Prof Jennifer Hunter MBE: Full Transcript

I:             It’s Tuesday, 9th August 2016, I’m Richard Barratt and I’m here at the Association with Sarah Dixon-Smith to interview Professor Jennie Hunter, MBE, who’s kindly come down from Liverpool for the day. Professor Hunger, thank you very much for coming down to this interview, perhaps we could begin at the beginning and you could tell us something about your early life?

P:           Well, I’m part of the post-War baby boom. My father stayed in the army after the Second World War and so I grew up as the child of a regular army officer. My mother came from Nantwich in Cheshire, my father was Scottish. I spent a lot of my early years at my grandparents’ home, my maternal parents’ home in Nantwich, I was born there, came in a hurry and have been in a hurry ever since; it wasn’t planned that I should be born there but I was born there. My early life was a very happy one; I had a very long and loving relationship with my parents to the end of their days. I had a very happy family life for which I’m very grateful. My father was still in the army when I needed to go to school, so my first school was in an army station in Kenya. My mother wasn’t terribly happy about this, about progress, and my first amusing anecdote is that I kept coming home from school and saying to mother that there was a black child in my class with white hair, and she was very irritated by my comments of this nature and it turned out that this child was actually an albino and it had got reddish hair. But I was starting to talk in the local language, my mother was getting worried. So my father’s mother was still alive in Scotland and so at the age of nearly nine I was sent to boarding school in St Andrew’s, which was a huge wrench for me. But I had two younger brothers and one of them was sent to school in Edinburgh, the other one was a baby. But I didn’t want to go to boarding school.

               Anyway, when I was about 13, my father finished his 25 years’ service in the army, they paid for him to go to Liverpool University to do a degree course which we were all very flippant about but now I realise in his late forties must have been quite challenging. My father had done a lot of map reading and planning of armed attacks from aerial photography, and he was sent and he did a degree in Town Planning at the university. So I was fortunate, when I was 14 I came out of boarding school and went to grammar school, and it was a grammar school (a la Theresa May) in Liverpool; all girls, of course. But at that time I was very keen to be a doctor. When I first went to school, even in Kenya, my mother took me along for a medical and they asked me what I was going to do when I grew up and, much to my mother’s surprise at five, I sat on the doctor’s knee and said, ‘I’m going to be a doctor just like you,’ and she nearly fell off the seat! So I went to an all-girls, very old-fashioned, grammar school, small school, which had a good academic record. It didn’t particularly have a great sporting record but I was never particularly good at sport.

I elected to go back to St Andrew’s to go to university, that was the link, but I had enjoyed it up there in some ways. And I was terribly happy at St Andrew’s and I think it was a good place for a 17, 18-year-old girl to go because it was quite safe really in those days, smallish and safe. I didn’t go for that reason but in retrospect I think it was a good place for a girl to go. And it was just at the time when they were starting to take more women into medical school. So of 95 in my year at St Andrew’s, 17 were women, but if you’d gone back 10 years earlier, there had only been 10, so the numbers were starting to increase. I loved every minute of it really, I’d do it again!

And then I did my house jobs, my professorial house jobs in Dundee, which was then a college of St Andrew’s, it became a university in its own right when I was there. I had been quite interested in psychiatry as an undergraduate because we were taught it very well, we had a very stimulating Professor of Psychiatry, and I had a cousin who was a psychiatrist, so I was quite interested in psychiatry. And I did six months psychiatry after house jobs but I very rapidly realised that I couldn’t keep quiet for long enough to be a good psychiatrist <chuckles>, to do two-hour case histories, and I also realised that over six months I was making no progress in the care of this patient’s health. But when I was a surgical houseman I was more interested in what the anaesthetist was doing than what the surgeon was doing actually; there was a mystique about it, how was it that these drugs were putting people to sleep and then they were waking up? And I also was very keen to use my hands in my work. I did enjoy my surgical house job and I was encouraged to take up surgery by those consultants I worked with then, but I don’t think I was ambitious enough then, at that stage, to have succeeded as a woman in surgery because there were still huge challenges for women in surgery then. And I didn’t have the desire to beat everybody else to it, I didn’t have that; I had the desire to do my work well but I didn’t have the desire to beat the next person to it. And I think a woman in surgery in my generation needed still to have that drive.

So after six months’ psychiatry I managed to get an SHO job in anaesthetics in Dundee, which I thoroughly enjoyed, but when I look back and think of some of the things I did, I don’t know if this applies to you, but after a month of training we were on call and in the area of Tayside around Dundee there were several maternity homes, for instance, where I could be sent out in the middle of the night after just a couple of months’ experience to do emergency caesarean sections. I remember going up to Montrose, 30 miles away, in the middle of the night, because I had a car, to do an emergency caesarean section. I’d never been to the building before. And they did children’s dental work in the back streets of Dundee, in the poor areas of Dundee, where it was thought that children should all have their teeth out for their 21st birthday, that sort of era, and I was being sent to do chair dentals at three months’ experience.

I worked in ignorance but I did realise that this shouldn’t be, at that stage, but it was a good grounding in the breadth of anaesthesia experience I had there, it was a much smaller department than it is now. But I realised I wasn’t being taught any paediatric anaesthetics, systematically anyway, so after Primary I applied for what was still labelled an SHO job in anaesthetics at Alder Hey Children’s Hospital, but it turned out that those jobs, really they wanted post-Fellowship people. But I was just about to sit the Fellowship final and so I came down to one of these jobs at Alder Hey, passed my final Fellowship 1975, and did a year at Alder Hey, which I thoroughly enjoyed actually. But I still didn’t think I was ever going to be a consultant, I was still at the SHO grade and enjoying myself and it was very hard work and you got every infection in the book; I used to think I’d have cholera by the time I’d worked for a year at Alder Hey.

I:             Who were you working with at Alder Hey?

P:           Jackson Rees and Gordon Bush, these were the greats of paediatric anaesthesia and I just lapped it up really. Of course Gordon Bush and Jackson Rees had huge numbers of visitors from round the world, because the Liverpool Anaesthetic Technique was really, by that time, only still being practiced in its purity at Alder Hey, so people came from round the world, and indeed SRs from departments in Leeds and Oxford and Glasgow, they all came to Liverpool to train in paediatric anaesthesia. So one didn’t get too close to Jackson Rees during the day, it was only on call that you worked one-to-one with him, but Gordon Bush, who Jackson Rees had trained, was the best technical anaesthetist I’ve ever seen in action; he was superb. We’re talking now about the mid to late seventies when they were developing fibre-optic techniques for intubation in these small children with difficult airways and things, so he was leading the way. It was an honour to work with these people. And I realised, actually, when I got to Liverpool from Dundee, that in Dundee when you went into work on the Monday morning the first conversation was about how successful your shooting or fishing had been over the weekend or your sailing; whereas when you went in to Jackson Rees on a Monday morning it was to talk about residual volumes and airway trapping in paediatric cardiac patients. It was just a different world. And that was late seventies, the end of the first Professor of Anaesthesia in Liverpool, Cecil Gray’s reign. He was Dean of the Medical School when I got there. So I didn’t actually work with him clinically but whilst he was still working the Liverpool Technique had to be practiced and hyperventilation and profound neuromuscular block and analgesics, but limited use of inhalation agents, and it was just coming to an end as I got there. So in adult practice I didn’t really ever use the pure Liverpool Technique, although some of my supervisors were still using it.

And then I got an SR job in Liverpool; those were the best years, weren’t they? The Fellowship was out of the way and the pressures weren’t on and I was enjoying contributing to the teaching of the postgraduates. And so I was working at the cardiac unit, which was a very good cardiac unit led by a bit of a maverick of a guy who was of Cecil Gray’s era, Dickie Richardson, and Dickie Richardson was a superb anaesthetist and also superb at using four-letter words and telling people where to get lost; he didn’t like people to question him too much. So it was always considered a bit of joke that he encouraged me to apply for a lecturer’s job because it was thought that I might apply for his job in his unit and I’d give him too much hassle! <Laughs> So I applied for a lecturer’s job just as the second Professor of Anaesthesia, John Utting, was appointed. He was appointed to the Chair in ’78 and in November ’78 I went into the department as a senior registrar/lecturer and this was probably my main bit of good fortune, because just at that stage … I did some animal research. I worked quite a lot actually with a veterinary anaesthetist because Cecil Gray had always wanted them in his department. Cecil Gray was a great kingmaker and he brought everyone into his department, no outsiders, everybody was under his umbrella. And so I worked closely with veterinary anaesthetists, I did some animal research when I was a lecturer. I can’t say that I particularly enjoyed that, that was anaesthetising dogs, they weren’t put to sleep at the end of the procedure, we woke them up, but what we were doing was looking at renal function under various levels of PA CO2, so we were hyperventilating them, we were looking at the effects on renal function, we were looking at the then new inhalation agents, isoflurane and enflurane, on renal function, and I did this because my supervisor of the veterinary anaesthetists, Ron Jones, who subsequently became a Professor, he was a very good supervisor, but I didn’t particularly enjoy that animal work; not because of my animal rights attitude but because of the smells and the excrement, cleaning everything up afterwards. I wasn’t somebody who particularly enjoyed that side of things. But it was very good experience.

But whilst I was doing that John Utting was approached to do work into atracurium, and that was a huge opportunity for me and that meant doing clinical research which I liked, dealing with patients and collecting data. And the door opened because atracurium and then vecuronium came along and there’s no doubt that for the whole of the next decade that was my research interest and I became a senior lecturer, and then subsequently… I was even then thinking particularly of an academic career but Professor Jones, this veterinary anaesthetist, and Professor Utting, started to put the pressure on for me to do a higher degree. So I did my PhD based on the work we’d done on atracurium and vecuronium.

And I had three sessions in the States during the eighties, at Boston, in Nashville, Tennessee with Margaret Wood who’d trained in St Andrew’s the year ahead of me, and in Oregon and Portland.

I:             Did you find research in America, the way its carried out, very different from –

P:           Well, there were many differences ‘cause there was an infinite supply of cash to do the work, so all the facilities were there. That’s probably the main difference. You could get staff, laboratory staff, clinical staff; you could get the space to have your laboratories, and in that sense it was another world. They seemed so well off compared with universities in the UK; you didn’t have to fight for money all the time and support. But the actual work that was being done wasn’t that different. It was just the whole ambience of doing it was different. Getting grants, NIH grants, was much easier than getting research grants in the UK. And in the eighties, of course, the pharmaceutical industry was supporting a lot of our work, but it was only the easy way to get research money. But I enjoyed going and seeing these people, but I liked coming back as well! <Laughs>

John Utting became ill prematurely, at the age of 63 he developed colonic cancer and died by the time he was 68, so that was in the early nineties and I became a reader then. And by that I’d established my own research group, he’d been ill and I didn’t need him, although interestingly the vets were also doing work on these two relaxants, so I was still doing quite a bit of teaching of the veterinary students as well as the medical students, and setting up modules for veterinary anaesthesia study, both at undergraduate and postgraduate level, thanks to my link with Professor Jones. And so by the early nineties you might have thought that perhaps I’d exhausted atracurium and vecuronium, but then mivacurium and cisatracurium came along and I was freewheeling. By the early nineties I’d presented at the ARS a significant number of times and so I expect my first national appointment was as Honorary Secretary to the Anaesthetist Research Society, and I was the first woman to do that and the first woman on their council, and I was involved with the Anaesthetist Research Society for a long time.

At that time Alistair Spence had not long moved to Edinburgh in the Chair and it was he who officially wrote to me to join the ARS Committee and he was also Chairman of the British Journal of Anaesthesia board then. At that time, so we’re into the early nineties, there were a few members of the BJA board who I’d had, for various reasons, had contact with. Cecil Gray had been the fourth editor of the journal, based in Liverpool, and he had passed it on to John Edmund Riding, known as Dinge, who was the fifth editor of the journal, and he was one of my big mentors in Liverpool especially when John Utting became ill. He was an NHS consultant but he’d been Dean of the Faculty of Anaesthetists and he actually had a wife who’d struggled to get a consultant appointment in her time with young children, so he was hugely supportive of women in anaesthesia in Merseyside and when Dr Riding was Dean of the Faculty of Anaesthetists, he had been involved with the instigation of part-time training for women, and so in Merseyside we had to lead the way on this, certainly in the North of England. And we started the ball rolling, we got some very good, slightly older, married women with children taking up part-time training in anaesthesia and thanks to him we led the way. Well, I was then Deputy Regional Advisor for Mersey so I was instigating the administration of this with Dr Riding. Dr Riding is still alive now at 92, he was a very good friend to me. But I think that there was a lot of discussion when Dr Riding put my name up to be a member of the board of the British Journal of Anaesthesia because they’d not had a woman and it was a bit of an old boy club. And now we’re talking about 1989, 1990, and I don’t think that the Chairman, Alistair Spencer, was that sure about me but I had a cohort of support. Interestingly enough, I must mention at that stage in my career, that Jimmy Payne was in the Chair in London, BOC Chair at the Royal London, and he too was quite a supporter of women and because he’d done neuromuscular work and presented at meetings alongside me, he stopped me once on the doorstep of the College when we were in Russell Square and the Chair was advertised in Liverpool and he said to me, ‘You must apply for this Chair for women in anaesthesia,’ <laughs> ‘And there’s no excuse, you must apply for it!’ And so I had support from him and John Norman and Tony Adams had examined my thesis and they were on the journal board, so by a slim majority I was elected in ’89-90 onto the BJA board. Soon after that Alistair Spence became president of the College and so he left and George Hall became the Chairman of the BJA board. He was at St George’s Hospital in London, a newly appointed professor. He was very supportive of girls too. I’m trying to make sure that you realise that by the nineties there were certain guys who were helping women quite positively to progress and it was up to the girls then to take the opportunity.

And George Hall immediately made me Secretary of the BJA board which was like being thrown in at the deep end, because I knew nothing about the structure but it meant that I had to write down everything that happened so I very rapidly learnt the game. And Graham Smith was editor of the journal at that time. He had, of course, built up a strong department in Leicester and he edited the journal for nine years but the maximum is 10 actually that you’re supposed to do it. And when he got to the end of his 10 years, well, was approaching it in 1996-97, he and George Hall cornered me when we were in the World Congress in Sydney in 1996 and strongly advised me to apply to be the next editor-in-chief, which came as a bit of a surprise actually! I was willing to do more for the journal, I was enjoying the journal enormously, but I didn’t really expect this, but I think again, this is a rather female’s fatalistic sort of streak, I just took it. Once they said, ‘You should apply,’ I applied, and so in 1997 I became editor-in-chief of the British Journal of Anaesthesia, which was a huge task, which I did for the following eight years till Graham Smith retired as Chairman retired as Chairman of the BJA board and I wanted to follow him into that Chairmanship, so in 2006 I became the Chairman.

But the editorship of the journal takes over your life, you know, it’s so busy that you can’t really say you enjoy it but I feel that that was the major achievement of my life really, because I’ve met so many people, both physically and electronically, I mean names of people round the world whose faces I never met but I feel I know because I’ve edited their work. And I learnt a lot about areas of anaesthesia that I didn’t practice because I was having to edit their work, like cardiac work and things like that, pain and things, and I met a lot of people who I’d never otherwise have met and I’m very, very grateful for that. In fact, when I retired from clinical practice and therefore had to step down from the journal as part of their rules, it was the biggest break to make really because they were my professional friends and I enjoyed it so much.

I:             Did you choose your advisers or the people you had with you on the board?

P:           Well actually, when you apply for the editorship, you have to produce an equivalent of a business plan on how you’d run the journal and up till that time there’d just been one editor, there hadn’t been an editor-in-chief as such, but the editor had had an editor of postgraduate reviews to help them, doing all the reviews in the journal which was a substantial amount of work, and each editor tended to have a local anaesthetist supporting them. Of course Graham Smith in Leicester had David Rowbotham and David Lambert, so he had two very strong academic assistant editors, but we changed the system when I started to that I had four editors independently working on manuscripts assisting me, because by the time I took over from Graham we were getting about 850 manuscripts a year, so one person couldn’t do that. And I set up the electronic handling of these manuscripts, you know, with the remote server so we could send manuscripts electronically to each other and edit them accordingly. So it was a time of change and by the time I passed on to Charles Riley in 2006 we were getting over 1,000 manuscripts a year and now it’s up to 1,500. Interestingly enough going electronic has attracted more manuscripts to be submitted from round the world, because it’s easier for people in darkest Africa and rural India to submit a manuscript electronically than to post a paper copy! <Laughs>

I:             Is there a public side to being editor-in-chief as well because you’re seen as a spokesperson?

P:           Yes, I think there is and I don’t think I realised that when I started really but in some ways even more than the president of the college, dare I say it, or the president of the association, when you go round the world everybody knows who the editor-in-chief of the British Journal of Anaesthesia is. The contacts round the world are significant and of course we were trying all the time to improve the international standing of the journal with having Chinese issues, extracted manuscripts, just six or seven an issue, translated into Chinese for the circulation in China and South African issues similarly. And then we tried Portuguese issues, we still do that. We tried hard to get into South America, which I’ve thought about a lot with the Olympic Games, but we didn’t succeed in that respect because anaesthesia and analgesia have got a grip over Spanish and Portuguese translations for South America. But I mean when I went to medical school I never thought I would learn so much about publishing and all this sort of thing so… Oh, I learnt a huge amount and I’m very glad I did it but you go on holiday with a pile of manuscripts, there isn’t a day when you don’t work, so you couldn’t do it forever, it couldn’t be a job for your working professional life, you just couldn’t do it.

I:             Had you left research behind at that point?

P:           No, well, I tried… It is difficult to do both but I did try and keep that on the boil because by the time I took over the editorship of the journal, as I said I’d got a research unit that was swinging, it was moving, so we did keep going and I had research fellows who kept going and I did still continue to write, but by the end of that eight year period I realised that if I didn’t stop editing the journal my research would grind to a halt. But very fortuitously soon after that, of course, sugammadex came along, so the research on this reversal agent for antagonising neuromuscular blocking drugs, aminosteroids in particular, that was a new start really and that came just as I took over the chairmanship and stopped editing the journal. The chairmanship was work but it was nothing like as much work as being editor-in-chief. It was different work. In some ways I wonder if I was a better chairman than editor-in-chief but that was probably because I set my standards higher as an editor-in-chief, keeping everybody happy as an editor-in-chief is almost impossible. So I was chairing a board, by which time we’d got two other ladies on out of 25, one was a scientist, Helen Galley, Professor in Aberdeen now, and a lady from Denmark, Anne Møller, and so getting women onto the board of the BJA was occurring but it wasn’t because we were turning the women away, and this is an important point to make at this time, I think, that now there is no hindrance to women coming on but it’s up to women now, if they want to do it, they can do it now but because of their family responsibilities and perhaps… I mean some women are ambitious, they must be to be PM and President of America, but I think there are fewer women who have that drive to get to the very top compared with men. I think there is a bit of a difference here because I strongly believe now that if women want to they can do it but the demands are such that they mightn’t always choose to. But chairing a board of 25 people, 23 of whom were all quite intelligent men and perhaps thought they were more intelligent than they were <laughs> is not an easy task, though one had to treat it lightly and with humour otherwise you’d have gone under. <Laughs>

When I’d done my 40 years… I kept my NHS pension actually because I never imagined I’d be a professor and when I got to 63 and I’d done 40 years and paid into my pension I decided just to retire from my clinical responsibility. I don’t know if you felt this but I wanted to go when the going was good, I dreaded having a clinical disaster at the end of 40 years of luck and a good run, you know? So I think it’s important, and Dr Riding again, he influenced me over this, he used to say, ‘Go when the going’s good.’ So after 40 years of clinical practice I took my pension and retired from hospital work but I still… because of my Emeritus title in the university, I still have access to all the university facilities and still spend at least two days a week doing academic work. In fact, it’s the serious end of the academic work now, it’s not teaching undergraduates which you can do when you’re half asleep, but it’s still writing manuscripts and preparing international lectures and those requests still keep rolling in. So again, just like most women, if I’m asked I say yes and don’t go looking for it but it just keeps coming in and I just do it. But it is now… I’m at the stage where I can say no if I want because when you’re working you can’t really, can you, you can’t say no to teaching veterinary undergraduates or dental undergraduates when you’re in an academic role, even though it’s a bit tedious when you’ve been doing it for decades.

I:             And also you fitted in an examinership in your career as well?

P:           Yes, I applied three times to be an examiner in the fellowship. I was the first female clinician to examine for the part 2 of the fellowship, when it was three parts. I very vividly remember it, it was still held in the Royal College of Surgeons in Lincoln’s Inn Fields and we went along and the part 2 exams were held in the Pathology Department. Richard Ellis then in the chair in Leeds was in charge of the part 2 and I walked in and he said, ‘Now, there’s only been one female examiner in this section before – Ferocity Reynolds!’ Her real name was Felicity –

I:             <Laughs>

P:           And Ferocity Reynolds was a very famous Professor of Anaesthetic Pharmacology, she wasn’t actually a Professor of Anaesthesia at St Thomas’s Hospital, very well respected still for her work on local anaesthetics, but he said, ‘She was an absolute rogue, so you’ve to behave yourself, sit down there and be nice!’ <Laughs> So that was, you see, again an example of I was just fortunate to come in as things were changing.

And the first time I applied to be an examiner I was about 35 and I was told to go home and come back when I was 40! <Laughs> I applied three times and actually I’m sure I only got into examining pharmacology because a pharmacologist, not an anaesthetist in Liverpool but a very famous pharmacologist who wrote a textbook of anaesthetic pharmacology, Norman Calvey, was an examiner for the part 2. And so eventually when I was 40, so that would be 1988, I was appointed a part 2 examiner and I did my 12 years but during that time the three part exam went down to two parts and I was examining in the first part, all the time fighting to try and raise the academic standards because I felt that the academic standards were sinking really. By doing away with the part 2 of the exam the science was disappearing from the exam. But I did my 12 years of that, to 2003 I must have done that, and again I enjoyed it because I met so many people in my specialty who I wouldn’t otherwise have met because they worked in different parts of the country and their specialist interests weren’t mine, and I enjoyed that too. It was hard work, 8 ‘til 6 everyday, but then you went out and had lots of nice meals, went to the theatre and met lots of people, I enjoyed it.

I:             And you examined abroad as well?

P:           Yes, well, I examined abroad for several reasons. The fellowship at that time had sittings in Cairo, in Columbo, and actually I never made the Iraq sittings because when the first Iraq War broke out they had to stop examining in Iraq but they did until then. But also Liverpool had a… because of the Liverpool course which was one of the first courses after the war in anaesthesia in the UK, there were five centres really, weren’t there, that were running courses to prepare for the DA and then the fellowship – Oxford. Liverpool, Bristol, Glasgow – and we had people coming especially from Commonwealth countries, to Liverpool for decades, including from Malaysia. The first three professors of anaesthesia in Malaysia trained in Liverpool and did their fellowship when they were in Liverpool, so we continued to examine for their fellowship when they tried to set up their own fellowship. There was always an external examiner from the UK, frequently from Liverpool and from Australia and so I examined a lot in Kuala Lumpur. I went to Hong Kong to examine but I think that was the fellowship exchange system with the UK college.

I:             How did you find the standards compared with standards in London, for example?

P:           Variable; I would say in Hong Kong it was the same as here. It’s very difficult, for instance, in Cairo, when you were taking our exams to Cairo and there’d be about 50 candidates and the average standard was undoubtedly less but you had to pass somebody, whatever the rules said <laughs> so the top 5% of the candidates probably would be equivalent to average candidates here. Of course a lot of these people were trying to get to Britain to work for the rest of their training because they didn’t have the equivalent of senior registrar jobs as it was then in their own country so the standard was more variable. But when the college were going out to examine the standards were set but my main memory is that it was hard work. In these countries they work very well, they’re hard… because all these trainees were having to work long hours as well as study.

I:             And I see you were a medical examiner for the diploma in veterinary anaesthesia as well?

P:           Yes, well that’s historic too, because Professor Cecil Gray in the fifties had approached the Dean of the Faculty of Veterinary Science saying, ‘Look, this marvellous Liverpool Technique of hyperventilation could be used in large animals, why not!?’ That was Cecil’s approach, his work could be used anywhere as far as he was concerned. And he was a good friend of the dean of the veterinary school, so they set up this training programme and Cecil appointed the first lecturer in veterinary anaesthesia in his department, Ron Jones, who became a professor. And by the early sixties Cecil was encouraging the Royal Veterinary School here in London, which is the equivalent of our college, to set up a diploma in veterinary anaesthesia, and, of course, Cecil insisted that they should have a medical examiner at every sitting, so he was the first one. And he did it for a very long time and when he retired, Keith Sykes took it over, and Ralph Thorne did it for a long time, Jean Horton did it, and because all this time I’d been teaching veterinary students in Liverpool about anaesthesia, when Ralph Thorne retired I took over from him. But of course veterinary students and postgraduates have probably a higher intellect than medical students but there are many fewer of them so when you examined you saw the whole cohort on one sitting. But they had a very similar style of examination, with the two parts, to us. I met some very entertaining scenarios and I learnt a lot from that, they know their physiology very well, veterinary anaesthetists, because they’ve got to work round comparative physiology all the time. So that was also a good experience but after I’d been doing it for five or six years they decided because of the limited numbers, they’d established a European Diploma of Veterinary Anaesthesia, and they decided to merge the UK one into that and I didn’t actually examine for the European Diploma but it’s very similar now.

I:             And then on top of that there are the eponymous lectures?

P:           Yes! <Laughs> Well, you just get invited to do those and you say yes as a [38:59 thank you] and you go! <Laughs>

I:             Were you ever tempted to go into, if I said, medical politics, for example, to stand for Council of the college?

P:           When I became editor of the journal I went to see the dean of the medical school on the advice of Professor Jones who was then head of department, because he wanted to make sure that the dean accepted that I would be giving a large amount of my academic time to the journal and it might affect my research development. And so I spoke to the dean and he was not against me editing the journal but I said the alternative was perhaps to stand for college council and he said he didn’t think that was a very academic pursuit! <Laughs> So that influenced me and in a way some of this is almost confidential, but when I was on the board of the journal I had a personal view and it was entirely personal, that there was a conflict of interest if you were on college council and the board of the journal as well. And I think this probably applies to the Association of Anaesthesia as well, because you must make decisions as editor of the journal or chairman of the board, which are purely beneficial for that journal and if you’ve got the college council business hanging over you as well you can’t make an independent decision. Now I would be in a minority of views over that because there are many members of the journal board who are on college council as well. The present chairman of the journal board, Professor Webster in Aberdeen, he would concur with what I said, because you’re taking responsibility for a charity that’s worth £9 million so you can’t have a dual conflict of interest, I don’t think. There are more academics on college council now but there was a time 10 years’ ago when there were fewer and so it wasn’t as important but I think it’s now becoming more important again. But that was just my view and also the amount of time I was committing the BJA when I was editor, any other time I had had to be committed to Liverpool University and my clinical commitment, not to college council, I felt. Perhaps if you were working in London it would have been a bit more practicable but I had to commit to Liverpool as well, so I have no regrets about that. If I’d have been an NHS consultant, having been deputy regional advisor in Mersey, I would probably have applied to be the regional advisor and could well then have gone that direction but I wanted a more academic stimulus really.

I:             What changes do you think have most influenced anaesthesia, the career in anaesthesia or anaesthetic practice over your period of clinical work?

P:           Well, of course I’m bound to say the introduction of atracurium and vecuronium has changed it, but probably of isolated clinical contributions the laryngeal mask airway must stand out for our generation, mustn’t it? I mean it’s just amazing to me, I’m very proud of the fact that the BJA published Brain’s first paper on the laryngeal mask airway in ’82 and that was marvellous, but it’s amazing that Portex declined to produce it for him, mass production, but that must be a major contribution of our time. And then the areas related to anaesthesia, like the development of chronic and acute pain services, I think development of acute pain services post-operatively by anaesthetists has been a major step forward. But I did, of course, a lot of my clinical work was in intensive care in general adult intensive care, and that has just exploded in size, hasn’t it? I mean when I was a houseman and an SHO in Dundee there was a three-bedded intensive care unit and the equivalent of the recovery room of the theatres in the main teaching hospital in Dundee and now we have 25-bedded units with full-time intensivists and from my personal, clinical work, not academic, clinical work, the development of intensive care to a freestanding specialty of high scientific calibre has been superb, I think. And out of hospital services that have been generated from that when you see these helicopters flying into major accidents and things. So the spread of anaesthetic interest beyond the operating theatre is very important, politically but also clinically, so it’s been great to see that explosion.

But of course the other main thing is the increasing numbers of anaesthetists, isn’t it? I mean you described in your own hospital the increased number of professional appointments, well that applies probably to all of us, and the profession has just exploded, it’s marvellous. But it’s still got some way to go from an academic point of view in equating with general surgery or paediatrics or obstetrics or all the sub-specialities in medicine on an academic level to improve its status, this specialty in society, to be acknowledged in the same way as surgeons are by the lay public, or physicians, gynaecologists, it’s still got some way to go.

And if I might say on a purely personal level, this is why I’m hugely supportive of medical graduates still doing anaesthesia because I think if we allow non-medical people in to provide the service then this will certainly harm our standing in the layman’s eyes. I realise there’s an argument at the moment that there aren’t the trainees out there wanting to take up the specialty but that applies across the board, people aren’t just leaving Britain because they want to do anaesthetics elsewhere, they’re not leaving for that reason, they’re leaving because of disillusionment with medicine generally. Although I know again <chuckles> I speak against the general pressures that’s coming from the college now, I am strongly of the view that we should have a medical [45:55] specialty.

There’ll be ups and downs, we’ve seen a circle of political views go right full 360 degrees, haven’t we, in our professional lifetime and it will happen again. That’s why I think… you asked me before about medical politics, I’ve never been attracted, for instance, to go into hospital administration because you just see the same old thing go round and round, circle after circle. Now I know it’s very important for anaesthetists to be represented in hospital administration locally and at national level and I want other people to do it, don’t get me wrong, but my interests have been more academic really.

I:             And then an MBE?

P:           Yes. <Laughs>

I:             Congratulations.

P:           Well, that’s a bit like getting a third-class degree, you know! <Laughs> I went to Buckingham Palace last autumn and there were 125 of us and I think I was 120th to go up <laughs> but it’s an interesting experience. Princess Anne was giving the awards and I wasn’t surprised about that because they seem to tailor the member of the Royal family according to their interests, so there were a lot of sportsmen there, ex-Olympians from the 2012 Olympics here when I went, and the Queen doesn’t do many now, she just does the Knighthoods at Windsor to the pop stars and whatever. So it was an interesting mix of people from the Princess Royal’s charities and from her other special interests, equine interests and the like. But when I went up she does her homework, she knew who was coming up, and she said, ‘Oh yes, there’s huge pressure, isn’t there, to get more awards for anaesthetists, I feel it every time I walk into your college!’


But you see, that’s an example of where I say if our specialty is to get national recognition from the lay public we’ve still got a long way to go, the surgeons and physicians are getting Knighthoods and anaesthetists are getting the MBE, so there’s still a long way to go there.

I:             Looking back over your career, you mentioned earlier you had no regrets, does that apply to your whole career, is there anything you would like to have done differently?

P:           I don’t regret being an anaesthetist at all. I don’t really have many regrets professionally at all. When I was at school there was a great pressure on me to apply for Oxford or Cambridge to do biochemistry, the school realised that I wouldn’t get into medicine, to Oxford, apparently the year I was doing A levels they took five girls to Oxford to do medicine, just five girls, and they were well-connected. But they wanted me to apply for biochemistry or natural sciences because they thought I’d get in but I was desperate to be a doctor <laughs> and I wanted to go to Scotland really, back home, so I applied for Edinburgh and St Andrew’s and St Andrew’s offered me the place first and I took it but sometimes I think would my life have been any different if I’d have gone to Oxbridge? Academically I probably would have benefitted from that, but I’d still wanted to be a doctor, I’d still have had to get into medical school somehow <laughs> but that was… The school were very keen to get Oxbridge entrants for obvious reasons but they were mainly in the pure sciences or arts, modern languages. So I’ve kicked against the bricks. There’s always been a feisty side to me <laughs> and at school I probably wasn’t that easy to handle because I was full of energy and I wasn’t being worn out sufficiently to settle down. And I think that’s probably why I’ve enjoyed a medical career, I think the burden both physically and academically managed to temper my energies sufficiently, but I would have got up to no good if I wasn’t kept fully occupied.

I:          I think your energy has served you and anaesthesia very well. Thank you very much indeed, Professor Hunter, it’s been wonderful hearing your story and sharing it with us.