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And uh one of the great joys of neurosurgical practice is the colleagues that we work with from other disciplines. Um And I've had the enormous uh privilege and pleasure of working with Mr David Baldwin for all of our uh neurosurgical and uh ent careers as ever. It was Hugh Griffith who introduced us. Um Remember meeting David in the corridor at French, eh, eh, um and we struck up a lifelong personal and professional relationship following that I have lost count of the number of scrapes that he's got me into. Uh and quite a number that he's got me out of. So David, it's a great pleasure to welcome you to this meeting and we, we look forward to hearing the thoughts of an ent surgeon. Thank you, Rick for that introduction. Um Do I see this up there? Uh uh I feel a little bit like this King Penguin amongst his creche of, of babies that are sitting on a South Georgia beach that I had the luxury of visiting by yacht. Uh 10 years ago, I sailed down from Falkland Islands, so a few of my slides are going to be a reflection of that trip as well. You've all seen enough brains, you've all seen enough blood and gore. So, uh, I thought it was reasonable to inflict these upon you. Um, my links with French, uh, actually go back to medical school days when I did 1/4 year elective for some peculiar reason in the casualty department, uh, where I learned to sew up hands badly. Um, but, yeah, I've heard all about your transatlantic flights and you're, you're well traveled neurosurgical uh lifestyles. But I didn't move very far from home, having grown up and going to school here in Bristol itself. So I was a little unadventurous at that stage. However, that has changed and I think it's fair to say and I can reflect on another 33 career that we have seen some remarkable changes in surgical practice, whether it be your neurosurgical practice or my head and neck ent practice, um, or at that interface. Whereas Rickel, uh suggested we have cross, uh, cross cross paths. Um I put nearly, nearly retired because I think I'm the uh last uh eldest uh, member of the Ent fraternity and Bristol still on active duty. Um But that might stop tomorrow. Uh Well, maybe so. Oh, that's gone on one more. Mhm. That's the one. So just as a bit of background cause everybody's had a bit of background this morning. Um, I actually trained at Southampton, um, which was a bit unusual at the time because I was one of the fourth intake and they hadn't really had any graduates. So it's a slightly uncertain pathway to take. And I suppose that's reflected my career subsequently. Um I went uh went up to um Great Ormond Street and was fascinated by the ent and got picked up then at the Marsden Hospital with Professor Charles Westbury, who was a vascular surgeon from the Westminster. But he was just, I don't know, he just had skills in every domain mean his interest was in breast surgery, breast cancer, sarcoma, melanoma, and carcinoma in the head and neck. And it was as sho with him that I learned and admired the dissection capabilities that you could have under magnification as he dissected out the facial nerve in peru, it'd prostatectomy. And that's where I really started my love affair with the facial nerve. Um I continued that and went on to the London Hospital where I had the undoubted benefits of the joint expertise of Andrew Morrison and Tom King. Um It was in the latter years of Andrew Morrison's career that uh I was able to fully flex my muscles in the skull base department and learned a lot of the lateral skull based techniques. At that time, I had a then a final finishing year at the Marsden again for more head and neck experience and reconstructive surgery. The lessons that I learned there was trust your colleagues to make good decisions, work with them where you can and exchange ideas and you will get a better overall experience for yourself. And also a better outcome for the patient working in silos was for the a thing of the past. So the back country warning there is really a reflection of uh early checklists that have come into healthcare since. Uh well, in the last 10 years or so, when I got to Bristol, I, I actually did meet up with Mike Torrance, um because I explained to him that I was quite a useful pair of hands in acoustic neuroma surgery. Um And um we had a similar discussion that I think some of you have had, which made me feel a little bit shorter than I really am. But I came away with a sort of small tail between my legs thinking not really going to get on here, I think with uh with temporal bone surgery, uh they clearly fixed in their ways here. They like their post area fosse's and uh and I thought so I went away and sort of sucked, sucked on it a bit and went off and met up with plastic surgery and general surgery and tried to expand my other head neck interests which were microvascular work. Um But the obstacles that I was coming across for the development of a surge of a surgical service or a combined skull based service were these, there were three separate hospital sites in Bristol were down to two now. But the physical separation meant that meeting of minds and ideas in the coffee rooms and the of the hospitals just didn't take place in the relevant areas. Um We were in a period where there was clearly some political argument, arguments going on in the city about where we should have a future Super hospital and that blighted planning for development of uh of surgical services. Um At that time, there were very few um CT and MRI scanning facilities. Uh and we had a severe lack of um up to date equipment. We've heard about endoscopes and where they were pinched from where my original sinus endoscopy uh set up was a hysteroscope with a, a security camera attached with uh elastoplast around the head and a re diffusion television to view it on. And my senior register at the time sort of Russell this up out of a second hand shop essentially, but it was my first introduction to sinus endoscopy and sinus surgery under good illumination and visual conditions. Um The pictures here are from Grit Frickin in uh in South Georgia, the harpoon um on the front of the petrol uh was just to remind myself that actually, we did have a very early interface with pituitary surgery in the early sixties with Jack Angel James who still lends his name to a number of the instruments that we all use for knocking holes in the front wall of the sphenoid. But that was, it wasn't the microsurgeon that you do. Now, that was known as harpooning. Um, the other instrument there is a bone saw which in it's heyday in the fifties and sixties were used for soaring up the carcasses of Wales before Flensburg. Uh, um At the time I took over here in Bristol, I was one of two surgeons at South need with an enormous waiting list of tonsils, adenoids, snoring septal surgery and then the odd odd thyroid or parotid thrown in. But it was a very clear demarcation at the time that Ent was a little grubby specialty that only bothered people elsewhere when it sort of got out of hand. And in your case, that would usually be when we were dealing with infections in the sinus or, or the ear. So, what did I have to do to break that? That hold well, you're recognized the man in the steam. Um And it was over a chance meeting at a mutual friends in, in Bristol in the winter of 91 probably, maybe late 90 but we had a chance to meet over dinner and discuss our recent appointments to our various trusts. Um And I've got to realize that Rick had shared a number of similar uh lifestyles that I did enjoyed, um, enjoyed skiing, uh as well as, uh you know, working on the, on the boundaries of uh current surgical practice. Anyway, one thing led to another and we decided that we'd have to meet up and get this thing more formally recognized as a skull base MDT. Now, at that time, there were, there was skull base surgery, there was acoustic neuroma was being operated on by Hugh Coke. Um and uh Dick more, but it was a bit more of an ad hoc arrangement. And I wanted to along with Rick, develop a more uh inclusive um arrangement which included plastic surgeons, uh much more closely integrated with pathologists and radiologists. Um And anybody else that we felt might be useful in the rehabilitation side of things. And so we got on with developing the skull base MDT. Um We said about marketing it to some degree. Um And it was really to get it out to the local community in the Southwest Peninsula that we were now in a position to offer uh combined surgery for predominantly acoustic neuromas. Um But we would essentially take all comers. Um And so we, we didn't restrict ourselves to any specific boundary. Uh The beauty of working across a specialty boundary like that is that if you want to know what's on the other side, you ask your friend to get you there or you get there yourself and they clear the mess up. Um So we set up this as a largely a neuroma service but took on ganglia uh neuromas chemodectoma as there's obviously my interest in head and neck cancer and sinus disease. We brought in quite a bit of malignancy as well. And over a period of 15 to 20 years, this became quite a sizeable uh part of our workload. Um We were still though, still having to work around to hospital sites, French and South, not far apart. But I used to have to cancel a list on a Monday and come and work with Rick. And sometimes I get a call in to go in on a Thursday or whatever. When we, we had to have a very flexible working arrangements, didn't always go down with the management at the various areas who essentially saw me coming over here as uh uh me downing tools at home. So the development of the new South Meat Hospital looked like the think the ticket that we, we actually needed to get us on one side. And I think both Rick and myself plugged very hard to try and get a combined head and neck stroke, neurosurgical stroke, skull based service at uh at the New South Main Hospital. Unfortunately, through various political wranglings, uh we were uh the ent department was had to up sticks and go to the BR I. So we still have that five mile gap between our uh uh main base of operating. However, over the 33 years, I think there have been some very tangible benefits which have been reflected in better patient outcomes. And certainly from my point of view, a much more exciting um operative history, um we now have very clearly defined anterior and uh lateral temporal bone, skull based services. Um That's not to say that we don't join up the gaps around the margins or around the top and underneath where that's appropriate. We work very closely now with the radio therapy services and Alison Cameron has uh sort of brought the stereotactic radiotherapy services to our, our city has helped in maintaining a multidisciplinary approach to acoustic neuroma work. Um where necessary we have good rehabilitation in place for speech and swallowing. Uh These are things that have developed over the last 30 years. We also have huge resources in in uh hearing um as well, uh hearing rehabilitation, whether that's been conductive or sensorineural loss with a large regional cochlear implant program. Um We have recognize that training opportunities that are available through working across specialty needs to start at a very junior level. And there are a number of registrars in the room. I know who have benefited from uh a spell with the ent and some of our uh genius of almost uh benefited from neurosurgical input too, Rick and I have sort of mirrored uh sort of surgical career's over about 33 years. Um So we had to leave something behind. What we've left behind, I think is uh two possibly three more surgeons that have taken on my workload in the in the ent department. Our department has grown from 5 to 12. I think yours must be in the twenties somewhere, but we know of uh Mario and Kumar who have taken on a large element of, of Ricks uh school based work, um as well as other stuff that's been disseminated to others. So I think it's been, um it's been a challenge. It's been an exciting opportunity to grow through that service. Um It won't stop here. I'm sure that and this is Rick and myself on the Colon Ridge a couple of years ago, as I say, we started a long way from where we ended. Um, we've taken on all comers when that's been appropriate and we've seen some really wacky things on the way. Uh, I look forward to what the next 35 years might bring to everybody in training and in there, uh developmental years as consultant. Um, it's a small part of what you are. Um, it's a large part of what I've done, but I'm very grateful for the opportunity of talking to you this morning.
