I: I’m David Hatch, and I’m here in the Association of Anaesthetists on the 20th of May 2014 and I’m here to have a chat with Dr Sean Tighe. Sean, thank you very much for spending the time to come and talk to us. Let’s start at the beginning and tell us a bit about your early life.
P: Well, I was born in 1955, June, in Singapore, where my father was serving in the British army, and he was a glider pilot, which was spotting Indonesian terrorists. My sister was born there as well a year later, spent two years there. I gather that was a very happy time for my parents, and we then came back to the UK and my father was closely associated from then on with the army air corps, although he wasn’t in the army air corps. He did then subsequently train in America as a helicopter pilot and developed a career in the army as a pilot, and so we were based a lot of the time around Middle Wallop, Old Sarum, near Salisbury, and we settled in Salisbury, where my mother still lives.
When I was seven my father was posted to Aiden, and we went there and I was then sent to boarding school because the army basically paid for it, and I was sent to a school called Barrow Hills in Whitley, near Godalming, at the age of eight, and I stayed there for four years and then we went to the big school, as it was called, which is St. George’s College in Weybridge, and by that time my family had returned back to Salisbury and for the rest of my time at St. George’s they weren’t too far away.
I was the first of five, two sisters and two brothers, and we had a very happy family life, although boarding school was a problem. It wasn’t a very happy time for me, and my brother went as well and my father’s career developed quite well early on and then sadly he had a coronary at the age of 38, although today it would be diagnosed as acute coronary syndrome, it was enough to stop him flying, and he never really got over that. He eventually got a job, a career job in Whitehall, and was commuting every day from Salisbury and back, and then he had a proper coronary at the age of 45, something like that, which effectively put an end to his career. So he left the army prematurely about the age of 50 or so, as a Major, and then he got involved in the health service, funnily enough, for his last few years, he was Chairman of the local Community Health Council, and then he trained as a furniture restorer at West Dean College <chuckles> for a year, and set himself up as a fine antique restorer. Sadly he died last year, but he had a good inning, he was 84 or something like that.
I: And was your mother working as well?
P: My mother worked in an on-and-off as a sort of PA for various managers/executives. She followed my father along. Basically wherever he went, we all followed.
I: So you had a military atmosphere in the family.
P: Military background from the word go, really, yes. I was very influenced by my father’s military life. He thoroughly enjoyed his job … until he got his health problems. Incidentally, his heart was never a problem to him! <Laughs> He didn’t die of it. He was more troubled by his lack of hearing ‘cause of the noise from the helicopters.
I: Was there a bit of pressure to go into the forces for the boys?
P: No, there wasn’t any pressure, but my father was delighted when I did decide to do it.
I: Did anybody else in the family do it as well?
P: No, I was the only one. It was a strange story really. Obviously I got my medical school place. Shall I tell you a bit about that before I talk about the Navy?
I: Yes, do.
P: So medicine, well I had an uncle, called Kelly, who was a big influence on my life as well. My father’s brother, older brother, and he was a GP in Croydon, and he had got the military medal in Greece in the Second World War, for street fighting in Greece, where he was a mere orderly, medical orderly, and because of the war he didn’t start his proper education until he was 25 or something and he had to start from scratch, and in those days you had to matriculate and then you, after matriculation you then applied to medical schools, and he applied to every medical school in the country, with quite good matriculation grades, and couldn’t get in. So eventually someone recognised his name at Guy’s and he was asked for interview and he was asked if he was the same Kelly Tighe who’d been in the RAFC and of course he admitted he was, and that’s basically what got him into Guy’s, where he had an illustrious career. He was Chairman of the Medical Students, he got Honours in surgery, but he didn’t qualify until he was 31 or 32, something like that. So as I said, he was a big influence. I was quite fascinated with him and his work and what he did, and I think, my parents tell me, from the age about five I said I wanted to be a doctor, and it never left me really, and I’ve always felt that was hugely helpful to me because I had an ambition right from the word go. My father was an extremely dominant character and academically demanding, pushed me very hard towards academic success – some people might argue too hard, so that although I was never top of the class, I was not far off it. And when it came to academic subject choices, which I’d had to make as early as 13 between Spanish and Biology or something, I don’t know, I was able to instantly make my mind up, what was good for medicine and what wasn’t. And those choices were made repeatedly between 13 and 15. Now at that school, if you did well at ‘O’ levels we had then, and I didn’t do particularly well, I just did well, a few A’s and the rest were B’s and C’s if I remember rightly, but I did well enough <laughs>, then you skipped the fifth form, you went straight into the sixth form to start your ‘A’ level subjects. So I did that.
I did Biology, Physics and Chemistry, my results in Physics and Chemistry were a bit disappointing, I got an A in biology, and two Cs, a C in Physics and a C in Chemistry, which these days wouldn’t have got me anywhere near medical school! But I was advised to try and take two S levels and I did pass those, so I had an A2 a C2 and a C, a very odd combination. And that basically got me interviews. And I did seventh term Oxbridge, which I was unsuccessful in, I was interviewed at Emanuel College I think in Cambridge, it was quite a disappointment to me that I didn’t get in… for other reasons I’ll tell you about in a minute. But then I was able to apply through UCCA with my results as opposed to asking for a conditional offer, so I got interviewed by Bart’s, Guy’s and King’s. Tommy’s rejected me outright. <Laughs> And I got offers from Bart’s and Guy’s and of course because of my uncle being a Guy’s man, I went to Guy’s.
So whilst at school I’d developed other interests. I’d always been very musical and was heavily involved in choral singing and I still am. I’m still in a choral society and I’m very active in that, and one of the reasons I wanted to go to Emanuel, or wanted to go to Cambridge, was I wanted to get involved in one of the Cambridge choirs, but I think if I had I’d either have given up medicine or I’d have given up the choral singing, because you can’t actually do both! <Laughs>
And I also was quite successful in rowing. We were a very good rowing school, and when I was fourteen/fifteen we had a rowing eight which won all but one race in the country, so I’ve got loads of these tankards and things from those days, in the seventies that was, where we used to win, and I had to give up really seriously competitive rowing because it took up too much … it was five days a week training and I had to get my ‘A’ level results, and it was a choice again doing them. And the crew that I left went on to row for England … and win.
So those were the two things that I got involved with at school.
So I went to Guy’s, having had a year off, nine months off between … they used to do Oxbridge in December and then you’d go to university the following September, and I went home and worked. I worked in the Common Cold Research Establishment in Harnham near Salisbury. I learnt a little bit, actually, about research, which was quite interesting. They used to get these volunteers to come and sit in a nissen hut for two weeks and be infected with a cold virus which they grew in eggs, and my job was to take them food. They were basically isolated from everybody else. They weren’t allowed outside the cabin for two weeks.
I: Were they paid?
P: They were paid, but they were royally fed! Fantastic food was given and of course I got the food too, so it was a pretty good job, and I did very little work otherwise. And then I actually got sacked from there because I was too efficient. I would have everything done by one o’clock in the afternoon, and the boss there didn’t like the fact that I was sitting on my backside most of the time with nothing to do, so I then went and worked in a nursing home as a nursing auxiliary for about three months, looking after little old ladies, and that was quite a good job actually, because it gave me a job in the holidays for the first two years, where I could earn some money. And it taught me a lot about compassion and care and particularly care for the elderly.
I: So you sailed through medical school, did you?
P: Not exactly! No. I had an interesting first experience of examinations. In my first term I had a viva voce examination in anatomy with Professor Roger Warwick, who was a very famous anatomist, now dead. He was editor of one of the editions of Gray’s Anatomy. And I told Professor Warwick that the surface anatomy of the aortic arch was x, and he politely told me that no it wasn’t, and I said, ‘No, it is!’ <Laughs> And I basically had a row with him over the examination table and of course he was right, and he didn’t like that one little bit and he nearly threw me out of the medical school, but I managed to do a grovelling apology and realised that I had to work a darned sight harder if I was going to get through this, and from them on I didn’t have any trouble. I wouldn’t say I sailed through it, but I got through all the examination hurdles at nearly the first attempt – except for one rather important one. I was an extremely idle and lazy medical student. I never went to anything before 10:30 in the morning, sometimes I never went to anything unless it was in the afternoon, because I’d usually been partying too hard the night before and I was terrible at getting up in the mornings, still am terrible about getting up in the morning, and in those days, once you got through the first two years, got through Second MB, the final three years of clinical you could just do whatever you liked. The first two years there was virtually no exams at all. And I just lived it up, I just had a great time, because I joined the Navy half-way through that.
I: Were you rowing and singing?
P: No, I tried rowing, I did a little bit of rowing, got quite involved in singing, yeah. I used to do a lot of Gilbert and Sullivan, lead parts for the medical school. We did a lot of Gilbert and Sullivan shows and had enormous fun doing those. I joined the BBC Choral Society and I was in the last year, and then I kept in with them for another three or four years after that, so I performed in the Albert Hall on the first and last nights of the proms several times, with the famous conductors of the day. I remember Colin Davis and Malcolm Sergeant and all these people.
But rowing didn’t go so well, ‘cause I went down to the rowing club the first year to have a go and I found they were all three times bigger than me and ten times fitter, so I didn’t have a look in, so I soon gave that up in favour of partying.
I: So when did you join the Navy then?
P: Right, well what happened was I’d had a row with my father – was that when I had a row with my father? No, that was earlier on. You’re entitled to apply to join any of the three forces within three years of qualification, and I think that’s still the case, so I forgot about it and applied a little bit late, about two years nine months or something, and I didn’t actually get in until about two years before I qualified. As soon as I got in of course they paid you a very handsome salary and because they gave you an allowance called ‘lodging allowance’ and all the other medical students who were in the forces were living the high life, ‘cause they were actually earning … the lodging allowance was for people who held an officer’s rank of any of the three forces, who could not get suitable mess accommodation within their area of work, and of course no medical student could go into any … so they gave them this handsome lodging allowance which was related to their rank and they were all earning more than the registrars, these students.
I joined up and within a month of joining, they removed the lodging allowance and I didn’t get it! However, I’d been struggling financially for quite a long time, having to work in pubs and all this sort of thing, and on the holiday time having to work, and of course in the clinical years there was no opportunity to work in holiday time. My father wasn’t very well off because he was trying to educate the other four kids, and he didn’t give me any help. I had a grant though, but it wasn’t really totally useful. I couldn’t live on just the grant, it wasn’t easy. So the military offered this, they pay your fees, they paid you this allowance, and I went straight out and bought a Lotus car <laughs> on a never-never, and within three months I smashed it up and wrote it off, and I couldn’t afford fully comp insurance so that was it, I was straight back to square one financially ‘cause I was paying off this loan the next three years.
But they didn’t ask me to do anything to do with the Navy, just said, ‘Get on with your studies and make sure you pass your exams.’
I: Did you choose the Navy?
P: I don’t know why I chose the Navy. I think it was more to do with I wanted to join the military but I didn’t want to follow my father’s footsteps, I wanted to be … I think it was something more like I wanted to be more independent, exert some sign of independence and not do what he did. And there was some romantic sort of ideal of going away to see. I wanted to see the world and be paid for it, and I was aware that in the RAMC at that time the only real choices were Aldershot or Northern Ireland, and so the thought of not actually being shot at but seeing the world was quite attractive, so that’s really why I did it. Also I liked the uniform better. My father was delighted.
I: You’d been on the water in rowing boats.
P: I’d been on the water in rowing boats but I knew nothing about sailing or ships or anything. I knew I wasn’t sea sick, that’s about it. It was a very good deal.
I: You say your father was delighted but you said you’d had a row with him or something?
P: Oh, just before I went to medical school, because I was living at home for that nine months, of course I’d never lived at home since I was eight and I was also a bolshy teenager and he didn’t like that, and it came to a crisis at one point where we had a fight and we were rolling around on the floor <laughs> it was quite ridiculous! So in the end he won basically and I was so humiliated I walked out and said, ‘That’s it, I’m leaving.’ So I did, and went and lived with some friends who took me in.
I: But you made it up afterwards?
P: We made it up, but I vowed that I was not going to ask him for any money and I was going to do it on my own, which he was rather grateful for I think.
I: Then I see you took the [18:21 Conjoint], which most of us did in those days.
P: That was the disaster I was telling you about. I told you about my uncle, who had Honours in surgery, didn’t I? And he was very astute actually, I used to visit him regularly, and he lived in Purley and I used to go round every month and have a Sunday lunch with him where he winded and dined me. He was a wine connoisseur and he had the most fabulous wine collection. I’ve never forgotten it. I mean I have drunk lots of bottles on 1961 Margaux, Lafites, fabulous Burgundys, wonderful Sauternes and things. Sadly I never really learnt because by the time we’d usually finished these wonderful Sunday lunches I was so pissed I couldn’t remember a thing. I could hardly walk. It was absolutely amazing. Anyway, he was a great clinical raconteur as well, and a very well-respected doctor. Sadly, in my final year at medical school he got lung cancer and he actually came in to Guy’s, was operated on, and ended up recuperating in St. Olive’s Hospital, which was just across the park from where I lived, so I used to see him every other day while he was in hospital, for about nine month period, while I was trying to take part of my exams. Actually that was a good year before …
I didn’t see so much of him for the final six months because I took the opportunity, which I discovered far too late, that I was entitled to accommodation at the Royal Naval College in Greenwich, so I moved in there and that was absolutely fantastic! My food, my laundry, I was woken up with a cup of tea in the morning, I had my shoes cleaned, had my room cleaned, everything was done. I ate twice a day in the Painted Hall in Greenwich. I don’t know if you’ve ever been there but it is the most magnificent piece of Christopher Wren architecture and internal painting, and I used to sit in there like a king, and it was cheaper than living in my digs before and allowed me to then really get down to some serious hard work. My uncle was still in St. Olive’s hospital, so I still used to go and see him. He eventually got home and he actually died a year after I qualified, while I was in my house jobs, and it was all very unpleasant, but he was there when I qualified, or so called ‘due to qualify’ because I did MB and the Navy paid for me to do Conjoint at the same time. So I did. The trouble with Conjoint was Conjoint surgery you needed to do some anatomy, clinical anatomy as opposed to formal anatomy, and you didn’t have to do that in MB surgery, so I was a bit perplexed when I passed everything in Conjoint but failed surgery in the MB. So that was a disaster – I had to tell my uncle that I’d failed in the subject that he’d got Honours in! However, I qualified, that was the important thing. And I was able then to go and do my house job, which I did in Eastbourne, and then in the December that year I retook the MB surgery, which I passed with no problem at all, because by then I’d actually seen a few patients, which of course I hadn’t done in the previous three years, because I’d been so idle! <Laughs>
So the Navy allowed me to do one house job outside the Navy and the other house job had to be in the Navy, and so I did my house job in Eastbourne, which was terrific, was in medicine, and I learnt an enormous amount, I mean it really was fantastic. Within two months I was feeling quite confident. I was completely ignorant when I started that and it was only because of the nurses, the senior nurses really, and a very sympathetic registrar, that I actually didn’t kill anyone. It was appalling, really, when you think about it, that I only learnt on the job. And then I went to a Naval hospital in Haslar to do my surgical training. I was in uniform for that whole time, it was the first time I’d ever put it on. While I was for the two-and-a-half years at medical school I didn’t have any contact with the Navy other than my pay cheque. I had long hair, I was wearing jeans all the time, I was scruffy and I had to clean up my act when I went to Haslar. First three months was absolutely awful at Haslar. I was put in a firm with a very well-known, very senior surgeon who was Professor of Naval Surgery and he was an absolute bastard, he was the most awful man. He taught by humiliation and he used to go at you until you got something wrong and then he’d humiliate you and then he’d move onto the next person and he’d go on until they got it wrong and then he’d humiliate them, and it went right the way up to the senior registrar. He was absolutely horrific. Completely useless training. And he wasn’t that great a surgeon either, he just thought he was. But the worst thing about him was that he insisted that the whole team joined him for a drink in the evening, about 5:30 something like that, in the Mess. And this was an introduction because the Navy had this wonderful boardroom they called it, fully staffed, you were fed royally at lunch time and in the evening, and a full bar, and you had to stay there and drink with him until eight o’clock at night sometimes you’d consume gallons. It was three, four, five pints, something like that and he would have five or six. It was just horrific. I was beginning to wonder what the hell I was doing in this place! <Laughs>
But luckily after the three months I was moved over to an orthopaedic firm, and I met two senior orthopaedics consultants who were absolutely delightful, very, very nice to me, taught in a completely different manner, helped me through the system, and I realised actually I’d just had a bit of bad luck. I did, however, have a great time at Haslar in all the other respects.
I: So after Haslar, what was next?
P: Right. Well then I went off … well actually while I was at Haslar doing that surgery I was beginning to think, ‘What am I going to do and what specialty am I going to go into?’ I didn’t really have any idea. I went there to Haslar thinking I’d like to do surgery but I had such a terrible experience from these surgeons, and I was aware that one of my defects in my character, which I’d been told since I was twelve, was that I was a bit verbose and tending to be arrogant, and it’s a problem I’ve had throughout my entire career and I admit I’ve still got it.
I: Ideally suited to surgery, I would have thought!
P: <Laughs> Well exactly! I felt that that would only bring out the very worst in me, and that with my character, I had rare insight I think actually <chuckles> – that’s an arrogant thing to say, isn’t it? <Laughs> There you go, you see! I had insight enough into my personality that I would probably get into trouble in surgery. I think I was right you know, because things changed, because that sort of personality is not allowed anymore. I would never have got through training I think. Although in those days it was positively encouraged, you had surgeons throwing instruments round the rooms and having screaming habdabs in theatre and swearing at people and cursing and everything else, and shouting their heads off. That would not be tolerated now. You’d be on a suspension charge before you know. And the surgeons are actually really very nice, that I work with now, they really are. I have huge respect for them and they’re really nice people. But then it was a different story. There were people who were really nice, and the people who looked after their juniors and assisted them with study leave and had high exam success rates, ‘cause I looked at all this, were the anaesthetists. And I suddenly noticed what they were doing. It took me a while to work out what they were up to, when they were just the quiet little chaps in the corner, but I realised that actually these chaps were keeping some quite seriously damaged patients alive <chuckles> while the surgeons try to sort it all out. And I realised that they were at the sharp end, and I quite enjoyed being at the sharp end, doing all the resuscitations, being involved when anyone’s really sick, and yet having senior colleagues who were genuinely interested in your career progression, and that’s what the team at Hasler were like. There were several consultants, there was a chap called David Lavernham, Ray Radford, Tony Revel, these guys were really, really nice people. Senior, just as senior as the surgeons, but nice people. And they were prepared to cover their juniors when they went off to the Southampton Primary Preparation Course, ‘cause I was very aware of the academic hurdles I would have to take through anaesthesia. So I thought I’m interested in anaesthesia, and I let it slip that I was looking at it and interested, and Ray Radford said to me, ‘Ah,’ he said, ‘well if you are interested, what I’ll do is as soon as you’ve finished your training, I’ll send you off for a few months intro into anaesthesia, and then we’ll send you to sea as the anaesthetist on HMS Invincible,’ which was just coming out of build, brand new aircraft carrier, very exciting, the latest thing in the Navy warfare, and ‘You’ll be there with a Surgeon Commander who is a surgeon and you’d form a surgical team that will go with the carriers. We’ve decided the carriers will all have a surgeon and an anaesthetist and enough kit to do surgical procedures.’ And he said, ‘You don’t have to commit to anaesthesia, but it means if we can send you there, we don’t need to send one of our trainees who’s further on in their training, to whom this will be disruptive. So it would be a good deal for us and it would be a good deal for you, and in particular,’ he said, ‘we can probably avoid you having to spend any time in a shore establishment.’ Because normally in the Navy you had a choice between serving on a surface fleet and half the time, about eighteen months, would be spent in a shore establishment dealing with venereal disease and common colds and things, and the other half would be on a ship. Here was an opportunity for me to spend the whole two-to-three years of my short-service commission at sea, which is what I joined the Navy to do. The other choices, by the way, were submarines or the Royal Marines. I didn’t want to spend my life underwater seeing nothing, and the Royal Marines was far too much like hard work. You had to be so physically fit to do it.
I: And presumably there wouldn’t have been much medicine in submarines, would there?
P: There isn’t a lot of medicine, no. There’s an enormous amount of nuclear medicine. They have to learn a lot and they become the Radiation Safety Officer and all that sort of thing, and they’ve still got 100 men to look after, and they still work in the shore establishments when they go back.
So I said, ‘Yeah, that’s great. I’ll do that.’ Then I went to Dartmouth. All medical officers have to do their new entry medical officer training, and there was a three-week, two weeks I think it was in Institute of Naval Medicine in Alverstoke, where they talked about naval medicine things, and then you went off to Dartmouth and did some square bashing and learning to march and salute and do all that stuff, which was great fun, we had a great time, wow! By this time we were promoted to Surgeon Lieutenant so we had two bars when everybody else there were midshipmen, so we outranked everybody, it was great. I remember walking across, it’s a beautiful place too, Dartmouth, really beautiful place, and I remember walking across from the accommodation to one of the sporting facilities, and a sub-lieutenant was coming across opposite me and saluted me and said, ‘Good morning, Sir’ and I saluted him back and I realised it was Prince Andrew, who’d saluted me, which is terrific! And I met him a couple of times after that, he was very pleasant.
After Dartmouth then I went to Plymouth and I did my five months when I was there training, and I was under strict instructions at the end of it not to let the surgeon do anything unless it was absolutely life-threatening, because the ship was never going to be more than 150 miles from a port and we had eight helicopters that could go 200-300 miles, and so it would have to be a really extraordinary situation that I, with five months training, would be asked to give an anaesthetic.
Unfortunately they did also know that the so-called surgeon was actually a GP who liked to do surgery – he was a Surgeon Commander and he was quite a character, he thought he was a bit of a bon viveur, he thought he had a bit of a practical joke personality but it was actually all rather embarrassing, he used to wear false noses and put peculiar hats on and things. He was the most odd man. But he had this fearsome reputation of taking out 20 appendices in nine months on HMS Eagle, right? He liked to operate. And I was told how to deal with him, which was basically to either refuse point blank to do it, go and see the Commander and drip and suck, give antibiotics, and if possible hide the patient from him in the Mess deck. And within 48-hours of sailing he had one, and I applied this principle and he backed down, and we never did anything in the end. We did a circumcision eventually, but that was the only case I did in eighteen months on HMS Invincible.
I: What sort of anaesthetic equipment was there then?
P: Well we had a basic standard Boyle’s machine with halothane. It was a plenum system with cylinders, a very similar anaesthetic machine to that which we had in the hospitals at the time, we had an ECG, we had a von Recklinghausen oscillotonometer blood pressure, stethoscope and an East Radcliffe Ventilator. The East Radcliffe Ventilator was actually a great ventilator, you know. It was hugely versatile because it was made of bicycle parts and if anything went wrong anywhere in the world, all you had to do was find a bicycle shop. It had one of those three-gear things like you had on the back of a bike those days, so you had three speeds <laughs> and it had the chain on it and all that, and if worse came to the worst, you could just pump it by hand and it could be connected, it had a small electrical motor in it as well so it would connect to an electrical supply. It was a pressure generator, a bit like the Manley, so you had a weight on the top which you could adjust and it was actually quite an effective ventilator, but a bit bulky. I’ll tell you a bit more about the East Radcliffe later but it was quite a nice piece of kit. However, I was trained to do rapid sequence induction to spontaneous respiration, extubate deep whenever possible and basically that’s what I did.
I: You had muscle relaxant or something?
P: We had muscle relaxants, curare and –
I: [33:50 IA]
P: [33:50 Sucks], curare, alcuronium I think. So I’d do a rapid sequence with sucks, tube down, hand bag them with 3 or 4% halothane, nitrous oxide, oxygen, wait for them to breath spontaneously and then extubate them on their side, deep. That was the standard technique that the seniors back at Haslar had been doing while they read the newspaper! <Laughs> Everyone got intubated and it wasn’t such a bad idea, because I learnt how to intubate quite a lot. Some of these matelots were rather large and bearded and smoked and drank themselves silly, and they were quite difficult to anaesthetise some of these guys. Gallons of thiopentone.
I: Quite a number of anaesthetics on a –
P: Not at sea, no. We did one. He was a young, very fit sailor who genuinely did need to have a circumcision done and the PMO talked me into giving him a quick anaesthetic to prove the system, that it worked. I explained that to the matelot and said that there were risks but we were only 20 miles off Portsmouth, so if anything went wrong it wouldn’t be a problem, that I felt totally confident about it, I felt happy the surgeon knew what he was doing and that he would avoid him having to leave the ship and then have to come back down. It all went very successfully. Later on we circumcised two members of our surgical support team using local anaesthetic. I worked out how to do it with a [35:22 cordle] and I did two with just a cordle, wide awake.
So we worked up HMS Invincible, did basic sea trials, then we had to do … quite a lot of trialling involved, but we did have some nice trips as well. We went to Norway and we went down to the South Coast of France, we went into the Mediterranean, and we went once over the Atlantic. The trips were reasonably interesting but they were interspersed with quite a lot of work. There was quite a big ship’s company there, keeping men in date for all their medicals that they had to have annually, because that was all part of the examination that the Flag Officer did. It was called basic, operational sea training and advanced operational sea training, if I remember rightly, and the whole ship had to go – and we had to get First Aid worked out, we had pretend fires and attacks and we had the ship’s smoke being pushed through the ship and all this sort of thing, we had exercises all the time, it was becoming a bit of a pain in the neck some of the time to be honest.
Anyway, towards the end of that I was asked if I wanted to go off early, off the ship, and I was expected to be there for two years, to do a six-month patrol in Armilla in the Persian Gulf, instead of a senior registrar in anaesthetics who didn’t really want to be that far away from his family, and he suggested would I like to go to the Armilla and have some fun in the Persian Gulf, while he took over my job on Invincible, and he put this to the appointer, who tells you where you go, and I said, ‘Yeah, that’s fine. I’ll quite enjoy that.’ So off I went, changed ship and went off to the Persian Gulf. I went out on a ship called HMS Glamorgan, in company with Glamorgan, but in fact I was again with a surgeon as part of a small surgical team, and the surgical team was actually on the supporting vessel called RFA Fort Austin, and we were on her most of the time, where we could set up –
I: Oh, that’s Royal Fleet Auxiliary?
P: Royal Fleet Auxiliary, which is the supply ship that carries the fuel and all the supplies and the beer and keeps the deployment ships supplied. We had some fabulous trips. We went to Muscat, where unfortunately HMS Glamorgan ran aground and very embarrassingly had to limp home. Her Captain and Navigator were Court Martialled. Replaced by HMS Sheffield, and I actually found, Sheffield went off to the Indian Ocean and they wanted one of the doctors to go with them and we went to Mauritius and had a jolly good time! Then I re-joined Fort Austin in Mombasa and I had six weeks in Mombasa over Christmas, just amazing! And everything was really going far too well. I was on Sheffield for quite a few weeks and actually sailed with her on the return trip and where we came into Gibraltar, and this was the end of a seven month deployment.
I: This would be about 1982?
P: This is 1982, yeah. And this was I think February, March, I don’t know, and anyway, there was I coming back into Gibraltar harbour, again where I met an old friend of mine, Alistair MaClean, who I still keep up with, he was the medical officer on Antrim, and we had some very good times ashore with him in Gibraltar, and then it was time to go home and I was going home with the team and going on Fort Austin, so I moved over to Fort Austin and off we sailed, but we were very aware that something was happening down in the Falkland Islands and there was a lot of in the press. We didn’t take too much notice ‘cause we were having a jolly good time ashore. We hardly knew what was going on in the world really! <Laughs> And it was only when I got on the Fort Austin that somebody told me this was all quite serious. HMS Endurance had sent in marines and god knows what. I thought oh my god, this sound quite serious. Anyway, can’t possibly do anything, can’t possibly be a war or anything! Anyway, instead of turning right to go round the Bay of Biscay and home towards Portsmouth, we turned left and we were told, ‘Well, we’re not actually going home. We’re off to the Falkland’s. You’re not allowed to write and tell your relatives because not only are we going to the Falkland’s, you, the surgical team, will be transferring to another assault crew to re-take South Georgia’. <Laughs>
So that was all a bit of a shock really, ‘cause we all thought it was all over and then suddenly we were having to prepare for war, for real action. We never thought that was actually going to happen in those days. But I have to admit it was also rather exiting. I was only 25, 26, something like that, and I had no huge commitments back home, and my only concerns were for my parents, who thought I was still on HMS Sheffield, and that’s when it really hit it of course, HMS Sheffield was attacked and sunk and I knew everyone who was killed on board, I knew them very well indeed and of course I was worried for my parents, who thought I was on it. They were, however, informed that I wasn’t. They weren’t told where I was.
Anyway, we went to Ascension Island, Fort Austin, and somewhere around there we transferred to another fleet auxiliary called Tide Spring and then we went in company to South Georgia with Antrim, my friend on it, HMS Plymouth and Broadsword, which was a new … HMS Plymouth was a type 21 Leander, Antrim was the same class as Glamorgan, one of those old ones, and Broadsword was a very modern type 42 Destroyer. Broadsword had a Lynx helicopter and Antrim had one of those old Wessex 5’s, but Tide Spring had two helicopters as well, and we also had a rather disturbing detachment of SAS with us, whose cabin we shared. I remember one particularly stormy night, lying there hearing a sort of click-click-click-click-click, click-click-click-click-click, and it was driving me mad, this noise going across the deck, and in the morning I woke up to see what was happening and it was a grenade rolling across like this from one side to the other! And I said to the SAS, ‘Do you realise what’s come out of your knapsack there. There’s a bloody grenade rolling across!’ He said, ‘Oh, don’t worry about it. It’s not armed!’ I was slightly reassured to see them go ashore eventually when we got into Grytviken, South Georgia.
Now something happened just before that, but in retrospect I didn’t know what it was. We used to do a lot of pretend evading, to evade submarines. We were told there was an Argentinian submarine down there, and we did in fact detect it I think, with sonar, one or two points, but we were replenishing Broadsword I think at the time, so we had all the pipes out and everything going across. By the way I did that twice in my noble career, I did these jacks, the transfer across between the two ships, which was quite exciting.
Anyway, we were doing this replenishment and we suddenly broke away, which is a very rare thing. Suddenly there was an emergency breakaway, so they cut all the pipes, diesel starts pouring all over the place and you zoom away, and we went zooming like this, but that was actually apparently they had detected a submarine and they thought it was tracking us, the supply ship, which of course would have been a complete disaster, because if the supply ship had gone then the ships would be 9,000 miles away, in real trouble.
However, we were lucky one day. We’d got into Grytviken and the submarine was in the harbour, and so the Lynx helicopter from Broadsword or Battleaxe, I can’t remember but it was one of the two, went in and attacked the submarine and put several missiles into it, one of which went through the conning tower of the submarine, and it was then disabled, couldn’t really move, but in the conning tower was one of their sailors who had a very serious leg injury as a result. Grytviken was immediately, because it was immediately we just walked into Grytviken and there was hardly anybody there apart from the submarine and the submarine surrendered immediately. They did have orders to attack us, we discovered, in there, when we got in, but there was a surgeon there from the army detachment who had already done a tidy-up of this leg and amputated what remained of it, no formal stump. The surgeons there are trained to give spinal anaesthesia and he’d done a spinal anaesthetic on this young lad, which I was quite impressed by, so he actually has the first anaesthetic of the Falklands campaign, that surgeon. Don’t know who it is, but he’s an Argentinian. We then took them prisoner, put them on our ship and three days later we did a tidy-up, created a stump, and that was the first anaesthetic of the Falkland’s war, because at that time nothing had happened in the Falkland’s. And of course that followed the surgical principles that they were required to have, which was military injuries carry huge contamination, and it was drummed into our surgeons that thou shalt never sew a wound up if it’s a high-velocity injury or an injury associated with significant contamination. What you do is you anaesthetise them, you go in, you debride, you remove whatever dirty tissue you can, you remove any dead tissue that you can, and then you pack, and then you come back three-to-five days later and after three-to-five days later you do it again, but if it’s clean you can then sew it up at that stage. And then you end up with much less chance of gangrene and that sort of thing. So the fact that the Argentinian surgeon who’d done the initial surgery hadn’t completed it was completely appropriate and it was completely appropriate then that three or four days later we tidied up and sewed it up into a stump. So that was good medicine at the time.
I: You had some experience with blood transfusion I think.
P: Ah yes, on the way <laughs> down from Ascension Island to South Georgia, we decided to have a little medical conference about how to prepare for war if it came to it, between the three ships, the Plymouth, Antrim and ourselves. So we talked about resuscitation, we talked about surgery, we talked about ketamine, we talked about antibiotic prophylaxis, and we decided that we really needed some blood, ‘cause we had no blood, we had the facility to take it. We had a time scale that we were going to be there within two weeks, so if we took it at a week ahead, we’d probably be alright to administer it down there. We had all this kit to take it with, a SIT tray and all that sort of stuff. So we announced that. We didn’t want to do it too close to it, so that our people who had given blood would be anaemic, so I think we did it about two weeks, something like that, and we asked for volunteers to take blood.
I: You had grouping [46:53] presumably.
P: We could group, we could cross-match, we did the whole thing. Group [46:57] and cross-match. So I decided that I was going to lead the show, and I was going to be first in the queue to show willing and everything like that. I’d never given blood in my life before, so in I went, gave my blood. Navy had to wear white shirts, black ties, and I went in, gave my blood, went out to have my cup of tea, poured my cup of tea, brought it to my mouth and noticed my left arm was red – the whole white shirt had gone red from the top to the bottom! And what had happened was that I’d just leaked from the thing. But I looked at it and then I felt very faint and I collapsed, fainted, in front of the entire crew! So there was the doctor, who’s trying to arrange this whole thing, completely cocked it up, ended up collapsed on the floor. When I woke up the queue was half as long as it was before.
But that blood was never used, ‘cause we didn’t do much, and in fact, when we got back to Ascension Island on the way back it had all gone off and we noticed on the way down that there were a lot of fish, particularly sharks, Hammerhead Sharks, in the Ascension Island harbour, so we threw all the blood into there and went fishing. We caught loads of these sharks with the blood we threw in. Anyway – sorry!
I: So you get the Falkland’s about three weeks later do you?
P: Yeah. Then of course the battle group, I’m not quite sure how they did it but there was a disaster in South Georgia of course, you probably all heard about this, but one of my cabin mates no Tide Spring was SAS, as I said, and the others were pilots of the two Wessex helicopters, and they were really nice guys, and the SAS guys had decided that they were going to try and attack Leith which is where Colonel Astiz and his band were established, and Colonel Astiz was well known to be a very nasty piece of work, he was the one, if you remember, who’d been accused of taking those nuns and killing them, back in Argentina, and he was an international criminal at large I think, awaiting war crimes and things, I seem to remember, but anyway, he was there with his band of special forces in Leith and the SAS had decided that they wanted to go in and retake Leith by surprise at night, by going onto the glacier, called Fortuna Glacier, and then coming down the glacier and attacking them from behind, and they would expect us to take them from the sea of course.
They were warned, these SAS guys, by our SBS Royal Marines on Antrim that this was not a sensible thing to do because it would be very difficult to put them in at 10,000 feet, the weather was very bad up there and it would be very difficult to get them out if they got into trouble.
They ignored them and went up, and of course six hours later we got a call saying, ‘Help – we can’t see, we can’t move, there’s a complete white-out. We’re stuck.’ So our helicopter went up to pick them up. Now I knew about this problem in helicopter flying, you get a condition where you get white-out and you get disorientation and you don’t know where you are, and the first helicopter got them all in but then immediately crashed and flew into the ground, called again. The second helicopter from our ship was called out, did exactly the same! So now you had I think eight SAS and six or seven crew from two helicopters, all stuck up on this glacier in the freezing cold in a blizzard with a whiteout.
I: No injuries from the crashes?
P: No injuries, no. They just flew very quietly and slowly into the ground and smashed up. And finally the helicopter from Antrim which had a sonar device on it, which the other ones lacked, managed to get up there and with a great feat of aviation, he managed to get all 16 out, I think partly using the Doppler to work out where he was, and they got out, and he got the Distinguished Flying Medal for that, and it was an amazing piece of flying, because that helicopter at 10,000 feet was struggling to get the lift that it needed.
The sad thing was, having just survived two helicopter crashes, eight of those SAS were subsequently involved in the helicopter that crashed off the back of Intrepid, I think it was, in the Falklands, after an attack on one of the islands, and they were all drowned.
I: But Astiz was taken prisoner eventually.
P: They did. I can’t remember how we did it. I wasn’t involved. We were offshore, but we suddenly found ourselves with 15 or 16 Argentinian SAS equivalent prisoners in our hold.
I: Including him?
P: Including him, which was a bit disturbing, because I knew a bit about the special forces and I didn’t like the idea of having special forces right next to me who wanted to get out! And particularly Astiz. Anyway, they didn’t cause us any trouble. We had our patient, we looked after him as if he was just one of our own and he seemed to be very grateful for the services we gave him, and we looked after all of them and their needs too.
I: And then you met up with SS Uganda?
P: And on the way back to Ascension Island yes, SS Uganda was on its way down and I knew a lot of the anaesthetists on there, it was an entirely Royal Navy medical field hospital, hospital ship that they’d created out of nothing in a matter of a week or something, and we got in contact with them over the radio and signalling and things, and they said, ‘Why doesn’t your surgical team come and join us? You’ve got all the kit and everything else. Come and join us and you can cut off that triangle and you’ll be of great assistance to us when we go down to the Falklands,’ but the surgeon I was with, who was a Lieutenant Commander now, and he was a bit wet behind the ears, said he had his orders to go to Ascension Island, so he refused to do it. But I managed to talk him into giving them our only East Radcliffe ventilator. They only had one East Radcliffe ventilator and I said to them, ‘What do you want?’ He said, ‘We could really do with another ventilator ‘cause we could have a lot of casualties and we don’t quite know how we’re going to do it.’ So we transferred the ventilator over on a jack stay and they were very grateful for that. In fact I met one of the doctors there only last week, two weeks ago, at the Society of Naval Anaesthetists meeting, chap called David Baker, he’s now in his seventies, and he says, ‘I remember that day when you sent us over your ventilator!’ <Laughs> He was very grateful.
I: And then you transferred to HMS Fearless.
P: Eventually. No, we went from Tide Spring, then back to Ascension Island, dropped off the prisoners, then turned back south, and into the Falkland Islands, and then we transferred to Fearless for the landings on Bluff Cove and Fitzroy. We missed the major landings, we missed the San Carlos landings, we missed the attacks on Goose Green and the famous attacks on all the ships in the harbour at San Carlos and we weren’t part of the field hospital that was created in San Carlos Bay by Surgeon Commander Rick Jolly and colleagues, but we were asked to cover these landings, and what happened was having secured that area, the Welsh and Scots Guards and the Royal Marines were asked to converge on Stanley and they did that from two different directions. The marines walked, but the Welsh and Scots Guards insisted on being taken by ship <chuckles> and the Marines came out with this famous phrase of yomping, and they yomped the 30 kilometres across, really quite nasty conditions. So we were landing these guards, Bluff Cove at night from Fearless, and I remember watching them going ashore, thinking gosh, these guys are going into battle for the first time, they were all very young and a lot of the Scots Guards were all terribly posh as well, and I was just thinking to myself, ‘I bet you didn’t expect this, mate! This was the last thing on your mind. You’re well away from Sloane Square now.’ But they did a great job, because these are the same guys that ended up fighting on Tumbledown Mountain and all that, on the final assault for Stanley. But we did have three nights of that, and on the day after the third night the disaster of Sir Tristram and Galahad occurred, where they were caught in the open in Bluff Cove, in a freak break in the weather, they were seen by Argentinian aircraft and there were attacked almost immediately and they were set on fire and sunk, and they had a lot of the Welsh Guards on there.
Now what had happened was that at San Carlos Field Hospital they’d had four operating tables, I think the RAMC had provided two of them and the Royal Navy Medical Service had provided the other two, but the RAMC two table contingent was being put on Sir Galahad to move to Fitzroy to provide an advance field hospital for the assault on Stanley, at least that’s as I understand it. But of course all that equipment went down with the ship. Luckily none of the medical staff were injured, although an enormous number of Welsh Guards were, so we were rapidly asked to deploy back to the original San Carlos Field Hospital to re-establish the two operating tables, which we did. We only provided one equipment but we managed to beg and borrow equipment from elsewhere to make up the other one, and the team that were on Galahad came and joined us, or some of them did. Some of them went on to Fitzroy as planned, some of them came back. And so that night I will never forget, because we had at least 150 apparently very badly burned Welsh Guards and Chinese crew members. I felt particularly sorry for the Chinese crew members, of whom there were quite a few, because they didn’t speak a word of English and I got the impression they didn’t know what the hell was going on, they didn’t even know where they were. And they looked absolutely terrible because it was all face and hands and their heads and eyes were totally blown up with oedema, and their hands were all terribly blown up. However, they looked far worse than they actually were. We went through our burns protocol and loaded them with fluids and analgesia, and oxygen as and where appropriate. We were all very concerned about smoke inhalation and we gave them all steroids to cover smoke inhalation, at the insistence of one our senior physicians who had a research interest previously in inhalation injury, insisted that this was a good thing to do; and they were coughing their guts up a lot of them. But it turns out that the majority of these patients were actually flash burns and they were actually surface and there was not a lot of deep second-degree, third-degree burns and they were very, very painful. We had to do a few escharotomies on hands and things. We had three patients who were ventilated and who went back to Uganda, two of them I think survived, and who did have second degree burns, but all the others almost had quite significant recovery, and of course one of them, one of the very important ones, was that chap David Weston is it? Who came quite famous and he actually works and lives near where I am now, and he was one of the ones who got second degree burns quite significantly. There were a few but there were far fewer than looked at the time. And then after that most of those went to Uganda. The system was they went to Uganda and were stabilised in Uganda, sent to one of our survey vessels, which are the white Royal Navy survey vessels called Hecate and Hydra and that sort of thing. Quite small little ships, and they would then take them to Montevideo where they’d be picked up by the RAF and taken home. That was the sequence of events.
I: So what was your state of mind at this stage then?
P: Well, I was quite keen to get home because I’d been away for eight or nine months by now, but it was all very exciting really.
P: No. I was too naïve to think about it I think. It never really came to me that I was under any personal threat. ‘cause don’t forget, I’d missed all the main action and what threat I had been under I hadn’t realised I was under, the submarine attacks and things. The only time I saw any real action was when I happened to be on the bridge of HMS Fearless I think, watching what was going on, and I saw HMS Plymouth attacked by an Argentinian aircraft and hit and smoke coming out of it, and I did feel a bit concerned then, because I knew the medical officer on there, and I was concerned that he might have been injured. The other occasion was when I was again standing on the bridge and I saw one of the ships fire off their Sea Dart missile system, which at that time was the latest state of the art missile system, which could pinpoint a flying aircraft and it could even shoot down a shell they said. And there was an Argentinian aircraft going over at 20,000 feet, a brilliantly clear day, and you saw this thing go off like a rocket, this Sea Dart, and the ship had the radio on of the pilots in that aircraft, and I could hear their screams of panic as they realised that this locked onto them and were taking evasive action, and then I heard … it was awful, calling for their mother and all sorts of things, it was terrible. ‘cause they knew it was coming for them. And then you just saw poof in the sky, and then just a glint of … glinting on and off as the aircraft fell to the ground. That made me realise my god, this isn’t a game, this is all dead serious stuff. And then of course we were seeing a lot of casualties in that next time, but I never really had time to think about my own personal risk. Part of it was enormous trust in the forces that were with me, who I was with, the Royal Marines, the Parachute Regiment, these are the cream of our military personnel, and I had huge confidence they knew what they were doing. They were all walking around with weapons, but one thing that did concern me a little bit initially was that when we put our sleeping courses, you know there was a [62:00] stretcher that we slept on, it was right underneath an unexploded 1,000 pound bomb in the wall of this refrigeration plant that we were in, and I said, ‘Aren’t you a little bit worried about that?’ I mean it’s enormous this bomb, absolutely enormous, as long as that table, a huge thing, and they said, ‘Oh no, no. It won’t go off. It’s no good without the firing mechanism. There’s a little propeller-thing on the end of it,’ which there was, a little propeller on the end, and he said, ‘You have to set that just right so that it has time to arm it, so it blows up at the right height, and it all depends on the height it’s dropped. And they haven’t armed it properly, look, it’s only half in’ and I thought, well fine then, it’s perfectly alright, and I just slept there for the next three weeks thinking nothing of it. But I’m told by other ballistics experts, that’s not necessarily the case at all! <Laughs>
I’d had five months anaesthetics training and I was thrown into this. It was absolutely terrifically exciting and professionally challenging. There I was, rushing around, resuscitating people from severe burns, resuscitating them from peripheral military injuries, and then taking them through to theatre, anaesthetising them, for quite interesting surgery.
I: And you were using the Triservice apparatus?
P: I was using the Triservice apparatus, yeah.
I: We’ve got one here.
P: You have indeed. I recognise it well. It was a fantastic piece of it. It’s a credit to it that with only five months’ training and one or two demonstrations I was able to use it with ease.
I: We’ve interviewed Ivan Houghton, who was responsible for it.
P: It’s a terrific piece of kit and it’s still in use today in difficult circumstances, and so it should be because it’s a really excellent piece of kit, and it makes you wonder why we have to pay £20,000 for a Plenum anaesthetic machine, when you actually give quite a good anaesthetic with something that costs you £500.
I: But you weren’t using that on the ship?
P: No. We had a Plenum system on the ship.
I: You didn’t use oxygen sometimes with the TSA?
P: No, we hardly ever used oxygen with it, because the oxygen supplementation system on it is actually very clever, a very sensible system, it’s just a simple T-piece with a reservoir, and you have three choices on the oxygen switch on it that is attached to the oxygen cylinder. As part of this kit, it’s not here actually, is the actual device that you connect to the oxygen cylinder, which gives you this switch, and it’s 0, 1 or 4 litres a minute, and 0 you get 21% oxygen, nothing, 1 you get about 35% oxygen, something like that and 4 litres you’re getting about 70-80% and there is a trick to giving 100% if you want to pre-oxygenate: you put a plastic bag on the end and fill the plastic bag up. I learnt that in a later conflict.
You can do it without oxygen at all just using 21% oxygen, and effectively the techniques works on the alveolar air equation, you hyperventilate, drop their carbon dioxide, increase their alveolar oxygen concentration and you can maintain a reasonably oxygen … of course you don’t have any great store of oxygen reservoir or oxygen if something goes horribly wrong, but in the Falkland’s we didn’t have much oxygen. We had to be careful about how we used it and when we used it. When we needed to use it, we did use it. We didn’t have any oximetry so we didn’t know what the oxygen levels were. We were working in bad light. This was a converted refrigeration plan that we were in which had no windows, so once you went in it was just dark, so we had electric lights which were very basic and we had our own generators and they generated really quite poor light to the surgeons and to us, and you had to guess whether they were blue or not. It was a bit difficult! <Chuckles>
I: Did you have any power failures?
P: No, we never did, they kept them going the whole time.
I: Did you have to get involved in resuscitation at all?
P: I did, several times, yeah. That’s an interesting point, because a statistic that’s widely promulgated about San Carlos and the field hospital was that we had 750 odd casualties through in the total period it was open, and only two deaths, and it’s widely said, ‘Wow, wasn’t that fantastic?’ Well yeah, it was a good record, but there was a problem with interpretation of that data, and that is that 350 of those were trench foot from Argentinians, and some UK, and trench foot was a very big problem out there, which is completely incapacitating and horribly painful. You often saw these gangrenous toes, it was really very unpleasant. And it’s a weird non-freezing, non-cold injury. It’s a very strange pathological process involved in it.
And the vast majority of the others were peripheral war injuries, and the reason that they were peripheral war injuries, was that the injury to reception time was very prolonged. We didn’t have enough helicopters to get them out in sufficient time. Before then in the Vietnam war they had fantastic results of very serious injuries because their injury to reception time to the hospital was an average of 12 minutes I think, but in the Falkland’s it was measured in hours, and sadly therefore if you were hit in the chest, abdomen or brain, you didn’t survive, before you got to hospital they all died, and so the only time we saw those, and there were a handful, they’d been injured very close by or the helicopter happened to be very close by. And I wasn’t involved in any major intrathoracic, intraabdominal injuries. I know other were.
I: You did write up a resuscitation protocol.
P: We did, yes.
I: In the BMJ.
P: Well my colleague, Richard Moody, and … I don’t think I was an author but my colleagues, I think the consultants got together and wrote an article which was published in the BMJ, on resuscitation in the Falkland’s, showing the protocol that we used, which was the first attempt at having an organised resuscitation policy and pre-dates ATLS and used very similar principles of we’re going to do it this way, we’re going in organised, ABC, and we’re all going to do the same, and we all know what we’re doing, and I got involved in ATLS later on in my career and recognised that this was very much where it all started really. I reckon I did 20 or 30 odd anaesthetics down there and it was the most interesting, probably one of the most interesting and challenging periods of my life. But because we’d been away for 7 or 8 months, they gave us priority to go back, which was rather nice of them, and so we went back with some casualties on one of these survey ships to Montevideo and then we were flown back from there, with the casualties, by the RAF, and arrived back in Brize Norton I think in May/June some time, and without an enormous amount of razzmatazz and everything, it was all a bit low key.
I: Were you suffering any aftereffects?
P: No, I didn’t really.
I: You know everyone now gets counselling for –
P: They do. I was fairly tired and looking forward to a good meal, a good shave and a good sleep in a nice, warm bed, but other than that I can honestly say I didn’t feel any psychological trauma, but I was very aware that after the Falkland’s Islands, we as a military force became very aware of post-traumatic stress disorder and how serious that was and how incapacitating. There was a doctor, one of the surgical trainees who was on one of the ships as a medical officer, who had a serious episode of traumatic stress disorder actually down there, and it was quite problematic at the time. But the poor guy had actually been blown up in Ambuscade and ended up in the water being rescued and things like that, so he had a pretty rough time.
I: So by then you’d decided that anaesthesia was for you, had you?
P: Yeah. I mean that experience really said wow, that was terrific, this is exciting, and I’d quite like to try this as a career. Again, because I’d had such wonderful support from the senior consultants who I’d been with, who’d been so enormously helpful and so pleasant, and who I respected hugely as clinicians as well, and so I went back to Hasler to continue my training.
Now, I had a problem with physics. As I said, I had a C at ‘A’ level in physics and I was a bit worried that the one specialty in which we had to be able to know physics was probably anaesthesia! So I actually gave myself a test and I said I’m going to have maximum two attempts at Primary and if I can’t get it in two attempts, then that’s it, I’m not going to do it. Happily again the Navy were fantastic, they let us off to do a day release course in Southampton, we went off every week for about 3 months. They let us off to do a course at the college. There were 3 other colleagues in the same hospital all doing it, all of whom were clever guys, and we all got together and we were highly competitive and we all got it at the first attempt. And that, I think, was a credit to my seniors really more than to ourselves. And that was when Primary FRCS – what was it then?
I: FFA RCS.
P: FFA RCS then, Primary had a pass rate of about 25%, something like that, it was pretty bloody awful, the pass rate, it was very offputting.
I: And you went on and got the Final in 1984.
P: Yeah. As I said, the Royal Navy had practiced the principles of MTOS 20 years before the Royal College got onto it, but and basically as soon as I passed my Primary I was immediately promoted to registrar the next day, and I then took up the duties of a registrar, and my boss immediately organised for me to go and do my additional modules of training to sit the Final Fellowship, so I needed to do paediatric element, obstetric element, neuro, cardiac, and I decided to go to Oxford because I’d heard good things about Oxford, and the most important thing was that their Final Fellowship pass rate was 80%, so I went and I just looked around, ‘cause don’t forget we could go wherever we liked, we were just a supernumerary add-on, it cost them nothing, joined in the rotas and everything.
I: Yes, several came to Great Ormond Street.
P: So they were quite keen for us to go. And Oxford have a fantastic Final Fellowship course led by people like Valerie Goat and people like that, who are terrific, absolutely excellent. And I got my Final Fellowship the first attempt as well, from Oxford. Met my wife there, she was doing the Oxford anaesthetic course, which I think lasts six months, so that was another boon from Oxford. We got married two or three years later.
After Oxford of course they said, ‘Right, it’s time for you to do your Second CDIP duty, so I went off on a ship called HMS Minerva and again went out to the Persian Gulf and the Indian Ocean, and we went to the Seychelles on that, which was quite good fun! Marred by my LMA, my medical assistant, he unfortunately got killed in the Seychelles in a car accident, which was rather unpleasant, and I had to deal with all that, but otherwise that was an excellent trip.
Back then to Haslar, and as I said, because I’d got my fellowship I was automatically started work as a senior registrar! No interviews, just straight into it, and then I was automatically organised and put in they year I had to do in my 3 years SR training in an NHS institution, and I decided to go to Glasgow for that, mainly because it was close to my new passion, which was the Scottish salmon rivers, and I wanted to take every opportunity to be fishing in Scotland. And in addition, my wife came from near there, from Stirling, so it was quite nice to go out there, and I had a great time, they did a wonderful job for me. This time I was not supernumerary, I was actually in a numbered type post.
I: And you did a bit of research up there, didn’t you?
P: Well actually I’d done quite already, before I was up there. In fact I’d done it all really before I went there, because of the Falklands, because of Horton’s [74:23], I got very interested in two aspects of it. The first was this business of oxygenation. What is the oxygenation we’re achieving on air, and is it safe and how do you optimise it? And so I did a nice, well I think it was nice, I did a study taking arterial blood-gas samples using the techniques we used down there, and I showed that in fit, young sailors, if you hyperventilate into a pCO2 of around 4 or 4.5 you can easily oxygenate them on air, no problem at all. And I compared spontaneous – it was not so good on spontaneous respiration, but with hyperventilation effectively it was effective, and that was quite important of course, to allow people to know that subsequently, that in those circumstances they could use it.
I: So has that changed the technique a bit? Because you told me before that you use spontaneous respiration most of the time.
P: Yes, well I did subsequently recommend that you actually paralyse and ventilate with it, if oxygen is a problem, and there’s another reason for that; actually it’s quite difficult to use without taking over the ventilation because without nitrous oxide … I know the trichloroethylene is supposed to take over but it has a very slow onset, trichloroethylene, and the whole thing is pretty irritant. They cough and splutter and take a hell of a long time to go deep. It’s really quite difficult to get someone deep with this kit, but it’s quite easy to get them adequately asleep if you stick a tube down and ventilate them and add a bit of morphine usually, something like that.
I: Did you induce them with this, or did you have intravenous induction?
P: We almost always intravenous. I did try once, in a difficult airway, to induce someone with 5% halothane, and it worked but my god it took – and then I introduced the trilene but it took for ever, I mean probably half-an-hour or so, and I never got the impression they were really, really, really deep.
I: So your usual technique would be intravenous induction and then –
P: Thiopental or ketamine, sucks, tube, hyperventilate, 5% halothane and is it 2%, 1% trilene, for a couple of minutes, and then gradually bring it down and keep the hyperventilation on as you bring it down, watching the patient for signs of deepening of anaesthesia. I wrote it all up in that paper.
I: But do you get both agents going on all the time, do you?
P: Both agents going all the time, but if you get down to 2% halothane and 0.2-045% trilene, and then fifteen minutes before the end you turn the trilene off, so that they actually have a reasonable wake-up time, and then we would extubate them on their sides with the reversal, and giving them morphine usually.
I: You went to Iraq at some stage?
P: I did, yes. In 1990 I was Consultant at Haslar, and in my first year as a consultant in Haslar, and the first Iraq war had already happened and I wasn’t required to go to that, happily. It was recognised that we had to have a contingent to staff the baseline hospitals to receive any casualties. In fact there were no casualties from the first Iraq war, it was all a big damp squib in that respect, and in the second Gulf War there were a few more, as you know. But in between, just after the first Gulf War there was a problem with the Kurdish population, who decided to go and sit on a mountain rather than risk coming down off them and be gassed by Saddam Hussein, because they had been gassed by Saddam Hussein in the past. And Saddam Hussein, if you remember, was still out there. And they were all starting to freeze and dehydrate on the top of this mountain, and this operation called Operation Hayman went out there to try and look after them and get them back off the mountain and back into their normal lives. So we went out there with the Royal Marines to do that operation, we were there for about 9 weeks, we did 90 operations, an awful lot of them were traumatic, a lot of people standing on mines and ordinance and exploding themselves by accident, and an awful lot of children, 50% of our casualties were children, and one day we had seven kids, all under the age of 12, blown up, and one of them was dead on arrival, exsanguinated from a femoral artery injury. Another one was literally holding his guts out like this. He lived, we got him through it and we [78:51] a little intensive care unit for him. Another one with intra-abdominal injuries, multiple intra-abdominal perforations and peripheral limb injuries, and several others with other various nasty shrapnel injuries, horrendous situation. And the other thing we had were these babies coming in with severe malnutrition and marasmus and kwashiorkor, in other words some of these babies looked like bouncing babies, they looked quite fit and well, but of course it was oedema, they were severely [79:24] anaemic, and their electrolytes were all up the Khyber and they were severely swollen up and they often had nasty infections, and we tried our best but we had no biochemistry, we had some quite good monitoring by then but we had no biochemistry so it’s all done blind, and a lot of them died, and they died in that unit, and I don’t know if you’ve ever heard an Asian lady in distress, but it’s just the most terrible noise you’ve ever heard in your life, they wail and shriek in this high-pitched thing and it goes on for hours, hours, hours on end. I did feel terribly sad for them that they were losing these babies who they clearly loved very much, and sadly we just couldn’t do anything for them and … tried our best. When it got to the stage of intubation and ventilation, there’s no point. We had no facility to back it up.
I: That really encompasses most of your military career. When did that end and what happened after that?
P: Right, well I got married in 1989 I think – 1987, sorry, my wife will kill me! And we had our first child in 1990, Andrew, just around the same time as becoming a consultant, and then I had this experience in Iraq and I realised that I wasn’t desperately keen to do it again, living in privation, living with rations. One of the funny things about Iraq, or I think amusing now, is that we had to share a lavatory with six other people, which I was pretty concerned about initially, and one of the other things that happened while we were there is that everyone got gastroenteritis for some reason or another, including me, and when you’ve got gastroenteritis I assure you, you really don’t care! <Laughs> And you just sat there and you chatted about your bowl habits with the guy next-door to you and the guy on the other side. It was the most extraordinary thing! Anyway, when I got back I reflected on that and I thought actually I don’t really want to do that again!
At the same time I had a young family and the Navy were moving me from pillar to post. After Iraq I went down to the Naval Hospital in Plymouth as Head of Department down there and I realised it was highly likely they’d post me back again and I’d have to go to sea again at some point, and if I wanted to have a career in the Royal Navy it would have been quite limited. They had announced that they were reducing the number of promotions to Surgeon Captain and to Admiral and all this sort of thing. I was very aware, I’d had a bit of an argument with one of my commanding officers about how he defined my own time, so that I could do some private practice, and he basically said, ‘You haven’t got any.’ <Chuckles> And it was that time in 1992/93 that the NHS were desperate for consultants. You almost had to be careful what job you chose. So I left the Navy, I resigned. By the way, I’d been promoted a couple of years before that to Surgeon Commander, so I resigned prematurely as a Surgeon Commander, with the pension of a Surgeon Commander, and got a job in Chester, and I’ve loved it ever since. A great decision. I’ve got wonderful colleagues, it’s a good hospital, it’s one of the top 40 in the country in terms of the overall results, it’s financially stable, which is rather good in this day and age, and it’s a very nice part of the world. I’ve been Lead Clinician, I’ve been an acting Assistant Medical Director, I’ve been Chairman of the [82:57] for a number of years and I’ve been involved in a lot of work outside the trust in regional anaesthesia in particular.
I: And you were Secretary of the British –
P: I was Secretary of the British Ophthalmic Anaesthesia Society, one of the inaugural members of that and Treasurer, and I’ve been a member of what used to be ESRA, the Regional Anaesthesia Society, it’s now RAUK, I’ve been a member for about 25 years, and I was Treasurer for about 8 or 9 years and I became President last year.
I: And you’re an elected member of this council, in 2010.
P: I was elected in 2010 to this august organisation, AAGBI, and I come to the end of my term this September, having been Chairman of the Independent Practice Committee but also heavily involved in workforce issues, in education and e-education, and other aspects of welfare of anaesthetists in general.
I: And I’m sure you wouldn’t be the first to mention it, but of course you were given the Pask Certificate.
P: Along with several others.
I: But from what we’ve heard <laughs> you all very much deserved it! That was immediately after the Falkland’s War.
P: We were very honoured to receive the Pask Certificate of Honour, amongst the I think about eight or ten military anaesthetists that were down there, and this was based on the fact that the seniors in our profession recognised that no anaesthetists got any honours or awards or mentions in dispatches, they all went to surgeons if anyone, and so it was absolutely wonderful to be recognised in this way, and in the name of someone who was historically such an innovator and risk taker himself.
I: And association with water as well!
P: And water, absolutely! Have you seen that film he’s in where he anaesthetised over the water upside down. Unbelievable wasn’t it?
I: Extraordinary, yeah!
And you got the South Atlantic Medal as well.
P: Yes, I’ve got two medals. I’ve got the South Atlantic Medal with rosette, because I was inside the exclusion zone, and I have a General Service Medal for my services in Northern Iraq.
I: And you got an award from the International Trauma Critical Care Society.
P: Yes. That was a prize for presenting, after … Iraq, wasn’t it? I managed to get I think four papers together as abstracts to go to the Trauma Conference in Amsterdam, and to be quite honest they weren’t great research. They were just descriptive, but they gave me the prize for the best paper. I know everyone says that, don’t they, they don’t think they deserve it, but I really don’t think I did deserve it!
I: And now are you getting time to do things outside anaesthesia? You’ve got the family – tell us a little bit about how they –
P: My wife would argue that I’ve never had less time because of the various things I’ve taken on recently, but yes, I have a son who is 24 and is working on London, and he’s trying to get into film sales. He’s got a degree in Chinese from Manchester. And I have a daughter who’s 19 and she’s at Manchester too, doing History of Art. So they’re both very happy.
I: And you’re singing a bit still?
P: I’m still singing. I’m a key member, I like to think, of the Chester Bach Singers, but my main passion is still fly fishing for salmon and I’m about to go to Scotland for a two-week trip in two weeks’ time and then I shall go off to Russia for a week as well, fly fishing, so can’t wait for that.
I: Wonderful. Well Sean, thank you very much for giving such a fascinating account of that unique period in anaesthetic history, which we hope will not have to be repeated.
P: So do I!
I: And we wish you well for the future.
P: Thank you very much, David.