I have been very fortunate to learn medicine by practicing with some excellent physicians and surgeons. My surgical house job, just after qualification was in Broomfield Hospital, Chelmsford with Mr Richard Boggon who specialised in vascular and breast cancer surgery. I got to see him at the end of his career, one of the last of a passing breed, the true general surgeon who was as happy performing a femoral embolectomy in the middle of the night as he was doing the most beautiful dissections down onto the thyroid, or removed diseased lymph nodes in the axillae of breast cancer patients. He was extremely firm, as one would need to be providing an excellent clinical service dealing with the harmful effects of cigarettes and diabetes mellitus, alongside hypertension and dyslipidaemia on the heart, brain, kidneys and peripheral vasculature, As Mr Boggon retired I caught the start of the Mr Yiannis Panayiotopoulos, a quick and gifted surgeon's, who could complete an emergency repair to a ruptured aorta in under an hour to protect the patient from the consequences of having to clamp the aorta for any longer than necessary. Statins were a novel therapy at the time and we were limited in our choice of, and familiarity with ACE inhibitors, drugs that with wider use would protect so many people from vascular disease. I learnt about directed yet thorough, prompt, clinical evaluation in the surgical emergency, the necessity of adequate analgesia so patients are comfortable, hydration and maintenance fluids and when to resuscitate with fluids and/or blood products to protect the circulation and kidneys. Our intensive care at the time had excellent critical care outreach, no patient could deteriorate in hospital and the ITU doctors and nurses not know about it and I became familiar with the management of very unstable and sick patient, skills that I still use today.
For the second half of my house jobs I was delighted to return to The Royal London Hospital to work on the Professorial Medical Firm with Professors Ashley Grossman and Michael Besser, Drs John Monson, Peter Trainer and Shern Chew; my registrars were Dr Paul Jenkins, Rupert Vessey, Sabina Russel, Ayesha Siddiqi and Saleem Janmohamed, and we worked alongside the clinical firm of Professor Robert D Cohen and Frank Marsh. The standard of clinical medicine was excellent and I recall using thrombolysis and aspirin therapy for the management of acute ST elevation myocardial infarction, learning about the emergency management of diabetes mellitus and metabolic emergencies and seeing the early rises in tuberculosis and immunosuppression in our ethnically, socially, politically and culturally diverse city. Our academic meetings were held under the supervision of Professor Cohen and it in this environment that I became fascinated with endocrinology, diabetes, metabolism and the importance of the liver and kidneys in maintaining homeostasis. Bob Cohen and Mike Besser were intellectual giants who defined the role of the liver and kidney in metabolism and established endocrinology as a speciality and who both trained a great body of the endocrinologists and metabolic specialists in the latter half of the 20th Century. I was sat down by Mike Besser one day, after a long ward round, asked what career I wanted to pursue and told that my answer was endocrinology. There was clinical medicine, laboratory practice with wonderful biochemistry, physiology and pharmacology and the time of molecular medicine was arriving at great speed. What impressed me the most was the fact that you might look after patients, and their children and grandchildren in certain conditions, in fact you might pass these patients and families on to new colleagues at the end of your career. Indeed I looked after several patients I had first met as a House Officer at the London when I returned there, and to Bart's, over the years; it was heartening to see my own writing in their notes, to still get the benefit of my clinical assessment after all those years and to feel the benefit of forming a true therapeutic relationship with my patients. That is how I was taught, and that is how I still practice, whether it is a pituitary tumour and I need to restore your fertility, Graves' thyrotoxicosis, testosterone replacement, preventing your osteoporosis worsening, or your blood pressure causing too much difficulty, or making a decision with you about how to manage your anaemia or which test to do to work out why you are breathless or in pain.