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And is that uh yeah. Uh I think continuing the theme of a neurosurgical work life balance. We have Mr Peter Kirkpatrick uh from Cambridge who's going to talk about from neurosurgery to flying hurricanes. Good afternoon, everyone. And uh great joy for being here. I feel a bit of a fraud because I never actually did my formal neurosurgical training at French. Eh, I did my first six months sho job but clearly cause so much trouble in that period I was remembered. Um Now uh next slide, please. So I, I trained as a medical student in uh Cambridge and after my house jobs, I decided to go north and partly attraction to that was go to this place, the middle one there. That's the Edinburgh Royal Infirmary. And as a time when Douglas Millar used to run the head injury service in one of those turrets. It was something uh you know, kin to Harry Potter sort of seen and you'd have to climb a load of stairs to get up there. Usually have to exchange nice words with a ghost, come in the other direction and get right up to the top and there's this fantastic facility, which had its own theater dealing purely with head injuries. So I did two months of that and uh then returned after doing a higher degree in neuroscience and started my surgical training and the first job was of course that French a as a uh sort of a rather arrogant and uh hotheaded sho um Now, within about a millisecond of me arriving there, I had Hugh Griffiths and Brian Cummings kicking the hell out of me. I can tell you and uh Hugh and uh Mike soon joined in the fun as did the sisters on the wards and the theater sister and I thought I'm not going to win this battle. Uh So I had to behave myself and do what they said. And I think they sort of endeared my personality because probably when they were younger, they were exactly the same. Um But that six months completely changed my whole avenue in terms of uh career in the same way we just said about Charles. And one of the things that happened there was I noticed even in those young days that the guys that subspecialized example here with his post here, uh posterior fossa stuff and Mike with dysfunctional stuff that's once they concentrated and Hugh with his pituitary is that the results were absolutely fantastic. But some of the pathology was more common pathologies like head injury and uh over vascular stuff was more generic and that was very much sort of hit and miss and that was copied throughout the whole country. At that time. I remember going into theater once with Hugh Griffiths, uh going to clip a middle cerebral artery aneurysm and he couldn't find it. And I think I've been there about three weeks and uh he was huffing and puffing. And then I said, Mr Griffiths, you need to go further laterally in the uh Sylvian fissure. If you're gonna find this aneurysm, the whole theater went silent. The ODS ran out literally taking one other scrub nurse and the theater nurse who's scrubbed, I can't remember her name but, but she's looked at me in a blood just drain and uh, Hugh just went completely silent, didn't see anything but then quietly went along lateral uh fish. And I was just praying that he'd find this aneurysm. And he did said nothing, didn't thank me. And he just said, close up, closed up. And, uh I said, Kirk, have you been born with a death wish or you just plainly stupid? I think it's a mixture of both. And if I tip to my way back into Hughes office, saying your patient has woken up fine. And I was about to say, and she's very grateful you found the aneurysm, but that's sort of stopped it at that point. And he says, Kirk, you've obviously got an eye for vascular anatomy. You need to be a new uh vascular surgeon out. Um, and I had a similar sort of feedback from uh Brian Cummings who's very influential as well. So from that time, he uh and, and Hugh Coke um recommended I went off to this place, which is the Maudsley because that was slow me down again or a bit. And um there I got trained under Jeffrey mccabe who was a Norman dot pupil and also by Tony Strong, who was a Lindsey Simon's pupil and to sort of techniques were superb and I sort of managed to gather bits and pieces from both of them. And I certainly learned that you can learn more from one operation done very well than 100 done badly. And Maudsley was very, very slow in that respect. And then I was hoping to get back to two French at some point, but the stars didn't align. And uh there was an appointment in this uh architectural wonder of uh Addenbrooke's Hospital with uh John Picard and I, I've been there ever since. Next. Life is uh so I went on uh two sub specialize, in fact, a subspecialized that the s are levels really think about it. And uh John Picard and David Hardy, they were very supportive, they realized that vascular. So it's a bit of a mess there. And from that, we sort of developed a new vascular unit and then went on with the help with people like rick to develop British neurovascular group. And sub specialisation started to take off in UK next time. And of course, when you think about neurovascular surgery, you think of all the fancy stuff and assume, realize that. In fact, it's a simple stuff but large volumes of it that rarely had the impact. If we could get all that lot done very, very well, then you'd be actually providing a decent service next live. One of the things we found out, Peter Hutchinson when he was a, I think it s a joy this stage, we sent them off into the region to go and gather all this information. And we found that uh 200 patient's of thereabouts who had not been admitted to the hospital for new with ruptured aneurisms had succumbed and about 80% of them are avoidable because we should have brought them over in time or they had poor grade, you'd hydrocephalus and so on and so on. And we transformed this and accepted every patient and numbers of annual admission's subarachnoid hemorrhage doubled within ear just on that pace is next time a few things that I felt were key to impacting our, our service was um certain bits of kit. Now this is a portable CT. And I remember Brian saying to me, but one day on a ward, he said, you know, when you're trying to get a patient into a scan, he said, what we need is a portable CT scan and of course they didn't exist then. But as soon as the one that came available serotonin. We purchased one out of uh charity funds and it just transformed a lot of the maneuverings on the intensive care unit. You know, if a patient didn't wake up from uh their operation, you could have a scan within five minutes. We also started to get on table CT angiograms which gave us that quality control check at the end, which I felt was very strongly missing. But that facility soon got superseded. Next line by this, this is a game changer EICG stuff. I'm sure every vascular surgeon will, will acknowledge this where you even as a seasoned neuro vascular surgeon, you think you've got your clip in the most perfect position but perforators not seen their adjusted by just a fraction of an angle and the perforators fill up. And uh we found that these sorts of maneuvers virtually eradicated, technically um derived disabilities in his patient's next life. The other thing alert from Brian and uh Douglas Mill of course was the, was the uh importance of monitoring our patient's. Uh And um uh we'll set off firstly with this ICP but then modified to seems like TCD laser Doppler near infrared. And when Peter Hutchins did his phd added a Micra Dallas iss, these are key developments uh for designing trials next slide and I just picked a handful of papers, you know, your, you know, published children's papers, most of which have no impact whatsoever, but these ones did. So this was looking for a solution which would improve several blood flow and reduce ICP for more than just 20 minutes, which manifold did most of our patient's took four or five hours to get to us. And we had a whole range of fluids from the modern plasma expanders and oxygen carriers except for blood and none of them came close to the good old hypertonic saline. And you can see the change of flow characteristics in the scene on scan, dramatic dramatic changes in ICP improvements in oxygen and lasting up to six hours after even further. So this publication, I think is quite key because that really encouraged the whole country if not the whole world to swap from Mannitol two hypertonic saline. Of course, the vets could have told us this 70 years ago because that all that came up to me when he heard this, he said, you know, with these cows was septicemia, we'd go up to the mid film antibiotics and nothing would happen. We'd give him some Mannitol, nothing happened to give him some fluids and nothing happened. We fill them up with hypertonic saline and they stand up and walk away. It's extraordinary that we didn't have that sort of information next time. Uh And these things underpinned two key international studies which I was investigated for, which is one after the uh rescue ICP study based on this one slide here which shows with head injury induce ICP, the mortality shot up at an ICP of about 25. So we chose that there's a threshold and if we hadn't, this study would have been negative so that this was crucial, Mount Chanaka, it takes a huge amount of credit for that. And likewise, next slide for some but not hemorrhages stash study was based on this information again, TCD and so on. Uh phase two studies which showed promise uh regrettably the stash study was uh negative for reasons. I don't fully understand, but at least we answer that question. Next line, neurosurgical training had great fun. I think um Rick and uh French and um Cambridge is probably responsible for populating most of the country with neurovascular fellows in the early stages. And uh I've had great join doing that. I think probably about 90% of them were okay and the other 10% or less okay. But uh we did a good job with these next please and also started uh to the SPNS. Um I was the uh conference organized which gave me great scope in terms of seeing all the units and how people worked and so on around the country. And this was one that we held in uh Cambridge. And at this stage just beginning to get an interest in uh these little devices. Next, life retirement planning. Next it strategy or my, my colleague Ramos Kyrillos is from Alexandria, uh Egypt. Um He was on to this and he told me I should be building a boat, uh ancient boats. When I died, my wife had through the ashes into this boat and drift off into the afterlife. So I took that with all seriousness but didn't actually build a boat. We built, both built an airplane before I died. Um Next time the aviation side of things. Um I started a medical student with the only thing I could afford to do, uh, still maintain the best entertainment you can ever get, but it's so time consuming and, uh, you know, it doesn't take a weekend at competitions a longer. If you're on international competitions, the girlfriend's didn't like it either stance, sitting on a windy uh hill and then being summoned to come and pick you up 300 miles away. Um, and all of hang gliders pilots I've competed with either divorced or had a failed business or both. Um, so I knew that that wasn't compatible with a neurosurgical career. So we, we went to the next stage which was a microlight, had some great fun with this. And I was very pleased that when Brian Cummings came over to Cambridge to give a talk. It's about probably in about a year or two years before he unfortunately passed, he insisted, um, he still treated me like, you know, schoolboy at that time and insisted I took him up in this. And so I arranged at five o'clock in the morning because he was early waker and took him over and being Brian is quite economic with the truth. At times when I asked him what he weighed, he said 15 stone, which is at the upper limit of our combined weight. Of course, he wasn't in the near 18 stone. And so the Microlite was crowing down this uh grass runway which was a golf driving range towards this potato field and no sign of air coming between and can. He's shouting instructions from behind saying Kirk get this fucking thing off the ground and said, I'm trying to cause you got to know point. Eventually it kept took off and it's sort of leveled a few of these potato plants as we took off and he was laughing his head off. And now as I was sucking my some at the front, going backwards and forwards and the sweat and uh eventually got it down. It's a great memory for me any we didn't when I moved to Bristol operated on a farmer's uh father with a big meningioma. And as a, as a sort of a compliment for that, he said, oh, come up to my airfield, which we did and it's only two miles from where we live. And um he got me involved with the RF people and everything we learned how to fly this, which is an aerobatic pit special. And he soon learned that when you get into that, you have no idea how to fly an airplane. It took two or three years to get to get to grips of this. And um we use it as a test for the neurovascular fellow. I think that's Dedryck Baldrick in there. Um And uh Diedrich is uh an iron man. He goes on all his iron course everything, but he just fell apart in this. I totally fell apart. So we had to keep him back three months. Um Next lively and it's about 608 years ago now that I was made aware of this project, which involved the renovation of a Mark One Battle of Britain serving Hurricane. And um uh with a couple of colleagues interested people, we said, well, we're going to have to do this and help to get it finished. So we spent four years watching the scene being put together and it is absolute privilege, the engineering, it goes into these things over a million bits going to haul Carrick and yet they're turning out 20 a week. It's just extraordinary. Um And the complexity of, you know, thousands of bits of paper with these sorts of schedules on schematics rather, next slide and equally famous, of course, as well as well as engine and had the joy of watching this being uh an old instructional um engine being taken down to its bare bones and eventually coming out like a, you know, a work of art. So these were the Merlin threes which powered all the Spitfires and Hurricanes in about the Britain exactly the same plane about engine, about 1100 horsepower and it fits in like a glove like so uh next slide when this has been done next, life is um realized that obviously have to go and get trained to fly the thing next one. And lo and behold, David Hardy had a colleague. Does anybody recognize him? The Hume Coca might actually he was, he's, he's um Jo Goodman. He trained under Tom King as a uh an acoustic surgeon and he was from Ohio and he happened to be this visiting um David and came over and see the hurricane projects. And I was thinking, how earth am I going to get? 40 hours of training in one of these, which is a Harvard T six military plane. And he said, oh, I've got one of those Kirk, you just have to come over and put fuel in it. So I did and this was Southport and Wilmington. And uh he even provided a military instructor guy who served in Vietnam, badly affected by agent orange. And if you know that that's the insecticide. So he had every single joint in his body replaced and his cardiac vessels changed, etcetera. And yet uh he's still alive and kicking and this was an immense fun. I spent three weeks over. That's absolutely fantastic next live. Um So this is it, we've got going with the plane and uh even get paid for flying it at uh photographers in another plane, the cockpit is busy. The plane as you can imagine, it's got this 1000 horsepower engine, 80% of which is just generates heat. So the cockpit that gets absolutely oven. Like you've got these tiny little 19 thirties instruments which you're telling you how the engines working can barely see them. That one. There is the water pressure and he's like, as you can imagine our critical. So if that needle starts to point towards the vertical, I over 100 degrees, you've got about a minute before that engine stops. So it's quite stressful. You could when you first fly these things, as you're looking at this the whole time in a hot and noisy and everything, it's flying around a huge speed. Um It's not just a visual effect that we become passionate about. Of course, the Merlin Sound, the engine next slide. Um So it's been used obviously for film settings and you'd fly buys and so on. Next slide. So my next door neighbor's attractive woman whose grandfather used to be a groundsman for the Hurricane cruise. And so he had to share that connection. She lost her father a year ago and this was the anniversary of that death. And she asked was I fly in the hurricane that day and said, yes, said, well, I'm having a private ceremony. Would you just fly by? And uh next slide, the giggle says it all, it doesn't, I mean, it's just so much passionate next life. Um So she's pleased. Now we found out quite a lot about this plane and very interestingly who shot it down. It's just chap here. Good staff, Sprick Western Front and he was very famous pilot. And um uh we asked Germany, a surgeon used to visit us. You know, could you find out if Sprix got any surviving relatives and hopefully they're billionaires and they can have pay for, to put the bloody thing back in the sky again. Unfortunately, very fortunately, that was good hearted. Found her. We did and that's law and she was a school teacher. She lived in the same farm that was her kids. Uh my wife and son at the time and she had a box or remember billiard given to her by her mother and she was terrified about opening it because it may attract an unwanted visit even to the day. So, but she did open it for us and in it was his Irons Cross and he was awarded this, the shooting down his 20th plane and a bittersweet factors. Ours was the 20th plane. Next slide. You also had a whole uh three albums of him going through Hitler's use his training, you know, these were boys and he was only 22 in his picture with his uh Irons Cross and this is him and his messerschmitt which shot down our plane. Interestingly, we always think these cartoons, an American only thing the RF wouldn't allow you to do this. But in fact, it was the Luftwaffe which started this off. We wondered what that was and we eventually found out it was a cartoon from the 1920 30 is bringing up Father by Manus. This is his hapless father who kept getting himself into mischief. And obviously the Germans appreciated those, uh, Anglo American cartoons and each plane had something like that on it. Here is some, er, beside the Christmas, the Christmas decoration, this is him uh with his eyes cross. We think it's the time he was actually anointed with this cross. Uh but he's looking a lot of sheepish and we've got a psychologist to look at this and she said, oh, he doesn't want to be there. He really does not want to be there. And I'm only showing you part of the picture because when you see the full picture next, you see why not? And uh so this, this picture popped out of the album and we sort, he still scares the living daylights out of us. Uh And um so huge about the history mainly from the German side uh connection with ours. Next slide, our chap Rogers, you in Rogers was fortunately survived and having been shot down and he went on to get a distinguished flying medal for bomber command and survived the war. One of the few did next slide, there was not without its moments. So, so this is uh was only into my second hour flying. This thing did a loop and suddenly there's a huge vibration and the pain the plane went into a deep spiral and I managed to control it, thinking what the hell has happened and looked out the wing and saw this and your heart just sinks because the plane was stricken. You could, you could only just about keep a straight and level with a stick right away over the plane was still full of fuel, you know, 80 gallons of fuel. It was getting dark at night. So you had to land fairly soon. You're thinking how the hell you gonna configure the plane to landing? Um, you did successfully landing, but we found out the cause because the plane had been used by Dan Snow too. Uh Film Battle of Britain and our plane featured quite lots of the camera crews and everything we're in it. But what we didn't know is after we've gone home after the flying, the camera crew asked an engineer or can we have a look in the gun panels? These, you know, browning machine guns and the technician clearly hadn't buttoned down. So this is about two square meter piece of metal of which about half of that was stuck up causing a perfect break. And by the grace of God who managed, managed to get it down intact, I'll come back to these two little bits in a moment. But uh one of the mentors, you know, Brian like mentor uh from the re I said uh did you, did you, did the world go in front of you? Did you know, did you, what, what did your life go in front of you? Did you have a picture of your, your wife, a child? And I said no, um what came into my mind was this next slide? It was the dog, I mean, who, who is going to walk the dog? Come on, let's get real here. Can you go back and slide again, please. There's another issue. So just survived that I got patched up and, uh, see a looks all over it and everything. But there's this, which is a joint on one, the undercarriage, it called a fork joint is six of them. And we discovered at one point that they had over engineered this as a, as a borehole crochet right into the shredded plates. So it made it highly vulnerable and the consequence of that next slide. And the next slide was that absolute disaster. This was about 2.5 years ago and we didn't know what had happened and I got blamed for it. Uh, and the, you know, that oil painting of Brian, well, I've got a similar one on the insurance wall that's splattered with rotten fruit. Um, but it happened to another airplane and discovered the problem and looked at these joints and about four hours were critical. So, in retrospect, it was a joint failure. Next slide before we start this, this, this is a part of a film um set. Uh It's quite, I find it quite emotional because it's showing quite a lot of the 501 squadron uh members, most of whom I know the names of, most of them didn't survive. But just to let you know, SD, this is suffix I was sdoxsd is from 501 hurricane uh squadron and the suffix is, is personal to the plane. Uh the X and you start off with a BCD, go all the way through his head and you start back at a again because by the time 26 had been shot has been built, the had been shot down. Um Next side as soon as you, why you need to keep your head in when you're starting. Thanks. So um time well spent, I've no question in my, my mind that neurosurgery having done medicine was, was the correct discipline for me. Very much a right sided brain person. I suppose you could make the argument that medicine is a bit of a waste of intelligence. And we should all be going into much more entrepreneurial areas and earning the country money rather than extracting money from them. But there's another argument I've loved the places I've worked, only slight regrets not coming back to uh to French A for some of my training, the people I'd say about 90% of them. I really did respect and, and, and your, and I think all the uh consultants at French, they were exceptional. Um Remember Mike Tom's uh asking a question, why do you need 20 neurosurgeons? And I'd asked that very question because there's no doubt there's a linear relationship between the dysfunctionality in a department and the number of consultants there. So, um I think Mike, you probably had the happiest period available flying without a doubt, it's an absolute pash in and honoring those people that, that allowed us are free lives. I think it's something very important to me. Would I do it the UK? No question about it. I think I went through a good time in the UK. Of course, you would have probably um earn more money, etcetera in a different country. But for me and a period of time and the freedom of developing it was, was a UK based and I wouldn't have had it anywhere else. Am I going to continue to stay in the UK? Well, that's another question, of course. Um and Ian Poeple, you know, sort of has laid out the bones of a potential move. We, we go out next slide, we often go out to Antigua and um again, it's Brian current coming. She told me was the, the source for a happy life is a happy wife. And uh my wife is very much happier in the warm climates and she becomes much less user friendly in the cold for a cold, I have to say. And, and interestingly, even though antigen only got 80 90,000 people, you know, it's got a pretty good health service as well. You can access them immediately. And, um, yeah, you probably wouldn't looking for a brain surgeon problem, but you wouldn't quite choose your open heart surgery, brain surgery. But a lot of the other stuff they're not bad at and it's free. I just can't get. Why are health services having so much trouble when Antigen, who has the most corrupt, uh, you know, government that you can think of, who can get it? Right. Um, so any fancy, some holidays in Antigua, this is going a very, very economic rate, uh, to those who attended the, uh, French, I suspect what will really happens. We'll spend probably about two or three months a year out there and rest back in the UK because I can't really think of any other place I'd want to live. Um, on that note, I'm just thanks to the organizers and particularly thankful to those four neurosurgeons who are, who really did sentence send me on my way. I was just very regretful. I didn't have more time with Hugh Griffiths before his illness. Um, but plenty of time with Bryan and Annie and that was, you know, a real joy for me. Thank you very much. Thank you.