Dr David Wilkinson is a retired consultant anesthetist from Barts Hospital in London. He is a Past President of the World Federation of the Societies of Anaesthesiologists and was curator of the Charles King collection, setting up the Anaesthesia Museum in 1987. For the full transcript of the interview, click here.
I won a scholarship to Warwick School, which was one of the great public schools, I think it’s the third oldest school in the country, founded in 912. It was a very sporting school and I’m very big and I’m very ataxic, and quite fat and so sport was really a nightmare for me. And then I had the intellectual curiosity of a snail I think… nothing captured my imagination somehow at all at school. It was grim.
I decided I wanted to be a doctor at the age of seven and then it becomes a self-fulfilling prophecy because you then go and see aunts and uncles and they, ‘What are you going to be when you grow up, David?’ ‘I’m going to be a doctor.’ ‘Oh, that’s wonderful!’ And so, is it? Alright. Better go and do that then!
‘What are you going to be when you grow up, David?’
‘I’m going to be a doctor.’
‘Oh, that’s wonderful!’
Is it? Alright. Better go and do that then!
I came for an interview at Barts from the sixth form. Because we were in Warwick we used to go to Stratford for the theatre and it was three and sixpence for a school trip to go and sit in the gods, so I must have seen the whole of Shakespeare and everything else for years… I scrawled all this on all my application forms and I had two people interview me and the first one was an ENT surgeon called Cope and he said, ‘Do you play rugby?’ and I said, ‘Yes sir’ ‘cause I was captain of one of the house teams but I was pretty hopeless. And he said, ‘If you came here, would you play?’ And I said, ‘Yes sir.’ He said, ‘I haven’t got any more questions. What about you?’ So he turned to the next chap and this, I then learnt later on, was George Ellis, who was an anaesthetist, and George said to me, ‘You’ve written this thing about going to Bradfield College to an open air amphitheatre to see a Greek play. Tell me about that.’ So I’d been to see Antigone at this school play and it was an absolutely stunning place, they’d converted an old quarry into a Greek amphitheatre and I couldn’t understand a word of it, but it was emotionally quite a fantastic thing, so I said all this. ‘I’m pleased you enjoyed that,’ he said. ‘I went to Bradfield College as a boy.’ So I felt I was in there and I was.
“Do you play rugby?”
“If you came here, would you play?”
“I haven’t got any more questions.”
I suppose I thought I was gonna be a GP because that was the only sort of doctor I’d ever seen and I saw a lot of the doctor, I had really bad asthma as a child, so I was sick a lot of the time and so the doctor kept coming to call and that’s what I saw, and he seemed to have a good lifestyle, always seemed to be going away on holidays and he drove a nice car and things, so it seemed to be the right thing to do.
Medical School & Exams
I didn’t do any work at all for five years. Not a stroke. I was a terrible medical student. I never went to anything. When I first arrived I started to go to everything …you did two years of Second MB where you did physiology and biochemistry and anatomy and, that’s what I’d done at school, there wasn’t very much more to that. Anatomy I hadn’t seen before and I didn’t really enjoy very much. I failed Second MB anatomy and so had to retake it that summer, and eventually passed it and it was a nightmare really.
“I was a terrible medical student. I never went to anything.”
You had a month’s compulsory anaesthetics and so I went to some of that..and then I failed finals… we took conjoint and MB so you could take conjoint in bits and pieces so I failed medicine and surgery conjoint to begin with, and then I think we had to take obstetrics as MB and I failed that, then failed conjoint obstetrics and pathology and then retook it again and failed it all again.
Because you start conjoint so early I managed to then qualify by September of the year when everybody else was qualifying in MB, and I then got my house jobs and I took MB in April the following year and passed it, which was fairly straightforward.
I did a house physicians at Connaught Hospital which was a very small cottage hospital next to Whips Cross in Walthamstow. It was general medicine. There was myself, a registrar and the three consultants, so when you’re on a call there was just you and the consultant, quite stressful. I think I survived thanks to the skills of the nursing sisters and the general staff nurses on the wards really.
The next step … I had this in my mind I was going to be an obstetrician gynaecologist and I was going to solve the problems of eclampsia, I’d decided that was going to be my contribution. I was just going to be able to do this in my spare time while delivering women. So I applied for a whole series of obstetric jobs and didn’t get them. And so I … wasn’t sure what to do, I went home and learnt to drive for the first time… and applied for a few more jobs and then eventually applied for a job at Whips to do obstetrics and was given that.
So I went to Whips Cross, and met three quite extraordinary people there. There was a wonderful lady who appointed me called Daphne Caton, who would do ward rounds where we used to discuss the state of the curtains and the patients’ handbags and general clothing, and occasionally used to do the obstetric side of things. And a mad Irishman who had a huge private practice, and then another chap who suffered from very severe depression and used to wear sunglasses all the time even during the operating theatre, and on one occasion I remember him driving round and round the outside of the obstetric block at Whips Cross, and he eventually died, sadly. And one of the obstetricians there, another chap, was the Lord Mayor of Henley and he used to turn up in full regalia at times, in a morning suit to do his ward rounds and things. That was quite spectacular.
“I’d done virtually no anaesthetics as a student, and then found myself as an SHO… left to myself almost instantly.”
I did enjoy obs and gynae to begin with, and then it drove me crazy really, gynae outpatients was a nightmare for me. And postpartum women I found quite hard to equilibrate with or whatever you want to call it. So I realised that wasn’t for me and I hadn’t a clue what to do, and I was sitting there one day and there was this wonderful man called Bill Chew, who was the senior anaesthetist there at the time. And he said, ‘What are you going to do next?’ And I said ‘I haven’t a clue.’ He said, ‘Well there’s an anaesthetic job coming up. Why don’t you try that.’
So I applied and he gave me the job and it just suited me. I don’t know why or what but it just suited my personality. I’d done virtually no anaesthetics as a student, and then found myself as an SHO… left to myself almost instantly.
I can remember there was a chap called Louis de Jode who was a brilliant vascular surgeon at Whips, and he got called for a ruptured aortic aneurism and came in with his senior registrar, and I was an SHO in anaesthetics and I remember ringing up the consultant and asking could he come along and help with this and he said, ‘There’s no point’ and put the phone down.
“Congratulations getting the job. When you’ve done a bit more time here, come along and apply for a job at Barts. I’m sure we’d love to have you there.”
No point. And I remember Louis leaning over at one point and he said, ‘Do you think you could give a little more blood old chap? It’s leaking clear fluid through the graft at the moment.’ Just hadn’t a clue what I was doing really. It was pretty frightening.
I’m not sure how long I was an SHO for. Over a year I think. I took my primary and failed that several times. There wasn’t any teaching really as such. I can remember going along and asking one of the bosses to tell me about the oscillotonometer,and he said, ‘Oh, I’ve no idea. Look it up in the book’ . I think I failed three times really but they were very kind, ‘cause I’d been there for a while they put you up to registrar even though I’d failed primary. And then eventually I … was in my interview for the registrar post, the outside assessor was Dick Ellis from Barts, and he said to me afterwards, ‘Congratulations getting the job. When you’ve done a bit more time here, come along and apply for a job at Barts. I’m sure we’d love to have you there.’ So I thought wow, that’s really nice, so I then passed my primary and almost instantly there was a job available at Barts.
Consultant at Barts
I was in a completely different place because the consultants were there and they were teaching and it was remarkable and I took my final exam, I worked with a chap who’s still a very good friend of mine, and we used to bounce ideas off one another and we both passed first time. He took it the day before me and I passed the next day and so that was the stimulation I think to get me through. First time I’d done any work probably as well.
I was at Barts until March ’77, and then I became a senior registrar there. I became the chief assistant so I did all the rotas and things, I really wanted to be a neuro-anaesthetist. Neuro was just fantastic in those days. You used to do these aneurisms [by] cooling them so you’d put patients in ice baths with subcutaneous ECG electrodes and freeze them down, and you’d have oesophageal and peripheral temperature probes on them and you’d watch as it came down to a certain point you had to get them out fast or they’d fibrillate, so you had to take them out the ice bath and then you’d put them in a cooling mattress and then they were able to clip these aneurisms.
“I really wanted to be a neuro-anaesthetist. Neuro was just fantastic in those days”
I can remember going along and saying to Ian Jackson, ‘Can we introduce nitroprusside into doing these aneurisms?’ He said, ‘Yeah, you can do whatever you like.’ I said, ‘Well, going to have to put in an arterial line into these cases …’ ‘Yeah, that’s alright… pop it in, carry on…’ So I said OK and I couldn’t get the darned thing in! And I was walking up the arm in my usual way, up the radial artery, and he said to me after a bit, ‘Would you like me to have a go?’ And I thought, ‘Oh goodness, this old buffer, what’s he gonna do?’ And he just picked it up and slotted it straight in. And I sort of went … and he smiled at me and said, ‘Have you read my paper on arteriotomy and neurosurgery?’ And I said, ‘No sir, I haven’t.’ And he’d done this technique for doing aneurisms where he put in a cannula into the radial artery, bled them into a bucket, which he’d put some citrate, and then brought the mean pressure down to almost nothing. He’d then clip the aneurism and then they’d pour the citrated blood back into them and the pressure came back, arteriotomy, written up in Anaesthesia. So all these guys had done it all before.
In the senior registrar mould one of the things you could try and do was paediatric anaesthesia, I wanted to go and do paediatrics, and when I was working at Whips Cross … my registrar at that time was a guy called Rob Ayres,a very extrovert Australian who got the Nuffield Prize and then went back to the children’s hospital in Melbourne, so I wrote to him and said, ‘Can I get a job in Melbourne as a senior registrar?’ And he wrote back and said, ‘I don’t think there’s much hope but I’ll ask Kester-Brown, who was the consultant in charge there at that time. We’ve got so many of our own people here, it’s very tough for outsiders to get in, especially one as bad as you.’
So Kester then wrote to me and said, ‘I can’t offer you a job, but there’s one probably in Perth in Western Australia if you’re interested in that.’ So I thought that’s fantastic! And at the same time I got offered a job in Kingston, Jamaica, at University of the West Indies, because I’d met John Homi who was Professor of Anaesthesia there . Right at that time there was a lot of unrest in Jamaica and I remember ringing up John and saying, ‘Look, my wife now is …’ I think she was about 30 weeks pregnant at the time, ‘and we’re a bit unsure about coming to Kingston, and I’ve been offered this job in Australia and I’m not sure what to do. What do you think? Am I being silly about coming to Kingston?’ He said, ‘Don’t come David! Go to Australia. You’d be fine on the university campus, but as your wife went out on busses and things and going down to the market, people might give her a hard time, so I think you’d be better in Australia.’
“We’ve got so many of our own people here, it’s very tough for outsiders to get in, especially one as bad as you…”
So I went to Australia and had an interview at Barts for a consultant post and I was appointed to start in January 1979. I said to them, ‘Well I’ve just been offered a post in Australia for a year. Would you get a locum and allow me to go and do paediatrics for a year?’ and they said yes.
I think that was quite good in a way because I think if you’re a senior registrar for four years in a hospital and then become a consultant … It’s difficult… it’s different if you’ve been away and come back as a consultant.
Perth was magical, really, absolutely magical. Paediatrics was fantastic, I had a wonderful teacher there who I still see when I go out to Australia, Mary Liddell, a fantastic lady.
“There were times when I was sitting in deepest, darkest suburban London with the rain pelting down and I’d think maybe I should have been in Perth…”
I did an extraordinary amount of research which I never published. We had an oral pre-med which was partly amnesic and I bought a huge red lion which would be about the size of these two chairs put together, an enormous blow-up red lion, and I would give the child … half of them I gave the pre-med to and half of them I didn’t, and then in the anaesthetic room I’d show them the lion and say ‘remember this lion’ and then I’d go and see them afterwards and say, ‘Do you remember the lion?’ And the ones that had had the pre-med didn’t remember it and the ones that hadn’t did remember it. Just a sort of remembering through amnesia and that. So it was quite fun.
They offered me a job there in Perth. When I left they said they understood that I had a consultant job waiting at Barts and they understood I had to go back for that, and they said, ‘Any time in the next three years if you change your mind we’ll take you into our practice’, private practice there, and I often wonder what it would have been like. I would have had a very different life obviously and the kids would have done well I think and thrived, and I would have done all sorts of different … but who knows what it might have been like, but there were times when I was sitting in deepest, darkest suburban London with the rain pelting down and I’d think maybe I should have been in Perth.
Back to Barts
I came back at the beginning of 1980 to a new post. I had a vascular surgery with a professorial surgical unit so one professor was very keen on endocrine disease, so did a whole series of FIOs and parathyroids and thyroids. And the other one was vascular surgery … his big interest was intracranial extracranial anastomosis for patients with abnormal vasculature. So that was pretty heavy stuff and the FIOs were really a nightmare and they had a brilliant medical professor who’d control them all and then do those. Then I had urology, dental, gynae and neuro x-ray lists.
I went straight into private practice in a big way because fairly soon after I’d got home we bought a house. … I remember it was 5 years before my NHS salary was more than my mortgage repayment on the house… I found an old diary a few years ago which I was working in about ten different private hospitals around London, running around in the evenings and at weekends, just accepting everything and other consultants who were double-booked would offer me cases. I had just nightmare things I went to do.
I changed the job plan at Barts a lot. Neuro x-ray was really tough lists, we were doing bilateral carotid stabs and bilateral vertebral stabs, four injections to do carotid angiography and we used to do air encephalograms under neurolept anaesthesia where you’d have the patient on oxygen who would be strapped in a chair and then they’d inject air into the CSF and then whirl them around trying to outline all the ventricals, and they’d vomit and the cardiovascular systems would go haywire, and it was just really tough stuff.
My sessions were fairly standard and very stimulating and the trainees coming through were very stimulating, but I felt that as a consultant I ought to be doing something else as well, perhaps I ought to write something or publish or do … something. So I went and saw Peter Cole and he said, ‘No, I’ve got nothing for you. Why don’t you go and talk to the Department of Medical Electronics, or Medical Physics.’ So I went and saw Professor Watson and he put me in touch with a guy called Steve O’Conner who was a PhD physicist there, and together we decided we’d measure respiratory volumes and patients breathing spontaneously on a McGill circuit. For the first time we built a wet wedge spirometer and then tried out a whole series of agonist antagonists, nalbuphine, meptazinol, and a pre-med called Zopiclone. And we did amazing studies on this and then … I did a study on the use of ginger as an antiemetic, which was fascinating and worked as good as metoclopramide … not much different from placebo. So that was really quite exciting ‘cause working with this physicist, he really understood how to write papers and how to do proper science, and so our studies were well set up.
The Anaesthesia Museum
In my whole career, I’ve published 50 papers I think, something like that. But most of those were historical. The history started with final exams because in the FFA they asked, in the final viva, you sat at a table and they’d give you a Clovis inhaler and say, ‘Tell me about this.’ So we went to St Thomas’s Hospital and met the great Charlie Foster there. Charlie had got this huge museum at St Thomas’s and he taught us all about the equipment and it was magic. And I came back from there and Lorrie said to me, ‘Ya know Dave, you oughta have one of these museums here at Barts.’ And I thought, ‘Yeah, that’s true! Why don’t we?’ And so I started collecting.
“I’ve found this cupboard in the bottom of Theatre C with this stuff in it…”
There was a free GP’s magazine called Pulse and I used to put free adverts in that saying, ‘If you’ve got any old anaesthetic equipment I’d love to come and get it off you and have a look’ and Norma and I used to drive off round the country collecting anaesthetic equipment and bringing it back to Barts. And then you’d find the ODA would suddenly come up and say, ‘I’ve found this cupboard in the bottom of Theatre C with this stuff in it…’
I think I went to a couple of the Association’s annual meetings and joined at that stage, and Dick Ellis at that time, with Charlie Foster were co-curators of the Charles King collection. They’d taken over from Bryn Thomas who’d been the first curator, or the second after Armstrong. So Dick was too busy doing other things and Charlie Foster never went to see the collection, which at that time was in the College of Surgeons in the Nuffield Block on the top floor. So Dick suggested that I could… take an interest in that and I met Tom Bolton and we got on and so I got appointed to Charles King Curator in 1982, so it was only a few years after I’d become a consultant, and I carried on doing that until 1995.
“History is my passion really… I’ve given hundreds of lectures all over the world on history”
We set up the museum in the basement of 9 Bedford Square. We’d had it in the Nuffield Department and … they were shutting the whole thing down so we had to get rid of the whole collection. So we got the company to come along and pack the whole thing into cases and store it. It disappeared off the face of the earth and then when the Association bought 9 Bedford Square they gave us the basement area and Tom was the head archivist, I was the curator, and Ian McLellan from Leicester, another youngish person like myself fascinated by history, he looked after the books, he was the librarian.
History is my passion really and always has been, and worked really hard at history, I’ve given hundreds of lectures all over the world on history. I haven’t written as much as I should have done because I’ve been so busy doing other things. I’m constantly being chided by other historians that I need to write more. The final culmination of that was being appointed Wood Library Lauriat in the History of Anaesthesia, which I was appointed in 2008, a four-year position, and that was a highpoint as it were, but I was President of the History of Anaesthesia Society, editor of their proceedings when it first started.
“Things were really alive still. And the people that you meet, I think that’s the excitement for history for me because it is so tangible”
When I was collecting for my museum… I remember being given a Clovers inhaler down near Southampton once, and the chap told me that he’d last used it in 1966 in this domiciliary obstetric practice for somebody with a retained placenta, and so things were really alive still. And the people that you meet, I think that’s the excitement for history for me because it is so tangible, and it’s not something you’re trying to find on the tomb in Carnac or whatever, trying to understand the hieroglyphics. It’s there, it’s in black and white, and the other thing is you’d think by now with all the stuff that’s been written on anaesthesia history there’s nothing new, is there? But I go along to history meetings on a regular basis and there’s always something brand new and really exciting coming out of it.
GB & Ireland, Europe and the World…
I enjoyed my time as Honorary Secretary at the Association. It was a fantastic job. I think it’s the best job in the world really! Because you knew the whole of the country, you knew exactly what was going on throughout the whole thing. And I had a wonderful president that I served, Leslie Baird, in Glasgow… it was just a very social time… and Leslie was a big influence on me because he at that time was Secretary of the European Section of the World Federation of Socities of Anaesthesiologists [WFSA] so he then became president and I became his secretary there.
Because I was then meeting people from all around the world it seemed like a natural progression to apply for Council of the WFSA, which I again didn’t get elected onto that. I failed and I was appointed onto the Constitution Committee, what was then statutes and bylaws, and then I became Chair of Statutes and Bylaws, and Chair sat on Council. And then I applied from there to be Secretary and Treasurer and then President.
“It was a fantastic job. I think it’s the best job in the world really!”
I think Great Britain and Ireland, Europe and World were all so different, although they were all stimulating in different ways. I’ve always been very much an Association person. I think I flogged my guts out for the Association really. It was something I really believed in very strongly. I worked very hard for that, and so that was my prime focus. And then moving into Europe was a lovely expansion. All those phenomenal people that I met across Europe, the SENSA board were really exciting meetings to go to and to listen to people talking about so many different things in different countries.
I think the other thing that was going on at that time in parallel with that was my work for the College. I became an examiner for the College fairly rapidly and got involved in the primary, where you start off, and I was the guy who brought the OSCEs into the primary, so I ran the OSCE exam and… it was a 12-year examinership at that time and usually after about 6 or 7 years you moved up to the part 2, but I enjoyed the OSCE so much I didn’t want to do that so I stayed with the primary for my whole 12 years and I had a fantastic group of people running the OSCEs together and producing new questions and running the whole thing. It was really challenging. I really enjoyed that.
I think the Association did serve its members well during that time… it was in touch. I think one of its great strengths has always been the GAT Committee, the Trainee Committee, and to have the incredible nous to put GAT right into the Council so that everything happened all the time. I think that’s such a skill to bring the next levels through and so I think it’s served its membership very, very well. I think everybody who was involved in it really cared about trying to get things right for the person who was working out there on the periphery.
“We rejuvenated the whole of the Board and Council… and made it a much more vibrant, active sort of business”
I’m very proud that the WFSA now has an organisation in an office which can support whoever is appointed president in the future. My big concern was that we had too much of the … the WASP syndrome, the white Anglo-Saxon Protestant running WFSA, not totally but it pretty much … and there was a need to create a structure that would allow anybody, whatever their language, whatever, wherever they lived, to be able to be president of this organisation, and it’s supposed to be a world organisation. So one of the first things I did was appoint a Chief Executive and … I was very fortunate to find a unique person who’d spent a long time working with the Red Cross, had worked all over the world, spoke three or four languages fluently and understood what we were trying to create. So he’s there in the office and then we appointed four other staff to make it a really vibrant, active thing.
The other thing I’m really pleased about was reopening our links with the World Health Organisation. Back in 1955 we used to have talks with them all the time and we’d been invited to meetings all around the world… which must have been pretty dull I think, a lot of them, because they’d be discussing clean water as an anaesthetist in wherever, so after some time in the seventies they’d stopped replying to World Health Organisation and that had been that, and I reopened that link and started going to Geneva attending the World Health Assembly and we’re really right in the forefront of the World Health Organisation again as a prime mover.
And the other thing I think, we rejuvenated the whole of the Board and Council and… rewrote the constitution twice and made it a much more vibrant, active sort of business. It used to be if you joined Council of the WFSA, you met on the day that you were appointed at the World Congress. You then might meet two years later on, and then you’d meet when you handed over two years after that, so people didn’t do anything. Some people did an incredible amount and some people did nothing, and there was no communication or anything so we’ve changed all that. If you don’t communicate, you don’t contribute, you’re asked to leave and we appoint somebody else, and that applies to all the committees as well, so it’s very exciting I think.
I’m no longer President of the World but I’m still connected. I’m a trustee of the charity, the WFSA UK Charity.
My wife and I met at Whips Cross Hospital. There was a bar in the hospital in a place called India Lodge… and this lady appeared with another chap one evening. They used to have discothèques every Friday night. We were just chatting and she said, ‘Why don’t you ask me out somewhere?’ And I … what? I couldn’t imagine. I mean she was stunning, I thought! And I couldn’t imagine anything less likely that she’d say yes. And we went out and had a drink in a pub in Loughton and one thing led to another.
’76 we married. I was still a registrar. Fiona was born at Barts when I was a senior registrar there, so she was born in ’77. And then … when she was fairly young, a year-and-a-bit, when we went to Perth, and Norma was about 32 weeks’ pregnant… We went along and saw an obstetrician and he sent her for a scan and I was doing a list in the theatre in the Children’s Hospital and they said, ‘Phone call for you, David’ so I wandered off and a voice said, ‘Ah, can you come and get your wife? She’s really making a heck of a fuss down here at the scanning unit… about this cripple child you’re having.’
“It’s about this child you’re having… I can’t find one of his legs at all on the scan… your wife seems rather upset…’
I said ‘WHAT?’ ‘Oh, haven’t they talked to you about that?’ ‘Erm … no…’ ‘Ah, hang on a minute, I’ll go and get the doc for you.’ So I’m on the phone thinking … what, what … and this voice in an upper crust British accent said ‘Oh, hellloooo… oh, you’re English. How marvellous! Where are you from?’ I said, ‘Look, what the heck’s going on?’ ‘Oh, your wife’s very upset, it’s about this child you’re having. Honestly, it’s terribly hydrocephalic and I can’t find one of his legs at all on the scan, so I’m afraid you’d better come and get her. She seems rather upset.’
So I went and picked her up and I remember sitting on this park bench next to the beach wondering what on earth we were going to do. We went and saw the obstetrician and he said, ‘Look, it looks really grim… We need to deliver it straight away because otherwise you’re gonna have to have a caesarean section ‘cause the head’s so big …’ So at about 34 weeks or something we went in and Norma was induced and… out came a baby boy with a normal-size head and all limbs normal, absolutely plumb normal, at about 34 weeks… well it was just a horrible mistake they’d made and I think scanning at that time was not very accurate. Stuart is now two inches taller than me, so he’s about 6’7” and a pretty mean basketballer…
Then seven years later, after Stuart, we had Andrew, who’s my youngest. Andrew was born at Barts as well. I was a consultant there then obviously. He was one of the last obstetric births because they moved the obstetric out to Homerton after that.
My daughter became a physiotherapist, she’s in Canberra in Australia… she met an Australian and married him. So I’ve now got two grandchildren in Canberra. My eldest boy Stuart, hydrocephalic with one leg …who isn’t, is now a consultant respiratory paediatrician in Manchester, and he looks after home ventilation of children, which is extraordinary. I didn’t know it existed but he’s got some couple of hundred patients on home ventilation, and so he’s married with two daughters in Manchester. And then my youngest son, Andy, after two years in Australia after he’d qualified, came back to this country and started his anaesthetic training and he passed his FRCA two months ago. He’s working at Barts and the London, but he has been at Whips Cross as well. So it’s a very strange thing…