Dr Roger Eltringham: Adventures in Anaesthesia

Dr Roger Eltringham is a retired anaesthetic consultant, and now runs Safe Anaesthesia Worldwide, a charity that provides anaesthetic equipment, training and research around the world. In this interview he discusses his adventures in anaesthesia, including the unexpected link between rugby and anaesthetics, working around the world, and the best way to anaesthetise an asthmatic chimp in the middle of the night.

Cricket vs. Medicine

At school, I did alright at rugby and I played for Kent. Then when it came to leaving, I was going to do physical education, and I’d got a place at Loughborough College, but in the mean time I went on a cricket tour of Holland. And after about half an hour we were all called off the field, and along came a very distinguished man who wanted to address the team. And he said, ‘I must apologise for being late but I’m a surgeon at the local hospital and I was called back to operate on a child because he was losing blood faster than we could give it.’ And I’d never heard anything like this. I thought ‘what dedication. Perhaps cricket isn’t as important as I had thought. I want to do what he’s doing’. So I then came back from the tour to Kent, and said, ‘I want to study medicine.’ My father said ‘Medicine? What are you talking about? You don’t know anything about it.’ I said, ‘Well, that’s the idea of the course. You study it and get to know about it.’ But I hadn’t got any idea where to apply. I applied to all the hospitals in Britain and Ireland.

An Unexpected Vacancy

I had maths, physics and chemistry, which was almost alright. No biology. I’d never done any biology at all. So only two places even replied. One was St Mary’s in Paddington, and the interview was something like Doctor in the House. There was a James Robertson Justice type of chap and… there was a lot of indrawing of breath and shaking his head. And I could see where the door was and I was thinking, I’m gonna be there in a minute.’ He suddenly said, ‘Oh, wait a minute. I see you played rugby for Kent.’ I thought, this is the only chance I’ve got. I said, ‘Played for them? I was captain of them.’ ‘Oh. Well, what position can you play?’ I said, ‘Well, I can play anywhere.’ This is a bit of an exaggeration. And then he said, ‘Oh, well we do seem to have, now I look again, an unexpected vacancy.’ I’d love to have seen what was in front of him. I don’t think there was anything on the page.

‘The interview was something like ‘Doctor in the House’… there was a lot of indrawing of breath and shaking his head…’

But then I had an offer at St Andrew’s. And my doctor was a Scotsman, and said, ‘If you don’t take St Andrew’s I will never speak to you again.’ So St Andrew’s got the vote and that’s where I went. Now that was a very extraordinary university, really. I think it still is. It was a very traditional sort of place with a terrific emphasis on anatomy.

‘”I’ve been examining for 40 years… In all that time, you are the only candidate who you got every bone wrong”… I thought I’d done quite well’

I got knocked out in a rugby game once, just before an anatomy viva. I took the viva the next day and I seemed to be doing alright. The professor of anatomy had a lot of bones on a table and he kept picking them up and passing them over to me and saying, ‘What is this?’ And I’d say what I though it was and, ‘This hole is for this artery.’ ‘How about this bone? What do you make of that one?’ Anyway, after the exam, he said ‘I’ve been examining in anatomy in this university for 40 years… In all that time, you are the only candidate who didn’t know a single thing about the human body… All these bones; you got every one wrong.’ I thought I’d done quite well. Luckily a friend of mine came in next, and said, ‘Oh, did he tell you he was knocked out yesterday?’ So I was called back a week later and remembered a few facts. The annoying thing was I thought I’d done so well!

Introduction To Anaesthetics

Everybody had assumed I’d go into general practice, and I went along with them. And then somebody said, ‘Well, for general practice you’ve got to know about obstetrics.’ So I applied for the Rotunda Hospital in Dublin, which was regarded as a good place to go. So I went to the interview, and it was a rather unusual interview. He only asked one question: ‘Have you got a driving licence?’ I said, ‘Yeah.’ ‘Is it up to date?’ ‘Yeah.’ ‘Good. Well, you can start next week.’ I thought, I wonder what I’ve agreed to. Perhaps this is the hospital chauffeur he’s interviewing for.

‘In the back of the ambulance were two cases: one marked ‘obstetrics’ and the other marked ‘anaesthetics”

But it turned out to be very relevant, because our job was to drive the hospital ambulance around. And you’d go to all the people who were having home deliveries, which seemed to be just about everybody. And on day one I arrived at the hospital and collected the keys and I was very relieved to see in the passenger seat an experienced obstetrician and a map of Dublin. And in the back were two cases. One was marked ‘obstetrics’ and the other was marked ‘anaesthetics’, which I didn’t take too much notice of. Wish I had, now. When we got to the various houses my job was fairly basic. I’d pick up the two cases and follow him up the steps and then we’d go into the bedroom and he’d either deliver a baby or sew up something. My job was to sit there and take notes and keep quiet.

‘He said, “You are the anaesthetist”. So this was very alarming…’

And then one day I could see he was struggling, and things were obviously not going very well. And he suddenly said, ‘Open that case marked “anaesthetics”.’ So I opened it and there was a lot of things I’d never seen inside it before. I was getting a bit nervous at this point, so rather optimistically I said, ‘Shall I phone back to try and summon an anaesthetist from the hospital?’ He answered with words I did not want to hear. He said, ‘You are the anaesthetist.’ So this was very alarming…

‘I thought I never want to have anything to do with this; this is the most dangerous subject I can imagine…’

I’d seen a picture of a Schimmelbusch mask and I could see something rather like it. I said, ‘What do I do?’ He said, ‘Put the gauze on there and then there’s a bottle of chloroform there. Well, pour the chloroform onto the mask until I tell you to stop.’ Oh my god. So I did this, and patient collapsed unconscious, but had a difficult airway; and I knew to hold up the jaw but there was quite a lot of noisy breathing and the patient went blue. He was white and I was feeling very yellow at the time. So it was a most awful situation. Luckily she survived, but I thought, this is not for me; I’ve gotta get back to England. So I left as soon as possible.

That didn’t endear me to the subject. I thought I never want to have anything to do with this; this is the most dangerous subject I can possibly imagine.

Rugby vs. Anaesthetics

So I went back and I got a job in Bath as an SHO and then a casualty in Bristol. Now casualty in Bristol… there was punch-ups every night. I think at the end of my six months I was punched three times and bitten twice. But for recreation I joined the hospital rugby club, where there was still a lot of biting and punching but we were able to take part.

‘I think at the end of my six months in casualty, I was punched three times and bitten twice…’

I did notice most of the players seemed to be anaesthetists… and a very, very sociable team. I didn’t realise how important this was to my subsequent career. There was a big room and water would come out of showers and you couldn’t really see, there was so much steam and a lot of singing was going on and various other entertainments – suddenly, out of the mist came this burly-looking figure with a Northern Ireland accent. And I noticed he had a cauliflower ear and there seemed to be some blood coming down here, and his teeth bleeding as well, and his eye was slightly closed.

And he said, ‘What are your plans for the future?’

‘Oh, general practice.’

‘You won’t be any good at that.’ Which was a bit of a blow, really, ’cause I thought I was going to do that. ‘If you want to play for this team you have to study anaesthetics.’

‘I’ve got no interest in it.’

‘You’ll get some.’

‘I’m not very good at exams.’

‘We’ll help you.’

‘Well, there’s a lot of good candidates for this job.’

‘The job will be yours. Forget the candidates.’

He wouldn’t take no for an answer. So I did apply.

General Practice

‘I got a job at Butlin’s… I thought it would be a little holiday… it was like a concentration camp’

I had to do a few other jobs first while this job that I’d been promised came up. And so I got a job at Butlin’s in Minehead, which was rather more than I was expecting, because I thought it would be a little holiday with Lorna and the children, but as we approached the camp it was like a concentration camp. There was huge, big fences up around it, and watchtowers that seemed to have searchlights. I said, ‘This is rather bigger than I thought. How many people are here?’ ‘12,000 holidaymakers and 3,000 on the staff.’ I said, ‘Gosh, 15,000. How many are we in the team?’ He said, ‘Team, what are you talking about? It’s you. You are the doctor for this lot.’

‘The first two doors I’ve been into, they’re both dead… I won’t try any other doors in case everybody’s dead…’

Then I got a job as a GP deputy in Bristol. And we used to deputise for the emergencies. And one Sunday night, I got called to some alms-houses, and it was getting dark so it was a bit spooky and they were spooky alms-houses and grey, big arches around the central lawn. And I was told to go to residence number three. So I went to this residence and knocked on the door. Nobody came. So I shouted out; nobody. So I opened the door and it opened with a creak; and I called out, ‘Mrs Jones?’ No. I couldn’t find a light. And I fell over something, and it seemed to be a foot. And I suddenly realised, oh god, there’s a body on the floor. So still no lights. Felt the pulse. There’s no pulse; no breathing. I thought, my god, this patient’s dead. So I’d better go to the warden; tell them. So I went to the warden’s house and it was pretty eerie. Strange feelings down the back of my neck. I went to the warden’s; knocked on his door. There was no answer, so I knocked a bit louder. There was no answer. So I opened his door and it was a similar creaking door. I went in; he was dead. And I thought, oh god, this is terrible. Maybe there’s been some awful incident here or some chemical’s been released. So I thought, I won’t try any other doors in case everybody’s dead. So I phoned the police in Bristol and said, ‘I think you ought to come down to this alms-house because I was summoned to a patient. The first two doors I’ve been into, they’re both dead, and I’d rather some police were down here before I go anywhere else.’ And eventually they came, and we went into a third door, and this one was alive. It was just a freak coincidence. But that did put me off. So it was quite a relief to get back into the hospital.

Anaesthetic Training

My first experience of proper anaesthesia was in The Royal United, Bath. In those days, you were thrown in very much at the deep end. You had a couple of days with the registrar and it seemed after a very few days you were given your own list. But they said, ‘Don’t worry, he will be in the next room.’ Luckily, we had in those days people called technicians. But these were Second World War veterans, and they were not easily frightened, thank goodness. So they would tell you what to do. You would be greeted in the morning and they’d say, ‘Doctor, I’ve drawn up all the drugs in the correct doses and I’ve labelled them for you. But don’t give anything unless you check with me first.’ So you would hold up a syringe and they would nod; they did look after you, and they were very calm, and I owe them an awful lot.

‘You didn’t get much formal teaching… you had a couple of days with the registrar and after a few days you were given your own list’

You didn’t get much formal teaching. Very little formal teaching. There was no tutorials or teaching sessions; you just learned everything with the registrar. Occasionally, if you were very good, you’d have a session with the consultant anaesthetist, but often they wouldn’t be present in the room for quite a lot of the time. And they would say, ‘Well, look, Roger, if you need me I’m having a cigar with Matron in her office. Call if you need me, but do what you’re happy with.’ Or else they’d say, ‘Now, Roger, this list; there’s still another three cases, but I have to go off to the Nuffield. If you wouldn’t mind just finishing off these easy cases.’ It was good for getting experience.

Agents and Equipment

There wasn’t much regional or local… Spinals were banned because, I think, there had been a famous case somewhere where people had been paralysed. And so we weren’t to touch any spinal anaesthetics at all. Everything was under general and we only had a few drugs. We had thiopentone and suxamethonium, and then we had ether, I think, and chloroform. Chloroform was going out. I was very pleased after my previous experience with that. Halothane had been introduced. And there was a vaporiser – wasn’t part of a machine, it was a standalone vaporiser – but the SHOs weren’t allowed to use it because it might cause cardiac arrest and you wouldn’t be able to deal with that. So stick to ether and Trilene. Those were the main agents at the time. And curare.

‘Spinals were banned… we weren’t to touch any spinal anaesthestics at all’

Face masks and Guedel airways were very much to the fore. Boyle’s machines, of course, with low central gas… Glass bottles, which got very cold of course, and there was a thing like a saucepan that you put the vaporiser in with warm water in it, which kept the temperature. Gases in cylinders: We had oxygen, of course, and a bosun whistle. And that wasn’t supposed to go off because it disturbed the surgeons. And nitrous oxide and carbon dioxide. I never quite understood what that was for, but I was told, ‘If they’re not breathing, give them carbon dioxide.’ I didn’t use it very often. Cyclopropane was a winner. Now, I did like this drug because it was easy to give. They said, ‘One litre of cyclo, one litre of oxygen. Put them to sleep. Once they’re asleep, get rid of the cyclo. Turn it off. Don’t take it into theatre otherwise there’d be explosion; everybody would be killed; bad medicine.’

‘Don’t take cyclopropane into theatre, there’d be an explosion; everyone would be killed’

We used glass syringes and reusable needles, which we had the responsibility of keeping clean. So at the end of the case, or during the cases, you rinsed them out and then put them in a steriliser at the end of the anaesthetic room. One occasion I noticed that – it was just before Christmas – a lot of nurses kept coming into the anaesthetic room who weren’t really due in there, and would go up to the far end, open this steriliser and do something and then walk out. And after about three or four different nurses came, I thought, I’ll go and see what’s going on. There’s something strange going on. So I went along and opened this steriliser, and inside were three Christmas puddings.

All the intravenous drugs and fluids, including blood, came in glass bottles. And the only way you could pump it in was to pump air into the glass bottles and build up the pressure. But you had to pay close attention because, of course, if it ran out, all this air would go into the circulation and be fatal. So although it was effective, I was very pleased when plastic bottles came in and we didn’t have to do this. I think it was a Higginson syringe we used to pressurise them with.

‘There was hardly any monitoring. Finger on the pulse; watch the breathing; look at the pupils’

There was hardly any monitoring. Finger on the pulse; watch the breathing; look at the pupils of the eyes. If they’re big then either you’ve got too much or too little; and if they react to light they’re just about to wake up. So watch those pupils very carefully. If there’s tears coming down then they’re probably a little bit light. Respiratory rate was very important, and pulse. Cyanosis was very difficult to pick up in some lighting too. I was told to look at the eyes – which was quite a good one. A little torch that you could show, but the monitoring was really clinical and nothing scientific at all. To be honest, it was good training, because in later life I came across places where there wasn’t any monitoring, and this training came in terrifically helpful.

‘We weren’t involved in any perioperative care… or expected to see the cases beforehand’

We weren’t involved in any perioperative care at all. We weren’t expected to see the cases beforehand. They’d say, ‘No, this is your list. The house surgeon has seen them and you will see the patient in the anaesthetic room and introduce yourself.’ There wasn’t much time for any talk. The surgeon’s face would be at the door if there was any chit-chat.

‘There was no recovery area… no notes… you weren’t expected to see them again’

There was no recovery area. As soon as the case was over, turn them on their side and took them outside. You phoned the ward and the nurse would come back and you had to explain what they’d had. No notes, of course, we just had a piece of sticky paper, which you put in the notes, and it said patient’s name and what drugs you’d given and what the operation was, and any comments. And that was the anaesthetic notes. You weren’t expected to see them again.

Denver & Liver Transplants

I joined a rotation… and they said to me, ‘You’re going to Truro.’ So I said, ‘Are there any other alternatives? Nothing against Truro, but I just wondered.’ He said, ‘Well, there is Denver in Colorado.’ Actually I said, ‘No, I think Denver’s probably more suited for my skills.’ Or lack of them. So I went to Denver, where I found they were very impressed that I had so many years of anaesthesia and I was immediately put onto the consultant rota.

Denver Airport was very high – I think it’s about 5,000 feet above sea level. The altitude affected the anaesthetic, because nitrous oxide and oxygen wasn’t enough. Partial pressure, apparently. I was used to using nitrous oxide and oxygen, so that had to change.

“You have to anaesthetise a chimpanzee…”

Professor Starzl, the great transplant surgeon, was there and he was in the early part of liver transplants. And sometimes they couldn’t get a liver, if there was no match they used to use a chimpanzee. They couldn’t get any Americans to work on the liver transplant service because it was miserable, and lots of long cases going on for about 23 hours.

And one night I was on call: ‘Professor Starzl, he wants to do a liver transplant in about three hours.’ This was about midnight. You have to anaesthetise a chimpanzee.’ I said, ‘What are you talking about?’ ‘Well, there’s no human donor so we use the chimpanzee.’ So I thought, my god. I couldn’t even envisage what I could… I knew it was a sort of monkey, but I…

“The chimp’s got asthma. What do you usually do?”

So I phoned up one of the American chaps and I said, ‘Look, I don’t know what to do here but he wants to anaesthetise a chimpanzee.’ He said, ‘Oh, no, I’ll do the chimp; you do the human.’ So I got my patient in a nice position, and there was no sign of the donor. So I phoned up the animal house and I said, ‘Look, we’re ready to go. What’s happening up there?’ ‘Oh, Christ, there’s a lot gone wrong… We lost the key to her cage.’ I said, ‘You’d better bloody well find it because we’ve started.’ So apparently there was chaos up there and they sawed a bar through this cage. Anyway, somehow this chimpanzee was overpowered and brought into the next room. Then he went home and one of the residents looked after the chimpanzee. Messages would come through, like, ‘Wow, got some trouble in here. The chimp’s got asthma. What do you usually do?’ I said, ‘Well, what we usually do is to titrate aminophylline until the breathing’s better.’ ‘Oh yes, of course, thank you very much. Glad to have someone with such experience on duty with me.’ ‘Pleasure.’ Anyway, this got through. Unfortunately it wasn’t a success, but it bought some time for this operation to go ahead.

 Back to Gloucester

Then consultant jobs [in the UK] lured over the horizon. I applied for one or two and came second or third. At one interview I went to, the first question was, ‘Well, tell us why we should appoint you as opposed to those excellent candidates outside.’ Well, if you’re not ready for that sort of question… I couldn’t think of any reason; nor could the rest of the panel.

‘I got the job to start an intensive care unit. It was quite new, nobody knew how to do it’

When I eventually came to Gloucester – I’d had a lot of coaching by this time – and was asked the same question; but I was ready this time, and I got the job to start an intensive care unit. And of course it was quite new, and nobody knew how to do it. So we ran it on Bristol lines; resuscitation service and that sort of thing.

So I got established in Gloucester. Still playing rugby, but getting a bit long in the tooth. One of the attractions of Gloucester was this team that I’d seen coming up. They weren’t the most fashionable team in England, but they were very good.

A friend of mine was the team’s medical officer, and when he retired he told the club, apparently, ‘Well, there’s only one person. You’ve gotta get Roger Eltringham’ So I was called to interview at Kingsholm. And I was expecting to face the committee… and instead this chap said, ‘Hello Roge, I hear you’re joining us.’ I thought, I seem to have got the job. He said, ‘Do you know anything about rugby injuries?’ I said, ‘Well, no, not really.’ ‘Good,’ he said. There were no subs in those days, but he said, ‘In Gloucester, what we do, if they play for the opposition, don’t take any chances: send them up the hospital straight away. They play for Gloucester, you try to keep them on the field.’ So I got very strict instructions on this.

‘What Are You An Expert On?’

When I came to the Association, Peter Baskett – again – phoned me up, and he said, ‘I’m putting you forward for nomination for the Council of the Association… it’s too full of academics and we want somebody to redress the balance,’ which I think was meant as a compliment, but I’m not absolutely sure. Anyway, I stood rather reluctantly, and I came fourth. I said, ‘I’m sorry I came fourth. I’m sorry to let you down.’ He said, ‘Don’t be ridiculous. Fourth is excellent. I’m putting you up next year.’ So next year I was put up and I came top. So there was no way of getting out of it then..

So I came up to the Association, went in and I was greeted by someone who said, ‘Who are you?’

‘Roger.’

‘I never heard of you.’ It wasn’t the warmest welcome I would ever get.

‘Well, what are you doing here?’

‘I’m a new council member. I came top of the poll.’

‘Oh, alright. Well, what are you an expert on?’

‘Well, nothing, really.’

‘Well, you’ve gotta be an expert. You’ve gotta sit on one of these committees. How about finance?’

‘I don’t really know much about money.’

‘Oh, alright. Research?’

‘Well, no, I’ve not had an original idea in my life.’

‘Education?’

‘Well, I failed the exams.’

‘Safety?’

‘No, I take a lot of risks.’

By this time he was practically hysterical, and he said, ‘Alright, well if you’re no good at anything we’ll put you on the international relations committee.’ So I was put onto this committee and it was fabulous. I loved this committee. It was full of people who I think had similar knowledge to myself, therefore they were excellent people and it was fabulous. And we would take in the requests from overseas. The tradition seemed to be that we turned everything down. And I said, ‘We could do that. We could help them.’ They said, ‘Well, they want someone to go to Nigeria.’ I said, ‘I’ll go to Nigeria,’ and I had to lecture to the Nigerian army, which was quite handy, really, because after the lecture they said, ‘Look, that was a very good lecture. Is there anything we can do for you?’ I said, ‘Yes; I would like an armed escort to Lagos Airport,’ because it was a bit hairy. So that international relations committee, we accepted everything and got to have links and be invited all over the place.

‘By this time he was practically hysterical; “Alright, we’ll put you on the international relations committee!”‘

And so I was elected to the international relations committee of WFSA, I think they called it. And so we assembled in this room in the Washington Convention Centre, and this chap comes in, ‘I’m Kester Brown. I’m the chairman, and there’s a lot of problems out in the world, and you lot have gotta solve them. Who’s Roger Eltringham?’ I said, ‘Well, me.’ ‘Right. You take care of Africa.’ I thought, Africa? That seems a big area. Anyway, the next chap was told to look after Asia, so I thought, maybe Africa’s not as bad as I thought. You were given quite a free rein. He said, ‘Look, work out where they need refresher courses.’ And you take a party of three or four and cover as many subjects as you could in about three or four days, and then perhaps go on to the next country and do the same. And we got better and better at these as time passed.

The Glostavent

Another of my great interests is equipment. Particularly the Glostavent and its development.

I think one of the things that absolutely shocked me would be to go to these very poor countries with very rusty old-fashioned equipment, and then go into the store rooms and see modern Drägers costing £50,000-£100,000. Useless. They’d say, ‘We couldn’t get this to work… when the electricity failed the machine stopped working’, or, ‘when we were out of oxygen it wouldn’t work.’

‘City after city, all these machines… millions of pounds were being wasted’

And this went not just once but city after city, all these machines, and I thought, this is awful. ‘Why don’t you do something?’ ‘Well, we can’t do anything about it. This is what the aid agencies have provided.’ And millions of pounds were being wasted. And I was thinking, Tom Bolton used to have a drawover anaesthesia, which of course could work without oxygen. He said, ‘If you’ve got no oxygen, use air. What’s wrong with that?’ I couldn’t think of anything wrong with it.

And then at that time we had a Russian naval lieutenant came to Gloucester, and he said, ‘Well, we’re using oxygen concentrators in parts of the Russian navy.’ So we managed to get one from somewhere and we put it on a trolley and had a Manley multi-vent and a drawover circuit. And we worked out, there was no nitrous oxide but oxygen-air was becoming fashionable, and we thought, we can do all this. So we put this lot together and wrote it up, and it was published in Anaesthesia. As I was working at Gloucester rugby club we thought we would call it the Glostavent. And I pointed out to the president, ‘I think we’re the only rugby team in the world with an anaesthetic machine named after it. But if we discover another one, we should play them in a championship.’ We haven’t found another one.

‘We’re the only rugby team in the world with an anaesthetic machine named after it’

It took a long time to get developed, ’cause it didn’t look good. Several people got interested, but it didn’t catch on. Nobody liked the look of it.

One day I had, out of the blue, an invitation from the Institute of Electrical Engineers. And there was a whole room full of people; and lights went out; I started to talk. And then I could hear there was a snoring. And no questions; there was a modest applause. And nobody took any interest. And I was just about to leave for the train and somebody came over and said, ‘Who’s manufacturing this?’ I said, ‘Well, that’s the problem. Nobody’s interested in it and yet it’d be good.’ ‘Can you get down to Devon, ’cause I’ve got an engineering firm which would be interested.’ Well, I went down and they were making things like mosquito nets and things like that. But there was a brilliant engineer there… and everything I asked for, this chap could do, and it started to catch on.

‘We bought 18 machines about 15 years ago… quite a few are still working. It’s now in 70 countries’

When Professor Rosen was secretary of the WFSA he was very keen on the Glostavent, and he knew it was important to have a machine which countries could afford, and so he backed this very much. And he contacted the British Council and, I think, the ODA. Clare Short, I think, was the Minister for Overseas Development at the time. And he arranged for her to come down to Gloucester and see this machine. And she was very interested and was very, very supportive for us, and awarded a big grant for us to try it out in southern Africa. And so I think we bought 18 machines and put them in 18 different hospitals in southern Africa, and tested them out. And some went better than others, but quite a few are still working. And that’s about 15 years ago. Gradually, as the machine got better and more smooth and more popular, it succeeded. So Glostavent gradually started to look better, and now it looks like any other machine, really. It’s now in 70 countries, they can’t seem to meet the demand for it! Still being made by the same firm. Cooperating with engineers was something which wasn’t really fashionable. But this is the best thing we ever did.

Other Associations & Awards

There are one or two other bodies that I’ve been involved with. The British Council adviser on anaesthesia, I think was via the Association. They said, ‘Would you help the British Council? They want to appoint somebody to go to Zambia.’ And we had training programmes in Khartoum and Ghana as well.

I seemed to get on to the American Association. I’m not sure what I was doing there, really, but via Yale I was nominated for their international education committee. So that meant going to the ASA, which was very interesting, and I managed to make a lot of very good contacts there.

I don’t know if they still do it, but each university has a reception at the ASA. And I went around with one of the American doctors, and there was one reception where they were playing music, a string quintet playing, so I said to him, ‘Let’s go in here.’ He said, ‘We don’t know anybody in here.’ I said, ‘Leave the talking to me.’ So we went in there but we were approached by a young registrar type, and he said, ‘When were you with us?’ So it was a difficult one to answer ’cause I didn’t notice which particular university we’d gone into. So I stalled a bit, and he said, ‘Who was chair when you were there?’ I hadn’t got a clue who the chair was. I said, ‘Well, to be honest, he wasn’t very well-known. He used to stay in his office most of the time’… and it turned out it was Leroy Vandam, who was a world-famous chap. Anyway, we were allowed out.

“Well now Roger, I’d like you to meet Professor Leroy Vandam…”

The next day there was a great meeting of these American grandees. A professor from Yale was there, Harvard and everywhere. And the professor from Yale called me over and said, ‘Roger, I want you to meet these gentlemen.’ And they were all the famous names in America. And he said, ‘Roger, do you mind just repeating that story about what happened at this reception the other night?’ I knew I was being set up. I told the story. And then he said,Well now, Roger, I’d like you to meet Professor Leroy Vandam.’ So I said, ‘I’m sorry, I had to use your name.’ Anyway, he loved the story and we corresponded for several years. But it was a difficult situation.

I become vice president of the WFSA. The president actually resigned for a short while, and I was told – I wasn’t in the room – they said, ‘You’re the president.’ I said, ‘What?’ ‘No, the president’s resigned. You’ve gotta take over.’ To be honest, I felt like resigning myself. Anyway, she withdrew her resignation. I think when she realised who was going to take over she decided perhaps she would stay on. So I wasn’t president for very long.

I became an honorary member of the Association, a great honour. And of the Intensive Care Society. They gave me the Ralph Waters Memorial Lecture in Wisconsin, and the Humphrey Davy Award of the College.

Safe Anaesthesia

For the last three years we’ve won innovation awards from the Association; different types. I think a recent one that went down very well was the CPAP generator. The problem with this treatment is that it works very well if you’ve got the money, but so many of the hospitals we visit can’t afford the vast amount of oxygen that’s needed or compressed air. So Robert devised a sort of mobile machine where the oxygen and the air mixture came from the oxygen concentrate, so they could have whichever volume they wanted of each; vary the percentage. And of course this was done at a fraction of the price. Probably less than 5% of the price. And suddenly hospitals all over the world are asking for this equipment, because they can do such a successful treatment. But sometimes it needs to be carried on for not just hours but days and even weeks, and of course devastating if they start it but can’t finish it. So this is probably the most popular thing that we’ve devised.

‘We need to be able to respond to urgent requests for help… we are so safe here and so expensive, that most of the world is falling further and further behind’

And in retirement now I’ve established a charity related to safe anaesthesia. When I left Gloucester, I still used to go on these teaching tours for the WFSA and refresher courses. But it struck me we needed to be able to respond to urgent requests for help, and that often it wasn’t a lot of money they were looking for; they just wanted some immediate help. So I talked to a few friends and we decided that we could set up a charity, because… we were so safe here and so expensive, that most of the world was falling further and further behind. There was no way they could cope with what we were expecting. So we decided that with the aid of Diamedica, who were making very inexpensive machines but exactly what was needed… and then their oximeter, Lifebox, came on the scene and we thought, this is just the sort of thing we could buy. This is not expensive. So we started this charity and we had three aims: equipment, teaching and research. We thought these are three things which we could do. Equipment would be expensive but the other two weren’t. So we started to raise money locally, but it got bigger and bigger… Schools were one great source of money because they like a lecture on anaesthetics. And I used to take a mobile anaesthetic machine with me, and this always went down very well.

‘We had three aims: equipment, teaching and research’

I retired about 10 years ago, I suppose. I retired in stages. I stopped doing intensive care one year; and then the next year I stopped doing night call; and then the next year I stopped doing something else; and then gradually I was hardly doing anything. So I had a fairly soft landing. I didn’t want to go flat-out. And then this has taken off. But it’s very enjoyable.

I’m very grateful to those that have helped me in my career; Peter, especially, but I was so lucky with the people I was surrounded by. No, I feel I’ve been very fortunate and I’ve met some really first-class people all over the world. After a bit you realise there are nice people everywhere. Even people that we’ve fought against, you think, well, what were we doing fighting against them? These are good blokes. So I think I’ve been very lucky to be able to travel so many countries.

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