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This is a recording on 7th August, Robert Migros being interviewed by Derek Hockaday.

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Robert, when did you first get the idea of coming to Oxford to do medicine?

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Probably about 1957. I was at a boarding school, St John School, Leatherhead, in Surrey, and I decided by then to study medicine.

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But, you know, things are much more laid back in those days. And no one said, come on, you should apply here.

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You should apply there.

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In fact, I applied to St Mary's Paddington because obviously five years to qualify is better than six and a half or so, you think in the sixth form.

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And I think I had to go up and do a multiple choice questionnaire, which I had no training in.

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So I suppose I was pleased when they put me on their waiting list.

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So then I did what my father wanted me to do and he wanted me to come to Oxford, where my elder brother had already come.

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So I applied to Oxford and that's where I got my place. Right.

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Do you remember anything of the admissions process? Oh, very well indeed, yes.

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What did you think of it? Well, I we weren't interviewed by the medical school in those days.

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We were just just interviewed at the college at Peter's College.

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We had an entrance exam. So I think I took biology and physics with chemistry and there was a general paper.

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And then I think a couple of days later, there was an interview in the senior common room of St Peter's.

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In those days, I was very small. There were probably only eight or nine fellows, and the interview went very well.

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So I was pleased when they offered me a place. Was Davidov heavier than I?

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If he was, he wouldn't have been a fellow at that time.

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Obviously there were seven or eight fellows and then you had the tutors who were probably fed in from other colleges.

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He was certainly around during my time, but I don't think he was fair then.

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But he told. No, no, no, he didn't. The the tutor in college physiology was Gustaaf born all right.

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But he left after a year to go and be a professor at the Royal College of Surgeons in London.

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And Keith Cooper came Keith Cooper worked with with George Pickering and eventually went off to to Canada to be a professor there.

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So what do you remember as enjoyable? Was it the best work or the schools were so interesting.

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I mean, looking back, I'm, you know, 100 percent glad that I did come to Oxford and I did do what other universities called into collated decree.

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I really did enjoy the third year working for the physiology finals.

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You know, I remember reading papers from eighteen fifty six and that sort of thing they really did is um because I was in Pickering,

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Missouri, that where Cooper was. So I knew very well he had a very basic sense of humour that came over there.

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Well if he did I don't remember it. I guess I wondered if it.

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Was he a good teacher? Yes, he was. He was in fact, a better tutor than the good stuff.

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Yeah, yeah, yes. And what did you do?

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Did you do pathing back after school was a yes. Yes, we had two terms back and back and I think we did more pharmacology, those two terms.

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And of course, Bill Payton was a professor. He was one of the best teachers.

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I mean, I had a lot of excellent teachers, but Bill Patten used to lecture nine o'clock on a Saturday and the room was always packed.

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And the way he drew these little mice, you know, he just arrows and things like that, it was magical.

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Who else do you remember from your school? Yeah, uh, from the schools.

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Yeah. Uh, that's an interesting one.

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We'd had change, I think, in the professor of physiology. Uh, I don't remember.

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But going back. To first PM or second PM, whatever, of course, I had people in biochemistry like.

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Um, and then I put my mind to it.

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I could think of others. But on the anatomy side, of course, we had the Clark Clark he was still going with is very grace.

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And there were other people I mean, their names would come back if I put my mind to it.

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But whether he was a great lecturer that I can read or write.

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But Crib's was crib's a bad lecturer that I don't remember.

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I mean, I was not the best attender at lecturers at lectures because, uh, if the lecturer had written a book,

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I used to prefer to go to the library and read the book that suited my style more.

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Uh, but certain people, both preclinical and clinical, really were gripping and you wouldn't miss but others, you know, skipped.

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What made you decide where to do your clinical work training up?

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Well, of course, like all the others in those days, I was going up to London, wasn't I?

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And I suppose it was in the autumn after schools that they advertised an afternoon,

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a look round and look round the infirmary, and they obviously notified everyone in the back and back.

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So I thought, well, I'll go. And we had a look around and then we had tea and I was the host.

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And probably people like you said, where are you going for your clinical I so I'm going to London.

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And the immediate comeback was why. Yes.

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Anyway, with very little brainwashing, I changed my mind and stayed here with the sort of people there was George Pickering or Mike down now.

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And Mike Duncan was probably at that time. George Pickering.

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No. Right. Uh, and, um.

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And you're glad you stayed in Oxford. Oh, it was wonderful.

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Is, uh, you know, it was a close knit group.

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I think the whole medical clinical school in those days was probably less than 60.

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And that spread over whatever three you three years.

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We had most people from the preclinical time went off to London.

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We had a few come over from Cambridge and we had one or two come down from Leeds or Sheffield who'd done their inarticulately degree up there.

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So we were a small it was it was just good.

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It was good home and er practical procedures we do have done as a student.

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Were you qualified, would you have been taken? I'd have taken blood.

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I really can't remember what else I've done. You wouldn't have done puncture?

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No, definitely not. Definitely not. Put up a drip.

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Probably, yes. Yeah.

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Because that was, in a sense, an advantage the Oxford students had over London possibly at that time got the chance to do a few things.

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Oh, well, yes, because when the House went on holiday, they had student locum.

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Right. You did run. I did what I possibly did, too.

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And of course, you'd be taking blood every morning.

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And what you really remember of your training.

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I mean, the medicine, the surgery or orthopaedics and the memories?

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Oh, many, many. Uh, yes. Uh, I.

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I can't immediately recall which firms I did in which order I think I would have done the, uh, the the the cook, the, um, as a medical student.

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And so I did the Malony on the surgical side and I went on to be housemen to both those.

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Uh, yes. Uh, I mean there were some great people around, weren't so qualified about sixty five to December.

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Sixty five. Yes. And then you did one has travelled to in Oxford to uh I was very calculating, uh and I'd worked out that not everyone could do too,

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but I worked out that if you did your medical one first because there were twice as many surgical tube affirmance against one of them,

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if you did your medical first, you were pretty likely to be able to go on to be a surgeon.

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And that's what I did. So I started off with Dr. Cook, uh, and then surprise, surprise, halfway through it became Baid knocking Hockaday.

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And then I went on to be with, uh, with, uh, uh, Ted Malony with my senior registrar.

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Mike is very good. Oh, excellent. Excellent teacher and well, excellent surgeon.

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I what was Turtleback? Because he wanted to be a physiologist way back, believe it or not.

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And what was he like? Oh, he was great to work with. I mean, we'd got to know each other as when I was a medical student.

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So going to his firm as housemen.

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Uh, no, it just seemed fairly natural.

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So then we you're beginning to feel one way or the other medicine with a drill when you know it is what I don't know.

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But for you. But for me, I'm just enthusiastic.

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Yes. So you go into your medical house job and of course,

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you're going to be a physician and then you go over to surgery and you help in the theatre and you may be stitched up after a couple of months.

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And, wow, this is just wonderful. So you're going to be a surgeon, but you have to decide at the end of that year.

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And I did decide to be a physician. And so towards the end of that, uh, uh, preregister, I started looking for senior House office jobs in medicine.

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But, uh, I think I had three tutors in my clinical school.

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Uh, one year you had a surgeon and one year you had a physician.

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And the third year you could choose.

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And, uh, I started off you'd given the first and I was given Stuart, who was the, uh, he was the surgical tutor.

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I had, uh, I forget his first name, but with Stuart, you can imagine he was a Scot.

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And so I had him as my personal tutor, as well as the class tutor, the school surgical tutor.

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And then I chose Clough's Shilat. And for my next year, uh, and I can't remember why.

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And then in my third year, I opted for Terence Ryan.

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In fact, in retrospect, I was probably given talents. You know, I think it would give the first two and you chose the third.

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I chose Terrence. Right. And the reason I chose Terrence was it was rumoured.

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That although he was a great guy and a good dermatologist and you couldn't work better, uh, he had a knack of failing exams.

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It was rumoured that he only got MRSA at the 13th at.

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So I said, what if he's taken that exam 13 times? He's got it.

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No, you know, he's my tutor. And, uh, but going back to Class Chilla, uh, I, I think whether we did essays or not, I can't remember.

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We obviously did essays, so our tutors and preclinical anyway, class Schiller said to me one day said, you're going to be a physician.

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And I said, Oh, why? And he said, because you think that's, you know, God's truth.

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But Ted Malone, he didn't quite persuade me to change. Yeah.

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When they're harassment. How much help did you get from the Wood Sisters?

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Uh, let's see. I started off in medicine that was roundly Ward and Alex, uh, the round robin ward.

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We like that. We like that, you know, down in one of the Nissan huts. Yes.

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Uh, I can half visualise a sister. She was young and she was great and very helpful.

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Uh, looking back, the sister and Alex, the female ward, she was not so warm as a person.

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And maybe I'm being harsh, but could be a bit churlish on occasion.

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Uh, but I wouldn't say she was antagonistic and antagonistic.

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Then when we moved to surgery, uh, Morris Ward, then, uh, I can see her clearly on this ward.

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I can see her. She went by a nickname.

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Ligi, would it be like a company with glasses?

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Uh uh. And she was always very supportive.

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And I think the same for the the male surgical.

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So you really needed to support and Jerry Mendelson was the as a yes.

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Yes. Terry Middleton was the. Because you inherited him.

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Uh, and it was I think while I was a house surgeon that he was admitted with, uh uh, he had a major cast lead.

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He's, um, Sevigne, which is her job.

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Did you get. Well, uh, I applied for one in geriatrics.

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Uh, and Leo Warner interviewed me and clearly recognised I had big gaps in my knowledge and didn't appoint me.

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So we went up to Lancaster, which was absolutely great, uh, because it was a time of the expansion of the District General Hospital.

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So they were in the process of doubling, doubling the number of consultants just to medical to for medical.

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Uh, and they had taken over some beds in the psychiatric hospital up the hill.

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The more the more hospital. And, uh, they had medical and medical beds and surgical rehab beds up there.

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So, uh, it was great, uh, you know, for consultants.

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Uh, well, okay.

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It was the old tradition, really, of the man, the boy and the dog, the consultant, the registrar and the houseman.

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But we were inserted for the first time as as they chose.

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And because of the split side, we were almost, uh, you know, we were almost like registrars.

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Uh, and so it was a wonderful experience. I mean, I always recommend to young people, don't stay in teaching hospitals.

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You want experience. If you want to become a good clinician, get out into the periphery.

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You'll see patients, you know, when did you get back to Oxford?

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I wonder what level we had to go back to Oxford when I was appointed, uh, to to, uh, Sober House in seventy six.

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So what had made you go into terminal care. Oh, right.

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In 1963, January 63, I went with another medical student from new college, John Cox,

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to an international conference in Bristow organised by the Student Christian movement.

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Were you a member of that? Well, I'm not sure that you had to be a member in those days.

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But the chaplain of little more hospital who I happen to know, he I think encouraged us to go, OK.

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So at that conference, one of the keynote speakers was Cicely Saunders, and she was in the process of buildings and Christophers,

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but she had several years experience of St. Joseph's Hospice in Hackney, and she had a collection of photographs and she had a collection of slides.

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And she was a brilliant lecturer because she would not only give the principals, she would tell patients stories.

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Uh, and you know that I really said, that's great.

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That's the sort of thing I want to do with an emphasis on holistic care.

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So I did invite her to come and talk at the medical school the next year.

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And she came and she obviously put the chairman of some design group.

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Well, I just set it up as a one off grade. Right. So she obviously put me in her little black book.

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And, uh, I did write to him once or twice because of the book of her published correspondence and several of the letters to me in the 1960s.

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Uh, so you qualify. You've got your house jobs, you continue in general medicine.

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Uh, because after Lancaster, we went to Epsom District Hospital for two years and then up to Manchester.

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And you didn't take 13 times? No, no.

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I was married. I married as a medical student. I had my first child as a medical student.

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I couldn't afford to take exams 13 times a year. So I was very careful to make sure I passed first dive.

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Well, when was your first because of the clinical term for the membership?

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Oh, God, there were no I don't remember. But let's get back anyway.

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Yes. So I'm going through my my early years in general medicine.

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Uh, and I think, you know, even when I moved from Lancaster as Satchmo to Epsom as registrar,

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even at the interview for Epsom, I remember mentioning I had this interest in palliative care.

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Uh, and but anyway, the end of my year in Lancaster, that would be December sixty seven.

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I got Cicely Saunders in effect saying, you know, the hospice opened in July.

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Sixty seven. I'm not looking for a research fellow. Would you like to come or would you like to, uh, to to to apply.

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Uh, so I wrote back and said thank you very much but no, I've got to get membership and uh and you know, that was it.

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And then a couple of years later, when I was at the Manchester Infirmary in the Department of Cardiology as a registrar,

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uh, I got a letter, uh, so that would be probably three years later, December, December 1970.

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And it said, uh, tragically, our research fellow around the world and died, uh, and the post is now vacant.

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And would you be interested in applying? And but I did because I'd gone from a registrar post in the district in the periphery to a

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registrar post in a teaching hospital just to get back into the teaching hospital and beyond.

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And the aim was the end of a year or so to apply for a senior registrar.

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So I was actively looking, thinking, well, some things you know, you talk about epiphanies, don't you?

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So this letter comes. Curiously, my wife had opened it and she'd read it before I got home and she saw the station,

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Cicely Saunders, and she was quite convinced I would, you know, just ignore it.

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I read it and laughed and said, OK, we're going. Well, obviously have to go down and visit the place.

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And that had to be screened by the research committee, which included Duncan there at the London and the guy at University College,

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Desmond, whatever, is both very well known clinical pharmacologist in those days and subsequently and so on and so on.

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So I arrive at St. Christopher's as a research fellow, March nineteen seventy one.

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And of course, you know, people said, well, you know, you're going down a cul de sac.

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And I said, well, yes, I'm prepared to do that.

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But, you know, I can go back into geriatrics, you know, if I cut myself off from general internal medicine.

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But of course, by the time I finished high five, five and a half years at St. Christopher's as a research fellow,

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there were jobs just emerging because during that period,

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the early seventies, the National Society for Cancer Relief, now Macmillan Cancer Relief, they've changed their name so many times, I'm not sure.

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00:24:54,580 --> 00:25:10,090
But everyone knows Macmillan is there anyway. They and then and see, ah, they had started working with the NHS, with local enthusiasts or vice versa.

192
00:25:10,090 --> 00:25:19,630
But it came together. You had a local pressure group, you had the NHS and you had NCAR and the NSA would do the negotiating.

193
00:25:19,630 --> 00:25:31,240
And as with Sober House, they would raise the money to build the building on an NHS land and to equip the building.

194
00:25:31,240 --> 00:25:39,790
And then they would hand it over in perpetuity to the secretary of state, ie, to the National Health Service.

195
00:25:39,790 --> 00:25:50,800
So there were two jobs, in fact, coming up in, uh, in seventy six, you know,

196
00:25:50,800 --> 00:25:57,070
knew about them from the end of seventy five and I was finishing at Christie's

197
00:25:57,070 --> 00:26:04,360
in seventy six and one of them was Oxford and the other was South Hampton.

198
00:26:04,360 --> 00:26:10,870
So I haven't been the right person in the right place at the right time.

199
00:26:10,870 --> 00:26:23,560
During your years in hospitals, how worried were annoyed or whatever at the town care that was going on right from the days and the there?

200
00:26:23,560 --> 00:26:30,430
Oh, it's very difficult to say because although one thought one had taken on board.

201
00:26:30,430 --> 00:26:42,880
You know what? Cicely taught it before that. Yeah, well you see I Cicely I met in sixty three quarters here in sixty four, read her publications.

202
00:26:42,880 --> 00:26:48,730
We had an impact even while I was a clinical student in my thinking in the or indeed of my thinking.

203
00:26:48,730 --> 00:26:55,360
Did you feel that Oxford other places were failing in that department.

204
00:26:55,360 --> 00:27:08,500
Very difficult. I mean looking back, I think it, I think we were failing just like across the board.

205
00:27:08,500 --> 00:27:12,730
Yes. With few exceptions, we were failing when it came to communication.

206
00:27:12,730 --> 00:27:24,640
And, uh, and Cicely had emphasised the importance of openness and enabling people to express their fears and anxieties and so on and so on.

207
00:27:24,640 --> 00:27:30,130
So but I took that on board.

208
00:27:30,130 --> 00:27:37,870
I really didn't know how to do it. You know, I I'm not sure that I should tell you some of the embarrassing stories.

209
00:27:37,870 --> 00:27:48,460
When I look back at the bad communication, you know, I would start to, uh, whatever it is, intellectual, cerebral.

210
00:27:48,460 --> 00:27:57,220
You know, I I hadn't the empathy I had and the sensitivity to handle these, uh,

211
00:27:57,220 --> 00:28:10,160
and you may remember, uh, quietly admonishing me because the mother of, uh, a doctor have had.

212
00:28:10,160 --> 00:28:22,580
Being diagnosed with cancer and in my non empathic, youthful ignorance stage, she said to me, she wants to know what it was.

213
00:28:22,580 --> 00:28:28,040
Uh, and Cicely said, you know, it's important to be open and honest.

214
00:28:28,040 --> 00:28:42,540
So I go in, uh, you know, probably at five thirty in the afternoon and I say, uh, the the the biopsy report has come back and it shows you got cancer.

215
00:28:42,540 --> 00:28:48,260
Uh, and I probably had one or two sentences and then went off for an evening off.

216
00:28:48,260 --> 00:28:52,730
Uh, well, that's not quite how you break bad news.

217
00:28:52,730 --> 00:28:59,940
And I think the family, you know, complained to you and you quietly admonished me,

218
00:28:59,940 --> 00:29:10,400
uh, but, you know, took me well right through my Preece and Christophers days.

219
00:29:10,400 --> 00:29:15,670
You know, I was hopeless at communication. Hopeless.

220
00:29:15,670 --> 00:29:24,950
Uh, I suppose you absorbed I was research errors and Christophers I didn't actually work alongside Cicely.

221
00:29:24,950 --> 00:29:27,290
I kept myself at arm's length.

222
00:29:27,290 --> 00:29:38,690
But I did have clinical, uh, couple of clinical sessions over St Joseph's Hospice as visiting medical officer to supervise their chair.

223
00:29:38,690 --> 00:29:43,310
Uh, but somehow I must have improved a little bit.

224
00:29:43,310 --> 00:29:52,220
But really, it was only possibly could it have been as late as 1990?

225
00:29:52,220 --> 00:30:00,980
Certain it was way after I come here and started running courses and all this sort of thing.

226
00:30:00,980 --> 00:30:11,060
It was way after that. I actually went on a communication skills course run by Pete McGuire up at the Christies in Manchester.

227
00:30:11,060 --> 00:30:15,950
And he was you know, he had this three day course. Think you also had a five day course?

228
00:30:15,950 --> 00:30:30,240
I never made that, but it really was an I. So, you know, as I look back, uh, I am I am embarrassed at how bad we were, how bad I really was.

229
00:30:30,240 --> 00:30:34,540
You mean your research was that for a high degree or was.

230
00:30:34,540 --> 00:30:38,820
Oh, yes, I got my degree. And what was it?

231
00:30:38,820 --> 00:30:50,960
Uh, well, I got a copy over there that is in the use of diamorphine in the management of cancer pain or some such title.

232
00:30:50,960 --> 00:31:10,160
Yes. Uh, so SISSELA had started off using morphine as her strong opiate of choice because that's what she learnt from various people.

233
00:31:10,160 --> 00:31:24,110
Uh, and then she changed to diamorphine. Uh, uh, and she started teaching that morphine, uh, was better than morphine because it was less sedative.

234
00:31:24,110 --> 00:31:33,530
It was, uh, less adverse effect on your appetite and one or two other things.

235
00:31:33,530 --> 00:31:43,490
Uh, and she wanted to find out whether it really was better than morphine, uh,

236
00:31:43,490 --> 00:31:52,050
because we were the only country apart from Belgium where it was restricted to miners with cough.

237
00:31:52,050 --> 00:31:57,380
Uh, we were the only country in the world where there was still medicinal morphine,

238
00:31:57,380 --> 00:32:07,940
heroin because of the League of Nations funded by the United Nations banning it because they thought if you bandages medicinal agent,

239
00:32:07,940 --> 00:32:14,810
you would stop its abuse. But of course, that was always a nonsense because, you know,

240
00:32:14,810 --> 00:32:25,130
the amount of medicinal morphine when it was more widely used was just, you know, say one percent of that of the total abused.

241
00:32:25,130 --> 00:32:29,420
So. Right.

242
00:32:29,420 --> 00:32:36,890
So she wanted to put this to the test. Was it really that there was a difference between morphine, morphine?

243
00:32:36,890 --> 00:32:43,680
Was one better than the other, or was it just that she had got better at using it?

244
00:32:43,680 --> 00:32:49,910
Uh, so that's what she wanted to do. And I had a clear field.

245
00:32:49,910 --> 00:32:58,040
No one else was researching in it one world and hadn't really got as far as setting up any trial.

246
00:32:58,040 --> 00:33:02,720
So I did a trial in those days.

247
00:33:02,720 --> 00:33:10,520
We used the Brompton Cocktail. I remember, uh, and that was basically.

248
00:33:10,520 --> 00:33:22,340
Morphine or diamorphine, plus cocaine in a vehicle containing alcohol, sugar and chloroform, water.

249
00:33:22,340 --> 00:33:31,520
So I started off having two sets of Crompton's, one diamorphine, one morphine.

250
00:33:31,520 --> 00:33:40,790
And I think ethics was a bit easy in those days because of the equipoise,

251
00:33:40,790 --> 00:33:49,820
as some people used to call it, because, you know, the standard teaching was there's no difference.

252
00:33:49,820 --> 00:33:58,530
We felt able to to to randomly allocate morphine diamorphine to all the admissions.

253
00:33:58,530 --> 00:34:04,940
And Christophers, there were 54 beds. And that's what we did.

254
00:34:04,940 --> 00:34:12,320
And I thought, well, I've got to convince the nurses because they all believe what system the diamorphine was better.

255
00:34:12,320 --> 00:34:26,330
So in our pilot trial, we gave the nurses and the doctors, uh, you know, three question, three questions questionnaire.

256
00:34:26,330 --> 00:34:31,910
You know, do you think this patient was on morphine or morphine and why?

257
00:34:31,910 --> 00:34:40,010
And obviously, when we cracked the code, you know, they couldn't tell, you know, what they really were saying.

258
00:34:40,010 --> 00:34:43,640
If the patient did well, it's morphine.

259
00:34:43,640 --> 00:34:52,640
If a patient did badly, it was morphine. And also with those two groups going in,

260
00:34:52,640 --> 00:35:00,320
it enabled us to work out the equivalent of low dose because we started off believing the equipment or days was two to one.

261
00:35:00,320 --> 00:35:07,760
And clearly, when you looked at what of the stock bottles we used, it was clearly not two to one.

262
00:35:07,760 --> 00:35:19,820
It was one and a half to one. So we're not only in that pilot study, but over the issue of inherent antagonism to do a controlled trial like this.

263
00:35:19,820 --> 00:35:26,840
But also we ended up with a better, uh, potency ratio for choosing the starting dose.

264
00:35:26,840 --> 00:35:35,240
Then we went on to and we continued the hospice just continued, everyone being randomly allocated to one or the other.

265
00:35:35,240 --> 00:35:42,230
But we quickly set up the controlled trial and that included crossover.

266
00:35:42,230 --> 00:35:51,590
Uh, and of course, you you randomly allocate, I don't know, seven hundred patients,

267
00:35:51,590 --> 00:36:01,830
but you end up with one hundred and thirty four or whatever it was that were actually well enough to cross over.

268
00:36:01,830 --> 00:36:13,790
Right. And because you have to be practical, they had to cross over on a Monday and we would monitor the Monday to Friday and that sort of thing.

269
00:36:13,790 --> 00:36:21,170
So you had two weeks, you had a one week monitoring on the parent drug weekend was probably cross over.

270
00:36:21,170 --> 00:36:24,020
I don't remember. And then we had a five day.

271
00:36:24,020 --> 00:36:40,010
So the end result of that was, in fact, in terms of efficacy and unwanted effects, there was no difference between oral and oral morphine.

272
00:36:40,010 --> 00:36:49,490
So that meant that we could although it took to nineteen seventy seven to do this.

273
00:36:49,490 --> 00:36:58,700
When I come here, uh, we uh, it enabled some Christians hospice to shift to morphine.

274
00:36:58,700 --> 00:37:03,950
And because all the other countries in the world had morphine, they could no longer say,

275
00:37:03,950 --> 00:37:09,590
we can't do what you're doing because we haven't got done more than Christophers could say.

276
00:37:09,590 --> 00:37:16,040
Oh, yes, you can. You've got morphine. Now, what about the injections?

277
00:37:16,040 --> 00:37:26,270
We had a huge stock of ampules about morphine and morphine as free, dry and freeze dried pellets.

278
00:37:26,270 --> 00:37:36,230
But it became immediately apparent that it was very difficult to maintain the blinding because morphine

279
00:37:36,230 --> 00:37:49,130
is far less soluble or morphine as assault is far less soluble then and morphine is so and so.

280
00:37:49,130 --> 00:37:56,150
We then said, well, if diamorphine hydrochloride is so much more soluble,

281
00:37:56,150 --> 00:38:04,100
then when you come to give injections and you're perhaps mixing it with an antiemetic or something like that,

282
00:38:04,100 --> 00:38:10,110
it's it's obviously preference and the point of view of not having a big bulky.

283
00:38:10,110 --> 00:38:16,110
Injection. Yes, so we moved on to say, you know,

284
00:38:16,110 --> 00:38:28,460
diamorphine has advantages in terms of solubility and we're going to go on using that as the preferred injection.

285
00:38:28,460 --> 00:38:32,900
And you have Avivah on your face. Well, there were other trials.

286
00:38:32,900 --> 00:38:40,340
We had to look at the cocaine. Right. And we we decided that again on this.

287
00:38:40,340 --> 00:38:53,510
Do we cross over business? We decided that when you stopped the cocaine and followed them for the next week, there was no difference.

288
00:38:53,510 --> 00:39:02,690
But if you had them off cocaine and then cocaine the second week, you got a bit of a fillip in terms of alertness.

289
00:39:02,690 --> 00:39:10,880
And so I in my thesis, I didn't actually put it this way.

290
00:39:10,880 --> 00:39:14,570
You know, you're allowed to allow your thoughts to develop.

291
00:39:14,570 --> 00:39:29,900
But eventually we said, well, what we think is happening, cocaine helps stop the initial SEDAT effect of the morphine.

292
00:39:29,900 --> 00:39:40,160
But, you know, if you get it when someone is already stabilised on morphine, then you don't get any benefit, right?

293
00:39:40,160 --> 00:39:45,410
Well, cocaine costs money and it's another controlled drug. And again, you've got problems overseas.

294
00:39:45,410 --> 00:39:49,100
So if you could cut that out, then so much the better.

295
00:39:49,100 --> 00:39:55,340
I've told you the story slightly wrong. But the the the the outcome is correct.

296
00:39:55,340 --> 00:40:00,170
And then I had to look at methadone and, you know, I had one or two other studies because,

297
00:40:00,170 --> 00:40:05,210
you know, blood levels and all that sort of thing and urine levels.

298
00:40:05,210 --> 00:40:25,220
So, yes, I submitted my dissertation, I think, in June 1976, and I don't know how long it took them to decide.

299
00:40:25,220 --> 00:40:34,790
But believe it or not, I was not called for Viva Grange and I was asked to do no correction.

300
00:40:34,790 --> 00:40:39,980
And you published this, I suppose, at the time? Oh, well, I mean the thesis.

301
00:40:39,980 --> 00:40:44,390
No, no. Is basis. All the trials they publish, there's no cost is.

302
00:40:44,390 --> 00:40:50,330
So you done that before you applied for the Nobel prise? Yes.

303
00:40:50,330 --> 00:40:59,300
Yes. Uh, I applied for the same job in February, March seventy six.

304
00:40:59,300 --> 00:41:08,570
I submitted my dissertation probably in June, but the interviews, the interviews for this job were delayed.

305
00:41:08,570 --> 00:41:16,510
And I'll go into that if you wish. It was delayed until early July.

306
00:41:16,510 --> 00:41:25,620
I said, uh, well, it's because Harold Wilson resigned as prime minister.

307
00:41:25,620 --> 00:41:31,360
Uh uh, he resigned in Holy Week that year.

308
00:41:31,360 --> 00:41:41,540
Uh, I think it was the beginning of April. And apparently when a prime minister resigns, everything is held in suspense.

309
00:41:41,540 --> 00:41:51,920
So the the final agreement that there could be this new job in Oxford,

310
00:41:51,920 --> 00:42:00,810
it is on the desk of the secretary of state for health, but he was not allowed to sign it.

311
00:42:00,810 --> 00:42:06,650
Uh, amazing. And then and what do you remember the appointments committee?

312
00:42:06,650 --> 00:42:12,860
Well, the thing was, you see, you had two places trying to get me, right, OK?

313
00:42:12,860 --> 00:42:22,160
I had an interview and so on. And obviously I had to to, you know, come out top of a group of three or something like that.

314
00:42:22,160 --> 00:42:29,960
But, you know, I had almost the perfect CV, whereas the others were you know,

315
00:42:29,960 --> 00:42:38,690
our job is showing that with no, uh, palliative care and in-depth experience.

316
00:42:38,690 --> 00:42:47,160
So, uh, Southhampton was ahead.

317
00:42:47,160 --> 00:43:02,460
And Oxford was, you know, several weeks behind, possibly e you know, when Harold Wilson resigned, I think South Hampton was six weeks ahead.

318
00:43:02,460 --> 00:43:09,270
But there was someone in Oxford who had been one of the godfathers to Sober House Artist Alang.

319
00:43:09,270 --> 00:43:18,980
Yes. Radiotherapists. Uh, he wanted me and he'd wanted me for some time.

320
00:43:18,980 --> 00:43:33,270
And, uh, and he had a spy in South Hampton and he kept track of what was happening when they were advertising when the closing date was.

321
00:43:33,270 --> 00:43:44,610
And the interesting thing is, you know, once information came through for us to go ahead, uh, he made sure that Oxford caught up.

322
00:43:44,610 --> 00:43:53,010
So it's the closing date. Well, that got down to, I think, a week or 10 days after South Hampton.

323
00:43:53,010 --> 00:43:56,130
But that and I was quite convinced I was going to South Hampton.

324
00:43:56,130 --> 00:44:05,220
In fact, I took a day off to go on House Hunt, uh, because, you know, with the family and so forth.

325
00:44:05,220 --> 00:44:14,990
And then to my amazement, the date for the interview for Oxford was one day before South Hampton.

326
00:44:14,990 --> 00:44:23,760
And as they are excellent. So, I mean, in those days, you took the first job which was offered Saigo in South Hampton.

327
00:44:23,760 --> 00:44:30,420
And in fact uh they uh, they didn't appoint anyone, they really advertised.

328
00:44:30,420 --> 00:44:38,550
But at the time, looking at the two jobs, if it hadn't been in August, which would you have preferred.

329
00:44:38,550 --> 00:44:40,810
Well it's very difficult to say.

330
00:44:40,810 --> 00:44:50,730
And uh, you say I'd never gone back anywhere near, you know, it had been Oxford, Lancaster, Epsom, Manchester, London.

331
00:44:50,730 --> 00:44:54,570
Did South Hampton have a history of serving as a sober house?

332
00:44:54,570 --> 00:45:05,510
No, they were built at the same time because, you know, the first medical director or whatever at either it's, uh, I.

333
00:45:05,510 --> 00:45:11,400
I just was convinced South Hampton was getting there first and I said I'd take the first.

334
00:45:11,400 --> 00:45:17,700
And after I was appointed, I mean, my, my uh.

335
00:45:17,700 --> 00:45:21,870
Yeah. Several people said, oh, I'm so glad you're going to Oxford.

336
00:45:21,870 --> 00:45:26,460
You know, that's that's really, you know, whatever that meant.

337
00:45:26,460 --> 00:45:31,860
And they're fine with it because this was very much an NHS job.

338
00:45:31,860 --> 00:45:36,900
Well, it was university represented. Oh, I'm sure. I'm sure it's, uh.

339
00:45:36,900 --> 00:45:40,530
I mean, who was on the interview committee? I'm sure Mr. Lang was.

340
00:45:40,530 --> 00:45:47,520
Jim Holt was. I can't remember who was. And I mean, where was the building then?

341
00:45:47,520 --> 00:45:58,890
This level right up finished. It was finished because the building received its first patients in mid-April.

342
00:45:58,890 --> 00:46:03,450
Seventy six. We're talking about an interview early July.

343
00:46:03,450 --> 00:46:08,040
Seventy six and I came mid August. Seventy six.

344
00:46:08,040 --> 00:46:17,490
Uh, so, yes, it was up and Alistair Lang was sort of, uh, babysitting for whoever was appointed.

345
00:46:17,490 --> 00:46:28,170
But of course it was early days. Uh, don't forget, uh, I think seventy five was when the first cutbacks had to come or something like that.

346
00:46:28,170 --> 00:46:40,410
Uh, and so this unit, which had been set up by, uh, NSC in conjunction with the NHS, with the NHS,

347
00:46:40,410 --> 00:46:48,090
agreeing to run it in perpetuity before it was open, they welshed and said we only going to open twelve beds.

348
00:46:48,090 --> 00:46:52,620
So it was small. So and it was early days.

349
00:46:52,620 --> 00:47:13,360
So Alistair Lang plus two, uh, clinical assistants to GPS, uh, from Headington, uh, Donald Richards and Patrick, what's his name anyway.

350
00:47:13,360 --> 00:47:24,000
Uh, Donald and Patrick, they were there. Uh and anyway, uh, it was up and running when I got there in the middle of August.

351
00:47:24,000 --> 00:47:31,920
So you were the consultant, whether in the junior medical staff, apart from the two of you, not to start with Goresh.

352
00:47:31,920 --> 00:47:45,420
Indeed, because I believe that like cows, which require milking seven times a year, I believe that patients should be, uh, looked after.

353
00:47:45,420 --> 00:47:53,460
Only Monday to Friday, but also Saturday, Sunday, so I think guys effectively, you know,

354
00:47:53,460 --> 00:48:01,630
doing three out of four out of five weekends, but of course, it was small, it was small, and we didn't have mobile phones.

355
00:48:01,630 --> 00:48:08,290
And if I wanted to walk on Shotover, I just ring and say I'm going to be on shot over you know, for a couple of hours.

356
00:48:08,290 --> 00:48:15,740
Uh uh ring. When I get back I first get Junior's stuff.

357
00:48:15,740 --> 00:48:23,630
Uh. I asked for more help.

358
00:48:23,630 --> 00:48:32,420
Fairly early, as you might expect, and both Alex Khadra, the area medical officer,

359
00:48:32,420 --> 00:48:41,210
and Rosemary, through the regional medical officer, they were both immensely supportive.

360
00:48:41,210 --> 00:48:51,650
So Rosemary had a retraining scheme for women doctors coming back after having a family.

361
00:48:51,650 --> 00:49:02,180
And she, uh, she, I think, supplied the money for four sessions.

362
00:49:02,180 --> 00:49:08,750
So I had somewhere someone there for mornings.

363
00:49:08,750 --> 00:49:15,110
Uh, I can see her quite clearly. And I apologise to her that I can't remember her name.

364
00:49:15,110 --> 00:49:22,010
But she was superb. She was just steady, conscientious, good.

365
00:49:22,010 --> 00:49:34,500
But I also probably early seven, I went to talk to, uh, primary care, general practise.

366
00:49:34,500 --> 00:49:47,920
Uh, that was probably Multiversity even in those days. Uh, and, uh, you know, they were building up these rotations was going to be founded by them.

367
00:49:47,920 --> 00:49:54,410
OK, if he wasn't, he was there within a few months.

368
00:49:54,410 --> 00:50:00,620
So the upshot was they were just starting a new rotation and they had a three month gap.

369
00:50:00,620 --> 00:50:13,500
Yes, I could have it. So then I got as far as three months with NATO, three months without three months with the NATO, three months without.

370
00:50:13,500 --> 00:50:22,100
And you can imagine what that was like, uh, but eventually got Godfrey Fouler.

371
00:50:22,100 --> 00:50:42,610
Uh uh. One of the other rotations, they had, a period which I think was more almost medical epidemiology,

372
00:50:42,610 --> 00:50:47,380
if it would be, uh and you know, they didn't like that very much.

373
00:50:47,380 --> 00:50:53,380
So he was happy, uh, to, uh, to move that three months to save a house.

374
00:50:53,380 --> 00:51:03,760
So, I dunno, possibly by seventy nine, by 80, we'd have had three month, three month constant year.

375
00:51:03,760 --> 00:51:09,520
And of course, uh, probably in seventy nine.

376
00:51:09,520 --> 00:51:18,340
I got my first research fellow who would be research, but he would need to have some clinical exposure.

377
00:51:18,340 --> 00:51:22,840
Uh and that that helped a lot.

378
00:51:22,840 --> 00:51:29,740
Who funded him. Uh it was Jeffrey Hanks'.

379
00:51:29,740 --> 00:51:34,640
He was the Harry Stewart Trust.

380
00:51:34,640 --> 00:51:39,850
Honesty Trust uh had funded me and St. Christopher's read.

381
00:51:39,850 --> 00:51:52,160
Uh and then after Jeffrey Hanks', he went to the Royal Marsden as their first, uh, palliative care specialist.

382
00:51:52,160 --> 00:51:59,080
Uh, we had, uh, Claude Retno, who was funded by National Society for Cancer Relief,

383
00:51:59,080 --> 00:52:05,160
who felt they owed him a big responsibility because they'd taken him out of general medicine and put him into this,

384
00:52:05,160 --> 00:52:10,510
uh, other unit which had opened before us, uh, down in Christchurch.

385
00:52:10,510 --> 00:52:15,440
And they were concerned, you know, how could they develop a career path for him?

386
00:52:15,440 --> 00:52:22,390
So he came as a research fellow. So that was the second UNSCR Macmillan.

387
00:52:22,390 --> 00:52:30,760
And the third, in fact, uh, came from what was then Imperial Cancer Research.

388
00:52:30,760 --> 00:52:35,080
I had good. Uh, but it was very nice.

389
00:52:35,080 --> 00:52:42,280
I mean, the the head who I can see, but I can't think of his name at the moment.

390
00:52:42,280 --> 00:52:48,580
He and his sidekick came and talked and said, you know, we'd like to help and support you.

391
00:52:48,580 --> 00:52:59,350
So I said, well, yes, I'd like to have a research fellow specifically to look into lymphoedema because this had become a big issue,

392
00:52:59,350 --> 00:53:10,330
uh, clinical need and also research need. So that probably took us around to about nineteen ninety.

393
00:53:10,330 --> 00:53:22,550
But after that I didn't have a research fellow, which in retrospect was a mistake, but my teaching responsibilities, both with annual courses here,

394
00:53:22,550 --> 00:53:34,960
uh, well not to mention the undergraduates but annual courses and increasingly abroad, prompted by the W.H and my involvement with the WHL.

395
00:53:34,960 --> 00:53:40,150
I guess you can't be a clinician, a teacher and a researcher.

396
00:53:40,150 --> 00:53:43,240
You could probably only do two of those three.

397
00:53:43,240 --> 00:53:56,620
Uh, and I do regret, uh, that did David Wetherall did not take me in hand and say, you know, Robert, can I help you?

398
00:53:56,620 --> 00:54:04,250
You maintain a research. We can be seeing him much and not as much as I should.

399
00:54:04,250 --> 00:54:07,600
Uh, and he's, you know, the old school.

400
00:54:07,600 --> 00:54:18,020
So and when we were meant to have, uh, annual assessments or something like that, it was, uh, you know, risibly, because it's you know,

401
00:54:18,020 --> 00:54:27,250
I go and see him about something and have a cup of coffee and he'd say, oh, by the way, can we call that your assessment or whatever?

402
00:54:27,250 --> 00:54:31,900
Um, who is really deciding what you're deciding?

403
00:54:31,900 --> 00:54:39,970
Who is admitted, but where did they come from? How did they get referred to the patients who are coming in from the beginning?

404
00:54:39,970 --> 00:54:46,300
And then, uh, well, clearly, Alice de Lange being in radiotherapy,

405
00:54:46,300 --> 00:54:54,640
some would come via radiotherapy and he would perhaps encourage his colleagues, uh, like Spain and so on.

406
00:54:54,640 --> 00:55:02,440
George Vernick, that what George Vernick was, uh, involved in saving the house before I was standing there,

407
00:55:02,440 --> 00:55:12,370
he took a step back when I took over the chairmanship of the department and became the key link with the evolving unit.

408
00:55:12,370 --> 00:55:18,720
Uh, so, yes, there would be referrals straight from radiotherapy.

409
00:55:18,720 --> 00:55:22,420
Uh, you know, could you come and see them?

410
00:55:22,420 --> 00:55:28,570
And then you'd say, I think we can make a move to save our house.

411
00:55:28,570 --> 00:55:36,230
Uh, but, um. Some would come from GP's and there had been some preliminary work in, you know,

412
00:55:36,230 --> 00:55:44,150
letting people know that we there and we had to keep clinical assistants up,

413
00:55:44,150 --> 00:55:56,460
but we were the only hospice in Oxford Park, probably Buckingham and I think Northants,

414
00:55:56,460 --> 00:56:04,550
they they had their own sayWell house, uh, probably from seventy seven.

415
00:56:04,550 --> 00:56:14,720
Seventy eight. But you had Buckinghamshire, Oxfordshire and Berkshire and we could get patients from all of those.

416
00:56:14,720 --> 00:56:26,570
OK, this side of Berkshire, this side of bucks. And the numbers grew up and I don't know what it was, but you know,

417
00:56:26,570 --> 00:56:38,000
the numbers grew and at some point I had to say, you know, we can only take from chart because numbers grew.

418
00:56:38,000 --> 00:56:52,100
But at some stage the right of home at Nettelbeck opened, which took a bit off the south and eventually possibly not until the late 80s,

419
00:56:52,100 --> 00:57:01,130
you had the one in Adebari, just south of Bambury, uh, which took off the top part.

420
00:57:01,130 --> 00:57:08,660
So in a sense, as the work has grown, we had to cut off because of the greater more local population.

421
00:57:08,660 --> 00:57:14,240
But if somebody was referred to, say, by a GP, did you go and visit them at home or.

422
00:57:14,240 --> 00:57:19,130
Uh, sometimes, uh, yes, sometimes.

423
00:57:19,130 --> 00:57:28,700
Uh, but because you must have had to say no, sometimes I would not often in the early days, no.

424
00:57:28,700 --> 00:57:37,050
Right. But, uh, I mean, obviously we did at almost every visit.

425
00:57:37,050 --> 00:57:42,980
It might end up with a referral, uh, a suggestion that would come in.

426
00:57:42,980 --> 00:57:52,580
But other times it might not, as you would expect us and some of the home visits were.

427
00:57:52,580 --> 00:57:56,900
Oh, by the way, he doesn't know his family doesn't want him to know or,

428
00:57:56,900 --> 00:58:02,300
you know, he's d'elegance come in to save our house and you do get unnecessary.

429
00:58:02,300 --> 00:58:10,400
Uh, you chat it through with the GP in the kitchen, you'd go back to speak to the patient, uh, and say,

430
00:58:10,400 --> 00:58:18,560
you know, we've talked it through and we have some recommendations which will be, uh, actioning.

431
00:58:18,560 --> 00:58:25,760
Uh, but don't forget, we're in the background and quite a lot of people who, uh, were saying,

432
00:58:25,760 --> 00:58:31,790
no, no way to save the house after I'd met them in the home and spent time with them.

433
00:58:31,790 --> 00:58:38,580
And these consultations would take all in all, the best part of an hour is through.

434
00:58:38,580 --> 00:58:44,600
Um, you get a phone call the next day saying Mr. Smith would like to be admitted with.

435
00:58:44,600 --> 00:58:49,880
But of course, as time went on, you had to concentrate more and more on home care.

436
00:58:49,880 --> 00:59:01,370
And the Macmillan nurses, we drew those from nineteen seventy nine onwards, uh, first one, then two and three, then four.

437
00:59:01,370 --> 00:59:10,340
Uh so and then of course after I had it on the NHS battle to Michael Mintern in

438
00:59:10,340 --> 00:59:16,930
mid nineteen eighty eight and moved sideways into my university readership,

439
00:59:16,930 --> 00:59:28,640
uh he was able to help in the development of a roving symptom control team or in the John Raptor's.

440
00:59:28,640 --> 00:59:32,570
And I think there's one now for the Churchill as well.

441
00:59:32,570 --> 00:59:42,230
Uh, so the backup and say, well, House have become more and more back up, you know, and not first choice.

442
00:59:42,230 --> 00:59:47,450
And that's as it should be. Yes. As it should be. Presumably you didn't do outpatient and.

443
00:59:47,450 --> 00:59:59,720
Oh, yes, I should have mentioned that, uh, outpatients was my preferred method of meeting patients so that, uh.

444
00:59:59,720 --> 01:00:09,800
And when are we going to, uh, I think mostly one one a week, one a week at the church.

445
01:00:09,800 --> 01:00:18,050
Uh, what I'd say about House, we wanted to introduce them to Sober House, uh, because, you know,

446
01:00:18,050 --> 01:00:29,760
a lot of people had this fear of say when they heard that it was, uh, you know, uh, they probably wouldn't put it quite like this, but it does seem.

447
01:00:29,760 --> 01:00:35,700
I mean, that was one of the reasons for the Odomes salaries because of Carandiru, you know, that was all right.

448
01:00:35,700 --> 01:00:42,360
And again, going to the house and talking about it could get people to agree to come together.

449
01:00:42,360 --> 01:00:48,480
Yes. And because they discovered that I, you know, wasn't horns and a tail.

450
01:00:48,480 --> 01:00:54,030
Absolutely. So when did the bid increase roughly, or how much of a battle was that?

451
01:00:54,030 --> 01:01:01,140
Oh, it's it was a battle, even though they were almost halcyon days.

452
01:01:01,140 --> 01:01:11,640
You know, people were so thrilled with this. And Alex Gatherum, Rosemary Rue and Alistair Lang, you know, there was a big groundswell of enthusiasm.

453
01:01:11,640 --> 01:01:18,060
So, you know, things were as easy as they could be.

454
01:01:18,060 --> 01:01:20,430
But, of course, I wanted extra beds.

455
01:01:20,430 --> 01:01:37,500
Uh, and so I started talking with, uh, Macmullan, uh, and I think they did a deal that would open an extra eight beds,

456
01:01:37,500 --> 01:01:43,080
possibly put in the money to fund them for a couple of years or something, maybe five years.

457
01:01:43,080 --> 01:01:55,830
But we were able to move up from 12 to 20, I would guess, before the end of nineteen seventy seven, but it could have been seventy eight.

458
01:01:55,830 --> 01:02:03,560
Uh, so we had a 25 bed unit with for five days and five single rooms.

459
01:02:03,560 --> 01:02:10,350
So if you work that out you can have your 20 beds and still have a spare five.

460
01:02:10,350 --> 01:02:18,220
Betty Baye. So we converted that into a mini day centre and that was the beginning of the day.

461
01:02:18,220 --> 01:02:27,420
Said Yes, straight and then of course things grow and well in a room twice the size of this room.

462
01:02:27,420 --> 01:02:29,080
This is what, eighteen by twelve.

463
01:02:29,080 --> 01:02:39,570
But if you imagine something roughly twice this size that that becomes impossible to run an effective day centre once it builds up.

464
01:02:39,570 --> 01:02:46,500
So then we started fundraising for a day centre which opened in eighty three.

465
01:02:46,500 --> 01:02:58,200
Uh, and then we started fundraising for, uh, the study centre which was completed in the autumn of eighty seven and formally opened in eighty eight.

466
01:02:58,200 --> 01:03:04,320
So to go back on the funding, George Wernecke had been important to getting the save money.

467
01:03:04,320 --> 01:03:08,130
And was it from saving himself. It was correct.

468
01:03:08,130 --> 01:03:17,260
Uh George Bernick uh had been instrumental when he had contacted the National Society Tax Relief.

469
01:03:17,260 --> 01:03:24,320
Uh, I think some people say, well at that stage was already the president of NASA.

470
01:03:24,320 --> 01:03:32,250
Uh, but anyway, uh uh, yes, George is very important, very committed.

471
01:03:32,250 --> 01:03:41,970
Uh, and he would have done all the, you know, intermediaries with the National Society Council and so on and so on and so on.

472
01:03:41,970 --> 01:03:51,270
And his family are quite adamant that we must not forget the contribution he made, because, as I say,

473
01:03:51,270 --> 01:03:58,170
he did it in his role as chair of the Department of Radiology, radiotherapy,

474
01:03:58,170 --> 01:04:04,970
radiotherapy, and he handed that on because they did it in a five year rotation.

475
01:04:04,970 --> 01:04:09,660
And he added that on to Alistar. So he passed that battle on to Alistar.

476
01:04:09,660 --> 01:04:19,770
And Alistar became, you know, the key figure, you know, in the eyes of the public and the major fundraising that you talking about.

477
01:04:19,770 --> 01:04:22,240
Did you do that or go, oh, no, no, no.

478
01:04:22,240 --> 01:04:37,950
You, uh, via the national society, uh, you know, the guy in charge in the seventies and eighties was Major Henry Garnett,

479
01:04:37,950 --> 01:04:46,080
who had moved into charity work from formerly is being, uh, senior executive at Gillette in Redding.

480
01:04:46,080 --> 01:04:53,850
But anyway, he changed the national stage for cancer relief from one hundred thousand pounds a year to a million.

481
01:04:53,850 --> 01:04:58,110
And, um, I mean, it's mega now. It's mega.

482
01:04:58,110 --> 01:05:02,760
But, you know, uh, he and I got on very well together.

483
01:05:02,760 --> 01:05:11,790
You know, I was one of the only boys, uh, and so he kept me in touch and he wanted to develop sober house.

484
01:05:11,790 --> 01:05:16,980
So it became more and more, uh, what have you like to call it?

485
01:05:16,980 --> 01:05:22,320
Uh, potential modern architecture was rapidly overtaken.

486
01:05:22,320 --> 01:05:30,030
But, you know, the idea that you should have an inpatient centre without patients, we place into the study centre.

487
01:05:30,030 --> 01:05:40,140
That fitted his vision, so they were the negotiations on the building.

488
01:05:40,140 --> 01:05:53,640
This was between NASA and the health authority and NASA pointed specific fundraisers to raise the money.

489
01:05:53,640 --> 01:05:59,120
Right? Uh, Locarno. A bit of both.

490
01:05:59,120 --> 01:06:13,530
A bit of both. And you had to have a chair of the fundraising committee and for the study centre, surprisingly, it was Edward Abraham.

491
01:06:13,530 --> 01:06:19,470
That's a good joke. Yeah, but he can only put money in if there's an educational component.

492
01:06:19,470 --> 01:06:26,670
But legitimately, uh, we had said because we didn't have a teaching area.

493
01:06:26,670 --> 01:06:35,320
We said we will have the day centre dining room, which is also a small lecture.

494
01:06:35,320 --> 01:06:40,500
And we had, you know, the, uh, the whiteboard and all that sort of thing.

495
01:06:40,500 --> 01:06:45,780
The medical students, when they came the day centre, couldn't have their lunches.

496
01:06:45,780 --> 01:06:51,470
They had to go back into their big room and double up.

497
01:06:51,470 --> 01:06:56,770
Uh, and those early medical student courses from about nineteen eighty three.

498
01:06:56,770 --> 01:07:03,090
Uh, well yes. From nineteen eighty three. They, they, they were based on the study centre.

499
01:07:03,090 --> 01:07:09,500
So because we had that definite educational component, uh, uh,

500
01:07:09,500 --> 01:07:23,820
Abraham was able to put in money and then for the study centre someone who want to put in a big dollop of money, that was John Badenoch.

501
01:07:23,820 --> 01:07:29,550
But it was lovely to work with his again because of the earlier Connexions is.

502
01:07:29,550 --> 01:07:36,390
And how long did the cause last for the clinical students?

503
01:07:36,390 --> 01:07:46,650
Right. Uh, well, I think it was John letting them approached me in seventy seven and said, would I take the medical students for two weeks.

504
01:07:46,650 --> 01:07:51,900
And I wrote back and said, no, I can't take medical students at the moment.

505
01:07:51,900 --> 01:07:59,130
We've got to write down the science primitiveness that uh but I'll continue to do what

506
01:07:59,130 --> 01:08:07,260
had been started or done in collaboration with Mr. Lang when they were in oncology.

507
01:08:07,260 --> 01:08:09,330
They would have two 1/2 days with us.

508
01:08:09,330 --> 01:08:19,020
One half day would be with me and one half day with our liaison psychiatrist Caple Standiford, talking more about the psychosocial aspects.

509
01:08:19,020 --> 01:08:23,280
So they started off just by doing having two 1/2 days.

510
01:08:23,280 --> 01:08:29,310
Uh, but clearly just, uh, just a taster.

511
01:08:29,310 --> 01:08:38,440
Uh, when I had written a couple of textbooks, one came out in eighty three and one came out in eighty four.

512
01:08:38,440 --> 01:08:42,270
Did those energies when you read it. Yes. Yes. So great.

513
01:08:42,270 --> 01:08:51,990
I'm young and I could get uh so uh yeah.

514
01:08:51,990 --> 01:09:01,410
Possibly even before the uh the, the lecture in a book called Therapy in terms of cancer possibly before that was published,

515
01:09:01,410 --> 01:09:06,900
because I had built up a whole lot of lecture notes over the years.

516
01:09:06,900 --> 01:09:15,660
Uh, I read to, uh, to John Lennon, I think it would be, and said I can now take medical student.

517
01:09:15,660 --> 01:09:23,040
And he wrote back and said, well, we have one week. So the original two weeks to one, which is probably sensible.

518
01:09:23,040 --> 01:09:29,880
And in those days, uh, it was usual to do it as a block,

519
01:09:29,880 --> 01:09:40,020
whereas now you're part of an eight week block and you have bits here and there for directions, but here and there for palliative care.

520
01:09:40,020 --> 01:09:54,630
But for me, because I worked, um, on off with the WTO and had, uh, teaching commitments, uh, increasingly here and there around the world.

521
01:09:54,630 --> 01:10:05,940
Uh, I wanted to do a week long book, so we had a week long blog and we kept a weeklong blog, uh, and, you know, they came to save one house.

522
01:10:05,940 --> 01:10:08,280
And I wanted it for a number of reasons.

523
01:10:08,280 --> 01:10:21,120
One is, uh, I felt if you had it half day, half day, you know, dotted around, it wouldn't have the same psychological impact as a week,

524
01:10:21,120 --> 01:10:30,160
uh, an intensive week, week when you would invite them to meet patients, relatives.

525
01:10:30,160 --> 01:10:37,990
Sessions on communication skills and ethics sessions, that was one of the conditions interesting.

526
01:10:37,990 --> 01:10:46,930
There was no formal ethics course. This is before, uh, the ethics side got set up.

527
01:10:46,930 --> 01:10:52,870
So they actually said, yes, you can have the medical students a week provided you include medical ethics.

528
01:10:52,870 --> 01:10:57,760
So that suited me down to the ground. So we had medical ethics, we had communication skills.

529
01:10:57,760 --> 01:11:02,860
We had nurses, therapists of various descriptions doing sessions.

530
01:11:02,860 --> 01:11:13,960
And it was a great week. And however, I should at least give them the chance to see patients over time in to come in.

531
01:11:13,960 --> 01:11:25,350
Yes, I think that's very helpful. And then you were beginning presumably your sort of teaching load was increasing nationally, internationally.

532
01:11:25,350 --> 01:11:29,560
And is that why you went for the university job? Well, yes.

533
01:11:29,560 --> 01:11:42,190
You see, if you start off in 1976 with a new unit in a new speciality and you recognise, like you're your mentor Sicily,

534
01:11:42,190 --> 01:11:49,820
that you need to have clinical practise, education and training and research very soon.

535
01:11:49,820 --> 01:11:54,690
You know, as you allow things to build up, it becomes intolerable.

536
01:11:54,690 --> 01:12:02,890
And, uh, so in retrospect, I was metaphorically on my knees at the end of, uh,

537
01:12:02,890 --> 01:12:10,330
eighty five, but it took me several months to realise that I had burnt out.

538
01:12:10,330 --> 01:12:23,830
Uh, and I went to Alex and said, you know, I need a few months off and those days the NHS could give you extended leave.

539
01:12:23,830 --> 01:12:31,470
So I had three months off that summer, including my usual vacation,

540
01:12:31,470 --> 01:12:37,810
and I had to face up to the fact I've either got to cut down on the academic side

541
01:12:37,810 --> 01:12:45,370
and concentrate on being an NHS consultant or I've got to go for an academic post.

542
01:12:45,370 --> 01:12:57,160
When I decided to go for an academic post, uh, and at that time, uh, NCR was setting up a few,

543
01:12:57,160 --> 01:13:07,290
uh, academic posts, uh, uh, you know, similar ships and, you know, their vision of development.

544
01:13:07,290 --> 01:13:14,110
They said they wanted to move the speciality forward and there was going to be one in Birmingham.

545
01:13:14,110 --> 01:13:23,740
Uh, so I told a few of my closest colleagues, you know, I'll be off into the er the end of 86 or something.

546
01:13:23,740 --> 01:13:28,720
But obviously, I talked to Major Garnett at NASA about this,

547
01:13:28,720 --> 01:13:36,400
and because they were setting up a post there, he immediately set to to try and set up a post here.

548
01:13:36,400 --> 01:13:40,930
Uh, and the upshot was I didn't go to Birmingham. I stayed here.

549
01:13:40,930 --> 01:13:46,120
There was a promise, you see. Yes, we will set it up. But it still took time.

550
01:13:46,120 --> 01:13:51,040
And I eventually moved into the readership at the beginning of eighty eight.

551
01:13:51,040 --> 01:14:02,740
I already was the university to accept that. Uh, well, of course, uh, NASA had promised five years of funding, uh,

552
01:14:02,740 --> 01:14:09,310
and usually they would like a promise it'll be continued there in several universities where they did this.

553
01:14:09,310 --> 01:14:25,900
It was a continued uh. But I think the NHS because of race and Alex Gatherer, they did accept responsibility after five years.

554
01:14:25,900 --> 01:14:33,420
Uh, and that was great. So.

555
01:14:33,420 --> 01:14:41,940
I think if the money is being given, you know, yes, I would say the first five years, the NHS was funding it after that five years.

556
01:14:41,940 --> 01:14:57,850
Well, actually, yes, it was. In those days, uh, I think Rosemary had quite a pocket of money, which she could, uh, fund with NHS money, academic post.

557
01:14:57,850 --> 01:15:08,790
And I'm sure that's past history and can't happen today. But that's how it started and how much as it obviously was a change.

558
01:15:08,790 --> 01:15:12,510
What did you read the change into doing? Teaching in Oxford?

559
01:15:12,510 --> 01:15:24,120
Teaching National. Teaching International? Well, it was a changed because I had to work with a colleague, a slightly younger colleague,

560
01:15:24,120 --> 01:15:33,720
a less experienced colleague who had been trained in medical oncology and radiotherapy and had developed an interest in palliative care.

561
01:15:33,720 --> 01:15:44,220
Uh, and I was happy for him to be appointed, provided he did what we called in those days, prophylactic training.

562
01:15:44,220 --> 01:15:53,160
Uh, so he was appointed and then went off for six months to another hospice and then, you know, got, uh,

563
01:15:53,160 --> 01:16:01,440
radiotherapy a bit out of the system and that sort of thing, and focussed more fully on palliative care.

564
01:16:01,440 --> 01:16:10,770
So there was a gap of six months when I think my research fellow, in fact, did something personal and I tried to get out of the way.

565
01:16:10,770 --> 01:16:22,080
Uh, but then I came back with a reduced clinical load, uh, and continued my research for quite some years.

566
01:16:22,080 --> 01:16:32,010
Uh, but writing textbooks and teaching and, you know, that sort of thing, uh, continued.

567
01:16:32,010 --> 01:16:37,590
How many of the patients claimed to be not cancer, you know, terminal cardiac or whatever?

568
01:16:37,590 --> 01:16:42,780
Uh, well, very, very few in those days, it has all changed.

569
01:16:42,780 --> 01:16:51,600
Uh, but because the origins were cancer, uh, you know, that's how it was.

570
01:16:51,600 --> 01:16:59,940
You could define terminal illness and cancer much better than you can in chest or heart.

571
01:16:59,940 --> 01:17:06,420
Uh, and there was a massive need in cancer, I think, partly because of pain and so on.

572
01:17:06,420 --> 01:17:18,690
So, uh, as an Christophers, it was sort of 95 percent cancer and then maybe five percent, uh, neurological activity.

573
01:17:18,690 --> 01:17:24,360
Motor neurone disease. Yeah. Uh, and that's how it was so well house.

574
01:17:24,360 --> 01:17:34,350
But we had the occasional other patient. But now and I can't give you the details, but now it would be much, much different.

575
01:17:34,350 --> 01:17:39,540
Uh, the Americans are behind us in many ways in palliative care.

576
01:17:39,540 --> 01:17:45,960
They were ahead of us in terms of not being so restricted to cancer.

577
01:17:45,960 --> 01:17:53,820
But I couldn't afford to, you know, to canvass for non cancer patients because we had more than enough to do this.

578
01:17:53,820 --> 01:18:00,120
And there will be now again. And then, uh, yes, I'm going down this afternoon.

579
01:18:00,120 --> 01:18:03,990
Uh, so I haven't seen what they're up to.

580
01:18:03,990 --> 01:18:08,850
I know what they're up to. Uh, yes. And that's encouraging.

581
01:18:08,850 --> 01:18:24,480
I think they are having some extra beds, which will be mainly, I think nurse led, uh, possibly for patients with dementia.

582
01:18:24,480 --> 01:18:33,480
I can't give you the exact, uh, but we've had this interest, which a number of the early hospices had in lymphedema.

583
01:18:33,480 --> 01:18:40,650
So we set up a lymphoedema clinic probably in nineteen eighty four, which grew and grew and grew.

584
01:18:40,650 --> 01:18:45,480
That's my my third research fellow was, you know, it was lymphedema.

585
01:18:45,480 --> 01:18:53,580
So you said that. Yes. That's the only one that exists in the renal setup, as it were, in the renal area.

586
01:18:53,580 --> 01:18:58,410
Now the lymphoedema. Oh yes. Outpatients, no, we started that.

587
01:18:58,410 --> 01:19:09,000
And it was the second research fellow, Claude Rainard, who was doing research on morphine and that sort of thing, who latched on to this.

588
01:19:09,000 --> 01:19:17,370
And we got more and more referrals. It got bigger and bigger. Uh, and again, we had to wait.

589
01:19:17,370 --> 01:19:25,800
We didn't have the backing of the NCI, but we had to sort of inveigle our way into getting proper funding from the,

590
01:19:25,800 --> 01:19:32,310
uh, from the NHS, which probably wouldn't have come until the mid nineties when, of course, Michael.

591
01:19:32,310 --> 01:19:38,540
Clinton was responsible for engaged in his negotiations at the House.

592
01:19:38,540 --> 01:19:49,490
So this new extension, I think, will have some beds for long stay palliative care, put it that way, long stay palliative care.

593
01:19:49,490 --> 01:19:56,540
And also there will be a purpose designed lymphoedema clinic and I don't know what else.

594
01:19:56,540 --> 01:20:01,250
Now, you must have worked with lots of people. Obviously, the nurses must have been crucial.

595
01:20:01,250 --> 01:20:14,750
The nurses were absolutely crucial at one point in my career as being tempted to go to St. elsewhere as a first professor,

596
01:20:14,750 --> 01:20:28,100
palliative medicine in the U.K. But when it came to the crunch, again, you know, it was taking years to mature, but the person concerned wanted me.

597
01:20:28,100 --> 01:20:34,260
And then when eventually she said, I've got to go ahead.

598
01:20:34,260 --> 01:20:40,710
I thought, I can't leave Oxford if I go to St. elsewheres,

599
01:20:40,710 --> 01:20:52,400
it'll take me two years to build up my support network and my nurse colleagues and other colleagues here were absolutely vital for,

600
01:20:52,400 --> 01:20:54,750
you know, my equilibrium.

601
01:20:54,750 --> 01:21:04,960
So I turned that down and never became the first professor of medicine in the U.K. The very first one must have been crucial,

602
01:21:04,960 --> 01:21:10,350
I mean, which is somebody interested in the subject. But just somebody got moved into it.

603
01:21:10,350 --> 01:21:15,010
No, it was my first research fellow, Geoffrey Hanks'. Sorry, the system.

604
01:21:15,010 --> 01:21:18,450
I mean, the nurse. Oh, the sister. I better finish that sentence.

605
01:21:18,450 --> 01:21:29,520
The first professor of preventive medicine in the UK was Geoffrey, so moved from us to Royal Marsden and then his poached by St. Thomas as well.

606
01:21:29,520 --> 01:21:36,270
Good on him. Yeah, but that would the first sister that you must have been an experience for too.

607
01:21:36,270 --> 01:21:51,030
Oh yes. In those days we had a senior nurse and two ward sisters and they Preciado was the senior nurse and she was probably uh.

608
01:21:51,030 --> 01:22:00,240
Well she was 50 or 50 plus and she was a very experienced nurse and I can't remember her, but not the palliative experience.

609
01:22:00,240 --> 01:22:04,380
Well, I can't remember. And then show up.

610
01:22:04,380 --> 01:22:14,040
And then there were two younger nurses, probably in their late 20s, Alison and Jane Anderson Parry and Jane Harvey.

611
01:22:14,040 --> 01:22:21,430
And they were appointed six months before the unit opened.

612
01:22:21,430 --> 01:22:29,680
Uh. They've had to commission the unit and appoint staff.

613
01:22:29,680 --> 01:22:35,610
But the two nurses, Jane and Alison, went off for what you might call prudent training.

614
01:22:35,610 --> 01:22:40,510
And, uh, and they were all they were superb.

615
01:22:40,510 --> 01:22:47,830
Absolutely superb. How much the laboratory radiology support would you need?

616
01:22:47,830 --> 01:22:53,000
Mean, you know, a usual ward, you know, having scent of blood.

617
01:22:53,000 --> 01:23:01,930
And I thought was the very little of that. Uh, there was very little I mean, obviously, if you suspected hypoglycaemia.

618
01:23:01,930 --> 01:23:13,090
Right. Then. Right. Uh, but we couldn't do without, uh, blood, though it was very small in terms of number.

619
01:23:13,090 --> 01:23:22,690
And, uh, we couldn't do without, uh, diagnostic radiology, uh, particularly in relation to bone pain.

620
01:23:22,690 --> 01:23:30,160
Uh uh, and we couldn't have done without palliative radiotherapy, particularly for bone pain.

621
01:23:30,160 --> 01:23:40,690
Uh, so the the emphasis in those days was to keep it as low tech and high touch as possible.

622
01:23:40,690 --> 01:23:57,130
The trouble is, doctors like gadgets. Uh, I don't know about you, but I suspect the modern generation of doctors do scans on everybody twice a day.

623
01:23:57,130 --> 01:24:02,200
Uh, yeah, I know. I know you talked about international teaching.

624
01:24:02,200 --> 01:24:13,530
Was that, as it were, a day visit or a week visit or a month, uh, let's say, uh, probably on average a week.

625
01:24:13,530 --> 01:24:24,730
OK, I say when I got some Christopher Zinn, 71, Cicely Saunders already had, uh, an international reputation and she would receive invitations.

626
01:24:24,730 --> 01:24:30,370
And there was one she asked me to go on in Greece in September.

627
01:24:30,370 --> 01:24:38,570
Seventy three, uh, she then encouraged me to go to the States and she told me a whole lot of people I should get in touch with.

628
01:24:38,570 --> 01:24:48,700
I went over there. But really, the international word developed in conjunction with the World Health Organisation, the WHL,

629
01:24:48,700 --> 01:24:55,240
and that came about because they had a visionary head of the cancer unit

630
01:24:55,240 --> 01:25:02,110
appointed in nineteen eighty who had worked as a professor in oncology in Kenya.

631
01:25:02,110 --> 01:25:11,860
And he knew that almost all the patients turned up when they were beyond cure, when they were terminal.

632
01:25:11,860 --> 01:25:21,760
And he moved that pace knowing that a well, he called it pain relief, but it became a pain relief and palliative care.

633
01:25:21,760 --> 01:25:33,550
So he set up the W.H programme, a comprehensive programme for cancer care, which was early detection and curative treatment and prevention,

634
01:25:33,550 --> 01:25:39,700
prevention, prevention, early detection and curative treatment and pain relief.

635
01:25:39,700 --> 01:25:49,120
Uh, and so he set up a working group, uh, chaired by one of the leading lights in the,

636
01:25:49,120 --> 01:25:56,500
uh, Intractable Pain Society, which is almost all anaesthetists in this country.

637
01:25:56,500 --> 01:26:05,410
Uh, he set up an international group to develop some guidelines on the treatment of cancer pain.

638
01:26:05,410 --> 01:26:09,640
And we probably met in nineteen eighty two.

639
01:26:09,640 --> 01:26:17,590
And the, uh, draught interim guidelines were published in eighty four in trial in various countries.

640
01:26:17,590 --> 01:26:25,930
Uh, it was really what we were doing already, but this was uh, you know, uh, quite new for most countries.

641
01:26:25,930 --> 01:26:38,380
Uh and then there was another big, uh, working party and so on in eighty six when I was probably the uh the rapporteur.

642
01:26:38,380 --> 01:26:43,390
So that required some time. Uh, uh,

643
01:26:43,390 --> 01:26:51,190
one stage the guy's going out to Geneva for three days every month or something like that to to complete the

644
01:26:51,190 --> 01:26:57,430
work on this report because all the contributions of various people which had to be integrated and so on.

645
01:26:57,430 --> 01:27:08,830
And so and so it went on, uh, we became the WTO Collaborating Centre for Palliative Cancer Care were really hosted.

646
01:27:08,830 --> 01:27:17,440
Uh, so how serious are Sober House? Yes. Uh, again, I said, uh, you can't do that immediately.

647
01:27:17,440 --> 01:27:22,230
Got to wait. And I said, you can go ahead. Now, when we got the study centre.

648
01:27:22,230 --> 01:27:33,920
Uh, so we with. From 1988 until I think, uh, earlier this year or last year, but because of various things,

649
01:27:33,920 --> 01:27:39,300
I didn't know that I was the chap from Kenya, African trained or European trained.

650
01:27:39,300 --> 01:27:44,050
Uh, he he's Swedish. Youngstown's hard.

651
01:27:44,050 --> 01:27:57,080
Uh, uh, and he's obviously he pushed his whole cancer programme, but his commitment for palliative care around the world has been second to none.

652
01:27:57,080 --> 01:28:01,010
Did you have much to do with the Oxford anaesthetist?

653
01:28:01,010 --> 01:28:15,260
Well, uh, my appointment, which was full time Alister was only, I think, given six sessions and he knew I wouldn't come if it was six sessions.

654
01:28:15,260 --> 01:28:28,100
So he chatted up John Lloyd. And so I think my original appointment was six sessions, several house and five at the pain relief unit.

655
01:28:28,100 --> 01:28:33,860
Yes. And John Lloyd, of course, would be on the interview panel, uh, presentation.

656
01:28:33,860 --> 01:28:43,910
Yes, it was. Uh, but he said right from the beginning, I went to see him before the interview, uh, but had a nice barbecue at his house.

657
01:28:43,910 --> 01:28:49,790
And, uh, and he said, you know, I won't watch for five sessions.

658
01:28:49,790 --> 01:28:54,890
So I said, great. I used to go out for two sessions.

659
01:28:54,890 --> 01:29:05,460
One was to observe what he was doing. One of three, I went for a week to walk round one to witness procedures and try my hand.

660
01:29:05,460 --> 01:29:11,480
And the third I set up, uh, clinic on a Friday afternoon for posthypnotic neuralgia.

661
01:29:11,480 --> 01:29:20,240
And, uh, so when I had a research fellow was Jeffrey Hanks to do the, uh,

662
01:29:20,240 --> 01:29:26,900
urology clinic because it was identifiable and it was a good experience for many reasons.

663
01:29:26,900 --> 01:29:31,760
And so as my work expanded, I tended to go to Abingdon less and less.

664
01:29:31,760 --> 01:29:38,080
In fact, I almost, uh, seconded Jeff to to cover my sessions.

665
01:29:38,080 --> 01:29:46,010
I told Alex gathered around that, you know, I'm sure I really wanted to to be just full time at Sober House.

666
01:29:46,010 --> 01:29:53,540
And so in those old fashioned ways, I, I yeah, that's good.

667
01:29:53,540 --> 01:29:59,550
And you must have been on national committees, part of the age of your own national committees going up to London.

668
01:29:59,550 --> 01:30:04,460
No, uh, no, I don't think so. You have to be careful.

669
01:30:04,460 --> 01:30:07,370
You can't do everything. No, of course.

670
01:30:07,370 --> 01:30:23,060
But you know, by the mid 1980s, we were setting up the Association of Palliative Medicine for the UK and Ireland.

671
01:30:23,060 --> 01:30:30,620
And I was one of three who, you know, really got that underway.

672
01:30:30,620 --> 01:30:38,660
Uh, and no one was chair, one was secretary and I was treasurer.

673
01:30:38,660 --> 01:30:40,940
But that was a time when I was falling apart.

674
01:30:40,940 --> 01:30:52,670
So, in fact, I, uh, resigned as treasurer within a couple of months and never held office in the association again.

675
01:30:52,670 --> 01:31:01,010
So I've been a bit of a loner. Right. And I mean, how long did it take to put yourself together again?

676
01:31:01,010 --> 01:31:07,490
Yeah, right. OK, so I recognised I needed a break in April.

677
01:31:07,490 --> 01:31:13,450
Eighty six. I had three months off over the summer when I got in a locum.

678
01:31:13,450 --> 01:31:20,030
Uh, but I reckon it takes several years.

679
01:31:20,030 --> 01:31:27,590
If you really do burn out, you know, you come to the end of their emotional resources.

680
01:31:27,590 --> 01:31:36,060
Uh, but unlike some people, uh, after a few years I could look back and say I'm OK.

681
01:31:36,060 --> 01:31:45,740
Yes. But I continued to overdo it. So I used to have a sort of mini burnout every two or three years, some time.

682
01:31:45,740 --> 01:31:50,150
And what I would do is, OK, the work is grown. What are you going to amputate?

683
01:31:50,150 --> 01:31:54,830
What are you going to amputate? And would you take a couple of months?

684
01:31:54,830 --> 01:32:01,850
Oh, no, no, no. Only that once. Yes, I only met once, but OK, you talk about internationally,

685
01:32:01,850 --> 01:32:13,530
uh nineteen eighty six and it started a long association with Argentina, uh quite soon after the Falklands War.

686
01:32:13,530 --> 01:32:20,340
Uh and I'd been going over to America probably since nineteen eighty.

687
01:32:20,340 --> 01:32:24,520
Uh I had a big course, five day course over here.

688
01:32:24,520 --> 01:32:36,830
One year and I had another one, uh, in New Haven the next year and my colleague over there, uh, she would come to Oxford, you know, turn it.

689
01:32:36,830 --> 01:32:42,550
So we did it together for many years. Uh, so Argentina.

690
01:32:42,550 --> 01:32:47,290
Yes. Uh, Poland probably came in in about 1988.

691
01:32:47,290 --> 01:32:53,380
Eight. India came in in nineteen ninety one. Where did you get the heat in India.

692
01:32:53,380 --> 01:33:07,450
Oh well over the years I've been to about 18 or 19 out of what is now I think 30 states because they've divided some of the states up.

693
01:33:07,450 --> 01:33:13,440
So we've been all over into. Yes, but not for a good few years.

694
01:33:13,440 --> 01:33:23,500
It's been two or three times. Did you ever go to Brazil because receive was sort of the second time I went to Brazil?

695
01:33:23,500 --> 01:33:28,870
Well, I've been there twice. If I've been there three times.

696
01:33:28,870 --> 01:33:35,060
Uh, but they were short visits tagged on to Argentina, Argentina.

697
01:33:35,060 --> 01:33:45,820
I ran lots of courses. My colleagues out there, uh, you know, there were probably three or five days, two days and so on and so on.

698
01:33:45,820 --> 01:33:50,230
Did you ever teach undergraduates in Oxford? Well, yes.

699
01:33:50,230 --> 01:33:57,940
Yes. Not clinical students. Oh, it's you may remember people graduate after three years.

700
01:33:57,940 --> 01:34:05,200
You're quite right. Uh.

701
01:34:05,200 --> 01:34:18,700
I don't think I did that today. I mean, we moved towards being moved towards lecturing in the introductory course, the clinical study.

702
01:34:18,700 --> 01:34:26,950
Yes. You know, I think there was a six week introductory course, which, of course, didn't happen in my day, but we had a presence in that.

703
01:34:26,950 --> 01:34:32,480
But we never taught the undergraduates. Yes. What happened to that?

704
01:34:32,480 --> 01:34:38,500
I should have. What do you want? What happened last year that I should have asked?

705
01:34:38,500 --> 01:34:49,090
What do you want to tell me? That I haven't been probing a very difficult because, you know, uh, there's a lot more to my life than I've told you.

706
01:34:49,090 --> 01:34:55,960
And one and a half hours, that's all I want is for the medical school, not the rest of your life.

707
01:34:55,960 --> 01:35:00,080
Oh, right. I mean, in the past. I know, but that's fine, Robert.

708
01:35:00,080 --> 01:35:07,120
But is there anything about the Oxford Medical School that I haven't asked that you should have?

709
01:35:07,120 --> 01:35:18,200
Well, as I said at the beginning, my years at Sobol House were halcyon years and it was a wonderful experience and a close knit group of people.

710
01:35:18,200 --> 01:35:25,040
Uh, and you could want better, but it doesn't exist anymore because it's, you know, what is it?

711
01:35:25,040 --> 01:35:28,810
One hundred and fifty hundred and sixty students a year, is it.

712
01:35:28,810 --> 01:35:34,330
Yeah, it is. Uh, no, it was great.

713
01:35:34,330 --> 01:35:41,800
It was great. And there's nothing else that I should be asking you about.

714
01:35:41,800 --> 01:35:50,680
Uh, no. I've continued to write books, and I think apart from, you know, teaching here and teaching there and,

715
01:35:50,680 --> 01:35:55,900
you know, my main academic activity progressively became, uh, writing books.

716
01:35:55,900 --> 01:36:03,010
And, uh, we had an in-house book of preferred drugs, because if you're having housemen every three months,

717
01:36:03,010 --> 01:36:08,290
you don't want them coming with their own favourites. You have to impose your favourite.

718
01:36:08,290 --> 01:36:14,200
Uh, so that morphed into the palliative care formulary.

719
01:36:14,200 --> 01:36:19,630
So named as a take off on the BNF is, uh.

720
01:36:19,630 --> 01:36:29,950
So that was first published in nineteen ninety seven with one of my former senior registrars who had become clinical reader, Nottingham.

721
01:36:29,950 --> 01:36:37,450
And that has been a very big part of my life and a very big part of my contribution to palliative care.

722
01:36:37,450 --> 01:36:48,100
Uh, with a year ago we published the sixth edition, uh, the other textbooks, uh, which have reached four, five editions,

723
01:36:48,100 --> 01:36:59,350
and they've all been very well received and often translated to I was wondering how many languages I, I, I used to keep.

724
01:36:59,350 --> 01:37:12,280
But there comes a time when you say I can't afford it and you copy and I may have I may have uh,

725
01:37:12,280 --> 01:37:20,860
I got a couple of shelves like this in Australia for but that was a terrific interview.

726
01:37:20,860 --> 01:37:26,990
If you feel we finished. I think we have to finish it sometime. Well, thank you very much indeed.

727
01:37:26,990 --> 01:37:28,000
You have the.