Thursday, 21 June 2012

MIKE ( PAGGERS ) PAGLIERO 1962 -2012 with reminiscences

1962 and the end of a wonderful five years. I was still undecided as to ‘what next’?. A few possibilities had been discarded like skins, eyes even anaesthetics but where next ?
Cardiothoracic surgery seemed to embrace medicine and surgery comprehensively so I found myself trembling in front of Sir Russell Brock not realising that I would get his SHO post unopposed by anyone else stupid enough to want to spend half their nights in Intensive care or hold retractors for upward of six hours at a time. Unknowingly I had entered a world of staggering advances with homograft and heterograft valve replacement, the advent of coronary artery surgery and even heart transplant.

It was a wonderful era but I found myself fascinated by and veering towards oesophageal surgery with the vagaries of gastro-oesophageal reflux and the horrendous and unacceptable mortality of resection;with Brock's blessing I applied to Exeter with its geriatric population beckoning, to sort out a few swallowing problems.Those who care to 'google' me will find a Pathe news excerpt which describes my early interest in the art of swallowing while at University! Soon after I arrived one of my colleagues asked for my contribution to a book he was preparing on “Surgery for the aged” - so I turned once again to my mentor the now Lord Brock who wisely in his own inimitable style pronounced that “It is not the distance from the beginning that matters it is the distance from the end!!” How true.

 Devon as well as providing a good oesophageal population was useful to me in having no specialist gastro-enterologist which allowed me to embrace the entire spectrum of therapeutic possibilities such as intubation, laser ablation and particularly brachytherapy as well as my own surgical options. This really was my life’s work planning optimal and appropriate treatment for this difficult disease and with careful selection and improvement in anaesthetic care and surgical technique we were able to achieve appropriate symptom control with insignificant mortality by the time I retired. If I look at a surgeons load of consultation, diagnosis, case selection, operation, follow up, research, administration I found nothing more rewarding than 'Teaching'. I was fortunate to be accredited by the Royal College of Canadian surgeon as a trainer for their Thoracic programme and I enjoyed a series of North American fellows many of whom I meet regularly even now and follow their progress with as much enthusiasm as I do my own children and grandchildren. My interest in teaching led me to take the role of clinical tutor at Exeter and subsequently became Chairman of the National Association of Clinical Tutors during which time I fed in quite a lot of ideas that formed the Calman report. I was also pleased to sit on the Royal College of Surgeons Training Committee with my old chum Terence English, the then President.

 In my private life I was fortunate while a registrar to meet a little 'stripey' (second year student nurse), Anne, who agreed to be my wife and the week she got her S.R.N. we married. She knew only too well the stresses of the profession and I can say that what modicum of success I have ever achieved would not have been possible without her I have four children. The oldest, who is somewhat of a clone of me, has followed my footsteps and I think the proudest moment of my life was standing with him in front of the Hunter statue in our full regalia when he received his Fellowship diploma.

The other three when asked said “We don't mind what we do so long as it's not medicine, Dad!” One is a Historian (TV producer), one is a language teacher just a stone’s throw from S.E.1 and one is in computer-graphics. At last they are beginning to produce some delightful grandchildren - and I am now nicknamed “Bam Bam”! Most of you will remember that sport dominated my thoughts at Guys and indeed I think I was selected for Guys on the strength of playing rugger for the school. I don't feel that that has been a bad thing as my colleague 'rugger buggers' have all done well and one, Terence, made it to President of the College. I remember once as Captain of Guys Cricket XI talking to 'Bo', its President and suggesting that we might 'appoint' some rugby scholarships at Guy's. He said wisely “No we are not going down that path. What we do at Guys is interview and appoint anybody who has succeeded at something be it sport, academia, art or even County champion at tiddly winks! This means, on qualifying, he or she would take forward the ‘quality’ to succeed into professional life”. I thought that was an excellent answer and explained to me the fascinating mix of highly skilled and interesting people around me at Guy’s with its variety of student clubs performing well on the sports fields, producing plays, art exhibitions, debates and musical events to name but a few. Talking of music, it was always a hobby of mine, which didn't rear its head too often at Medical school though I did contribute to a Jean Pierre Voos’ performance of Faure’s requiem (on the piano for want of a 'harpist'). Latterly I wrote music for three Residents plays in the sixties. Now I am an enthusiastic village organist which as my faculties recede with age has become a major interest.

 I live with vivid and happy memories of the Alma Mater and lament the emasculation brought about by the ‘changes’. What sums up the biggest change in Guy’s history is perhaps the short speech of Sir Hedley Atkins at the biennial dinner marking the 250th anniversary held in a marquee in front of New Guys House to which nurses and physiotherapists were all invited- “Ladies and Gentlemen we have just had a Royal visit and I sincerely hope that on the next occasion that this great hospital is graced by Royalty that he or she will be greeted by the Senior Physician, the Senior Surgeon, and the senior Nurse and not by somebody from administration!” Ah well...........! No “Front surgery”, no “Back surgery” (whatever happened to Doris Chrimes?);  the death of the renowned department of cardiac surgery;  do they still have the orange and blue bikes that sped us to district deliveries?
 The Gordon museum is still there and the wonderful wax models and the Park of course where after the 1962 rugby cup final the Tommy’s cannon was temporarily cemented; where once I met dear old George Scott carrying a microscope case - I said “Come on George, you don’t know how to use that thing”; whereupon he opened it to reveal a bottle of whisky and four tumblers! Gone is the old attic ward of Pat and Sam where on winter afternoons student nurses would gather in their jumpers around a coke boiler poking wires down epidermic needles ready for sterilisation and reissue! No longer will nurses, students or doctors run the risk of tripping over a veritable mass of flowers in vases laid outside the ward door lest the patients suffer an excess of CO2!! No longer dear Sister Falwasser eyeing each of the patients in her care and accurately assessing the size of the ‘dollop’ of cottage pie that would satiate him. No more raiding the ward fridges for a midnight feast between emergency cases or obstetric deliveries. No more wading through reams of ECG paper all over the floor before the coming of the oscilloscope; no more “Navarin of Lamb Jardiniere” in the Spit! Words still ringing in my ears, issuing from a Spit waitress all those years ago, “Do you want stuffin’ Mr Penny” (Dear Dick R.I.P.)?
 Does Tommy Steele still do a ward round at Christmas? Well do I remember the response of one dear lady to the sobering suggestion of Robert Brain and Ralph Kauntze that a mitral valvotomy might be the way to go - “I’ll ‘ave to ask me doc’* first” she said curtly!(*medical ward clerk Conrad Guerrier). And there is that lovely warm Borough accent - I remember well the start of a consultation with ‘Batch’ impeccably asking ”What seems to be the trouble young man?” to which came the contrasting reply “I fink I dun me ‘spoin’!! Whatever came off the bell in the ‘College’ that tolled whenever a diptheritic trachea obstructed - the museum I hope. And the book of Gershwin songs that a grateful patient in Hunts House donated to the residents and passed on by Charlie Baker after giving us a roasting for singing long into the night? - and following that by reprimanding us that lady guests were not leaving by the 10 o’clock curfew and therefore in future “they would have to leave by 11 0’clock”!! Oh! that wonderful, wonderful aroma of hops that became more pungent with every step along St Thomas’ street. Oh! such lovely memories and thank you all for your contribution. God bless all, of you. Michael Pagliero

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