| Description | Dr DEREK KING interview at the Sir Duncan Rice Library, University of Aberdeen on Friday November 18, 2022. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) DEREK JOHN KING born 16 June 1951 in Elgin, North-east Scotland. Retired 2015 holding the position of Consultant Haematologist at the Royal Aberdeen Children’s Hospital, and Clinical Lead for the Haematology Laboratory. Explains why he chose medicine as a career. Credits influence of his GP Dr Ernest Dawson, who also looked after the medical unit at Dr Gray’s Hospital in Elgin. Speaks of school influences, did not come from medical family. (0:03:00) Describes life as a medical student at Aberdeen University, six year course in those days. Started at King’s College, then moved to Marischal College in second year. Describes what that was like, the unforgettable smell of "The Drain", the dissecting room. Recalls visiting it a few years ago when The Anatomy Rooms were being used for the North Atlantic Fiddle Convention - as a fiddle player himself he had volunteered to help steward the event - and leaving a lasting impression on famous Scottish fiddler Alasdair Fraser! Anatomy good because you worked as a team, learned a lot, continuous assessment. Felt part of the medical community, very much in group of your own students, about a hundred of them in those days. Talks of living in digs. Speaks of what it was like to start dissecting a human body as a young medical student. Treated cadavers with respect. (0:07:28) Describes medical lecturers. Recalls lectures from Prof R.V. Jones, chair of Physics at that time. Amazing, large ego, explained his role in World War Two, not sure he taught us much physics! Recalls Colonel White in Anatomy, retired Army medic. Gilbert Hamilton, joint author of standard anatomy text in Aberdeen. Did a lot of the neuro anatomy lectures, and also about body snatching, and what had happened locally, mort safes. Prof Sinclair, Dr Skene; really got to know the anatomy staff because you spent four terms [on review of this summary corrected this to five terms] there, very supportive. Talks about first encountering a real patient in Third Year - spent a year at King’s, best part of two years at Marischal, then to Foresterhill. (0:11:06) Vivid memories of first lecture. Explains how Prof Alastair Currie, professor of pathology, came to ask him for his definition of pathology. Charismatic, very good lecturer. Describes enjoying pathology, did an extra year, explains how this led to a degree while still studying, so seven years as a student. (0:14:58) Graduated as a doctor in 1976. Describes in detail what he did then, and how he eventually became a haematologist. Mentions Dr Audrey Dawson. Talks about getting to know patients on the ward, this continuity started making him think did he want to do pathology? A lot of the patients you got to know were the haematology ones, because they were in for a course of treatment, got to know them and their families. Did orthopaedic surgery for six months, talks about registrar Tom Scotland, who later became colleague at children’s hospital. (0:19:21) Talks of the North-east of Scotland being a close community, and recalls meeting a former teacher from his Elgin school days as a patient. After the two house officer jobs for a year, full GMC (General Medical Council) registration, did a year in pathology. Was then thinking of going into medicine rather than surgery. Describes this, and being at one time Dr Andy Hutcheon’s Senior House Officer. [Brief pause in interview at 0:21:16 to deal with recording interference] Talks of doing gastroenterology with Professor Brunt and Dr Ashley Mowat; some oncology with Dr Hutcheon, also worked in coronary care unit for two months, broad experience. During that time passed second part of membership exams for Royal College of Physicians of Edinburgh, could then apply for registrar jobs. By chance a registrar job in haematology came up. Had already worked as a House Officer in haematology unit - knew the two consultants Dr Dawson and Dr Bennett, and Prof Douglas the professor of medicine. Got the registrar job, route of training to become a haematologist. But this meant two more exams. Explains why. Third time working with Audrey Dawson, as final year student did his elective with her. Another taster for haematology, wrote one of his early papers based on suggestion she had, refers to Audrey"s "ploys" to get junior staff to do a bit of research, start on ladder of publications. When he came back as a Registrar, struck by difference between ward and out-patient haematology. (0:25:13) Wondered why when he was a House Officer they were putting people through chemotherapy, because of side effects, toxicity. In the ward saw patients at their worst, some would die. When back as a Registrar saw patients he had seen in the ward, at their worst, but now recovered. Reassured him about what was done in the ward. Talks of later years at Children’s Hospital, getting nurses from the ward to come occasionally to the clinic to show them what outcomes were, that patients did do well, getting on with life. Reassurance again, that was rest of his medical life. Emphasis changed over time, but still haematology. Trained with Audrey and Bruce, then two years out in Canada. Prof Douglas had a link with McMaster University in Hamilton, number of Aberdeen and other Scottish trainees went out there. Went with his wife and two small children, 1982-84, had great time. So he was experienced and getting ready to sit second part of membership of the Royal College of Pathologists, but this was opportunity to see a different country and attitudes. Lot of staff in Hamilton from Britain, explains. More a British style of training, emphasis on clinical and lab work, suited him for coming back. It was almost like finishing school, more training and getting ready for that final exam. (0:30:52) Talks of differences between his experience of Aberdeen and Canada. Evidence based medicine, department at McMaster led by David Sackett, how to look at evidence and bring it into clinical practice. Medicine in Canada a cross between NHS and private. More advanced in terms of nurses doing more, more recognition of scientific staff in labs, though that has now changed here. Talks of patients in Canada, Hamilton a steel town, so large Scottish ex-pat community, but also other nationalities. Some of the grandparent groups did not have much English, recounts dealing with one such case of lady with severe anaemia, and having to explain what had to be done, a hysterectomy, through her twelve-year old son. Sign language also came into play, explains. (0:33:52) Came back to Aberdeen in 1984. Lecturer in Dept of Medicine, at Senior Registrar level. Explains what this meant, almost a consultant. Explains in detail how he became a consultant in 1986 and what that post meant for Aberdeen at the time. Audrey Dawson’s workload enormous and she wanted to reduce it. Part of his job was to do paediatric haematology, part to do oncology with Andy Hutcheon at Woodend, and part some adult haematology, so a bit of a mixture - what was needed at the time, a compromise post. Evolved over time when he concentrated on paediatric component, took over running of haematology laboratory. Still had some adult patients. Advantage of haematology is you can take the lab to the bedside, almost. Gives example of child with leukaemia, would always review the blood film first before seeing the child. Explains why, and explains in detail what he means by "the blood film". (0:40:27) (Change of interviewer’s microphone) Talks about haematology lab in Aberdeen, serves whole of Grampian area. Small lab at Dr Gray’s Hospital in Elgin, but Aberdeen lab linked to that. 50% of work from primary care, 50% from the hospitals. Now there’s a computer system that links up all the results from all the labs in the block, available to hospital doctors to general practitioners. Another important part of the labs is the links with clinicians, explains, used to enjoy phone calls from GPs, helping them with patient care. Clarifies what his title was when appointed as a consultant in 1986, and how his role differed from what Audrey Dawson was doing. Her original job was Haematology, when she became a consultant Professor Currie had concept of the Link Building. Explains this in detail. Linking of academic to NHS - in that building there is pathology, haematology, biochemistry or clinical chemistry, and microbiology/virology. At that time also a lab at the City Hospital which did most of the general practice work, also served patients at that hospital and Woodend Hospital, and Dr Gray’s. Reminded him of his student days doing clerkships at Dr Gray’s under Dr Ernest Dawson, when he had to take blood samples and get them done in time to have them taken by taxi to the train for sending to the lab in Aberdeen. Now Dr Gray’s has its own lab. (0:45:41) Expands upon the role of Dr Audrey Dawson at that time. Senior lecturer at the time in the Dept of Medicine, but her main roles were Clinical Haematology and the laboratory. Also did some solid tumour work in Oncology. Then Andy (Hutcheon) came to Aberdeen, first medical oncologist, then says he always gets confused between medical and clinical oncology. With Andy’s arrival Audrey concentrated more on the haematology side, wide ranging with adult work and children’s work. In those days talks about anomaly - if patient with leukaemia had infection and low blood count they went to the Infection Unit at the City Hospital and not into ARI. With Andy’s arrival Audrey concentrated on haematology, along with Bruce Bennett. Pays tribute to Bruce Bennett who he thinks was probably under-recognised because he was quiet, but did world-leading work on haemophilia and clotting. Moved at a different pace to Audrey. A lot of modern structure of haematology in Aberdeen based on the work that Audrey did and recognition that Aberdeen had to link to other centres. We’re not a big centre, but we’re good - and that applies to lots of things in medicine in Aberdeen. Audrey developed links within the hospital, nowadays multi-disciplinary teams are recognised way of managing patients, explains. Audrey recognised that very early, and had what was initially called the Joint Reticulosis Clinic, reticulosis an old term for lymphoma. She worked there with the radiotherapists, developed a lymphoma group in East of Scotland, also including Newcastle. Linking in, pooling knowledge and discussing patients. Led on when Derek was working to national leukaemia multi disciplinary team meeting, involving main centres in (Aberdeen), Dundee, Glasgow and Edinburgh. Explains about haematology patients following set protocols. Importance of multi disciplinary teams when things do not go quite to plan, you get accumulation of knowledge. (0:52:09) A lot of advances in treatment of blood cancers have been with clinical trials, mostly UK trials, sometimes European, comparing treatments. Explains process, including in Aberdeen. Important thing from children’s point of view, when Audrey and the paediatricians were looking after the service at the Children’s Hospital, creation of UK Children’s Cancer study group, involving all recognised centres in UK, Audrey got Aberdeen as a member of that. Has evolved into Children’s Cancer and Leukaemia Group, but important thing is Aberdeen is in there. Explains what this means, pays tribute to Audrey Dawson for this, Aberdeen one of the smaller centres in that group. Common theme in Aberdeen, are you too small to do certain things? Has to be balanced against what happens if you don’t do them? Explains with example of child with acute lymphoblastic leukaemia, three years of treatment etc. If not doing this locally, it would be Glasgow or Edinburgh, with disruption for child and family. Continuing fight for Aberdeen to retain status for that and other things. Some things you can’t do because they are so rare, but retaining local service benefits local population. (0:57:30) Talks of change in haematology being increasing specialisation. Talks of how the patient is important. Long term follow up. Speaks about side effects of chemotherapy, including fertility being affected. Linked with fertility service in Aberdeen to do sperm banking, explains. Relates story about one patient with Hodgkins Disease, eventually had twins with in vitro fertilisation. Talks about developing a late effects children’s clinic in Aberdeen, worked with Peter Smail, an endocrinologist, which led into the adult side. Talks of what happens when child patient becomes an adult, long term health issues, when do they move to adult hospital and who looks after them. So he organised a clinic with Prof John Bevan, another hormone expert. Derek was the continuity between children and adults, but John would take over with input about growth and development. Talks about importance for families, but how things developed as the child got older. (1:03:16) Increasing specialisation in haematology, explains in detail what this means for patients. Mentions sickle cell disease, prevalent in people of African-Caribbean race. Saw only occasional instances when he was training in Aberdeen, but that changed with development of the oil industry in Aberdeen. People from Africa came to Aberdeen, quite steep medical learning curve as they developed a service for that. Now a Scottish service exists for this. Change in demographics of population in North-east, though not great change in numbers, mixture of different ethnic groups now. On academic side, Prof Davidson, Prof Fullerton, Prof Douglas; all had interests in different aspects of haematology. Prof Mike Greaves appointed as professor of haematology in Aberdeen, those senior academic figures have brought status to Aberdeen in haematology. Talks of prestigious appointments that reflect well on Aberdeen, mentions Henry Watson and Dominic Culligan, involved in development of national protocols. Mentions Bruce Bennett and Derek Ogston again, leading researchers in the clotting side of the blood. (1:08:36 ) Explains why he thinks Bennett and Ogston were under appreciated locally. Better recognition outside Aberdeen. Explains why Audrey Dawson chose not to take part in this interview. Derek wrote the written history with her. Explains that his own main achievements relate to the Children’s Hospital. On adult side it was Audrey, Bruce, subsequently people like Dominic Culligan, Jane Tighe and Henry Watson led it, now have group of younger haematologists who are taking that forward. Talks about the lab side. Ron Davidson used to run lab at City Hospital, then came to Foresterhill, mainly a lab haematologist, very good at microscope side and advice to GPs. One of the things Ron recognised was Grampian has its own haemoglobin variant, Haemoglobin Turriff - explains. Pregnant lady from Turriff. Mimicked abnormality that related to diabetes. (1:13:12) Explains he was really appointed to provide more input at the Children’s Hospital. As well as haematology side, did solid tumours. Bone tumours with Tom Scotland. Kidney tumours with Prof George Youngson, Chris Driver. Developing those strong links backed up by team in theatre, the anaesthetists, because being children did a lot of the tests under anaesthetic for their comfort. Explains. Out patient clinics. Bleeding disorders clinic. Talks of parental anxiety. Gives example of child at clinic with low platelet count causing bruising. But could also potentially be caused by leukaemia. It wasn’t in this case, but the mum knew what Derek did and panicked when she saw him. (1:16:22) Speaks about the ward team that he worked with. Social aspect helped the team, talks about the hill walks held every year, Audrey (Dawson) one of the prime organisers. Family event, highlight always going back to Audrey to get fed. Chocolate pudding a favourite. Talks about Christmas in the hospital being different in those days, in the 1970s to the 1990s, even when you weren’t on duty you came in, family thing. But changes in workload and hours staff work makes it more difficult now. Talks more about comparisons between then and now. Talks about the hours he worked, when he did medicine as a house officer, there were two residents on the ward, only looked after that ward. So it was either you or your colleague that were on. Now if you are on at night, may be covering a large number of wards. Talks about when he did orthopaedics, if you were on for the weekend left home on Friday morning and got back on Tuesday evening. (1:21:56) Recounts in detail his typical day as a consultant haematologist. Typical working hours and days. Enjoyable, what he wanted to do. (1:24:50) Talks in detail about specialised nurses, their importance. Link between medical staff and the families, and the ward staff. When he was telling families the diagnosis would always try to have nursing staff with him, and junior doctors if possible, importance of building up relationship, that takes time. Talks of importance of Play at the Children’s Hospital. Helps with relationship with a child. Another big area is scans, very important in managing child patients with solid tumours. Often needs an anaesthetic, but play could help prepare the child and alter the age at which they might need anaesthetic. Dieticians and physios important, not as easily recognised as important part of the service. (1:29:59) Talks of getting funding from the Malcolm Sargent Fund, nurse appointed was Maureen, got into Sunday Post newspaper, who because the department covered Orkney and Shetland, called her "The Flying Nurse". Example of importance of charitable funding. Talks about how charitable funding, including the Friends of Anchor, provided other things. Grampian and Islands Family Trust (GIFT) at the old children’s hospital, the Archie Foundation when the new children’s hospital was built, fund-raising going on for the new Baird family hospital. Talks of his relationship with a Clydesdale horse called Boris, explains how this was brought to the hospital by fund-raiser George Walker for the kids to see. The late Andy Gray, who performed in pantomime in Aberdeen, paid visits. Talks of dealing with families who wanted to give something back. (1:34:36) Talks about relationships with management. Greatest understanding of management when he was clinical service lead for the lab, involves major equipment, very good lab managers in Mary Allardyce and Paul Drew. Lot of discussions with management about contracts, analysers cost several million (pounds). Usually management were helpful. It helped to have managers who came from a lab background, sometimes in health service you might have manager who had never worked in a lab. No major clashes with management. There were times planning new children’s hospital, which took years. Funding discussions. Central government said we are not funding this, has to be funded within Grampian. Had to be funded by selling off stuff, one option was selling off Woolmanhill (Hospital). But the Children’s Hospital was opened about twenty years ago, but Woolmanhill only sold off about five years ago, so sometimes difficulty between central govt and local management. Talks about developing original Anchor Unit, Andy (Hutcheon) and he spent a lot of time with planners putting it in east end of the hospital (ARI), explains in detail about this. Then the AIDS/HIV epidemic started and management wanted to move the infection unit from the City Hospital to ARI. There was almost a custom made unit there for them, so we were told there is an area of the hospital that can be developed, take it or leave it, had to shoehorn the Anchor Unit into one of the old surgical blocks. Made best deal, but wasn’t what we wanted. What we are going to get now is so much better. (1:39:32) Another example of sometimes how management don’t understand things, one of great fears for patients is when they’ve had chemotherapy and they are at risk of infection. About to open the Anchor Unit, when Derek noticed they were starting building works on the floor below. Explains that building works in an old hospital basically means fungal infection, aspergillus. Derek said they could not open the Anchor Unit, too risky. So got Tom Reid over from Bacteriology, he did tests, we just couldn’t move in. Talks about risk reduction. But managers are under enormous pressure, aware of this in lab, where can you save money? Gives example. Labs led by demand, you don’t have enormous amount of control over it. Recalls when he was a resident, if you wanted blood count done overnight had to phone whoever was in lab and ask them to do it; now overnight 100-200 samples. In those days more blood tests done manually, compares it with present day automation. (1:43:09) Talks about relationship between university and NHS work at Aberdeen Royal Infirmary. Could be fragile at times, explains why. People like Derek Ogston, Bruce Bennett, Prof Douglas, Mike Greaves, Mark Vickers did their share of clinical work. Sometimes there was tension, university pressure to get research grants. Sometimes it felt a lot of the teaching fell to clinical staff, explains. Part of our contract to teach, and important to retain teaching hospital status of Aberdeen. Pressure from government to train more doctors, but only limited number of staff and patients, pandemic made it extremely difficult to teach because of access. Always issues on the adult side about admissions, recalls what it was like when he was a resident, looking for beds. Seems so much worse now. (1:47:14) Talks about still doing some teaching, explains. Talks about also being a vaccinator for the COVID pandemic vaccines. Like a medical reunion, quite a few GPs he knew, talks of where he did vaccine sessions, including the old John Lewis department store, now closed, but still being used as a vaccination centre. Talks of some ladies almost blaming the vaccinators for the closure of John Lewis. It was clinical contact again, interesting, even met some old patients. Lists other medical professionals who were involved. (1:51:39) Talks about relative stability of population of North-east Scotland, local folk are very supportive of local medical services, fund-raising, you get continuity, has looked after two or three generations of families with the same disorder. Refers to inquiry into AIDS virus infection and Hepatitis C infection related to blood products. Explains situation in NE, factor concentrates for clotting missing from patients, give it to them by injection. Manufactured in Scotland, we would get back what we donated (from the NE) in plasma, had such good donor base got back lot of concentrate that was free from HIV. Some other centres had to buy in concentrate, in early days it was mostly the concentrate from America that caused the problems. Had a benefit probably not appreciated that because of good donor population we did not have much HIV infection in our haemophilia population, unfortunately not quite the same for Hepatitis C. (1:54:42) Explains a bit more about the "ploys" Audrey Dawson used to encourage junior staff to get on to the publication ladder. Gives an example from his own career. Goes on to explain about the various threats over the years that Aberdeen was too small to be viable in particular disciplines. It was more from other hospitals. Don’t think there was a clinical reason, never any question of our outcomes being any worse than other hospitals. We weren’t a threat, would not be taking patients from Glasgow or Edinburgh. Looking at local service, if you start taking bricks out of the wall etc. Many years ago Andrew Foote and John Cockburn wrote paper saying small is beautiful, relating to coronary artery bypass service in Aberdeen. Threatened, but good local service with good outcomes. Have to be sensible about what you can and can’t do. (2:00:01) Explains more about diseases "new" to the North-east, referred to in the written history of Haematology in Aberdeen. Tells story about thalassaemia trait in the NE, possibly involving shipwrecked sailors from the Spanish Armada. Explains about thalassaemia. (ENDS 2:04:22)
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