.

327
00:34:14,180 --> 00:34:23,570
Anyway, um, about nine months later, the first test for what was called the three came out at St Mary's Hospital.

328
00:34:23,570 --> 00:34:30,530
And I went to the serum bank and I took it down to Saint Mary's Hospital and he was HDB three positive.

329
00:34:30,530 --> 00:34:39,510
So in fact, we had transplanted an HIV positive individual unknowingly because we didn't have a test and no show anyway.

330
00:34:39,510 --> 00:34:46,820
He was written up. And needless to say, many of the people who thought that I was talking through my hat were very pleased to be on the paper.

331
00:34:46,820 --> 00:34:51,560
So it was a pretty abrasive, really abrasive environment.

332
00:34:51,560 --> 00:34:57,410
And when you came back here after six years, how at this place changed or how did the kidney unit.

333
00:34:57,410 --> 00:35:06,280
Yeah. It hasn't changed much, and that was I think was the was was maybe why I was appointed,

334
00:35:06,280 --> 00:35:12,280
it was just doing the same things and the registrars were kind of carrying a lot of the work.

335
00:35:12,280 --> 00:35:22,930
But there was a little bit of research going on and not much teaching and, um, no seminars.

336
00:35:22,930 --> 00:35:29,920
And and so I think. But I mean, it was still working pretty well.

337
00:35:29,920 --> 00:35:37,570
So it was a good, safe, sound kidney unit. But it was it it was not it was punching well below its weight.

338
00:35:37,570 --> 00:35:43,510
And I mean, it should have and I think it was because there hadn't been an investment in in stock.

339
00:35:43,510 --> 00:35:43,930
But in fact,

340
00:35:43,930 --> 00:35:56,170
the interesting thing was that quite a lot of very bright Oxford graduates and registrars had for some reason got interested in the colleges.

341
00:35:56,170 --> 00:36:03,550
That much of the frustration of David Wetherall. I think a lot of them enjoyed working with John Ledingham.

342
00:36:03,550 --> 00:36:11,950
So I'm thinking of people like Peter Rateliff was a registrar and did a lot of clinical research, some of it very perceptive stuff.

343
00:36:11,950 --> 00:36:24,100
Nothing, nothing to do what he's doing at the moment. And a lot of his lab work had been very demanding, but not brought him any interesting results.

344
00:36:24,100 --> 00:36:29,500
He worked on hypoxia in the kidney and there was heavy rain and there was John first.

345
00:36:29,500 --> 00:36:38,260
So there was there was a very busy bunch of people around here. And so we try to build it up into into an academic unit.

346
00:36:38,260 --> 00:36:45,220
And Peter Bingo got a chair. So I said, this is really gonna sound like namedropping.

347
00:36:45,220 --> 00:36:49,870
But because I went to the Hammersmith and because I've worked here, I've worked with some really interesting people,

348
00:36:49,870 --> 00:36:55,390
most of whom have now, of course, the stratospheric while I'm at my feet on the ground say so.

349
00:36:55,390 --> 00:37:02,140
Let's check Barzeh, which is the vice chancellor of Cambridge University, was the senior registrar when I was down.

350
00:37:02,140 --> 00:37:10,300
Sir Robert Leclair, he's now head of Kings, was massively distraught as a Peter Radcliffe was Sir John Saville.

351
00:37:10,300 --> 00:37:15,940
He was the head of the MRC. He was son as a senior lecturer. So I think they've probably forgotten who I am.

352
00:37:15,940 --> 00:37:19,580
But I do. I was it was great fun.

353
00:37:19,580 --> 00:37:22,810
Oh, Peter Matheson is now going to be Vice-Chancellor Hong Kong University.

354
00:37:22,810 --> 00:37:32,710
He was a senior registrar that the professor of medicine at at at Brighton was the registrar.

355
00:37:32,710 --> 00:37:42,580
Patrick Maxwell was say so I've it's been great fun working with some extremely talented people.

356
00:37:42,580 --> 00:37:47,250
So when you came as a consultant, you weren't swamped by the clinical work.

357
00:37:47,250 --> 00:37:51,880
He could get some research. Yeah, I did. But in fact, I drowned eventually.

358
00:37:51,880 --> 00:38:01,240
Right. And it was just this was, I think, exhausted and burnt out.

359
00:38:01,240 --> 00:38:06,460
And we were going through the crisis.

360
00:38:06,460 --> 00:38:10,420
I mean, Derek, he would remember when we used to ration dialysis. Yes.

361
00:38:10,420 --> 00:38:14,530
Such the diabetics were not favourably thought about.

362
00:38:14,530 --> 00:38:18,250
And now thirty percent of the patients starting dialysis are diabetics.

363
00:38:18,250 --> 00:38:23,230
There was there was a kind of almost prejudice against diabetics and prejudice against the elderly.

364
00:38:23,230 --> 00:38:32,440
And that and Des had a day fix that everybody had to go into home dialysis, which was going to break because not everybody could put up with it.

365
00:38:32,440 --> 00:38:36,100
Yeah. And it was it was it was pretty tough.

366
00:38:36,100 --> 00:38:45,070
I worked one in two nights and weekends and then things improved a bit in 1995.

367
00:38:45,070 --> 00:38:54,670
But so I became a collaborator. I collaborated with the team on polycystic kidney disease, which we had a lot of polycystic disease here.

368
00:38:54,670 --> 00:39:00,640
And that was that was fun because they found the gene hajee.

369
00:39:00,640 --> 00:39:06,550
Yes. They found the fact they found the major underlying chromosome.

370
00:39:06,550 --> 00:39:13,720
The the original author of the paper, um, called Steve Reed, has actually been headhunted to Yale.

371
00:39:13,720 --> 00:39:24,070
Yeah. To finish the job they found. Yeah. They found they'd found here, Steve, and found the more place where the gene was but didn't find the gene.

372
00:39:24,070 --> 00:39:27,490
So Yalgoo recruited him and he went over there and they were going to find it in six months.

373
00:39:27,490 --> 00:39:33,550
But the gene is duplicate and they didn't find it. And the man he left behind, Peter Harris,

374
00:39:33,550 --> 00:39:39,730
had a lucky break because there was a family where there was a crossover and Peter found it and got the got the paper.

375
00:39:39,730 --> 00:39:44,200
It was an Oxford family contribution contributed to that. I've collaborated with him.

376
00:39:44,200 --> 00:39:50,050
And then I just got a new interest, actually, which was one of two things,

377
00:39:50,050 --> 00:39:59,600
is that people with myeloma can develop acute kidney failure because they're like Chanes, some of them about 10 percent in the light chanes.

378
00:39:59,600 --> 00:40:07,220
Will find covalently to timbales for protein and form superglue in the tubules, and so the kidneys will just go off like that.

379
00:40:07,220 --> 00:40:13,580
And we saw cases like this and we had a very good pathologist to stain the kidneys beautifully

380
00:40:13,580 --> 00:40:20,120
and showed me the almost what I call red protein in the wrong peptide in the wrong area.

381
00:40:20,120 --> 00:40:25,940
And then I was a very big, very big state of patients here.

382
00:40:25,940 --> 00:40:35,000
And I was asked by the International General Assembly to give what was called a kidney forum,

383
00:40:35,000 --> 00:40:42,380
which was named by somebody to give a lecture on a case which is then recorded.

384
00:40:42,380 --> 00:40:46,910
And they invite the great and the good to hear it. And then it's published.

385
00:40:46,910 --> 00:40:51,450
And I offered the military personnel have done this because I'd seen leptospirosis.

386
00:40:51,450 --> 00:40:55,880
I said we've done that. So I said, well, I see a lot of my limited knowledge about it.

387
00:40:55,880 --> 00:41:05,090
They said, we'll do that, but learn about it. So I went dry for five months and read everything on on myeloma and gave this case.

388
00:41:05,090 --> 00:41:12,320
And it's been an enormous milestone. We've done two clinical trials here on trying to improve the prognosis.

389
00:41:12,320 --> 00:41:21,650
And interestingly, we can now pretty well stop the disease in its tracks because there are better drugs for turning off the light gene synthesis.

390
00:41:21,650 --> 00:41:28,890
But in the laboratory in America discovered which like Chanes who caused this catastrophe,

391
00:41:28,890 --> 00:41:34,070
we don't have a peptide blocker for it yet, but we've improved the prognosis.

392
00:41:34,070 --> 00:41:42,510
But so I've become the the person that people chatter about difficult cases of myeloma.

393
00:41:42,510 --> 00:41:56,180
And the nice thing about having worked in Oxford is watching my subject go from depressing to to quite optimistic big changes.

394
00:41:56,180 --> 00:42:00,680
When did transplantation come in to change the clinical scene?

395
00:42:00,680 --> 00:42:11,690
1974. Peter Morris arrived in 1974 and he had they were about 140 home dialysis patients who were young and otherwise fit.

396
00:42:11,690 --> 00:42:19,490
And he brought the Melbourne Royal Melbourne Hospital expertise here and started in 1974.

397
00:42:19,490 --> 00:42:25,100
We've not done they've done over 3000 transport must be getting on nearly 4000 now.

398
00:42:25,100 --> 00:42:30,320
So we do about 150. And it meant that there was not such a need for dialysis.

399
00:42:30,320 --> 00:42:33,560
But what it meant is that we were then taking on other people.

400
00:42:33,560 --> 00:42:41,300
And then Peter Friend arrived about 12 years ago and brought kidney pancreas transplantation, which when it's good, it's fantastic.

401
00:42:41,300 --> 00:42:45,170
I mean, you see these people's lives, the diversity activity transplant,

402
00:42:45,170 --> 00:42:52,040
if you do a great deal for the long standing tissue injury, in my view, the autonomic neuropathy, the disease.

403
00:42:52,040 --> 00:43:00,770
But it it it certainly stabilises. Yes. But that's been a very exciting event to hear.

404
00:43:00,770 --> 00:43:06,620
Now, that's fascinating that because I always think really the tissue damage is at least two stages.

405
00:43:06,620 --> 00:43:14,270
And if you go to the second stage, you're never going to reverse it, let alone stop it completely, but reduce the rate of progress,

406
00:43:14,270 --> 00:43:25,010
because it reminds me of another wonderful moment in my time as a working here is that angiotensin converting enzyme inhibitors,

407
00:43:25,010 --> 00:43:35,930
which we were told would not would not really fly. And I was the one and there was a woman with a bad blood pressure.

408
00:43:35,930 --> 00:43:42,120
It was had renal failure and undergone it again. And we couldn't control it except with drugs that made it very symptomatic.

409
00:43:42,120 --> 00:43:47,090
Mithal Dopa and Minoxidil, which made her hair. And she said she was in terrible way.

410
00:43:47,090 --> 00:43:52,880
And John Ledingham said, we've got to give her this new squibbing drug, which I think was need to think about it all.

411
00:43:52,880 --> 00:44:01,580
So he got on the phone and asked them all see blood pressure in Glasgow to send him a packet and they sent him packing and leaving with.

412
00:44:01,580 --> 00:44:06,100
Absolutely. So he said, oh, they said, no, no, we can't do this.

413
00:44:06,100 --> 00:44:16,010
This the drugs under way. So he said, but if you send us the patient, Sir John Ledingham turned to me Friday afternoon about three 45 said,

414
00:44:16,010 --> 00:44:23,840
Chris, get this weapon on the shuttle up to Glasgow due tomorrow and get her sent to the MRC blood pressure.

415
00:44:23,840 --> 00:44:32,270
So I said to John Hughes, Doctor, I think you've got a slightly optimistic idea of my powers of influence here.

416
00:44:32,270 --> 00:44:38,180
I think you better phone the House governor and see whether you can fix up a taxi to Heathrow and pay for the air ticket.

417
00:44:38,180 --> 00:44:42,720
So he said yes. Suppose he said, but what you have to do is do a very good discharge.

418
00:44:42,720 --> 00:44:49,880
I mean, I don't want to a poor discharge summary going. It's not by now that quarter past four and the secretary's gone.

419
00:44:49,880 --> 00:44:56,400
So I went into the office and there was Molly, who was the home dialysis organiser, and I said, Molly, I have a favour to ask you.

420
00:44:56,400 --> 00:45:03,420
Molly typed on a golf ball typewriter. My. That went up there and this woman went up to Glasgow and they put her on Captopril

421
00:45:03,420 --> 00:45:07,710
and it works and she came back and she's still the patient mine right there.

422
00:45:07,710 --> 00:45:11,670
Just terrific. And she's in The Lancet. That's terrific. Yes.

423
00:45:11,670 --> 00:45:18,570
Was there any connexion, apart from oxygen between your Ripperton work and the oxygen sensing were?

424
00:45:18,570 --> 00:45:27,000
Absolutely. But I thought I must say what Sir Peter Radcliffe, I come here as the consultant director to senior registrar and I get invited to a

425
00:45:27,000 --> 00:45:34,600
basic science meeting on hypoxia and the risk ripperton and I said to the organisers,

426
00:45:34,600 --> 00:45:39,780
I don't think I'm the right person to go to this meeting because I would love to go.

427
00:45:39,780 --> 00:45:48,330
But I would be a spectator because I've got nothing to contribute. And could I give my place to Peter Ratcliffe, who's interested in regional hypoxia?

428
00:45:48,330 --> 00:45:54,960
So they said, no, you can't, but you can go with him and you can share the travel money and the hotel room.

429
00:45:54,960 --> 00:46:00,000
So if we went and it set him off and he's kind enough to admit that, that's what I mean.

430
00:46:00,000 --> 00:46:05,940
So he went and he heard all the best basic scientists. And then he came back and he taught himself molecular biology.

431
00:46:05,940 --> 00:46:08,730
TAUTOU He said, I want to understand what turns the other person on.

432
00:46:08,730 --> 00:46:15,900
And as you know, he discovered the mechanism, which I think you'll probably get recognition other than his fellowship, the Royal Society.

433
00:46:15,900 --> 00:46:20,680
And he he took on the registrar, Chris Pugh.

434
00:46:20,680 --> 00:46:26,340
He'd also been a student here, and he took on Patrick Maxwell, who'd been a student here.

435
00:46:26,340 --> 00:46:32,580
And and the rest is history. So it was he said, I'm not interested in hiring reposing works name.

436
00:46:32,580 --> 00:46:38,310
It works, but I'm interested in I'm interested in in how it's controlled.

437
00:46:38,310 --> 00:46:44,640
Yes. And his wonderful experiment was everyone thought the kidney was the only organ that had an oxygen sensor.

438
00:46:44,640 --> 00:46:52,190
So you get a whole lot of experiments in which he transected cells with reporter Jean and he found that they all seem to switch on.

439
00:46:52,190 --> 00:46:54,240
And he thought he must have missed his experiments,

440
00:46:54,240 --> 00:46:59,820
that he'd found the phenomenon of widespread oxygen sensing death, which he had some trouble getting published.

441
00:46:59,820 --> 00:47:06,510
But of course, it led into understanding of of of possible Lindahl disease.

442
00:47:06,510 --> 00:47:10,650
And he did into the understanding of tumours and all sorts of things.

443
00:47:10,650 --> 00:47:15,360
So it was it's a it's a been a major biological discovery.

444
00:47:15,360 --> 00:47:23,760
I didn't take I didn't take an iota of credit, but it was rather nice that he was interested in kidney hypoxia and I was interested in the right spot.

445
00:47:23,760 --> 00:47:28,680
And it just happened that there was this wonderful little meeting in Paris that we both went to.

446
00:47:28,680 --> 00:47:31,090
So his labs were in the main job.

447
00:47:31,090 --> 00:47:39,220
They were in the erm and I think actually how much of the church do you feel sort of bit isolated from the German general?

448
00:47:39,220 --> 00:47:45,930
Fairly. I think it's I think we would have been a bigger and a better kidney unit if we'd been on the mainland side,

449
00:47:45,930 --> 00:47:50,940
because I think we would have collaborated with cardiology and chronology and everybody else.

450
00:47:50,940 --> 00:47:56,130
I think we would, yeah. I think I could imagine that we would have seen research projects.

451
00:47:56,130 --> 00:48:02,190
But because because there was this London road between us, we didn't have an intensive care unit.

452
00:48:02,190 --> 00:48:09,150
We I think we were a little bit the the country cousins in that, which I think is a pity.

453
00:48:09,150 --> 00:48:13,140
I mean, we have we only wanted to be down. We wanted to not aged or a coronary angiogram.

454
00:48:13,140 --> 00:48:20,940
The patients had to be shipped over there. The other thing we didn't have the we didn't you know, you didn't have that sharing of ideas and chatting.

455
00:48:20,940 --> 00:48:27,270
You know, we were a bit isolated. We had the best ideas is always in the gaps. And so that wasn't a good time.

456
00:48:27,270 --> 00:48:37,920
Did you go to the Thursday afternoon round round, for instance? Yes, I doubt I the they were kind of slightly the high point of the of the week.

457
00:48:37,920 --> 00:48:44,670
I set up our own renal runs here on a Tuesday afternoon for the biopsy meeting with the grand rounds.

458
00:48:44,670 --> 00:48:50,760
I made a point of getting to and I just had the standard of the presentation was excellent.

459
00:48:50,760 --> 00:48:54,060
The sad thing is that they're not very well attended anymore.

460
00:48:54,060 --> 00:48:59,610
I don't know what it is. I mean, they were almost a three line with medical students to be there and the junior doctors would be present.

461
00:48:59,610 --> 00:49:05,160
And it was considered, you know, it was a thing you did. They didn't seem to be taken quite seriously.

462
00:49:05,160 --> 00:49:11,790
But the stand is extremely high. And Peter Radcliffe is a fantastic, fantastic chairman.

463
00:49:11,790 --> 00:49:16,560
He always asks very searching questions. David, whether it was a very good one.

464
00:49:16,560 --> 00:49:17,370
Wonderful occasion.

465
00:49:17,370 --> 00:49:29,760
Tim Littlewood presented a case of thrombotic TGP and they treated the patient and they got better with infusions of fresh frozen plasma.

466
00:49:29,760 --> 00:49:36,560
Never knew how this worked. So did Wetherall knew that work, but he was too embarrassed to meet with.

467
00:49:36,560 --> 00:49:45,270
And so he said, Doctor, what is it? Dr Littlewood, do you know how plasma infusions work in TCP?

468
00:49:45,270 --> 00:49:49,860
Latimers would said yes, yes, yes.

469
00:49:49,860 --> 00:49:54,000
I guess so. They were. Are you going to tell us?

470
00:49:54,000 --> 00:50:05,390
No, it's a secret. Which I thought was a nice way of saying, you can mock me, but I could get my neighbour to, in fact, as you know,

471
00:50:05,390 --> 00:50:14,360
and I discovered that actually it's because these patients lack of approaches that breaks down one valbrun factor.

472
00:50:14,360 --> 00:50:18,980
So we knew that she knew how it worked. Now, you mentioned pathology.

473
00:50:18,980 --> 00:50:27,660
How important is that? And the back up to the original. What I said is we we we we would be incapable of doing our jobs.

474
00:50:27,660 --> 00:50:30,710
We've had three excellent pathologists. We've had Michael Dunn.

475
00:50:30,710 --> 00:50:40,440
He was of course, he's a fellow American and he was one, but he was also a director of clinical studies.

476
00:50:40,440 --> 00:50:46,790
And I was told when he came, he came as a lung pathologist and there was no such thing as a pathology.

477
00:50:46,790 --> 00:50:51,060
And John Ledingham said to him, you have to take this on as an aside. And he did.

478
00:50:51,060 --> 00:51:02,930
And he wrote Donal's textbook of renal pathology to be up there somewhere and gave us a fantastic service.

479
00:51:02,930 --> 00:51:13,220
And then when he retired, we managed to recruit the reader in pathology in St. Thomas's, who David Davis.

480
00:51:13,220 --> 00:51:15,650
And he was wonderful, very supportive.

481
00:51:15,650 --> 00:51:24,320
And when we were doing talks or writing book chapters, they would always come up with the illustrations, very loyal to the kidney unit.

482
00:51:24,320 --> 00:51:32,810
And and then when he retired, we'd been even luckier because we recruited one of the top four pathologists in the world.

483
00:51:32,810 --> 00:51:41,730
And a chap called Ian Roberts, who is has a fantastic reputation, is a brilliant teacher,

484
00:51:41,730 --> 00:51:47,550
a fantastic diagnostician and and a good researcher and very loyal to us, too.

485
00:51:47,550 --> 00:51:55,000
So he's not somebody who's sort of absent without leave. I mean, he's here for the meetings and that.

486
00:51:55,000 --> 00:51:59,540
The trouble is that and this does worry me a bit as the NHS university divide,

487
00:51:59,540 --> 00:52:07,010
is that if I wanted to make a suggestion to people, I would in fact have no university hospital divide.

488
00:52:07,010 --> 00:52:12,890
I would have a set of salaries. And the clinical director could say, you're doing good work.

489
00:52:12,890 --> 00:52:18,830
I think what we're going to do is to reduce your clinical work a bit, give you more time. But people are stuck in a rather rigid job description.

490
00:52:18,830 --> 00:52:23,810
So he has a huge workload. And I think he would say, well, he was one example.

491
00:52:23,810 --> 00:52:27,050
A lot of people, I think, where you could see early in your career,

492
00:52:27,050 --> 00:52:32,360
you could flex the amount of of clinical and research work you doing in someone's research work was going well.

493
00:52:32,360 --> 00:52:38,300
You I think you could ease off on that. Someone was an excellent teacher. You know, you could flex things, but people look.

494
00:52:38,300 --> 00:52:42,290
So anyway, pathologies been pretty good.

495
00:52:42,290 --> 00:52:46,120
So the aspects you have. Bacteriologists Yes.

496
00:52:46,120 --> 00:52:55,850
Interestingly, the great change in in in in microbiology and microbiology used to be a place we sent samples.

497
00:52:55,850 --> 00:53:00,950
We went in there. You could smell the ego. Now they are out amongst us.

498
00:53:00,950 --> 00:53:06,980
So terrific and everything. And you can find them up and say, what should I do?

499
00:53:06,980 --> 00:53:08,870
You can say, I've got this job. What should I do?

500
00:53:08,870 --> 00:53:16,880
Then I on the wards, in fact, they come to our transplant meetings, they help us diagnostically and they've got new diagnostic methods.

501
00:53:16,880 --> 00:53:21,920
Say, for example, cytomegalovirus, which is diagnose in retrospect from seroconversion,

502
00:53:21,920 --> 00:53:28,460
is not diagnosed today by PCR test on the number of CMB copies.

503
00:53:28,460 --> 00:53:34,340
And they can tell you straightaway, they can tell you how the patient can help us with the patient's treatment.

504
00:53:34,340 --> 00:53:43,700
So there was a lovely virologist. She was you started that his name is going to go to my head at the moment who died some years ago?

505
00:53:43,700 --> 00:53:49,880
John Tobin. Oh, yes, Sir John was lovely because he would come to the meetings and say,

506
00:53:49,880 --> 00:53:54,380
I've got some results here, and he would tell you what the significance of the results were.

507
00:53:54,380 --> 00:54:04,280
But he wasn't really a clinical microbiologist. And now we've got Derek Crook and Chris Conlon, who will have very strong infectious disease.

508
00:54:04,280 --> 00:54:07,790
So the good collaboration between them.

509
00:54:07,790 --> 00:54:13,940
So, I mean, John Kerry and I particularly remember because he was supportive on the virology front, that we've got good,

510
00:54:13,940 --> 00:54:19,850
good virologists and they all got a clinical trial, some of them new clinics, and they do stuff on John Walker.

511
00:54:19,850 --> 00:54:26,770
And I would say that's true. Never we never lonely now. And there's any of the bacteriological genetic now.

512
00:54:26,770 --> 00:54:41,750
Yes. As you probably know, they did a beautiful piece of work on Castrillon difficile, which proved that it's not in intra hospital.

513
00:54:41,750 --> 00:54:51,890
It actually is coming in from outside. And given the thrashing that we got from the Daily Mail and in Parliament, from the Department of Health and,

514
00:54:51,890 --> 00:54:59,480
you know, we were Macchi doctors, you should have learnt from what was his name in Austria, you know.

515
00:54:59,480 --> 00:55:10,080
Some of them, obviously, and, uh, when this piece of work, it was not as simple as that, are a lot of organisms, actually it's not much inside.

516
00:55:10,080 --> 00:55:15,980
It's it's coming in. I don't remember seeing any of that in the Daily Mail or on the Today programme.

517
00:55:15,980 --> 00:55:23,300
So that was work done by, I think, Derek Crook, Peter Panopto heavily involved there.

518
00:55:23,300 --> 00:55:28,790
Now they've been tracking the MRSA. Is that looking at the tuberculosis?

519
00:55:28,790 --> 00:55:36,170
We had one fantastic example of a woman who became hepatitis B positive on the dialysis unit.

520
00:55:36,170 --> 00:55:41,990
And the assumption is immediately that we've given to her by the dialysis needles or blood transfusion.

521
00:55:41,990 --> 00:55:50,330
And anyway, she they took her hepatitis B virus away and they and they sequenced it.

522
00:55:50,330 --> 00:55:59,600
And actually, one journey found in Indonesia. And she migrated from there about 40 years ago and it must have been dormant in her.

523
00:55:59,600 --> 00:56:04,400
And so we were let off the hook as not having been the the criminals.

524
00:56:04,400 --> 00:56:19,050
So watching molecular microbiology. So cytomegalovirus, hepatitis C, I mean, we can even call B.K. virus that infects kidneys.

525
00:56:19,050 --> 00:56:23,720
Did you talk to anyone then? It's like now because just, you know, you just get the test,

526
00:56:23,720 --> 00:56:29,110
whereas we had to work on it on the basis of this is clinically likely, but we can't be sure.

527
00:56:29,110 --> 00:56:35,660
Yeah. And dietitians well, renal units can't function without dieticians.

528
00:56:35,660 --> 00:56:43,080
The interesting thing was that we really needed was the dietetic service that was prohibitive and we stopped people eating.

529
00:56:43,080 --> 00:56:50,070
Yes. And now actually they're completely different. Now they are nutritionists rather than less than that.

530
00:56:50,070 --> 00:56:54,530
So we have our own team have their own offices here. They got all our patients.

531
00:56:54,530 --> 00:56:58,880
We refer to those that are malnourished.

532
00:56:58,880 --> 00:57:04,250
They they're pretty on to us. They track the ward patients and their caloric intake.

533
00:57:04,250 --> 00:57:10,950
And if they're not feeding, they're the first ones to start telling us it's time to set up the initial feeding.

534
00:57:10,950 --> 00:57:19,160
And they're very good at constructing the central feeds based on so interesting example of

535
00:57:19,160 --> 00:57:26,210
multidisciplinary working because nephrologists alone wouldn't really be able to do anything.

536
00:57:26,210 --> 00:57:31,220
So we have the first I mean, our nurses are have a lot of independence,

537
00:57:31,220 --> 00:57:36,200
so we have no specialists and they come to us, they say, I've done this much, done three quarters the job.

538
00:57:36,200 --> 00:57:44,300
I just need to know whether we going to go left now right or stay the same nurses, dieticians, the two I can think of.

539
00:57:44,300 --> 00:57:46,700
And the other thing is quite a lot of social support.

540
00:57:46,700 --> 00:57:55,910
Yes, I'm sure because of the with the families, because I mean, renal disease is not a kind of thing to a family and physiotherapists.

541
00:57:55,910 --> 00:58:00,860
Yes. We don't have enough of them there. They're the ones that stop up,

542
00:58:00,860 --> 00:58:09,530
get our patients mobilising because they're tough with them and have difficulties once again with this example of being on the wrong side.

543
00:58:09,530 --> 00:58:16,910
You know, we have kind of strokes. And what we need is straight medicine is completely different from what it was when I was a junior doctor.

544
00:58:16,910 --> 00:58:24,860
I mean, it was it was a sort of Didden phenomenon. So there that we can't do without them occupational therapists as well,

545
00:58:24,860 --> 00:58:34,400
because the occupational therapists will suss out a person's abilities and their suitability for home pretty quickly and courteously.

546
00:58:34,400 --> 00:58:38,440
They seem to have the wherewithal to say, give me five days and I'll get the wherewithal.

547
00:58:38,440 --> 00:58:42,000
And then here you are in Oxford.

548
00:58:42,000 --> 00:58:51,500
But you went after the region probably. Yes. So Oxford is a it's got a hospital for a big city in a small way, essentially.

549
00:58:51,500 --> 00:58:59,060
What is a small town, really? And I was very keen that we should not lose out.

550
00:58:59,060 --> 00:59:07,550
Ah, just to general hospitals. Not only do they teach our medical students, they are junior doctors go out to rotate out there,

551
00:59:07,550 --> 00:59:11,150
but also our clinical our clinical referrals come from there.

552
00:59:11,150 --> 00:59:16,970
And Oxford couldn't justify being a big kidney unit if we only looked after the city of Oxford or 600000 people.

553
00:59:16,970 --> 00:59:25,700
So we took off. We are really in it for for about one point eight million and the transplant unit for about 2.5 million because we do wedding.

554
00:59:25,700 --> 00:59:29,090
So quite early on, I offered to go to Northampton.

555
00:59:29,090 --> 00:59:35,780
I used to go to Northampton, where I met the famous Charles Fox who worked with him on his diabetic nephropathy patients.

556
00:59:35,780 --> 00:59:39,110
And we set up a dialysis unit there. So that was quite a lot of travel.

557
00:59:39,110 --> 00:59:45,650
So I used to look after that. And then somebody in Whitehall decided to redraw the map and created something called Northampton,

558
00:59:45,650 --> 00:59:53,240
Leicestershire and Rutland Water and confiscated Northampton Practise that we took on the whole of Buckinghamshire.

559
00:59:53,240 --> 00:59:59,210
So we run a big kidney into Milton Keynes, a big kidney unit in Stoke Mandeville and had been kidney unit in.

560
00:59:59,210 --> 01:00:05,990
We can and we've always lived up to Swindon. And after much fighting, we have a big kitchen unit in Swindon.

561
01:00:05,990 --> 01:00:12,920
We never looked after reading and we used to look after lost by referral, but then they go to Bristol.

562
01:00:12,920 --> 01:00:19,940
So I'm in favour of a hub and spoke model because it's good for our referral.

563
01:00:19,940 --> 01:00:27,070
Practise is good for patients too, because the patients are getting difficult for just a general hospital and not being patronising.

564
01:00:27,070 --> 01:00:36,350
It's nice to know they can go in and have the registrars get good experience and it means we have a lot of throughput.

565
01:00:36,350 --> 01:00:40,400
What it means is a good team working for the patients and go back there and we need

566
01:00:40,400 --> 01:00:45,530
the number of beds in our transplant unit transplants for later reading as well.

567
01:00:45,530 --> 01:00:54,220
So they've got a very big catchment area. So you do have patients in Banbury and er and I do the mistake and the mistake madam, but I'm the only one.

568
01:00:54,220 --> 01:01:03,000
Northampton was confiscated. I lost my clinics there, so I became peripatetic so I would go to any unit that was under pressure.

569
01:01:03,000 --> 01:01:07,100
So I worked in Milton Keynes, I worked in Swindon, I worked in Sacramento.

570
01:01:07,100 --> 01:01:16,520
I would just get in the car and go and do the clinics out there because like when you're a bit older, you can work a bit faster and take a registrar.

571
01:01:16,520 --> 01:01:24,770
But it wasn't ideal. What they needed, I think, was a consultant there who the the the general physicians could come and talk to.

572
01:01:24,770 --> 01:01:30,620
So we're trying to set that up. We've set that up in Milton Keynes and and in and in Swindon.

573
01:01:30,620 --> 01:01:38,960
But these two doctors, both of whom were registrars of ours, you are teaching the students out there and the registrar.

574
01:01:38,960 --> 01:01:49,940
So it's a it's a it's virtuous. How often do you get up to London for the conferences or, you know, government bodies?

575
01:01:49,940 --> 01:01:52,340
I used to be quite a lot of that. I was a sense of the Royal College.

576
01:01:52,340 --> 01:01:58,610
I had, um, I was secretary of the association and I was a clinical vice president.

577
01:01:58,610 --> 01:02:04,580
I was asked to stand for president, but then a colleague of mine rang up and said, I understand, are you standing?

578
01:02:04,580 --> 01:02:08,480
And I said, if you're standing, I'm going to nominate you. And he was brilliant.

579
01:02:08,480 --> 01:02:13,310
So I never became president. I found that.

580
01:02:13,310 --> 01:02:23,060
Yeah, I. I find that really exciting being in the middle of your speciality when you thought you could make a difference.

581
01:02:23,060 --> 01:02:27,350
And we did make a difference. We wrote persuasive public policy documents.

582
01:02:27,350 --> 01:02:34,070
We argued our corner on things. We revitalised our national society.

583
01:02:34,070 --> 01:02:40,850
We made it really buzzy. We didn't make it London centric. We made we had one meeting a year.

584
01:02:40,850 --> 01:02:47,480
We met round the country. We got the young consultants on board and we gave them jobs to do.

585
01:02:47,480 --> 01:02:53,690
We set up a registry of all the patients, the renal failure. So it was really fun being in the middle of that.

586
01:02:53,690 --> 01:03:01,150
I did a bit of advising of the Department of Health occasionally, but they then got their own person.

587
01:03:01,150 --> 01:03:08,630
I've done a few things for the BBC and the BBC came here and was talking about great

588
01:03:08,630 --> 01:03:15,560
engineering discoveries and some of the college that I go up to Oxford and not.

589
01:03:15,560 --> 01:03:18,980
We discovered the kidney machine was discovered in Holland at the Second World War.

590
01:03:18,980 --> 01:03:25,400
And in Sweden we had some of the original one, one of the original ones here.

591
01:03:25,400 --> 01:03:32,720
And John, let me say, this chap came up, Porter came up to interview me and he was wonderful.

592
01:03:32,720 --> 01:03:38,090
He's very good looking man. And all the nurses were sweet. He came along and he talked to a patient that I talked to him through the day.

593
01:03:38,090 --> 01:03:42,050
And he was a very nice programme. He I gave him the history, whatever.

594
01:03:42,050 --> 01:03:45,510
It was a really nice programme. And I was fed up into Wednesday afternoon.

595
01:03:45,510 --> 01:03:55,460
Here it is. But I have a sister in law who quite a long time find me a rather annoying brother in law and quite annoyed,

596
01:03:55,460 --> 01:04:00,230
I think, because she's very close to my wife. And when we came here, she didn't have any contact with her.

597
01:04:00,230 --> 01:04:08,540
So we got all right. But I think she try me a bit irritating. Anyway, she was travelling on the outback of America, of Australia in a four by four,

598
01:04:08,540 --> 01:04:13,790
and the Australian Broadcasting Corporation buys presents from the ABC.

599
01:04:13,790 --> 01:04:20,570
Say she rang my wife and said, here am I in the middle of the outback?

600
01:04:20,570 --> 01:04:31,130
And I turn on the radio and he said, Oh, yeah, but your bloody husband and you were writing textbooks about subjects.

601
01:04:31,130 --> 01:04:36,470
Yeah, we've done I've edited the fourth edition of the Oxford textbook of Clinical Neurology.

602
01:04:36,470 --> 01:04:48,500
But, uh, when does the first, uh, first was the first time in the in the in the late 80s,

603
01:04:48,500 --> 01:04:57,920
I was an associate editor and, um, especially a clinical textbook, the American textbooks, a very theoretical, um, um.

604
01:04:57,920 --> 01:05:03,620
And this book is. Supposed to be for the practising the Folger's, a squad of illustrations.

605
01:05:03,620 --> 01:05:09,790
It's good, but I actually think the days of textbooks are numbered because you can't you produce it.

606
01:05:09,790 --> 01:05:12,950
It's out of date. And I think actually people are going to do everything online.

607
01:05:12,950 --> 01:05:25,760
Yeah, I read a textbook on Earth Ripperton, which was not textbook, but what I refer to not as quite quite fun.

608
01:05:25,760 --> 01:05:33,200
No, I mean, I think that's the lovely thing about being in Oxford is I've had a nice mixed life of clinical and research.

609
01:05:33,200 --> 01:05:44,390
And about 10 years ago, I was asked to take in the Peter Redcliffs role as the clinical trial Jesus college girl that introduced me to college life,

610
01:05:44,390 --> 01:05:50,090
which is quite different from anything else one can possibly experience,

611
01:05:50,090 --> 01:05:57,200
because they're are people with very different interests and some of them are broad minded and some of them are rather narrow.

612
01:05:57,200 --> 01:06:03,500
And they don't have extraordinary traditions like, for example, that when a fellow retires,

613
01:06:03,500 --> 01:06:07,640
the most recently appointed fellow makes the farewell speech because he's the person you know,

614
01:06:07,640 --> 01:06:12,770
she's the person most least likely to to have any grudge.

615
01:06:12,770 --> 01:06:18,860
Exactly. So I had to do a speech on retiring, but his name was Bill.

616
01:06:18,860 --> 01:06:23,640
So I said, well, when I Googled it, I said I got rather more than a bug.

617
01:06:23,640 --> 01:06:32,780
And I have asked me to be a bit more specific. And so I teach the medical students I've been involved in student.

618
01:06:32,780 --> 01:06:42,150
You know, the GMC requires a clinician to be involved in in interviewing students and they have to be for the colleges.

619
01:06:42,150 --> 01:06:49,400
So they get there, that they get in, but they have to be interviewed by more than just the preclinical scientist.

620
01:06:49,400 --> 01:06:55,710
And I find I've actually written about not shaji, I've written about because I find it I quote,

621
01:06:55,710 --> 01:07:04,400
I guess they're called discomfit in December because you meet 30 remarkable young people and you can choose for.

622
01:07:04,400 --> 01:07:10,250
Yeah. And you don't know how the interview ends and you look at their at their personal statements and what have you.

623
01:07:10,250 --> 01:07:14,720
And of course, I, you know, I'm always pleased with the ones that have come here,

624
01:07:14,720 --> 01:07:18,890
but I was worried about the ones that didn't and and this whole business.

625
01:07:18,890 --> 01:07:29,990
But I think Oxford has a very tough time trying to balance a fairness agenda and and and equality attract the best people.

626
01:07:29,990 --> 01:07:34,250
But that's been been fun and I must be supervised and so on.

627
01:07:34,250 --> 01:07:37,800
The pastoral tutor for four students in each year.

628
01:07:37,800 --> 01:07:41,990
So I must have I've taught them about I think I've done about 60.

629
01:07:41,990 --> 01:07:46,840
Some of them are consultants and and that come and talk to me about how things were going.

630
01:07:46,840 --> 01:07:54,470
And most of them are fine, but a few of them are not. You'd be the field supervisor to the University of NSW.

631
01:07:54,470 --> 01:07:58,460
One of these is actually what I would mostly supervise.

632
01:07:58,460 --> 01:08:05,270
I mean, I would be I think they used to call them up to the pastoral tutor, most of them all right, actually.

633
01:08:05,270 --> 01:08:12,920
But every now and then you have someone who runs into into choppy water and you just need an avuncular figure to talk things over.

634
01:08:12,920 --> 01:08:17,240
And I've been examined. The other thing was nice was the thing that was really one of the most exciting

635
01:08:17,240 --> 01:08:22,640
things that I was made an examiner and then had the temerity to criticise the exam.

636
01:08:22,640 --> 01:08:27,040
Yeah, yeah. As I said, I said, you know, you can spot just three essays.

637
01:08:27,040 --> 01:08:31,460
I said I said, well, what would you do differently?

638
01:08:31,460 --> 01:08:41,730
So then I found myself with a job and they made me senior principal examiner in medicine, which I found really great fun.

639
01:08:41,730 --> 01:08:47,360
Yeah, it did. So we we restructured the exam. So we did lots of stations.

640
01:08:47,360 --> 01:08:51,650
We did short questions rather than just three essays.

641
01:08:51,650 --> 01:08:59,510
We did some laboratory medicine. Um, we carried on doing physician surgeon.

642
01:08:59,510 --> 01:09:05,960
I said what I what I like about it. Well the, the wonderful thing was that most students were outstanding and the good thing

643
01:09:05,960 --> 01:09:09,860
was that the students that had lost their way were picked up by the exam.

644
01:09:09,860 --> 01:09:19,560
And either many of them, some of them repeated, but some of them were then had their electives lost and had to be put back on the straight and narrow.

645
01:09:19,560 --> 01:09:21,590
So I did that for for about eight years,

646
01:09:21,590 --> 01:09:30,890
actually setting the exam and having great fun looking to see how various questions correlated with the art of ventriloquism.

647
01:09:30,890 --> 01:09:35,510
But I, I used to come back after the exams and we do the honours fibres as well.

648
01:09:35,510 --> 01:09:40,690
And I would say to my wife, I've had the same as I used to call it, interviewing in December,

649
01:09:40,690 --> 01:09:45,920
services to call it, sort of know what I say does come discomfit in December.

650
01:09:45,920 --> 01:09:52,880
And I said Joy in January. I mean, when I examined it, I say, you know, we've done something right.

651
01:09:52,880 --> 01:09:59,520
These are bright. Someone would pass membership, actually, and.

652
01:09:59,520 --> 01:10:05,460
And and they're going to be housemen in six, seven months time and they're going to be looking after you and me.

653
01:10:05,460 --> 01:10:09,450
So, yeah, all this doom and gloom, I was rubbish.

654
01:10:09,450 --> 01:10:14,670
That's what I didn't ask about. Biochemists, how much did you have to do with them?

655
01:10:14,670 --> 01:10:17,580
We didn't have a great deal to do with them.

656
01:10:17,580 --> 01:10:34,610
Actually, we we we developed a good relationship with when a a really interesting bomb was dropped on us about two thousand and seven.

657
01:10:34,610 --> 01:10:40,910
And it went something like, this is not a criminal affair out there and it's not being diagnosed,

658
01:10:40,910 --> 01:10:46,640
it's not being treated properly or people are getting to see somebody too late.

659
01:10:46,640 --> 01:10:49,280
And it's because people can't interpret plasma crack.

660
01:10:49,280 --> 01:10:57,800
The plasma cracklin is determined not only by renal function, but by muscle mass and and age and race.

661
01:10:57,800 --> 01:11:04,100
So some guys in the states had done a study of dietary treatment, of renal failure,

662
01:11:04,100 --> 01:11:14,840
but that actually measured kidney function using a direct method and fellow made an injection and decay that they had all the plasma cracked.

663
01:11:14,840 --> 01:11:19,770
So they gave all the data to some mathematicians and said, what are we to the crack?

664
01:11:19,770 --> 01:11:24,760
And we tell you the the the actual GFR, which are you?

665
01:11:24,760 --> 01:11:34,670
The gender and the race and the age come up with the formula which saves us injecting Filaret.

666
01:11:34,670 --> 01:11:44,090
And they called it the indictee form. So all you have to then do was plug your crap and just plasma craton and you'll get a GFR.

667
01:11:44,090 --> 01:11:55,190
And this was like magic. So they did this, but of course the only patients that studied were patients renal failure and they hadn't got the upper end.

668
01:11:55,190 --> 01:12:03,440
And they and the and and it wasn't particularly accurate. But then they decided that anybody had a GFR, less than 60 had chronic kidney disease.

669
01:12:03,440 --> 01:12:09,380
And then the government decided that everybody chemistry department would have to say the craton was such and such.

670
01:12:09,380 --> 01:12:17,420
And this is a GFR of such and such. And then tell the doctor that this meant the patient either did or didn't have kidney failure.

671
01:12:17,420 --> 01:12:23,490
So, of course, a muscular man with the Craton 140 would be told that he had kidney failure because his GFR,

672
01:12:23,490 --> 01:12:29,270
he like these craton, it was high and take into account his muscle mass and they didn't take count of age.

673
01:12:29,270 --> 01:12:33,810
And the GP's getting these letters saying a patients got chronic kidney disease.

674
01:12:33,810 --> 01:12:41,480
So we talked to the the biochemists about this. They they they did the formula and we set up a system of warning, the GPS.

675
01:12:41,480 --> 01:12:45,050
It has to be interpreted based on mammograms and what have you.

676
01:12:45,050 --> 01:12:50,330
And they basically said Jonathan Kay was very supportive of Dr. Wilkinson, was very helpful,

677
01:12:50,330 --> 01:12:54,290
you know, with difficult cases where you had to measure things like Aluminium's and what have you.

678
01:12:54,290 --> 01:13:00,110
But I didn't we didn't do any sort of what I would call collaborative work with him.

679
01:13:00,110 --> 01:13:05,090
And of course, the imaging people, the radiologists will not be friend.

680
01:13:05,090 --> 01:13:13,380
Right? Well, I saw Fred died recently, so I arrived here and this was a one man band.

681
01:13:13,380 --> 01:13:19,280
And he was very hardworking, very helpful, but a bit idiosyncratic.

682
01:13:19,280 --> 01:13:29,820
He was he was very helpful. Very good. And I think he is an equal raise the money through the end of the give away his babies first to.

683
01:13:29,820 --> 01:13:36,470
Yeah. Which, you know, it's unbelievable because he kind of felt that it was his personal fiefdom, but he was pretty supportive.

684
01:13:36,470 --> 01:13:42,800
And then we got Fergus Gleason, who is a wonderful radiologist,

685
01:13:42,800 --> 01:13:47,120
and he's the sort of man you can go there on a Friday afternoon to try to fix the

686
01:13:47,120 --> 01:13:51,710
problem and find him thinking he's getting to the end of his week and he says,

687
01:13:51,710 --> 01:13:56,160
hello, how can I help? I think that's a wonderful thing to say to a colleague on Friday.

688
01:13:56,160 --> 01:14:04,450
I would say he was very good. And we had a radiologist called Nigel Cowan who left under a bit of a cloud, unfortunately.

689
01:14:04,450 --> 01:14:12,550
So, um, but we now have two other two other radiologists, and the other thing that we we we got we had what he Fletcher,

690
01:14:12,550 --> 01:14:17,210
he was a great doctor, scenography, and we have very good interventional radiologists.

691
01:14:17,210 --> 01:14:22,390
They and these guys can do the most magical things going up arteries.

692
01:14:22,390 --> 01:14:28,300
So they did our best to do our parathyroid sampling stuff. They would occasionally do our adrenal sampling.

693
01:14:28,300 --> 01:14:35,740
We didn't to do very often. They would plug holes in the kidneys that we biopsied that were bleeding.

694
01:14:35,740 --> 01:14:43,830
They would not very large restenosis. And, uh, I mean, as colleagues, there are they're pretty special.

695
01:14:43,830 --> 01:14:48,220
They're like the areas of these days that they've done is they do they.

696
01:14:48,220 --> 01:14:51,880
So actually, Nigel continues to do that. He used to he used to do these.

697
01:14:51,880 --> 01:14:53,950
Did they put the idea,

698
01:14:53,950 --> 01:15:01,510
that sort of thing they do to deal with obstructive eurocracy now is not the nightmare it used to be with Joe Smith trying to get something.

699
01:15:01,510 --> 01:15:08,410
And now as long as we can fix the patient not hyperventilating, not thrombocytopenic uraemic,

700
01:15:08,410 --> 01:15:14,180
these guys will pop up and degrade cafetorium and they consider it pretty routine.

701
01:15:14,180 --> 01:15:21,490
So we we take the obstructive Shomron. So interventional radiology and then MRI is come along,

702
01:15:21,490 --> 01:15:30,370
which has transformed our lives in terms of diagnosing kidney diseases because they very specific appearances in polycystic and lithium toxicity.

703
01:15:30,370 --> 01:15:38,830
Gosh. And and now we've got functional MRI, which helps us to diagnose the patients.

704
01:15:38,830 --> 01:15:47,410
We have patients transplants. You get you get Evvie driven lymphomas, but they are not in lymph nodes.

705
01:15:47,410 --> 01:15:54,430
Very often they're in the tissue lymphoma and they use this bluecoats.

706
01:15:54,430 --> 01:16:01,720
Yeah. UPD and and they said, yes, it's there and then we cannot track them so that we don't have the CT scans.

707
01:16:01,720 --> 01:16:07,060
They tell us it's getting smaller. This is all on the church because I mean, the cancer imaging here is pretty special.

708
01:16:07,060 --> 01:16:12,130
Yes. Yes. I mean. And how much cricket did you manage to play?

709
01:16:12,130 --> 01:16:21,220
I played a fair bit, um, but I couldn't do it when I was working one in two because I couldn't I couldn't get the weekends off.

710
01:16:21,220 --> 01:16:24,580
I used to play for the United Oxford Hospitals team.

711
01:16:24,580 --> 01:16:35,110
And, um, and he was the senior technician who's been here as long as I have used to be the used to be the groundsman.

712
01:16:35,110 --> 01:16:43,180
He used to do the ground at the other side and, um, and but now they've built a building to live.

713
01:16:43,180 --> 01:16:49,920
Yeah. I think a lot of people felt that it wasn't what it was supposed to be for. I people know where do they play just for interest.

714
01:16:49,920 --> 01:16:53,290
I think it's the clubs going around the city.

715
01:16:53,290 --> 01:16:59,300
Played a little bit of that sentence, John. I think it, uh, there was a ground up.

716
01:16:59,300 --> 01:17:03,670
Yeah. And of course, the last question, nobody can answer how to do it.

717
01:17:03,670 --> 01:17:12,280
It's all in, but nobody can answer that. Now, is there anything I should have asked you about Chris that I haven't?

718
01:17:12,280 --> 01:17:30,360
Come to me, I probably want to. But I can't think of anything except to say that I consider myself to be very lucky to have landed up here,

719
01:17:30,360 --> 01:17:37,430
and the thing that I find if I were to write my own obituary,

720
01:17:37,430 --> 01:17:49,590
I would I would wonder whether I would say that luck it favoured me or whether I'd actually made made the best of what I've got.

721
01:17:49,590 --> 01:17:58,770
But I have to pinch myself occasionally to think that that I was just going to be a I think, an academic physician in Cape Town.

722
01:17:58,770 --> 01:18:07,770
And then all these extraordinary accidents occurred. The accidents of getting I call myself an accidental Rhodes Scholar and then coming here.

723
01:18:07,770 --> 01:18:12,840
And I've been lucky enough to get a house job, which I wasn't because I wouldn't have had a house job otherwise.

724
01:18:12,840 --> 01:18:16,650
So that was a, you know, a little gift.

725
01:18:16,650 --> 01:18:28,110
And then meeting Peter Morris and getting a position in his life and being welcomed by the as Oliver and then getting that job at the

726
01:18:28,110 --> 01:18:34,230
Hammersmith and then being given the opportunity of working on the Metropolitan Museum of Art to give them their right hand to do that.

727
01:18:34,230 --> 01:18:47,730
Yeah. And then getting this job. So I every time I like I happened, I thought was it was it was lucky.

728
01:18:47,730 --> 01:18:52,440
But I hope that that I, I didn't.

729
01:18:52,440 --> 01:18:58,380
And I did something with the luck. But you never Garriock said that I practise.

730
01:18:58,380 --> 01:19:01,770
I find the luckier I get. Now you must have heard.

731
01:19:01,770 --> 01:19:08,670
I've heard that straightaway. So I just was one thing.

732
01:19:08,670 --> 01:19:15,030
If I, if I, when I talk to the students, I'm invited to go and talk to them before finals now that I'm no longer the principal

733
01:19:15,030 --> 01:19:20,010
examiner because I was incredibly nervous and they all decided they're going to fail.

734
01:19:20,010 --> 01:19:25,080
So I said, if you're sitting in this room for this tutorial, you're probably not going to fail.

735
01:19:25,080 --> 01:19:30,090
One of the failures are not here today because they're not not engaged.

736
01:19:30,090 --> 01:19:42,390
I said, can you just do me a favour and remember that in clinical medicine, you have to abide by clinical method.

737
01:19:42,390 --> 01:19:49,740
And clinical method starts with taking a history. And then you examine the patient and then you plan your investigations and then you

738
01:19:49,740 --> 01:19:54,250
interpret and then you're trying to make a diagnosis and then you plan treatment.

739
01:19:54,250 --> 01:19:57,946
You don't start slamming treatment into people as they come through the door.