Dr Gordon Lyons
2005-2008 - President
My first brush with obstetrics came as an undergraduate in Leeds in 1970. I was not the best attendee, but I did go to a home delivery in the Blackman Lane area. The small terrace house had no hall; just a door separated us from the street. Periodically, someone would bang on the door and inquire if we were alright for fish and chips. There was no inside toilet, but a large bucket was provided. The placenta went on the coal fire. My first memory of obstetric anaesthesia was also at this time. I was despatched with the Flying Squad in Rosemary Macdonald’s Vauxhall Viva borrowed for the purpose, to one of the suburbs, where a woman with a retained placenta was in a bedroom. The anaesthetist discovered that he had left the bulk of his circuitry behind and, after a discussion with the obstetrician it was decided to remove the placenta within the duration of a single bolus of thiopentone. The bag of saline swung from the light fitting whilst the obstetrician scrubbed in the bathroom. The thio went in, the anaesthetist said ‘Go’, in went the hand, and out came the placenta.
I never wanted to be an anaesthetist. I was working in Brighton in the era when we were expected to put in a day’s work at the end of a 48 hour shift, and was drifting reluctantly towards general practice. The atmosphere was lively and sex, drugs, and rock and roll ruled. In the wake of a major hospital scandal, a certain registrar by all accounts, was advised by his consultant to leave town by the quickest route. At the time, none of this seemed relevant to me, but subsequently one of those involved was the only applicant for the vacant SHO job in anaesthesia, and the Department was desperate to find someone else. I innocently went to a Christmas party, and chatting to one of the anaesthetic consultants, let slip that I was uncertain about my future. I got hit by the full force of the press gang, and had no choice but to apply. I started in January, but it took until June before I was hooked.
I did not want to spend the rest of my life in the south-east, and as soon as I had passed the Primary exam, I looked for a teaching hospital outside London. The first advertisement I saw was for Aberdeen. I drove to Gatwick, flew to Dyce, and got the job. I was the only Englishman in the Anaesthetic Department and it was a major culture shock. I was taught to do epidurals with the Macintosh balloon using an oblique approach. Mike Tunstall demonstrated his failed intubation drill and his isolated arm technique on real patients. I watched him inject the thio, blow up the tourniquet, and give the sux and intubate. Then he would ask the woman to open and close her hand if she could hear him. The hand opened and closed. Then he asked her to repeat this twice if she was comfortable; she duly obliged. Then he took her into theatre and as the surgeon made the skin incision I watched the agonised contraction of the isolated arm. I was horrified to realise that what I took to be general anaesthesia was largely muscle relaxation with a veil of amnesia. I was very happy to leave the opportunities here to Ian Russell who had also joined the Department. I wanted to establish my interest in obstetric anaesthesia so I embarked on a respiratory physiology project during general anaesthesia for Caesarean section. Looking back, if I had known then what I know now, I would have gone for something less ambitious. With ignorance it seems, comes courage. In due course, the BJA accepted my paper, but years would pass before the next.
Opportunities in the North East of Scotland were few and far between, especially if you were English. I left the senior registrar job to Ian and went back to Yorkshire. Mike Tunstall had told me to look out for Dereck Holdsworth, and I asked if my rotation could include Dewsbury where he worked. I think I must have been the first person ever to ask to go to Dewsbury. Dereck had been researching sodium citrate, which was new to practice, and he made me use a push and squirt technique for epidurals, this time in the midline. Later on, Rosemary Macdonald who had been on the Kingston course, taught me the Andrew Doughty technique, a continuous loss of resistance to saline. With some minor modifications, this became the unit technique in St James’. My view that this was the best of all was borne out by the unit’s tap data over many years.
I applied for five consultant jobs, leaving the best until last, and I joined Rosemary Macdonald at St James’ in Leeds. Within six months I felt that I had mastered my ENT list, but it was seven years before I felt the same way about obstetric anaesthesia. I began to collect data, and before long the first of many audit papers was in preparation. It was not all wonderful. There were the unguarded comments that had unwanted consequences, until I learnt to keep my mouth shut. There were consultations that could have gone much better, and errors of clinical judgement. I gave a load of blood products to a coagulopathic woman with HELLP, disregarding her declining renal function. She developed life-threatening pulmonary oedema and only prompt dialysis saved the day. I went to help a registrar struggling with an epidural on a drug addict with Hep C, and got my hand on the end of his needle. There were lectures that I pitched too high, and lost my audience in the first five minutes, and the year’s work I had to bin when I discovered that the research fellow who mixed our syringes had become a fentanyl addict. The unhappiest time of all was when I lost my admirable colleague, who used to laugh at my rants and steer me back to usefulness. I watched him go down the corridor to get a sandwich for lunch, and began to fret when he did not return. I fretted all afternoon, and all the time he was dead upstairs in the on-call bedroom with a venflon in his arm.
There were some very enjoyable occasions. One was winning the best paper prize at ESRA in Barcelona in 1994. Peter Brownridge, over from Flinders, Australia, came to offer us a congratulatory beer, the first of many that day. Another was establishing a base for obstetric anaesthesia on the Labour Ward. We had been offered a large shell of a room, in need of total renovation at a cost of £20,000. I had to wheel and deal, tease and coerce, raiding 6 different budgets over two financial years to make it happen, and it was a palace. And there was the day my MD thesis was accepted after a two hour viva with three professors. We went for lunch together; I and two of the others tucked into fish, chips and mushy peas, whilst Felicity Reynolds dissected a spiny crab.
Other memorable events include the time Gary Vasdev threatened to fly into Paris from Minnesota with a bag full of pig tracheas for his airway workshop at the Versailles meeting. The sniffer dogs really would have thought that Christmas had come early, and I wondered if the OAA would have bailed him out. Then there was the pretty traveller girl that someone had tapped. When I went to give her my standard PDPH consultation, her father was there, sitting in the corner, looking like an Italian film star with his swept back silver hair, his impeccably tailored pin-stripe suit and immaculate black leather shoes. When she opted for the patch, I left the room to organise it. He took my arm, arrested my progress, and bent his head towards my ear. “You ARE going to do this yourself, aren’t you Doctor?” It was an invitation I could not refuse.
The most stressful thing I ever did came at the end. The OAA outreach team was in Iasi, in North-East Romania. After a day of lectures we were asked to give a live demonstration of epidural pain relief and spinal anaesthesia for section the following morning. The other two members of our team ducked out, leaving Geraldine O’Sullivan and I to perform in front of the cameras with a live link to the auditorium. The hospital was foreign, neither the staff nor the patients spoke English, and the equipment was not the best. The only saving grace was an attractive nurse who, bejewelled and made up, was dressed to kill for the cameras. Across each theatre shoe in sparkly letters was written SEX. The cameraman was much keener to get her in his viewfinder than he was us.
I trained with Boyles machines left over from the forties, with glass plenum vaporisers, learnt to program mainframe computers and saw in the electronic era. Every individual has their own personalised snapshot of history and that in a large nutshell is forty years of my working life.
