This is the interview with Peter Berg about the 8th of August, and Derek, how could we interview Peter?
When did you first go to the NSC as a medical students,
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?
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?
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.
And I hadn't yet appreciated that.
Orthopaedics was relatively clean and with few smiles, little infection and almost no cancer was all those problems were rife in general surgery.
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.
I've gone back to the NSA believing that experience of Predix would be useful for a career in general surgery,
but then partly because the work was more appealing and partly because of the people I met, was taught by orthopaedics, grabbed me.
Right. And we were working for a particular person there or for several at the end.
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.
I wasn't terribly attracted by that prospect because I had learnt I was at sea when I was a student,
that the that person that he was the only other young chap in the department.
He worked for several masters. And it was quite difficult to to put it all put it all together.
But fortunately, somebody else for the I think someone from overseas with an enthusiasm for working in
the academic department arrived and I was shunted sideways to work for John Goodfellow,
which which was wonderful. Yes, I enjoyed that tremendously.
And it was John Goodfellow did manage to to direct me away from general surgery and into orthopaedics.
He was a wonderful teacher.
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,
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.
And he was a beautiful surgeon and an artist.
After six months of that, I was directly, firmly towards orthopaedics.
And did you have to take another job in an orthopaedic surgeon? No, no.
Although I wasn't working for the professor, Robert Duthie,
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.
And I went to him for advice on on how to develop my career so I could come back to orthopaedics.
It was always easy to make an appointment to see him to discuss your career. It was always on a Sunday morning, so.
And he said, oh, you must go and do general surgery and some other branches related to general surgery,
you need to do need to acquire surgical skills in general surgery and then come back to orthopaedics, which is good advice.
But is it? But I went later on, I went back to him for advice.
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.
But anyway, he said we need to do more general surgery. So that brought us to the middle of 1974.
There was a strong connexion and that sort of stature level between Oxford and Bristol in both directions at that time.
And I had by then met and decided to marry Susan, who was finishing her.
She was in her final year of medical school, right?
No, she she she did have preclinical breast. Right. Actually doing A, B, C.
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.
Um, they they changed it back to three years, not long afterwards.
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.
Right. And before we were planning to get married in January 1975.
And she had um she was going to move to the to the professorial Hellström Bristol in medicine.
And so we talked about that she was keen to get back to Bristol was a good place for me to go.
So I was lucky enough to get onto an NHS rotation in general surgery, urology and thoracic surgery,
starting at Southmead Hospital in general surgery, followed by Urology and Southmead, followed by general surgery.
Frontier Hospital, Bristol,
and then the thoracic surgery was last on the rotation and you been having some experience and you went straight back to being housemen,
running on the thoracic, that everybody was always keen to move out of it.
Unfortunately, the registrar general surgery left Robert Duffy, who told me to do more general surgery.
So I took a temporary post as registrar to Roger Celestron, the man who invented that tube,
maybe still used as palliative care for people with a lot of cancer.
Um, I'm technically very, very but a very man and a very gifted surgeon.
And I enjoyed the time in Bristol a lot. There was lots of experience.
The staff were good. The hospitals were good. Um, how would you compare them with the hospitals?
Well, it was it was different in the sense that it was well, of course, the city is bigger.
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.
Um, I think the standard of care was equivalent. Um, the teaching was good.
Um, and the patients were probably similar.
We had a few quaint customers from places like the Forest of Dean and Minehead.
But, um, but but by and large it was it was similar that, as I say,
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.
And just to be able to smooth things for the interested.
You said there's not much infection. Had osteomyelitis gone out with antibiotics or with a GP's giving antibiotics, it was of similarities.
So yes, yes, there were still cases in open tibial fractures, for example, but the antibiotics had made a huge difference.
Osteomyelitis in children in the pre antibiotic days frequently led to chronic osteomyelitis for that.
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,
of course, and the antibiotics usually needed in the body and prevented chronic illnesses.
My brother had it in about 1941 and was treated with the traitor technique, which was, you know, gouged out and sulphonamide.
Yes. And then wrap it up in it. And he did alright. It's been great because it had just come in.
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,
would you say you were a natural surgeon or did you do a lot of woodwork or metal work and on training?
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.
I've made models. We did chemistry experiments in and in the garden shed.
I made a guitar and we said my model.
So I would go, oh, I know how out have kids usually.
Yes. I mean, we did.
Yes, I was interested in chemistry. I was always interested in science.
So, yes, I probably spent more than the average amount of time making things or doing things with my hands.
And did you decide to go to Oxford or did other people decide?
So I was I was at a grammar school in Melbourne, age 14, and not and I was in the middle stream.
But Oxford was probably a long way off on that stage. I probably wasn't heading in that direction.
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.
So I was sent away to boarding school age 14, where the classes are smaller.
And maybe I was just just maturing a bit later. But but then I did much better.
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.
And then I went back the year after and the scholarship exam. But I didn't get a scholarship.
But, um, and I and Pembroke College was chosen for me, probably my father,
who talked to people in London, and he had wanted to social friends in Oxford and learn from them.
The Pembrook at that time was drawn from medicine is at least partly on account of its of its biochemistry tutor,
Percy O'Brien, who was also, of course, a biochemist at the raccoon family.
Um, he he was wonderful, is somewhat a fierce teacher.
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.
I knew you share it, but I actually replied to him it was our job to bring the sherry.
And he he drank more of it than we did because he liked it more,
partly because we thought we had to keep our wits about us during the dishes and that if you are to other people.
So Pembrook had a physiology tutor and the person of Bill Keating, an expert in in the body's response to cold,
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.
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,
um, and then arrive somewhere and bring the electron microscopist, um, as a as a young scientist and teach.
And he was brilliant at teaching anatomy, he said, because in those days, because there were no laptops,
there were no mobile devices, it was all in your paper notes which you kept in these A4 folders in ring binders.
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.
So he was very good at getting us through the exams.
So we were lucky to have chemistry, physiology and anatomy tutorials on three main subjects in medicine.
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.
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,
because he spoke very slowly but in it and said, well, are you interested in music?
Yes, I was. I think I really wasn't much interested in classical music at the time.
I had a musical interest, I guess was in the modern music at the time.
Of course it was.
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.
In fact, we even performed on whether there was a concert on Prised at school.
And I finally and we performed my father was absolutely horrified, absolutely horrified.
It was only when I got the. Physics prise. So what if you and David Nabarro is rock group?
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,
I don't know, humanitarian a bit before, probably a bit before and several was a considerable protest you know.
Did you know that. I think it is a very fine.
So you came up and you did what, two years to the first b.M.
Yes. And then what happened to schools? Well, of course, in those days it was all physiology.
And I think it's a bit broader now than maybe not as broad as it always was in Cambridge.
Um, I had quite a bit of neurophysiology. Who did you do that with?
Mathew's. Yes, in Christchurch. I didn't know the college because it was all done in the department.
Yes. So there were many happy witnesses to the practise of husbandry pouring through dusty journals of this and that.
Um, so what was Matthew's name? I don't remember very much about it because we were in it was a big Grigoryan.
There were 100 students who were all doing during the final year of school.
I remember I remember the tortoise heart, um, with there was a lady and what was her name.
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,
which may be our experience, were responsible for that was children who came lived in north or south of the country.
Sure. And do you think that was a necessary part of your career?
The honours,
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,
to write essays in a much more critical fashion. I think it was very.
And then you did pass back and forth. Yes. That was two terms.
I think we would we were taught by Lady Flori. We still that that was fun.
And she was. Well, I don't know.
Again, I don't recall an awful lot about that, but but I do recall enjoying it and enjoying the course, particularly the pharmacology.
We did lots of good experiments. Yes. And I did well.
I think it came third in the end pharmacology exam because you could make experiments were probably.
Yes, of course. And in those days, the recordings, you know, of muscle contraction, for example, were traced on to a drummer smoked paper.
So a lot of time spent trying to trying to get the Bunsen burner just right.
So deposit carbon on your paper, I would imagine going everywhere.
And then when you'd done it, you had to have to spray varnish on it. And then these days it's different.
So let's go back to your clinical career and now Robert Duffy.
I mean, the thing I remember is Saturday morning. Yes.
Sessions case presentations. Well, in the clinical conference was on a Thursday morning at forty five.
Um, the the cases were posted on the board the previous evening,
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.
So then there was a of, to be frank, people trying to trying to talk to the doctors,
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.
The nine actually arrived a bit beforehand because you've got a hard time.
If you were late and Robert had the clock in the lecture theatre set slightly faster so that when his colleagues arrived on time,
if you're part of them for being late or so, he's and he the it was a standard slightly recommended theatre.
But on the right, as you just sat in the seats and look towards the screen on the right was a little raised area
on which Robert sat and he had his chair at the engineers put his chair up a little bit higher.
So he was kind of like everybody else.
And and it was a somewhat terrifying session as a junior because he'd sit there and you think it was all going well.
Other people have been grilled and suddenly a voice would say Mr might stand up and talk for two minutes on epiphyseal stapling.
And before you knew it, you were on your feet and the brain wasn't working out what to say.
And I mean, did you get a lot of education out of it or was it.
Yes, so did I. No, no, no, no, no.
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.
So that was the. And then it was then it was coffee.
And the the professor's registrar would duck out at nine thirty to write the extra cards for all the patients in his
clinic because there were 100 patients to be seen between ten thirty and one o'clock and they'd all arrive at ten thirty.
But come back to the Saturday in the mechanism he returns.
There was a programme, the Basic Science Lectures, which would comprise one lecture from usually from the visiting speakers,
six thirty on a Friday evening and then two lectures on a Saturday morning,
usually one from visiting speaker for an hour, carrying all of the basic science and then more technically related topic for the second hour.
And then on the Friday evening, it was sherry and a dinner with the visiting speaker.
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,
we had Collingwood's teaching a pathology, which was and he was a lovely man, wonderful knowledge about pathology, somewhat monotonous voice.
And the lights had to go right down so you could see these astonishing slides on the screen.
And, boy, it was hard to stay awake. And Saturday morning, to me, it wasn't difficult.
What kept me awake was watching my senior registrar, Jan, my CNN colleague John Murray, go to sleep at night.
Were we doing that? Oh, I did not feel he was much when you were on call.
Probably one night in six or seven, but.
And you might have a call or two, but the need to operate was pretty unusual things like reducing a dislocated hip.
Well, if you were the senior registrar and the registrar could easily do that.
And osteomyelitis and children accepting arthritis, those sorts of things.
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.
And two nights out of five, I think it was quite busy and less busy than it is now,
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,
rather than having operations in the middle of the night. But it was two out of five. It was two weekends on five.
So it was quite busy. I mean, obviously, you weren't really directly involved in it.
But all the argument about the excellent service in the area, surgeons splitting with the job market,
do you remember the tremendous controversy about that or did you have views on that?
Well, we and we all certainly had views and the views that the neurosurgeons should stay with the trauma service,
with the service, as it was then called, because it worked really well with the Jackson family.
There was there was a head injury registrar because a surgeon and provide a neurosurgeon department.
We provided the head injury senior house officer and the two of them made rounds every day and looked after the head injuries.
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.
It was all down to it was the pain of your shifted on the skull x ray.
I guess it was angiography if you really had to. But a lot of it was done, technical skills.
And that and that was a very was a very good arrangement for a problem that was very frequent at the time,
especially in the days when I was in researcher anyways,
before the introduction of seat belts and not only minor head injuries, many motorcyclists also had put in place that had helmets.
Probably, yes. I can't remember when helmet legislation came in, but probably they did.
So we we regarded the move to the John Radcliffe as as bad news if the neurosurgeons are not going to come with us.
But but I'm not I guess that funding was a risk was clearly a problem.
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.
And you remember clinical disadvantage from that?
Yes, there was a public health that the child of a public health physician was badly injured and I
think may have died partly because of the lack of the ability that had to have us have a scan.
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.
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.
And he he was because he knew the system. He was very determined and articulate.
And I think it was largely that that eventually got it got a scanner up at the jail.
We always had the feeling in the department anyway.
It was the hospital authorities didn't give nearly enough priority to the care of injured patients.
Everybody thinks they do. And yes, yes, they may be right or wrong.
We were right. Yeah, I'm sure. Now, Robert, does the follow trait, is that right?
Yes, yes. Yes. And he it will change the NSC or bring it into the 20th.
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.
And so by the time I went, he'd already been in person seven years,
by the time I was a student and for ten years for the time I went to the NSA chair.
And because he he'd been a terrible graduate and worked in Scotland,
but then been a professor at Rochester, New York, for twelve years before he came back to Oxford.
Yes. So he did bring back some American features.
Not he didn't actually bring back the very early start in the morning.
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.
Um, uh, clinical practise.
No, I think his view was that the professore department, which is a big department,
should be able to deliver the whole spectrum of orthopaedics with him.
And he had first one and then two first assistants later rebadged as clinical reasons.
And he felt that between them they could deliver the whole range of experience and they could deliver.
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,
as the rest of us thought he was wrong, that those trainees should be exposed to a wider group of consultants.
And eventually eventually, I think he saw that was correct and it happened. So there would be three managers, consultants?
Well, I would say that no one in the hospital as a whole,
there were about eight was the Goodfellows Somerville later replaced by Michael Bents transpiring.
David Fuller tragically killed in a helicopter accident shortly before his taking up a post,
a professor in Bristol, um, Telford Taylor and Morgan Times.
Right. Um, gosh, I'm sure I did.
And I should know this and many others do.
So there were about I think there was something like six or seven NHS consultants and then three on the professore unit.
Then did you know James got an accident? It that he he had also retired and John Cochrane.
John Kenwright. I just remembered where they were the other two.
And so, so the professor with his assistants and for NHS consultants ran the expensiveness, Cockayne Kenwright Spivvy.
And so yeah. But they also actually worked with the NSC and Goodfare and Benson, um, good friends,
some of them later replaced by events well attended, worked at the NSC.
And they also had rather curiously covid trauma at Banbury.
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.
That was pretty uncommon and it wasn't a very satisfactory arrangement. Is that changed?
It really is very dependent. Well, I think I think they were fine.
I went up as a trainee with Michael Benson to do his case in Banbury and we can get X-rays with him.
And what stage did you go to America to Caroline? Well, I am John Goodfellow, new people in in Baltimore at Hopkins,
particularly a joint replacement surgeon there who actually worked at a rather like an
elective orthopaedic orthopaedic hospital out of town called a Good Samaritan Hospital.
And with his good offices, I've had an offer of a chief resident post there.
So I just, um.
And, um, and that would have been fine, probably, though, as I later learnt, um,
post posters, a fellow completely different from person as a chief resident.
The chief resident runs the show. Yeah, absolutely. And wants to do most of the operating.
And it would have been quite difficult for me not having not knowing anything about the American system when I arrived.
I might have been difficult for the other residents as well, so that that would have been mainly joint replacement.
But my interest in heart surgery was was growing. And I might talk about how that develops space.
Um, and, um, about a year before I maybe not before I went, Michael Benson was awarded the ABC Training Fellowship.
So this is a fellowship run by American, Canadian, British, South African and Australasian Orthopaedics,
whereby about eight orthopaedic surgeons under the age of 40 are awarded a training fellowship and they all go off in a group.
So one year, eighty six Americans and two Canadians come to Britain and they tour around hospitals,
giving talks and listening to talks for about six weeks. And they come to Britain and they go to South Africa.
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.
So like being a very prominent and Breitman orthopaedic surgeon under the age of 40, was awarded this.
And on his travels he went through Duke University in North Carolina and was impressed
by it and by the heart surgery and thought this would be a good place for me to go.
And he knew the the, uh, one of the senior people there, Jim Urbanek, who was probably then aged in his early 40s.
And there were links. And then I had an offer of a fellowship there. So I kind of I said to Hopkins, thank you.
But I thought that was a that was a very good decision because I had a wonderful time.
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.
Again, basic science and. Of course, 10 years after graduation, Sandra back home was just plain different than parasitic worms.
So you had to know about fungal disease in South Carolina and and the brown recluse spider and
how to deal with snake bites and the burden [INAUDIBLE] have the public health in America.
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.
She passed and I had failed. You just can't imagine. So we took that.
That was fine. And we had to take the English test as well.
So we're going to be able to get our licences and we have the most fantastic year in America.
So how much operating did you do there as a burden? It was mostly assisting, yes.
Because the as I said, I already had my surgical skills, as it were.
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.
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.
It didn't matter what it was. I mean, the scariest is correct. And the chief resident always did it.
I mean, he'd help. But if the chief worked because it was the chief resident.
Yeah. They really got all the experience. And if if they weren't allowed to do it, they just go on strike, right?
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?
I know what I think at you do it.
Well, the it it was quite busy.
We do it for six months to two of a second, six months, two or three of us.
So we were on call until 10:00 at night.
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,
which really started in the late 60s and work through the 70s and by the time
we were there in 1981 was really in full swing and a lot of equipment and um.
And but but there weren't very many places doing microsurgery.
And in those days, safety at work in America was put in North Carolina.
The state industries were woodworking and textiles, all with sharp implements.
And people love going out into the woods with a chainsaw and the hydraulic log splitter.
Um, so there were many, many digits were lopped off, sometimes one digit, sometimes several.
And there were very few places. And it was then possible to reattach them if it was indicated, not always indicated.
If it was indicated, it was usually possible, maybe 80 percent survival rate, but there were very few places doing it.
So patients were flown in from Pensacola, Florida, from from Kentucky, from the north of Virginia.
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.
But of course, it's usually a six hour, six hours of the first four hours for each subsequent finger.
So it's quite time consuming. And so a lot of the difficult handful, including the finger attachments, was flown in from outside.
So it was there. And of course, it was usually a non-social up because of the time they got to you.
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?
Yes, they were doing microsurgery.
So it could have done actually, the cases here have always been far fewer and probably the indications would be would be more restrictive.
Um, no. They tended to do both and they were pushing the boat out, trying to see what the indications were.
And, um, and and also people didn't take patients,
didn't particularly want to fly for us right at the wonderful hospital and checked in the bit a tendency to put it back.
Um, there was Mike expense and I had said no to his children's orthopaedics, but a in children's orthopaedic surgeon.
So what got you into this?
And, um, when I was doing general surgery, more general surgery that I needed it in Bristol, but felt that for a career orthopaedics,
I needed a rather wider experience and plastic surgery would be useful, particularly in in trauma.
And there was a strong plastic surgery unit in Bristol with four.
So at that time, um, and they had post for senior research, some people who had already done the FARC.
Yes. As it was then, um, I applied for and got one of those starting, I guess, um, in late 1976.
And was lucky enough to work for Ron Hiles HIMSS, who was then a youngish surgeon,
and he did have surgery beautifully, actually, he did everything beautifully, was very calm, logical.
Um, I realised the girlfriend sitting down and the I guess the intricate workings of the hand appealed to my liking for mechanical things.
And it it just rang a bell. Did you read what and in the anatomy.
Right. Because he wrote a book about the which was very good and.
Right. So you had that interest and that was sort of revived or increased in Duke?
Oh, yes. Well, by the time I could go back to Oxford after Bristol, having worked with Ron Hiles,
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,
which wasn't so easily available in the UK at that time,
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,
you ask what else we did and to do? And we looked after two small children.
Yes, it's a very strange way to Florida, to Disney World for a long weekend.
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.
Of course, it was about five hours. It's just a very good big.
And then at the end, we put the kids and our belongings into into a station wagon and drove from East Coast, West Coast.
And we went off there and they paid quite well.
I think I was paid twenty five thousand dollars for the year, which in 1980 was kind of a journey.
And Susan worked part time. She was she was paid as well. I mean, we we rented quite a decent sized house.
We always realised we would come out with a loss. But long in the scheme of things, that was that was fine.
So in those days, it was about surgery and rheumatoid arthritis.
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,
the the the policy was that you you waited really until you saw erosions and signs
of joint damage before exhibiting the more powerful drugs completely different.
Now the concept now is early in aggressive treatment to prevent joint damage.
And there's good evidence, evidence of that works, but very different drugs. Some of them.
Well, there was hydroxyl. Chloroquine was available then stoolies.
Now SASE gold was used then isn't used so much now is usually rather little.
Now, I'm not sure when methotrexate, which is a mainstay nowadays, came in.
I think it wasn't used much back in back in those days. Aspirin, of course, was on steroids.
Yes. But certainly by then the dangers of steroids would appreciate it.
I mean, they were used to used a bit. Um, but but but not so much.
So there was there was plenty of damage to deal with.
There was lots of uncontrolled sinusitis.
Um, one of the surgeons at Duke, Robert and Robert McCallum, had been interested in arthritis surgery generally,
but certainly did and not large numbers of rheumatoid arthritis.
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.
It was only the tricky stuff that was said. The cerebral palsy, brain complex's injury, amputating fingers, multiple trauma cases, congenital.
Yes. So it was in this country you'd be doing quite well?
Yes, because we had to do a deal with the generality of handset funding from the local population.
So the commonest operation by far is carpal tunnel decompression. What else is common pigeon trigger finger dubiousness?
Contractures is common in the UK, less common in the USA because it has because it's been populated by people from European
countries where different disease or African countries where democracy is much less common.
In Africa, almost areas of the population prevalence becomes lower as you move from north to south through Europe.
But we don't think it's temperature because the northern Europeans still get it when they migrate to other countries.
Then it was the sea change. When did Robert stop?
Because the NSC went into a roller coaster. After that, it would said to me, yes, well, Robert, gosh, roughly.
Yes, it was late already early nineties.
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.
So I when I came back from the States, I took a year to go and my senior registrar post,
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.
And I was about to apply for a job that was coming up in Cheltenham, which would have been nice and different.
But then one of the clerical readers left and I got that job.
And so it was supposed to have time for academic stuff,
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.
So I built it some of that on two, which didn't leave actually enough time for the academic staff.
And I think the university wouldn't allow it now. But but my intention, of course, was to develop the Hansadutta interest.
So by the time I was ready to move on from the to readers post, the hospital knew it had done.
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.
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.
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.
And when I say private, I may have got it wrong, you know what I mean. It went independent.
Um, what it was. Of course, it was part of the United Hospitals.
And things, of course, go round in circles, but it was partly in the hospitals then.
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
something and a medical leader at that time really was just finding a very a very smart man,
Trinity College. In fact, we had three consultants educated at Trinity College, Cambridge, John Sparboe, Jennifer Black and Roger Smith.
And sometimes you'd see them together and copy them and be able to point to a trinity.
And I was I guess this was in the late 80s because I loved spinal surgery.
Colleague Greg Halpern was killed in a bicycle accident in North London one evening.
He was chairman of our medical staff committee and I took over, having only been in post for about three years.
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
in the chair trying to fight for the interests of orthopaedic patients and along along with everybody else.
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.
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.
Well, it was it was intended to make us less influenced by the larger hospitals.
We felt that would be more in the interests of patients and was always very focussed on on patient care.
And until we could plan our direction better.
And they found a wonderful chairman in the of Frank Davis, a man who rather than making bottles,
and he was he was a small Welshman, a man of relatively few words, but they were good ones.
Um, uh, for example, he is the man we were having to do accounting for the team we were giving.
He would say to his team, his team, there are two ways to lose money.
One is not to charge enough and the other is not to charge at all. And it's full of pithy sayings like that.
And of course, it it stimulated a lot of opposition from elsewhere and in Oxford.
But actually, in the end, they went down the same route. So we weren't surprised that there was opposition.
But they but we did feel I think most most of the staff felt then that the the more independents there are,
in fact, would be who would be good for our patients. And that was that followed by rebuilding.
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?
When I was there as a student in 1970 and there were only two operating theatres,
that old operating theatres where you could open the windows and peel gumboots.
And but by the time I went back, as I said,
they built three operating theatres on the other side of the hospital, together with two wards through ethology.
Ward said Ward and the admissions would say they were all built on the Oxford system, which was sort of white,
slightly prefabricated system development in the regional health authority in Oxford.
Probably in the late 1960s, it was put up rather quickly. They had a limited lifespan that maybe, maybe 40 or 50 years.
And so there were three nice operating theatres, two of which had the glass enclosures called Charnley Tents.
After John Charnley, the man who invented the really invented hip replacement through which of a downward draught of highly filtered,
sterile ER came to try and maintain a completely and operate feel completely free of bacteria.
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.
The patient was wheeled in there and then were put up to seal it.
So the anaesthetist was so we were one side of the break and the latest was the other side.
And the nurses always referred to the drape as a blood brain barrier. And how did you communicate?
You could hear that you had to. And it was it was awful.
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.
There was a microphone and earphones in it, and there was a long hosepipe, like a large, thick rat's tail.
There was. There was. And through that air was I was attracted to the hosepipe and so of see everywhere else,
but if you were in there, somebody stood on your hands and you start miss, that wouldn't feel funny.
And you couldn't it was often difficult to hear what you were saying because the Hamas
rule one size and people had different sizes and sometimes the effects were about here.
And it was and you can only see like this, it was terribly easy to turn around and bump into something.
If you bumped into the walls, then you have to leave and all get sterile again.
So it was a nightmare that was very uncomfortable.
And in the end, they were abandoned because the evidence for efficacy was, well, they did reduce the infection rate, but not by much.
It was a very low infection rate anyway, and people felt it was so difficult that it would introduce other complications.
But they were there probably, probably for 10 years since they were two of these in the normal conventional sense.
And they were very nice. I thought sounded like you at the hip.
But yes, McKie developed a metal on metal hip replacement in Norwich, I think.
But that did not stand the test of time. And Charlie, he he learnt from the American space programme.
The Teflon was a very non-stick material and and thought that low friction was the key component to joint replacement.
So he put it in three hundred hip replacements with the cup water and the acetabulum cup made from Teflon, and they all failed.
It wasn't hard enough. And then he said, well, what else do we know?
And he hit on high density polyethylene, which which is to his right.
And it was very often in those buildings in those days he did the first experiment was on people then.
Then you're trying to prove the concept in experimental animals. And then finally it was migrated into veterinary practise.
So that's been the sort of rebuilding of NASA.
You thought a great deal of that much, much later. And that started sort of roughly it doesn't matter what happens.
I think we moved into that in something like 2000 and what it's been up about ten years.
Yes. So it's the way who is here funded by. Well, he he he retired.
It's difficult to say really.
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,
which was a mixture of heart surgery and trauma and a bit of and some elective heart surgery.
And some of the sessions came because John's father wanted to move into management and move out of trauma.
And so I think four or five sessions. So I really took over his historical practise.
But when he when he retired finally from the NSC, it's hard to say because the number of surgeons expanded so much.
His sessions was subsumed into it, into others. And I think it wasn't a direct successor in that sense.
So all this time, you've been linked with the excellent service. Yes.
So the the I was appointed at 86 and for eight years I ran every Thursday and one weekend in five.
And then in 1990 to probably we appointed Peter Wolak, who had been trained in Nottingham and had different ideas.
The the if you go back to the nineteen 1940s,
there were really two concepts of and it's the Oxford concept really started by James Scott was the orthopaedic surgeon,
was the primary person responsible for the care of the patient and brought in all the specialists as needed.
And that was the actual service concept. The Birmingham Accident Hospital was different there.
The the trauma surgeons did everything they drop and and so on.
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.
Someone Amador's was better. Let's call the action service.
But and we look, we ran the the department, which is that actually called the action service, because as I'm sure you remember,
most medical missions came with a letter from the GP and went straight to the physicians were never seen by that.
But action service, the only medical cases who were seen by our research shows were people who came off the street with a
medical problem and asked if they didn't need resuscitation and then just directed them to the team,
to the medical team on the surgical team.
So we had five originally five such as a national with three researchers who ran the front door 24 hours a day,
seven days a week partway through and how it was.
It was busy, but less busy than now, but it's certainly busy, but that was almost all true.
But the concept of the department was taking off around the country.
And and I think although we fought it for a while, it wasn't going to be a battle between long win, long term.
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.
He recruited Keith with a very smart move. And between them,
they they just they they changed in the trauma into a trauma service in which the consultant there was a consultant resident every night.
So there was consultant in the premises 24 hours a day, seven days a week.
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.
But they were very, very determined, very, very far sighted and extremely committed.
And I think then the unit for the very ill from the Navy, the Anestis, took that right,
because at one time the anaesthetise were running the sort of the high density nursing centre where very ill people.
And so well, back in the regular family, there was an intensive intensive care units.
It's my certainly my recollection as a husband was there was because there was a tower
block built of the American family that was probably built in the late 60s or 70s,
maybe, um, but it was certainly up. And I was working there as as a surgical house in 1972.
Right. And there were two intensive care units, those neurosurgery intensive care to one side.
And there was a bigger general intensive care unit on the other side. And it was run by the anaesthetist.
I think some of that was developed out of the respiratory illness at the Churchill.
Yes. Which is where their initial experience in ventilating patients came from that unit,
mainly for people with with respiratory failure from neurological causes.
Yes. To cramped space would have been. Yes.
Yes. Um, so so yes, of course. In intensive care, it's broadened.
Now, there are some physicians doing it as well. So it's just then it was really run by scientists.
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.
But the nurses were running it. Yes. Yeah, it's very difficult.
And I've been there. That's another story. So what about hand surgeon colleagues really waiting to be joined by other people?
Well, it was just me and I did have had surgery along with General Speaks from eighty four.
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.
And the first was that the that the on call for had surgery was becoming um, there wasn't really any uncle for surgery.
They just call me if they had a case and it was becoming a bit intrusive.
The second was that the plastic surgeons historically had not treated had trauma and
abuse recognition for their training programme unless they the trainees did some.
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.
And we decided that with the plastic surgeons, really with Tim Goodacre and David Coleman,
that plastic surgery would take and emergences one week and I think the other week.
So then for another eight years, I had a colleague join.
I wasn't doing a job trauma, but I was on call to heart surgery twenty six weeks a year, which is fine.
But but I'm busy. And that, of course, eventually became unsustainable. By the mid 90s, we had on the electric side,
we had huge making patients wait a year for an outpatient appointment and a further 18 months for an operation.
Just three months. But could we persuade anybody to give us more resources?
Um, and so that led to the appointment of my first Hansadutta colleague, was a plastic surgeon, had Gill,
who'd come from Perth, Australia, as quite a young chap, to be the overseas fellow of the plastic surgeon.
And they immediately recognised he was a person.
He was very bright and he was a very gifted surgeon, um, withinside for planning, technically very gifted, very good at microsurgery.
So they sent him off to be a fellow with the hand surgeons in Paris for nine months.
Um, but we had a really good time and we thought this would be a good person to appoint.
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
we had a heck of a story on that every Monday morning and it was just wonderful.
I didn't see so much remark as it moved on to bigger things in plastic surgery and so on and on the hospital.
I did differently. But but he was a he was a fantastic colleague.
But and that helped with the waiting list.
But it's always the more we provide resources and more patients come in. We were still struggling.
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.
And that was a very, very successful appointment then.
And I have to look at the dates.
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.
And then the plastic surgeons also made appointments of potentially at risk, Coxwell and Bramston,
a couple of other people doing who are doing mainly trauma and also some head trauma.
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.
Yeah, you mentioned the ER but I mean did you do the work. Yes.
Until the I.
Yes. I mean it's showed the though the Apelin really including elbow replacement and shoulder replacement
operations because my original elective work that is when something really was up was arthritis,
was really rheumatoid arthritis and also a lot of other joint replacement there.
But another Starwind spotted rising through the ranks was in car.
It was Joe in our hospital and he was appointed as a consultant to do many children.
Now, I think in 1992, and as soon as I have not passed all the children held to him.
Where did he come from? He was a Bristol trainee originally.
I think he had had a I think he had applied to Oxford anyway.
He was a Bristol trainee and a man of great determination and enthusiasm and and foresight.
So he took over the show. I still did some observations about 1996 and then.
And then. And then stop. I'd never really been trained as a self taught children organisation.
So and that's never been more been properly taught to do the heart surgery.
And, um, but but I still did pretty complex surgery, which I did well until I stopped doing drugs, just which was 2009.
And those were often all their cases. And and I had great fun really.
Um, the rewards were slow and you had to wait and see any sign of recovery.
So it was all there was no instant gratification in that work. And you never got into what you could do that was limited.
It was useful. It was limited. Um, was there a lot of the euro area neuralgic pain?
Sure. Yes. When they every three months. It's a terrible problem.
Yeah. And it takes about three years just to reach its final stages and still be problematic.
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.
Seems to reduce the pain now with the knee. You know, I always think of endoscopy.
Is there any endoscope in the upper limb? Oh, yes.
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,
the the rehabilitation is easier and it's used to a more limited extent than the other,
but it's widely used on the shoulder for both diagnostic and therapeutically, and it is used in the wrist.
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.
But you can train bits of the triangle pharmacologists to the police and some surgeons used it a lot for diagnostic purposes.
We always had very good imaging in Oxford and I was I tended to rely on that on the CT and
the MRI scans or arteriography rather than consume scarce operating time for arthroscopy.
And it's not a completely complication free procedure. I mean, you mentioned the X-rays there.
All the other people who, you know, you interact with pathologists, you have pathology.
Er you know, you need specimens. Yes.
I mean, of course, all of the all of the lungs we remove, there's not much cancer and had surgery.
But for the balance. Well as we get histology we usually send the disease.
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,
um, but the the pathologist's main role was in what I could think elsewhere and was predicting with with brain tumours.
And, of course, that some aspect of the work of the NSA has expanded hugely.
And just by being Michael Beck, similar to surgeons who did most of it in the early days.
But but then Oxford became the centre of the brain tumours, also centre for sarcomas.
I need to ask them where they get all their files from now.
But I believe for a while we've been dealing with all the kind of referrals and a bunch of referrals from the Southwest.
So that's a big service. We have two, two and a half full time orthopaedic tumour surgeons.
And of course, the imaging is very important for the diagnosis and assessment of tumours and the pathology is crucial.
So there's some MDT meeting every Monday morning with all these cases have gone through MDT sorry, multidisciplinary team.
And is there anything wrong with death is waiting?
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,
all the consultants could give a view. In fact,
if you looked through the notes of some of the other patients that the patient would be admitted there'd be
a typed preoperative assessment and then it would be a take note of the presentation at the conference,
including the opinion that Mr Taylor said this.
Mr Scott said that then the operation that you talked and read and then did post on this would be tucked in.
The records are very good. So those meetings were done. They were recorded in.
Yeah, I think this is before I but I was there, I went back to the 1960s.
Somebody was there taking notes about what the opinions were. But of course, when I had surgery, I showed said in spinal surgery,
he got to the point where we weren't really able to make a public comments
and we went to have very constructive comments about management of patients.
And so it rolled into meetings and the individual teams. And I I think some of us bemoan the loss of those meetings.
But but it wasn't a viable option in the long term. So anaesthetists interact with a lot and they could do for them.
No, not much. Good, great.
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,
almost 30 years to work with just two anaesthetists from all day less lovely.
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.
The the soprano would be singing and Gordon would lean over and the patient was usually awake.
So hasn't that nurse got a lovely voice? He was one of, um.
And then when he retired, he was followed by Graham Byrd, who'd been a student,
I think maybe six months ahead or behind and in the medical school here,
keen cricketer and golfer who had done some anaesthesia and then worked for a while in the medical attention in London.
And I think at the time when when crime indemnity took over all that work in the NHS, was it?
And then he moved back and finish his anaesthetic training. And he was,
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.
So he will the next one. Because while I've been working, he had been with the patient.
The nurse would be the patient. When I'm working, he's in the anaesthetic room making the next patients all.
No. So it was a very efficient system.
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,
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.
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.
And I think a lot of that was probably when I was consultative and it was probably done about it by the junior staff.
And in an enhanced entry, I mean, we we did not do blood you because we were dealing with the patients.
Yeah. And so, um.
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,
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.
And we and we just had a great time. Well, there are some some surgeons say that finding this this difficult,
it's probably because the surgeons are difficult and that now we have very good anaesthetise in Oxford and Annegret,
great professional colleagues and bacteriology. Do you have much?
Yes, we do. We do send specimens off. But but again, the the um.
Well, I guess there are two there are two scenarios.
One is when you have a fairly straightforward infection, you need to know what it is and when we can deal with it.
The other is the more complicated problem. Maybe this wound or this infection is not responded to this kind of therapy.
Then the advice of the other microbiologists is crucial.
And that's becoming more so because although people say we don't have any new new antibiotics,
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.
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,
but with input from the from the microbiologists. So with any sort of complicated infection.
Well,
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.
So that's compared to that was started by Taliban, which is the Taliban of either Baron, um, um, BrisConnections or others.
I should know the names and I'm a bit rusty. Haven't been out of it for a couple of years.
And sure. Now, you mentioned Roger Smith.
Was he researching always or was he clinically involved?
Know both. Yes. Yes. He ran, uh, clinics, um, for metabolic disease.
And he was interested in in skeletal dysplasia and knew a lot about those, um,
various sorts of dwarfism and what he was used to for the diastrophic dwarfism he was used to refer to as catastrophic deficiencies, probably.
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.
And he used to refer to the Journal of Surgery as the Pig Farmers Weekly News, always trying to disparage it was being searched.
And he said that he was very he was very good in conferences.
He was a great opinion. And I seen him in the hospital quite recently.
So getting into to it them, I think he's still writing. He is a prolific writer.
Yes. And he is at the botnet. Yeah. Yeah.
And so, I mean, all the work on Polly Phospholipids, Bisphosphonate disposable.
Yes. Yes, I was he he he worked with the there was a metamorphic my research unit run but run by gentrifies.
Right. And before that by Moreno there was MRC Funding Research Unit um which is which I think ran, ran for many years.
I think that's now been subsumed into the botnet and it was generating animosity and and because he lives in our village.
Cadeaux, you had to ask him about that. Yeah. Yeah.
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?
And I know that I said that, but the work that was work on bisphosphonates, there was quite a bit of work going on.
Well, there was certainly work oncology, um, osteogenesis imperfecta.
And, um, is a Roger Smith was into that.
Yes. Um, what other university research, as it were.
I was going on in the industry, but from the botany with the bailout or not.
Because you were saying yes. You said yeah. So um the the there was a biochemist, Martin Francis.
Yes. It was really he wasn't clinical. He he he just did research.
He was active. He was very active sort of through the 70s, 80s, probably into the early nineties.
Um, we had an animal house on the back of the sea with to the technicians who ran it.
So the um experiments with all rats on small animals, rats, rabbits, licence.
So when he said the back would be near where the Boatner is or.
Yes, yes, pretty much where the ball is, the left hand side of the bottom.
And it just didn't just in front of the swimming pool.
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,
hardcourts that they gradually turned to grass courts couldn't maintain.
But in the end, it was decided that wasn't fruitfulness of the nature of space.
They were they were demolished. In the end.
I was talking about the basic science lectures in literature in the summertime that was replaced by an anatomy
session so that the one of the rooms in the Animal House was approved by the Home Office for dissection.
So in in April, the cadaver would arrive fully, present a cadaver, and for eight weeks it would be dissected and then presented.
So during the week, two residents would dissect the body part, the head, for example.
And then on the Friday evening and again on a Saturday morning,
one of the consultants would supervise the presentation of the anatomy and would grill the assembled company of trainees on the surgical approaches.
That was another. At least we knew then which bit of the body, but it was not open at all.
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.
I don't know whether it's a concept he brought in the USA, but it was very good.
But unfortunately. Well, I think with the Animal House closed, of course,
it folded and therefore a little bit before that because of changes in the Home Office rules and so on microvascular surgery,
was that getting more and more makram and that changed in the diameter of this?
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,
the right femoral artery, which is the standard model for experiments and practise, is about a millimetre or slightly less than that.
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.
So you from the late 60s, early 70s onwards, repair of those structures was possible.
If you can smaller vessels can be repaired to make sure there isn't a huge need for that.
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.
That's used a lot of plastic surgeons nowadays, generally based on larger vessels, which isn't in Manhattan.
And and small vessels are really pretty hard to repair. And you need very fine sutures.
The the the tenno not, for example, suture diameter, 22 microns, that's a big one.
Now, the needle, 75 microns, the CO2 is 22 microns, that seven red cells.
So that's three red cells standing shoulder to shoulder. And and it it breaks easily.
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.
That's really the limiting factor you can see pretty well. But it's the battle against a mountain.
And you do that by Plasto. How do you know what?
It's just in preparation is everything. You need to be comfortable and you need to have your elbows and your hands right.
Supported like this. If you're working like that, more shakes at all.
It's a small muscle actually in the hand. And then the NSA came out of the trust and rejoined.
Is that right? We're doing the sort of well, the the the the NSA with its own trust for quite a long time.
And then the Oxford Radcliffe Hospital is the other trust.
And and then the the NSA, what we did for the NSA as a separate trust was it's building, um,
the original plan for the building was for twenty four point nine million on the
basis that if it's twenty five and it has to go to the Treasury for approval. So they're staying there 24 hours.
And so the story goes mean.
It costs more than that in the UK and it had to go to PFI, which meant we were saddled with this big mortgage.
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.
But then, of course, there are economies of scale and the tariff for speed is quite challenging.
And so, um, it eventually I guess this is by well, I'm not sure when the merger happened.
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,
and it was all I understand, all because of the mortgage payments we to make the PFI company.
Yeah. And that was why we had to take away all the hospitals and all.
But but it's it's to me, it was disappointing what we have lost control.
And I think without getting into into it probably wouldn't be appropriate to go into detail for the record.
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.
Well, the two things matter, the parent patient kind of teaching, and it's had a detrimental effect on both.
Do you think? What does the patient care?
I think patient care is teaching because the the the management never really had much of an impact on them, not on the teaching.
We that um but if the the need to have some of our, um,
services managed from from afar has not been constructive or advantageous to get clinical students,
how long do they come from during the they they they still come for two months.
But they're also doing um general practise, um actually emergency.
So the exposure is less. I think that's I think that's fine.
I mean, you know, the students, the the the contribution of different fields to student education has changed not as much as anatomy.
And that's appropriate because there's so much else to learn.
And details are actually you can learn as a surgeon, you don't need to know as a medical student.
And so they can for two months that they aren't attached to firms quite as much as they used to be,
which means that they don't get a chance in a formal relationship with a group of doctors and so on.
But I I guess when they get that in in medicine or surgery in years three and six,
that they do come to clinics that were usually a couple of students in my group on Monday morning.
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.
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.
But they were fun to have in the in the clinic because you can find a suitable patient.
I said new patient and get the student to examine them and take a history exam.
Was that the case?
Um, uh, um, uh, patients in the waiting room, patients felt something was was being done in the students and the management, the right.
And, um, I don't want to look after them.
Now you're dealing with National International Societies committees, but, uh, yes, I'm principally in British society for surgeons.
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.
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,
it's bigger than some uh some of it's bigger than actually cosmetics for example.
We currently have about three hundred and twenty four members and about 600 association and um
it shares offices with offices in the Secretariat of the Plastic Surgery Society in London.
It's basically the College of Surgeons on the fourth floor. We have um so I was undersecretary for 1947.
There are a couple of years off then I guess in 97 we a group of us began to organise,
um, an instructional course which ran over two days in February and two days in June,
um, based on three year cycles, cover the whole field of heart surgery run in Manchester.
So I was involved in the organisation of that and only only on the organising committee for that for three years.
And I remember being the being the chairman of that for three years.
That was great fun, because if I could just like or help choose programme not to use the speakers.
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,
some of whom came from Central Europe to learn. And, um, and then that took me up to 2000 and 2004.
Then, uh, and maybe in 2003, I was grabbed by the elbow and said that the intel that the society was running the.
National running the European Hasadi Congress in Glasgow in 2006, and they'd like me to organise it,
and it was always organised by the presence of the president in 2006 and have
there on this Congress for some 700 people in Glasgow in the in the same year.
That was huge fun because, again, I could you know,
I could get to choose we had some papers with that symposia and the structural things and was like get to choose the speakers.
And, uh, so that was a nice. But was it difficult to do it being investigated?
No, we flew up a few times to do it. And we we have a very good secretariat with its leader.
And Hal Roberts is hugely experienced in organising meetings and knows all the records and so on.
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.
And then about 2000 six, we realised that the society had a rather primitive website.
So I was elected to be the webmaster and we went out to a company.
We made much better a good on that sort of thing. I quite enjoyed that.
And I said, You have to know much about the website.
No, no, no, no. That was all done with the technical people. It's all a question of design.
And we chose a company, um, who, uh, who were going to design that.
They wrote songs for the NHS, but also from the hospital they design and they're very clear writing,
which is also important for anybody to put a computer. But it was the content that was important.
Um, so I ran that for a while. And then when I stopped doing that, um, I've been there, I mean,
coming to the end of my third or fourth year as the honorary archivist, which is also a great on societies council.
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.
And then you were writing articles, editing journals. And I was one of the editors for the the um.
So we have to have well there are two main angles this gentleman had.
There's an American Morning published by Elsevier and there's the what used to be the British
volume published now by Sage and the in about the but other Hansard Hansard has done.
Other European countries always been keen for our British channel to be the European Year.
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.
So the decision was made a typical committee decision in the early nineties.
And instead of being called General Panzeri British, we be British, British and European and British.
We will not forget that it was a tough decision.
But finally, we agreed. We bit the bullet and agreed to call it the European body that we still edit.
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.
Um, we used to think about it now and then it was changed to a managing editor and three editors.
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.
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,
but I've been a member of that society for a long time.
And it's a it's a very it's a very good society and it's a big society, lots of smart people.
And it does it does a great job in education. And have you written articles?
Yes, mostly technical, mostly technical research.
What would that be? Would it be developing a new operation or a new volume?
Yes, some of it's been some of it has been technical. Some of it's been biomechanical to do with tendon repair.
Um, I've had an interest in the effect of smoking on some of the things we do in the hand.
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,
who was a senior editor at the time in the department about investing. Right.
So we had a lot of expert epidemiological advice and we and we took 220 patients maximum with 220 controls,
people having 220 patients do the 220 controls, having a little bit of operations and sending questionnaires about smoking and drinking.
And then to be sure that then we had to have community control as well.
So we took fifty of our patients. The maximum was four controls in the same general practise controlled for socioeconomic status.
And both the study showed that smoking was a strong risk factor, at least for having an operation to do release.
We chose people having surgery because they more severely affected. They thought any effect of smoking might be more of this.
So that was that was that was quite a lot of work, was a solid finding has been confirmed by by others that, um.
And I tried writing, I so enjoyed reading it,
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.
And again, we showed that smoking was a very strong risk factor for failure operations to that.
That was that wasn't the case control study.
That was just looking at the the the key rates in smokers and non-smokers in about 80 cases to be treated in Oxford.
Do you get a lot of long term, you know, 30, 40 years české for travel for people who practise it?
Oh, yeah. What is that? Well, the risk doesn't the risk moves the wrong way and becomes arthritic.
Um, but but it's surprising how often you see somebody with something else.
You take an X-ray or they just fall and they have another injury and you take
an X-ray and and there's a problem that they've been coping with for years.
Can you do anything about what you can do? Yeah, yes. But quite often the treatment is worse than the pain.
That's a minor injury if you leave it for a while and they just get better.
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.
Why did you decide to do your clinical enoxaparin? You're kind of.
Yes, I had a place at Thomas's, um, but after two years, um, I, I loved Oxford, the family home.
We just moved from Wimbledon to start terms.
I could see myself living at home, taking the train up to London every day and to anoxia seemed like a much nicer prospect.
So where did you live? In flats or in in Oxford as well.
How live one year in college, two years and digs down the bottom of the road on the right line.
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.
I went past it the other day. Uh, they bought in five thousand pounds.
It's the basement and ground floor and two floors above semi-detached pretty.
And six of us have lived there for three years. And I hate to think what it's worth now.
What did you think of your clinical claim? Very good.
Very good. And so the we started off, of course, learning medicine in the West Lecture Theatre with Jim Holt,
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.
And he was brilliant. And also he ran the revision course where it all really clicked and fitted together.
Um, my my first marathon was the Regis professor of medicine, George Pickering, with his first assistant, Larry Bailey.
You remember, it was in fact, I think Sir George retires towards the end of my attachment to the firm.
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.
Um, and I forget which which medical condition is it when the breath smells of fish?
Anyway, I said it presented because the world is full of all of the professors, physicians,
us on the continent presenting this case and said that the breast milk, the fish, the Pickering.
Let me go on for a bit. And then he asked me on which day of the week it will examine the patient.
And I had to confess it was a Friday. So I had was George and Pennbrook when you were in bed?
It was after he retired as Professor Days. And then then he moved to, um, I'm not quite sure about that maybe beforehand,
because I know when I got started in the pharmacology exam before last night for the city's history of 400,
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.
Yes. Did you have anything to do with Geoffrey Arthur in Penbrook?
Was he that he followed you, which may have been after your time?
After my time Master was Robert McCallum when I was a strange historian.
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.
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.
They moved to postgraduate college, to that college. But as has written for us, they get to.
Vision technology, they do industry with which we didn't, um, compared to your preclinical,
you know, the three years preclinical in Oxford, how busy you as a clinical student?
Well, a lot busier in the vacation because once you graduate.
Yeah. Yeah. Well, there was less what am I call swotting because.
Because the um. Yeah. The second B.M. and especially finals.
I mean that, you know those those were tough exams. Um whereas with the clinically the functional design that was that was pretty straightforward.
Right. And we've been about also the business sitting in Lamaism and making it up.
So so the business it was we were busier during the day.
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.
But we only had six weeks of the year, sort of. Yeah, yeah, more vacations, longer than the terms of the.
You mentioned Jim Howard's medical teaching. Did you anything comparable in surgery?
Yes, we did. Surgical choucha was was dying, and I'm trying to remember his first name for it.
Yeah, I think we have to bet we had some very good teaching.
Manelli was great. Um, uh, I wasn't involved at all with a professorial surgical unit that was filled out.
So I think it's still and coming with me, but I'm going with it.
Yes, yes, yes.
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.
I can remember both gasping a bit when this thing came out of the Senate.
And did you do many practical procedures as a clinical student taking blood drips, lumbar puncture?
Yes. Is catheterisation? Yes.
And, um, assisting in the theatre more than they do now?
Yes. Um, I don't think I really did any operations.
Um, I probably sewed up your wound, especially in the final surgical and higher education.
So that has just the two has to prerace. Oh yes.
I mean. Well, of course you you are learning, you're getting on on the job, but because you're so busy,
you know, you're planting a large number of patients and the medical techs that they they seem busier.
Maybe I'm as busy as they are not. But we were on for twenty four hours, I think.
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,
I mean I learnt a lot, a lot about organisation because you had to have it all your fingertips.
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.
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.
Yeah. Now, that was a one learnt very quickly about organisation as well as one as well as one medicine.
During that time, did you ever have time to open a textbook again rather than by osmosis?
Yes, I don't. There's much less takes more as a class, I think.
I think moment to look things up is, um. Uh.
I don't I don't recall I can I can recall, as I did my surgical hospital first,
I can recall going to bed at about 2:00 in the morning on the first night, my bleep on the bedside table.
And from then on, I slept like a lot ever since, you know, you're just always tired.
And we were very tired at the end of the preregistered. Oh, yeah, yeah, yeah, yeah.
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.
It's been the busiest time of your career. That's an interesting question.
I think probably the through the 1990s when we were we were we were struck, we had huge clients,
we were struggling to get through the the long queue of people waiting for elective stuff.
I was also doing things with the side, do things with the society and so on.
I wanted to on cowriter that I had to take 26 weeks a year because I had never recovered my vacation time.
And in those days when the plastic surgery trainees, if they were,
they did a lot of soft tissue surgery so they could really cope with a handful of that.
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.
I spent eight hours on a Saturday night on a Sunday and in in the hospital.
But I was doing because I guess I just I wanted to have surgery, not general.
That's the reason we made the decision.
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.
And then that was when we wrote the differences and smoking paper.
And I was on the Council of the Armed Society's only sectarian organising meetings and so on.
It was a busy time. Yeah, but well, that's been a lovely interview. Anything I should have asked you?
I have no problem with it, but I've no idea what to do. Okay.
Well, thank you very much. Thank you very much. It's been really fun to talk about it. And thank you for your questions.
Okay, great. And all the best and stuff.