| Description | Mr JETMUND ENGESET interview on Thursday 9th November, 2023. Interviewer Eric Crockart. Summary by Eric Crockart.
(0:00:00) JETMUND ENGESET, born on the 22nd July 1938, in Vega in north of Norway. Retired on 1st February 2004 as Consultant Vascular Surgeon in Aberdeen. Father was a consultant radiologist at the Oslo University Hospital, before that he was a GP on Vega island; when the war came he started specialising in radiology in Oslo. At primary school Jetmund was interested primarily in mathematics and physics, blames a terrible teacher for losing his interest in mathematics at secondary school. Always wanted to study medicine, spent a lot of time at his father’s place of work in Oslo, explains, including Jetmund’s fascination with the blood involved. When he finished school in 1957 his marks were not good enough to get into Medicine in Norway, only a hundred places available, two-thirds of Norwegian students had to go abroad to be trained in medicine. Decided to go abroad, but had a year off earning money to be a student somewhere else. Applied to study medicine in Leyden in Holland, in Bristol in UK, and in Aberdeen. Accepted by Leyden and Aberdeen, explains language was why he chose Aberdeen. Came to Aberdeen at end of September 1958, describes various digs he stayed in thereafter. (0:05:01) Describes life as a medical student in Aberdeen, some language problems, had to make money to continue his studies. Recalls being with a group of fellow students round a patient having a lumbar puncture. Talks about inspiring teachers. Prof Lockhart, a real personality; Prof Hans Kosterlitz, who taught us physiology; Dr Roy Strathdee, who taught chemistry in Jetmund’s first year, a fantastic teacher for foreigners, five Norwegians in the year, he made everything so clear. Explains his ambition was to be a surgeon. (0:09:41) Graduated in 1964, did his House Officer jobs in Aberdeen, first in Sick Children’s Hospital, most importantly in general surgery with Peter Jones, and Norman Matheson (Summariser’s note: In the interview Jetmund also gives a third name, Andrew Foote. But later during the correction process for this summary he said this name should be removed, writing:) [ The third consultant at the children’s hospital was David Blair but his work was done by the registrar who was very competent, and although he was consultant I never as far as I remember had any contact with him.] Second job was medical in ARI in Prof Macgregor’s ward, old Ward 4 of Aberdeen Royal Infirmary, interesting time with Prof Macgregor, and James Crooks, who became professor of medicine in Dundee. During that first year was approached by Norman Matheson who wanted him to do some research, explains. So that was his next year in 1965-66, did one year with the MRC (Medical Research Council) grant, then got another year’s extension on that grant 1966-67. Talks in detail about the specialisations in surgery when he was starting his career; Peter Jones, Norman Matheson and Andrew Foote all general surgeons. But knew that specialties were appearing and that Peter Jones was basically a paediatric surgeon [but also a highly regarded general surgeon]; as time developed Norman Matheson became more and more an endocrine surgeon and a GI (Gastrointestinal) surgeon, and Andrew Foote became a thoracic surgeon. (0:14:17) Describes what the Department of Surgery was like in Aberdeen when he started working there in 1965. Professor of Surgery then was George Smith, Norman Matheson was a senior lecturer consultant, Andrew Foote was another senior lecturer. Talks about reputation of the department at that time, thought it was high; George Smith became the Secretary of the Surgical Research Society in the UK, prestigious, explains; research papers from Aberdeen, a lot on hyperbaric oxygen from George Smith [and Nelson Norman], and from Norman Matheson there was Dextran and the micro-circulation that was appearing over the next few years. At that point Jetmund explains he was not contemplating a career in surgery in Aberdeen, because he did not know if he was going to go back to Norway or not, though that was his aim; explains it was Peter Jones’ advice that led to him taking the research job offered by Norman Matheson. But as he approached the end of his two years with Norman Matheson, George Smith told him that next year he was coming to work with him! Explains this involved him working as an SHO (Senior House Officer) on Ward 16, that year was his introduction to general surgery. Was then told by George Smith that the next year he would be working for him on Gastric Mucus, peptic ulcers were then common, had got a grant to do that kind of research. Jetmund went on holiday to Norway, and when he returned he was told by George Smith that there was a problem with the grant money and he had no job! So he then did locum jobs in surgery in Aberdeen for the next year; he was still doing his research work at that time. The following year a lecturer job came up in Surgery, George Smith told him to apply for it, no buts! Downgraded from Senior Registrar job to Registrar job because that was the level Jetmund was at that time. Round about 1971 he was upgraded to Senior Registrar. Was then on "island duty", so had to go to Shetland and Orkney when required, explains. (0:20:39) By that time he had realised his career course was firmly rooted in the UK, rather than going back to Norway. But still did not know what he was going to do in the long run; one of his mentors was Professor Efskind at the Oslo National Hospital, where Jetmund had done locums during his summer holidays as a student. He had advised Jetmund that the postgraduate education in surgery in Britain was far more advanced [structured] than in Norway. Said he should get all his training in Britain before coming back to Norway as a trained surgeon. Jetmund says he was never asked what he wanted in his career, it was chosen for him, explains. In 1972 George Smith told him he should go and learn about transplant surgery, explains. Happy to do this because he had done a lot of the research for Norman (Matheson) and had very good contact with Charlie Gelin, professor of surgery in Gothenburg, at that time in the 1970s the biggest kidney transplant centre in Europe, explains in detail. By October 1972 was on the way to Sweden with his whole family to work for a year and a half. (0:24:20) Explains the setup in Gothenburg, initially helped other surgeons do transplants, then did them himself, as part of the team; and because of his experience in Aberdeen, he ended up doing most of the renal access surgery in Gothenburg at that time. Did quite a lot of vascular surgery, of small blood vessels. No language problem working in Sweden, as Swedish basically same language as Norwegian. Talks about all being part of Euro Transplant or UK Transplant, exchange of kidneys between all the European countries; tells story about dealing with an offer of a kidney from Denmark, and ending up speaking in English. Recalls getting a call in Sweden from George Smith to tell him that George Mavor had died, and advising Jetmund to do as much vascular surgery as he could while he was there. Talks about returning to Aberdeen, and rapidly getting a senior lecturer consultant job in 1974. George Smith had taken on the responsibility for vascular surgery in Grampian, so Jetmund automatically on call for vascular surgery too. Thrown into the deep end, not the sort of vascular surgery he had been used to in his short introduction to it. Problem of patients surviving major aortic surgery often ending up on acute dialysis because their kidneys failed because operations took too long, explains in detail. (0:30:02) Realised there was a major problem in Aberdeen because major vascular surgery had not been attacked aggressively enough. Recounts memory of a senior registrar in Aberdeen saying not to go into the room of a patient, because the patient had no chance of surviving. Jetmund did not like that, because he knew that was not the same for patients with aneurysms in other parts of Europe. Jetmund then became involved with George Smith and Tony Ah-See, who was appointed as a senior lecturer not long after Jetmund, he had the same interest in trying to do something about this, explains this was why he was thrown into major vascular surgery on his return, very challenging, turned out to be a fascinating career. Explains in detail what Vascular Surgery encompasses, including history, and with reference to Aberdeen; including that the most common operation he and Tony Ah-See did was to put in aortobifemoral grafts, shared doing those till about 1990, when Tony went into breast surgery and Jetmund continued in vascular surgery with other colleagues. (0:35:56) Talks about vascular surgery at that time being a relatively new specialty, surgery of the lower legs on accident cases. Talks about anaesthetic service not being able to cope with the massive surgery that an aortic replacement involved, explains in detail. Not necessarily that we were better than the surgeons before, but that developments around the world meant they were there at the right time to take things forward. Jetmund thinks he became a specialist in vascular surgery from the early 1980s, gave up more and more of his general surgery, to Zyg Krukowski, Peter Jones and Norman Matheson. There was so much vascular work, it just happened, explains. He and his team did a lot of work on patients that would not have had a chance of anything being done a few years before. (0:40:13) Explains in detail about his surgical team, hardly any times when he wasn’t present on his operating list. Had very good senior registrars at periods; George Youngson, Zyg Krukowski, and Sammy Asfar, a trainee from Kuwait who later became professor of surgery in Kuwait; they could take over on occasion, explains in detail about the surgical team required. Then also about the anaesthetic team required. Anaesthetics developed much faster around the time he became a consultant than surgery did, explains. Says he was lucky enough to work with anaesthetist Greg Imray, who took up the setting up of a really proper intensive care unit in Aberdeen, explains. Thinks surgeons tend to undervalue anaesthetists, explains. Talks about it taking him a long time to get specialist anaesthetists who could cope with the ruptured aneurism patient, resistance from the anaesthetists, and then Greg Imray offering to take it on for a year. Jetmund then took on ten [later changed this figure to 12] patients with ruptured aneurisms in succession and they all survived, showed the importance of having the right team, the anaesthetist was intensely important. Thereafter they got more specialist anaesthetists, explains. Same thing happened in cardiac surgery, explains. Lots of changes in the period of the first ten years of Jetmund being a consultant. (0:46:07) Talks about becoming head of the Department of Surgery in 1982, George Smith at retiral age, university in financial difficulties, money not there to replace Regius Chair of Surgery. So Jetmund was appointed as head of the department as a senior lecturer. Rapidly realised it was not what he wanted, wanted to be in theatre and looking after patients. Recalls Pat Forrest, the senior medical officer for Scotland, asking him if he was interested when the Regius Chair was advertised. Jetmund refused, then Alec Eremin was appointed as Prof of Surgery. Shortly after in 1986 Jetmund was appointed as a health service vascular consultant in Aberdeen, that was more or less the end of his general surgery. And in 1990 it split off completely, the Vascular Unit was started in Ward 36 of Aberdeen Royal Infirmary. Tony Ah-See decided to become a breast surgeon with Alec Eremin and Jetmund got a new colleague, Graeme Cooper. Explains more about being head of the department of surgery, and that at the time he was employed by Aberdeen University. Jetmund not interested in all the political committee work. He was the only transplant surgeon in Aberdeen at that time, on call, had very good assistants, Zyg Krukowski and George Youngson, and John Logie in Inverness. But needed two surgeons to do the transplants, so Jetmund needed to be involved. That was 168-hour a week on call duty! And the vascular work with Tony (Ah-See) and him was also 168 hours a week (on call)! A lot of night work, explains. Tells anecdote about how he and Tony worked together, when they had to deal with three aneurysm cases in one night. (0:52:15) Talks about how the university’s financial difficulties affected the Dept of Surgery. Explains that in 1987 he was already a senior lecturer consultant, primary appointment to the university, but his job was entirely health board, so it was natural that he changed over to the health board (to be a consultant), but still had teaching responsibilities as all consultants had. Talks in more detail about the creation of the Vascular Unit in 1990. Tony had left so Graeme Cooper came in as a new young consultant. The unit required a Vascular Laboratory, explains it took some years to get it. Got it when they got Ross Naylor as a third consultant, explains in detail about him. The British Vascular Society required them to have a Vascular Lab, but management of Grampian Health Trust did not accept that. So Ross Naylor resigned because of the lack of a lab, great loss to Aberdeen, he got the Chair of Vascular Surgery in Leicester shortly after. Jetmund in no doubt this resignation led to them getting a vascular lab, explains. (0:57:45) Talks about his work assisting surgeons in other specialties. Tom Scotland refused to do any major cancer surgery without Jetmund being present; he was called to help gynaecologists who had to deal with patients who were bleeding at the Maternity Hospital. Jetmund loved being able to help, dealing with unusual challenges. Similarly he called on colleagues like Peter Jones when he had problems in fields that were not his speciality. Also mentions Norman Matheson, and tells story about a young patient who had terrible injuries from a road traffic accident, Jetmund on call for general surgery, found the patient’s liver was torn to shreds, was not able to control the bleeding and had to call Norman in during the night, describes how the patient was able to go home ten days later. But alludes to cases where surgeons dealt with patients with problems they knew nothing about, some of them private patients, surgeons who did not do any vascular surgery at all, and at the end their patients were dead, but they got their fees. The vascular help was there, but Jetmund says they did not want that, because of money. (1:02:38) Explains about how in the 1980s he became Surgeon in Scotland to Her Majesty Queen Elizabeth, a great honour. Talks in detail about what this involved, including the fact that he was not a British citizen! Got call on Hogmanay from, he thinks, Sir John Batten because Peter Jones had retired and they needed a new surgeon for the Queen in Scotland. Was on call for being Queen’s surgeon for 180 days a year. But during the nineteen years he did the job he saw no more than six to eight patients a year. Except for the Queen Mother most of them were visitors to Balmoral. He was a member of the Medical Household of Queen Elizabeth, which held its last meeting shortly after her death (in September 2022). Jetmund remained a member of the Medical Household even after he retired, as a member of "The Club", explains. Never got a call from Balmoral during the night during his tenure. Prof Peter Brunt was the Physician in Scotland and he got called much more, because most surgical problems were dealt with in London. (1:08:17) Talks about how the Dept of Surgery changed during his association with it, refers to research work, mentions Prof George Smith, and Prof Nelson Norman, who was heavily involved in offshore medical problems and the Antarctic. Research went much more in that direction, of offshore medical problems; Nelson Norman and the Dept of Accident and Emergency were much more involved in that than the Dept of Surgery. George Smith was by then getting to retirement age. Jetmund was not doing much research, because he hadn’t time for it, explains. Then Prof Eremin took over, changed completely, his interest was breast surgery. Norman Matheson was interested in microcirculation, which was Jetmund’s interest in his research project. When Jetmund left the department it focussed on breast surgery and cancer treatment. Explains that the staffing did not increase in the Dept of Surgery during his time there, though there were more professors of surgery, but these were honorary appointments to health service staff like Prof Youngson, Prof Krukowski, Prof Keenan, not university appointed professors. Comments on the assertion by other interviewees for this project that during the 1980s and 1990s the health service was working well in Aberdeen. Jetmund thinks it worked very well, and in conversation with people in Sweden and Norway that the health service we had in Aberdeen was as good as anywhere. Not just for the patients, but also for the surgeons, explains in detail. Explains how EU (European Union) rules from the mid-1990s meant that they needed to get five vascular surgeons, because no one was allowed to be on call for more than one in four weekends. (1:13:48) That ruined it all. Jetmund recalls he used to run the department with the Sister in charge of theatre, Morag Middleton, she was theatre sister for most of his working life, pays tribute to her as "a fantastic theatre sister". Talks of frustration of working with people who don’t know where things are, had to phone Morag at night to ask. And when he knew there were going to be really difficult problems, he would ask her to come in, no extra pay for her, and she would still come. Describes how things then changed, theatre nurse in charge of theatre, saying you cannot send for the patient till all the staff in theatre had their lunch. No one listened to the surgeons, so from twelve o’clock till two o’clock they did nothing because it was the lunch break. Operations in the afternoon that would take too long could not go ahead because the staff all had to be out of theatre by five o’clock. Jetmund spent more time in his room, could see the deterioration as more and more managers took over everything. On the health board side the same thing happened, surgeons had no decision-making rights any more, decisions taken by God knows who! Got more and more unpleasant, so that job that he and Tony (Ah-See) used to do with two of them, long hours and when on holiday they had to cover the place 168 hours a week, but not a problem because they were not called that much. Before Jetmund retired there were five vascular surgeons, not enough work for them to do. (1:17:55) As a result surgical standards couldn’t be maintained, explains. But has no evidence to say it has deteriorated because of progress in surgery, lots of things now done by different methods, explains in detail. Talks about the issue of deciding if elderly patients should get expensive surgery. Says he and his colleagues were part of the small aortic aneurism trial, a British study published in The Lancet around 1998, explains about the issues, relating to deciding when patients should be operated on, in detail. Jetmund was the biggest contributor to the study, though he was not running it. The mortality for patients in Aberdeen’s part of the study was zero per cent; Jetmund had something like 37 patients in the study, Graeme Cooper had about 10 patients. In the total study the death rate among the patients taking part was 10 per cent. In Scotland the death rate was 2 per cent, so most of the deaths were in the English centres that took part. But the purpose of the study was not to compare the death rate, but to see whether you should operate on the patient when the aneurism was below a certain size, explains. (1:23:28) Explains that he did not want to retire. Before he retired he spoke to Alex Cumming, the chair of the health board, but was told that all consultants in Grampian had to retire at 65. He told him that it was not a problem, he had a house in Norway, and had spoken to the hospital in this little town Rjukan, where they always had difficulty getting staff, and the chief executive there was keen for Jetmund to come and help them when he retired. Two weeks later he got a letter from Alex Cumming saying that they had not decided what was happening with transplantation in Aberdeen, and would he mind working another six months! So instead of retiring in July 2003 he retired in Feb 2004. Did not go back to the hospital in Norway, because he decided he had had enough. But says the last six months were fantastic, explains why. Asked if there are any patients he particularly remembers, recalls a farmer from the Turriff area who needed a kidney, but unfortunately also had an aortic aneurism, and other problems which meant he needed an aortofemoral graft, explains. So did a combined operation, dealing with the aorta first, putting in an aortofemoral graft and then put in a kidney after that. He lived for a number of years afterwards. Refers again to the operation he did with Norman Matheson on the young man with the ruptured liver. (ENDS 1:28:22)
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