| Description | Mr JOHN HOLMES interview on Thursday 31st August, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) JOHN DAVID HOLMES, born 9th December 1949 in Cheltenham, Gloucestershire. Retired on 17th May 2010 as a Consultant in Plastic Surgery at Aberdeen Royal Infirmary. Family background contained no medics. Always wanted to be a doctor at school, not certain why. Went to Cambridge (University) Medical School, then to St Bartholomew’s Hospital in London to compete his medical training, decided while an undergraduate that Surgery was what he wanted to do. Father in the Royal Air Force, so family moved around quite a lot, ended up in Gloucestershire, went to Dean Close School in Cheltenham for primary and secondary education as a boarder, explains. Interests in hillwalking and birdwatching; also music, sang in school choir from age 9. Studying medicine a gradual evolution, explains. Clarifies his undergraduate training process starting at Cambridge, then clinical training at St Bartholomew’s. Then his House Officer jobs; one at Barts, working for famous oncologist Gordon Hamilton Fairley, who was killed by a bomb, explains. Talks about life as a medical undergraduate; explains difference between being a medical undergraduate then, and now; you were part of the medical team; contrast with now, explains. (0:06:40) Talks about his first encounters with patients, at St Bartholomew’s. Asked about inspiring lecturers, he recalls meeting two Sri Lankan visitors, a Surgeon and his Registrar, during his first attachment on a surgical team. Decided to go to Sri Lanka to do his paediatrics; lectures were all in English, recalls one of the surgical teachers there only taught in quotes from the Bible and Shakespeare! Talks about having hands on student experience of doing their own dissections at the Anatomy school; compares this with now, when it is all done for you; can’t weed out who is going to be the surgeon, explains. He graduated in 1974; then did his House year, six months on the Oncology Unit at Barts, then six months doing Surgery at Hackney General Hospital, where his boss was future Lord Mayor of London John Chalstrey; his Senior Registrar went on to become the Professor of Surgery at Charing Cross Hospital. This was in the days when the Houseman was encouraged to attend operations and actually did operations, explains. (0:12:29) Explains in detail why he decided to specialise in Surgery. After House year went on to become an SHO (Senior House Officer), that was when you decided you wanted to do Surgery, but to get into any specialty you had to do a general surgical rotation. From his house jobs went back to Cambridge as a Casualty Officer, combined with Orthopaedics and Neurosurgery, a single year doing all those things, a very busy job; explains in detail. Explains in detail the process by which he became a Plastic Surgeon. Went across the Sahara as Medical Officer to six undergraduates on an undergraduate expedition, explains. While he was in Cambridge went to his boss and asked him to act as a referee; boss recommended him going to Aberdeen, and telling General Surgeon Mr James Kyle that he had sent him. Describes what happened; got telegram from his mother while he was in the middle of the Sahara, telling him he had been offered a job in Aberdeen. Came to Aberdeen as an SHO in General Surgery, then did Thoracic Surgery. Then a Registrar post came up in the surgical rotation, in Inverness; became a General Surgical Registrar in Inverness for just over a year; then back to Aberdeen to do more General Surgery, Thoracic Surgery, and Plastic Surgery as part of his rotation. It was then that he met Ian Muir who inspired him to become a Plastic Surgeon. (0:19:35) Clarifies timeline; first came to Aberdeen in 1977, then Inverness in 1978-79, and then back to Aberdeen in 1980-81. Explains that he knew of Aberdeen because his mother had a house in Braemar, and he also came to work in Stracathro Hospital for a couple of weeks while he was a medical undergraduate, where he learned the terms "loon" and "quine"! Explains the definition of Plastic Surgery; Oxford Dictionary definition is "remedying of a deficiency of structure", John adds to that "and of function". Thinks he joined the Plastic Surgery department in 1980; two consultants, Ian Muir and Colin Rayner and John would have been the only junior member of staff, explains. Unit housed at Ward 7 at Woodend Hospital; Aberdeen was the last major Scottish Hospital to appoint a Plastic Surgeon, explains background to this in detail. When his rotation job came to an end he was employed by the Plastic Surgery department for another year as a Research Fellow. (0:25:33) Was doing research on children’s burns. In 1983 went south to continue his specialist plastic surgery training; at various hospitals in London, came back up to Glasgow for a year, went to Plymouth, explains this was normal process at the time. Explains that during his time in Aberdeen as a Registrar he met his wife, they got married in 1983, went south for ten years. Consultant job came up at just the right time when he was fully qualified, so came back to Aberdeen. Slightly unfortunate way of getting the job; Mr Fenton appointed in 1986 when Ian Muir retired, but explains how Mr Fenton moved to job in his home town of Wakefield when two surgeons there were murdered by a disgruntled patient. At same time Mr Rayner left to go to Birmingham, so two vacancies in Aberdeen at virtually the same time. John became Consultant in 1993; Mr Kolhe (Pralhad Kolhe) had already been in post for about eighteen months, explains. Also explains that while he was a burns research fellow in Bradford in 1988, the Piper Alpha disaster occurred. He and colleagues were at a plastic surgery training conference in Leicester, on burns and the management of mass disaster. Conference was attended by plastic surgeons who had been involved in the Manchester plane crash fire, and the Bradford Stadium fire. There were all at a party at the end of the conference when television pictures came on showing Piper Alpha. Some of them came up to Aberdeen by RAF helicopter, refers to picture taken at Aberdeen Royal Infirmary helipad showing John and some of his plastic surgeon colleagues arriving to help. (0:33:23) Describes how all the operating theatres got closed, they set up four or five operating teams; explains in detail how they knew exactly what was arriving from offshore, compared with what happened with the Bradford City fire. John learned from that that you don’t just treat the injury, you treat the whole patient, explains this involved psychologists, influenced the rest of his career; mentions Eric Brianchon, the French national who died thirteen days after Piper Alpha, and having to learn to deal with the Press, as calls got through to the ward from French reporters that had not been filtered out. Goes back to his career, and getting a Senior Registrar post in London at Charing Cross Hospital and Mount Vernon, happened to be Ian Muir’s old training hospital. Explains that Ian Muir used to do Cleft Palate surgery, tells anecdote about this. John spent two years at Charing Cross and Mount Vernon, prerequisite had just come in for getting a consultant post that you needed to have further specialist training (Specialist Fellowship from the Royal College of Surgeons); John got this accreditation, came to Aberdeen as Consultant in May 1993. (0:39:40) By this time the plastic surgery unit had moved from Woodend Hospital to Aberdeen Royal Infirmary, describes its facilities; explains that specialist services like plastic surgery were separate from General Surgery, had their own managers. When John came back to the unit he ran it with the other consultant Mr Kolhe, no consultant senior to the other, explains about the other staff. No junior staff capable of handling more complex emergencies, so they worked one in two days, explains. Talks of reputation of plastic surgery in Aberdeen at time he came back; fairly good, Ian Muir a superb surgeon, had done huge amount of work to set it up. (0:44:36) Talks of co-operation with other surgical units and medical departments, one of main reasons for plastic surgery coming to ARI; especially co-operation with orthopaedic surgeons on hand surgery, explains. With only two consultants you can’t specialise, you have to be a generalist. Talks in detail about how the plastic surgery department works alongside other specialties; they could call on each other for help. Gives example of this involving an operation by a colleague at Woodend Hospital. As result the Managed Clinical Network and Sarcoma Service got set up, explains in detail. A very challenging but enjoyable part of John’s work, explains. Talks also about trauma, motorcyclists coming in with mangled legs, orthopaedic surgeons could restore the bone, plastic surgeons the skin and the soft tissue over the bone. (0:49:20) Speaks of real advantage of Aberdeen as a major trauma centre, having all its specialties on one site, contributed a huge amount to the recovery of patients. Talks about his interactions with surgeons from other specialties; plastic surgery at the heart of reconstructions, explains. Misconception that plastic surgery is cosmetic surgery, nothing further from the truth. Talks of realisation after Piper Alpha that patients with major trauma did not just need physical repair, needed psychological repair; explains difference between psychiatrists and psychologists. Refers to the fact that this dual need had been realised by Ear, Nose and Throat Surgeon Harold Gillies in the First World War, he was the father of modern plastic surgery. Talks about how plastic surgery has been around for centuries, gives examples. (0:54:37) Speaks about his contribution to the book "War Surgery 1914 - 1918", edited by Thomas Scotland and Steven Heys. John’s chapter was on the development of plastic surgery and featured a case study of George Florence, who was originally from Peterhead; explains in detail, including the head injuries from shrapnel and bullets in the First World War; talks about how Gillies developed reconstructive techniques to deal with these injuries, and how it was classic the way he treated George Florence. Talks about difficulty of researching plastic surgery because records were destroyed by a bomb in the Second World War; but a doctor called Andrew Bamji has researched Gillies, there are the Gillies Archives; Gillies also co-operated with artist Henry Tonks on illustrations of the injuries he dealt with. Feels a main contribution by the Plastic Surgery department in Aberdeen during his time there was the idea that plastic surgery departments can co-operate with other departments as part of a fully integrated team. Their other contribution was, as a result of Piper Alpha, dealing with whole patients rather than just the physical aspect of patients, explains in detail. (1:00:12) Talks about how the plastic surgery unit developed during the time he was there from 1993 to 2010. Started with two consultants and really no permanent junior staff; by time he left they were four consultants and College-recognised junior staff; many of their registrars and senior registrars have become consultants in their own right; refers to usefulness of junior orthopaedic doctors coming through the department, now senior consultants in Orthopaedic Dept, recognising plastic surgery is part of what must happen to patients if necessary. Talks about working for the NHS, but having a small private practice. Talks in detail about what Cosmetic Surgery covers; mentions psychological benefits of breast augmentation, refers to study carried out by the State of Oregon, explains. Talks about his teaching responsibilities; being appointed as a Consultant in the NHS automatically enrols you as a Senior Lecturer in the university; regarded his entire job as teaching, explains. (1:05:25) Explains how teaching sessions worked. Explains how the department was organised during his time there, pretty much worked on an equal basis, one person got the burden of being administrative head; we all had to take our turn! Talks about relations with hospital managers, some were better than others; it’s been a struggle on occasion. Eventually got the resources they needed; gives example of the Dressing Clinic off the main corridor of the hospital. Talks about his unhappiness at what happened just before he retired, Ward moved to another place, no longer had everything on same site, consultants did not have offices in the unit. There are now six consultants, but they only have 19 beds, and only three days operating a week; explains consequences. Effect of COVID on training of junior doctors and nurses. Backlog; there is a 600-patient waiting list for skin cancer; thinks in his day there would have been a waiting list of 20-30. (1:11:05) Centralisation was not an issue for Plastic Surgery unit in Aberdeen, explains. Plastic surgery does not require a lot of technical bits and pieces; most technical piece of equipment he used was an operating microscope, explains. Likes to think he was a decent reconstructive surgeon, explains in detail. Explains the results they got with their Sarcoma Service. Commenting on patients, first patient he remembers was just six weeks after he had been appointed; chap who had put his hand through a circular saw, explains he successfully sewed the man’s hand back on; describes in detail what was involved. (1:17:53) Recalls in detail some other cases he dealt with; including girl he treated for a melanoma who later came back to him for a breast enlargement operation. Regarded the future of the plastic surgery unit as good when he left it in 2010, explains in detail. Most proud of the way he tried to integrate the plastic surgery department with other departments, explains. Says he was not an innovator in plastic surgery, but did some quite advanced operations, explains. (1:22:37) Talks about academic papers he wrote; also wrote a thesis on the treatment of burns in kids, explains. Gives his views on the current state of the NHS; something went wrong in COVID, explains. Thinks that the way medical students are trained now does not give them the appropriate resource they should have mentally, or even physically, to become the doctors like we used to be, explains in detail. Also mentions the Working Time Directive; people have forgotten that we are actually treating patients, criticises management. Talks about his work in setting up the unit that dealt with congenital hand abnormalities in children; co-operation with paediatrics and neonatologists, explains; first time in Aberdeen. (1:27:28) Talks in more detail about these operations on children’s hands. Speaks about his work at national level, serving on committees at the College; training committees at the Royal College of Surgeons; was on the editorial committee of the Plastic Surgery journal; the Scottish Audit of Surgical Mortality (SASM), explains. Talks about what he has done since retirement, including being a ship’s doctor in the Arctic and the Antarctic. Had worked as a ski patroller at Glenshee for many years, once he retired did a bit more, but also taught First Aid for the Association of Ski Patrollers, explains; it was through this work that he ended up becoming a ship’s doctor, explains. Still does ski patrolling. (1:33:45) Talks about regularly working on Thursdays with orthopaedic surgeon Tom Scotland at Woodend, explains about this, and how he persuaded John to write a chapter for his book on War Surgery 1914- 1918; got Tom to go to Arras where George Florence had been fighting. Talks about how soon after coming to Aberdeen he had to deal with a patient with an agricultural injury, a severe trauma to his lower leg; the experience led to John doing an Advanced Trauma Life Support course and eventually becoming an instructor. (ENDS 1:37:26)
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