Interviews with Australian scientists
Fiona Wood was born in a Yorkshire mining village in England in 1958. In 1978 she was one of twelve women admitted to the St Thomas’ Hospital Medical School, London where she graduated with her M.B., B.S in 1981. Wood completed her internship and residency at several hospitals in London before immigrating to Australia in 1987. She then took up a registrar position in plastic surgery at the Sir Charles Gairdner Hospital, Perth. By 1991 Wood had passed the plastic surgery exam and become a consultant. She began working with medical scientist Marie Stoner in 1993 on a method for burns treatment at the Royal Perth (RPH) and Princess Margaret (PMH) hospitals. From this collaboration an entirely new, and more successful, method of treatment was developed. Thus, in 1995, Cellspray®, a spray-on solution of skin cells, was launched and in 1999 Wood and Stoner founded Clinical Cell Culture (C3). Wood’s expertise in burns treatment came to the world’s attention in 2002 in the wake of the Bali bombings but she hasn’t let fame stand in the way of her research or teaching which she continues at the RPH, the PMH and the University of Western Australia.
Interviewed by Dr Norman Swan in 2008.
Toward scar minimisation
The search for a new ‘gold standard’ in healing
Two memorable burns cases
A value system of determination and respect
Dovetailing multiple commitments
The challenges of commercialisation
Disaster response leads to an inspirational year
The ‘must have done’ in 20 years’ time
You can order the DVD from us for $15 (including GST and postage).
This interview was funded by the University of Western Australia.
Fiona, you’ve just sat down here after coming from the national trampolining championships. Tell me about that.
Oh, ho! Well, my youngest child has been a gymnast and now enjoys trampolining very much. I’ve got lots of children, four boys and two girls, and I really like being involved in what the kids are doing. I’ve been on more sporting trips interstate, I think, than you can count on one hand.
So you’re the team doctor?
Yes, I guess I could be. But I’ve been to all sorts of sports: rugby, triathlon, ice-skating. That was a perverse one –ice-skating in Perth was a little unusual! (That was my older daughter.)
It’s been a cold enough winter for it. How’s your orthopaedics?
‘Well,’ I thought, ‘I’ve got my brother, who is a professor of orthopaedics, on the other end of the phone.’ [laugh] But I used a lot of strapping while I was over there with the trampolinists.
You come from an era when it was not so common for women to go into surgery. Would you tell me a little bit about your entry into surgery?
Surgery, for me, was a no-brainer. I was very excited and interested by anatomy – which may sound strange, but it was one of those things that I really was interested in. And the obvious place to go from anatomy was into surgery. I simply thought, ‘It’s not a question of whether I’ll be a surgeon, it’s just where and when.’ So that was my approach. And my approach to people who told me that girls didn’t do that was that I was very good at needlework. Actually, I do like embroidery, when I have the time!
So you decided to concentrate on surface anatomy rather than deep anatomy?
Yes. Initially I looked around and did lots of different surgical specialties. In those days you had to, to do your general surgical fellowship before you specialised. But plastic surgery was always very much more interesting, in that it was innovative and at that time it was exciting, as the microsurgery wave was just starting. Lots of really different things were happening, whether it be microsurgery or tissue expansion. I realised that I had to have a CV that would get me the job – since I didn’t have the genes, I had to have the CV. [laugh] And so I got involved in research early and with plastic surgical teams.
What sort of research?
Anatomy, doing anatomical dissections and looking at the anatomy for free tissue transfer. I did that as a medical student, and then from that I got into an anatomy BMedSci which was a full year based around research.
I find it quite interesting that apparently researchers have discovered muscle layers in the face that they didn’t know existed, and so on.
Yes. At that stage we were focused on the blood supply. When I look at a standard anatomy text I find that, as with a lot of things, when you start to gain knowledge and you start to peel the onion it gets more and more interesting: the way the blood supply comes through various muscles and through into the skin, and how you can use different muscles in different ways, the blood supply to muscle ratio, and the pedicles, and then how the nerve supply comes in and whether you can use it for reanimation or just surface cover, padding – all different sorts of things. It was an exciting time to be involved in that, with straightforward dissections.
Where was that?
In St Thomas’, in London.
Did you make any discoveries of your own, or were you always the junior in somebody’s team?
Well, at that time I was very much the fly on the wall. I was just so keen to be involved and simply directed. Then I did a BMedSci equivalent. That’s when I started getting really interested in neuroanatomy and did some work on the evolution of the brain, from worms to elephants. (St Thomas’ has a great museum, the Hunterian Museum, where I spent a lot of time.) I suppose the time when I started teasing things out for myself and driving research was when as a junior registrar I did neurophysiology research on tissue-expanded skin. That was my first real step into driving that innervation.
Yours is a funny specialty to get into. It’s kind of bifurcated, with people like yourself who are more in the public sector doing the burns, the major reconstructions and so on, but also, in tandem, people who have flick-back hair and are going to do breasts and nose jobs for the rest of their life.
I know, and it is interesting. Because if you look at the extreme make-over or the extreme rebuild, I work on the latter end of the spectrum, I think there’s a place for everybody. I feel very strongly about that in lots of ways and in lots of areas. You can learn a lot from the meticulous, cosmetic-type surgery: the tissue handling techniques, the approach. There’s a lot of scar revision work, and the best of it is scar minimisation. Plastic surgeons are in the game of minimising scars, and what I want to do is eradicate the scarring, so their work is a very good, solid starting point from an education and training point of view.
The scarring you are talking about, though, is not caused by a scalpel but by extreme heat, by burns?
Yes, and it’s certainly at the top end of the scarring spectrum, the most aggressive.
Minimising that scarring would be a very different kettle of fish. What’s been learned about that research-wise, and in particular in the sort of work you have done?
Again you’ve got to step back and look at really solid, basic principles. I try to look at what we know and what we can apply from what we know, before we start to push the boundaries. You’ve got to have the basics such as infection control, because anybody who has a wound that is infected compared to a wound that isn’t…
One will scar and one will not?
Yes. If you have two animals with the same genetic make-up, but one has an infected wound, you’ll get a scar as opposed to no scar or reduced scar in the un-infected case. So infection control is top of the pile, along with nutrition, tissue handling, tissue destruction: removing tissue that is damaged beyond its ability to regenerate and repair, because it continues the inflammatory process that causes the scarring process to go on, way beyond the surface healing.
So we’re looking at solid, basic principles before we then start to look at, ‘Well, how can I actually use those principles and drive them forward?’ Actually, speed to healing comes up to the top of the pile. Interestingly, it is much more important than your genetic make-up.
Even if the patient is a keloid maker?
Yes. The quicker you close that wound, the less scar you’ll get. In fact, that was what drove us along the cell-culture story. But as we’ve investigated and looked more at what was happening in that environment, we find we’re looking really at the future of it. What’s exciting now, from the point of view of our team, is understanding where the cells come from for the intrinsic healing, and the bone marrow response, and how that is driven not just by a humoral response but by a neural response as well. And looking at the nerve response to injury is where I’m going to spend the rest of my research life.
I started that, I guess, in the early 1980s, with the neurophysiology and the changes in the peripheral nervous system and how plastic it was in the skin responding to pressure of tissue expansion.
So these are the trophic changes, if you like, the change effects of peripheral nerve stimulation?
Not necessarily. The theory, I guess, is that we have the three-dimensional spatial information of a given body site retained in our homunculus, in the cerebral cortex and deeper, in the hypothalamus, in similar mapping-type homunculi. That is how it is in other areas with memory and things. And so we have that retention of the three-dimensional spatial information.
Now, what keeps our morphology the way it is? I think it’s the feedback from the surface. That feedback can be direct, cutaneous innervation; it can be indirect, such as visual or auditory; and it can be a cognitive overlay. I believe that in order to have a regenerative repair we have to have an intact nervous system feeding back that information for self-organisation. If we have a self-organising surface we have to have that information driven back to the central repository.
So your hypothesis, then, would be that you’ve got to treat the nerves as well as the blood supply and the skin?
Yes. I think that the nerves actually form the hub. They form the leading edge, if you like.
It is the hardest thing to treat.
Indeed, yes. Why do we have pain? We are told it’s for protection, but if so, why do we still have pain five months after an injury?
So you’re going to become a neurosurgeon, are you?
Oh no, not a neurosurgeon. [laugh] But I’d like to know a lot more about neurophysiology and neuropathology. My great belief is that lots of people out there have got this information in their heads, but they’ve not necessarily made the connection. I’m very happy to join the dots and collaborate to seek out the pieces of the puzzle to put together.
I talked earlier about a bifurcation: the major reconstruction people versus the bouffant-hair ones who’d like to do the noses and the breasts. But there’s also another kind of bifurcation, in that surgeons notoriously like to ‘do’ but not to find out ‘why’ or to research. The research tradition is not strong in surgery.
I’d have to say you’re right, unfortunately. But I’m doing my very best to engage the surgeons and get people interested. My colleague, Suzanne Rea – who is going to be submitting her PhD on the bone marrow work that she has done – has been a consultant with me now for four years. Also, we’ve got medical students coming through and I’m very keen that they understand that they can actually change the way we think and the way we practise. I don’t believe that we will be practising simple skin grafting into the future. We need to think beyond, ‘Is that as good as we can get?’ We have to get better, as skin grafts cannot be the universal gold standard. Every skin graft I have ever done, however nicely I’ve been able to do it, has left a scar. The gold standard has to be the skin of that area of that person at that time of their life. Anything less means we will jump the hurdle with relative ease. We’ve got to raise the bar. We’ve got to bring our med students into the understanding that they don’t have to believe all they are told. They can actually go out there and find out things that are new, that are novel, that can change people’s lives in an innovative way.
Did you have somebody who taught you that?
Piecing it together, yes. I have been really fortunate in some of the surgeons I have met along the way. In particular, Harold McComb, more latterly as I came to Australia, taught me that however mature one is in one’s career – and he’s well in his 80s now – one can always think of doing it better. And one should never think today is as good as it gets. I think he had that very clear in his mind, as he was a great cleft surgeon. (That is where I worked with him, in cleft lip and palate work.) He advocated the maintenance of that interest in the subject through to way, way into your career, to make sure that you’re learning how to do it better tomorrow, always better consolidating, doing a series of cases, investigating them and analysing them and coming back or working out how to do it better. That’s what I hope to instil in a few – in many, I don’t know, in one? [laugh] – because it’s really important not to believe that today’s treatment is good enough. If we do that, we just all sink into mediocrity.
What is the bone marrow work?
It is looking at where the cells come from that heal the wound. The traditional thoughts were that the healing came from the adnexal structures of the skin, and that when that was overwhelmed you had to reintroduce skin, in terms of skin grafting or of things like the skin cells that we spray. But we’ve demonstrated that there’s a significant introduction into the wounds not just of inflammatory cells but of mesenchymal cells from the bone marrow.
So, cells like stem cells?
Yes, maybe. Interestingly, however, in our animal work those are not maintained over the long term, not beyond 120 days. We are now looking at biopsy work in our burns patients to see if we can understand what is happening, to see if it is really maintained or not.
Some work has come from looking at when our patients don’t survive. Patients that don’t survive come in three groups – almost in equal thirds. We analyse that very intensively, trying to work out how we could do better.
The first group of people we can’t even start to treat. The injury is so overwhelming that it’s beyond technology as we have it here, right now. Then there’s a group where we try, but by the end of about five to seven days it’s very obvious that the injury is overwhelming and we’re not going to be able to ensure survival in that individual.
But then there’s a third group, who survive for about three months. Sometimes it’s a matter of nutrition, sometimes it’s infection, sometimes it’s a race against time to close the skin integrity while the waves of infection keep coming over. And in those people the question we raised was, ‘Is it bone marrow failure? Is it because the bone marrow cannot respond?’ We know patients are immunocompromised, but is it simply an immunocompromise or is the bone marrow being overwhelmed? So we’ve gone back, and we’re working with other groups as well, looking at the quality of the survival.
Is it regenerative collapse?
Yes. Is it that we’re just stressing this system too much? Might there be other workplaces we can learn from – people treating HIV, for instance – that support bone marrow in a different way?
Tell me about the first high-percentage burns case you ever saw.
There are two that spring into my mind at that question. The adult person, in October 1992, was a 29-year-old who was in excess of 90 per cent body surface area burned. He was a high school science teacher who had been helping his friend, a roofing contractor, on the school holidays, and there’d been an explosion. It was just before lunchtime and by the time he was in Royal Perth Hospital, just under two hours post-injury, he had had appropriate first aid, all the lines were in, he was beautifully set up. And in the hospital he’d seen a senior registrar in anaesthetics who had worked in the same hospital, East Grinstead in the south of England, where I had worked in the burns unit.
That is the famous plastic surgery hospital, going back to the Second World War?
Yes. I remember thinking, ‘If anybody will survive this, he will.’ He was young, he was fit – and he did, but at a price. It was a really long, hard road for him, and for his family. It still is. But he’s a fantastic individual who’s done great things.
There wouldn’t be many of him around – 90 per cent is usually reported as 100 per cent death rate.
Yes. It is interesting: if as doctors we stand back and think about it, we realise there are certain people that influence how our lives move, and for reasons beyond our control our lives will be connected forever. He is one of those. He changed my opinion on lots of things, including myself, basically. [laugh] It was a tough time. And I thought that we hadn’t done well enough and that we could do better. At the time I thought, ‘Possibly I shouldn’t do this, because I’m not good enough.’
What, did you make a mistake?
No, not a mistake. He was healed very quickly. We used skin culture from Melbourne, and it was all working beautifully, and although he got peripheral neuropathy and had, basically, die-back of his nerves, they almost all regenerated. But it took him nine months and it was a long road.
So he was, effectively, paralysed?
For a period of time, yes, which is very unusual and had not been recognised in such cases before. It’s now termed the polyneuropathy of the critically ill. Well, people are really surviving in the ICU against the odds, with massive injuries, not just burns.
Why do you feel bad about him?
I guess I thought, ‘Oh, this just isn’t good enough.’ I didn’t know if he would recover. This was in December, on the 16th – I remember it really well because I went down south, camping, feeling, ‘Oh, this is all too hard. I’ve done everything I possibly could and yet there he is now, paralysed. How could I have done better? How could I have avoided that?’ And there were no answers.
I’d called in all our resources, got everybody to work really hard, but I thought, ‘If that’s the best I can do, then it’s not good enough.’ It took me about 48 hours to come to the realisation, ‘Well, that's actually all I can do.’ And so I kind of re-engaged on a very different level, with a very different appreciation of everybody around me. To be honest, I think it was good for me to be able to accept that we were not infallible; we had a lot of work to do.
There are two ways to look at that reaction. The easier one is to shrug the shoulders and say, ‘That’s all I can do, and therefore I’m not going to beat myself up.’ But the risk in that is that you let standards drop. How did you balance it out? You were, from the sound of it, ready to jack it all in and just do breasts and noses!
[laugh] Well, I don’t think it’s ever been in my head space to shrug the shoulders and say that near enough is good enough. But the question for me was whether I was prepared for the emotional energy. I have a great deal of respect for my colleagues in psychiatry and psychology, because it’s something I couldn’t do. And I went close to the edge. I thought, ‘That’s not a place where I want to be, because I am not effective in that space. That’s not where my skills lie. Yet, am I strong enough to cope with that?’ I was quite well aware that it wouldn’t be the only time. And I guess it did strengthen me. It strengthened my resolve that there will be answers and we will get better.
What was the other case?
That was a young boy. He was four, and now he’s 22 and lives with the scars that have compromised his life. I have had pictures of him, of his face particularly, over my desk for about four years, trying to work out how to fix it. I haven’t yet, but one day I will. But it was, oh, tough times in children, in different ways.
I treat both adults and children but we see a lot more major burns in adults than we do in children, and in the Children’s Hospital burn unit over the last 20 years we’ve only had one death. Death is much more frequent in adults because the injuries are bigger. The pressures in kids are very different, because of the family and the fact that then they grow! That’s really hard for the kids and families, because when they grow, they grow out of their skin. So that’s another challenge, the reconstructive work, which we continue – the service continues all the way through, and we do the reconstructive surgery as well.
Are you religious?
So what’s your value system, and where does it come from?
My kids go to a Catholic school – my husband’s a Catholic – and when they ask me questions about what I believe, I talk about morals and ethics, that everybody knows what’s right and wrong. They choose to ignore it when it suits them. And that’s the choice you make.
Tell me, then, a little bit about your family and your upbringing.
I was born in a Yorkshire mining village. I had two older brothers so I was a sort of kid sister, but I did have a younger sister. My Mum and Dad left school when they were 13 and 14, and basically, I guess, my Mum realised that things weren’t going to go right for me from an educational point of view. They were very focused on education and sport, my parents.
What did they do?
Dad was a miner. Mum worked in the youth system until I was about 13. Then she saw a job advertised for a house mother in a Quaker boarding school. She’d been a PTI [Physical Training Instructor] in the WAAF [Women’s Auxiliary Air Force], in the era of National Service, and by this time she’d done lots of youth work. (She used to work nights and to pick brussel sprouts and so on in the daytime.) So she went off to have an interview at the school, and she came back as the phys ed teacher – which was most impressive.
I’m getting a sense here of where the energy comes from!
Yes. She went on and did great things. She was coordinator of the Duke of Edinburgh Awards for north England and things like that. She’s quite an energetic lady. She saw that what she wanted basically was for my sister and me to go to school, to the Quaker school. By then the education system had changed. My eldest brother had left school at 15, having been in the secondary modern system.
This is after they got rid of the Eleven Plus?
Yes. My next brother, who’s now a professor of orthopaedics, got through Eleven Plus and was rapid-streamed to the grammar school, so he was off and going. We girls were caught in the next stage. And so I went to the Quaker school, very aware that I’d been given an opportunity. My mother’s words were, ‘Grasp the nettle with both hands,’ and I thought, ‘Well yes, I will.’ That school was a very special place. I’d come from a comprehensive school, where I could run quite fast – for very good reason, to get away from the fighting. [laugh] My previous school had been rough, a really tough environment. I think I had a big mouth, as well, which probably didn’t help. Then I was in this Quaker school where they were all pacifists and wore long cloaks like Harry Potter.
You’re not pacifist!
Well, I certainly have a great deal of respect for my fellow human. If you ask me, ‘Are you a non-violent person?’ the answer has to be yes. I’m aggressive and competitive but, although I’m no pacifist, equally I see the results of interpersonal violence and how its changing. It’s in our society in a way that’s very uncomfortable for people working in trauma, like myself.
So what do you carry with you from those rough comprehensive times?
Nobody can tell you that you can’t do anything. It’s just a matter of how hard you’re prepared to work to do it. That’s really the bottom line. As I said, I can run fast. But my dad was very keen on sport and he’d played soccer for Notts Forest [Nottingham Forest] very briefly before he broke his leg and he went back down the mine. So he had a sort of sniff of the fresh air.
No child of mine is going downt’ mine – was that his attitude?
He was absolutely adamant about that. He used to say, ‘One of my boys will be in light blue, one in dark blue under Putney Bridge.’ One of my brothers did go to Cambridge, but it was a boxing blue in fact, not rowing. There wasn’t much rowing where we came from!
He must have been a very proud dad.
Why did you go to medical school at St Thomas’?
I went there because my brother went there. My interview was interesting. He’s a very good rugby player and when they asked, ‘Is anybody in the family in medicine?’ I said, ‘Only my brother.’ The Dean turned then to the Professor of Anatomy and said, ‘Oh, did you see the try he scored on the weekend?’ So all we talked about was the very impressive try he scored. (That one was even in the newspaper, the Telegraph, I think: ‘Wood crashes over the try line draped in Welshmen.’) [laugh] And that’s how I went to Tommy’s, because my Mum and Dad thought I needed to have my brother look after me. Oddly enough, later on he followed me here. It was great when he and his family came to Australia.
And you came here to follow your heart?
Yes, I married a West Australian.
Did you arrive as a consultant or were you still training?
I came here with a couple of years still to go. I had got my general surgical fellowship and I was part way through my plastic surgical fellowship, so we landed here with about two years to go. But I ended up sidestepping – being sideswiped is probably a more accurate description – into general surgery for a year, before going back into plastic surgery. I then passed the plastics exam. So I was a consultant in ’91.
People often complain that it’s a small medical community in Western Australia, they’ve got tickets on themselves, they think they’re better than they are, it’s a bit of a cliquey set.
It took me a while to break in to the plastic surgery guys, but I’ve had nothing but great support from the vast majority of them since. As far as I was concerned I would always be a surgeon, it was just where and when: I thought ‘If it’s going to be here, then good.’
At what point of your career did you start having kids?
I had two when I arrived here. (The first one wasn’t planned, but then we thought, ‘Well, we’ve started now. Let’s just keep going. We want lots of these.’) Tom was born when I was at East Grinstead as a junior surgeon in training. Then I had a child shortly before I leaving the UK. I left Thomas’ as a lecturer of plastic surgery to come here. My second child was just five weeks old when I moved to Australia. Then my third was born after the first six months of my plastics training in Australia. And I had three children as a consultant.
Did it slow you down?
No, not really, not that I noticed. But you probably are asking the wrong person!
What would you have been like if you hadn’t had them?
Someone asked me what I did and how I managed when they were young. I said, ‘Oh gosh, I can’t remember actually how I did it, but with great support.’
Somebody who once sat beside you at a dinner was quite impressed that you were taking the same phone calls as she would have taken from her children and yet, as if it’s not bad enough being a surgeon on call, you’ve got a research career as well. If anything’s worse than surgery for having no boundaries, it’s research. There are never any boundaries to research. If you’re running a culture in the lab, you’ve got to be there. You might have postdocs and so on, but the lab keeps going 24 hours a day. At least in surgery you get days off. Can you give me a brief sense of how you organise your life?
I guess it’s just juggling: juggling all the time, working out bits of time here and there. I guess you’re asking the wrong person again, you should ask the kids – I don’t want to hear the answer – but I’ve always tried to make sure that they took priority, that their reasonable needs were at the top of the list.
Well, it must be okay if they accept the plastic surgeon to look after their broken bones.
Yes, it’s something like that: ‘Oh yeah, Mum can come.’ [laugh] But it is a matter of juggling. If I’ve got a board meeting or a research meeting and then there’s theatre, it’s working out how to dovetail it all in. When the kids were younger I used to work a lot at night while they were asleep. Then as they have got older they want their bit of time as well. So getting up early helps. And I like to stay fit.
Anybody with two or maybe three kids would know about the logarithmic increase in driving and everything else. Do you still do all the driving?
Not all of it. Today, one has just gone from uni so he’s picking up two from school, and another one can also drive. I’ve got three drivers now, and that does make a difference. The older kids remember the younger ones being in the car as we drove them to every sporting event you can poke a stick at, and so they’re very good at taking them to training as well. For example, a number of them will be swimming in the morning or riding their bikes or whatever. So they have that sort of, ‘Oh right, okay, I can take So-and-So’ – even to trampolining. Even though none of the others do that they pitch in, and when I’m away they will drive half an hour to the trampolining place.
Your mother must have provided a model for this juggling of multiple commitments?
I think so. She was very much the sort to see the gap – though now it’s interesting, because she says, ‘Oh gosh, you’re just so busy. You should take it easy. Slow down.’ And I go, ‘What’s wrong? Hang on! Is this pot calling kettle black?’ [laugh] She only says, ‘Oh no. I was never as bad as you.’ But I tell her, ‘Just because you didn’t have an academic role early, when you were picking brussels sprouts or whatever, that doesn’t mean to say it wasn’t time and it wasn’t effort, working things out and then getting home for us, and going out to the youth club later.’ It got easier for her when she worked at the school, because then she had school holidays and so on.
Tell me about the challenges of commercialising your research.
That sort of commercialisation is probably, in retrospect, the hardest thing I’ve ever been involved in, because I have no education or training in that regard.
Is there anything that can prepare you for it?
I’m not sure. It’s interesting: I speak now at innovation sessions and things like that for the university, and speak to the commercial science side, and I say that you can’t have one without the other, it’s a symbiosis. If you expect your idea to be the best thing since sliced bread and expect everything from it, you’ll be disappointed. Equally, if you expect to get everything out of others’ ideas without rewarding the inventors appropriately you will be disappointed, because they won’t support the commercialisation and they won’t give you the next idea. I don’t know whether that falls on deaf ears or whether people are listening.
It really was an exercise in communication, collaboration and mutual respect. I met people along the way that were difficult to respect and caused problems. So I had to move on. That was painful and difficult. I remember Harold McComb saying to me, ‘You know, Fiona, you believe what people say to you. If someone says they’ve got pain in the right iliac fossa, you think they’ve got appendicitis. And if they say they’ve got pain in the right iliac fossa but only on a full moon, you still believe them; you just change the diagnosis.’ [laugh] Ah-hah, I needed to change the diagnosis!
It was difficult, having to realise that not everybody coming to you saying that they would do things actually had the capacity or the intent to do those things. So it was an interesting journey.
The research you were seeking to commercialise was for spray-on cell grafts?
Yes, taking a piece of your skin, processing it and putting it back on you. It was changing the dynamics of the healing process and really speeding it up, because speed was the big issue that we identified as the first cab off the rank to be dealt with in reducing scars.
By, essentially, creating islands of cellular regeneration?
Yes, because we were taking skin from an area that is programmed for regeneration. We are regenerating all the time, so we harvest the regenerating capacity and introduce it into the area where that capacity has been overwhelmed.
It was a fascinating journey, apart from the difficulties, and the learning curve was extraordinary. And it’s ongoing. Understanding how to devise research programs that are suitable for TGA [the Therapeutic Goods Administration] and FDA [the US Food and Drug Agency] is quite different from doing the papers that you will publish. As for patent scrutiny, when someone comes back to you and asks some of the questions you think, ‘Why on earth would they want to know that?’ But there are matters of ‘prior art’ or whatever. And then there is having to establish an experimental framework to answer a specific question when you think, ‘Well, really that’s not the best question. I want to be over here looking at what’s tomorrow, but I’ve got to tidy up today.’ It’s a real discipline. You have to make sure that you are rigorous about the frameworks.
The regulators knocked you back at one point, I believe.
Another interesting thing about the whole business was dealing with the media and the perceptions of things. For us it was part of the process we were going through. We would say, ‘We’re working on this. We have done this,’ but the response would be, ‘Oh, but there’s that.’ We’d say, ‘Right, sure, we’ll get that fixed,’ and send it back, saying, ‘Yes, now we are okay.’ It was rather similar to a peer-reviewed process.
So the normal hurlyburly?
Yes, with things going backwards and forwards. But of course in a public, listed company that has to be disclosed to the market, and it’s picked up and run with in a way that says simply that we’ve been knocked back. ‘No, hang on,’ we had to say, ‘we just followed the process.’
Did you feel you were a victim of the great Australian tall-poppy tradition?
There are some people, a couple of colleagues, that have made life difficult for me, but that’s their prerogative and their choice. As far as I’m concerned, the amount of energy it would take to engage and put those individuals right in a public arena would be inappropriate. My energy, really, is focused on the patient care, the research that will back up better quality patient care.
I think it’s fascinating that negative energy has such a disproportionate impact by comparison with positive. The vast majority of people, though, are extraordinarily positive and supportive.
I have talked to people like Charlie Teo, the neurosurgeon in Sydney who takes on difficult cases and is largely hated by his colleagues. One wonders whether or not some of the opposition arises from self-reflection that you could have tried harder, whether people get threatened, in a sense, by somebody else who is trying harder. Do you think part of the story is that you might be going a little bit further than others, and they feel bad that they didn’t go further with their patients?
I feel very strongly that everybody makes their personal choice. I believe that every morning nobody is trying to do things badly; we are all trying to do our best. Whether you are doing breasts or burns, you’re doing your best for that individual. That’s what I respect. All I ask is, ‘Give me the opportunity and respect me for doing the best I do with my burns patients, because that’s all I am about.’ I respect that others have made their choice. My choice is to work on the extreme rebuild end of the spectrum as opposed to any other place in the spectrum. We have to respect each other. You can’t fight if nobody will fight you. And I won’t fight. I’ve got better things to do.
I have asked you about the memorable patients. But presumably the memory of the Bali bombing is one of just an overwhelming workload very suddenly. It can’t be often that one gets hit with that volume of work.
That episode was a fascinating time, on many levels – again one of those times when you learn a lot about people and about yourself. We’d planned things, we’d been into disaster planning, so it was something that we were prepared for on one level, especially when you are actually in the thick of it all and doing things. People kept saying to me, ‘Isn’t this terrible! Is it really hard?’ I would say, ‘No. It’s not really hard, because we’ve trained for this. This is what we do.’ There’s no greater motivator than to be actually doing something and helping. That’s a real energy maintenance sort of scenario: you are going forward and you are doing, all the time.
What we hadn’t expected, though, was something that came to the surface about three weeks later. I remember the three-week point very well, because we had a mass exodus and we had only four people left after that – we had the boys go to Germany, there were interstate transfers, etc.
It’s also the danger period for people with burns.
Well, by then most of them were healed. In fact, we are really aggressive. We really push hard with early surgery and all care. Two people had died but the majority were healed. Out of the 28, we had over 20 people healed by three weeks and we had four left in the hospital: one, who went on to die, and three who took a little bit longer to heal.
But that was the time when one of my colleagues said to me, ‘You know, we’ve lived through something very special. We’ve lived through something we will never see again – hopefully.’ And as I thought about the positive energy that was generated out of something so negative, that too really changed the way I looked at things. I thought, ‘Hang on, why do we only see such positive energy, so much helpfulness, people going so much out of their way, at times like this? We could do more of that all the time!’
And I have looked and I have connected, and I realise there are people doing amazing things all the time that we just don’t know about. That was the pleasure of 2005, meeting people doing amazing things.
This is when you were Australian of the Year?
Yes. That was a real eye-opening education, an inspirational year: ‘Wow, there’s all this that we don’t know about.’
It seems pretty weird for a Yorkshire lass to become Australian of the Year.
Warren Pearson, the CEO of the Australia Day Council, asked me, ‘Are you Australian?’ I said, ‘No. Does it matter?’ and he went white. So I said, ‘Just kidding! Of course I am.’ But that got him going a little bit. [laugh] It is amazing, though, that I can be the proud Yorkshire lass and also a proud Australian – which I am. I have had opportunities in Australia I cannot imagine having had in the NHS.
Did you get any work done in that year?
Yes, I worked. I held it together; the team held it together. It was tough. I did a lot of night flying. I can sleep sitting up on Qantas planes – just sit there, and I’m asleep before take-off!
Was it a life-changing year?
It was. It was a huge privilege to see all those people doing so many things and to be connected with so many different people. It was a bit of a blur as well. It got to be really quite intense at times.
It must be easy to be sucked dry by it – making the same speech perhaps three times a week.
And I never write things down. (I’ve no time for that because I’m working.) I’d suss things out in the room and think, ‘Right, it’s a science group,’ or, ‘Okay, a Rotary group,’ or whatever, and work out their purpose in having me there. I’d have a quick chat and think, ‘Right, okay, I’m in.’ And that was stressful. I kept thinking, ‘One day I’ll just stand there and I won’t know what to say.’ [laugh] It was actually quite a pressure, thinking, ‘What do I say next?’
To be brutally honest, I did forget to go to a leadership conference at the Curtin University. I was in pink ugg boots and a tracksuit at the ice-skating on a Sunday morning, when I got a call to let me know, ‘Sir Charles Court’s almost finished.’ I thought, ‘Well, that will be my turn then, won’t it! Ah, okay, right!’ So I rang around, I got on to my nephew. I had my kids and other kids there, so I got everybody picked up and sorted. And I went to the university and said, ‘You know, the first lesson of leadership is that you’ve got to get up early in the morning. Otherwise, in my house, you don’t get the pink ugg boots!’
I remember being a bit stressed that day and thinking, halfway through a sentence, ‘Where is this going?’ But suddenly it did come to me, just before I looked a complete turkey.
Looking forward 20 years, what is your ‘must have done’ by then?
Gosh. Looking forward now, the ‘must have done’ for me is that I really want to make a big hole in the research all around the self‑organising surface and the innervation, and the reinnervation and the training of that surface such that we connect the brain with our function. We are, at the moment, going through a fundraising campaign. If we get $10 million, we will do $10 million of work. If we get $10,000, we will do $10,000 of work. But by January 2009 I will stop asking, because I will do the work. That’s what I want to be able to look back at in 20 years and think, ‘Yes, I did it. I had the discipline to do the work.’
It’s hard to get the funds. You spend a lot of time spinning round with grants and things. So whatever we get, we’ll tailor to and we’ll do, and we’ll build on from there. If at first we have to shrink to build, that’s what we’ll do. It’s really important to me that we make the links with people internationally, nationally and locally that have this in their heads, that have the understanding of developmental neurobiology, the understanding of MRI/PET scanning interpretation in people with wounds, an understanding of acute pain pathways, so I can connect all these together to actually drive the healing – so that in 50 years’ time we won’t be skin grafting, we’ll be driving regeneration. I have recognised now it will not be in my surgical lifetime. I was overambitious and overoptimistic, I think, 20 years ago. In 20 years’ time I want to look back and be realistic, and know that I have truly made a serious contribution. It won’t be the end game, but I want to be a contributor. That’s the bottom line.
Fiona, thank you.
Thank you very much.