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And uh we would not be able to do what we do without the support of our anaesthetic colleagues. Uh And I was very fortunate to work with Mike Milne for some 20 years. He was absolutely my anesthetic wingman. Uh looking after me and we got to the point where Mike and I could do a 10 hour high flow bypass. And the only form of communication was the occasional grunt as Mike would come up to the head end of the operation to see what was happening. Sometimes it might even be a uh as he, as he went back to twiddle another dial, Mike. You're very welcome, sweaty palms, tachycardia, dry mouth, all because of slide, anxiety. Oh, too far. There we go. I was right. So the background of that slide is my current uh working institution. So those are overgrown Christmas trees, uh autumnal horse chestnut and the shed. I mostly put it on there for the rainbow at the top because I now live in the land of rainbows, rainbows, rainbows. And I have eight acres of Welsh Hillside, not unlike Dave Sanderman, 24 acres of Cairngorms. Um And I can echo the fact that when I'm in the woods dealing with fallen windblown spruce trees that have died. Um, I do get visited by cases even from my houseman years and marry condo, like I'm able to say thank you and goodbye. I've had enough of that. Um It's quite interesting being in a room of people with whom I've shared some of the most unpleasant times of my life. Now I trained in Southampton as part of my training in Southampton. I went to the University of Michigan. Now, the University of Michigan's football chant is go blow, which ain't great for an anesthetist. Now, in the United States, I did some neurosurgery but not a lot. I did a lot of vascular surgery and I did liver transplantation. Now, if you've done liver transplantation, unexpected bleeding does not phase you provided your kitted up for it. But the thing that did always produce problems was this. Now, this is not a test, but you can see that the way forms are frozen, the patient's breathing 100% oxygen ish. And on the trace there, you can see the CO2 over the last 10 minutes just sliding down and then coming back up again and in the room propofol is about to run out, but actually there's no activity going on. So the diagnosis is air embolism. Now, I never had any problem whatsoever with a consultant saying, are you really when I said you're getting air, they just did the stuff. The only time I had problems with, with people who are early in their training, flying solo for the first time. And I would say you're getting there and I get you. Sure. Really? I said, yep, do it. And if you're gonna identify anything for team training because actually you've got the pioneering individuals who are moving forward to getting things done as part of a team train your theater staff, train your junior residents in recognizing and acting on air embolism quickly because it can be fatal. I've only seen one fatal one. The thing to do here, of course, is to measure the gap. We'll stop the air, measure the gap and then ventilate the patient on 100% oxygen. Why you go and have a cup of tea and stop your operating and get it right. The next time, anesthesia itself in the nineties was based upon put the patient's asleep, keep them, still wake them up at the end and keep them comfortable if you can over time, it changed to. Well, do you really need to paralyze them? Uh Do you really need to give them any anesthetic agents? Oh, and opiates aren't very good. So you've been twisting and turning and moving and changing and the ideas of how you can do things are ably aided by the invention of new agents. So when I arrived in 1995 Remy fentaNYL was a good idea that burrows. Welcome. Was selling in 1996 I was able to use it for the first time and I'd suggest to you that changes in anesthetic agents are also part of why things are a bit better now than they used to be. This was the background I used to use when giving lectures as my institution. The reason for doing that is of course, inverse snobbery. Uh because I most people were putting up large white block built buildings and particularly the UFM, which anybody knows is a huge white building in the middle, an Arbor. So going down down market as it were unable to say, well, we do good things in actually quite awful environments. George Malcolm once said to me kindly. Well, Mike, you are French chain marvelous. I said, he said, what do you mean am I one brick thick and liable to fall down at a moment's notice? No, not quite. So this was taken on a Sunday morning, I think around about 2011 and we're behind the Barbara Russell unit here. So over here is the entrance towards the pre assessment unit. Now, the pre assessment unit is of immense importance because we used to think that careful neurosurgery, really expert anesthesia can produce a good outcome for a patient. But actually the patient's got a huge part to play in that the bigger the procedure. So the pre assessment, the pre habilitating of the patient is becoming paramount in judging what you can achieve how you can achieve it and what the long term outcome for that poor person is going to be. So I put it to you that you're actually quite pioneering in developing a nurse based pre assessment service before anybody else did. And they chose to go with anesthetist, which is much more expensive. There, we are. Uh what else about this? So this was at the end of a Saturday morning or there's probably Sunday morning because there's no cars here Sunday morning, Ward round. Now on the program I've written as professor. Well, you can look professorial, you can act professorial but message been awarded the professorship. You ain't the professor and I ain't a professor. I just talk a lot. So apologies to all the registrars who came through in the intensive care unit for all the time I occupied in just talking at you. Now, the next slide. Now, how long do I wait for it to change longer than that? Uh Yeah, how do I get back? Thank you very much. Are you doing anything? No, right. One, two, three. There we are. Now, this is a Rhoads Gallery. Alcohol has been consumed. This was of course, Derek because of this man. That's Peter Basket. Now, Peter Basket was a character uh motor racing enthusiast. I'm not sure that Peter past ever did much neuro anesthesia. I know he did some spine anesthesia because Rick has told me of the time the patient has thrown the Jeep fell out and he spent some time trying to put a laryngeal mask in and then said, I got to change. And uh I think always, well, but if we start at the bottom here, this is Robin. Well, Robyn Weller famously described craniotomy as, oh, it's just the laparotomy of the head. Now, I think it probably wasn't that interested in your anesthesia. And my colleagues always used to say that they could tell who had been anesthetized by somebody who pretended to have an interest in neuro anesthesia or not Gareth Green Slave famously has just been appointed at this time in 1998. And he said, is French, eh still a gentleman's club also gives anaesthetics. Now I put it to you that actually it's not entirely a gentleman's club. Judith done it. Brenda Cochran, Cathy Stone of Claire Dukes. Where are we uh who else? There we are. And uh Jenny Jenny pioneer in postgraduate medication, medical education and a pioneer for less than full time training. So no matter your orientation, if you're undertaking less than full time training in the southwest of England, Jenny was a pioneer in that. So John's or a Bob gold medal holder of the Royal College of Anesthetists, of whom there are only four. So John's or OB was instrumental in setting up the World Federation of Society anesthesiologists, the European Society of Anesthesiologists and was a college council member of both college at and any association of anesthetists um behind him, John Carter steadfast and he statist most predominant for David Sanderman in the nearest fear. Great character. Always the author of the pithy email, sir, Peter Simpson, uh presidente of the Royal College of Physicians who I first met in 1985 when I went to French to take career advice as a medical registrar. He said, if you want to be an intensive becoming anaesthetist first, I went to see Sheila Will. It's at the BR I that same afternoon and she said exactly the same thing there we are. Sheila of course, was an anesthetist at French before going to be our i as an intensive ist I don't know if she'll a worked with Mike Torrance or not. Maybe, maybe. Yeah. Yeah. Distract. So Frank Waters currently struggling with severe illness, but he's the man who said, I don't believe a word they say if they say nearly finished, they have to say three or four times before you take the slightest bit of notice. The big extension exception to that of course, is Dave Sandra who if he said nearly finished was telling the truth and that really hot we've already heard about. Um and never, never, never wish a neurosurgeon to say oops. So we got there. Well, there's me looking distressingly like Gerry Adams as I apparently still do. Andrew Diamond Pain Click Steve Cockney in Pain Clinic, Cathy Stannard Pain Clinic. And here's a, here's a chalk and cheese difference between the approach to pain of interventionism versus non interventionism and psychological training. And it's still an ongoing problem in the management of chronic pain. Tony Bennett, who is predominantly thoracic anesthetist, but I think to do some neuro. Um and he was uh quite a character. He was a fabulous organist. Uh David Cochran, David Cochran, uh famously saying in intensive care, what exactly are we trying to achieve here? So these are readjusting comments that stand you back from the fact that you are no longer where you were a fortnight ago in the passage of this patient getting out of the hospital, which is what it's all about. Um Where's Alex Menara? There's Alex Menorah, Alex Menara and Claire Jukes who taught me all the intensive care. I know when I was a senior registrar and Mark Down Huber, current consultant of South Me Meritus Cathy. And at the back there, the man who actually took this selfie photograph, the guy called Mike Pahr who was appointed on the same day as me. Now, I have to thank Peter Simpson because there were two jobs, an adult job and a pediatric job. And actually on the day, they found that nobody had applied for the pediatric job and I haven't applied for the pediatric job. However, they did some fancy footwork and they made two jobs and I found all those pediatric sessions on my component there. We are, but we did okay for a time. Now, there's somebody missing from this slide who I think you will all recognize and that's Amber. So Amber died last year and I knew that Amber, Professor Amber Young, uh I knew Amber in exeter when I was a senior registrar in 1992 at a time when she gathered the majority of her speeding point. And I knew her in French when she was appointed and she was working as a research registrar and she knew when pediatric patient's were coming in and negotiated with me as to how we were going to manage the patient's and was a huge driving force in improving care. Now, I was brought up in the time of economically constrained, do what you can within the existing resource. And it was not about that. She was about doing the very best you can and then doing it better. And with that, she was kind and dedicated to her patient's and I grew too treasure her input and understanding and we had a lot of discussion's over cups of Earl Grey tea in our shared office and everybody misses him. The final thing I'd like to show is this piece of French aid memorabilia. Now, this is the plaque of dedication from the Octagonal Museum of Medical History that was attached to the uh medical education center and you might reasonably ask why I've got it. Am I a scrap metal dealer? No, but the, this is dedicated to Monica Britain and there was a Monica Britain they used at the old children's hospital as well. Now Monica Britain's original name was Monica Main Milne and she was born in 1918. We are no relation to a, a Milne so no royalties there. But Monica was the my father's eldest sister and she was the first woman to pass the civil service exam, having been to Somerville College Oxford and she was posted to the British Embassy in New York as her first posting. But she decided to get married and therefore lost her job. So she never fulfill that ambition. And she became that rather old looking lady in a huge hat in the corner of the medical history museum. And Jack Britain was the son of the founder of GB Britain and company footwear manufacturers of Kings with Bristol. And that part of the world provided an awful lot of your patient's. But he was quite a philanthropist and he gave this memory of medical history. Now, there's an awful lot of museums, medical history filled with obsolete anesthetic equipment. So it didn't have any particular merit. But the reason I've got that is because of my family connection with French shape. So in some respects, George Sr consultant, neurosurgeon, you were correct. I was French shape and that's, that's why I was interested in working there. I don't think anybody knew that when I was appointed. I hope they didn't because it sounds like Thank you very much.
