| Description | Prof ZYG KRUKOWSKI interview on Wednesday 13th September, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) ZYGMUNT HENDERSON KRUKOWSKI, born 11th December 1948 in a Nissen Hut in Logie Camp, near Crimond Aerodrome, Aberdeenshire. Explains he did not retire, he was forced to resign in 2016 from his post as Consultant Surgeon with a special interest in Endocrine Surgery, Professor of Clinical Surgery, and Surgeon to the Queen in Scotland [after raising clinical concerns.] The resignation was subsequently found to be constructive dismissal and he won his case against Grampian Health Board [whose actions were found to be “unfair, incompetent and unlawful”]. Family background, father was Polish, fought and was injured during the Second World War, explains in detail; met his mother in Scotland during the War, she was told he was dead after the invasion of Europe, but he was not dead, explains what then happened to his father. No medics in his family background. Went briefly to school in Crimond, then family moved to Aberdeen, went to school in Balgownie, then [Bridge of Don primary school], which was in the county. Sat an entry exam to get into one of the senior schools in Aberdeen City, but was then offered a bursary to get into Robert Gordon’s College, which he attended between 1960 and 1966; talks about the experience of being at Gordon’s. Worked hard, got all the Higher exams he needed to get into Medicine, but because he was only 16 had to wait another year, explains he did Advanced Art in Sixth Year and won prizes for his art. (0:06:27) Explains he was attracted to Medicine because it demanded the highest qualifications. As first person in his family to go to university, did not apply to anywhere other than Aberdeen, explains. Started six-year medical course in 1966, explains. Life as a medical undergraduate, not the usual one, did not drink, did not do usual socialising because at the time he and his brother were interested in racing motor-cycles, were Scottish champions in 1970. Zyg painted the wall decorations for the Athletics Ball one year. (0:10:26) Recalls first day as an undergraduate when he went into the wards, old Ward 3 in the Medical block, thinks it was Dr [Ian] Gordon, an [impressive] old-fashioned physician; explains about the first two patients he encountered. Talks about his reaction to what he encountered, and how he gravitated towards Paediatrics; interested in all aspects of Medicine, except Psychiatry. Inspirational lecturers; Colonel White in Anatomy was a terrific teacher, Dr Mackenzie the Embryologist was outstanding, explains about his illustrative skills on the blackboard. Zyg’s class came after Prof Lockhart, Prof Sinclair had taken over the Chair of Anatomy; Zyg really enjoyed Anatomy dissection, explains. Lectures in Human Ecology were a new subject. Speaks about Physiology being peculiar, practicals were Victorian, explains. Clinical teachers who stood out; Prof Currie had trick of picking people to answer questions out of a group of about a hundred; Jim Petrie, not a professor then, was a lecturer full of enthusiasm and go; Andrew Foote, a Consultant General Surgeon, was a senior lecturer and always very innovative, explains. Talks about how Prof George Smith was placed in Aberdeen, by Prof Sir Charles Illingworth from Glasgow, ahead of Hugh Dudley; explains in detail. (0:18:17) Graduated in 1972 with Distinction and the prize in paediatrics, first House job in paediatrics in the Children’s hospital in Aberdeen, explains in detail; second House job in Ward 10 with George Mavor and David Blair, a complete epiphany, decided Surgery was for him, explains why; talks about difference between David Blair and George Mavor, and how the latter was one of the prototype vascular surgeons in the world, standard long vein bypass done nowadays was his operation, explains in detail about this and his approach to surgery; and how he dealt with angiograms. (0:23:34) Tells anecdote about colleague Jim Cosgrove, who struggled a wee bit with George Mavor. Zyg explains why he sometimes had to take blood from his boss George Mavor. Zyg explains he wanted to do Surgery, but not appreciating the antagonism between the NHS and the university he spoke about this to George Smith, the Professor (of Surgery), who said he should get the Primary of the Fellowship of the Royal College of Surgeons as fast as possible, and get a demonstrator’s job in Anatomy. George Smith phoned Prof Sinclair, and Zyg went to see him and arranged to have an Anatomy demonstrator’s job the next year; a year in Anatomy in preparation for the Primary academic part of the FRCS, The second part was taken a minimum of four years [after graduation] when you actually got the FRCS, although could take four to ten years to get it. Recounts after one of the ward rounds how they were having tea in the Sister’s room, Peter Woodruff was the Senior Registrar (nephew of Sir Peter Woodruff the Regius professor in Edinburgh) and he said to George Mavor that Zyg had decided to do Surgery, Mavor’s reaction when he discovered Zyg had already spoken to George Smith; said he needed to also do research, phoned Prof Malcolm, professor of Physiology in Marischal College and arranged for Zyg to do vascular research in the Physiology Dept at the same time as he was [studying for primary]. Zyg explains in detail what this involved when he finished his House year. Explains about studying, also research, and the help he got from his father who made a device for the research to Zyg’s design. Sat first diet for the Primary, came second overall, first time this brought his name to attention of Norman Matheson. (0:28:45) Carried on with the Anatomy teaching and more vascular research. Explains how he met his future wife Margaret, who was doing midwifery in Aberdeen. [In late] 1973 Margaret phoned telling him George Mavor was dead, a bombshell in the hospital because he was only [54], explains circumstances. Zyg had become quite friendly with his son, explains. George Mavor had written down the names of people he wanted at his funeral, and Zyg was one of them, attended it in Ballater. Explains arrangement with George Mavor was that once he had completed his year in Anatomy, got his Primary and done the vascular research, that he would join his ward as Senior House Officer. But when Zyg spoke afterwards to Mr Blair, who was now the senior surgeon on Ward 10, he discovered the SHO job had already been given to someone else. Blair phoned Prof Smith; Zyg was offered SHO position in his department on condition that he did a PhD; this position meant Zyg being employed by the NHS for three years; explains this involved a lot of clinical and research work. Important consequence of George Mavor dying was that Jetmund Engeset, who had been sent to Sweden to learn transplant surgery, was phoned by George Smith who told him he had better learn some vascular surgery; so he came back as a vascular and transplant surgeon. Zyg and George Youngson were both on the academic unit as SHOs, got on extremely well with Jetmund, a terrific teacher. (0:34:15) Zyg assisted at the first six kidney transplants in Aberdeen, with George Youngson, explains in detail. By the time they got to the ninth and tenth operation, George and Zyg were doing all the operating with Jetmund assisting them. Describes in detail the twelfth operation, Jetmund and George away, Zyg as an SHO had to perform the transplant operation by himself; unimaginable that would happen with an SHO operating unsupervised nowadays. Explains how and why he took every opportunity to operate, and how he came to assess other operators. Doing PhD convinced him that he did not want to work in a lab, though gave him invaluable exposure to lab methods, statistics and [critical assessment]. (0:39:58) Explains that six months in Casualty was a requirement for the second part FRCS and he spent the equivalent in the Orthopaedic Trauma unit as an SHO. Also did a spell as registrar in Urology and Neurosurgery, explains; talks of the benefits to him of doing Neurosurgery, mentions Chris Blaiklock as being an excellent neurosurgeon. Explains the university had arranged for one of the Lecturer/Senior Registrar’s in the academic unit to go to Raigmore and the RNI (Royal Northern Infirmary) in Inverness as a Senior Registrar for two years. John Logie was first person to do that, Zyg was the second, explains; George Anderson and Arthur Robb were the consultants there (in RNI), describes them both. Raigmore Hospital had two consultants, including Richard Baker whose interest was vascular surgery. Second year Zyg was there Alasdair Munro was appointed consultant, great working with him because he had spent a lot of time working with Peter Jones, and some with Norman Mathieson. (0:44:03) Zyg introduced Alasdair Munro to Flexible Endoscopy, explains. Also explains that before he went to Inverness he had worked with Norman Matheson to see [his abdominal and endocrine surgery]; he had also taken over the Endocrine surgery when Bill Michie retired, so Zyg saw assisted him with thyroid, parathyroidand parathyroids and GI (Gastrointestinal) procedures, including gastrectomies and colectomies, explains he never saw anyone do it so neatly, elegantly and quickly. George Anderson a droll individual, tells anecdote about him. Zyg was on call for two years as Senior Registrar in Inverness, experience he gained was terrific, explains. (0:48:15) Explains why George Smith wanted him to go to Canada for a year to work with Neil Mackenzie, who’d been sent there to learn cardiac surgery with a view to coming back to set up cardiac surgery in Aberdeen. He was so good they kept him in Canada. Talks of culture shock of going from being a Senior Registrar in Scotland, virtually autonomous, to being what they called a Resident or a Registrar in Canada, where you were junior. Second six months were much more enjoyable, explains, promoted to Senior Resident, compares system with Scotland and UK. Neil Mackenzie an excellent surgeon, very organised, learned a lot, but Zyg did not want to do cardiac surgery, explains. Came back to Aberdeen to be Senior Registrar with Norman Matheson for about a couple of years, then with Jetmund for less than a year, explains about Norman Matheson. Decided to become a GI surgeon after working with Norman Matheson, explains; acquired the Endocrine along the way. Explains about the varied operations he carried out after he was appointed as a consultant. Talks about reorganisations of Surgery, closure of Woodend. (0:53:24) Jetmund Engeset took over Vascular Surgery after George Mavor died, Tony Ah-See became more vascular as well. Principal GI surgeons were Norman Matheson and Peter Jones, explains. Tells interesting story about the evolution of Thyroid surgery in Aberdeen; mentions pioneers, Kocher and Dunhill. First surgeon in Aberdeen with definite interest in thyroid was Gordon Bruce, explains about him, did most of the thyroid surgery till the NHS came along; then Bill Michie took over the mantle. Talks about development of alternative treatments to surgery. Difficulties of doing parathyroid surgery. Bill Michie retired and passed the thyroid mantle to Norman Matheson. Then Zyg acquired that [practice]. During the time Norman Matheson did it he introduced and evaluated the role of Aspiration Cytology, explains. Aberdeen the first unit in the UK to do it systematically and write it up, reduced the operation rate on thyroid swellings by about 40 per cent. (0:57:59) Explains this does not go down well in environment where activity equals income, like the US; compares this with attitude in the NHS. Hilal Al Sayer, a Kuwaiti who had trained in Aberdeen up to FRCS level, went back to Kuwait and became head of surgery at the Amiri Hospital, the Emir’s hospital. Subsequently became Minister of Health, he and Zyg have remained friends; Halal wrote his ChM (Master in Surgery) thesis on the introduction during that period of Aspiration Cytology and the Thyroid. Also mentions work by Carol Mackintosh and Eleri Cusick. Explains Norman always had a connection with Sweden and the Pharmacia Company. Also talks about Hugh Dudley, mentioned earlier, Senior Lecturer in Aberdeen, everything had to be done right, very demanding, explains Norman thrived on this, based his practice on the way Dudley did it. Zyg talks about one of the innovations between the two of them, relating to treatment of acute renal failure in the 1960s, explains in detail about peritoneal dialysis, and their use of antibiotic Tetracycline to achieve a spectacularly low infection rate. Zyg recalls when he was working with Norman Matheson, Hugh Dudley invited Zyg to St Mary’s in Paddington to give a lecture. Zyg was astonished at what he thought were unnecessary things being done there, and queried them; years later discovered he was remembered in London as the Scotsman who had come down and dared to challenge Hugh Dudley! Dudley had a cottage in Strathdon, where his wife lived; cannot have thought too badly of Zyg, because years later he referred his wife, and then himself, to Zyg as a patient! (1:05:02) Recalls that when he first worked with Norman Matheson before going to Inverness, information about each operation was being collected on a foolscap sheet of paper. When he returned from Canada in 1980, was going to talk at a conference in Thessaloniki when he came across of flyer for a Sinclair ZX81 computer with 4K of memory and a 2K push-in module; Zyg thought this was the future. When he came back he discovered the university had just installed the biggest non-military Honeywell mainframe computer in Britain. Zyg persuaded them to give him a user number, which allowed him to access the mainframe from a shed at the back of the Medical School, but only after 6 o’clock at night, explains. Pays tribute to John Lemon, who helped him and was incredibly patient, answering calls at 11 o’clock at night when Zyg could not get the computer to work. Zyg really wanted to analyse data; Norman had started collecting data on paper from 1977, Zyg had to convert that into a format that could be entered into the computer, explains in detail what this involved. First paper they wrote using this computer data was a five-year audit of Surgical Infection, published in the BMJ (British Medical Journal). Then did a ten-year paper called Infection After Abdominal Surgery, published in the BJS (British Journal of Surgery); showed spectacularly low infection rates, a lot of people did not believe them, but we had Registrars who worked on the ward for a year and did not see a wound infection. Every patient was followed up after six weeks, because two-thirds of infections occur after the patient has left hospital, explains. (1:10:26) Explains other reason for collecting information, when he went to Inverness in 1977 started documenting his own data, most people have no idea about their outcomes. Importance of keeping data, but explains caveats in detail. Amount of work people do is so variable; refers to re-organisation of General Surgery, used to be four receiving units, went down to three. Explains in detail the consequences of this, refers to work of surgeons Peter Jones, James Kyle, George Youngson, and Ron Keenan. The GI (Gastrointestinal) unit and the Woodend unit closed, went from four receiving units to three, explains in detail the consequences of this. When Zyg started in Ward 49 with Norman Matheson and Stanley Miller, he was a new appointment, extra consultant. Nine consultants receiving in three units; but explains why he was doing a two in nine receiving rota on top of his elective work. Compares this with what happens nowadays with 22 general surgeons. Thought the one in three rota was unsustainable (1:17:19) Explains in detail how things were organised when there were traditionally four General Surgical units; talks about how referrals were handled, the people who got the most GI referrals were probably Peter Jones, Norman Matheson, and Alan Davidson. Forces involved in the change were the reduction in the availability of junior staff, reduction in hours they were allowed to work, European Working Time directive explained, saying being on call was the same as being at work had a huge impact on organising cover. Zyg recalls having discussion with French, German and Italian professors about this and discovering that only in Britain was the letter of the law being followed. Returns to discussing effect on closure of Woodend (unit) and effect of all this on the three remaining units. Zyg had become head of service for general surgery; formulated a plan to take account of recent report by Sir David Carter about an elective/emergency split, explains; needed to appoint consultant general surgeons who were capable of doing the emergency take, explains. Zyg was subsequently accused of being against sub-specialisation in general surgery by people who did not know that he had introduced it! (1:23:32) Explains he was a general surgeon with a special interest in endocrine surgery, but did a lot of GI surgery as well; originally did a wide range, but as consultants with an interest were appointed in the 1990s, Zyg’s practice would get smaller in that area. Big change came about in 1990 with the development of Laparoscopic surgery, explains he was one of the early innovators. Talks in detail about how this changed his surgical work, teaching technique to others, and what sort of operations he did. Talks about getting annual visits from the Dept of Defence Studies in London, and how this eventually led to him getting a trip in an RAF fast jet. Returns to subject of sub-specialisation, and tells story about how when they had all the problems in general surgery in 2014-15 someone had said he wasn’t even a colorectal surgeon, yet Zyg was the only consultant surgeon in Aberdeen to be invited repeatedly to give lectures at St Mark’s Hospital on colonic surgery, and also to the Colorectal Conference in Switzerland. (1:28:22) Explains in detail what Gastrointestinal surgery covers, anything from mouth to anus. Gastroenterological would encompass the liver, pancreas, and bile ducts as well, so he was a gastroenterological and endocrine surgeon. Talks about soft tissue sarcomas in the abdomen, require a multi-specialty approach; explains what this would involve him doing. Talks about colleagues abroad who are exceptional surgeons; Prof [Brice] Gayé in France, refers to how he operates across the week. Talks about how people who are good surgeons can work across the spectrum, providing they have access to a lot of operating time; explains this is the one thing that is badly lacking now in the UK, and in Aberdeen in microcosm. Politicians and management thought that by increasing the number of surgeons you would get more operations done, but without operating time surgeons are a waste of space, explains; compares number of cases at ARI now with what it used to be in Zyg’s day. Explains in detail why he thinks that in the 1980s and 1990s the NHS in Aberdeen was running as near perfection as it could. Now it’s incredibly inefficient, and people are de-skilled. Returns to subject of laparoscopic surgery, popularly known as “keyhole surgery”, it was a revolution, explains, including how he got Aberdeen off to a flying start. Next step was a remote manipulator, [wrongly referred to as a “robot”], which Zyg says appeals to a lot of the young folk, but he talks about the downside. (1:35:16) Explains in detail the process by which he became a consultant; incredibly competitive in general surgery in the 1960s, 70s and 80s. Senior lecturer status at the university, with honorary consultant status, was his first substantive appointment. Describes subsequent appointments, and about 2000 being awarded a personal chair as Professor of Clinical Surgery, explains. Special interest in endocrine surgery, particularly thyroid surgery. Aberdeen had the longest prospectively collected database on thyroid cancer in Europe. Explains about treatment of thyroid cancer, doing minimum necessary, describes disagreement about this. Zyg is proud of the database, which was basis for an MD thesis done by [Wendy] Craig, which was awarded to her with Honours. (1:39:45) Explains about importance of teaching to him. Did more post-graduate teaching than undergraduate teaching. Liked to operate in silence, this meant he did not do much teaching in the operating theatre, explains; but laparoscopic surgery lends itself more to teaching, explains. Recalls some patients he particularly remembers, two young women with cervical cancer, required multiple operations to deal with consequences of the treatment. One young woman subsequently invited him to her wedding. Remembers cases and conditions much better than patients’ names and faces. Recalls about being called in for a second opinion about another case of an elderly lady faced with having a colostomy, this was anathema to Zyg, explains. (1:45:43) Discusses issue of young surgeons being too aggressive in terms of operating, and not necessarily doing them well. Talks about the new Consultants’ Contract introduced in 2004, which limited consultants’ working time, including on-call, to 40 hours per week, or 44 if you wanted to do private practice; Zyg was Head of Service at the time this was introduced, said it was nonsense, explains what the governments and the managers thought it would achieve. Zyg got people to keep diaries, turned out average general surgeon in Aberdeen spent about 68 hours a week in the hospital [later corrected to 60 hours a week]. When this was presented to management, who were told this is what it takes to deliver the service, the response was there was no way they were going to pay that, so the surgeons were capped at 48 hours; explains consequences in detail. New generation of appointed consultants were quite different from the traditional way of working introduced in 1948, explains; older consultants checked on their patients every weekend, newer generation said they would only come in one weekend in four when they were on call. Zyg had to to look after their patients as well as his own at weekends, but caused issues if he decided one of these other patients needed treatment over a weekend, explains. Atmosphere between general surgeons and management became increasingly toxic, explains this did not just affect general surgery. Management cut the number of beds for general surgeons; things escalated to the issues of 2014-16, very unhappy episode in ARI. (1:52:11) Explains how as a result of this he was accused of being a racist bully, was suspended and eventually forced to resign; GMC (General Medical Council) later decided there was no case to answer, explains; Zyg took the health board to an industrial tribunal and won. Zyg explains why he was not given support by the BMA (British Medical Association). But says he was completely supported by the Royal Medical Household, explains. Explains about his appointment from 2004-2016 as Surgeon to the Queen in Scotland, and what this involved. GP for Balmoral, Dr Glass, would liaise with either the Physician or the Surgeon in Aberdeen. Interesting work, talks of the perquisites. Addresses release by the BBC the day before the interview of a survey of more than 1400 surgeons in the UK, half of them women, which revealed a majority of the female surgeons reported being sexually harassed, assaulted and in some cases raped by colleagues; also that most of those surveyed had witnessed some form of sexual misconduct. Zyg says these findings do not really surprise him, explains in detail. Talks about surgeons being suspended because they have not been trained properly. (1:59:10) Talks in detail about his contributions at national and international level; importance of surgical technique, refers back to Norman Matheson; in the 1970s one of the doyennes of colorectal surgery was Prof Goligher in Leeds. Surgery to remove cancer of the rectum and join the bowel is difficult; Goligher reported a leak rate of about 60 per cent when tested with X-rays for these operations, and a clinical leak rate of about 25 per cent for these operations. Norman Matheson thought that was outrageous and documented his leak rate as 6% radiological and a 2% clinical leak rate; those results being achieved now 40 years later, but at the time that was revolutionary. Zyg describes the achievements of which he is most proud. Reorganisation of General Surgery. In terms of Audit, wrote a computer program called EMAS (Expandable Medical Audit System), explains about this in detail; ran without professional support for 25 years from 1990, on almost a hundred thousand patients across different disciplines in Aberdeen, explains what this achieved; replacement system not so good. (2:04:18) Thyroid cancer work, showing that [conservative] surgery was as good as more radical surgery. Major innovations in laparoscopic surgery. Minimising the use of antibiotics. Reducing the complication rate from surgery. He won prizes for the operative videos, explains. Proud to be the Queen’s Surgeon. Asked if there is anything he misses about being a surgeon, replies "Operating", explains in detail, including importance of working as a team. Had some outstanding theatre nurses, Eloise Pearson the Theatre Sister was world class, David Gove a Scrub Nurse who was a joy to work with, accompanied him to India once to demonstrate colorectal operating, explains. One of the very interesting things Zyg did was go to Groote Schuur Hospital in Capetown as a Penman visiting professor, explains; volume of trauma there, believes it would be a huge asset to British surgical training if our trainees went somewhere like Capetown or Johannesburg for six months, explains why. Refers to recent outcome of court case against nurse Lucy Letby and subsequent calls for legislation to control medical managers in the same way doctors are regulated. Also refers to case of Dr Harold Shipman; explains why he thinks the worst thing that came out of the Shipman case was revalidation for doctors. Thinks the problem with medical managers is you did not have a Medical Director who could hire and fire, explains; again compares things in general surgery in the 1980s with nowadays in Aberdeen. Explains why he thinks things ran better in the 1980s and 90s, without the massive waiting lists they have now; a lot of it down to productivity and maximising the throughput of operating theatres. Explains in detail why the move from the old Nightingale ward and theatre system did not quite work the way that management had hoped; thinks that working in small groups of people is more efficient; the big theatre suite has not worked in some ways, explains in detail, refers to anaesthesia and intensive care. Comparison with way things are done in countries abroad regarding anaesthesia, with roles for the anaesthetist and a nurse anaesthetist. Praises modern anaesthesia. (ENDS 2:16:43)
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