I: Today is the 4th July 2016 and this is Dr Michael Ward at Portland Place interviewing Dr Venkarta Ramana Alladi.
I: Is that how most people know you?
P: Well, many people know me as Ramana Alladi.
I: Then we’ll stick with Ramana Alladi. What I’d like to do really is to talk about you. I don’t know how good you are at talking about you. I looked up, because I wanted to be sure I was correct, the expression SAS doctors, what does the SAS stand for?
P: Staff grade Associate Specialist doctors.
I: When I looked it up on the web it said speciality and associate specialists, so is there an alternative or what’s the commonly used expression now?
P: Traditionally, actually when it started a long time ago we were known as non-consultant career-grade doctors. And many of these doctors didn’t like the term ‘non’ and then [1:14] we’ll take career-grade doctors, but the reason why we start to use SAS doctors was the traditionally by British Medical Association this group of doctors were called SAS doctors because the only grades that were recognised nationally, according to national terms and conditions, were staff grade and associate specialist.
I: So we’ll stick to –
P: Yeah, even though there are other groups of doctors grouped into this category. It has always been controversial, because for example in the Royal College of Anaesthetists they started off as non-consultant career-grade committee, then it changed to SAS grade committee and went back to career-grade doctors. Now it’s called SAS committee.
I: Well let’s say if it’s good enough for the BMA and it’s good enough for the Association –
P: Exactly, that’s one of the reasons why we stuck to it, because everybody else in the country refers to this group of doctors as SAS doctors.
I: Great. Well let’s get back to you, and it’ll become apparent as we continue why I asked that question, but where were you born?
Right, OK, and your parents, were they medical at all?
P: Yes, my father was a doctor. We are ten siblings and six of us are doctors in your family, and I am the youngest of the ten.
I: Good lord! You have nine siblings, my goodness! And is it all the men who are the doctors?
P: No actually, two brothers and two sisters are doctors. My brother is a paediatrician, my sister, one of them is a neurologist and the other one is a consultant gynaecologist, they’re all professors in their respective fields.
I: And where did you go to school?
P: I went to a school called [3:32 Kurnool] Medical College, we call them colleges, in South India, in Andhra Pradesh.
I: And you qualified when?
I: And when you qualified, what specialty did you want to follow?
P: I wanted to be a general surgeon, but actually I did surgery for eight years, even in this country, I was a surgical registrar for a year and the story of how I got into anaesthetics was I was preparing for my surgical fellowship in a hospital and I was studying in the library and this consultant anaesthetist happened to see me every day studying work, doing my work, and he made a proposal. He said, ‘We’re short of anaesthetists, we will give you a job for six months, three months you don’t have to work, give you study leave and teach you how to do anaesthetists. You won’t be put on call, but I would like you to work for six months for us.’ And I got into anaesthetics when I instantly fell in love with it.
I: It has that effect on people, doesn’t it? <Laughs>
I: Where were you when this happened? In England by now?
I: What made you leave India? To further your studies or –
P: There’s a lot of glamour for the degree of RCS, and I was sent by my family abroad to get that fellowship and come back, so that was my mission when I first came here.
I: How did they react to your change of career?
P: I’m sorry to say that they didn’t appreciate it at all. They thought, in those days anaesthetists were playing second fiddle to the surgeons, and especially my sisters were very cross that I changed it to an inferior speciality, so to speak, which I don’t believe at all, and I didn’t know how to impress on them it was … I thought there was a great future for the speciality and when I entered anaesthetics, because of the introduction of the intensive care and also I like doing procedures, doing things with my hands. For various reasons I thought anaesthetics is the appropriate thing for me.
I: When did you first become interested in medicine? Was that because your father was a doctor?
P: We have a tradition, because I’m the youngest … I remember my mother telling me once when I was very young, ‘If you become a doctor, you can go anywhere in the world, sit under a tree, give an injection and get money for it. So job won’t be a problem.’ And then I saw my father and my brothers and sisters very well respected in society, like for example they were getting free milk, free vegetables, you don’t have to buy theatre tickets. But they were working 24/7 so to speak, but they seemed to enjoy what they were doing.
And thirdly, I had a fancy for the stethoscope and the white coat and the bleep and so on. And one of my sisters said I also fancied, strange thing to say because you asked me, I wanted to wear spectacles. I thought it was a very fashionable to wear spectacles, so I asked one of my sisters and she said, ‘If you do medicine and you work really hard, you will end up with having spectacles!’
P: This is about when I was eight or nine years old, so all these things appealed to me.
I: That’s funny! OK, did you enjoy your medical school time?
P: Yes. Unfortunately the town where I studied medicine, there was nothing else happening, and it’s not right to say, but I didn’t totally enjoy that. I thought I’d wasted my time because I had lots of other interests in life, which I couldn’t pursue. The only thing I could do in that medical school in that town was to work, do medicine, which is probably good for me.
I: But it was a medical school with a good reputation I’m sure.
P: Yes, it has a very good reputation.
I: Maybe it’s because there were no distractions!
I: But you have other outside interests. Did you have them back then?
P: Yes, I always … I write, I started writing short stories and I write poetry in local languages, I’m trained in classical music and the dance called [8:37], and I read a lot and if you ask any of my family members they always remember one of those want to compete and win prizes all the time. I was very competitive. I wanted to show everybody that I am the best.
I: When you came to England, 1975, is that right?
P: Yes, it is.
I: When you came did you come on your own or did you bring –
P: Yes, I came on my own. I’d never been abroad. I didn’t have any friends, nor relatives, and my first job was in a place called Law Hospital, Carluke in Lanarkshire, in A&E. In those days we had to do what we called Clinical Attachment for two weeks and the consultant you were under, he would look at you and then say if you are good enough to go onto registration, so I took all the risks and one of my sisters financed my trip and yes, luckily after one week the consultant thought I was good enough and I joined that place as an SHO in orthopaedics and casualty. I was still studying surgery at the time.
I: And how far along the fellowship role in surgery did you get? Did you take your primary?
P: I’ve done my fellowship.
I: Your FRCS.
I: And you completed that?
P: Yeah, I completed while I was just doing SHO job in anaesthesia.
I: Wow! That must be pretty unusual!
P: No, in those days I already worked here as a senior SHO, [10:21] registrar job, and no prospects unfortunately for overseas doctors to get into professional training, and I was looking … I love England, I always loved England, I wanted to stay here and do something really constructive, not just do the exam, and I looked around and then I said, when I got into anaesthetists, I instantly fell in love with it. And I was doing surgery … before I came here I did neurosurgery and cardiothoracic surgery and even in this country I did burns and plastic, major burns unit in Birmingham Accident Hospital, and I did [11:07] surgery and yes I trained … my main ambition at that time was after coming here, to be a trauma surgeon, so I did all these specialities that are useful like orthopaedics, vascular, plastics and cardiac.
I: You were ahead of the curve again in that because that’s where a lot of the best and brightest are going now.
P: <Laughs> Mm.
I: And then having been persuaded to start anaesthetics, up to that point, you started in Lanarkshire, did you do other jobs in Scotland or did you come to England?
P: I worked for 1.5 years in Lanarkshire and then I did six months in Loch Lomond, the Vale of Leven Hospital, Alexandria. I loved it because it’s a beautiful place, and because I had this desire to continue on in trauma thing, I worked in Coleraine Hospital in Northern Ireland, and there the general surgical department, they dealt with really speciality, I mean [12:19 IA] and I was a Casualty Officer during when the Ballymoney bomb took place in ’76 so I had to admit at least 40 patients and they all came and then when I actually joined the hospital and I still remember two or three patients who were admitted to the intensive care unit with the blast injury, lungs, they left after I left six months later, so I had the whole experience I was looking for in trauma in one day!
I: Gosh. Overload I would think.
P: And then I always wanted to get back to England so I got a job as a, even though I was very experienced I worked as a senior house officer in Birmingham Accident Hospital Burns Unit.
I: You must have been applying, when you were starting to apply for anaesthetic posts, an unusual candidate with the Fellowship in Surgery and that sort of experience you had, so where did you start anaesthetics?
P: I started in Darlington Memorial Hospital, where I was trying to do my surgery, and then I got a job in Whittington Hospital as a locum SHO to start with. At the time it was a problem. I had to defend myself, why I want to do anaesthetics, and I was always found to be overqualified for whatever job I applied for. And because I’d been doing SHO jobs till then, for nearly four years, I thought I was a little bit stuck, and then after working as an SHO in Whittington Hospital I was appointed as a registrar in Wigan, Royal Albert Infirmary, and I worked there for four years and I got my fellowship right at the end of the registrarship.
Once again I was stuck because I had all this experience and I was doing all the major anaesthetics, in those days registrars used to do whatever. First day when I was appointed, as a registrar I was asked to do a [14:39]ectomy, no problem. So I was stuck again, because whenever I applied for a job I still remember, without naming the names, when I applied for higher permission training job, one of these guys, I would say guys ‘cause I don’t want to say who he is, he told me, ‘I can get you a job in Johns Hopkins but I’m afraid give you a job, we’ve got our people to do these jobs. Why do you want to come here?’ And I told him that now I’m married – at the time I’d just got married and got two children, and told him I love this place and I think I’m entitled to be here, and I probably … <Laughs> may not be appropriate for the interview because he asked me, I have to tell you the truth, I had to give a piece of my mind to the chap who interviewed me on the day.
I: Well you haven’t mentioned who it is or where it was. So you got your fellowship in anaesthetists, first attempt?
P: No, third attempt.
I: That’s also pretty common! But you got it, and did you look for senior registrar and consultant jobs at that point?
P: I did for training, higher personal training, because I was working in a smaller hospital, [16:15 Bedford] Hospital. If you are an overseas doctor it’s rather difficult because of the age and qualifications I couldn’t support myself, they wouldn’t give me … but some of my colleagues who are working in the teaching hospitals, they had connections I guess, and they managed to get onto this higher personal training. So no I did try and I couldn’t.
I: So how were you earning a living?
P: Well, I was really too stuck and I wanted to be in England, so the only thing I could do was … they just opened a private hospital near Stockport, it’s called Alexander Hospital, where they were doing open surgery in private sector. They wanted an anaesthetist who was trained to look after the intensive care and so on, as an RMO. So I just had to leave NHS and I took a very risky move to be a senior RMO at the Alexander Hospital in Cheadle. And I worked there for nearly five years.
I: What years were they?
P: 1985 to 1990. And I was not doing what I was supposed to do or trained. As Senior RMO you admit patients, take their concerns and give night sedations and put up the drips and that sort of thing, but they wanted me because when we do open heart or anybody who was very ill then the consultants had confidence that I was there, I could take them to theatre, I could take an open heart surgery fail, take them to theatre while they are waiting for the anaesthetist to come, so yeah. But again I was stuck. That’s not what I was looking for at the time.
I: So for five years you weren’t giving anaesthetics?
P: I was giving locum anaesthetics at the same time and locum RMOs and I probably worked in about 15 different hospitals and I remember doing a locum consultant job in Luton, commuting every morning. I could set off at 5 o’clock in the morning and I would be in Luton by 7:30 and do the work and go home, and I could go to Scarborough to do an RMO, because I had to maintain things. I was approached by the anaesthetist from Tameside Hospital one day and he said, ‘We are going to look for somebody to look after our intensive care unit. You’ve got a lot of experience and none of our consultants are trained to do it. Would you mind coming as a clinical assistant,’ or whatever. And then I thought about it, I was doing a locum consultant job there for DES, and the main session I was doing at the time was the Saturday morning trauma list. These are the ones that fractured femurs, the consultants do it in the week, they cancel, I used to come and do them for them.
P: I’ve done about four to five fractured femurs for about five years every Saturday no problems I guess. Then I said to them that I would come if I am appointed as an Associate Specialist rather than a clinical assistant, and there was a hitch then because the Associate Specialist jobs were given only to people who were already working in the NHS at the time, so this particular doctor went out of the way to recommend my name, that is [20:16] good enough.
I: And you got the job.
P: I got the job. 1991. So I was appointed as an Associate Specialist in anaesthetics in Tameside Hospital.
I: And what sort of job programme did you have?
P: Well I was supposed to look after the intensive care to start with, under the supervision of consultants, and I started doing independently, I mean in those days I think 10 PAs, and you didn’t have PAs, 10 sessions. All the five days I was doing this and every third night on call, resident on call.
I: And weekends off?
P: No, weekends as well. But again I want to generate as much money as possible, money but –
P: Yes, I was doing one in three to start with. I think in the very beginning I was doing one in two nights on call, and then go and do all these locums, and all the other hospitals around. Yes, I did that.
I: So you did locums in the other hospitals on top of –
P: On top of that, yeah.
I: When did you see your family? <Laughs>
P: I remember when I was working as an RMO in the private hospital, one of the chaps was doing heart transplants they were getting very popular between ’80 and ’85, by ’85 or ’90, and he told me repeatedly that, ‘Whatever you do, don’t become a cardiac anaesthetist, you won’t have a family life. Look at me, I have to NHS work, private work and then heart transplants come up any time.’ And he repeatedly told me and convinced me. But I over the years made it a point that I remembered that, because he didn’t see the children growing up, but I always … you may not believe it, I took my children to schools and whenever possible I was always there to collect them. Even now I tell the registrars and other colleagues that’s very important that you should not miss out on your children growing up, and my children used to come and tell me their friends whose parents were doctors would always say, ‘How come your dad is always here?’ I used my tactics, somehow managed … because you ask me, I try and not miss out on family life.
I: I’ll come back at the end, if I may, to talk about your children and your family again if that’s acceptable to you.
I: So I’ve now got you in Tameside as an Associate Specialist starting about 1991 and you stayed there until you retired.
I: And when did you suddenly find your interest in … well OK, I’ll ask a different question, what about other things apart from clinical practice. I guess you didn’t or had no time to get involved in clinical research?
P: Not for research. Once again, because you asked me I have to bring it up <laughs>, I used to… in those days I think the [24:01] were pretty popular and I was very fortunate to work with Brian Kay who introduced RTC and he taught me that and I did some work with him. So I designed some drug studies, which I proposed and when I took it to the professors in Manchester at the time they said it’s not good enough.
I: Who was the professor?
P: I don’t want to name that person. And you could see in three weeks’ time one of the senior registrars doing it.
P: Yes! So one of my [24:41] you can make out, I got a genuine interest in research and one of the things, the absence in my life is to innovate and do something having come all the way as an SAS doctor it was very difficult to do that, but I did try but I was not successful.
I: If you were doing things differently, let’s take you back, you’ve just arrived, got interested in anaesthesia, would you plan your life differently or would you be happy to relive it all over again?
P: What I realised from my life is that the greater the risks you take and the greater the sacrifice you make, the more successful you are, and much better person you are. If I were to live in for example India, I would be extremely popular, my family was very well known, I wouldn’t have encountered any of these problems. Because I come abroad, I lived on my own, I know how to assert myself and I went through all these things, some of them maybe crises but at the same time I manoeuvred myself through it. For that I think I am a better person. It definitely got me confidence. And also in life I realise that you don’t have control of your destiny. You have to do what is presented to you at that particular time and make the best of it.
I: Well it was our good fortune that you didn’t go back to India at that point with the fellowship!
P: Thank you!
I: And regain that sort of respect and standing that you should have had, because you stayed here and you devoted yourself to do other things.
I: I’m tempted to say to try and help to better the lot of your peers, your countrymen and people from overseas doing the same sort of roles, but let’s come on and talk about that. When did you join the Association of Anaesthetists?
P: In 2002. I was contacted by Dr Kate Bullen, who was the elected SAS member on the Council of the Association. I think I happened to write an article about SAS issues in Anaesthesia News, and that prompted her and she wanted to see me, and she was in the process of forming an SAS committee and I was asked whether I would be interested in being a member of the committee. It was in 2002. It’s totally accidental, because I think it sprang from the article I wrote in Anaesthesia News.
I: I’m sure it did. I have to ask you, because I think at about that sort of time, 2002, I think I was … if I wasn’t already on I think I was about to join Council, I certainly knew Kate Bullen on Council, and I wonder why you hadn’t joined it already? Why you hadn’t become a member of the Association way back when you started anaesthesia?
P: I’d been a member of the Association of Anaesthetists, sorry. I thought it was when you joined the committee, I’m sorry. I’ve got this habit of showing off! Even now I’m paying subscription for at least six, seven journals, which my wife may not agree with! No, as soon as I joined anaesthetics I became a member of the Association.
I: I’m delighted! I’m very, very pleased to hear that. I’m glad we’ve resolved that
P: And I read the journals and keep up to date.
I: And then in 2002, that’s when Kate Bullen invited you to join the committee that was being formed.
I: The SAS committee as it was called then. And I think it still is called now?
P: No, at that time it’s called non-consultant career-grade committee.
I: Ah right. And you served on that from then until –
P: A few months ago this year.
I: And I think you became its chairman?
P: I’ve been the chairman since 2003 because Dr Kate Bullen finished her term in 2002.
I: Now have you enjoyed the experience? <Laughs>
P: Absolutely! There’s no doubt about it and I had lots of ambitions as a doctor, as an anaesthetist, and everything I wanted to achieve and more than I wanted to achieve, to prove myself … I wouldn’t have had the opportunity to do all that if I had not been associated with the Association as a member of the committee and also as a member of the Council all these years.
I: If you were on the committee all those years, you must have seen a lot of presidents.
P: I have, yes, it started off with Professor Mike Harmer, and Richard Birks and David Whittaker, I’ve seen … whoever was there up till now.
I: And do you think you have been able to make things a bit better?
P: I would think so from the accolade I got, from the [30:31] I got from the Association. Yes, I think I probably made a difference but I don’t say that … I don’t know, it’s not up to me, is it, to say how much I contributed, but … my main aim was to raise the profile of SAS doctors and make their lives in the hospitals better, that was my main aim.
I: What do you think is the main reason people stay at that level and don’t want to progress to a consultant post? Is it because they haven’t got the qualifications – well I won’t put more thoughts, I’d like to ask you, what do you think?
P: There are many reasons why people get into SAS grades. Number one, people don’t want to do postgraduate exams, but yet they want to work in the speciality. And the only opening you have here in this part of the world is to become an SAS doctor. And people did exams but were not successful, but still they want to continue anaesthetists, they want to be SAS doctors because that’s what they did for four or five years and carry on. There are some doctors coming from overseas and they already have, most of the doctors who came from overseas who had to take this SAS grade jobs, because they are qualified and have the post-graduate qualifications abroad, most of them, and they did a survey and about 75% of the people who are working there are MDs from wherever they came from. So going by my example, they could not get onto the higher professional training so they want to continue [32:34 IA]
I: So their higher anaesthetic qualification wasn’t recognised?
P: Not it’s not being recognised but they had no opportunities to get onto the higher professional training, so they have to take up these jobs. We are talking about doctors between 40, 45 kind of thing. That’s not the time to change a speciality. Some people reluctantly became general practitioners and could do clinical assistant sessions in hospitals and it was allowed then. I don’t think it will be now because of the revalidation and so on. That’s another reason. Another thing is they’ve got families and children going to schools, they don’t want to move around looking for further progression and so on, and again this is the only opening they have.
I: If somebody wanted to do that for a while though, could they then get back into higher training from an SAS position?
P: Not in those days.
I: But you can now?
P: That’s one of the things, my problems, my personal achievement was this article, on the PMETB, that’s one of the reasons why I wanted to get onto the PMETB Board, Postgraduate Medical Education Training Board, and I was a member of the assessment committee and I tried to fight for that, along with Kate Bullen, and then I want to make it a reality because it was virtually impossible even though they created another pathway, to get accredited and become consultant was extremely difficult. I tried to the whole structure so that it’s slightly easier, now possible. Like for example a lot of people are failing in one or two speciality experience, like paediatrics or surgery, or pain management, that sort of thing. And SAS doctors working already, they couldn’t get experience in those specialities, which means that they have to leave the jobs and go somewhere or whatever, while families are ruined. So it wasn’t easy. So like that I think I probably helped quite a few SAS doctors to get them these fellowship jobs or some deputation, that sort of thing. I did, quite a few people I helped them to get accredited eventually.
I: So one of the questions I was going to ask you was what do you feel have been your greatest achievements. You’ve answered me with one. Working with the PMETB, ‘cause you were on the PMETB committee weren’t you, appointed to the PMETB for anaesthesia.
I: How long did you serve on that committee?
P: About three years. After that of course it is all [35:32].
I: Yeah. And what other achievements have you that make you feel pleased with yourself for having got them?
P: One of the things I could do as a [35:50] member of the council of the Association was when I was put on any committee I had an opportunity to contribute myself that way. For example when I was on the Education committee I started organising seminars on my own. As you probably know, I have run eight or ten general seminars in the Association over the last 10 years, and they were all fully booked.
I: Is it designed for and do you want the attendees to be primarily SAS doctors?
P: Not at all. This meant for all the grades people, yeah.
I: What are the subjects of those seminars?
P: For example I did optimisation, anaesthesia for emergency surgery, transfer, a two-day course on anaesthesia for ENT surgery, anaesthesia for orthopaedics, and I have done a lot of combined meetings, for example with the Royal College of Anaesthetists, and I designed sessions for winter scientific meeting and Annual Congress. I have had my own meeting, called Manchester Core Topics, which I’ve done for the last ten years. It was started as one-day meeting but it is now for the last four years I’ve done two-day meetings. I’m very pleased to say when I did this last month, recently, there are people who come, the only meeting they go to is that meeting, they wait for it. Unfortunately this year I couldn’t do two days and they were asking me why I cannot and were very disappointed. They are all regular attendees. And also I ran SAS-specific seminars. There’s always been an argument about SAS doctors should be treated as consultants. They don’t need to have meetings exclusively but where it is, I agree with it but in a way they got different kinds of needs for all the circumstances, because they’re not fully trained but at the same time their need for the training as well, and some of them work as consultants anyway. And also they’ve got different issues, so what I did was I normally done that the last few years, called SAS seminars, and also conducted an SAS session in the Annual Congress every year. And I, before I’d been elected to the council for the Royal College of Anaesthetists, I used to run the Joint Review Days for SAS doctors. Unfortunately I could do it, from the other side they couldn’t quite make it happen so that sort of disappeared over the years.
And also I’m very proud of one of the meetings I done, three-day meeting for SAS doctors in the British Medical Association, attended by at least 300 people. People were absolutely shocked – how did they manage kind of thing, and people still remember the reception we had and the organising Indian Classical Dance for the dinner and that sort of thing.
I: Yes, I heard about it. I wasn’t there.
P: So that’s the other achievement, of organising those sessions.
And then I have sat on the panel for numerous guidelines like … I’ve got a special interest in health-service management. I’ve done a fellowship, so I did Dick Burg’s [40:05 IA] for management, and like I said, the pre-op assessment.
I: Did I see in your CV that you’re also a member of the Association of Medical Managers?
P: Yes. [40:19 IA] Unfortunately that brings … I was the education advisor for it, I did three annual conferences for the [40:33] and they’re very well attended, but when I left, I had to leave the management because I had been elected for the Council of the Royal College of Anaesthetists. Unfortunately whoever took over couldn’t manage it.
I: So you were sitting on the Royal College of Anaesthetists, you were still a member of Council here?
P: There was a time, a short period, when I was on both the councils.
I: <Laughs> Good for you!
P: And then I thought there would be a conflict of interest, so I couldn’t concentrate on either of those, so I –
I: And then the AAGIBI awarded you honorary membership last year?
P: Two years ago.
I: And you got the Anniversary Medal.
P: Thank you. Council Medal as well.
I: And when did you leave the Chair, 2015?
I: Of SAS Committee.
I: You’re still working, still giving anaesthetics?
P: I stopped giving anaesthetics in October last year, but … now you asked me about them and I got three things that I’m very lucky about, four things probably. Obviously my wife, and my children.
I: Very understanding wife I would think!
P: <Laughs> She is absolutely, yes, under the circumstances, and my children, and Association [42:13] Acupuncture.
I: I was going to ask you about acupuncture because I read that you use acupuncture in pain management.
P: Absolutely. I’ve been running a clinic for chronic pain for the last 12 years with one session I do for 10-12 patients. I’ve been doing that continuously.
I: And you’re still doing that session?
P: I was coming to that. I’ve stopped doing anaesthetics in October and I continued to do the acupuncture clinic, and then last month at the end of May I stopped it altogether. It’s because I’m 68 going on 69 this month, and also my daughter gave birth to a baby daughter.
P: Thank you. So I thought it’s time to enjoy myself.
I: So is that your first grandchild?
P: Yes it is.
I: It’s a wonderful gift. I wish you well to enjoy it.
P: Thank you very much.
I: And you’re healthy?
I: I can’t imagine you retired somehow!
P: That’s what everybody says, but I’m not retired really because now I am the Education Programme Advisor for the Royal College of Anaesthetists.
I: Still doing that?
P: I’ve just started now, after I finished on the Council they wanted me to do that, which I agreed to, so I am responsible for most of the meetings next two or three years.
I: That’s a big job!
P: It is indeed, yeah. I’m on all the CPD Board, Education Board, [43:47] learning webcast. Because I’m not giving anaesthetics I have to fill ten sessions!
I: <Laughs> OK, you have to fill your time!
I: Now you’ve got two children I believe.
I: Is it a son and daughter?
P: Yes, it is.
I: And they’re both doctors?
P: Yeah. My daughter did medicine in Cambridge, she’s been doing paediatric training in London, she was actually about to finish when she got married and her husband has got a job in Washington DC, so she had –
I: Is he medical as well?
P: He is a Director of Aspen Institute.
P: He works for the United Nations. Clinton’s project.
I: And that’s the daughter who’s just had a baby.
P: Has a baby. My daughter, during her paediatric training, spent a year in [44:47] and did a masters in Global Health, so she fell in love with it. She wanted to pursue her … she wanted to have babies as well, so the only thing you can do now is to get some kind of public health-oriented job. And she has been a clinical lead here, a clinical lead for female genital manipulation [45:13] committee, and she also worked with Wendy Reed as a clinical fellow after she came from [45:19 Hamburg] to be Director of the NHS England. So now she’s being a mother. She’s quite happy.
And my son also did medicine in Cambridge, and he did the foundation year training and he became a professional actor now.
I: He’s a professional actor?
P: Yeah. He’s done a lot of productions in high school and in Cambridge, he did a course in LAMDA as well. And now he’s done a few dramas in National Theatre. Right this minute he is playing Puck in Midsummer Night’s Dream, Trevor Nunn’s production, in Ipswich.
I: Wow, that’s amazing.
P: He still works every now and then as a locum in A&E in [45:18 the MU,] but he tells me his heart is in drama, so he will probably do this, make money as an actor is not easy.
I: Even more difficult to break in, but there we go. That’s an amazing story. Thank you.
And what’s his professional name?
P: Esh Alladi.
I: Well that’s a name for us to watch in the future. We’ll all say, ‘Ah, we knew your dad!’
P: Yes, he’s done already a play recently, WIT in Royal Exchange Theatre, which happened to be in Manchester, and then he had to stay with us, so lucky to have him after all these years. Yeah, good.
I: How do you feel about the fact that he’s given up medicine? You’re happy.
P: Absolutely, yeah. When I watched him, from the age of five he could sing and dance and he’s a different person when he’s on the stage, and in his characterisation of Puck I didn’t realise that he could dance like that, kind of … so I think you have to follow where your heart is. Probably in my case, my people wanted me and I also wanted to be a surgeon, to start with, but I got into anaesthetics, which I love it immensely, so I’m very lucky that I got into anaesthetics.
I: And now, if you ever have any time to relax, what do you do to relax?
P: I write poetry, and especially in my mother tongue.
I: Which is?
I published a book of poetry recently. What I did was when I stopped doing anaesthetics I had a lot of time on me so I started addressing and putting down my thoughts every … like a Monday morning or sort of when I … time I used to do clinics, I thought I would sit down and write, and I read out some of the poetry to one of my cousins in India and he said it should be published, so it’s being published. I’m writing my experiences here in anaesthesia and in the country, and I’ve taken up a project, one of my grandfathers is a quite famous man, he wrote an autobiography in Telugu and he is really well known for his political science and things. And he wrote this autobiography in Telugu, one of the Indian languages, and one of the second generation people who are living abroad, they wanted me to translate because I know both Telugu and English, so I’ve been translating that book into English. That’s a very big project. It’s about 400 pages. I’m about to finish actually.
And I’m interested in music and dance, but I’ve become lazy now.
I: You don’t sound lazy!
P: <Laughs> I’m absolutely restless at home, but –
I: You used to write short stories, you said.
P: I wrote short stories yeah, in college days.
I: When you say you’re writing your experiences, there is a fad at the moment for doctors to write about patients, I’ve read a couple recently, write about things that have affected them or interesting cases, there’s the neurology one and there’s the one recently about near death decisions that’s very big. Is that the sort of book you’d like to write now?
P: Well I’ve got three folders now. One I’m writing about anaesthetists, with lots of little silly things that we do which have got no clinical evidence. Say for example we gave gallons of normal saline when we were students. Nowadays it’s the wrong solution to give. Like that antiseptic you’re always [50:36] and probably would just wash my hands with soap and operated and nothing seemed to happen. Now they’re talking about different kinds of antiseptics and how we apply and this and that, and especially infection risk. Still we don’t have any rational behind using antibiotics. Things like that, that’s one thing. The other thing is lots of things we can improve. I mean in the NHS for example we talk about productivity and that sort of thing, efficiency and so on, but when we go and when we see, go to hospital, there are no beds, and basic need for a productive day is having enough beds, and then having efficient people to do things, it’s no good. And I remember writing an article to Anaesthesia News about 101 things that can go wrong kind of thing. It was taken up by the NHS Quality Management people and they asked me to do a workshop, because a lot of little things which can be helped and we don’t do it and then … that sort of thing. So I’m writing down all that kind of thing. We did lots of things without any … blood transfusion, there was a time I suppose you remember, I worked in Wrightington Hospital, hip surgery unit, with Charlie, and we used to give prophylactically blood transfusion for hips, even before we started. And how things have changed and why we did it and what clinical evidence you have at that particular moment, how we agreed to these things, and that’s one thing. The other thing is in general NHS I think there’s so much we can do it improve if only we had control and a lot of non-medical people will come in. They have theories but no real understanding of what goes on in the field. That’s my personal view. So writing that down, doing that kind of thing. And there are lots of cultural nuances for patients when they come here and they go through … the expressions they make and thank you, sorry, excuse me kind of thing, how … I’m listing them out and trying to explain why they are like that. They are seen as disrespectful gestures but that’s the way they are and they don’t tend to thank people for anything, they take it for granted, and they interrupt, it’s taken as rudeness, so there’s lots of these cultural nuances, so my children when they’re going to schools and that, they also suffered a lot of that kind of expressions and things. Certainly when they started beating everybody, coming first in the class, the parents also understood us and then … that all changed. So all these things I want to … just educate people really because they don’t know.
I: I’ve saved asking you these next couple of questions to the end because we might not want to keep them even, but I have to ask you, you’re the first SAS doctor that I’ve interviewed, you’re the first SAS doctor that’s been included in this project, and I’m glad that we’ve added this aspect of it, but do you think part of the problem … particularly at this time in our lives now, with the EU referendum and the worry about immigration, was part of the problem protectivism on the part of the doctors, the problem that you experienced in not becoming a consultant anaesthetist? Because we were being protective of training posts, we were keeping them for white, English or British graduates and stopping people from overseas getting them? There’s a … it’s not just from the Indian Sub-content, it was from Europe as well now, all parts of the world. Do you think that was a factor? I suppose what I’m asking is do you feel you’ve ever been disadvantaged by your race, by your colour?
I: I would say yes and no, because if you were in the right place with a good network and that sort of thing … because a lot of Asians became consultants of my generation, and I failed to become one. As I mentioned to you before, that’s because they were working in teaching hospitals and there were some gaps and then there happened to be… so luck more than the … I think that’s one thing. I don’t think … there are no openings for SAS doctors. I mean now the problem is with career progress and development of SAS doctors, I think traditionally the SAS doctors had low esteem, they were not recognised for the talents they have. I think increasingly this is going to be a very popular grade because of various reasons, because the new generation of doctors, even my kids, they say they don’t mind being an SAS doctor, having got all this [56:36] experience, because they have got other things to do in their lives, they have other interests in their lives and they don’t want to be spending all their time being a doctor. So there are some people who want to work part time because they want to go abroad, work in Africa, Australia, do public health, that sort of thing, and there is no provision for that kind of thing in the present training schemes. If you miss out on the regular programme you lose your number and you’ve had it, see? So they are going to take up SAS grades because there may not be that kind of restrictions, you can come and go. So but again I don’t say there’s been any racial reasons for it. Just that there are no avenues open for people who are experienced, slightly aged and there are only limited spaces in training and I can see any employer would like to take a younger one. To give a typical example now, people who have got [57:48] and they’ve got accredited with the specialist register, 55-year-olds … about 35% of them can’t get consultant jobs. They have been accredited and all that. Because the employers prefer somebody who’s 35 or 40 I guess. But I’m not saying age discrimination, because … it’s not up to me to interpret these things as racial or whatever.
I: I was interested to ask the question. I’m very encouraged to hear you answer.
P: But in my case, yes I have been badly done in earlier days. I explained to you my experience and I explained to you my qualifications and why couldn’t I get a place? It’s not a lack of trying. A lot of people at that time went to America or Middle East … but I loved the place where I lived all these years so I didn’t want to make that kind of … and for my family I wanted to be in one place and I wanted my children to have a sense of belonging to the place. So I won’t call it a sacrifice but I suppose that’s the best thing for me to do.
I: Ramana, thank you very, very much.
P: Thanks for having me.
I: Well, it’s been my pleasure. I hope you’ve enjoyed it.
P: Absolutely, yeah.