Derek Hockaday interviewing That Is Splendid Home on the twenty sixth March 14.
Nick, you were just telling me that you came to Oxford as a registrar in 68.
What made you advise it? What made you want to come? Um.
I had a very old friend who was on the consultant staff, Joe Smith,
but we had worked together at Bart's when I was a housewife and he was the senior registrar.
Right. Um, and we had kept up, uh, over the years.
And when the Post came up in Oxford, I thought, that's pretty good.
It's pretty good news. And that was registrar to whom? Um, well, I was, uh, there were three there were four surgical firms in those days.
Uh, and the first the first surgical firm was on with Ted Ted Maloney and Malcolm Goffstown.
And as a registrar, you spent most of your time at the church.
So I was mainly attached to Malcolm Golf. And then I did a um and I think it was six months we did maybe in the, uh, with Tim Tintern and Joe Smith.
Um, and then I went to the Professore unit, Alison and outgunning um and then in due course the senior registrar came up which I got, which was in 72.
And then I worked pretty well exclusively for Ted Maloney, Tim Tebow and David Tibs, not with Malcolm Duff now.
Right. Because now was Malcolm doing the paediatric surgery when he was and is that when you first got into paediatric that,
you know, I had always wanted to be a paediatric surgeon,
um, and, uh, but there were a subsequently I got a scholarship to go to the Royal Children's Hospital in Melbourne to do a whole year's research.
Um, and I'd already worked Great Ormond Street. Um, but there were it was very interesting.
But all my contemporaries, a Great Ormond Street, um, ended up in person abroad.
They were very, very few openings in the UK.
And, you know, all the people who had been appointed as pure paediatric surgeons were relatively young.
So there were no vacancies coming up. So you either went to Liverpool or Great Ormond Street or Bristol, I think, in those days.
And so I ended up, as you know, as a general surgeon with a paediatric interest,
like Malcolm Gough himself had told you that one day that might be to paediatric surgeon.
And I said, no, no, no. And I think he rather hoped I might be a urologist.
We had both worked on a urology firm in London, um, but it didn't take my dogs to, um, and in the general said everybody sort of memories of Lazreg.
Yes. Well, I mean, you can't help but reflect on the change.
And, um, uh, it as a registrar, you were on take, um, two days a week or one day a week.
And the weekend I went, um and now I think they can take about one day in a fortnight and then it's totally changed
so that the work intensity was just totally different and everybody was a generalist.
Yes. Okay. You know, Joe Smith was a urologist who did quite a lot in general, so he went on general surgical take.
Um, David Tibs, vascular surgeon, went on general surgical take, said the degree of specialisation with hand and.
And occurred back in those days, did you feel you were supervised enough?
Uh, yes, I was very lucky. I was very fortunate indeed.
When I when I came, uh, I wasn't supervised by my consultants, but, um,
I had a very good close working relationship with the senior registrar, who was my guess who you will remember.
Yes, I do. And I really hit it off with my gear.
And he took me through a lot of my first surgical procedures.
You know, I'd seen the boss doing them, but it was the boss wasn't supervising me, doing them.
And that wasn't exclusive. But I think I probably more for my gear as seen as a senior registrar teaching a junior than anybody else.
But then, you know, we did all the all the emergency takes were done with the senior registrar.
Um, and you trained about that, right? Yes.
And the great great on the street.
Now, after you've been in Oxford, say, three months, what did you think of the standard compared to the London hospitals?
Well, it was you know, I was the first generation of, um,
I think it's true to say I think I was the first generation who did not aspire to stay in London.
Right. You know, the pinnacle of one's ambition is back in the 60s,
50s and 60s was to be a London concert at a concert in London teaching hospital and have a Harley Street practise.
And it was it was just beginning the transition was just beginning that the centres of excellence were building up outside of London.
And, of course, in terms of lifestyle with a family that really influenced me.
And I mean, I was the first surgical job I did in general surgery was in Bristol.
And and that was every bit as good as about where I trained.
Um, and then when I came to Oxford, what it was really, really,
really fired me up at Oxford was that if you actually spoke to individuals about where they had trained,
they were from all over the country, but everybody on the staff was both trained and the same would have been to Thomases and guys.
But, you know, if you look down the names, you know, there was Ted Malone in New Zealand outgunning South African,
Alison from from Leeds, you know, go on down the line.
And that was really I thought that was really good, that people had come from so many different centres with their own ideas.
But it wasn't just with the boss way. Yeah, because you're too young to have done national service, is that right?
I was called up for national service, but got deferment because I got a place at medical school.
Oh yes. By the time I'd finished my medical course and was eligible to do national service, they they just stopped it.
Great. But literally I was just on the cusp years now.
I mean he was a slightly eccentric er I would do that.
He just loved doing big operations, you know, the bigger the operation, the more he liked.
But actually it was he wasn't you know, I'd been a Great Ormond Street working with two particularly good surgeons,
you know, who had been very dextrous in here, whereas Ted was, you know, he used to borrow.
So but in terms of it, he had a heart of gold. And if anything went wrong with his patients, he was absolutely devastated.
So his heart was absolutely in the right place. And he was a tremendous supporter, you know, supportive of me.
So I'm very grateful to him when I had the opportunity of going to Australia because he was from that from the antipodes,
he was full of enthusiasm and gave me all the support he could.
Who funded the scholarship that was funded by the University of Melbourne right around.
So I applied for so, um, uh, and I suppose my credentials,
having been a great organ street with people that they knew of at the Royal Children's Hospital in Melbourne.
You talk to big operations now gurning like big operations.
Yes. Oh, and did you think he was a bit of a guy?
Yeah, he was O'Gara. And in a cardiac and cardiothoracic surgery.
And when I reflect on it, you know, I had a huge mortality, um, and I was accepted and Älskling could cope with that.
I mean, I would have been devastated if, you know, every third patient I had operated on at succumb.
But Alf could cope with that. But he was a good surgeon. Yes.
Oh, yes. Yeah. Uh, David Davis came to do the vascular work, is that right?
That's correct, yes. And that must have been a sort of change because then he specialised in that.
And, um, when did you begin to get a whiff of research?
Not in Oxford, perhaps not till now, but no. Um, oh, no, no.
My attachment in Melbourne was specifically to go and do research before that.
Had you done in the end of year and what did you do in Melbourne then?
Um, I developed a new operation for oesophageal atresia, so I did a lot of work in, uh, in conjunction with the Melbourne Veterinary School.
That's where I could actually go. And that I did quite a lot of research on motility, studies in children with oesophageal atresia.
A lot of them postoperatively had swallowing problems and actually identifying
it and seeing if there were drugs that would actually help their motility.
And so that's why I spent my year doing and I was I was very much that was very much, um,
to further my prospects of getting on a teaching hospital because I always enjoyed teaching.
And I you know, I was hoping that I would get on.
I didn't expect to get on in Oxford, but I was in my aim was ultimately to be in a teaching hospital.
So you enjoyed the undergraduates through the clinical students? Oh, enormously.
Enormously. And it's one of the great sadnesses now that they're so relatively to contact with the students, with the consultants.
And that is a real for the destruction of the firm system because they're always irritating, mean they're all rotating.
And but they you know, when you had as you had in medicine, you had students on the firm for three months was now three months.
You've got to let the students really well. Now, the the firm system's gone.
And so the students don't really identify with consultants.
And, you know, we as consultants, you can be you can be good role models and bad role models.
But whether if you're a bad role model, that's actually quite educating. You know, they say, what?
Yeah, I'm never going to be like that. And this is exactly like that.
Yes. And I mean, did you feel the hours were excessive in those days?
Well, straight answer is yes, because they were absolutely horrendous.
And in fact, for the whole of my working life, the hours were pretty, pretty incredible.
No paediatric surgeon in Malcolm Gough had incredible. Yeah, well.
And when did you pair with him? Sort of split it. Yeah. Yes.
And you were still pretty busy. We were. Well, I suppose, you know, as the years went by, there were more things that you could do a bit.
I reflect now that that they're called index cases and in paediatric surgery say things like a soft you know,
trees are in the same diaphragmatic hernia spine different than the cool index cases.
Now, Oxford was in Malcolm on Monday. We're doing about 120 of those a year now.
There are not a whole lot more. Index cases that come in from the region, right, but there are five full time paediatric surgeons now, you would.
I was I was I succeeded by, um, uh, Timoteo, which is Intercrime practise.
Yes. And you did the thyroids and the right and the adrenals.
Uh, there are now three full time Intercrime surgeons.
Having said that, there is more that there is there is definitely more endocrine surgery coming in,
because, as you know, um, there's a government policy that major cases should be centralised in places.
So and it's had an incredible impact on hospitals like Northampton, which was in the Oxford region.
And I've got a close friend in in Northampton whose morale is absolutely hit the deck because they've lost their vascular surgeon.
They left oesophageal surgery. They've lost no major colorectal surgery.
So they're doing just basic, very basic routine, simple operations.
And interested that you did find them before,
because I thought it all went to Sheffield and there was a guy the window there was a physician in Sheffield and there was a surgeon up there.
And at one time they were doing an immense amount. They were you're quite right then.
But it was widespread, in fact. Oh, yes, yes, yes.
Um, you see, now the paediatric surgeons do know the before the, um, the general paediatric surgeons on the staff.
Right. It's all done by paediatric neurology neurosurgeons who I and you may have seen him on television recently, got a very big nose, I think.
Well, I think that it is. But he he does.
I don't I don't think he single-handed I think there are two of them who do it all.
But Malcolm and I did all the spine of evidence. Yes. And the putting the bit talked about what the hydrocephalus story is so and so.
I mean, that's been that's been the big change that we were multitasking is when I started.
I mean, obviously, as the years went by, parts of my practise fell off.
I mean, like I did a lot of breast surgery is now there are maybe two.
There are two, maybe three surgeons or nothing else but breast surgery and don't get involved with General Take or anything like that.
So and I suppose it's the same happened in medicine. Yes, I think it is, yeah.
So how did you enjoy all the thyroid work? Because they're interesting patients.
I had a lot of fun doing that. And it's again, it's a bit like paediatric surgery.
There's a there's a precision about it. Um, uh, it brought me into contact with, um, Alister Lang at the church,
who was the specialist radiologist giving radioiodine for those patients where that was more suitable than surgery.
Um, and Chris Burke, who was a bit quirky character, um, and then he was succeeded by John Ross,
but we used to do a joint thyroid clinic, um, once a month.
Well, complicated, um, thyroid problems would be discussed.
And I really enjoyed that. Yes. Chris was a very bright guy.
Oh, he was. Yes. He was just a quirky character.
Um, I mean, sometimes, you know, he'd come into this clinic and he would be, uh, effusive and overpack.
And then another time he'd come in and sit in the corner and just a grump.
Yeah. So he was very sort of labour emotionally.
Um, but it was I really enjoyed that and I thought John was lastly, I really clicked with him.
Now you're FLC is would you get that as a registrar or senior registrar?
I we sat down in those days. You set your reference.
Yes. There's a registrar, right? Yeah. And then was it your Australian work for a doctorate in.
Well, that was the idea is that was the plan. Um, I was preparing to play together names.
Um, so I did all the years research acquired all the data.
Um, I really enjoyed my time in Australia. Um, you know, four young children grow at their early years there.
And at the end of my time in the Royal Children's Hospital, they offered me a job.
Um, and I was I was really tempted because, you know, we were very it was the three day working week in England and.
I just thought, you know, the future for our children, that you took any profession, there were openings and we're coming back to England.
We knew it was going to be tougher for them. But anyway, I came back because I had to work out my contract.
Yes. And in the three three months that I came back from Australia, my job came up.
The job that I got came up.
And I've never been so relaxed in all my life going into an interview because I thought if you didn't want me, I'd go back to Australia.
But the bottom line of that was that I immediately into consulting practise,
I didn't have time to do my my and which I had regrets about because I've got all all the data.
I've published a lot of papers, but I hadn't got the time to sit down and do a thesis.
So it was in a register. You you'd be in training up registrars?
No, the US had two or three. Well, one at a time, yes.
Yeah, yeah, and then what was really the difference, looking back between being a senior registrar and being a consultant?
Well, of course, the buck stops with you as a consultant. And that's that that's the, um.
Where does the buck stop on the ward round or in that patient's.
Well, yes, you've got to you as the senior registrar, you take a lot of decisions on your own band,
but if if you're at any any doubt at all about what would be the right thing to do, you can you you defer to the consultant.
So that's the major difference between as a senior as to how often roughly would you ring up or,
you know, get in touch with the consultant twice a week? Oh, no, no.
I thought know very, very. That's right. But you see, we were getting a huge amount of experience, which they don't get nowadays.
And the more I won't name who, but I mean more the ones I would ring up the consultancy to.
I trust you. I'm sure you'll make the right decision rather than get out of bed and come into the hospital.
So you did bring them up at night and just occasionally. Occasionally I did.
But overall, we were you know, by the time you got on the staff, on the staff is the senior registrar,
you actually had quite a background, a bit of knowledge and an experience.
Um. And then did you carry on your research at all when you were a consultant?
Oh, yes. So what did you. Oh, I did a huge amount of, um, you know, across all the specialities.
I, um, I didn't focus on, I would say I didn't focus in on any one thing in particular, although I did a lot of I did a lot of,
um, uh, research in rectal anomalies, um, measuring the continents and how we could improve their continents.
And, uh, so that was that was probably I probably publish more papers than that in the paediatric surgery, but then endocrine surgery.
I was very motivated to find ways of identifying parathyroid.
Yes. Um, which are really difficult to spot.
And, uh, I developed in Oxford a method of of, uh,
an intravenous drip with a dye that would actually show up the with the the and then you'd see them colour that operation,
that operation when you open doors and see them in the um. And that worked.
Yeah. Yeah. I mean it was slightly irritates me because it's actually still not still done.
Right. And they've developed something much more expensive and then now they're now picked up with the radiologist which cost a lot of money,
whereas actually methylene blue, which is what we developed. And that was a just a chance finding.
Um, and it's safe and it's pretty safe.
Um, but yeah, I know I had I had a number of research projects, you know, rectal stuff, Joe it Joe Smith was interested in that was,
you know, not because he worked I mean, on the bladder side, I suppose, but very much the cloaca, you know.
But with the pharmacologists, you did smooth muscle. Yes.
And did you work with her at all? No, I didn't. You know that I don't it wasn't quite the same type as Joe's research, with which smooth muscle.
Yes. You know, this was much more, uh, pelvic musculature and then how you could reroute the recommended for an erection anomalies, right?
Um, no, it wasn't, because there was a remarkable business, wasn't there,
that if you kept stimulating some of the pelvic smooth muscle, they became voluntary.
That's why it is absolutely incredible. Yeah, but that yours is more routine there.
Yes, I get it. And, um, when did you begin first to get an interest in, as it were, abroad, Ethiopia, Palestine, whatever.
Um. Well, Ethiopia is just one of the many places that I've been to with my surgical travelling 12 years.
We have a home meeting once a year and an abroad meeting.
So while you were still working. Yes, yes. Yeah.
I think surgical travelling clubs are losing their appeal, which I think is rather sad, um, because, again, it was a very good network.
Uh, you only had one member from any one centre.
Um, now I've been travelling with my group, uh, for the last 30 odd years and um,
and at a time when concerns had much more say about where their registrars and senior registrar went to know,
I could pick up the phone and I talk to somebody in Cardiff or in Colchester and say, we've got a really good guy who's looking for a place to, uh.
So it was very good networking. Yes.
Um, but that seems to be a lot of the surgical travelling clubs are struggling.
Uh, the format of the meetings always is. We have, um, we if we go abroad, we always have a contact.
Um, I don't know if you've read that book about the and the fistula hospital in Addis Ababa.
Have you heard about it now? Uh, Absi fascinate girls in Ethiopia, Mary.
Um, when they about 12 or 13 years and then they get pregnant,
get into obstructed labour for days on end and they the baby's head causes scheme
and they then get a fistula and we're back to somewhere they a fistula and,
uh, and a hugely prevalent in Ethiopia.
And two Australians, um, uh, went out and devised an operation to change these girls lives because once they became incontinent,
they were ostracised, you know,
they were shunned by society and some of them would walk hundreds of miles to get to this hospital in Addis Ababa, which is still going and doing it.
I visited it when we were there, but we've been all over the world with the and went to Cuba to, you know, you name it, we've gone.
So when you went somewhere like Undeservingly, how long would you spend in Ethiopia?
The club we spent, um, I think less than three weeks.
The format is always and that's unusual that unusually long because we were very keen to see the southern part of the country.
So some of the some of the team who were still in active practise couldn't afford to spend too much time away from work,
but knew I was a retired layabout so we could we could go to we could go down to the south and see more of the country,
which was absolutely fascinating. But the format has always been three days with the local medicks who we have a contact with.
And then we see a bit of the country and you'd be operating?
No, it was always lecturing. The only exception was when we went to Ghana and we did.
And the basic what we did, I did the first laparoscopic cholecystectomy in in Ghana took all the all the gear from Oxford.
And, uh, we were on television. It was a big, big thing.
And you only went to Israel after you retired. Did you Palestinians just say yes?
Yeah. Um, I don't know if the College of Physicians does this, but, uh, I don't know if they're still doing it.
But when I just retired, the college had a symposium for people recently retired who wanted to do VSOE.
And I went to this meeting. And this won't surprise you. This will make you chuckle.
Derek, um, there was a succession of talks by surgeons during the day who were all on ego trips,
and they all said, oh, I think you should go to Tanzania.
I went and I take a team every year and we carve up 200 natives in doing such and such a procedure.
And then they come home. And I thought, you know, anything that goes wrong, they're off.
They're off the planet. Yeah. Um, and so at the end of the afternoon, the man sitting next to me said, what do you think of that?
And then I said, well, actually, I'm very disillusioned. You know, I said, just what I've said.
Just, uh, I think, you know, if anything goes wrong after you've left, you haven't you're not there to pick up the pieces.
You haven't taught the locals anything.
You know, what I had in mind was going to actually show people how to do things themselves and stand over them and watch them.
And, you know, you've then left a legacy and they said, well, I.
On the island, I'm professor of research surgery at UCLA, and I've got a very close link with Al Quds University in Jerusalem,
would you like to go there and teach anatomy, which I did?
I well, um, I usually two or three weeks.
Yes. Um, and, uh, the following year they said we would really like some surgical, uh, guidance at our hospitals in the West Bank.
Um, do you think you could recruit some people and then it snowballed and I've been doing it every year since.
And last November 12 of us went from Oxford, from Oxford is predominantly Oxford based.
Some of them are people like you remember Tom.
They do some Tom work got on at Redding, the royal, uh, you know, so people with close Oxford links, um, so we took it expanded.
We now take three paediatricians, three surgeons and three physicians.
I've been trying to talk David Warren into it, but Chris Caldwell in this column, Tim Littlewood, like Peggy Fritz, Peggy Fritz, come regularly.
Yeah, um, and I think it's hugely appreciated.
Yeah, I bet it was like, what is new? Is it?
And this last year for the first time we I had been before, uh, but just to see rather than teach this last trip was to garner to Gaza.
Right. Where the leader of the need is even greater in the West Bank.
In Gaza is basically a ghetto. Yeah. It must be terrible.
It's surrounded by a security wall. The locals have great difficulty getting out.
And if they do get out, they're not allowed to get back in again. Um, so they feel very isolated.
They're hugely appreciative of what's going on. But getting there is quite difficult.
Getting the visas to go is a long process. And so that's how I got caught up in the night trip.
So you did your preclinical in London? Yeah, yeah, yeah.
Now, I know this is very difficult question and time is changing all the time.
Do you think there's any marriage in the Oxford Preclinical School?
Absolutely. My great regret is that I didn't go to Cambridge and do my preclinical because I was offered a place
that Alan Keyes the year after I left school and in those days having a gap year was it was unusual.
It was very unusual. I didn't come from a particularly wealthy family. They put me through public school and boarding and everything.
And I had a real conscience about it being a burden to them for any longer.
So I was offered a place at Cambridge the year after I left school to what is fifty eight or something.
Yeah. And would be about that is um mind you, if I had gone to Cambridge, I was a very keen horseman,
I probably wouldn't have qualified and I'd probably found a way to spend my time on the river.
On the river. Really. That right. Yes. That was my number one sport at school.
I did a lot of rugby as well, but I was rowing was my major stroke.
I was well, I wasn't big enough to be, you know, middle of the boat.
But I stroked the, um, when I stroke my school crew and then I stroked the butts first date and went to England.
But now you're answering your question. Um, I think if I had my time over again, I would do my preclinical at Cambridge,
because I think probably it has slightly the edge for basic science is on Oxford.
On that I'd come to Oxford to do my clinical. Yes, because I think I think Oxford for Clinical is as good as anywhere I've seen.
And I talk to I say all these members of my surgical travelling club who came to Oxford and saw what was going on,
they all said, this is this is one of the best places in the country in our estimation.
The, um. So then how did you link up with the district hospitals in Wallingford and, uh, Whitney and didn't didn't you.
I did. Oh, very much so now. Well, I don't know if it's still going on, but, uh, there was a vogue for doing peripheral clinics.
And I did a peripheral clinic in Didcot and I did another one in time, which both had a little cottage hospital.
And then I think they did cover and it's now quite expanded. Um,
but actually I quite know quite like I very much like having contact with the local GP's
who are referring patients to me rather than just to an anonymous name on a letter.
And if you actually went they quite often sat in all my clinics or they'd bring a patient is um and I really like that because the Markus's routine,
they were I never knew them very well, Andrew said sadly, no longer alive.
But, uh, Pat, I still see when she comes to any medication, um, um, just trying to remember the name of the guy that I had a very difficult course.
No, Bill, Bill Colson was called some years, whose wife was at the, um, cancer centre in terms of OK, well, she knows.
And then she ran it. She was so said she had nothing to say about it.
But Bill was a very good GP. And you've got the you know, you've got the vibes about people if you actually saw them in their own environment.
Um, so, yes, we had a and then I became ultimately I became regional advisor for the College of Surgeons.
So and we had to go and assess hospitals. So I visited all the hospitals in the region, um, to see how they were running things.
And if it was it was up to standard. Was there. Advisor for training to visit.
Yeah, yeah, both. And what did you think? Did you think people were being well trained?
It was quite variable. Um, and I was just mentioning a while ago about North Hampton.
I mean, I was hugely impressed with Hampton in the United States is really good in that area.
You remember Brian Dowling, who was he went from Oxford to become a consultant there.
And then two of my senior registrars went to to North Hampton. And that was that was doing a fantastic job.
Um, reading Roebuck's and reading.
There was a lot of personality clashes there. So that went through a bad phase, but then had a better phase.
Um, Milton Keynes again hospital, where a number of my registrars and registrars went on to become consultants.
Um, so yes, I got to know all the peripheral hospitals very well, but mainly through being the college representative.
And would you be getting up to London to committee meetings, so. Yes.
Yes. But I was chairman of the Court of Examiners for the Fellowship.
Wow. Um, so that brought me into contact with a lot of people.
Did that mean travelling around the country as well or not?
Laughter It did when I first started all the bit like the membership, because I think membership was exclusively held in it, wasn't it?
And I don't know if that goes out and about it does now. Yeah. No change in the eighties.
Yeah. Yeah, that was right when I when I was chairman of the Board of Examiners up until that point has always been that in Lincoln's infields.
And then I remember the first, uh, the first, um, exterior examination for the fellowship was in Liverpool.
And I can remember going there and then Manchester and um.
So yeah. Yeah. And private practise. How much do you deem.
Um, enough is enough. What's that come down to.
And we do have several six operations a week or three or was very variable.
And then the er if it's a big enough operation it needs to be doing what it's going to take that I needed.
I consulted one morning a week, which is on Saturday morning, um,
because the rest of my week was very busy and I did one afternoon's operating at then I didn't want,
I didn't want private practise to completely take over my, my life.
And, you know, because I was very dedicated, dedicated, I mean, I was very driven to to do a good job with my NHS patients, which I had a lot of.
Um, but I, I, I wouldn't have missed private practise because it brought me into contact with, with people in the city that,
you know, most of the downs, for example, including the very left wing door, they had private practise.
Um, I didn't know that, uh, so I had some very interesting patients who I wouldn't have otherwise had contact with.
Um, and, you know, in those days, all the private practise was done out of the åkerlund in the Banbury Road.
And that was very that was very easy. Um, you know, geographically,
it was very easy to just hop across the road and who look after those patients sort
of post office with your registrar or husband to talk to you almost exclusively.
Yes, myself. But actually, there was resident staff. Yes.
In the act. Yes. I don't know if that's still true at the at the manor, but, uh,
a lot of the demonstrators in anatomy is had rooms in the åkerlund and were on call at night.
So if somebody is blocked or something,
there was something you didn't have to get the consultant come in to put up another drip or something like that.
But no, most of the day to day care was very much in your in your hands.
And you were publishing, as you said, were they, as it were, trials of therapy or development of new operations or both?
It's both. Uh, what therapies did you try? Gosh, I better go get my file.
Right. I mean, I'm only one day I published it, but I think I published one.
I think I know I published about seventy papers, but about a whole range of things.
Yes. And then I was I got very involved with the Oxford textbook on surgery.
Right. Uh, who was editing that. I needed to know.
I mean that was Malcolm, that was um uh Peter.
I had um Prof.
And I'm just trying to remember who he is and his co editor was.
And then I also got involved with the Oxford textbook he medicine to write the bit on, uh,
Thornwood um, surgery of treatment, which I liaise with, uh, thing that was written, John was.
Um, and then his own book on the chronology. Yes, he wrote me into the Adreno chapter for that.
So yeah, I did quite a lot of writing and in the surgery book, Take Obstetrics with Surgery.
What did you write about in that? That wasn't quite serious. Yeah, I think I did the thyroid chapter and the adrenal gland and the paediatric,
you know, that was done entirely by Paul Tan and been my mind got my hands for it.
Yeah. Yeah. What difference did Peter Moritz's coming make?
Um, oh, Peter was pretty inspirational actually.
Um, he was very much better with the general surgeons than his predecessor, Philip Anderson, who was pretty remote.
Yeah. And if you remember him, he was he drifted off. He was a very remote character.
He didn't, um, whereas Peter really did make a big effort to, uh, to integrate with,
um, you establish one of the things which I was I thought was fantastic.
And, uh, I'm still in contact with with the people that it generated.
But Peter established a link with Johns Hopkins Hospital in Baltimore and their chief
resident came over to work with our one of our surgical firms by rotation every six months.
And I'm still in touch and that my surgical training at this year is going to Boston and Harvard just down the road.
And my my the guy that came from Baltimore to me got fired up to do endocrine surgery.
And he's now chief of surgery at Harvard. And we're going to meet up with him in the autumn.
So, uh, that was a that brought into contact with North America.
And Peter was responsible for that, which I thought was really, really good.
Yeah, very good link. It's gone now. Sadly, I don't know why they let it lapse, but, uh.
And did he, um, change the sort of research culture in any way, did you feel.
Yes, you did. Oh, yes, definitely.
Uh, um, there were at any one time there would be always two or three of our registrars seconded into the department to do to do their research.
Um, but that aside, that he had a lot of people come from Australia.
Right. And was the research mostly immunology of everything.
So, um, I was very much related to his two major specialities, uh, transplant transplantation and, um, and vascular.
Yes. Um, but yes, I think it was a lot to do with, uh, immunosuppression.
And it was, uh, he did a good job.
Yes. And then cardiac surgery was developing quite separately.
Yes. Wasn't that was sort of split off and. Yeah. And had its troubles.
Uh, yes. Yeah. And that's a better personality thing.
That's what I was thinking there. Tell me about anaesthetists. How important are they for surgeons?
Oh, no, they're absolutely pivotal. So would you have sort of one or two fixed ones or.
Yes, yes. Yes, I think they still do. I think people have.
You know, it's rather nice if you have a good relationship with a guy at the top of the table.
And and I was very fortunate, Dick, for him. And I, um, and he also did for the cardiac surgeons and he was really on the ball for them.
But if I had a really, really premature baby that was needing operating, there was nobody better than him.
And he would quite I would if I got a really, really challenging baby came in that needed emergency surgery and it wasn't his night on.
I would I would contact him and he would always come. He was, uh, but I did have some other very good colleagues, uh, John Stevens and Thea Schofield.
Uh, Schofield is here. I am a GP or there is one.
There is another. Schofield is quite right. But, um.
No, it's not. It's so it's a different Schofield but it's not Schofield.
You're quite right. Uh Schofield um was mainly work with Malcolm but occasionally Ontake he would uh I would work with him.
But the two ones maybe I mainly work with, with Dick them and and they are having a good, a good again it's a team approach.
If you know, if you have people that you work with regularly, they know how you operate and that you know how they operate.
And so this is this is really important. Likewise, it's like, wow, how many would be I having to that you'd work with or more than that.
Well, I I think it's still I think it's still the case, uh,
all the emergency surgery is done at the John Radcliffe and each theatre has a sister and, uh, who had started if it's changed now.
But, you know, whenever I was on take, it was pretty nearly always the same during the daytime.
It was nearly always the same sister and the church were likewise. So I'm I'm still in touch with my theatre sisters.
The, um, how much difference that I make to you is there you are the church for quite a bit of the time.
Right. And what I mean, I started off my career at the Radcliffe Infirmary.
So, uh, which was everybody, as you remember. And that was so cosy.
And you knew you knew everybody who we all met for lunch in the piccalilli, uh, uh, at the top table with all consultants and all the juniors below.
And, you know, uh, if you got a referral, you could just get up from the table and wander over and say,
Derek, would you come and see if this patient on my ward was very cohesive?
Um, moving to the John Radcliffe, um, I was I was very concerned that we should remain cohesive.
And I fought tooth and nail that we should have a common room, which never was.
Not in the original plan. No. Yeah. You know, there was was a.
Elitism that consultants shouldn't have they should be eating with everybody else.
But I mean, again, I thought that was really good, that we would be able to, over the lunch table, be able to talk to each other.
Um, uh, so that was a real struggle to get to get that, uh, get that set up.
Um, and a lot of people started having bring in a lunch box and having their lunch up, not in their office and not meeting anybody else, which I saw.
I found that much less personal. And, um, what about actual physical conditions?
Had the church been getting grafted? Yes. Bottom line, yes, it was.
But you remember I mean I mean, two of the wards I worked out of Nissen huts, um, nothing wrong with that, except, you know, they were modern.
They weren't modern facilities. Uh, now when I go to the to the church of that new block, have you been in the new block is the concept of cancer.
That's absolutely amazing. That it is absolutely fantastic. Um, but no, it's the it was it was a field hospital, American field hospital.
That was, um but again, it had a very good atmosphere. Um, and, uh, it worked well, um, and it was right for doing elective surgery.
It was no backup intensive care unit or anything like that.
You know, if you had a patient who really went off when they got into serious trouble, you had to transfer them to the job after.
Um, how does the development of imaging in various ways affected your work?
Because the imaging is made huge. Oh, yeah. Oh, yes.
Dramatically. So dramatically. So do you think that affected your diagnostic approach?
Well, I tried to not make it in as much that I think the old traditional skills, uh, are very important.
And it's very, very interesting. When I got to Palestine, uh, they can't just click their fingers and have an MRI scan or CT scan.
They've got to be able to examine the kidney or liver and the basic the basic skills, which I think is still very important.
Um, uh, so all this imaging.
Yes, it has improved accuracy of diagnosis, no question about it.
But I think it's a bit overused, probably. Why is it expensive.
Yes. Yeah. Yeah. Oh yeah. Um, you know, I think people can become very overdependent on imaging and say in the news that lose their basic skills.
Um, I can lose. I was remember years ago when I went out, I got I got two scholarships, I got one to go to Australia,
but I had another one from the regional authority to visit surgical clinics of North America.
Uh, when I when I was a senior registrar. Yes. When I.
Right. Um, for how long? Six months. Six weeks.
Six weeks. Yeah. And, uh, and I went to the Mayo Clinic. I went to Philadelphia Hospital.
I went to I went to Chicago.
Um, but I, I do remember going to Boston to the Mass General Hospital in Boston and patients would go there,
uh, through the front door of outpatients, which was a complete.
A separate block away from the main hospital that had been sent up by they don't have GPS, but you know that their primary physician, um,
and they would their first calling station was haematology and then have blood drawn and every investigation under the sun would be done on them.
And then the next court of call would be radiology and then have a chest X-ray,
then have this test and the other scan and then they'd finally see a consultant with all these results.
So, you know, so that's one of the one of the disadvantages of over investigation,
all these these things that are now available that people are not thinking, you know, that's appropriate to do or that's appropriate to do.
Probably means a lot of people have much more radiation that is good for them. But what was that about America that impressed you?
Um. For example, going to mass general they were doing at that time,
I think something like a hundred title tank protectiveness a year, so, you know, way ahead of us, they were centralising things.
Um, and, of course, the degree of expertise that you get if you do that volume I've talked to May not.
The other day when I was doing oesophageal surgery with Outgunning,
we had about a 40 percent in hospital mortality for for surgery on the oesophagus because we were doing perhaps five.
Here now is part of government policy.
All the cases are centralised. So Nick Maynard and his team at the John Radcliffe are now doing something like one a week.
Wow. Yeah. And their mortality is two percent less so.
And that's where I think where America was ahead of us. They have these big centres, lots of centralisation.
And, you know, it would be the same in your speciality in medicine.
There would be people who would just be seeing droves of patients with Addison's disease and they'd get very,
very good at dealing with Alyson's, for example. Yeah. And you would have had to do with it.
You paged paediatricians neonatal. You had a lot to do with that Peters out and.
Right. He was there. Yeah. Yes. And then who succeeded in him?
Really good question. The next professor was Moxham as a was, but he wouldn't have been.
But he did. So then actually it you didn't have a professor.
I mean that was his speciality, but he was also head of the department.
So he would he would be chairing meetings about general paediatric care.
Uh, Moxham, who succeeded him, um, had virtually no neonatal experience at all, um, very rarely went on the wards.
So he was, you know, really research professor. Good case actually is to have two professors.
Actually, that's true in medicine and surgery, where you have a research professor and you have somebody who is hands on clinician.
I quite agree. Absolutely. Um, because Wilkinson came through it and it was that in your time.
Yes. Yeah. He would have been he on a chair in the end. We did. Yes, indeed.
You know, he was the lead after after Tizard died.
He was in between or not. Um, I don't think it was that during the time of tenure.
And then, I mean, tragically, as you remember, we got the chair in Bristol and before he could take up the chair,
he was a helicopter crash and was a bicycle ride. He was doing a charity bicycle ride.
I'm pretty sure it was not a cardiac surgeon who got knocked off his bike in the Banbury Road.
There was one indeed. But you think, David? I do.
That's the only thing that I thought he was on a helicopter trip to the Isles.
It's possible maybe one of his brothers. I mean, I'm not sure.
I mean, he's got a famous brother. Yeah. Still alive. Yeah. But he had a lot of brothers that did it.
But Michael is actually looked after one of our very close friends with breast cancer.
And he was one of the first people to blow the whistle about, um, about the inefficiency of breast screening.
Really good for him. Yeah. Uh, because I gather I was very keen on that.
Um, the breast screening, promoting it. Promoting it.
Oh, yes. Well, it was it was very much government driven. And I was seen as I don't know if you would agree with me, but I got the feeling that,
you know, this was, you know, look what we're doing to save women from this dreadful disease.
But actually and I was picking up a lot of cancers. We didn't need radical treatment.
Right. What was your feeling about the administrators and their involvement?
Well, again, you know, I was aware of that generation. We were we saw seismic change.
Um, the old Radcliffe Infirmary. We had the medical staff council who called the shots.
We we set the priorities. Uh, now the administrators call the shots and they, by all accounts, didn't have a great deal of input from clinicians.
So that's a completely seismic change. And that was that was happening latterly where we were being.
Holds what to do rather than we were saying these are the priority. This is what we should be doing.
How did that come about when you make. How did that come about?
I don't know is the honest answer. I don't know really.
And were you ever told you said they were calling the shots, so anybody administered to tell you what to do and you felt it was wrong?
Um, I'm struggling to remember specific examples, but there were, um, I just there were there were things that cropped up where I thought,
gosh, in the past we would have discussed that amongst our colleagues and decided that actually that was the priority.
But in Lashley, it was the administration saying we'd actually decided that we're going to do so-and-so without any reference to us.
No, but when you heard that, did you go along with it?
No, I didn't. No, no. Because what do we do?
So you just do something else and keep quiet. No, no, no.
I remonstrated like crazy with, um, Ralph Johnson, who was just postgraduate.
Lived in the village here. Yeah. But no, I had I enquired.
I said it was it was very sort of civilised, you know, our disagreements with Ralph Johnson,
for example, he was just one of them, you know, about the European Working Directive.
And I said, you know, this is this is absolutely devastating for the phone system and it will be bad for continuity of patient care.
But he was you know, he was under the government's remit and pushed it like crazy.
But I and I was I was senior enough to stand up to him.
But junior colleagues would have never dreamt of standing up to him to, you know,
all that sort of thing, because he was a very influential figure for them. And I got my marriage award and I was going to say, this is wrong.
So I think it was quite pleased to me off of a thing that was very much been on the training side.
That was you were talking about the management and the management side.
Um, yes. You are talking about on a personal level, you know, I can only think of examples where I was personally involved,
but there was a there was a move which was successful to completely take out general surgery from the church.
All right. And take it all into the job market. And that was driven by the administrators.
And was that a good thing? No, it was. And what's and what's very interesting, in the fullness of time,
they completely reversed the policy because I knew that if we took all the elective surgery out of the church and into the John Radcliffe,
if we had a very heavy take with emergencies, then all the elective patients would get cancelled.
Yes. So the church was a protected environment in the fullness of time.
That and the population rising and were becoming more of a referral centre.
That's exactly what happened. And more and more patients were elective procedures were being cancelled.
And so now all the elective surgeries go back to the church. But it's it's taken a new block to do it.
And what happened last year about that, I should add, because you're getting some bits of paper.
This was just to remind myself of names. You may have thought, you know, who what sort of people influenced me when I first arrived.
And there were certain and I mentioned Eric Pete because, you know, he operated in an adjacent theatre to me, Sir John Stallworth.
He also had an operating theatre next to me.
And I got to know him quite well. And how did he influence you, as you said, John Stewart?
When he was just doing interesting things? I mean, I think surgeons are only quite stickybeak and they like to see what other people do.
And that sometimes gives you ideas about where to do things. You know, particularly when endoscopic surgery came in.
I did a list on a on a on a Wednesday morning, as I said, at the Occlude.
Yes. Um, what's the name of the Neimann? Chris, I think, anyway, he was doing endoscopically, um, arthroscope, arthroscope,
but he was also actually putting a new cruciate ligament and I was absolutely fascinated.
I was looking at the instruments that he was using,
but I was at that stage doing some of the very first laparoscopic gallbladders and he was actually fascinated what I was up to.
So there was a cross-fertilisation which was very good. Now, Germany in Britain has always thought I was a pioneer.
Yes, you were sort of together. We were actually together. Yes.
Julian and I went to the very first demonstration at the College of Surgeons and we came back to Oxford and said,
this is this is something we've got to develop.
And I can remember we got hold of of a camera and the ports, you know, and in a cardboard box.
And we used to buy chicken legs from and from a test case.
And we would dissect them because, you know, you're no longer looking at your hands.
You're looking at a screen. Um, and, um, Julian did a lot of RPG surgery, uh, but I was very, very motivated to do it for deals that I did.
The first one in the country. Right. In Oxford. Vitrines, I don't know from back is no Transcom transmission.
And that that actually revolutionised adrenal ectomy, which actually was a very difficult operation to open.
It could only get to the adrenal by opening the chest and abdomen, which was very traumatic.
And, uh, um, and I was invited over to I had a great chairman, Leo.
He was the president of the French Association of Endocrine Stage and not as president as the English and the British Association and Gruntled.
And we used to meet up at conferences and he he got the first man in the world to do a general ectomy laparoscopically to Leo.
And I was invited to go and watch this man and then came back to Oxford.
And I said, we did the first one in the country. Um, then and our Greg Sadler, my successor, is doing more than anybody else in the UK.
And we're peeling oranges and deservingly because I remember Julian saying had the best we do.
Well, we did all sorts of things the same way when we were practising our stitching.
It was to put the skin back on the leg of a leg of chicken and we were peeling oranges and it was just getting our skills, um, organised.
You know, when you say you went over to Lille now, did you in any way feel I can't go to LA because I've got to do my NHS work?
I mean, what was your sort of feeling about that? It's obviously vital that you go to the you you know, the insurance.
And how did that sort of fit in? You could be happy to leave your senior registrar today.
Do is again, we're talking about the invasiveness of administration now.
Um, I mean, this team that I take to to Palestine, uh,
is a really tough call because they they all have to negotiate with the administrators to have their rotor's covid or um,
whereas, um, you know, nobody ever challenged you in the past.
So they just knew that you were you were the rest of the year you were pulling your weight like nobody's business.
And that that was beneficial actually to go to to meetings in Paris or in there.
And so it's got much more difficult to get to.
Uh, but I think one of the reasons I just mentioned about the surgical travelling,
perhaps that, you know, people that don't have the time or that they're being bred,
that they're being sort of marginal much more closely, you were saying that the the terraces, the structure structures more or less going on.
What about the the sisters and how do you think the nursing home those.
They got worse, got worse. Yeah, really sad is I see it a little bit through relatives and uh, and I'm not just talking about the John Radcliffe now.
I'm talking about Countrywide. Yeah. I think if you'd agree with me.
But I think, you know, the moment they started saying, you know, if you're going to be a decent, you're going to have a degree,
you actually started recruiting people whose whose heart wasn't quite in the caring, caring side of it was not so such a high priority.
Um, and the number of nurses came came on to the wall type thing,
particularly in paediatrics, you know, the paediatric wards, which I was involved with.
And they would come back having got their degree and then their ambition was actually to be a nursing administrator.
They didn't want to be on call or actually be on the mend, you know,
having to wipe somebody Baltimorean on the wall that it was and that was let them learn.
So the culture, I think, is quite changed in nursing is. Yeah.
And they never made enough use, it seemed to me, of the state qualified nurses or whatever they were called, the ones who weren't state registered.
Right. But the sort of second guess the next the next year. Well,
I think they're much more dependent on them than the ones who don't have the degree that they have at the scrubbers and rubbers or anything else,
Nick, because I think we're getting to the right.
Um, this I said and I quote, I knew when you said you were coming up, I wonder what he's going to talk about.
That is one, if there's anything else that really would that. Oh, you know, just there are a few things that just that struck me.
I'm just what it would do to me. Um, I've just jotted down here.
I mean, one of the things when I very first arrived at the Radcliffe Infirmary was Cronshaw.
What do you remember Cronshaw Ward off the main on the main corridor?
Yes, I do.
Before you got to the main theatre on the right, the main theatre was on was just beyond the is when I Cronshaw Ward was where all the patients went,
had broken their hips, the old ladies who'd broken their hips and they were all put.
This is before beginning of hips. Yeah. They were all put in traction.
Um and the mortality from bronchial pneumonia immobilised was astronomical, you know.
Now you think that they sort of really aggressive orthopaedic surgeon, they will come in and have,
you know, with a fractured hip, there'll be pain and they're out in 48 hours. But in those days, what war was the kiss of death?
If you've got admitted that because you say you put in traction, you know, most of them were elderly people,
70s and 80s with a broken hip put into traction and not moving, probably not getting particularly aggressive physiotherapy.
And they all that long. Yes. Um, was there anything else that just goes to show there is?
Because that's a really good point. Well, you know, that was just one of the things which really hit me when I was thinking about it.
Ten anaesthetise and the staff, yes.
How many there are now, but sixtyish cents, all the orthopod who wrote the book used to come and do a week at a time of any.
There were never any specialists, they wrote.
And then there is the huge battle of the three or amongst the neurosurgeons.
Yes, service. Yes. Joe Pennypacker is I've just jotted down a few name people who made a big impression when when I first arrived,
because, I mean, these were these were jobs. Yes. I mean, how close to did you get?
Oh, not at all. No, no, not at all. I mean, it wasn't there wasn't there wasn't a speciality I was aspiring to.
But, you know, he again, you know, one of the things which has changed with its grand rounds, um,
I don't know what it's like in medicine now, but I'm talking to my colleagues, my contemporary and contemporary colleagues.
Uh, they they say that grand rounds have completely lost their their sort of all-embracing audience.
They used to have I mean, everybody used to get your Friday morning grand round.
Now, at the colorectal surgeons don't go at all.
They have their own mini grand round.
So you're not interacting with people so much, which I think is so what I which is something I enjoy because I'm a people person.
I like interacting with people. And you learn things.
I mean, one of the things I go to this medical club hearing from Rabbi Pelli or somebody about what they're doing now and so grand rounds in surgery.
And I don't know what it's like in medicine, but it's, um, is not well attended.
Right. Did Addison have grand rounds? Well, he his he he would be he'd be allotted a space to do grand rounds.
That'd be what, a surgical round round and Edison's time.
Yeah, we were we had great crowds in those days but I mean the way it was and I think it's still,
still probably goes on is that one week it would be the urologists who would be,
you know, who would be George Smith and great fellows would be doing the ground round.
And then the next week it would be David Temp's doing a vascular grand round.
And then it would be me doing endocrine, um, because I had imagine and Peter Morris's term that he would run.
It wasn't that Peter had a very strong hand in it. You're quite right.
He did. And he was always there in the front row asking awkward questions, which is good, you know, stimulating.
Absolutely. And he supported it very strongly. But did you have anything by the take positions, we had a meeting that wasn't in any way.
Granted, it was an administrative meeting. Yeah, we did, yes.
How often roughly? I think that was held a sentiment that was held once a month.
Yes. And was that useful? Oh, tremendously. Now that we get you over things that, um, you know, administrative matters,
which was and it would be a collective decision, um, Peter was pretty forceful.
You know, he would Peter Morris when he would because he I think he I think he always chaired it.
I tried it for quite a long time. Um, but that was a good interaction and I'm not sure that happens anymore.
Anything else on your list? Have a look at.
Well, I think we've covered pretty much everything that. Jotted down here.
I was very lucky with my career that, you know,
I'm looking at things that I did abroad and I did a lot of it because I was on the court of examiners at the college.
I went out to Rijad, Hong Kong, Kuala Lumpur, lecturing, examining the fellowship.
Right. Um, I was also on on the Court of Examiners of the Edinburgh College.
So I did know I went to board with them. Um.
I went as a visiting professor to North Shore Hospital in Sydney, a visiting professor to, um.
Beijing lieutenant, um, I think I did a month I did a month in, um, you know, in, uh,
in and out in Sydney and I did a month in Hong Kong and a month in in um, in Beijing, which was absolutely fascinating.
Absolutely fascinating. You know, you you know, you saw different cultures.
And I mean, take for example, um, um, Nephi blastoma now, you know, we would put I would put a lot of effort into those children.
A very different world, a completely different world out there that the Iraqis will be putting out all the stops for a child with that,
uh, that they would assess the child. Thought if that's the problem, if the prognosis is not good,
just in the back of the country and this is the 80s or 90s or that must have been in the 90s.
Yes, it was toward the end of my career when those sort of things actually. That was the end of your career.
Would you have these invitations to go to these places? And, um, and we do operate in China.
No, we are purely went there to lecture. And how about Australia?
Um, again, I've been I've been back to the Children's Hospital in Melbourne on several occasions.
And two years ago, I went to a fantastic meeting in Tasmania for Oxford alumni, um, uh, Cradle Mountain Lodge up in the air, which is fantastic.
And there were a number of people there but that I had remembered working in
Oxford because Roger Bradley would have organised that absolutely spot on.
Yeah. He's he had a I don't know how, you know, but he's got a joint or had a joint base.
I think he still has a joint post in Stoke Mandeville and in Tasmania.
OK, so I think that six months in each of them. Right. But there was another guy with his name who you would remember was on the NDA.
Um, there was Tim Davis, who was a dermatologist. Oh, he was there.
But I don't know. I just remember this guy's name if I mentioned it.
Yeah. You'd know exactly who was talking about. I mean, he would have been I think he was senior lecturer to, uh, Pickering or something like that.
Right. Oh, Laurie Bailey. That's the man.
He was there. And I hadn't seen Lawrie Bailey for ages.
That's right. Um, I, I see. I mean, I was in good form.
Very good form. Yeah. Uh, there were a number of people who had worked with Peter Morris and not surprisingly because they'd come out from Melbourne,
worked and then and then the NDIS and then had gone back to Australia. No.
Then he'd actually groom some very prominent people there, a number of professors at the various universities in Australia.
So that was a lot of fun. Yeah. Um, but yes, no, I've, uh, I've kept up my Australian contacts, uh, very closely.
So, you know, when I was still working and I they invited me back and, um, I like Australia and I said, Yeah, that right down to it.
Yeah. So, OK, Nicole, thank you very much.
Is that me to take the box for you? Absolutely. OK, thanks a lot.