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This is the interview with Peter Berg about the 8th of August, and Derek, how could we interview Peter?

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When did you first go to the NSC as a medical students,

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which must have been in 1970 for what was then an eight week attachments with the action service at the infirmary and led orthopaedics at the NSC?

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And did you take to that? I mean, did you know at the end of it that you wanted to do with politics or not at all?

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I certainly enjoyed it. My intention then, I think, was to be a general surgeon because my father's analysis was not always wanted to be a surgeon.

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And I hadn't yet appreciated that.

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Orthopaedics was relatively clean and with few smiles, little infection and almost no cancer was all those problems were rife in general surgery.

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And it wasn't until I went back to the NSC as a senior House officer in 1974 that that that the pay really dropped.

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I've gone back to the NSA believing that experience of Predix would be useful for a career in general surgery,

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but then partly because the work was more appealing and partly because of the people I met, was taught by orthopaedics, grabbed me.

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Right. And we were working for a particular person there or for several at the end.

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Well, it was originally planned when I moved to the next year and I say, Joe, in 1974, that I would be the researcher for the professor, Robert Duffy.

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I wasn't terribly attracted by that prospect because I had learnt I was at sea when I was a student,

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that the that person that he was the only other young chap in the department.

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He worked for several masters. And it was quite difficult to to put it all put it all together.

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But fortunately, somebody else for the I think someone from overseas with an enthusiasm for working in

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the academic department arrived and I was shunted sideways to work for John Goodfellow,

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which which was wonderful. Yes, I enjoyed that tremendously.

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And it was John Goodfellow did manage to to direct me away from general surgery and into orthopaedics.

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He was a wonderful teacher.

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And I think the word is perspicacity and perspicacity is this close because he being able to explain clearly, he had a wonderful gift for that,

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both in teaching, actually also in his in his writing, he made it clear, he explained the mechanical basis behind the treatments that we were using.

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And he was a beautiful surgeon and an artist.

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After six months of that, I was directly, firmly towards orthopaedics.

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And did you have to take another job in an orthopaedic surgeon? No, no.

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Although I wasn't working for the professor, Robert Duthie,

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and I think he had taken an interest in what I was doing and initially as a student and then later in 1974 as a researcher.

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And I went to him for advice on on how to develop my career so I could come back to orthopaedics.

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It was always easy to make an appointment to see him to discuss your career. It was always on a Sunday morning, so.

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And he said, oh, you must go and do general surgery and some other branches related to general surgery,

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you need to do need to acquire surgical skills in general surgery and then come back to orthopaedics, which is good advice.

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But is it? But I went later on, I went back to him for advice.

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He said, no, you need to do more general surgery, which in hindsight was a mistake and not what we tell people to do now.

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But anyway, he said we need to do more general surgery. So that brought us to the middle of 1974.

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There was a strong connexion and that sort of stature level between Oxford and Bristol in both directions at that time.

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And I had by then met and decided to marry Susan, who was finishing her.

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She was in her final year of medical school, right?

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No, she she she did have preclinical breast. Right. Actually doing A, B, C.

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And then she came to Oxford, who at the time had a shorter clinical course who was two and a half years rather than three years.

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Um, they they changed it back to three years, not long afterwards.

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So by the time I finished it in I field in the middle of nineteen seventy four, she was finishing her final year qualifying in December.

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Right. And before we were planning to get married in January 1975.

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And she had um she was going to move to the to the professorial Hellström Bristol in medicine.

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And so we talked about that she was keen to get back to Bristol was a good place for me to go.

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So I was lucky enough to get onto an NHS rotation in general surgery, urology and thoracic surgery,

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starting at Southmead Hospital in general surgery, followed by Urology and Southmead, followed by general surgery.

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Frontier Hospital, Bristol,

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and then the thoracic surgery was last on the rotation and you been having some experience and you went straight back to being housemen,

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running on the thoracic, that everybody was always keen to move out of it.

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Unfortunately, the registrar general surgery left Robert Duffy, who told me to do more general surgery.

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So I took a temporary post as registrar to Roger Celestron, the man who invented that tube,

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maybe still used as palliative care for people with a lot of cancer.

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Um, I'm technically very, very but a very man and a very gifted surgeon.

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And I enjoyed the time in Bristol a lot. There was lots of experience.

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The staff were good. The hospitals were good. Um, how would you compare them with the hospitals?

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Well, it was it was different in the sense that it was well, of course, the city is bigger.

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The hospitals were more numerous. Acute care was was the standard, the misruled infirmary at Southmead and to some extent in front of a hospital.

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Um, I think the standard of care was equivalent. Um, the teaching was good.

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Um, and the patients were probably similar.

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We had a few quaint customers from places like the Forest of Dean and Minehead.

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But, um, but but by and large it was it was similar that, as I say,

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the weren't there were quite a few and there were a number of people who moved between Oxford and Bristol and new best places.

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And just to be able to smooth things for the interested.

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You said there's not much infection. Had osteomyelitis gone out with antibiotics or with a GP's giving antibiotics, it was of similarities.

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So yes, yes, there were still cases in open tibial fractures, for example, but the antibiotics had made a huge difference.

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Osteomyelitis in children in the pre antibiotic days frequently led to chronic osteomyelitis for that.

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But that was rare and it was usually if it was an acute illness that came to hospital, the principles of surgical drainage by the most established,

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of course, and the antibiotics usually needed in the body and prevented chronic illnesses.

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My brother had it in about 1941 and was treated with the traitor technique, which was, you know, gouged out and sulphonamide.

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Yes. And then wrap it up in it. And he did alright. It's been great because it had just come in.

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I think that. Yes. And I would you say I mean it's a funny question, but your father was a surgeon and I know your brother said I mean,

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would you say you were a natural surgeon or did you do a lot of woodwork or metal work and on training?

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It's difficult to to define what makes a national search and secondly, as it as a boy, I was very interested in how things work.

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I've made models. We did chemistry experiments in and in the garden shed.

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I made a guitar and we said my model.

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So I would go, oh, I know how out have kids usually.

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Yes. I mean, we did.

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Yes, I was interested in chemistry. I was always interested in science.

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So, yes, I probably spent more than the average amount of time making things or doing things with my hands.

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And did you decide to go to Oxford or did other people decide?

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So I was I was at a grammar school in Melbourne, age 14, and not and I was in the middle stream.

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But Oxford was probably a long way off on that stage. I probably wasn't heading in that direction.

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And I was in big classes. And my father, I think my parents, particularly my father, were concerned that I wasn't wasn't maximising my potential.

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So I was sent away to boarding school age 14, where the classes are smaller.

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And maybe I was just just maturing a bit later. But but then I did much better.

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I could go and I'm not quite sure how I went up to Oxford for an interview, I think age 17 before my A-levels and was offered a place.

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And then I went back the year after and the scholarship exam. But I didn't get a scholarship.

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But, um, and I and Pembroke College was chosen for me, probably my father,

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who talked to people in London, and he had wanted to social friends in Oxford and learn from them.

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The Pembrook at that time was drawn from medicine is at least partly on account of its of its biochemistry tutor,

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Percy O'Brien, who was also, of course, a biochemist at the raccoon family.

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Um, he he was wonderful, is somewhat a fierce teacher.

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And he he used to keep a shillelagh in his drawer. And if we weren't doing well in tutorials, he'd bring it out the way that never knew it.

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I knew you share it, but I actually replied to him it was our job to bring the sherry.

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And he he drank more of it than we did because he liked it more,

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partly because we thought we had to keep our wits about us during the dishes and that if you are to other people.

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So Pembrook had a physiology tutor and the person of Bill Keating, an expert in in the body's response to cold,

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used to chat volunteers and to see swimming pools and see what happened. Um, and it had to be a teacher who in our first term was Max calm.

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But then he would he was head up to the best place in the USA and was a small gap during which time we were taught with a huge biopolymer can move,

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um, and then arrive somewhere and bring the electron microscopist, um, as a as a young scientist and teach.

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And he was brilliant at teaching anatomy, he said, because in those days, because there were no laptops,

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there were no mobile devices, it was all in your paper notes which you kept in these A4 folders in ring binders.

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And we had you wanted to make sure we had our notes. We should take them as well as we on the buses and just read your notes before exams and so on.

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So he was very good at getting us through the exams.

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So we were lucky to have chemistry, physiology and anatomy tutorials on three main subjects in medicine.

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We're all in one college and there were six of us at Pembroke, which was probably more than than in most other colleges at that time.

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I know Bill Keating's words were very useful, but like Sydney Truelove, I always could stand as slowly to remember that I don't know,

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because he spoke very slowly but in it and said, well, are you interested in music?

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Yes, I was. I think I really wasn't much interested in classical music at the time.

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I had a musical interest, I guess was in the modern music at the time.

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Of course it was.

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It was the Beatles and the Rolling Stones and and at school, I was one of a group of four who played who who played rock music at the weekends.

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In fact, we even performed on whether there was a concert on Prised at school.

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And I finally and we performed my father was absolutely horrified, absolutely horrified.

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It was only when I got the. Physics prise. So what if you and David Nabarro is rock group?

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No, that doesn't mean I know I do. Well, I do recall playing with I would change Paiano Rudd and Tony Kooch and and Roger Vickers, but Novarro,

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I don't know, humanitarian a bit before, probably a bit before and several was a considerable protest you know.

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Did you know that. I think it is a very fine.

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So you came up and you did what, two years to the first b.M.

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Yes. And then what happened to schools? Well, of course, in those days it was all physiology.

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And I think it's a bit broader now than maybe not as broad as it always was in Cambridge.

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Um, I had quite a bit of neurophysiology. Who did you do that with?

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Mathew's. Yes, in Christchurch. I didn't know the college because it was all done in the department.

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Yes. So there were many happy witnesses to the practise of husbandry pouring through dusty journals of this and that.

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Um, so what was Matthew's name? I don't remember very much about it because we were in it was a big Grigoryan.

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There were 100 students who were all doing during the final year of school.

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I remember I remember the tortoise heart, um, with there was a lady and what was her name.

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I can't remember. Maybe, maybe it'll come to me, but probably those experiments around done these days owing to a shortage of tortoises,

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which may be our experience, were responsible for that was children who came lived in north or south of the country.

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Sure. And do you think that was a necessary part of your career?

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The honours,

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what it was it was it was useful because it took the large you to drill down into a subject more detail to to treat it in a more critical fashion,

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to write essays in a much more critical fashion. I think it was very.

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And then you did pass back and forth. Yes. That was two terms.

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I think we would we were taught by Lady Flori. We still that that was fun.

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And she was. Well, I don't know.

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Again, I don't recall an awful lot about that, but but I do recall enjoying it and enjoying the course, particularly the pharmacology.

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We did lots of good experiments. Yes. And I did well.

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I think it came third in the end pharmacology exam because you could make experiments were probably.

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Yes, of course. And in those days, the recordings, you know, of muscle contraction, for example, were traced on to a drummer smoked paper.

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So a lot of time spent trying to trying to get the Bunsen burner just right.

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So deposit carbon on your paper, I would imagine going everywhere.

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And then when you'd done it, you had to have to spray varnish on it. And then these days it's different.

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So let's go back to your clinical career and now Robert Duffy.

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I mean, the thing I remember is Saturday morning. Yes.

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Sessions case presentations. Well, in the clinical conference was on a Thursday morning at forty five.

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Um, the the cases were posted on the board the previous evening,

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but I would just say to Mr SASO fairly broad hip problem which didn't give a lot away, and we knew we were going to be grilled on it.

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So then there was a of, to be frank, people trying to trying to talk to the doctors,

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looking after the patient, find out what was actually wrong with them. So they made up the lot for then you arrive at the court.

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The nine actually arrived a bit beforehand because you've got a hard time.

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If you were late and Robert had the clock in the lecture theatre set slightly faster so that when his colleagues arrived on time,

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if you're part of them for being late or so, he's and he the it was a standard slightly recommended theatre.

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But on the right, as you just sat in the seats and look towards the screen on the right was a little raised area

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on which Robert sat and he had his chair at the engineers put his chair up a little bit higher.

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So he was kind of like everybody else.

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And and it was a somewhat terrifying session as a junior because he'd sit there and you think it was all going well.

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Other people have been grilled and suddenly a voice would say Mr might stand up and talk for two minutes on epiphyseal stapling.

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And before you knew it, you were on your feet and the brain wasn't working out what to say.

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And I mean, did you get a lot of education out of it or was it.

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Yes, so did I. No, no, no, no, no.

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It was it was very educational, partly because of the work you did, trying to make up on the cases on one pilot, partly because of the content.

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So that was the. And then it was then it was coffee.

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And the the professor's registrar would duck out at nine thirty to write the extra cards for all the patients in his

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clinic because there were 100 patients to be seen between ten thirty and one o'clock and they'd all arrive at ten thirty.

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But come back to the Saturday in the mechanism he returns.

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There was a programme, the Basic Science Lectures, which would comprise one lecture from usually from the visiting speakers,

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six thirty on a Friday evening and then two lectures on a Saturday morning,

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usually one from visiting speaker for an hour, carrying all of the basic science and then more technically related topic for the second hour.

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And then on the Friday evening, it was sherry and a dinner with the visiting speaker.

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So that was very sociable. The problem was, you know, on particular on the Friday evening, trying to stay awake because we at five o'clock on Friday,

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we had Collingwood's teaching a pathology, which was and he was a lovely man, wonderful knowledge about pathology, somewhat monotonous voice.

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And the lights had to go right down so you could see these astonishing slides on the screen.

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And, boy, it was hard to stay awake. And Saturday morning, to me, it wasn't difficult.

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What kept me awake was watching my senior registrar, Jan, my CNN colleague John Murray, go to sleep at night.

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Were we doing that? Oh, I did not feel he was much when you were on call.

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Probably one night in six or seven, but.

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And you might have a call or two, but the need to operate was pretty unusual things like reducing a dislocated hip.

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Well, if you were the senior registrar and the registrar could easily do that.

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And osteomyelitis and children accepting arthritis, those sorts of things.

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But it wasn't very much it was different than they was because half the rotation was at the action service at the infirmary that it was.

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And two nights out of five, I think it was quite busy and less busy than it is now,

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partly because that's the number of cases this year was smaller and partly because there was less you can do the more people get on track and so on,

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rather than having operations in the middle of the night. But it was two out of five. It was two weekends on five.

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So it was quite busy. I mean, obviously, you weren't really directly involved in it.

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But all the argument about the excellent service in the area, surgeons splitting with the job market,

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do you remember the tremendous controversy about that or did you have views on that?

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Well, we and we all certainly had views and the views that the neurosurgeons should stay with the trauma service,

189
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with the service, as it was then called, because it worked really well with the Jackson family.

190
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There was there was a head injury registrar because a surgeon and provide a neurosurgeon department.

191
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We provided the head injury senior house officer and the two of them made rounds every day and looked after the head injuries.

192
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And it was at a time, of course, when you couldn't just plug the patient into a scanner and see what was going on.

193
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It was all down to it was the pain of your shifted on the skull x ray.

194
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I guess it was angiography if you really had to. But a lot of it was done, technical skills.

195
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And that and that was a very was a very good arrangement for a problem that was very frequent at the time,

196
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especially in the days when I was in researcher anyways,

197
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before the introduction of seat belts and not only minor head injuries, many motorcyclists also had put in place that had helmets.

198
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Probably, yes. I can't remember when helmet legislation came in, but probably they did.

199
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So we we regarded the move to the John Radcliffe as as bad news if the neurosurgeons are not going to come with us.

200
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But but I'm not I guess that funding was a risk was clearly a problem.

201
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The the floor was put on the jail to make room for them. There may have been other issues, too, that I wasn't aware of.

202
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And you remember clinical disadvantage from that?

203
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Yes, there was a public health that the child of a public health physician was badly injured and I

204
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think may have died partly because of the lack of the ability that had to have us have a scan.

205
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Maybe this has more to do with CT scans. I think we didn't have a CT scan of the CT scan was not the right in February with the nearest surgeons.

206
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And we didn't have the CT scanner and it was perceived that she would have done better if she had a scan more quickly.

207
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And he he was because he knew the system. He was very determined and articulate.

208
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And I think it was largely that that eventually got it got a scanner up at the jail.

209
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We always had the feeling in the department anyway.

210
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It was the hospital authorities didn't give nearly enough priority to the care of injured patients.

211
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Everybody thinks they do. And yes, yes, they may be right or wrong.

212
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We were right. Yeah, I'm sure. Now, Robert, does the follow trait, is that right?

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Yes, yes. Yes. And he it will change the NSC or bring it into the 20th.

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I didn't know to Robert. I think he took over in about 1963 and I'd need to check the date, but something like that.

215
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And so by the time I went, he'd already been in person seven years,

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by the time I was a student and for ten years for the time I went to the NSA chair.

217
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And because he he'd been a terrible graduate and worked in Scotland,

218
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but then been a professor at Rochester, New York, for twelve years before he came back to Oxford.

219
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Yes. So he did bring back some American features.

220
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Not he didn't actually bring back the very early start in the morning.

221
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That would have been a bridge too far. Um, but he had a very firm focus on teaching, which is generally very good in the USA.

222
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Um, uh, clinical practise.

223
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No, I think his view was that the professore department, which is a big department,

224
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should be able to deliver the whole spectrum of orthopaedics with him.

225
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And he had first one and then two first assistants later rebadged as clinical reasons.

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And he felt that between them they could deliver the whole range of experience and they could deliver.

227
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A whole range of training so that the there were two lecturers who was senior registrar status, they got to go for their training in his department,

228
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as the rest of us thought he was wrong, that those trainees should be exposed to a wider group of consultants.

229
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And eventually eventually, I think he saw that was correct and it happened. So there would be three managers, consultants?

230
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Well, I would say that no one in the hospital as a whole,

231
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there were about eight was the Goodfellows Somerville later replaced by Michael Bents transpiring.

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David Fuller tragically killed in a helicopter accident shortly before his taking up a post,

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a professor in Bristol, um, Telford Taylor and Morgan Times.

234
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Right. Um, gosh, I'm sure I did.

235
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And I should know this and many others do.

236
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So there were about I think there was something like six or seven NHS consultants and then three on the professore unit.

237
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Then did you know James got an accident? It that he he had also retired and John Cochrane.

238
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John Kenwright. I just remembered where they were the other two.

239
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And so, so the professor with his assistants and for NHS consultants ran the expensiveness, Cockayne Kenwright Spivvy.

240
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And so yeah. But they also actually worked with the NSC and Goodfare and Benson, um, good friends,

241
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some of them later replaced by events well attended, worked at the NSC.

242
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And they also had rather curiously covid trauma at Banbury.

243
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It was a very good clinical assistance programme whose name I forget the um but occasionally that have to wear off in the middle of the night.

244
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That was pretty uncommon and it wasn't a very satisfactory arrangement. Is that changed?

245
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It really is very dependent. Well, I think I think they were fine.

246
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I went up as a trainee with Michael Benson to do his case in Banbury and we can get X-rays with him.

247
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And what stage did you go to America to Caroline? Well, I am John Goodfellow, new people in in Baltimore at Hopkins,

248
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particularly a joint replacement surgeon there who actually worked at a rather like an

249
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elective orthopaedic orthopaedic hospital out of town called a Good Samaritan Hospital.

250
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And with his good offices, I've had an offer of a chief resident post there.

251
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So I just, um.

252
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And, um, and that would have been fine, probably, though, as I later learnt, um,

253
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post posters, a fellow completely different from person as a chief resident.

254
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The chief resident runs the show. Yeah, absolutely. And wants to do most of the operating.

255
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And it would have been quite difficult for me not having not knowing anything about the American system when I arrived.

256
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I might have been difficult for the other residents as well, so that that would have been mainly joint replacement.

257
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But my interest in heart surgery was was growing. And I might talk about how that develops space.

258
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Um, and, um, about a year before I maybe not before I went, Michael Benson was awarded the ABC Training Fellowship.

259
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So this is a fellowship run by American, Canadian, British, South African and Australasian Orthopaedics,

260
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whereby about eight orthopaedic surgeons under the age of 40 are awarded a training fellowship and they all go off in a group.

261
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So one year, eighty six Americans and two Canadians come to Britain and they tour around hospitals,

262
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giving talks and listening to talks for about six weeks. And they come to Britain and they go to South Africa.

263
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They might also go to Australasia. And then in the other year in Britain, the South Africans Austronesians for group and they tour North America.

264
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So like being a very prominent and Breitman orthopaedic surgeon under the age of 40, was awarded this.

265
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And on his travels he went through Duke University in North Carolina and was impressed

266
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by it and by the heart surgery and thought this would be a good place for me to go.

267
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And he knew the the, uh, one of the senior people there, Jim Urbanek, who was probably then aged in his early 40s.

268
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And there were links. And then I had an offer of a fellowship there. So I kind of I said to Hopkins, thank you.

269
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But I thought that was a that was a very good decision because I had a wonderful time.

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So Susan and I both sat on the visa qualifying exam to get a licence to practise medicine in the US equivalent to all of your medical school exams.

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Again, basic science and. Of course, 10 years after graduation, Sandra back home was just plain different than parasitic worms.

272
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So you had to know about fungal disease in South Carolina and and the brown recluse spider and

273
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how to deal with snake bites and the burden [INAUDIBLE] have the public health in America.

274
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And if you ever need an incentive to pass the exam, have your wife take it at the same time because she's quite smart.

275
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She passed and I had failed. You just can't imagine. So we took that.

276
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That was fine. And we had to take the English test as well.

277
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So we're going to be able to get our licences and we have the most fantastic year in America.

278
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So how much operating did you do there as a burden? It was mostly assisting, yes.

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Because the as I said, I already had my surgical skills, as it were.

280
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And I've done a lot of operating in the training programme in the U.K. the cases I wanted to scrub into in the difficult cases.

281
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And by a lot of it, they were being done by the senior staff or if it was a public case on their public service, the chief resident always did.

282
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It didn't matter what it was. I mean, the scariest is correct. And the chief resident always did it.

283
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I mean, he'd help. But if the chief worked because it was the chief resident.

284
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Yeah. They really got all the experience. And if if they weren't allowed to do it, they just go on strike, right?

285
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Yeah. And you had that authority both through that whole question that Belski, you were there and you said, what did you do the rest of your time?

286
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I know what I think at you do it.

287
00:32:18,280 --> 00:32:21,820
Well, the it it was quite busy.

288
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We do it for six months to two of a second, six months, two or three of us.

289
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So we were on call until 10:00 at night.

290
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So one of the three and it was busy, it was um do kind of the Duke hand team had a big interest in microsurgery,

291
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which really started in the late 60s and work through the 70s and by the time

292
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we were there in 1981 was really in full swing and a lot of equipment and um.

293
00:32:47,920 --> 00:32:53,500
And but but there weren't very many places doing microsurgery.

294
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And in those days, safety at work in America was put in North Carolina.

295
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The state industries were woodworking and textiles, all with sharp implements.

296
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And people love going out into the woods with a chainsaw and the hydraulic log splitter.

297
00:33:06,440 --> 00:33:13,300
Um, so there were many, many digits were lopped off, sometimes one digit, sometimes several.

298
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And there were very few places. And it was then possible to reattach them if it was indicated, not always indicated.

299
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If it was indicated, it was usually possible, maybe 80 percent survival rate, but there were very few places doing it.

300
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So patients were flown in from Pensacola, Florida, from from Kentucky, from the north of Virginia.

301
00:33:31,460 --> 00:33:39,220
And they all came to do so in the year I was there. I think we did about 80, which is not maybe that's only a couple of week.

302
00:33:39,220 --> 00:33:45,790
But of course, it's usually a six hour, six hours of the first four hours for each subsequent finger.

303
00:33:45,790 --> 00:33:52,660
So it's quite time consuming. And so a lot of the difficult handful, including the finger attachments, was flown in from outside.

304
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So it was there. And of course, it was usually a non-social up because of the time they got to you.

305
00:33:57,490 --> 00:34:07,960
It was 5:00 in the evening and you couldn't leave it for the next morning. So it was finger reattachment happening in then before you had to do it?

306
00:34:07,960 --> 00:34:09,940
Yes, they were doing microsurgery.

307
00:34:09,940 --> 00:34:20,560
So it could have done actually, the cases here have always been far fewer and probably the indications would be would be more restrictive.

308
00:34:20,560 --> 00:34:28,220
Um, no. They tended to do both and they were pushing the boat out, trying to see what the indications were.

309
00:34:28,220 --> 00:34:33,230
And, um, and and also people didn't take patients,

310
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didn't particularly want to fly for us right at the wonderful hospital and checked in the bit a tendency to put it back.

311
00:34:42,190 --> 00:34:48,920
Um, there was Mike expense and I had said no to his children's orthopaedics, but a in children's orthopaedic surgeon.

312
00:34:48,920 --> 00:34:50,320
So what got you into this?

313
00:34:50,320 --> 00:35:04,750
And, um, when I was doing general surgery, more general surgery that I needed it in Bristol, but felt that for a career orthopaedics,

314
00:35:04,750 --> 00:35:13,480
I needed a rather wider experience and plastic surgery would be useful, particularly in in trauma.

315
00:35:13,480 --> 00:35:16,370
And there was a strong plastic surgery unit in Bristol with four.

316
00:35:16,370 --> 00:35:23,200
So at that time, um, and they had post for senior research, some people who had already done the FARC.

317
00:35:23,200 --> 00:35:35,980
Yes. As it was then, um, I applied for and got one of those starting, I guess, um, in late 1976.

318
00:35:35,980 --> 00:35:42,560
And was lucky enough to work for Ron Hiles HIMSS, who was then a youngish surgeon,

319
00:35:42,560 --> 00:35:50,250
and he did have surgery beautifully, actually, he did everything beautifully, was very calm, logical.

320
00:35:50,250 --> 00:36:03,490
Um, I realised the girlfriend sitting down and the I guess the intricate workings of the hand appealed to my liking for mechanical things.

321
00:36:03,490 --> 00:36:10,520
And it it just rang a bell. Did you read what and in the anatomy.

322
00:36:10,520 --> 00:36:16,630
Right. Because he wrote a book about the which was very good and.

323
00:36:16,630 --> 00:36:23,250
Right. So you had that interest and that was sort of revived or increased in Duke?

324
00:36:23,250 --> 00:36:29,830
Oh, yes. Well, by the time I could go back to Oxford after Bristol, having worked with Ron Hiles,

325
00:36:29,830 --> 00:36:36,130
I was fairly firmly set on how sad it was then a question of how to engineer it and how to get the initial experience,

326
00:36:36,130 --> 00:36:39,970
which wasn't so easily available in the UK at that time,

327
00:36:39,970 --> 00:36:50,530
the word units where it was concentrated so much and also and it's good when you go to work in another country that's fun to work in another country,

328
00:36:50,530 --> 00:36:54,660
you ask what else we did and to do? And we looked after two small children.

329
00:36:54,660 --> 00:37:00,160
Yes, it's a very strange way to Florida, to Disney World for a long weekend.

330
00:37:00,160 --> 00:37:05,140
We went to the first free weekend. We thought we'd drive to the beach. We could see on the map of the USA it was only a short distance.

331
00:37:05,140 --> 00:37:09,160
Of course, it was about five hours. It's just a very good big.

332
00:37:09,160 --> 00:37:15,340
And then at the end, we put the kids and our belongings into into a station wagon and drove from East Coast, West Coast.

333
00:37:15,340 --> 00:37:20,020
And we went off there and they paid quite well.

334
00:37:20,020 --> 00:37:24,850
I think I was paid twenty five thousand dollars for the year, which in 1980 was kind of a journey.

335
00:37:24,850 --> 00:37:31,030
And Susan worked part time. She was she was paid as well. I mean, we we rented quite a decent sized house.

336
00:37:31,030 --> 00:37:38,260
We always realised we would come out with a loss. But long in the scheme of things, that was that was fine.

337
00:37:38,260 --> 00:37:42,400
So in those days, it was about surgery and rheumatoid arthritis.

338
00:37:42,400 --> 00:37:51,610
Oh, yes, there was. Because, um, because the medical treatment was poor, the the both in the States and in the UK at that time,

339
00:37:51,610 --> 00:38:00,850
the the the policy was that you you waited really until you saw erosions and signs

340
00:38:00,850 --> 00:38:04,970
of joint damage before exhibiting the more powerful drugs completely different.

341
00:38:04,970 --> 00:38:08,860
Now the concept now is early in aggressive treatment to prevent joint damage.

342
00:38:08,860 --> 00:38:13,580
And there's good evidence, evidence of that works, but very different drugs. Some of them.

343
00:38:13,580 --> 00:38:19,000
Well, there was hydroxyl. Chloroquine was available then stoolies.

344
00:38:19,000 --> 00:38:25,460
Now SASE gold was used then isn't used so much now is usually rather little.

345
00:38:25,460 --> 00:38:29,830
Now, I'm not sure when methotrexate, which is a mainstay nowadays, came in.

346
00:38:29,830 --> 00:38:36,790
I think it wasn't used much back in back in those days. Aspirin, of course, was on steroids.

347
00:38:36,790 --> 00:38:40,330
Yes. But certainly by then the dangers of steroids would appreciate it.

348
00:38:40,330 --> 00:38:46,420
I mean, they were used to used a bit. Um, but but but not so much.

349
00:38:46,420 --> 00:38:50,920
So there was there was plenty of damage to deal with.

350
00:38:50,920 --> 00:38:53,470
There was lots of uncontrolled sinusitis.

351
00:38:53,470 --> 00:39:03,290
Um, one of the surgeons at Duke, Robert and Robert McCallum, had been interested in arthritis surgery generally,

352
00:39:03,290 --> 00:39:07,810
but certainly did and not large numbers of rheumatoid arthritis.

353
00:39:07,810 --> 00:39:15,700
And then you done a lot of carpal tunnel do patrols, not indic now, but because they they were all dealt with by surgeons in private practise.

354
00:39:15,700 --> 00:39:25,750
It was only the tricky stuff that was said. The cerebral palsy, brain complex's injury, amputating fingers, multiple trauma cases, congenital.

355
00:39:25,750 --> 00:39:29,710
Yes. So it was in this country you'd be doing quite well?

356
00:39:29,710 --> 00:39:34,570
Yes, because we had to do a deal with the generality of handset funding from the local population.

357
00:39:34,570 --> 00:39:43,420
So the commonest operation by far is carpal tunnel decompression. What else is common pigeon trigger finger dubiousness?

358
00:39:43,420 --> 00:39:54,130
Contractures is common in the UK, less common in the USA because it has because it's been populated by people from European

359
00:39:54,130 --> 00:39:58,950
countries where different disease or African countries where democracy is much less common.

360
00:39:58,950 --> 00:40:07,600
In Africa, almost areas of the population prevalence becomes lower as you move from north to south through Europe.

361
00:40:07,600 --> 00:40:15,550
But we don't think it's temperature because the northern Europeans still get it when they migrate to other countries.

362
00:40:15,550 --> 00:40:21,040
Then it was the sea change. When did Robert stop?

363
00:40:21,040 --> 00:40:29,530
Because the NSC went into a roller coaster. After that, it would said to me, yes, well, Robert, gosh, roughly.

364
00:40:29,530 --> 00:40:35,060
Yes, it was late already early nineties.

365
00:40:35,060 --> 00:40:44,180
Overall, you know, it was only after that because he was a he was still in place when I was appointed as well, I was appointed as his clinical reader.

366
00:40:44,180 --> 00:40:49,880
So I when I came back from the States, I took a year to go and my senior registrar post,

367
00:40:49,880 --> 00:40:57,740
I applied for a job consulting job in Portsmouth, didn't get it. The private consulting job in Derby was a very uncertain I didn't get that.

368
00:40:57,740 --> 00:41:03,800
And I was about to apply for a job that was coming up in Cheltenham, which would have been nice and different.

369
00:41:03,800 --> 00:41:08,580
But then one of the clerical readers left and I got that job.

370
00:41:08,580 --> 00:41:12,770
And so it was supposed to have time for academic stuff,

371
00:41:12,770 --> 00:41:19,160
but I had to do the trauma and some and some arthritis surgery was part of the job, but I wanted to answer it as well.

372
00:41:19,160 --> 00:41:23,330
So I built it some of that on two, which didn't leave actually enough time for the academic staff.

373
00:41:23,330 --> 00:41:30,380
And I think the university wouldn't allow it now. But but my intention, of course, was to develop the Hansadutta interest.

374
00:41:30,380 --> 00:41:34,520
So by the time I was ready to move on from the to readers post, the hospital knew it had done.

375
00:41:34,520 --> 00:41:44,000
And certainly maybe that would be me. Good. Now I remember sort of manic chap who went up to the street corner corner Brannock on it.

376
00:41:44,000 --> 00:41:53,180
He was at the Nuffield before. I wasn't I didn't know him that I did meet him and a couple of courses in, um, in uh, in Austria.

377
00:41:53,180 --> 00:42:04,640
And I think it was description fits and it was the and I the thinking about getting private in Robert's time, presumably that all came later.

378
00:42:04,640 --> 00:42:09,410
And when I say private, I may have got it wrong, you know what I mean. It went independent.

379
00:42:09,410 --> 00:42:16,730
Um, what it was. Of course, it was part of the United Hospitals.

380
00:42:16,730 --> 00:42:26,430
And things, of course, go round in circles, but it was partly in the hospitals then.

381
00:42:26,430 --> 00:42:37,110
I'm not a little rusty on the dates here, but then the the concept of NHS trusts arose because the government's always keen to change

382
00:42:37,110 --> 00:42:48,060
something and a medical leader at that time really was just finding a very a very smart man,

383
00:42:48,060 --> 00:42:55,240
Trinity College. In fact, we had three consultants educated at Trinity College, Cambridge, John Sparboe, Jennifer Black and Roger Smith.

384
00:42:55,240 --> 00:43:04,470
And sometimes you'd see them together and copy them and be able to point to a trinity.

385
00:43:04,470 --> 00:43:14,100
And I was I guess this was in the late 80s because I loved spinal surgery.

386
00:43:14,100 --> 00:43:18,600
Colleague Greg Halpern was killed in a bicycle accident in North London one evening.

387
00:43:18,600 --> 00:43:24,790
He was chairman of our medical staff committee and I took over, having only been in post for about three years.

388
00:43:24,790 --> 00:43:37,230
So I was involved. I sat on whatever the the management committee was that was then held at the jail without a scanner and then

389
00:43:37,230 --> 00:43:43,800
in the chair trying to fight for the interests of orthopaedic patients and along along with everybody else.

390
00:43:43,800 --> 00:43:52,170
And Jones by we had had the family that I feel would be better if it can manage its own affairs, um, with with less interference.

391
00:43:52,170 --> 00:44:02,590
And when the and when this idea of NHS trust came along, he he pushed forward and we became one of the first trust, I think, going in.

392
00:44:02,590 --> 00:44:09,930
Well, it was it was intended to make us less influenced by the larger hospitals.

393
00:44:09,930 --> 00:44:17,670
We felt that would be more in the interests of patients and was always very focussed on on patient care.

394
00:44:17,670 --> 00:44:21,510
And until we could plan our direction better.

395
00:44:21,510 --> 00:44:27,450
And they found a wonderful chairman in the of Frank Davis, a man who rather than making bottles,

396
00:44:27,450 --> 00:44:34,780
and he was he was a small Welshman, a man of relatively few words, but they were good ones.

397
00:44:34,780 --> 00:44:42,820
Um, uh, for example, he is the man we were having to do accounting for the team we were giving.

398
00:44:42,820 --> 00:44:48,390
He would say to his team, his team, there are two ways to lose money.

399
00:44:48,390 --> 00:44:55,410
One is not to charge enough and the other is not to charge at all. And it's full of pithy sayings like that.

400
00:44:55,410 --> 00:45:02,430
And of course, it it stimulated a lot of opposition from elsewhere and in Oxford.

401
00:45:02,430 --> 00:45:07,950
But actually, in the end, they went down the same route. So we weren't surprised that there was opposition.

402
00:45:07,950 --> 00:45:14,340
But they but we did feel I think most most of the staff felt then that the the more independents there are,

403
00:45:14,340 --> 00:45:20,100
in fact, would be who would be good for our patients. And that was that followed by rebuilding.

404
00:45:20,100 --> 00:45:31,710
Did you do much rebuilding then, or was that the the the bulk of the hospitals built in the 1930s, those red brick square wards?

405
00:45:31,710 --> 00:45:36,810
When I was there as a student in 1970 and there were only two operating theatres,

406
00:45:36,810 --> 00:45:41,470
that old operating theatres where you could open the windows and peel gumboots.

407
00:45:41,470 --> 00:45:45,230
And but by the time I went back, as I said,

408
00:45:45,230 --> 00:45:52,500
they built three operating theatres on the other side of the hospital, together with two wards through ethology.

409
00:45:52,500 --> 00:45:57,780
Ward said Ward and the admissions would say they were all built on the Oxford system, which was sort of white,

410
00:45:57,780 --> 00:46:02,880
slightly prefabricated system development in the regional health authority in Oxford.

411
00:46:02,880 --> 00:46:12,010
Probably in the late 1960s, it was put up rather quickly. They had a limited lifespan that maybe, maybe 40 or 50 years.

412
00:46:12,010 --> 00:46:21,030
And so there were three nice operating theatres, two of which had the glass enclosures called Charnley Tents.

413
00:46:21,030 --> 00:46:34,020
After John Charnley, the man who invented the really invented hip replacement through which of a downward draught of highly filtered,

414
00:46:34,020 --> 00:46:40,500
sterile ER came to try and maintain a completely and operate feel completely free of bacteria.

415
00:46:40,500 --> 00:46:47,400
So these glass walls came from the ceiling all the way down to about to about six inches on the floor in the ER, the bottom one side is open.

416
00:46:47,400 --> 00:46:50,310
The patient was wheeled in there and then were put up to seal it.

417
00:46:50,310 --> 00:46:55,070
So the anaesthetist was so we were one side of the break and the latest was the other side.

418
00:46:55,070 --> 00:47:03,150
And the nurses always referred to the drape as a blood brain barrier. And how did you communicate?

419
00:47:03,150 --> 00:47:07,470
You could hear that you had to. And it was it was awful.

420
00:47:07,470 --> 00:47:16,560
You put on a sort of helmet like a space helmet, which had a sort of whether it was there was a visor with a plastic mask on it.

421
00:47:16,560 --> 00:47:22,680
There was a microphone and earphones in it, and there was a long hosepipe, like a large, thick rat's tail.

422
00:47:22,680 --> 00:47:29,480
There was. There was. And through that air was I was attracted to the hosepipe and so of see everywhere else,

423
00:47:29,480 --> 00:47:34,370
but if you were in there, somebody stood on your hands and you start miss, that wouldn't feel funny.

424
00:47:34,370 --> 00:47:37,640
And you couldn't it was often difficult to hear what you were saying because the Hamas

425
00:47:37,640 --> 00:47:43,150
rule one size and people had different sizes and sometimes the effects were about here.

426
00:47:43,150 --> 00:47:48,510
And it was and you can only see like this, it was terribly easy to turn around and bump into something.

427
00:47:48,510 --> 00:47:54,110
If you bumped into the walls, then you have to leave and all get sterile again.

428
00:47:54,110 --> 00:47:56,150
So it was a nightmare that was very uncomfortable.

429
00:47:56,150 --> 00:48:04,250
And in the end, they were abandoned because the evidence for efficacy was, well, they did reduce the infection rate, but not by much.

430
00:48:04,250 --> 00:48:10,130
It was a very low infection rate anyway, and people felt it was so difficult that it would introduce other complications.

431
00:48:10,130 --> 00:48:15,020
But they were there probably, probably for 10 years since they were two of these in the normal conventional sense.

432
00:48:15,020 --> 00:48:19,760
And they were very nice. I thought sounded like you at the hip.

433
00:48:19,760 --> 00:48:24,560
But yes, McKie developed a metal on metal hip replacement in Norwich, I think.

434
00:48:24,560 --> 00:48:31,950
But that did not stand the test of time. And Charlie, he he learnt from the American space programme.

435
00:48:31,950 --> 00:48:39,170
The Teflon was a very non-stick material and and thought that low friction was the key component to joint replacement.

436
00:48:39,170 --> 00:48:47,360
So he put it in three hundred hip replacements with the cup water and the acetabulum cup made from Teflon, and they all failed.

437
00:48:47,360 --> 00:48:51,590
It wasn't hard enough. And then he said, well, what else do we know?

438
00:48:51,590 --> 00:48:57,680
And he hit on high density polyethylene, which which is to his right.

439
00:48:57,680 --> 00:49:04,220
And it was very often in those buildings in those days he did the first experiment was on people then.

440
00:49:04,220 --> 00:49:12,390
Then you're trying to prove the concept in experimental animals. And then finally it was migrated into veterinary practise.

441
00:49:12,390 --> 00:49:20,180
So that's been the sort of rebuilding of NASA.

442
00:49:20,180 --> 00:49:30,770
You thought a great deal of that much, much later. And that started sort of roughly it doesn't matter what happens.

443
00:49:30,770 --> 00:49:36,560
I think we moved into that in something like 2000 and what it's been up about ten years.

444
00:49:36,560 --> 00:49:45,830
Yes. So it's the way who is here funded by. Well, he he he retired.

445
00:49:45,830 --> 00:49:47,340
It's difficult to say really.

446
00:49:47,340 --> 00:50:01,250
Well, he he was followed by me in in terms of the action service because the in 1986 they made a post which I applied for was appointed to,

447
00:50:01,250 --> 00:50:06,710
which was a mixture of heart surgery and trauma and a bit of and some elective heart surgery.

448
00:50:06,710 --> 00:50:13,860
And some of the sessions came because John's father wanted to move into management and move out of trauma.

449
00:50:13,860 --> 00:50:19,670
And so I think four or five sessions. So I really took over his historical practise.

450
00:50:19,670 --> 00:50:27,940
But when he when he retired finally from the NSC, it's hard to say because the number of surgeons expanded so much.

451
00:50:27,940 --> 00:50:34,220
His sessions was subsumed into it, into others. And I think it wasn't a direct successor in that sense.

452
00:50:34,220 --> 00:50:39,290
So all this time, you've been linked with the excellent service. Yes.

453
00:50:39,290 --> 00:50:45,890
So the the I was appointed at 86 and for eight years I ran every Thursday and one weekend in five.

454
00:50:45,890 --> 00:50:56,040
And then in 1990 to probably we appointed Peter Wolak, who had been trained in Nottingham and had different ideas.

455
00:50:56,040 --> 00:51:00,770
The the if you go back to the nineteen 1940s,

456
00:51:00,770 --> 00:51:08,840
there were really two concepts of and it's the Oxford concept really started by James Scott was the orthopaedic surgeon,

457
00:51:08,840 --> 00:51:14,810
was the primary person responsible for the care of the patient and brought in all the specialists as needed.

458
00:51:14,810 --> 00:51:20,650
And that was the actual service concept. The Birmingham Accident Hospital was different there.

459
00:51:20,650 --> 00:51:26,540
The the trauma surgeons did everything they drop and and so on.

460
00:51:26,540 --> 00:51:34,420
But that was not a sustainable model in the long term because the surgery expands and no one person could really be competent in all that skills.

461
00:51:34,420 --> 00:51:39,380
Someone Amador's was better. Let's call the action service.

462
00:51:39,380 --> 00:51:49,820
But and we look, we ran the the department, which is that actually called the action service, because as I'm sure you remember,

463
00:51:49,820 --> 00:51:56,240
most medical missions came with a letter from the GP and went straight to the physicians were never seen by that.

464
00:51:56,240 --> 00:52:03,290
But action service, the only medical cases who were seen by our research shows were people who came off the street with a

465
00:52:03,290 --> 00:52:09,000
medical problem and asked if they didn't need resuscitation and then just directed them to the team,

466
00:52:09,000 --> 00:52:11,930
to the medical team on the surgical team.

467
00:52:11,930 --> 00:52:19,010
So we had five originally five such as a national with three researchers who ran the front door 24 hours a day,

468
00:52:19,010 --> 00:52:23,950
seven days a week partway through and how it was.

469
00:52:23,950 --> 00:52:29,170
It was busy, but less busy than now, but it's certainly busy, but that was almost all true.

470
00:52:29,170 --> 00:52:33,310
But the concept of the department was taking off around the country.

471
00:52:33,310 --> 00:52:39,700
And and I think although we fought it for a while, it wasn't going to be a battle between long win, long term.

472
00:52:39,700 --> 00:52:50,500
So by the early 90s, what plans to bring in 80 staff? And Peter Wallach had ideas for changing the organisation of the action service.

473
00:52:50,500 --> 00:52:55,780
He recruited Keith with a very smart move. And between them,

474
00:52:55,780 --> 00:53:07,300
they they just they they changed in the trauma into a trauma service in which the consultant there was a consultant resident every night.

475
00:53:07,300 --> 00:53:10,420
So there was consultant in the premises 24 hours a day, seven days a week.

476
00:53:10,420 --> 00:53:16,270
And I think they hope that model would take off and be adopted around the country. But it hasn't been it's just a bridge too far for most people.

477
00:53:16,270 --> 00:53:21,700
But they were very, very determined, very, very far sighted and extremely committed.

478
00:53:21,700 --> 00:53:28,690
And I think then the unit for the very ill from the Navy, the Anestis, took that right,

479
00:53:28,690 --> 00:53:38,530
because at one time the anaesthetise were running the sort of the high density nursing centre where very ill people.

480
00:53:38,530 --> 00:53:44,170
And so well, back in the regular family, there was an intensive intensive care units.

481
00:53:44,170 --> 00:53:51,460
It's my certainly my recollection as a husband was there was because there was a tower

482
00:53:51,460 --> 00:53:58,240
block built of the American family that was probably built in the late 60s or 70s,

483
00:53:58,240 --> 00:54:04,750
maybe, um, but it was certainly up. And I was working there as as a surgical house in 1972.

484
00:54:04,750 --> 00:54:09,610
Right. And there were two intensive care units, those neurosurgery intensive care to one side.

485
00:54:09,610 --> 00:54:14,320
And there was a bigger general intensive care unit on the other side. And it was run by the anaesthetist.

486
00:54:14,320 --> 00:54:20,020
I think some of that was developed out of the respiratory illness at the Churchill.

487
00:54:20,020 --> 00:54:24,760
Yes. Which is where their initial experience in ventilating patients came from that unit,

488
00:54:24,760 --> 00:54:29,650
mainly for people with with respiratory failure from neurological causes.

489
00:54:29,650 --> 00:54:33,580
Yes. To cramped space would have been. Yes.

490
00:54:33,580 --> 00:54:38,860
Yes. Um, so so yes, of course. In intensive care, it's broadened.

491
00:54:38,860 --> 00:54:43,960
Now, there are some physicians doing it as well. So it's just then it was really run by scientists.

492
00:54:43,960 --> 00:54:53,770
And because I put that in right from the beginning, I knew you'd be taking some medical patients, not many, but there were always a few on that.

493
00:54:53,770 --> 00:54:57,820
But the nurses were running it. Yes. Yeah, it's very difficult.

494
00:54:57,820 --> 00:55:07,000
And I've been there. That's another story. So what about hand surgeon colleagues really waiting to be joined by other people?

495
00:55:07,000 --> 00:55:14,560
Well, it was just me and I did have had surgery along with General Speaks from eighty four.

496
00:55:14,560 --> 00:55:28,320
Eighty four through to 92. That was eight years. And that and then the two drivers for that allow me to move out of doing general trauma.

497
00:55:28,320 --> 00:55:37,210
And the first was that the that the on call for had surgery was becoming um, there wasn't really any uncle for surgery.

498
00:55:37,210 --> 00:55:41,170
They just call me if they had a case and it was becoming a bit intrusive.

499
00:55:41,170 --> 00:55:45,470
The second was that the plastic surgeons historically had not treated had trauma and

500
00:55:45,470 --> 00:55:49,650
abuse recognition for their training programme unless they the trainees did some.

501
00:55:49,650 --> 00:55:58,900
Um, and then finally, John finally wanted to think all those things came together, really to to to allow me to give up general trauma.

502
00:55:58,900 --> 00:56:06,340
And we decided that with the plastic surgeons, really with Tim Goodacre and David Coleman,

503
00:56:06,340 --> 00:56:12,520
that plastic surgery would take and emergences one week and I think the other week.

504
00:56:12,520 --> 00:56:16,660
So then for another eight years, I had a colleague join.

505
00:56:16,660 --> 00:56:23,170
I wasn't doing a job trauma, but I was on call to heart surgery twenty six weeks a year, which is fine.

506
00:56:23,170 --> 00:56:30,400
But but I'm busy. And that, of course, eventually became unsustainable. By the mid 90s, we had on the electric side,

507
00:56:30,400 --> 00:56:36,010
we had huge making patients wait a year for an outpatient appointment and a further 18 months for an operation.

508
00:56:36,010 --> 00:56:40,360
Just three months. But could we persuade anybody to give us more resources?

509
00:56:40,360 --> 00:56:49,480
Um, and so that led to the appointment of my first Hansadutta colleague, was a plastic surgeon, had Gill,

510
00:56:49,480 --> 00:56:56,350
who'd come from Perth, Australia, as quite a young chap, to be the overseas fellow of the plastic surgeon.

511
00:56:56,350 --> 00:57:00,460
And they immediately recognised he was a person.

512
00:57:00,460 --> 00:57:09,670
He was very bright and he was a very gifted surgeon, um, withinside for planning, technically very gifted, very good at microsurgery.

513
00:57:09,670 --> 00:57:14,680
So they sent him off to be a fellow with the hand surgeons in Paris for nine months.

514
00:57:14,680 --> 00:57:21,340
Um, but we had a really good time and we thought this would be a good person to appoint.

515
00:57:21,340 --> 00:57:31,050
And so he was appointed in 1996. And we ran a trauma clinic together at the John A. and we had a clinic together and

516
00:57:31,050 --> 00:57:34,800
we had a heck of a story on that every Monday morning and it was just wonderful.

517
00:57:34,800 --> 00:57:40,710
I didn't see so much remark as it moved on to bigger things in plastic surgery and so on and on the hospital.

518
00:57:40,710 --> 00:57:47,550
I did differently. But but he was a he was a fantastic colleague.

519
00:57:47,550 --> 00:57:50,940
But and that helped with the waiting list.

520
00:57:50,940 --> 00:57:54,450
But it's always the more we provide resources and more patients come in. We were still struggling.

521
00:57:54,450 --> 00:58:07,620
So in in 2000, we pointed in McNabb, who was trained in London, did a fellowship in Melbourne and shoulder surgery with us also as a as a fellow.

522
00:58:07,620 --> 00:58:12,180
And that was a very, very successful appointment then.

523
00:58:12,180 --> 00:58:15,300
And I have to look at the dates.

524
00:58:15,300 --> 00:58:24,510
But about 10 years ago, we pointed this little one of our trainees did a fellowship in Birmingham to do shoulder and elbow as well as hand.

525
00:58:24,510 --> 00:58:31,650
And then the plastic surgeons also made appointments of potentially at risk, Coxwell and Bramston,

526
00:58:31,650 --> 00:58:35,940
a couple of other people doing who are doing mainly trauma and also some head trauma.

527
00:58:35,940 --> 00:58:44,090
So. So in terms of the whole time equivalents, we probably have between four or five, whereas previously we had one of the people are still busy.

528
00:58:44,090 --> 00:58:48,960
Yeah, you mentioned the ER but I mean did you do the work. Yes.

529
00:58:48,960 --> 00:58:53,550
Until the I.

530
00:58:53,550 --> 00:59:00,450
Yes. I mean it's showed the though the Apelin really including elbow replacement and shoulder replacement

531
00:59:00,450 --> 00:59:04,800
operations because my original elective work that is when something really was up was arthritis,

532
00:59:04,800 --> 00:59:09,660
was really rheumatoid arthritis and also a lot of other joint replacement there.

533
00:59:09,660 --> 00:59:15,390
But another Starwind spotted rising through the ranks was in car.

534
00:59:15,390 --> 00:59:21,470
It was Joe in our hospital and he was appointed as a consultant to do many children.

535
00:59:21,470 --> 00:59:25,770
Now, I think in 1992, and as soon as I have not passed all the children held to him.

536
00:59:25,770 --> 00:59:30,690
Where did he come from? He was a Bristol trainee originally.

537
00:59:30,690 --> 00:59:36,200
I think he had had a I think he had applied to Oxford anyway.

538
00:59:36,200 --> 00:59:47,440
He was a Bristol trainee and a man of great determination and enthusiasm and and foresight.

539
00:59:47,440 --> 00:59:52,300
So he took over the show. I still did some observations about 1996 and then.

540
00:59:52,300 --> 00:59:56,850
And then. And then stop. I'd never really been trained as a self taught children organisation.

541
00:59:56,850 --> 01:00:00,780
So and that's never been more been properly taught to do the heart surgery.

542
01:00:00,780 --> 01:00:13,960
And, um, but but I still did pretty complex surgery, which I did well until I stopped doing drugs, just which was 2009.

543
01:00:13,960 --> 01:00:20,520
And those were often all their cases. And and I had great fun really.

544
01:00:20,520 --> 01:00:25,680
Um, the rewards were slow and you had to wait and see any sign of recovery.

545
01:00:25,680 --> 01:00:32,400
So it was all there was no instant gratification in that work. And you never got into what you could do that was limited.

546
01:00:32,400 --> 01:00:41,460
It was useful. It was limited. Um, was there a lot of the euro area neuralgic pain?

547
01:00:41,460 --> 01:00:45,090
Sure. Yes. When they every three months. It's a terrible problem.

548
01:00:45,090 --> 01:00:51,240
Yeah. And it takes about three years just to reach its final stages and still be problematic.

549
01:00:51,240 --> 01:00:58,470
And that was actually the best thing you can do to help that is to try and try and reach out and reanimate someone and give us something to do.

550
01:00:58,470 --> 01:01:03,240
Seems to reduce the pain now with the knee. You know, I always think of endoscopy.

551
01:01:03,240 --> 01:01:06,240
Is there any endoscope in the upper limb? Oh, yes.

552
01:01:06,240 --> 01:01:16,500
I mean, in the in the shoulder, um, lots of work is done, arthroscopic, as we call it, um, because as has been found elsewhere,

553
01:01:16,500 --> 01:01:23,040
the the rehabilitation is easier and it's used to a more limited extent than the other,

554
01:01:23,040 --> 01:01:30,090
but it's widely used on the shoulder for both diagnostic and therapeutically, and it is used in the wrist.

555
01:01:30,090 --> 01:01:41,070
I've done I've done some at that. The the treatable pathology you can do with the rest is more limited than it is in the knee or in the shoulder.

556
01:01:41,070 --> 01:01:47,880
But you can train bits of the triangle pharmacologists to the police and some surgeons used it a lot for diagnostic purposes.

557
01:01:47,880 --> 01:01:53,760
We always had very good imaging in Oxford and I was I tended to rely on that on the CT and

558
01:01:53,760 --> 01:01:59,900
the MRI scans or arteriography rather than consume scarce operating time for arthroscopy.

559
01:01:59,900 --> 01:02:04,950
And it's not a completely complication free procedure. I mean, you mentioned the X-rays there.

560
01:02:04,950 --> 01:02:10,230
All the other people who, you know, you interact with pathologists, you have pathology.

561
01:02:10,230 --> 01:02:13,710
Er you know, you need specimens. Yes.

562
01:02:13,710 --> 01:02:19,050
I mean, of course, all of the all of the lungs we remove, there's not much cancer and had surgery.

563
01:02:19,050 --> 01:02:23,720
But for the balance. Well as we get histology we usually send the disease.

564
01:02:23,720 --> 01:02:31,130
Theology, I'm not quite sure why they seemed happy to receive it, and there were bits of research done on the back of that,

565
01:02:31,130 --> 01:02:39,800
um, but the the pathologist's main role was in what I could think elsewhere and was predicting with with brain tumours.

566
01:02:39,800 --> 01:02:43,500
And, of course, that some aspect of the work of the NSA has expanded hugely.

567
01:02:43,500 --> 01:02:49,490
And just by being Michael Beck, similar to surgeons who did most of it in the early days.

568
01:02:49,490 --> 01:02:56,630
But but then Oxford became the centre of the brain tumours, also centre for sarcomas.

569
01:02:56,630 --> 01:03:02,420
I need to ask them where they get all their files from now.

570
01:03:02,420 --> 01:03:08,630
But I believe for a while we've been dealing with all the kind of referrals and a bunch of referrals from the Southwest.

571
01:03:08,630 --> 01:03:16,400
So that's a big service. We have two, two and a half full time orthopaedic tumour surgeons.

572
01:03:16,400 --> 01:03:21,770
And of course, the imaging is very important for the diagnosis and assessment of tumours and the pathology is crucial.

573
01:03:21,770 --> 01:03:33,110
So there's some MDT meeting every Monday morning with all these cases have gone through MDT sorry, multidisciplinary team.

574
01:03:33,110 --> 01:03:37,040
And is there anything wrong with death is waiting?

575
01:03:37,040 --> 01:03:49,310
No, they they they folded because of the specialisation in orthopaedics and they were they were good at the time when when everybody could comment,

576
01:03:49,310 --> 01:03:51,200
all the consultants could give a view. In fact,

577
01:03:51,200 --> 01:03:55,460
if you looked through the notes of some of the other patients that the patient would be admitted there'd be

578
01:03:55,460 --> 01:04:02,810
a typed preoperative assessment and then it would be a take note of the presentation at the conference,

579
01:04:02,810 --> 01:04:05,240
including the opinion that Mr Taylor said this.

580
01:04:05,240 --> 01:04:12,890
Mr Scott said that then the operation that you talked and read and then did post on this would be tucked in.

581
01:04:12,890 --> 01:04:17,420
The records are very good. So those meetings were done. They were recorded in.

582
01:04:17,420 --> 01:04:22,290
Yeah, I think this is before I but I was there, I went back to the 1960s.

583
01:04:22,290 --> 01:04:29,630
Somebody was there taking notes about what the opinions were. But of course, when I had surgery, I showed said in spinal surgery,

584
01:04:29,630 --> 01:04:33,970
he got to the point where we weren't really able to make a public comments

585
01:04:33,970 --> 01:04:39,980
and we went to have very constructive comments about management of patients.

586
01:04:39,980 --> 01:04:49,250
And so it rolled into meetings and the individual teams. And I I think some of us bemoan the loss of those meetings.

587
01:04:49,250 --> 01:04:56,720
But but it wasn't a viable option in the long term. So anaesthetists interact with a lot and they could do for them.

588
01:04:56,720 --> 01:04:58,970
No, not much. Good, great.

589
01:04:58,970 --> 01:05:10,430
No, I think I've I've I've worked with some great colleagues and the Nuffield I was very fortunate as a consultant from 84 through to 1984 to 2013,

590
01:05:10,430 --> 01:05:15,590
almost 30 years to work with just two anaesthetists from all day less lovely.

591
01:05:15,590 --> 01:05:25,760
The first was Gordon Parks is someone who was great, had a wonderful sense of humour, and I'd like to play classical music occasionally on the radio.

592
01:05:25,760 --> 01:05:31,220
The the soprano would be singing and Gordon would lean over and the patient was usually awake.

593
01:05:31,220 --> 01:05:41,390
So hasn't that nurse got a lovely voice? He was one of, um.

594
01:05:41,390 --> 01:05:44,810
And then when he retired, he was followed by Graham Byrd, who'd been a student,

595
01:05:44,810 --> 01:05:50,930
I think maybe six months ahead or behind and in the medical school here,

596
01:05:50,930 --> 01:06:01,390
keen cricketer and golfer who had done some anaesthesia and then worked for a while in the medical attention in London.

597
01:06:01,390 --> 01:06:07,220
And I think at the time when when crime indemnity took over all that work in the NHS, was it?

598
01:06:07,220 --> 01:06:11,210
And then he moved back and finish his anaesthetic training. And he was,

599
01:06:11,210 --> 01:06:22,670
uh and he was one of these blokes would always work and they will one patient out of the operating room as soon as we are going out the door.

600
01:06:22,670 --> 01:06:26,270
So he will the next one. Because while I've been working, he had been with the patient.

601
01:06:26,270 --> 01:06:30,590
The nurse would be the patient. When I'm working, he's in the anaesthetic room making the next patients all.

602
01:06:30,590 --> 01:06:33,230
No. So it was a very efficient system.

603
01:06:33,230 --> 01:06:46,640
And almost all all the faces were awake with the little sedation is and on the way in the coffee room at teatime on my last list,

604
01:06:46,640 --> 01:06:58,640
he presented me with a bottle of Australian wine on the wine was called the dead arm, which I then say, and they go back home.

605
01:06:58,640 --> 01:07:09,260
It's the Germans, they're going to go by the chemist. We probably did ask for their help in managing seriously ill patients, doing trauma.

606
01:07:09,260 --> 01:07:14,660
And I think a lot of that was probably when I was consultative and it was probably done about it by the junior staff.

607
01:07:14,660 --> 01:07:21,350
And in an enhanced entry, I mean, we we did not do blood you because we were dealing with the patients.

608
01:07:21,350 --> 01:07:25,000
Yeah. And so, um.

609
01:07:25,000 --> 01:07:34,810
Sorry, so I was just going to say one of the thing about anaesthesia, the the, uh and the other variety of and it's this the first it is the majority,

610
01:07:34,810 --> 01:07:41,710
but the one I work with most was I have a doctor, um, who and we had a nice Ourisman with a fine sense of humour.

611
01:07:41,710 --> 01:07:48,460
And we and we just had a great time. Well, there are some some surgeons say that finding this this difficult,

612
01:07:48,460 --> 01:07:56,200
it's probably because the surgeons are difficult and that now we have very good anaesthetise in Oxford and Annegret,

613
01:07:56,200 --> 01:08:00,460
great professional colleagues and bacteriology. Do you have much?

614
01:08:00,460 --> 01:08:07,330
Yes, we do. We do send specimens off. But but again, the the um.

615
01:08:07,330 --> 01:08:09,610
Well, I guess there are two there are two scenarios.

616
01:08:09,610 --> 01:08:15,100
One is when you have a fairly straightforward infection, you need to know what it is and when we can deal with it.

617
01:08:15,100 --> 01:08:22,270
The other is the more complicated problem. Maybe this wound or this infection is not responded to this kind of therapy.

618
01:08:22,270 --> 01:08:26,170
Then the advice of the other microbiologists is crucial.

619
01:08:26,170 --> 01:08:31,690
And that's becoming more so because although people say we don't have any new new antibiotics,

620
01:08:31,690 --> 01:08:42,640
actually there are quite a number of new ones that that and not the ones that we learnt that not to use it as medical students.

621
01:08:42,640 --> 01:08:52,030
And their advice has been invaluable. And of course, at the NSC, we have this this large bone infection unit run by an infectious disease physicians,

622
01:08:52,030 --> 01:08:57,260
but with input from the from the microbiologists. So with any sort of complicated infection.

623
01:08:57,260 --> 01:08:57,850
Well,

624
01:08:57,850 --> 01:09:05,260
usually the patient's managed in their unit and they run the medical care of the patient or all the microbiology and the surgeon does a surgical bed.

625
01:09:05,260 --> 01:09:19,270
So that's compared to that was started by Taliban, which is the Taliban of either Baron, um, um, BrisConnections or others.

626
01:09:19,270 --> 01:09:23,770
I should know the names and I'm a bit rusty. Haven't been out of it for a couple of years.

627
01:09:23,770 --> 01:09:28,330
And sure. Now, you mentioned Roger Smith.

628
01:09:28,330 --> 01:09:32,470
Was he researching always or was he clinically involved?

629
01:09:32,470 --> 01:09:40,210
Know both. Yes. Yes. He ran, uh, clinics, um, for metabolic disease.

630
01:09:40,210 --> 01:09:49,750
And he was interested in in skeletal dysplasia and knew a lot about those, um,

631
01:09:49,750 --> 01:09:59,140
various sorts of dwarfism and what he was used to for the diastrophic dwarfism he was used to refer to as catastrophic deficiencies, probably.

632
01:09:59,140 --> 01:10:09,370
Uh, and he had he also had a fine sense of humour. His mode of answering the telephone was to pick it up and say me.

633
01:10:09,370 --> 01:10:15,670
And he used to refer to the Journal of Surgery as the Pig Farmers Weekly News, always trying to disparage it was being searched.

634
01:10:15,670 --> 01:10:20,780
And he said that he was very he was very good in conferences.

635
01:10:20,780 --> 01:10:24,880
He was a great opinion. And I seen him in the hospital quite recently.

636
01:10:24,880 --> 01:10:29,770
So getting into to it them, I think he's still writing. He is a prolific writer.

637
01:10:29,770 --> 01:10:33,850
Yes. And he is at the botnet. Yeah. Yeah.

638
01:10:33,850 --> 01:10:40,600
And so, I mean, all the work on Polly Phospholipids, Bisphosphonate disposable.

639
01:10:40,600 --> 01:10:48,850
Yes. Yes, I was he he he worked with the there was a metamorphic my research unit run but run by gentrifies.

640
01:10:48,850 --> 01:11:01,480
Right. And before that by Moreno there was MRC Funding Research Unit um which is which I think ran, ran for many years.

641
01:11:01,480 --> 01:11:11,290
I think that's now been subsumed into the botnet and it was generating animosity and and because he lives in our village.

642
01:11:11,290 --> 01:11:14,950
Cadeaux, you had to ask him about that. Yeah. Yeah.

643
01:11:14,950 --> 01:11:22,990
He'd be able to tell you a lot about it because he was there for a long time. And what did they discover, Goshi?

644
01:11:22,990 --> 01:11:31,990
And I know that I said that, but the work that was work on bisphosphonates, there was quite a bit of work going on.

645
01:11:31,990 --> 01:11:36,760
Well, there was certainly work oncology, um, osteogenesis imperfecta.

646
01:11:36,760 --> 01:11:40,310
And, um, is a Roger Smith was into that.

647
01:11:40,310 --> 01:11:44,310
Yes. Um, what other university research, as it were.

648
01:11:44,310 --> 01:11:50,920
I was going on in the industry, but from the botany with the bailout or not.

649
01:11:50,920 --> 01:11:57,040
Because you were saying yes. You said yeah. So um the the there was a biochemist, Martin Francis.

650
01:11:57,040 --> 01:12:02,180
Yes. It was really he wasn't clinical. He he he just did research.

651
01:12:02,180 --> 01:12:09,130
He was active. He was very active sort of through the 70s, 80s, probably into the early nineties.

652
01:12:09,130 --> 01:12:18,640
Um, we had an animal house on the back of the sea with to the technicians who ran it.

653
01:12:18,640 --> 01:12:23,850
So the um experiments with all rats on small animals, rats, rabbits, licence.

654
01:12:23,850 --> 01:12:27,550
So when he said the back would be near where the Boatner is or.

655
01:12:27,550 --> 01:12:32,000
Yes, yes, pretty much where the ball is, the left hand side of the bottom.

656
01:12:32,000 --> 01:12:35,100
And it just didn't just in front of the swimming pool.

657
01:12:35,100 --> 01:12:45,290
Now, Big Bear behind the swimming pool in the tennis courts, which also we lost and there was a large pool and also some of the three tennis courts,

658
01:12:45,290 --> 01:12:50,270
hardcourts that they gradually turned to grass courts couldn't maintain.

659
01:12:50,270 --> 01:12:53,940
But in the end, it was decided that wasn't fruitfulness of the nature of space.

660
01:12:53,940 --> 01:12:58,210
They were they were demolished. In the end.

661
01:12:58,210 --> 01:13:05,690
I was talking about the basic science lectures in literature in the summertime that was replaced by an anatomy

662
01:13:05,690 --> 01:13:12,500
session so that the one of the rooms in the Animal House was approved by the Home Office for dissection.

663
01:13:12,500 --> 01:13:22,790
So in in April, the cadaver would arrive fully, present a cadaver, and for eight weeks it would be dissected and then presented.

664
01:13:22,790 --> 01:13:28,100
So during the week, two residents would dissect the body part, the head, for example.

665
01:13:28,100 --> 01:13:32,270
And then on the Friday evening and again on a Saturday morning,

666
01:13:32,270 --> 01:13:41,240
one of the consultants would supervise the presentation of the anatomy and would grill the assembled company of trainees on the surgical approaches.

667
01:13:41,240 --> 01:13:46,670
That was another. At least we knew then which bit of the body, but it was not open at all.

668
01:13:46,670 --> 01:13:54,350
And it was very instructive, particularly for the people who were dissecting it was it was I don't see where it was wrong with this idea.

669
01:13:54,350 --> 01:13:57,950
I don't know whether it's a concept he brought in the USA, but it was very good.

670
01:13:57,950 --> 01:14:01,130
But unfortunately. Well, I think with the Animal House closed, of course,

671
01:14:01,130 --> 01:14:09,170
it folded and therefore a little bit before that because of changes in the Home Office rules and so on microvascular surgery,

672
01:14:09,170 --> 01:14:14,840
was that getting more and more makram and that changed in the diameter of this?

673
01:14:14,840 --> 01:14:24,530
What you can do now, I think from the the so that the human digital artery, the best thing is about one point two millimetres, external diameter,

674
01:14:24,530 --> 01:14:31,670
the right femoral artery, which is the standard model for experiments and practise, is about a millimetre or slightly less than that.

675
01:14:31,670 --> 01:14:42,740
And the it was really the development of operating microscopes and the and very fine needles and thread that allow the repair of the structures.

676
01:14:42,740 --> 01:14:49,070
So you from the late 60s, early 70s onwards, repair of those structures was possible.

677
01:14:49,070 --> 01:14:56,240
If you can smaller vessels can be repaired to make sure there isn't a huge need for that.

678
01:14:56,240 --> 01:15:04,800
In fact, most of the most of the very small vessel work is actually done in for the digital vessels in the hand of the free fat surgeon.

679
01:15:04,800 --> 01:15:13,040
That's used a lot of plastic surgeons nowadays, generally based on larger vessels, which isn't in Manhattan.

680
01:15:13,040 --> 01:15:18,830
And and small vessels are really pretty hard to repair. And you need very fine sutures.

681
01:15:18,830 --> 01:15:29,240
The the the tenno not, for example, suture diameter, 22 microns, that's a big one.

682
01:15:29,240 --> 01:15:33,930
Now, the needle, 75 microns, the CO2 is 22 microns, that seven red cells.

683
01:15:33,930 --> 01:15:41,120
So that's three red cells standing shoulder to shoulder. And and it it breaks easily.

684
01:15:41,120 --> 01:15:49,910
If you pull on, it'll break before you feel any tension in it. It's all it's already a battle against unwanted movement keeping the Haynesville.

685
01:15:49,910 --> 01:15:54,380
That's really the limiting factor you can see pretty well. But it's the battle against a mountain.

686
01:15:54,380 --> 01:15:57,890
And you do that by Plasto. How do you know what?

687
01:15:57,890 --> 01:16:04,700
It's just in preparation is everything. You need to be comfortable and you need to have your elbows and your hands right.

688
01:16:04,700 --> 01:16:08,440
Supported like this. If you're working like that, more shakes at all.

689
01:16:08,440 --> 01:16:17,120
It's a small muscle actually in the hand. And then the NSA came out of the trust and rejoined.

690
01:16:17,120 --> 01:16:24,620
Is that right? We're doing the sort of well, the the the the NSA with its own trust for quite a long time.

691
01:16:24,620 --> 01:16:27,890
And then the Oxford Radcliffe Hospital is the other trust.

692
01:16:27,890 --> 01:16:38,510
And and then the the NSA, what we did for the NSA as a separate trust was it's building, um,

693
01:16:38,510 --> 01:16:44,240
the original plan for the building was for twenty four point nine million on the

694
01:16:44,240 --> 01:16:48,980
basis that if it's twenty five and it has to go to the Treasury for approval. So they're staying there 24 hours.

695
01:16:48,980 --> 01:16:52,520
And so the story goes mean.

696
01:16:52,520 --> 01:17:00,200
It costs more than that in the UK and it had to go to PFI, which meant we were saddled with this big mortgage.

697
01:17:00,200 --> 01:17:08,990
It wouldn't have been a huge sum to find in those days. And if they'd done it and we had no mortgage, the hospital would have been viable.

698
01:17:08,990 --> 01:17:15,890
But then, of course, there are economies of scale and the tariff for speed is quite challenging.

699
01:17:15,890 --> 01:17:21,680
And so, um, it eventually I guess this is by well, I'm not sure when the merger happened.

700
01:17:21,680 --> 01:17:33,260
I was about five years ago, isn't it. The bodies that the powers that be decided that the NSC was not viable in the long term as a standalone trust,

701
01:17:33,260 --> 01:17:38,670
and it was all I understand, all because of the mortgage payments we to make the PFI company.

702
01:17:38,670 --> 01:17:45,620
Yeah. And that was why we had to take away all the hospitals and all.

703
01:17:45,620 --> 01:17:56,300
But but it's it's to me, it was disappointing what we have lost control.

704
01:17:56,300 --> 01:18:03,680
And I think without getting into into it probably wouldn't be appropriate to go into detail for the record.

705
01:18:03,680 --> 01:18:12,590
But I think I think the hospital has suffered, by which I mean patient care suffered because it is the only thing that really matters.

706
01:18:12,590 --> 01:18:20,300
Well, the two things matter, the parent patient kind of teaching, and it's had a detrimental effect on both.

707
01:18:20,300 --> 01:18:22,820
Do you think? What does the patient care?

708
01:18:22,820 --> 01:18:29,960
I think patient care is teaching because the the the management never really had much of an impact on them, not on the teaching.

709
01:18:29,960 --> 01:18:38,900
We that um but if the the need to have some of our, um,

710
01:18:38,900 --> 01:18:46,370
services managed from from afar has not been constructive or advantageous to get clinical students,

711
01:18:46,370 --> 01:18:51,770
how long do they come from during the they they they still come for two months.

712
01:18:51,770 --> 01:18:58,520
But they're also doing um general practise, um actually emergency.

713
01:18:58,520 --> 01:19:02,190
So the exposure is less. I think that's I think that's fine.

714
01:19:02,190 --> 01:19:11,240
I mean, you know, the students, the the the contribution of different fields to student education has changed not as much as anatomy.

715
01:19:11,240 --> 01:19:14,510
And that's appropriate because there's so much else to learn.

716
01:19:14,510 --> 01:19:20,240
And details are actually you can learn as a surgeon, you don't need to know as a medical student.

717
01:19:20,240 --> 01:19:28,280
And so they can for two months that they aren't attached to firms quite as much as they used to be,

718
01:19:28,280 --> 01:19:33,890
which means that they don't get a chance in a formal relationship with a group of doctors and so on.

719
01:19:33,890 --> 01:19:39,680
But I I guess when they get that in in medicine or surgery in years three and six,

720
01:19:39,680 --> 01:19:44,900
that they do come to clinics that were usually a couple of students in my group on Monday morning.

721
01:19:44,900 --> 01:19:51,860
I sometimes have them in the trauma clinic on a Friday afternoon, and they were the ones where the interest would come to the operating theatre.

722
01:19:51,860 --> 01:20:01,250
But it was, um, I think generally felt that they didn't they needed to see a few operations, but they didn't need to see the whole range of surgery.

723
01:20:01,250 --> 01:20:06,080
But they were fun to have in the in the clinic because you can find a suitable patient.

724
01:20:06,080 --> 01:20:11,000
I said new patient and get the student to examine them and take a history exam.

725
01:20:11,000 --> 01:20:12,120
Was that the case?

726
01:20:12,120 --> 01:20:22,250
Um, uh, um, uh, patients in the waiting room, patients felt something was was being done in the students and the management, the right.

727
01:20:22,250 --> 01:20:25,640
And, um, I don't want to look after them.

728
01:20:25,640 --> 01:20:34,010
Now you're dealing with National International Societies committees, but, uh, yes, I'm principally in British society for surgeons.

729
01:20:34,010 --> 01:20:42,920
I have, uh, I guess I probably joined I was elected to the council probably in about nineteen ninety three years on the council first.

730
01:20:42,920 --> 01:20:54,530
Then I was the only secretary from ninety five to seven. Was that however, um it is not an S.A.C. recognised speciality so but it's quite a big,

731
01:20:54,530 --> 01:20:58,700
it's bigger than some uh some of it's bigger than actually cosmetics for example.

732
01:20:58,700 --> 01:21:07,130
We currently have about three hundred and twenty four members and about 600 association and um

733
01:21:07,130 --> 01:21:13,310
it shares offices with offices in the Secretariat of the Plastic Surgery Society in London.

734
01:21:13,310 --> 01:21:20,660
It's basically the College of Surgeons on the fourth floor. We have um so I was undersecretary for 1947.

735
01:21:20,660 --> 01:21:28,250
There are a couple of years off then I guess in 97 we a group of us began to organise,

736
01:21:28,250 --> 01:21:34,070
um, an instructional course which ran over two days in February and two days in June,

737
01:21:34,070 --> 01:21:39,050
um, based on three year cycles, cover the whole field of heart surgery run in Manchester.

738
01:21:39,050 --> 01:21:43,980
So I was involved in the organisation of that and only only on the organising committee for that for three years.

739
01:21:43,980 --> 01:21:47,540
And I remember being the being the chairman of that for three years.

740
01:21:47,540 --> 01:21:53,270
That was great fun, because if I could just like or help choose programme not to use the speakers.

741
01:21:53,270 --> 01:22:00,950
And so we typically have two or three speakers from our conference and then on the speakers from the UK and on something like 200 people,

742
01:22:00,950 --> 01:22:12,980
some of whom came from Central Europe to learn. And, um, and then that took me up to 2000 and 2004.

743
01:22:12,980 --> 01:22:23,320
Then, uh, and maybe in 2003, I was grabbed by the elbow and said that the intel that the society was running the.

744
01:22:23,320 --> 01:22:30,390
National running the European Hasadi Congress in Glasgow in 2006, and they'd like me to organise it,

745
01:22:30,390 --> 01:22:35,480
and it was always organised by the presence of the president in 2006 and have

746
01:22:35,480 --> 01:22:40,900
there on this Congress for some 700 people in Glasgow in the in the same year.

747
01:22:40,900 --> 01:22:43,510
That was huge fun because, again, I could you know,

748
01:22:43,510 --> 01:22:49,700
I could get to choose we had some papers with that symposia and the structural things and was like get to choose the speakers.

749
01:22:49,700 --> 01:22:56,020
And, uh, so that was a nice. But was it difficult to do it being investigated?

750
01:22:56,020 --> 01:23:02,850
No, we flew up a few times to do it. And we we have a very good secretariat with its leader.

751
01:23:02,850 --> 01:23:07,960
And Hal Roberts is hugely experienced in organising meetings and knows all the records and so on.

752
01:23:07,960 --> 01:23:13,460
I learnt a lot about that. So it's 2006. Of course, you're on the council for a year before and the year afterwards.

753
01:23:13,460 --> 01:23:21,220
And then about 2000 six, we realised that the society had a rather primitive website.

754
01:23:21,220 --> 01:23:24,860
So I was elected to be the webmaster and we went out to a company.

755
01:23:24,860 --> 01:23:29,860
We made much better a good on that sort of thing. I quite enjoyed that.

756
01:23:29,860 --> 01:23:33,550
And I said, You have to know much about the website.

757
01:23:33,550 --> 01:23:37,470
No, no, no, no. That was all done with the technical people. It's all a question of design.

758
01:23:37,470 --> 01:23:42,140
And we chose a company, um, who, uh, who were going to design that.

759
01:23:42,140 --> 01:23:47,230
They wrote songs for the NHS, but also from the hospital they design and they're very clear writing,

760
01:23:47,230 --> 01:23:51,620
which is also important for anybody to put a computer. But it was the content that was important.

761
01:23:51,620 --> 01:23:56,650
Um, so I ran that for a while. And then when I stopped doing that, um, I've been there, I mean,

762
01:23:56,650 --> 01:24:03,280
coming to the end of my third or fourth year as the honorary archivist, which is also a great on societies council.

763
01:24:03,280 --> 01:24:11,710
And I was move off at the end of December. Quite I mean, it's been associated on pretty much on the council all the time for twenty years.

764
01:24:11,710 --> 01:24:21,110
And then you were writing articles, editing journals. And I was one of the editors for the the um.

765
01:24:21,110 --> 01:24:24,910
So we have to have well there are two main angles this gentleman had.

766
01:24:24,910 --> 01:24:29,180
There's an American Morning published by Elsevier and there's the what used to be the British

767
01:24:29,180 --> 01:24:36,610
volume published now by Sage and the in about the but other Hansard Hansard has done.

768
01:24:36,610 --> 01:24:41,520
Other European countries always been keen for our British channel to be the European Year.

769
01:24:41,520 --> 01:24:48,340
Um, and I think they'd like to take it over. We would let it because we own it, um, but we want it to be more European.

770
01:24:48,340 --> 01:24:52,360
So the decision was made a typical committee decision in the early nineties.

771
01:24:52,360 --> 01:24:59,230
And instead of being called General Panzeri British, we be British, British and European and British.

772
01:24:59,230 --> 01:25:04,030
We will not forget that it was a tough decision.

773
01:25:04,030 --> 01:25:08,650
But finally, we agreed. We bit the bullet and agreed to call it the European body that we still edit.

774
01:25:08,650 --> 01:25:15,970
And so I said we get the income from it and we still control it. So I was used to it used to be edited by one person, which is a nightmare.

775
01:25:15,970 --> 01:25:21,550
Um, we used to think about it now and then it was changed to a managing editor and three editors.

776
01:25:21,550 --> 01:25:29,620
I was one of those for three years. I still review for that journal and for the um, I was an assistant editor for the American Journal for time.

777
01:25:29,620 --> 01:25:37,060
The story of the papers for Major. Um, as far as the American society is concerned, I sat on the International Committee for a short time,

778
01:25:37,060 --> 01:25:40,480
but I've been a member of that society for a long time.

779
01:25:40,480 --> 01:25:47,200
And it's a it's a very it's a very good society and it's a big society, lots of smart people.

780
01:25:47,200 --> 01:25:52,270
And it does it does a great job in education. And have you written articles?

781
01:25:52,270 --> 01:25:56,410
Yes, mostly technical, mostly technical research.

782
01:25:56,410 --> 01:26:01,780
What would that be? Would it be developing a new operation or a new volume?

783
01:26:01,780 --> 01:26:08,740
Yes, some of it's been some of it has been technical. Some of it's been biomechanical to do with tendon repair.

784
01:26:08,740 --> 01:26:13,750
Um, I've had an interest in the effect of smoking on some of the things we do in the hand.

785
01:26:13,750 --> 01:26:26,680
And probably the the paper I've, um, thought was the best was one was a big case control study for smoking and disease with with help from Rory Milne,

786
01:26:26,680 --> 01:26:30,850
who was a senior editor at the time in the department about investing. Right.

787
01:26:30,850 --> 01:26:38,230
So we had a lot of expert epidemiological advice and we and we took 220 patients maximum with 220 controls,

788
01:26:38,230 --> 01:26:48,880
people having 220 patients do the 220 controls, having a little bit of operations and sending questionnaires about smoking and drinking.

789
01:26:48,880 --> 01:26:53,260
And then to be sure that then we had to have community control as well.

790
01:26:53,260 --> 01:27:01,960
So we took fifty of our patients. The maximum was four controls in the same general practise controlled for socioeconomic status.

791
01:27:01,960 --> 01:27:10,870
And both the study showed that smoking was a strong risk factor, at least for having an operation to do release.

792
01:27:10,870 --> 01:27:15,880
We chose people having surgery because they more severely affected. They thought any effect of smoking might be more of this.

793
01:27:15,880 --> 01:27:23,460
So that was that was that was quite a lot of work, was a solid finding has been confirmed by by others that, um.

794
01:27:23,460 --> 01:27:27,270
And I tried writing, I so enjoyed reading it,

795
01:27:27,270 --> 01:27:34,980
then we did a similar thing for non-union of the scaphoid scheme for non-union is quite a big problem, is difficult to get the bone to heal.

796
01:27:34,980 --> 01:27:41,760
And again, we showed that smoking was a very strong risk factor for failure operations to that.

797
01:27:41,760 --> 01:27:43,990
That was that wasn't the case control study.

798
01:27:43,990 --> 01:27:53,040
That was just looking at the the the key rates in smokers and non-smokers in about 80 cases to be treated in Oxford.

799
01:27:53,040 --> 01:27:59,730
Do you get a lot of long term, you know, 30, 40 years české for travel for people who practise it?

800
01:27:59,730 --> 01:28:06,350
Oh, yeah. What is that? Well, the risk doesn't the risk moves the wrong way and becomes arthritic.

801
01:28:06,350 --> 01:28:10,450
Um, but but it's surprising how often you see somebody with something else.

802
01:28:10,450 --> 01:28:13,530
You take an X-ray or they just fall and they have another injury and you take

803
01:28:13,530 --> 01:28:19,320
an X-ray and and there's a problem that they've been coping with for years.

804
01:28:19,320 --> 01:28:26,160
Can you do anything about what you can do? Yeah, yes. But quite often the treatment is worse than the pain.

805
01:28:26,160 --> 01:28:30,420
That's a minor injury if you leave it for a while and they just get better.

806
01:28:30,420 --> 01:28:39,480
So you can often when you when you explain it, because Stephanie Risk involved this in the arm, the patient will say, well, thanks, but no thanks.

807
01:28:39,480 --> 01:28:44,790
Why did you decide to do your clinical enoxaparin? You're kind of.

808
01:28:44,790 --> 01:28:57,130
Yes, I had a place at Thomas's, um, but after two years, um, I, I loved Oxford, the family home.

809
01:28:57,130 --> 01:28:59,400
We just moved from Wimbledon to start terms.

810
01:28:59,400 --> 01:29:05,430
I could see myself living at home, taking the train up to London every day and to anoxia seemed like a much nicer prospect.

811
01:29:05,430 --> 01:29:15,540
So where did you live? In flats or in in Oxford as well.

812
01:29:15,540 --> 01:29:20,380
How live one year in college, two years and digs down the bottom of the road on the right line.

813
01:29:20,380 --> 01:29:30,450
And then at my student friend of mine and his family bought a house in Kingston Road one hundred and fourteen Kingston Road named Dresden Villas.

814
01:29:30,450 --> 01:29:34,210
I went past it the other day. Uh, they bought in five thousand pounds.

815
01:29:34,210 --> 01:29:39,660
It's the basement and ground floor and two floors above semi-detached pretty.

816
01:29:39,660 --> 01:29:46,230
And six of us have lived there for three years. And I hate to think what it's worth now.

817
01:29:46,230 --> 01:29:51,120
What did you think of your clinical claim? Very good.

818
01:29:51,120 --> 01:30:00,060
Very good. And so the we started off, of course, learning medicine in the West Lecture Theatre with Jim Holt,

819
01:30:00,060 --> 01:30:09,060
who had the whole hold of medicine written down on a very long road of acetate and every every morning just wheeled on the carpet.

820
01:30:09,060 --> 01:30:16,590
And he was brilliant. And also he ran the revision course where it all really clicked and fitted together.

821
01:30:16,590 --> 01:30:27,240
Um, my my first marathon was the Regis professor of medicine, George Pickering, with his first assistant, Larry Bailey.

822
01:30:27,240 --> 01:30:35,670
You remember, it was in fact, I think Sir George retires towards the end of my attachment to the firm.

823
01:30:35,670 --> 01:30:44,550
And it was going to be a retirement wardrobe on which two or three of the students or the clerks, as we like to call them, would present cases.

824
01:30:44,550 --> 01:30:48,960
Um, and I forget which which medical condition is it when the breath smells of fish?

825
01:30:48,960 --> 01:30:54,330
Anyway, I said it presented because the world is full of all of the professors, physicians,

826
01:30:54,330 --> 01:30:59,280
us on the continent presenting this case and said that the breast milk, the fish, the Pickering.

827
01:30:59,280 --> 01:31:03,360
Let me go on for a bit. And then he asked me on which day of the week it will examine the patient.

828
01:31:03,360 --> 01:31:13,380
And I had to confess it was a Friday. So I had was George and Pennbrook when you were in bed?

829
01:31:13,380 --> 01:31:22,530
It was after he retired as Professor Days. And then then he moved to, um, I'm not quite sure about that maybe beforehand,

830
01:31:22,530 --> 01:31:32,320
because I know when I got started in the pharmacology exam before last night for the city's history of 400,

831
01:31:32,320 --> 01:31:41,460
um, and then the surgical pharmacist was a team till I knew have to tell him who was it who was who was great nurses hospital later on.

832
01:31:41,460 --> 01:31:45,570
Yes. Did you have anything to do with Geoffrey Arthur in Penbrook?

833
01:31:45,570 --> 01:31:49,860
Was he that he followed you, which may have been after your time?

834
01:31:49,860 --> 01:31:55,410
After my time Master was Robert McCallum when I was a strange historian.

835
01:31:55,410 --> 01:32:06,910
Um, so I know my my contacts with Pembroke became less even moving to us for House to be included in all of the activities of the house.

836
01:32:06,910 --> 01:32:15,930
We didn't go back to college is different these days because many of the time students have a much stronger attachment to the original college course.

837
01:32:15,930 --> 01:32:23,250
They moved to postgraduate college, to that college. But as has written for us, they get to.

838
01:32:23,250 --> 01:32:32,670
Vision technology, they do industry with which we didn't, um, compared to your preclinical,

839
01:32:32,670 --> 01:32:38,580
you know, the three years preclinical in Oxford, how busy you as a clinical student?

840
01:32:38,580 --> 01:32:47,860
Well, a lot busier in the vacation because once you graduate.

841
01:32:47,860 --> 01:32:54,360
Yeah. Yeah. Well, there was less what am I call swotting because.

842
01:32:54,360 --> 01:32:58,890
Because the um. Yeah. The second B.M. and especially finals.

843
01:32:58,890 --> 01:33:06,910
I mean that, you know those those were tough exams. Um whereas with the clinically the functional design that was that was pretty straightforward.

844
01:33:06,910 --> 01:33:15,180
Right. And we've been about also the business sitting in Lamaism and making it up.

845
01:33:15,180 --> 01:33:19,470
So so the business it was we were busier during the day.

846
01:33:19,470 --> 01:33:27,240
I mean, of course as a student you were the laughs and so on. But we were busy during the day as a student, probably less busy and that evening.

847
01:33:27,240 --> 01:33:37,910
But we only had six weeks of the year, sort of. Yeah, yeah, more vacations, longer than the terms of the.

848
01:33:37,910 --> 01:33:42,680
You mentioned Jim Howard's medical teaching. Did you anything comparable in surgery?

849
01:33:42,680 --> 01:33:52,060
Yes, we did. Surgical choucha was was dying, and I'm trying to remember his first name for it.

850
01:33:52,060 --> 01:33:57,110
Yeah, I think we have to bet we had some very good teaching.

851
01:33:57,110 --> 01:34:07,070
Manelli was great. Um, uh, I wasn't involved at all with a professorial surgical unit that was filled out.

852
01:34:07,070 --> 01:34:12,730
So I think it's still and coming with me, but I'm going with it.

853
01:34:12,730 --> 01:34:14,990
Yes, yes, yes.

854
01:34:14,990 --> 01:34:26,490
I remember sitting next to you in the gallery of the Afghan theatre when he removed the spleen from one of four and it was lost in North Korea.

855
01:34:26,490 --> 01:34:33,440
I can remember both gasping a bit when this thing came out of the Senate.

856
01:34:33,440 --> 01:34:43,290
And did you do many practical procedures as a clinical student taking blood drips, lumbar puncture?

857
01:34:43,290 --> 01:34:46,760
Yes. Is catheterisation? Yes.

858
01:34:46,760 --> 01:34:51,170
And, um, assisting in the theatre more than they do now?

859
01:34:51,170 --> 01:34:57,470
Yes. Um, I don't think I really did any operations.

860
01:34:57,470 --> 01:35:06,060
Um, I probably sewed up your wound, especially in the final surgical and higher education.

861
01:35:06,060 --> 01:35:09,980
So that has just the two has to prerace. Oh yes.

862
01:35:09,980 --> 01:35:17,090
I mean. Well, of course you you are learning, you're getting on on the job, but because you're so busy,

863
01:35:17,090 --> 01:35:23,420
you know, you're planting a large number of patients and the medical techs that they they seem busier.

864
01:35:23,420 --> 01:35:28,610
Maybe I'm as busy as they are not. But we were on for twenty four hours, I think.

865
01:35:28,610 --> 01:35:36,740
Yeah. Yeah, I know a lot of patients come through and it was not only did you you, you deal with cases and learn about medicine,

866
01:35:36,740 --> 01:35:40,820
I mean I learnt a lot, a lot about organisation because you had to have it all your fingertips.

867
01:35:40,820 --> 01:35:48,610
You need to know what the blood results were. I remember almost on the two medical wards and was used to be a big booth check for the blood results.

868
01:35:48,610 --> 01:35:55,640
You had to get this checked, make sure of the notes and particularly know what they know, what they showed when it came to the ward rounds and so on.

869
01:35:55,640 --> 01:36:05,120
Yeah. Now, that was a one learnt very quickly about organisation as well as one as well as one medicine.

870
01:36:05,120 --> 01:36:13,160
During that time, did you ever have time to open a textbook again rather than by osmosis?

871
01:36:13,160 --> 01:36:18,350
Yes, I don't. There's much less takes more as a class, I think.

872
01:36:18,350 --> 01:36:27,560
I think moment to look things up is, um. Uh.

873
01:36:27,560 --> 01:36:33,670
I don't I don't recall I can I can recall, as I did my surgical hospital first,

874
01:36:33,670 --> 01:36:40,640
I can recall going to bed at about 2:00 in the morning on the first night, my bleep on the bedside table.

875
01:36:40,640 --> 01:36:47,920
And from then on, I slept like a lot ever since, you know, you're just always tired.

876
01:36:47,920 --> 01:36:55,390
And we were very tired at the end of the preregistered. Oh, yeah, yeah, yeah, yeah.

877
01:36:55,390 --> 01:37:06,190
We are. Kevin, I mean, there's always I think one gets better with with with different sleep when you're when you're young, it's more difficult.

878
01:37:06,190 --> 01:37:18,110
It's been the busiest time of your career. That's an interesting question.

879
01:37:18,110 --> 01:37:26,130
I think probably the through the 1990s when we were we were we were struck, we had huge clients,

880
01:37:26,130 --> 01:37:32,180
we were struggling to get through the the long queue of people waiting for elective stuff.

881
01:37:32,180 --> 01:37:39,520
I was also doing things with the side, do things with the society and so on.

882
01:37:39,520 --> 01:37:47,720
I wanted to on cowriter that I had to take 26 weeks a year because I had never recovered my vacation time.

883
01:37:47,720 --> 01:37:51,590
And in those days when the plastic surgery trainees, if they were,

884
01:37:51,590 --> 01:37:55,760
they did a lot of soft tissue surgery so they could really cope with a handful of that.

885
01:37:55,760 --> 01:38:05,610
Getting to maxing out your trainees, nothing. So it was a fingertip injury often not to go and have and do up on a Sunday and many, many weekends.

886
01:38:05,610 --> 01:38:13,340
I spent eight hours on a Saturday night on a Sunday and in in the hospital.

887
01:38:13,340 --> 01:38:16,910
But I was doing because I guess I just I wanted to have surgery, not general.

888
01:38:16,910 --> 01:38:18,890
That's the reason we made the decision.

889
01:38:18,890 --> 01:38:24,830
So I think I think that was the that was the busiest time trying to combine and read this, practise a lot of cool stuff.

890
01:38:24,830 --> 01:38:30,830
And then that was when we wrote the differences and smoking paper.

891
01:38:30,830 --> 01:38:36,590
And I was on the Council of the Armed Society's only sectarian organising meetings and so on.

892
01:38:36,590 --> 01:38:41,690
It was a busy time. Yeah, but well, that's been a lovely interview. Anything I should have asked you?

893
01:38:41,690 --> 01:38:45,650
I have no problem with it, but I've no idea what to do. Okay.

894
01:38:45,650 --> 01:38:49,550
Well, thank you very much. Thank you very much. It's been really fun to talk about it. And thank you for your questions.

895
01:38:49,550 --> 01:38:52,657
Okay, great. And all the best and stuff.