You were just mentioning about the guy's son. Yes, that was the reason he went back.
He went back to be dean of the Sydney Medical School, stop neurosurgery and.
And he had a technique of tripping aneurysms which required me to do a sternotomy and clamp the carotid arteries going up to the brain,
having cooled the patient. It would take this all day, whereas I had been used to using hypertension and doing an aneurysm in about two hours.
But and Dick would operate furiously and then had to go away.
And I don't think he actually understood in those days.
And neurosurgeons had to know how to treat neurologists.
Yes, they did. Having spent a year at Queen's Square with some of the time with MacArdle, who's a wonderful neurologist and various others,
I mean, if you were asked to see a patient, you were expected to give him the opinion.
Mm hmm. And then the neurologist would decide whether or not he wanted you to operate or not.
And I've been well trained well both up to do that, whereas Dick would go along and before Brian Matthews knew where he was,
the patient was in the operating theatre, which did not go down.
Just to backtrack, who said her Cambridge Anatomy, was that Jeffrey Harris, was he then had he come to Oxford?
No, Jeff. Jeffrey Harris. He wasn't there when I was there as Chacko Boyd, who's professor of anatomy related to Richard.
And I might have been I think he was interesting. I never realised that Connexion is thinking about it.
They look similar. Right. But at one time, Pam Harris was Jeffrey Harris's daughter, who was my secretary.
Right. And so, yeah, I, I was a bit busy the first few years.
So who else was a consultant then? You must do a fantastic guy myself.
Yeah, but when he went to appointed, Mike Briggs was appointed and his interest was head injuries and stereotactic surgery.
Um, and to be honest I don't I was probably quite a difficult colleague.
Forceful. Well you need to be a surgeon. And I used to insist on basically running the department and I would do wardrobe.
And I see the patients at least every day.
And but it meant we were very efficient because if the patient needed to go, they went back to the same hospital, so few beds.
We managed to run quite a tight ship. How many did you have?
Roughly 50 in Central Park? No, I think we had enough in one ward.
Yes. And then there was one which was 21 beds, I think planned.
And then the head injury lot were downstairs and Cronshaw.
But the whole the AXTON service was really good.
Yes. And we supplied neurosurgery to it and we would see the patients and it it was a [INAUDIBLE] of a world winner in a way.
Yes. And very sadly, when the new hospital was built, that was destroyed.
That was one of the great arguments, wasn't it?
Well, I was very much involved with the with that argument because, I mean, initially we were destined to go up there.
And then Peter Morris came and said he wanted to go up there.
So we were left back at directive, which basically destroyed the accidents.
Yes. And I remember writing several documents and giving them to to double richardo,
saying the only logical way was that all the acute work within one hospital, you can have one eye to you and that should be the new hospital.
And then people would have to get used to doing the rescue work on a different side.
Not ideal, but it seemed to be logical.
The argument against that was that the university had supplied Cordura because they knew John Radcliffe Hospital.
Therefore they wanted a course hospital because they didn't want beds, but they would have the office space.
So they had a stranglehold of who went in and who didn't.
And basically, it wasn't good for Oxford Medicine.
That was a that was a huge argument and a lot of weeping about it.
It was, as I remember, David Hodgson coming into my office and he was white with anger because I what I thought,
which didn't agree with what he thought, but in a way, he was really suggesting that he said.
But his role was to to sort out who went up to the what the new hospitals didn't because we stayed and essentially had some patients up there.
And I was actually quite glad we had been, you know, reasonably cold.
Yes. And it was great, actually, in a way. It's a great hospital.
Yes. I really enjoyed the, um. It was a pretty though the ambulance service got this destroyed.
Yes. No, indeed. Then this summer, Akhmad haemorrhage. Am I right?
You did some work with Germana on clotting of fire at.
That's right. It wasn't you Joan on.
It was with another chap in the pharmacology department.
What what's very interesting about subarachnoid haemorrhage is the.
One of the really bad effects of a subarachnoid haemorrhage is after about three or four days,
the vessels in the head go into spasm and this is a very specific thing for intracranial vessels.
And the patients would just infarct off.
And I had one patient who I remember very well who had a subarachnoid haemorrhage.
She had an A. communicating artery aneurysm, a terrible spasm on the angiogram.
And I waited six weeks for that chap's spasm to clear.
And then I operated and found that that aneurysm had not ruptured and the culprit was one
in the posterior vertical or partially because it didn't do routine vertebral angiography.
We couldn't do it easily. So he had terrible spasm.
I really operated he developed even worse spasm and died.
Yeah, because, Jonathan, I was fascinated because one of Pickering's dicta was that you didn't get vascular spasm.
You knew that. But Pickering was always saying this. If I don't get it outside the blood, the head.
Yes, but it was incredible. You do an angiogram, there'd be no spasm.
And then just where the carotid goes through the dura.
Yeah. And we did a lot of work on that. We got it.
We used to do emergency RPM's and get the Basler artery and it would bust the arteries, continue to contract for several days after death.
So you can use it as a preparation. And we tried all kinds of things to counteract spasm.
We put on CSF from patients and watch a spasm and try and come through it.
And in fact, in those days I used to during surgery,
I used to canula the superficial temporal artery to feed a catheter down into the carotid so we could do serial angiograms in just in the ICU,
just one picture just to try and follow how this happened.
And then we could inject substances to try and stop it. We injected everyth everything we could conceive, prepare for it.
Didn't work. Nothing? No, nothing. Nothing worked.
I mean, there are some very powerful ways of doing it.
So I didn't touch who was the pharmacologist. Well, it.
David. Oh, yes, I know. With it's been there with Graeme Smith is.
Yeah. We did this work with David Boon who sat in a way lost interest.
And we still don't know the cause.
But there is something that takes about three days to develop in this blood CSF and some breakdown haemoglobin molecules.
But it doesn't happen to three days and then can what's the DNA at Queen's Kwabena Rosatom?
So so I know it was on the cervical spine.
Right. Which I still think people haven't got.
Right. Because the cervical spine is an amazingly mobile structure.
If you X-ray infection and extension, the range of movement is a hundred and fifty degrees or something like that.
And what I did was to put X-ray markers on the dura in the civil code and the nerve roots and took X-rays in the basement of the hospital.
Right. With that radiology radiographer, if you mention her name, I'll remember I went well, she was wonderful.
I mean, most people thought this was pretty bizarre. But how did you get inside the middle through Vallentine?
Of course, as I write it down. Yes. And I still think the biomechanics of cervical spine and what happens to the cord and the roots
when you move from flexion extension terribly important in the genesis of cervical Allopathy.
Yeah, because no movement, no more Allopathy right.
But nobody was doing flexion extension views before they, while they were trying to assess patients.
Extraordinary. And the other thing which was very relevant was that people were doing laminectomy and there
was a group of patients who after about 18 months would deteriorate and get further allopathy.
And this is always said we've got the diagnosis wrong. It's Hamas or some other reason.
But actually I am convinced what they did was they did the laminectomy.
They open the dura, expose the spinal cord.
And in those days it was considered a very good idea to cut the dentate ligaments on either side of the spinal cord to sort of free it off.
But actually, after about a year, you get a scar from cervical muscles, which would be attached to the spinal cord.
Right. OK, with that, with the dura left open sometimes, who would have been left?
So when they started regaining movement,
they were just tugging on this spinal cord because the jury was fixed for them and fixed where the surgery had taken place.
So there was a attraction on the spinal cord with flexion.
And I'm still think this explains.
Deterioration, and if that patient has a very mobile neck, then you shouldn't be doing a laminate and if you do a laminectomy,
certainly you should not be opening the door and cutting the dentist. So that was really the basis of my thesis.
And it's actually been a lifelong interest to me because nobody has accepted or thought about the importance of the biomechanics.
They began to do X-rays, infection and engineered at the.
Well, I did. Yeah, I know every patient.
It just in the logical. Yeah.
I mean if you're going to do an A. fusion which is open, which is often the better option, why not know what the movement has not.
And of course sometimes there's an natural slippage of one bone on the other, which is of course a one by Allopathy.
And you have to uh do flexion extension used often to see and I when I resigned
from the British Cervical Spine Society because I got so fed up with it.
Well, just about everyone else, but certainly the orthopod to belong to it, they just looked at an X-ray and that was it then.
No spinal troubles, lumbago that caused a lot of debate.
Always rage on. Lots of it. Yes, I did a lot of lumbar spine surgeries and I kept saying that you do back operations,
but like pain, not back pain from a can of cure, wear and tear in the back by operating on it.
Just very occasionally, there's some people with a slip of a four or five or three or four where you can
cure that pain by perfusing but basically do back operations for like pain.
And then away from the spondylolisthesis. Was was nature's way of doing a fusion?
Mm hmm. Mm hmm. Which meant you didn't have to put in lots of metal, which, of course, is the current trend.
People can't operate now on the neck or the back would not putting in schools and roads and engineers.
So it makes it a much bigger operation. I mean, sometimes it was vindication for that, but it's not.
Right. And then, Peter, today you got appointed Peter got appointed again, um, very difficult to get additional consultants appointed.
I think I had to threaten to resign before getting anyone.
But Peter got appointed and his interest is very much in the spine.
And he had two sessions at Stoke Mandeville and started producing stimulators in the spinal cord and this sort of thing.
Um. And I desperately wanted to get some sort of academic aspect to neurosurgery because I felt that it was a subject worthy of academic input.
Yeah, well, you were an investigator, obviously, in what you've been saying.
Yes. But when you were in that job, you couldn't have had that amount of time.
No. As a matter of encouraging others to do that sort of work and career, Hudson, as best he investigated a bit who had to had.
OK, the Hudson. Yes.
I mean, we did I saw the fraught relationships with the university, but I think it might be fair to say that, Professor, what is the real lesson?
So the neurosurgery was not an academic subject. And it is funny you didn't think the tribalism was.
And I apparently mortally upset him by saying I just did not have time to write a chapter for his book.
And I think he felt that it was a massive honour.
What I've just done, one for Peter Morris's yes book, that I was busy and I said I felt I could do a good job doing it.
And John Ledingham, who I thought was just wonderful, I just loved let him he said, oh, don't worry.
He doesn't understand that surgeons have to spend most of their time operating.
But Peter Morris there, to be honest, I felt Oxford was good for Peter,
but I'm not sure Peter is good for Oxford surgery because it was very much confined to his
particular renal transplantation and there wasn't any encouragement to develop academic,
uh, people in other parts of the world.
That's right. And I felt that was a real shame.
But eventually I did manage to get Richard Kerr appointed as a reader of neurosurgery,
and he was going to do some work on the effects of transplants in the ventricles
in relation particularly to treating Parkinson's disease with implants.
And unfortunately, Richard spent all his time doing clinical work and that upset Peter, understandably.
But that really put the kibosh on further development of academic neurosurgery till deposes arrived.
It was and is an absolute jewel in the neurosurgical arena, I think.
Incredible man, and then you must have been very gratified at the paternity results with Chris Burke.
Yeah, I was very lucky. The two big areas of my work was the pituitary side and the epilepsy side.
And I had John Kerry, who assessed the epilepsy patients and Chris Burke who assessed the pituitary.
And actually, there's absolutely no doubt in my mind that surgeons should not assess their own results.
Right. Um, I think lots of studies have shown that.
So I had John Oxburgh, who was very good at assessing patients who are candidates for epilepsy surgery, and Chris Burke,
who was obviously very good at it, was quite difficult as a surgeon to to get used to being criticised by positionally colleagues.
But it was the right thing. And he Chris Burke, was very rigorous in his assessment.
And it was right. It was good. And then John Ross took it on.
But the history of epilepsy surgery is quite interesting because I had seen quite a lot of epilepsy surgery.
The Murray, Faulkner and the guys with the unit and Kit Anstead was here when I came in the back.
Yes, he lived involved in it and he ran the Park Hospital.
And Kit always had a cigarette in his mouth, of course, but it was a wonderful man.
Yeah. He was really treated the children as a whole person and was very shrewd.
And I remember one patient that must have been very soon after I arrived here,
Murray Faulkner had been asked to see this boy who lived in Manchester and was destroying the family develop fits around 10 or 12,
beating up persisted, knocking doors down Morris and turned him down for surgery because he had by temporal independent sports and said,
You can't operate a kit USPI. He can't see Kit Anstead and Kit asked me to see it and I had to look at him and saw
the X-ray and I could see a very tiny speck of calcium in the right temporal lobe,
which I don't think Murray could have seen. But I said to Kate, well, there's the pathology.
And I was convinced that epilepsy surgery should be like any other form of surgery.
You find the pathology and remove it at Montreal, which was a form to epilepsy surgery.
They indulge in what I called Spike Chase.
They would do these massive operations on the local with young kids and do egs on the brain electrical topography,
find the spots and suck away the brain to the spikes could cause a lot of pathology went on suckler.
So anyway, I said to Kate, I thought we ought to do a temporal lobectomy on this boy.
And he agreed. So I did a right temporal lobectomy. I found a little calcified sort of astrocytoma.
Haematoma took it out and that boy never had another fit.
And the interesting thing to me was that the spikes on the other side, the left temporal lobe, completely disappeared.
Yeah. So I was absolutely convinced that you had to find pathology and remove it, rather, don't worry about the spikes.
But in those days, kids were going to Great Ormond Street and they would refuse to recommend people for surgery.
And I would often get them via Kit instead and we would operate on them.
But that that was the official line.
Epilepsy surgery was a no go area and the two paediatric neurologists great on the street would not recommend patients for it.
But I know it's all changed now. Yes,
but I made myself very unpopular going to some meeting in Palm Springs saying that it was a matter of finding pathology and forget about the spikes.
And of course, all the electroencephalography is, but.
I think in a subsequent events have shown that that's right. So how much did you use our pool?
And they looked very expensive. I mean, about other colleagues say compared to London, what did you think of the nursing directive?
Fantastic. Good. Really good. And the nice thing was we were a family.
We were a team for neurosurgery on Nafie one.
We all work together. We never, hardly ever cancel the patient now.
And if we ever had to, the ward sister and I, we would really sort of meet together and really think about it.
And it was so rare. And there was a there was a fantastic sort of family feel.
Right. And then the pathologists well, there was, of course, Trevor Hughes and David Oppenheimer, and they were very nice.
We had pathology sessions with them. David was David Oppenheimer was a delight, but he was much more academic, I think.
And my my memory of David would be if we sent off a biopsy during surgery,
he would poke his head around the operating room door and he would always say, could it be a meningioma?
And so anxious, not as a massive meningioma, which, of course, it benign, incurable.
And glioma is not basically but sometimes curable.
It's just not to draw.
I mean, sometimes most of course, on but on.
The very last patients I operated on was a young girl of 23 who had a Glomar which I took out and the centre of the radiotherapy.
And I said, ignore the radiotherapy.
So say you have six months to live, which in fact it did say and I said, I'm pretty confident I've taken this out.
And actually, she she was a lawyer and she went back to work.
She subsequently got married to a Frenchman and had three children. And I still have a problem from time to time.
And if that isn't to say that it's against the orthodoxy. Yes, no.
Well, I used to say statistics are meaningless to the individual. And, you know, so I mean, you said how you enjoyed Skylake and felt so good.
Did you feel like that after a big operation? I felt drained.
Yeah. I mean, acoustic neuromas. I always felt used to age me.
They're very difficult. Well, the patient is always worse because they may not have completely lost their hearing.
They usually didn't have a facial weakness. And you were incredibly pleased that you could take up what in those days were fairly
big acoustics and still preserve the facial and which was stretched as a tumour.
Yeah, and they were long, stressful operations in general.
I loved operating. I found it relaxing and.
You I, I suppose I found the operating room not difficult.
Mm hmm. And it was I was away from the telephone, away from my patients, and I was just there.
And I think it's a bit like being an athlete.
You get in the zone. Yeah. Yeah. And you're just totally concentrating on a microscope.
One my new area and nothing else impinges on you.
So, I mean, in your leisure time, what percentage of operations would have the dissecting microscope, the operating microscope, the majority?
You are sort of 90 percent in the head.
Yes, not in the not so well, occasionally in the spine.
If you were doing removing a tumour from the spinal cord.
And that was pretty rare. Um, I suppose my other area of interest, which is quite amusing story, really.
I got very interested in Trudgen around you.
And the theory developed that this was all due to compression of the fifth, the act where it enters the brainstem by an artery or a vein.
Uh, and the more I thought about that theory, the more it did not up.
Because one of the things about general neurology is that it's it's episodic.
People can go for months without it. Yeah. Uh, I wrote an article which I sent to the American Journal of Neurosurgery, which they they rejected.
And the reason was that it wasn't.
Everybody in America believed the cross compression of the test.
And I produced a lot of reasons why this couldn't be. And they're very unhappy about accepting it.
And I learnt a lot from this. The so-called science is full of emotion and very, very little to do with facts.
And eventually they published it and there was a huge outcry saying how unfair I'd be to genetics.
This American neurosurgeon whose theory criticised I pointed out some interesting facts are black Africans never get traditional neurology,
but they get hypertension early and that the vessels become torturous.
And you'd expect more often in people with dementia because of the atrophy in the brain and so on and so forth.
But about three months ago, I got an email from an American neurosurgeon who's always taken an interest in Trojan on the Rajha.
He said, I've been thinking about writing the project for the last 40 years and I think your paper is right.
What did that mean for therapy? Because they used to inject the game then?
Well, I said it doesn't. If you want to stop changing the neuralgia, you just have to damage the nerve prepared.
And Walter, daddy used to rub it, you know, expose the nerve and with a blunt hook, just rub it.
And his results were just as good as the microvascular decompression.
Um, you can use the gamma knife.
Uh, yes. Which is quite good. But the insulting it and the less you insult it, the more preservation of sensation you get.
But the higher recurrence rate. So it's a it's a sort of swings and roundabouts.
Does anybody know the pathogenesis? No, we don't.
And I'm sure that I'm sure there must be a genetic factor and I'm sure they'll find there's a biochemical effect.
I mean, if it does occur, people with their.
Of course, that's not uncommon.
Uh. And it may well be that some sort of mechanical disturbance of the nerve root is a factor, but it isn't in the majority.
I think the important thing is to to keep an open mind.
I was asked to go to the World Congress of Neurosurgery and to give a paper on trigeminal neuralgia.
And Ginetta, who was this American neurosurgeon, was asked to get the paper, said we were encouraging the debate.
So he gave his paper and then I got up to give mine.
And Janetta and a Japanese neurosurgeon called Fukushima stood at the back and barracked.
Well, I gave my paper, which is also slightly unusual.
And at the end, Fukushima came up and he bowed very low and he said, Mr. Adams, I'm very sorry.
That was a very Japanese thing to do. And we became very good friends after that.
If you see, uh, Tegretol is a great treatment.
But, you know, how does that suddenly work if it's a mechanical.
Yes. Compression. Yeah. So how many articles did you write for medical scientific journals?
Oh, quite a lot. Yeah. My Fusion 80.
I like to think that the sort of contributions I made with the cervical spine,
which I have to say I don't think my contributions have yet been appreciated.
But that's right. I tried to arrange.
I wrote a lot about and obviously epilepsy surgery.
I mean, I know one interesting story I went to.
I was asked to give a lecture in the Aether Dome at Mass General out on sabbatical, my Allopathy.
So I went along and I showed my research on movement and how that affects the dura and so on and so forth,
and explained that I like to analyse the mechanics of the spine and then decide what
sort of surgery should be done on the decompression or effusion from in front of.
So I gave my talk and the neurosurgeons there were pretty scathing, you can say, and they said, oh, we get very good results.
Just doing a decompressive laminectomy. Uh, I, we don't need infusions from from we don't need to analyse all this nonsense.
So I said, okay, well, we are. At the end of a lecture, Professor Raymond Adams came around to professor of neurology at Mass General and he said,
Mr. Adams, that was a very interesting talk. Thank you.
He said, you know, the results for surgery for survival lot correspondent allopathy here.
So by stop referring patients to that, surgeons are obviously, you know,
the surgeons were operating on a small group of people with very narrow and immobile cervical spine.
So there is a group where they're just they're born narrow and they get narrower and they can't move as far as well.
Those are absolutely ideal patients for doing a decompressive laminectomy because you open
up a canal and they're not moving much so that they can't cause the injury to the skull.
But all the others they weren't getting. So it's just an interesting illustration of how selection influences search results.
You've got to be so careful about making sort of sweeping statements and then of, they say, subarachnoid haemorrhage.
But other things do depend on the emergency medical people to an extent.
Well, not satisfactory. Did you find that in there? That I think people can pretty well trained in any sudden, unusual headache coming on.
Whatever, you know, which lasts for more than 24 hours, is a subarachnoid haemorrhage to prove otherwise.
One of the problems is getting people to do lumbar punches. Right.
Because in the old days, everyone did lumbar punches.
But you then the CT scan came along and people thought, well, we can get out of doing a lumbar puncture,
we'll do a scan, which because it couldn't, I had to wait till the next morning.
And this sort of thing used to drive me nuts because as I kept.
I kept quoting on Smith, I do remember. Oh, I do indeed.
But she said, you need 24 hours of life left to cure meningitis.
Right? And which is true. Yes.
And if you've got a fulminating pneumococcal meningitis, which can come on very quickly when they're dead in 24 hours.
So you got to do that lumbar puncture there.
And then and I stood over them as they chose saying I will take full responsibility for this lumbar puncture, but you've got to do that.
And as Trevor Hughes rightly used to say, more people die of late diagnosed meningitis than than people die from coding.
Yes, absolutely. But people became frightened that no punches when the fear of coding.
Yeah. Then after Philip Sheldon, would it have been pandemonium?
Yeah. And it was great. Yes. I think I was on the apartment committee for had and there were several candidates.
But actually what happened was that they appointed somebody who wasn't.
And they and I remember saying, I think we should have a spare in case this chap doesn't take the job.
And they agreed on and all of you being the up or he was right back to Jack.
Yes, he was the back. And the chap that offered the job to, in fact, decided not to take it and went to Manchester.
And I felt that getting and the point was the best thing I ever did for that cliff and third grade, he was he was fantastic.
And he got around to these words. Yes. Just incredible.
I mean, the Russians started this by by learning how to detach balloons and putting them in, and there isn't.
But it was really the French who perfected the technique of putting these wires,
these very fine Cass's just the watch flow directed into the aneurysm and then injecting superglue.
Later it became weaving a basket and are so skilful.
Of course, I thought this if I had an aneurysm,
I'd want I'd want you to do his basketry inside it fairly because of course, you didn't have the problems of spasm.
No. Mm hmm. And I was very key.
In fact, I encouraged Andy to do this big trial.
And because I was about to retire, I got Richard Kerr involved with that.
But that was a real contribution to the management of subarachnoid haemorrhage, doing a controlled trial between surgery and.
Well, that essential. Really? Yeah, great. The Americans did not like it.
No, they don't. Well, the trouble is that you have one operation.
Surgeons said they'd spent their lives learning how to clip aneurysms and any other technique was a real threat.
And they're driven to an extent by private medicine. Oh, I mean, how much private medicine surgery will you do?
Well, I did quite a lot. We got a lot of overseas patients and we were making about a million pounds a year for the hospital.
And I wrote a very I got very cross. But if you remember, the days of were three percent efficiency.
Know that? Well, in the early 80s, 90s, we had to do three percent.
We had to do our work with three percent less money. Right.
And of course, the people that were affected were the most efficient.
If you had fat to spend, three percent was nothing.
Not ran a tight ship, which I like to think we did. Three percent was very difficult.
And the only way you could accommodate this was to reduce your length of stay each year and our length of stay,
which is already much less than the national average, got faster and faster and faster.
We got to the stage of taking out a clot of a patient in North Hampton and putting him back in the waiting ambulance.
But to take him back to Northampton, I a general subject of interest.
OK, I said this was not safe and I wrote to David Wilson and said, we are now hyper efficient, which is not safe.
What are you going to do about it? So I got no reply, just standard administrator.
We try and avoid trouble and bury our head in the sand.
And so I wrote a paper called The Ox Down's Syndrome, the inevitable disease of the National Health Service Reform.
And I sent this to the BMJ and basically I drew pictures of how this sort of wheel of went faster and faster,
meaning the length of stay got shorter and shorter if you added it in three per cent efficiency each year.
And I pointed out that there was no way of making this will go slower in the NHS.
The BMJ liked the article very much. They said it's just the right mixture of passion.
And in fact. And before they published it, they sent it to the Department of Health.
So was like, you know, Wolf, going into a chicken run.
Yeah. Lots of flapping of wings and squawking.
And first of all, that the chairman of the region came down and said, Mr. Adams, this is not you know, you must do this.
You mustn't publish it. And it wouldn't be good for your career. Oh, God, that is so terrible.
Well, this is the truth. I'm sure it's true.
I'm sure if I chose to take no notice, I was fortunately fairly well-known in my career in that sort of thing that bothered me.
And then the regional medical officer came and sat in my kitchen, Barbara Stocking.
Right. And she said, oh, Mr. Adams, this unscrupulous, it's not right.
Surely we cost every patient in the NHS individually.
And I sort of looked at her gobsmacked and said there's not one patient in the NHS that's individually costed,
but you don't even know the cost of a private patient, how much to charge them.
It's all X amount of money divided by Y patients.
So there was the regional medical officer full of the buzz words, management buzzwords had absolutely no idea how costing happened.
Mm hmm. Mm hmm. I was pretty shattered. But she then went on to be head of Oxfam and is now head of Cambridge.
That's right. But I just felt these NHS administrators just didn't understand what it was all about.
No, they don't. I, I used to go around making myself no doubt extremely unpopular by saying no one says.
When I'm young, I wanted to be an NHS administrator.
They've all tried something else and failed and therefore and a girl dead and she left after six months.
Yeah. So they're all failures. I mean, this may have changed now, but I gather that getting more medicks into administration,
which is one thing since school, but the other my other aphorism,
which I'm afraid probably didn't make me many friends, was I used to ask academics, well,
what have you done with your research, which is change clinical practise and nature?
And they didn't like that at all. But actually, I don't think it's an unfair question.
No, I quite agree, because actually, if you're doing research, you know, we all know a lot of on the surgical side,
they all had suntans and they carried their golf clubs and they were away for six months in the year.
But actually, if you're being paid to do research, I think you're entitled to ask, well, how you not how many papers have you written?
But actually, what have you done to change how we do things? And they're absolutely Jane Pennebaker.
Whenever he saw me in the corridor, I would say, well, what have you discovered this week?
And I found that there was a GP out of Bedford who apparently when Joe was young,
would be coming in to see his patients because they did in those days. And he would say to Joe, what do you mean?
That's where they come from? Yeah. And then were there any other consultants?
I mean, the Mike Briggs, Peter Teddy then then those two say, is who?
I think it's fantastic. The Cole.
So many now. Yes. You know, they do proliferate and I don't know most of them.
Tell me about the anaesthetist. And, um, did you have one, as it were?
Who you who is John Edwards? SEAL and John Kerr?
Um, they're both very different.
John, I always found very, very good straight up and down.
He used to get a bit sort of write you on occasions, but. Said, Gosh, I really was full of admiration the way John coped with that and his work,
but he got obsessed by railways and trains and retired to run one of those little railways in Wales.
So. And yeah, I tried to introduce a three session operating, they said we've got these operating theatres and we use them from sort of eight to six,
but that's actually not a good, good use of a bit of capitalism and.
We should have instead of two morning and afternoon, we should have an evening session, and he was furious.
Never been so badly treated. Blah, blah, blah. It's going to be something to discuss.
But it just seemed to me to make sense. Well, absolutely.
But the anaesthetist, I mean, they were they limited surgery, but they don't have the general surgery.
I mean, in my time, because they wouldn't work after five o'clock and another session, I wasn't here know.
And you'd have had more anaesthetists. But I thought on the staff time.
So if you get the anaesthetist with you, you'd run because there are always hundreds of the best chairmen of the Medical Staff Council.
I thought it was Roger. He was an anaesthetist.
Oh, he was so good in those cities.
But he would take time to go around and talk to people before the meetings.
It was good. It was all sorted. Yes. And he was fantastic.
The other day, I was secretary of Medical Staff Council when I first arrived.
And as a consultant. Yes, Alan Sharp was the he was a lovely I was you know, I really was very fond.
Yes. Very sad when he died. But Roger must have been quite late.
Is that right? Yes. I wish I could remember. Been worried because, I mean, I think he's after my time.
Yes, I think he was. It took a lot of time and I suspect only anaesthetise had the time to go around and talk to people, but he was very good.
Yeah, Chris is something I should have asked you about.
Um, no, but I can think of I mean, know I probably being far too outspoken, no, it's very, very interesting and nothing rude at all.
But I think they probably, um, because I think people should say what they think.
You know, how it came about. Yeah.
I mean. I think I had the best time in the NHS to be honest and show, and when I qualified,
I had the choice of medical defence subscription of five pounds a year or fifty pounds for life and took the 50 pounds.
Where did you find the 50 pounds? Well, it was my first paycheque when I was a S.H. House officer, a guy.
So I stayed in for six months, but that was my first pay packet.
And now a neurosurgeon has to find about one hundred thousand pounds a year before he can.
Yeah, I did. Because you were with Joe Pennypacker just as an asset.
Yeah, yeah, yeah. How did he compare with the people in London?
I worked with Murray Faulkner who had been at Oxford and thought the world of Oxford Murray was still using black silk,
which everyone else had given up because it was a pain.
It became infected. You had to do that.
And I pointed out to Murray once that, hey, given that black silk in Oxford, and it was only when he heard that he would give up black silk.
But Murray had this rather sort of disturbing laugh, which was humourless.
But it was when he was in trouble and he was a television programme.
Phil Murray doing an acoustic. And I still cringe at this because there's this awful sort of cackle.
Oh, he was doing it. And it wasn't a great operation.
But then I worked for Valentine Logue, who was a I had great admiration for Valentine.
Um, he was quiet. He was obsessional. Very good neurologist.
Very nice man. He, of course, was the son of the King's Speech.
Yes. He was the little boy reading the book and he was a little boy reading book.
And also making model aeroplanes who try to do is avidly as a boy.
And I liked I suppose the only thing I'd say about Palantine was he really spent a lot of time sort of stopping every capillary bleed,
which is not really necessary. Um, but he would go home and then phone up at eight o'clock in the evening to ask after his patients.
And it was really very caring. I don't think he actually received the credit that was due to him.
Right. The other surgeon at Queen's Square at times one, because it was much more forceful personality and tended to get the sort of limelight.
And was there another at the Middlesex with Valentine, too, because Diana Beck stopped?
That's right. Diana got myasthenia gravis, didn't she?
I didn't know that. And then I think Lindsay Simon took go right, who was at Queen's Square as a sort of lecturer when I was the.
I mean, looking in time is a very general surgeon, I think he was more gentle.
And Joe, I always I remember being struck that Joe I thought was rather rough and everybody said it was a fantastic surgeon.
I think he was. And he probably knew how rough it could be to get away with that speeded up a bit.
Presumably he was fast, whereas John Potter was just rough.
And when he sort of his patience ran out, he it was a disaster.
And, uh, I think, you know, John, John should never have gone in for the research.
He was interested in head injuries. But, of course, that wasn't really bone surgery.
And I mean, his helmet work was the good thing. Yes. Yeah.
Yeah. I'm going to close down then, Chris, if that's all right.
Oh, well, thank you very much. That was really interesting. Thanks a lot.