MB ChB NZ(1955) MRACP(1960) MRCP(1960) MA Oxon(1973) FRCP(1973) FRACP(1978)
25 October 1930 – 24 October 1997
Des Oliver came to England in 1960 for a little postgraduate experience and to get the membership. Little did he know that he was to become a leader of the cadre of young physicians who pioneered haemodialysis in the United Kingdom later in the decade. He was born in Palmerston North, New Zealand, and had a distinguished school career before going on to Dunedin to read medicine. He took up rugby again in the third year, excelled, and found himself on the tour of Great Britain and France in 1953. He was a brilliant wing forward, representing the All Blacks against Wales, Ireland and France and scored three tries. He was described as “fast, with good hands, and a fearless tackier.”
His first job in London was at the Royal Postgraduate Medical School with Oliver Wrong, whose firm dealt with patients with both acute and chronic renal failure. The commonest cause of acute renal failure was apparently septic abortion and Des was horrified by the impotence of medicine to make any impact on renal failure. “They died whatever we did” he told his juniors. He took the famous Papworth course for the membership and the latter predicted that Oliver would get the membership first time. He did.
He was appointed a lecturer in Sir George Pickering’s [Munk’s Roll, Vol.VII, p.464] department of medicine in Oxford and developed expertise in phaeochromocytoma and renal biopsy, but remained troubled by the lack of treatment for renal failure. Pickering was said to have been impressed by his physique and since gardening at the Regius’ house at Norham Gardens and at the alms houses at Ewelme was part of the responsibilities of any Pickering registrar, Oliver was in pole position at the interview. Patients with renal failure gravitated to Pickering’s out-patients, so it was to his department that the hospital looked when it was suggested that a pilot haemodialysis unit should be set up in Oxford, amongst other places. Oliver accepted the challenge with his colleague John Ledingham and the unit opened in August 1967 in a prefabricated building on the Churchill Hospital site that had been used as an experimental ward (the experiments were on ward design, not on human beings). Knowing of this development, Oliver kept a 39 year old woman alive on peritoneal dialysis, with equipment that he made himself, from Christmas 1966 until August 1967. The patient celebrated her 70th birthday in 1997 and attended the funeral of the man who had saved her life. The demand for haemodialysis, even with the strict criteria for acceptance onto the programmes, grew rapidly and Oliver and Ledingham resolved that all patients should be treated by home haemodialysis and that four central stations be used for training and support only. They kept this philosophy going until the 1970s and peaked at 120 patients on home haemodialysis, scattered all over the six counties surrounding Oxford. There were a few unsuccessful attempts at renal transplantation, such that the patients refused to put themselves forward for the procedure. Salvation arrived in the form of Peter Morris as the new Nuffield professor of surgery in 1974. He set up the Oxford renal transplant programme with Oliver and Ledingham’s unstinting support and by the time Oliver retired over 600 patients were surviving with a successful transplant, compared with 350 on dialysis.
Oliver was very technically minded and he ensured that the unit had the best equipment possible. To do this he was a tireless fund-raiser and said he used to dread the many hours he spent propping up bars buying drinks for fund-raisers, only receiving the cheque at midnight, knowing that he had to drive all the way home and be up early to start a clinic in the morning. His and Morris’ success was such that it was possible to build a brand-new combined renal and transplant ward, which opened in 1975. Ironically, it was opened by Sir Peter Medawar [Munk’s Roll, Vol.VIII, p.330] who humbly poked fun at his own pessimistic predictions about the future of transplantation. Recognizing the importance of vascular access for the long-term care of patients on dialysis, Des taught himself how to fashion fistulas, insert Schribner shunts and Tenckhoff catheters. He only asked the help of surgeons over the more difficult procedures. Even the surgeons who worked with him admired his technical skills. He found putting Tenckhoff catheters into Douglas’ pouch rather difficult with his big hands so modified a rigid bronchoscope to feed the catheter down. The surgeons also found this useful and it is still used at the Churchill theatres and is referred to as ‘Oliver’s thing’.
He had an obvious gift for identifying the major problems in dialysis and supported the work of John Kanis on renal bone disease and the use of vitamin D metabolites, Ramanlal Gokal on iron overload, Mary Cotes and Christopher Winearls on erythropoietin, Mark Pepys on dialysis amyloid, and provided a marvelous platform for the Oxford transplant centre’s clinical research programme. The patients were always in the best possible hands before they were put onto the waiting list and this must have given Morris and his team a lot of confidence in setting up their clinical trials.
He had a special bond with his registrars for he was for most of his career a single-handed consultant. He drummed into them basic clinical skills and showed them the importance of attention to detail, doing the simple things well and keeping meticulous records. Although he had a sharp mind they did not look to him for intellectual stimulation or research ideas but reckoned that much of their nephrology expertise came from him. Four went on to be professors of renal medicine and a dozen or so of them are consultants leading renal units in India, the United States, Australia, South Africa and the UK.
He lived through the soul-searching in the renal community and the spotlight of the press on the problems of access to dialysis programmes in the United Kingdom. Unfortunately, the Oxford unit was singled out for attention by those seeking a cause célèbre. Oliver had decided to discontinue dialysis on a patient who had had a stroke, was known to have a chronic psychiatric condition and who seemed incapable of a normal quality of life. His decision was publicly criticized and, in defending it, he breached confidentiality. He, and the hospital manager, himself a distinguished doctor, were pilloried by the press. It was ironic that a man who had dedicated his life to the care of patients with renal failure should be accused of inhumane and unethical behaviour. The wounds of this attack never really healed. From a 14 hour a day man, he resolved to live a more balanced life and took up the hobby of wood turning and became an expert. He produced the most beautiful salad bowls from trees that he had felled and wood that he had aged. He gave them away, always with a dismissive remark, pointing to their imperfections.
In 1993 a GI haemorrhage was found to be caused by a malignant gastric ulcer. He underwent radical surgery and returned to work until his retirement in 1995. Within six months he had a recurrence and underwent further surgery which bought him another year of life which he enjoyed as much as he could by touring places in England he has always meant to visit, spoiling his two spaniels outrageously, studying the religions of the world and listening to the music that moved him most.
In 1972 he married Sheila Russell, herself a young dialysis patient, and Des acted as her ‘home helper’ for the eighteen years before she had a successful cadaveric renal transplant. She provided a temple of calm at their home in Horton-cum-Studley, adjacent to the beautiful priory and the fields and woods near it, where he walked his beloved dogs. He was at home on the day he died, restless and only settled for an hour while he watched a rugby international. He died on his feet, slumping in a chair in the hall where his wife cradled him. It was typical of the man that he should die on his feet. His funeral was a small one in St Barnabas Church in Horton-cum-Studley, but there was an irresistible call for a memorial service which took place at Christ Church Cathedral, Oxford. Over 450 people attended.
C G Winearls
[The Times, 25 Nov 1997]
Courtesy Royal College of Physicians London, Munk’s Roll, Volume X, page 368