This is the 22nd of May two, and for the record today, interviewing Andrew Friedman.
Andrew worked well. When really did you come to Oxford?
First, I was appointed an essay show on December the 1st, 1968, and it was the same as an essay show in EMT surgery,
having come up from Cornwall on the train, having missed EMT as a student.
But in Cornwall, I worked as a as I host opposition to a most wonderful person down there who
convinced me the D.A. was the way forward because he didn't get up at night.
And anyway, I applied for this job totally unqualified for it.
And at the same time, when I eventually got appointed in under some of the first 2000 and is very nineteen sixty eight,
Billund started his first day as a consultant in the hospital on the same day,
and a person who later became a great friend, Jack Freedberg from Canada, became a visiting senior registrar.
So there were three of us starting on that same day and Gavin Livingston was still alive and working.
And he was just a remarkable man. He is losing weight all the time, but he would insist on coming to work with pethidine tablets,
sitting next door to this useless surgeon of me and getting me to take a tonsils out.
And then I got it wrong. He took over and took the rest of it out or whatever. So it was a very generous man.
Yes. And where did you train? Well, I was I was trained at guys, you know, and run Macbeth, the Macbeth retard, I think, in about June 68.
But when Gavin died, he came out of retirement to do it alone.
So at that stage, there was a Coleman who was appointed in 1964.
He'd been a senior registrar in Edinburgh and then had been appointed consultant in Coventry.
And then the job came up in Oxford and Livingston Macbeth appointed him as a full time consultant,
not allowed to do any private practise, but to do research.
So he came in 64, having had an amazing reputation actually in one of the original people to do the operation of state.
That to me. Right, done. Which he did with a chuckle.
How shot nicked in Boston where they trained and then he bought it.
He bought the first operating microscope to Edinburgh and then the second operating microscope came to Oxford.
So it was the beginning of microsurgery of the ER and he was very much involved in that.
And would you say did much research?
I mean, did you know he had a programme Gang of cats, which I think most and he was trying to look at the stability of the operation in cats,
but looking at all the specimens later he decided that most of them had got cat flu, which I don't know what that was.
But the thing was in infected. He did, but he did do some very good early research in the states, which is still actually quoted.
As, you know, it's not a great paper. But anyway, so he he was there.
Bill loved and come from the Middlesex is where he was also a consultant for
a couple of years and then having been a senior registrar regent in Oxford.
So he went to the Middlesex consultant and he was appointed in 68 when I was a brand new asset.
So, I mean, to my mind, the feeling that the empty Oxford and its original name that they did or developed
new things from Macbeth was a remarkable man and quite a tricky chap to work with.
But he was appointed, I think, in 1934, somewhere around there, didn't go to the war,
but was very much involved in things going on in the war and kept a lot of the road running.
He used to start operating at 5:00 in the morning and finish at 2:00 in the afternoon
so everybody could go home to their families and get the blackouts organised. So he ran the department and he was singlehanded.
He came with no beds in the hospital with an ER syringe in 1934. Gavin Livingston joined in 1946.
And I think having been a society doctor from St Thomas's with huge private practise and a large Bristol
motor car that used to whiz up and down to Holland Street from Oxford to Hollis's practise on for a bit.
Yes. And he he started and wrote Macbeth and in the meantime realised that there was he knew Florey quite well.
And I know the stories always of the policeman and the I think the brain abscess, as far as I can remember.
But he started to work with all the chronic mastoid disease of putting this penicillin powder into the mastoid cavities.
So he was highly Motherwell. Lots of little stories that I don't know how true they were.
Basil Floran, you know, using the stuff until it ran out and had to be recycled in the urine and all that sort of business.
But it worked, but it seemed to be better than the sulphonamide, which was the other alternative at that stage.
And that was all written up to and but he then invented this operation for chronic sinuses,
which is very common in those days where he did it was called an austere plastic flap where the great big scar that ran from ear to ear,
the scalpel forward, the front wall of the frontal sinus removed and the whole thing cleaned out right down to brain has exposed and then replaced.
And he undoubtedly was quite a major advance on what is a dangerous disease that, you know, pre antibiotics.
People were dying very commonly of Simon's disease and there was a lot of osteomyelitis in the skull.
And he decided that the way forward was radical excising to get around the osteomyelitis and to do this flap.
So is always actually known, still is known as Macbeth's.
Operation in some textbooks that's been modified and it's hardly needed now with all the modern chemistry that's available.
And meanwhile, Gavin Livingston had got involved with the thalidomide disaster,
which not only caused tetraplegic of these children, but many of them were born without is right.
And we got a grant and this is before I knew anything about it.
But they got a grant in the Radclyffe from The Lady Who Thalidomide Trust.
And nearly all the thalidomide is done by cabbing Livingston Oxfords.
And he became a congenital er abnormality in the country and extensively lectured
and he became president of all sorts of children's foundations of things.
When you say they were born with that, is that the artery after the area of the artery was missing?
So was that it is all of the bronchial WFA there, but the middle ear was missing.
The obstacles were often missing. But the inner ear, the doctors developed some Mureta was there, so there was no side.
The potential for hearing was there, but there was no sound getting in.
You think the piano would be the plastic surgeons? Yeah, well, he worked very closely with St. Pete.
Mm hmm. And they did the they did all the piano work and Eric Peter the piano work and Livingston did all the middle ear,
the middle ear and trying to reconstruct an ear canal because that was missing.
And indeed, when I came in six days, we had a garden in the Oriente department where we we used to keep a pump.
That was the exercise for the laryngectomy patients was putting tar on the bottom of the pond.
So it would float that. Yeah, but there were always children having tea parties.
All there is bandaged up and their limbs. And I still got some photographs somewhere of all this that's in there.
And so he he got a huge reputation in community there and even well, you know, it happens today.
But even when I was retiring, we still were referred a lot of congenital er abnormalities or different ways of doing things now.
Yeah. So bathmat is a huge influence of this sort of thing.
And he became president of the section of the RASM R7.
Livingston did the same. Did they meet in Oxford. Yes.
I don't think they knew each other until they took those two, but they say, oh, I'm sure they did.
Yes, we have something called the back,
which that sample of the British Association of it's a it's a four yearly mega meeting that we have international meeting the Brits put on.
I've got actually what it's about. But the very first one was organised by Ron Macbeth in oral grade in about 68, I think was the very first one.
And it's progressed. And so he was a very much a national figure.
Yes. And known in Canada a lot, too, for some reason. I'm not quite sure why, but he went off there a lot.
Did you apply for Oxford on the advice, this chap in Cornwall or could he'd heard about the work?
We just know because I heard about the work. I just thought that he and D I wanted it to be a paediatric surgeon until I
met one who said he was up all night and I didn't like eyes because I agree.
So I said, well, I went to as a student, I remember going and goes to watch my operations and all you could see was his eye looking at you.
And I didn't mind blood, but just one eye looking good, right?
Well, somebody was to him. Once you've come, you're in a stage in Oxford always.
I did. A researcher in Canada right there was then in Toronto.
I worked in the Banting Institute actually with all the. Yeah.
Banting and best. So close to your heart in College Street. Yeah.
Where did you work. I was at that stage I was doing laryngeal cancer work.
It was nineteen seventy four when I was at the seventy three to seventy five.
And 1974 was a hundred years since Bill Roth in Vienna had taken the first larynx out of.
So my boss Douglas Brice at that said we're going to have the centenary conference laryngeal cancer work.
You're going to do the work my lad, and I'm going to present all the papers which is carried out.
You're quite frank.
If I were a lovely man, then I was stuck and they had this wonderful pathologist out there who taken an interest in the cancer work.
When he got a larynx, he did these very fine sections all the way through the larynx.
And so these big slides and it was to look at the growth and spread of laryngeal cancer.
So that's why we were quite heavily involved, actually classifying, you know, these TNM classifications,
which you could do from the pathology of that you couldn't see is by naked eye, in other words.
A small tumour might have spread somewhere, and that's really what we were doing.
So there are about 10 papers that came out that year and a half.
And that's what I did. But I am not quite sure why.
But then I got back to Oxford and then I was very much and dealt with all the children with congenital airway problems that got me up at night.
And before they invented the surfactant stuff that stopped the halah membrane to street disease or respiratory distress syndrome,
because up to then I was up there quite often sucking out the right main bronchus, which always got blocked up with its gunk in this country.
All babies. Yeah, yeah, yeah, yeah. In the neonatal intensive care unit.
And then and then I did a lot of the airway work.
In fact, when I was president of the larynx section, I my my presidential address was on trauma to the larynx because in Canada, the farmers.
That's exactly right. Well, in Canada, the farmers did not like snowmobiles going over the fields,
compressing the snow which wrecked the winter wheat so used to street piano across.
It was a snowball. They were almost garrotted, some of them, but that was one of them.
Apart from the cancer, that was the main clinical thing that I was taught about in Canada when I got back.
It was just before they had a proper seatbelts. They were still the lap belts and people were being injured by the dashboard.
And because I've done this in Britain, one or two things, a lot of patients, not nationally but regionally, came to Oxford.
So we had got quite an experience of laryngeal injuries. So you went to Canada, which is a senior registrar?
That's right. Came back and I came and I came back to see the registrar within about two or three months, two or three months, three to three.
I waiting still have retired. And for some reason or other, there was a decision made that they didn't need.
And I think that Dudley was already imposed and they didn't need another thyroid person.
The money and it may be something to do. Beth, although he retired by then I transferred to EMT.
So I think I was funded from Tim Tilse, pot of money as a third and consultant because I was.
But Beth Livingston is my Beth originally that Livingston joined him and then Coleman came.
So were three. Then Levingston died and none was appointed, so there were still three.
And then Beth retired. So we were left with London Koban and in nineteen I was appointed like seventy five years.
And then in 75 they decided they really need a third because the work was building up
and both London were busy and away quite a lot and they need a ladder on the ground.
And I was the devil they knew I. Yeah. So I wasn't that great.
I'm sure there were many but some within the senior editor of the students technical students, they would be attached for one month, three months to.
And, you know, I think they were they were much less than that.
They came I think we had them for two weeks.
It was never unfortunately was never really until it was realised how common E.A. was in general practise.
It was never considered terribly important to the core teaching.
And I think there were so many other calls clinically on the medical students that I
think EMT was also quite difficult to teach with a very different look down orifices.
It's so much easier when cameras came on and then the scopes that you could project images,
but actually to watch somebody not passionately looking on air and saying something or other, it wasn't terribly impressive to a student.
But we used to do we had I know we had a two week course that I used to run that and we should
try and do it fairly methodically to equip them for what they might expect in general practise.
But it wasn't as practically as it could have been. And you when say you ran it, was that as a consultant?
Yes, yes, yes. That was one of my jobs that was handed on to me right in front a bit.
Who then ran to do the teach.
Erm you personally or the senior registrar or that we had to see the registrars in those days and they were, they were always very good.
Yes. I think it was, I suspect it was a senior registrar who did most and never learnt he had a sort of invention to build.
And was it his arms on the pharyngeal puch and the formation of the financial part.
So he, he, he, he did a lot with that. And then he really got took over Gavin Livingston's work on.
Genitalia, surgery, right, but Kelmann also did that and there was always a bit of jealousy between the two.
But you've stolen my patient, that's all. But yeah, that's what happened.
And then. Yes, and that.
But I think there were three of us and two senior registrars, two registrars and a couple of researchers.
And actually, it was a very close knit community. When I first came as a researcher, we were housed where plastics is now, Kilner Ward,
and we go down the corridor on the right and we had a little outpatient room rooms upstairs, a tiny library.
And Bhathal is always upset.
We were never a university department and he thought we ought to be more academic and so did Colbourne.
And when Macbeth was chairman of the Medical Staff Council,
and I'm not sure quite one that was there was the maternity unit was being built at the John Radcliffe.
And I think that was opened, too, because my number three son was born there, the other two in the attractive.
And when they knew they were moving, but Beth said we will have he was chairman of the medical staff.
We will have the maternity block. So E.A. moved to the Wolfson's Street site of the Nuffield maternity home, as it was then called it.
And which is absolutely wonderful because we had two operating theatres upstairs.
We had large that's the second floor.
The first floor was two or three wards, one children and two adults that had a lot of space and then a down below and a lovely outpatient facility.
And we had an academic unit with a very nice library.
And in fact, it was one of the best, best libraries in the country from, you know, old journals going back to when Macbeth was appointed.
And we all used to contribute a bit of our salary into providing one journal and it was kept up.
And now I think it's all what the council library, I don't know.
But with all this, electronic journalism has changed. But we were quite proud of the libraries.
They're great. And then when the general surgeons went up the hill, I mean, did you feel bereft of them?
No, we didn't, because we had plastic's neurosurgery as an EMT and there was a huge amount of cross referral.
So we didn't. And I think that they were the natural link somehow because E.A. often used to stray into
neurosurgery and some of the brain abscess were caused by either the nose or the ear.
So it was very useful to have them. And I mean, I first exploits for that was with Joe Pennypacker and it as a very junior registrar.
He was upset and sorting out the odd cockup would end teaching and teaching is, oh, he's wonderful, man.
His father, my very first paper ever was he was the well, he was the main author, but he told me to do it and he corrected it all.
He was he got published and I was very proud of it and started as a very junior doctor.
And and then the plastics became more and more important.
I gave up doing head and neck cancer surgery and became purely Airds after a bit.
And my main interest had been children's deafness. And I we started our cochlear implant programme and one of the first ones in the country
then and still present to the deaf children to such and not they do very much great.
But I still keep a hand in it. The implants now, what is that?
Is that a mechanical bit of outrageous or biological bit?
No, it's mechanical and mechanical. Electrical. What happens is it's but children who are largely Emmies adults as well.
But it started really with profoundly deaf children with no hearing.
But, you know, hearing. And what happens is that a tiny electrode is winkled into the cochlea, which stimulates the nerve.
And since there are 32000 nerve endings in the cochlear and one's got a maximum of about 16 to 20 channels, how it works, you know.
But somehow at the end of very clever idea to get these things into a nine month old children, by the time they're three,
their speech and language development is almost the same as a normal three
year old having in the past when I started being defined to sign language or,
you know, special education or that sort of thing. So it is actually it's been a remarkable advance,
but it's nothing to do with the surgeons is actually to do with a very clever electronics industry where they invented this kind of thing.
There was a single Channel one done in the hospital in Los Angeles, probably in about nineteen eighty two or something.
And then the vast the bottom was rolled on in Melbourne, in Australia and.
Still the one where one of the two models we still use, I mean, it's been upgraded to normal, but so did the negativity due to the pituitary.
It didn't lead me to the pressure, which it did with Bill. He did a lot of work.
And then Chris Adams took it out when he found that by sticking a crime probe in the side of the nose
with reasonable with much less trauma than we because we had we were always very sceptical about that,
because we record if you're going to free something with the huge blood vessels around the
outside of the of how you actually froze the bit of the adenoma or whatever it might actually be.
But anyway, he seeing it. I mean, this would, I think two days and I think it's on x ray screening.
Yes. Yes. But I never I did want it to as a you as a trainee, but I, I didn't really do that.
But Bill Londoner's, Byron externalise mind approach when you did actually see it very well.
But there was the occasional problem with the transverse sinus went in front of the dura between the two cabinets on the right side.
And I don't know why, because I didn't seem to ignore that, but he seemed to get in there and it came and but we were very close to Chris Adams.
But he was a powerful man and a very, very, very good surgeon.
Yes. And, you know, if I was a patient, I think I'd be quite happy to have been handling it.
Then how does private practise interact with all this? I think private practise was I mean, it was always done over the road in the åkerlund.
And originally Billund was a big private man and Levingston and McBeath before him and they all worked,
took five Barberot, which was a little bit further up the road.
And then when 23 Bonbright became available, the rent's much cheaper than 85.
So I think everybody move. That is such an easy thing.
And although I did a bit of private practise, it was so easy being more or less on site all the time.
And Joe Smith taught me when I first appointed Subdivides to come and do a private clinic with I'll show you how you treat
private patients are the first thing I realised it had students in there teaching them how to behave and how to talk to patients.
And I often had students in my private rooms, I thought come over the road and you could just see how,
you know, I was always very against people calling patients by their Christian name.
And I always like people to look like doctors and shake hands properly and able.
And they were silly things. But Joe Smith taught me a lot of that might be slightly old fashioned,
but the first bloke I worked at the Middlesex and he told me that the more important the private patient,
the route that you get, you've got to get on top of that.
But I don't think I saw anybody very thin.
And then I say, what did you feel about the nursing nuts?
Oh, gosh. But we knew exactly when we when I first started who was in charge.
Yeah. And there was Sister Jean Buie who ran the the the wards, an EMT, absolutely superb mission.
And there was Sister Montoya, who still lives in Wantage, who's still alive, who ran the theatres and somehow all the nurses, they were different.
I think we had some very, very good devoted nurses that stayed for years and years and years.
And we had some wonderful scenes that looked after patients, but thumping that pillows up and they were always around and talking to them.
And in my opinion, I'm sure a lot of people's opinions, things changed a bit when some degree nursing came on and see Adamsville got rid of.
Yeah, but I never actually I never that must have been a major directive,
but I don't ever seem to remember meeting her didn't seem to matter very much because we knew
who Matron was in all those years and they seem to be permanent structures till they retired.
And then when they did retire we had yes to one became of third.
One of our nurses got upgraded to take out the system.
They stayed much the same. Right.
And one of them actually still a health hazard, I think in the Abbington practise, one of the Abbington practises, then the handling of wax.
And is that go with this is a one time you had a sort of wax clinic.
We did walk in. We had a wonderful website and it said, I mean, not you personally.
That was started in we had well,
I think there was a problem with GP rejiggered out is that they were bursting eardrums every now and again with a bit of extra pressure.
I think nowadays it's all done with Hooven or vacuum cleaners in use of oil, the ER with grease.
For a couple of days, and then it stuck it out under a microscope,
but we did have a wax cleaning, I can't remember too much about it run by the nurses.
Right. And the other clinic we had was a hearing aid clinic, which is absolutely wonderful, this huge old hearing aids.
But code, the Medical Research Council, Elektronik hearing, it was called redress against what it was always called big box.
It was. But we used the registrars when I was I used to love doing that because it needed no brain power.
They were fabulous. People had all been through the war. They were all different through the war.
They all had wonderful stories. And we have sweepstake on the average age.
But but it was great fun just talking and it sounded overcast, boring with hearing it.
But actually, what none of us made are doing it because we knew there wasn't going to be major decisions to be made.
I'm grateful talking to the people. Was there a lot of interference with those hearing aids over the trial?
Yeah, nearly all hearing aids spent that time in the top right hand drawer of the dressing table.
And they they I mean, I think in those days, almost the only reason for wearing a hearing aid is that you could see someone
was deaf and therefore you made a little bit more effort to speak clearly, but electronically, they were pretty useless.
And what would you do? I mean, how many patients who would you be doing?
What I started as a consultant. I did I did have three operating and four outpatient sessions a week, and there was one teaching session.
And I'm not sure what I suppose there was on call.
I don't know how it was divided. I mean, I was what they called 911 is I, I was telling them when I started and I became nine on that.
And the one 11th was that nothing was happening. That was private practise.
Yes. Right there something.
And then we did because we went to university departments and we although we were attached vaguely, we came under the Nuffield Department of Surgery.
Yes. So that that was our universities side, if you like, and you live in our area.
I was on a relationship with ordinary and very angry and I wasn't terribly good at that sort of thing.
But the students had great, you know, had great fun with them.
We always, for some reason, rather EMT course, always was just before generic.
So they were usually absent practising. And I mean the number of students who change the laws.
Do you think that altered anything? Read I yeah, I don't there was much more two or three people around the bedside that you could get to know.
I knew that names that was, that was that actually when you saw them in the corridor six months later, you knew their names.
And I think that was very nice now. Well, when I left, I find it very difficult to know who was who, who hadn't turned up.
Now, what I don't know is whether that's a function of the years or the numbers.
I'm sure the numbers were a huge part of it.
It probably was the numbers, but I think there's also a huge increase in the number of teaching staff or potential teaching staff.
I mean, if you look down the telephone directory of psychiatrists, I received some and anaesthetists anaesthetist is.
That's right. How important is it is vital that I work with one of these all my career.
And he retired two years younger, Jacqueline Looch, who I was engaged with,
and the other students were done with Dick Fordham and Toni Fisher, who were both.
And they stayed with we worked together all day and we enjoyed the sessions.
But Robert McIntosh and Ken Boston, like TMT and the Macintosh laryngoscope,
which is still in use today, was designed because Rollerball said, come and have a look at this.
He was put in one of those tonsil gags and they were boil Davis gags.
I thought he was a cracked it open and you could see the lyrics.
And so the blade of the tonsil gag is exactly the same shape as the Macintosh laryngoscope because Macintosh had a technician called Salt.
I remember him and he said, Salt can have a look at this, make me one of those Anabasis that people have intubated using a Macintosh laryngoscope.
The blade, which is exactly the same shape as the the Bodanis gag that's used for every tonsillectomy in the world almost.
And can Bostom there were a lot of Boston.
Um, instruments, I can't remember what they were, but they were things that were intubating people and bits of endotracheal tubes and things,
and we also worked very closely with John Lloyd in his pain clinic, but he started the first intensive care unit in transuranic.
Yes. Yes. You remember Cronshaw? I do, indeed. Yes.
And he there was this thing called the Oxford Tracheostomy Tube, which was a right angle, red rubber,
to which a lot of people were allergic to whatever the red rubber was that it was some I and
they were very clever because it was not for tube because they put a magnet in the opening.
So there's a ventilator with magnetically clip into the pipe from the neck that would fit into the tracheostomy tube and they would were Coolac,
the tracheostomy tubes. And I think somewhere they used to be a very good anaesthetic cabinets of old instruments and things.
And there are a lot of things like that design of the Macintosh laryngoscope of sorts, contribution to making them and that go up the hill.
It must be up the hill in the natural department of anaesthetics, whether you'll also see those red rubber right.
Angled tracheostomy tubes. And I had to I was a junior doctor.
I did a lot of the tracheostomy for John Lloyd in the debt.
And he was the. Now, Tunstall's I mean, there used to be a lot of tonsillectomies and then there are a few of these other led to that.
Is it right or completely right. Is this just a fashion.
Yeah, antibiotics. Nothing to do with it. They might have done I suppose, in that I think now you have to earn a tonsillectomy.
You know, GBE has to write from my records.
I've had this child or this adults being six times this year, missed school a few months of school or a few months of work, whatever it is.
And with years, it's not getting better.
But I think before they used to be an awful thing called a tonsil drive where and they were done with a guillotine.
And Beth started this.
But you could do 12 children and about sort of an hour and quickly, Gastón, with Aether as they were covering their tonsils snipped off.
And what stopped the bleeding? As a very good question.
At least one of them came back each night to be properly attired.
And it was all pretty brutal, but I never got involved with that.
That must have stopped actually in about six or seven or 68 because I never saw still drive,
although Beth did make us do Tunstall's on the local anaesthetic on a Friday afternoon, which was you had to be very stoical patient.
You sat up in a chair with a plank but behind you so you could put your head back and you sat in front of the local insight, local knowledge.
Is there any evidence that the time do you any good in later life?
I mean, now, you know, the know, if if you've never I mean, I've never had my top floor adenoids out.
By the time I was 11, I had no adenoids.
They with a completely by the time about 20, you don't have tonsils, you only have tonsils if they've been infected.
And the scarring from the from the healing infection leaves your toxins behind.
But nobody's quite sure what they are. But it's something to do with drug production.
And I think those things, like a lot of medical school now, I was just a very good but and I mean, so Johnson's tonsils are done.
But I think you have to admit that lot and actually just fledgeling.
Make Belrose without the stomach man as well. Exactly right.
Yeah. And there's I think that, um.
And have you been in the new department that I work for?
I retired in agency at 2008, in September.
And I think we moved up there in 2006. I had two years of that.
But the whole thing was so different because we moved from a completely identifiable unit with our academic department, with a lovely library,
the lab and all our private offices and things without patients with ward above, etc.,
but to an amorphous big block and shared our ward with the plastics and with the eyes.
And you'd never find your patients.
So I never got used to it as long as the show never, ever got used to it before you VMT moved up the hill, did you have to go up the hill?
Much of it was blandest to the church, right?
No, I would owe it to the respect for people to just stay.
And where we did go up the hill for children.
What got them into the children's intensive care?
You used to ask us to go up there to do tracheostomy, and that's a yes.
And I worked a bit with Steve West a bit, too. At one stage.
We're doing well. Well, Steve was very keen on artificial heart.
Yeah. Call the Jarvik heart. Yeah, the Jarvik heart needs electricity.
And because I've been screwing things into the head for implants and things, I did the wiring for it.
So we had to implant the electronics into the head and then feed a wire through the neck to connect up with the heart.
The thing he stopped inside. So that was my role with that.
What why didn't that succeed in the end, as it were? I know, but it didn't take that with no cardiology.
No, I think I I'm not quite sure because there were other devices,
because I was I went out with Steve Watts twice the Brockton Hospital, where we put them in and worked with the people.
The problem, and they were developing another one.
Now, whether it's one of these things that they were I think it was designed as a temp, the best use was for.
Cardiomyopathy, as far as I remember, and if you gave the heart a rest for long enough,
the cardiomyopathy would sometimes improve and I think that's what it was designed does.
But then I think they found that there were there were complications with the machine and the death rate was a bit high to.
And we're going up to London to committees and things. Yes, I was I wasn't on the College of Surgeons Council,
but I was on and what they are said quite a lot in the presence of the secretary and bit of that.
And would that be the one that was a yes. And you ran the programme?
I ran, but I was I was a few years before I was secretary of the thing. You enjoy it?
I loved it. Loved it. It had 420 consultants.
I was president in 1997 and I knew everybody and most of the trainees I knew because I worked with the College of Surgeons,
all the specialist advisory committee for quite a long time.
And so I used to go around on the interview panels, interviewing people for senior registrar jobs and things,
and also at the College of Surgeons in Ireland, as it was called, Dublin.
And there was a lot of an honorary Irish, whatever I might be added as I go, I still go over there to their annual meeting and you should play golf.
And I don't understand what they're talking about, but it's such a lovely bunch.
I you know. And what would you say had been the big changes in individual time, I think?
Well, apart from the increase in consulting staff, the big changes has undoubtedly been due to the sophistication of micro instruments,
of electronics, of very sophisticated visual equipment, not only microscopes, but also at discos.
So it's very, very rare that you have a science problem. I think this was all done.
Keyhole was and that became a problem because not everybody has good hand eye coordination to look at a television screen and operate down here.
But it sorted a lot of people out about speciality, you know, and people stop doing that.
But the biggest changes in my career have undoubtedly been the microscope,
the very fine instruments usually made in Switzerland or Germany and the the the electronics maybe to do with the ER.
Was there ever any difficulty buying instruments you wanted? A lot, you know, a funding thing.
What would happen. You didn't then. Yes, you did. I mean, what in the end happened?
The one of the girls worked out that actually for me personally, doing a certain number of operations, I was only using four or five instruments.
What was the point of a great try? These instruments were never used and she managed to work out what each of us was using most of the time.
And so we had doubles of those and kept in very good condition and a few extras.
But it was quite a good system because it saved it.
It saved money and it didn't and get damaged because they've always been damaged.
Originally in the old Redcliff, the instruments were looked after by the supporter or a technician.
We had then the beautifully looked after, but then when we moved to the autoclave system, they were put in a box, trundled down the corridor.
This very fine and these little micro scissors and things were getting damaged.
Yeah. And so there was an awful lot of damage going on.
So there wasn't a fire.
There's a huge problem in getting funding for the electronics because the cochlear implants, you know, originally was costing about 30000 per patient.
So you had to be very careful and work out who was really going to benefit.
And that was a bit of a lottery. And is that the administrators?
You'd have to convince your fellow surgeons, though. No, it was the administrators or the funding people.
But then what's happened, nice interfered is and it's become such a cost effective thing and much more cost effective than a hip or a knee.
That money has come from other budgets. Was making who was on the panel?
Do you remember the administrators? There were always two jeeps, right?
And then there was sort of finance people, administrators, but there was always a couple of jeeps.
But I don't think there was anybody there might have been a public health fact.
I think it was one of the public health doctors, somebody like Mulgrave Grey.
But it wasn't me or Grey. It was. But then no, as it were, consultant positions.
No, I don't remember that. That's interesting. So you had to write a pretty good news.
You had to be able to defend what you're trying to do, what the evidence was, but eventually nice of taking it on.
And since I've left, it's become you can you know, you have to get the criteria right.
It's not difficult in your time. Do you think the relationship between consultants and administrators has changed?
Well, I. Yes, I do. I mean, they the right if we always knew who the house gardener who is called.
I like that. Yeah. Yeah. And if there was a problem, if somebody was unhappy, one could always go and approach.
And particularly David Wilson. I've forgotten the chap before that, but they were very good engine Bario.
Yes, I do remember his job is. But I think I mean the awful thing well is now that I was up in the job market for two years and I never,
ever met the chief executive, Michael, whatever his name is, and it's the only time I see him as a charity concert in Dorchester.
I pay for the children's hospital now when he was sitting in front and I sort of said hello and he was not interested.
I just retired. But they used to give a little to the parties.
If you retarded the not that that matters at all,
but there was there was no communication from the what they call medical director now and or the chief executive.
So I think things have deteriorated. And although all those different what we call them there was the regional health authority,
the district health or the area health authority, although they all got sort of amalgamated, it's still one amorphous bunch.
But you quite well. Do you get out into the refugees?
You usually a witness? Well, I did want to join time. Yes.
And I got to know the GP's very well. And I love that I was. And in the region.
Did that Keen's or. No, I didn't when that what's happened now is that Stoke Mandeville,
High Wickham and I think Wex and Park Hospitals have all lost their inpatient beds and they're all being done on the job.
Right. All the emergency workers coming to John regularly.
So the consultants, they are curating day case work at Base Hospital, coming to the inpatient work.
Yeah. So there's so many people knocking around the emergency workers built up.
I mean, it's not you know, it's nosebleeds and other things, but nevertheless, it's keeping people on their toes,
which is really meant because the junior staff nurse have such a short period of training.
They're not the apprentice scheme has database that the consultants are in a lot more.
You know, if you're already on call corner one at an eight or something, as far as I can remember, they are on call.
When you are called, you're often in is enough and there's enough theatre space for these characters around.
I, I would doubt it. I think even all lost lists, you know, and, you know, I it's not I had a very, very good innings, I must say.
I thoroughly enjoyed myself, but I could see the writing on the wall when we left our of the pub that we also used to where we were autonomous,
where if we wanted a bit of help in the neurosurgeon's, somebody Popeye, if we wanted a bit of plastics or they wanted us,
we could just pop over because there was a big link with the cleft palates, for instance, of plastic with us,
because most children were also deaf with a single blue ear,
because a part of the title plate muscle opens the station to station tube doesn't get opened.
You get this fluid in the ear. So we had quite a link with that.
And it was so easy if they were doing a cleft palate and that could somebody just nip over and have a look at these ears while the patient's sleep?
And it was that sort of cooperation that was so easy.
And also, Jeriko became an important the Jerrica Cafe sort of basic place was in the building then.
And that's how it is. Yeah. Yeah. And there's a pub down there called Arachnophobes and then the administrators want to know where you were.
Oh, I think they're in the right club somewhere. But the junior staff, they love that side of it.
Actually being in town, being near that is really the university buildings and everything else.
You needed to go look at something the right to. Sounds like you could do that in your lecture is very easily hit.
Did anybody introduce protocols in their care about working down a scheme?
Yes. No sort of scheme? No. I mean, they tried to impose that on you in any sense.
I think I think it happens now, but it must happen that if, in fact, it's happened, I think with tonsils, you know,
you can't see a tonsil unless it's being referred from a GP and you can't see it unless there is a number of attacks per year.
And that when you get it in, you, you know. So I think there are these protocols.
But you said earlier England, what happened was I was never terribly good on evidence based medicine.
I always thought I knew best. And there's all this bit about your experience, but I've sort of seen it before.
So you think but actually trying to make it scientific, all this Cochrane collaboration, I could never cope with that.
And I couldn't put him down to about that issue.
But, um, I don't know.
I mean, it's difficult to predict the future of medicine, but I sort of I do worry about the future of medicine.
And I think with funding I can see a hospital like that.
You know, we've got an Oxford is a major teaching hospital. It's a major university hospital.
It's a major district hospital. And I think trying to cope with the district and regional referrals and teach and the
university is a very expensive business and I'm not quite sure what's going to happen.
But my feeling with a speciality like mine is that it's I mean,
already what I can see what's happened hearing aids provision has is now
disappearing out of the hospital to go to spectators and things get befogged out.
Yeah. And I can see a lot more work being done in the periphery.
Now, why do you need an outpatient clinic, an expensive hospital, when you could actually go out to the periphery, do it at an outpatient clinic,
but then you've got to think, well, how many patients you see in outpatients have got to come back for your MRI scan and then,
you know, should you be doing that kind of hospital afford with all the expensive stuff that's
now going on in medicine to deal with all the so-called tregear in medicine,
which are terribly important for the patient and but not necessarily life saving.
And it will all be and end up as a really first class emergency service,
which I think it will pass the rest of, if not in some sort of privatisation bit.
But the problem I see with absolute completely destroys cohesion within departments.
You know, I think the Education Department, if it started splitting up somehow,
it would be a different place to what you remember with a lot of joint meetings and cups of tea and well,
they've got this patient can we talk about and all that sort of business. And I think it's going to be difficult to teach doctors.
And I think it's going to be difficult to teach them the sort of, I don't know,
the almost the ethics of medicine and the how to break bad news and all this sort of business,
if it's all tangled up with because we spent a lot of time talking to our registrars and such as they would come and say,
look, you know, I don't know how to approach this patient obviously got horrible cancer.
What do we actually say? And it was it was very important to try to work out how you do approach these things, that it is a time.
But equally, they have counselling in this of the students and they do I mean,
they get more thoroughly taught in those formal ways against their practise way.
I'm sure now it's very clear and I don't know which is best, you know.
Yeah, but I sort of look at my career as being terribly influenced by my bosses.
It's actually as if they're totally rubbish.
I probably still practising. I'm not quite sure I did my my wish for university link ever come about.
I mean, not really. No there isn't one there. Well no I mean no there isn't there.
So I didn't know. And do you think that the NHS in Oxford is short changed at all financially because of the university?
I think so, yes. I mean, if I was going to run a hospital, I would go to somewhere like Swindon.
I wouldn't take on the most incredibly complex work. The cost money, I would do routine.
I mean, we never quite understood by the Daily Radclyffe when it was just left with neurosurgery,
plastic's eyes VMT couldn't have made a fortune just because there was no there was no geriatrics blocking up the beds.
There was no there was a neurosurgical high dependency unit.
I think that's what it was called. But there was nothing terribly expensive about the patients were getting.
And we always assumed that the finance of the racket was going into a black hole for John Richter, but you never quite knew what happened to it.
I know Chris Evans got terribly worried when he wrote that paper called Box Box.
Do you remember that? I didn't make it up to the time he got he, I think,
was seeing a huge number of Greek patients and all the private practise that he was earning was going back into the hospital,
he thought, to provide extra nurses and facilities. But when you looked at the accounts and the medical staff meetings,
it was quite obvious that neurosurgery, it was disappearing completely and they couldn't get anywhere.
I don't know that he would be interesting to talk to. Oh, it's a great way to be.
I think I'll certainly try as I'd like to interview him, because he would know if he would give me some very stern feelings,
I think about finance that he used to get three fifths of these medical is in any condition that as it were here,
it was more common in the end because of increasing ageing and deafness on dust and not noise.
Deafness used to be a major problem. The motor works, but that's been around here.
Yes, it was still there, but with the hammering, with all the banging and hammering and that,
you know, a lot of measuring was done at the same limits.
And a machine's got to be this rigid enforcement on air protection where you are doing these noisy works.
But I mean, I think there's no doubt everybody goes deaf if they live long enough,
like everybody needs a prostate surgery and what frequencies go in the networks that live frequently.
Unfortunately, it's for all the high for business, which is the one where the constant speech,
you know, the days of these F's and the children, I mean, the whole high pitched voices of the.
Yeah, that's right. Yeah. You know, the wife and I think you can't hear it, but it makes it very difficult.
It used to be called cocktail party because when there's a group of people all talking, yes.
It's very difficult to filter out what you're saying with the best and most expensive hearing and it still hasn't got sorted out.
And so I think that's increased.
And I think there's no doubt that I mean, I don't know enough about Katsunobu, but one of the Graeme Cox, you know, but he's just retiring.
But he's coming up a few days. But he undoubtedly has seen a huge change from the laryngeal cancer into the floor of most cancers.
And that is quite sure why that's happening. But, you know, horrific surgery has to be done to get rid of the jaw or the small business.
So cancers have changed and that many more women we've noticed with cancers of the head and
neck problem because women have not stopped smoking as much as men have stopped smoking.
Yeah. And so when they started later, they saw that when I was doing it, I always used to tell the students,
you got ten male laryngeal cancers to one woman, but I believe it's now four or five women to six men, something like that.
So that's changed. Yeah.
So I think cancers change. We're not quite sure apart from the male female and the fact it's changed from the larynx to the jaw.
And the French have got huge jaw problems from rough red wine and smoking cigarettes that hang on their bottom lip Gauloises without any filter tips.
That's where one of the biggest names for this and the red wine does it, red wine and well, that's where it's thought.
And and the Indians get a lot of it from Betelnut, chewing and spitting out the Betelnut and also the reverse cigarette smoking.
I'm not quite sure how you do that, but you put the lighter down in such a way that they do move it.
Right. Well, and that's terrific. Anything else you want to say? No, it's fascinating to talk about these things.
I remember all these people. You know, I never, ever knew Eric, Pete,
but he was a chap that I would love to go back because he had Gavin Livingston used to like each other tremendously.
And, of course, Gavin Livingston's nephews. What is kulaks? And from what did we see?
I didn't know you nailed it. Yes, I know. He said, is there a nephew of that, Mr Livingston?
Does that mean anything to you? Yeah, he was my sort of it was all but a different branch.
But he was vaguely related. It was a yes. But he he went to Australia.
I mean, you write as a surgeon. He was demoted. Right. Right.
But he was up, you know, an undergraduate. Yeah, yeah, yeah, yes.
Yeah. A very interesting and I like the people coming in there.
As brilliant as they used to be, I think much brighter. Yes.
I would never get in. Also multitalented. They've all got the right age at the piano.
And no, I, I originally started to think about doing forestry.
That was because I have no idea. When I left school, I was at the school where most people went to the army.
And then when I left school, I've no idea what I was want to do.
Yeah. Yeah. And then I, and it was also just for A-levels were graded.
So you were the school here and you go to the high court were upset because you had wasted any time.
The sport was very much encouraged. And then and then we lived next door to the man who founded Go Kent Rankin.
Founded the only private first company in this country,
and he went off to work every day in a Land Rover with a gun, a dog and a picnic camp, and I thought that was.
So he advised me when if I wanted to do that, you better come. You can come.
But you must go to Oxford, where we had a full first school this year.
So he gave me this tickets and I went up and I forgot the name of the first forester.
Anyway, he said, Well, yeah, we could take you, but you better get into one of the colleges, take this and run some jobs anyway.
I didn't get in or I didn't do it in the end, but I met Bob Torrance Johns, who later became a patient and he vaguely remembers meeting them.
He says he did. I probably didn't. But he said, Freedgood, there's no way to get to the university beside foresters and geographers of academic life.
And anyway, the only reason he considered is you could run quite quickly out.
So I never did. But because I was my idea suddenly changed.
If I get into jobs, maybe I could persuade me to take you to medicine.
I mean, you always knew you wanted to do medicine as well. No, I didn't know that.
I'd never it came up when I met some medical students who told me to be very high up the Darwinians scale of evolution.
You needed to be dependent on your parents a long time. Why not be a Medick?
Yeah, and I thought and then, of course, when I went to guys,
most of guys was full of South Africans playing rugby had been just like Marius's full of Welsh.
They're just going to train at Paddington and National Service.
I missed that. I missed that by two years. Yeah, yeah, yeah, yes.
I think that finished in fifty nine or thereabouts or something like that.
Yeah. So I left school at 61.
I suppose it was OK and really marvellous. Thank you very much.
What do you think of him and.