I get a lot of enjoyment from curiosity. When I was in Australia this last time we had a meeting and we had some time off for lunch. I like looking at things, at nature, watching things and I had half an hour outside eating lunch next to a wall, in the sun, watching over some water. There were some ants walking around, two species. I like looking at ants, they are always interesting animals. I put a tiny bit of turkey and a tiny bit of cheese down and they liked both. It took them a while to find it and they made trails and called their friends and got them all there. And they decided (I very much interpreted this in the wrong anthropological way, but they obviously decided) that the turkey was something they needed in their nest and they picked it up and carried it which was quite amazing along the edge of the wall and down for ages into their hole. The cheese they liked, but just like cows in a stall, they came and ate the cheese and nobody moved it at all. So I was interested in why they were doing that, there must have been something in the protein content in the turkey which made it more desirable to take back to feed the young or the queen or something like that, but the cheese didn’t have it. And if I’d been a zoologist I could have gone on and found out what particular things were necessary. I really enjoyed myself, just seeing what these ants did, it was absolutely fascinating. I am basically, although nobody would agree with me, a lazy person, and I am quite happy just doing things like that, it doesn’t require any effort.
I don’t work in my life with aims about where I want to get to in particular. I think all my priorities have been to do something which I enjoyed doing, was reasonably good at, and was going to be useful in some way to someone, and I can’t see that that has changed.
I started doing some teaching fairly early on in my academic career, so I think that fulfilled my need to do something which was useful to other people. I thought originally I would do cancer research, but this was probably pandering to the feeling that I should do something useful for mankind in general. But the real interest was wanting to do something that did find things out, because I always wanted to know how things worked and what was going on.
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How do you think your are helping the world in your work and what are the results?
There are three ways that I hope I am helping the world. First through my teaching – the tutorial teaching at Oxford allows a close relationship between tutor and students, and I hope that I will have helped the medical students I am responsible for to achieve their potential, and that they will have learnt from me to think widely about their work and end up as more perceptive doctors and people. Second through the research I have carried out and in particular the investigations my research group have made into the etiology of detrusor instability. Our research and the papers and book chapters we have written have helped change the way that people look at urge incontinence, and have given some fundamental insights into the mechanisms involved. I have published with collaborators more than 150 papers in peer review journals, and many chapters in books. I have also published one book (sole author) and been an editor of three others. Third is a combination of the above two, in the opportunities I have provided for a lot of talented young scientists and clinicians to carry out fundamental research, obtain higher degrees, and move on to become influential in their own right in basic research, academia and as consultant urologists or coloproctologists.
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I got polio when I was 18, I was in hospital for about a year and a half, but I never thought I wouldn’t go to university. Polio was a big thing, I was very seriously ill, I had respiratory paralysis. It was particularly bad because I was in West Africa and I was very, very lucky that I survived at all.
Obviously it has tremendously coloured my life because there have always been physical limitations to what I can do, but I don’t think it changed what I really wanted to do. I assumed once I knew what was wrong with me that I was either going to die or get better, and I very quickly came to the conclusion that I wasn’t going to die so I assumed I would get better. And it took me about a year to realise that I wouldn’t, but I think the fact that nobody ever told me meant I didn’t change what I wanted to do. When I realised I wasn’t going to get any better it was then just a case of ‘How am I going to do it like this?’ That has always been a problem in my life. It is a disease which doesn’t get worse, and you get more and more skilled at using the muscles you’ve got left (it goes for the motor neurones and once they have died they don’t recover), but once you get older you start to lose motor neurones. Then it becomes a problem, because if you only have a limited number, even if you can cope with these, when you start losing them then things get progressively much worse. So I have spent most of my life learning to use what I have got or adapting to things going. But that in a way has been secondary to my academic life, I don’t think this has been greatly affected. It’s a matter really of common sense.
My mother always said that she would never try and stop me doing things, that if I had set my mind on doing something then the chances were I would, and that she never found it productive to try and stop me doing things. But it must have been hard for her after I got ill, because the consultant told her apparently that I wouldn’t walk. But I did, I walked for ages, I still can walk, just.
I’ve always had to walk with elbow crutches, and there has been an element of danger in it, because since I got polio I’ve never been able to get up if I fall over, so that is always a danger in my life.
Independence is incredibly important, but I could manage being dependent, I am quite adaptable. When I was in hospital, I learnt how to cope from my physiotherapist She was quite small and I am quite tall, and she couldn’t manage me physically on her own, however she thought part of my progress was getting me back out into the world. She would take me into town, to the theatre and shopping, and she would just stop anyone in the street and ask them to help and they always did. So I learnt from that that you can actually use other people and that they are happy to help you. So I have been very pragmatic about it. I don’t like my disability to be a burden on other people. I’ve seen too much of that.
When my parents were looking for a house in Oxford I told them not to look for a house suitable for me. But this turned out to my advantage. My bedroom was up two flights of stairs. But if they had bought a bungalow I would never have learnt to do things like manage stairs, and it gave me the skills to live on my own. But it must have been hard for my mother to know that I was going to live on my own out of her reach, but she never told me that, she never discouraged me.
The lack of ability to do things physically has been a huge loss. I was very athletic when I was younger, but I was getting to the stage with my sports where to get any further I would have had to put in a lot more training, so I had had all that. Obviously I missed it, not being able to walk to places, but it is amazing how much you can do. It hasn’t stopped me travelling. The fact that I am known in my field means I do get invited to things. I went to San Francisco the other weekend, and got a $5000 fee for judging applications for research funding. It’s difficult travelling in third world countries. When I go to the US I hate travelling on motorways because you could be anywhere in the world and I want to know who is living there and what the country is like. As long as I’ve got an automatic car I can drive. I like to drive on the small roads, I like to see what things are like, I suppose that is curiosity. I’ve always wanted to see how things worked, not just bodies, but mechanical things. I think a lot of it is how you are brought up. My mother was a naturalist, we were all brought up with her showing us things in the country. She wasn’t educated in any formal sense, but she was an intelligent woman and very interested in things, and I suppose that must be in our family, that we are interested in birds and flowers and trees and nature and everything around them. It is very lacking nowadays. I find that more and more with my undergraduates. I teach medical students and they want to be out there. I suppose altruistically again, wanting to make a difference and cure people and all the rest of it. And they are all pretty intelligent, and their schools are telling them that they are good enough to do medicine, but the underlying curiosity is not as common as I would like, I find it quite surprising that a lot of the students just aren’t curious. The British Medical Board has this ‘core knowledge’ they need to know, and it is a desperate battle through the first years to keep our students thinking and not just learning. Because I have always hated learning, I try and teach my students that if you really understand something you don’t have to learn it. There is a relatively small amount that you actually have to learn once you have understood it, and it is a huge saving of time to put the work in to understand something in the first place. But it is a pretty intensive time at Oxford with these eight-week terms and huge amounts of work to get through. They really have very little time to think.
I don’t think it’s the recognition that I like so much, it is the doors that it opens. One of the things about being disabled which has been a huge benefit to my career is that I am memorable, everybody knows who I am. At first it’s ‘that lady in the wheelchair’, then ‘Who is she?’, then they discover. It’s not the buzz with the recognition, it’s the people. I meet very nice people, very clever people, and the doors are open to doing interesting things and things that are fulfilling. Although I suppose there are elements of recognition that I like.
I have a huge number of friends and a number of really good friends that I have made through my work, either directly or even relatively indirectly. Two or three of the closest friends of mine I have met attending the same meeting. Hundreds of my students have become friends and are still friends. One of my current students is actually the daughter of one of my former students, but she never told me. I only discovered once she came up! I like people on the whole.
For me it is very nice to have someone I can travel with. I would like a single friend, married friends are useless for this. The trouble with the friends that one would like do things with, is they all get married and have children. Luckily my brother has married a second time and had four more boys and I use them. Almost all of my friends have been made through my work, or at university with me, but they are scattered. We keep in touch. I don’t hanker for more friends. I’m actually getting much better now at enjoying experiences that I don’t share with anybody.
I don’t think power has ever been anything I’ve been interested in. I think the only time power or even recognition would switch me on at all would be if it made things possible that weren’t otherwise. There are times that one feels that things are going wrong and if there were only people with a bit more common sense we could get things right. I’m a very good solver of small problems. I can get things sorted, at that sort of level.
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How would you reinvent your job if you had the power? What work needs doing which is not done, and what are the obstacles?
The research work is very much in ‘systems’ physiology, and is currently rather unfashionable, as we are not using much of the advanced molecular biology and genomic approaches that are attracting the good funding. It is however extremely necessary, and it will become increasingly important in the future to translate all the molecular advances into useful medical or pharmacological treatments. The government needs to be putting more funding into these areas of research through its Medical Research Council. Currently it is necessary to rely heavily on short term, piecemeal funding from charities and drug companies to do the research, and longer term more reliable funding would be a huge advantage, and much more economical. Also the organization of the career structures of clinicians who are on track to become leaders in their fields, needs to provide proper funding for salaries for them to become trained in basic research techniques. Too often I had clinicians working without personal funding, and trying to make enough to support themselves by working locums at night or weekends. Universities are also grossly under-funded, and the salary scales for academics have slipped so badly that in Oxford, for instance, the starting salaries available preclude many very talented people from accepting university lectureships, because housing in Oxford is so expensive that it is impossible for them to get a mortgage. The science departments in the University are also underfunded, and have had to start charging people bench fees to carry out research, so that is becoming impossible to take people on to do research without substantial funding. I cannot understand how the government does not appear to realize that by underfunding the universities, they are likely to lose one of the country’s most important assets, that of well trained and knowledgeable people to take up all the important and wealth creating jobs in the future. Clearly university funding doesn’t carry many votes, but parliament should be organizing some cross party agreements that proper support for the universities is absolutely essential. We are already losing a large amount of the talent available to other countries where research is better funded and salaries are more competitive.
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Marriage, love, relationships, children
I’m sure if I hadn’t been ill I probably would have married and had a family and I don’t think my career would have gone as well, but I have no enormous regrets that it hasn’t gone that way.
I don’t know about loneliness. This is something obviously that I have to think about a bit. Working as I do in a science lab there are people around me all the time so I get all the interaction with people I want. And I’m very happy back here on my own, I’m very happy with my own company, I don’t normally feel lonely. But whether or not I will when I stop working is a serious concern. I might not, I don’t know, I might. It is very difficult to tell when you haven’t experienced it. I come from a big family, hundreds of cousins.
I’ve always had family, and I’ve had men, the big problem there…I don’t think there is any doubt that I would have got married and had a perfectly normal life had I been normal, but if you look at all the people I have known that have been disabled, women will marry disabled men but it is very rarely that a man will marry a disabled woman. You might get a disabled man marrying a disabled woman. I thought after I got ill that I wouldn’t have any relationships, or never would have. I thought that I would just have to rule that out. I came to terms with that reasonably well because I thought I can look and fantasise about men that I like, but just being realistic it was liable to be one sided, and I knew I could probably cope perfectly well. But I was surprised to discover that I was quite attractive to some men. I have had lovers, enough in my life, but never a relationship that ever would have led to marriage. Just looking round at my academic colleagues it always slightly irritated me earlier on in life, because as a woman lecturer we are very much in the minority in the sciences still, and your male colleagues would be able to invite all of their students home and just ring up their wife and say, ‘We are going to have six of my students home for dinner next week,’ and she would say, ‘Fine. Let’s do it.’ And for me I have to do everything and shop and cook for my students. I need a wife! That is what I always thought.
I’ve fallen in love with somebody for their mind, but it was somebody who was totally and absolutely, it couldn’t have been more, wrong. But you cannot stop yourself falling love with people however unsuitable it is. But that is the only time you feel lonely, not lonely, but wanting somebody who was really at your side. But I happened to fall in love with somebody who was programmed psychologically never to be able to love anybody. Whether that is why I fell in love with him I don’t know, it wasn’t my fault, it was his fault entirely, blame him! I think again one has to have a certain pragmatic approach. I hope to goodness that I never fall in love with anyone again as it is emotionally much too stressful. I have spent most of my life being disabled and not wanting to be a burden to people and eventually that makes you quite comfortable without having serious emotional relationships with people.
As you get older I think the flexibility…to live with somebody you need to be a bit younger. I had a very good boyfriend, (I’ve kept all my boyfriends, which is nice, and am still good friends in one way or another with them). He was one of the more serious ones, we vaguely wondered about whether we might get married at one stage but it was the wrong time in our careers. I later realised that that particular boyfriend would not have worked. I would have wanted to change him and I don’t think you can change people. At that age (24) I thought people could change. You can’t get someone who squeezes the toothpaste in the middle to squeeze it at the end! Perhaps you can grow to like these things. But that man is still a very good friend of mine and I like seeing him because he was very good physically at helping me and things like that which was nice and it still is.
Having children would have changed me a lot, but I have no regrets at all about not having children. I feel so sorry for people that are desperate for children. But I’ve had a lot to do with children in my life and I like children, but the problem about children is that they are there forever.
It seems to me that the best husband-wife relationships are ones where they are really good friends and lovers only on top of it. The being in love just doesn’t seem to last as far as I can make out. But it is easy to stand outside and watch. I would probably have been equally bad at it. It seems that people make the same old mistakes over and over again.
But it does surprise me the intensity that emotion can have and the physical manifestations of it and it is very remarkable, it is something that I find endlessly fascinating. I couldn’t work like some of my colleagues do on the brain because the complexity is just so great that it is almost impossible to interpret anything that is going to approximate proper explanation. I prefer to work with simpler systems, to get some sort of understanding about how things are working.
There is still an awful lot we don’t know out there.
The future
I have to think about the future. At the moment it pre-occupies me enormously because over the last two weeks my physical strength has somehow declined a lot. It always happens with me as a step change, because I’m on the edge of what I can do and always use the maximum abilities I have to get around. If it suddenly isn’t enough it usually stops me doing something quite major. The next preoccupation is being able to stand up. I can’t get dressed and undressed when I am sitting down. I’m looking into trying to find wheelchairs that will help me stand up. I am very unevenly disabled, and it is difficult to find some device that really suits me.
It is a serious worry for me at the moment, falling is a fear, a huge fear. Because before this house was a refuge, it’s a lovely cottage, but now it is turning out to be somewhere I fear, and I don’t want where I live to be frightening. I try and sort these things out! Something will happen. There is always some hope. I’ve got lots of other things to I can try, it’s the same as everybody, you have to cope. The fear, I hate it, I really don’t like being afraid and I have tremendous battles with the two parts of my brain with one saying ‘You are going to fall,’ and the other saying ‘Don’t be ridiculous you know very well you are not!’ But the one that is frightened wins, and there is probably a good reason that it does, because if I do fall I can hurt myself badly and can’t get up. There is a rational bit, it is probably quite rational, but the fear is incredibly inhibiting, it stops me completely. The other day I was standing for 10 minutes between here and the kitchen unable to move because one side of my brain was saying, ‘If you pick that foot up and put it there you are going to fall!’ I do not like that at all. It’s part of the situation. When I was younger things were getting better. I worked on the assumption that if I could do something once I could always do it, but in the initial fear of doing it, there were people around. On the down now it is not as good. Each step down is the next step further down.
Conversations
Deep intellectual conversations amongst friends at home have not played an important part in my life. I don’t want to get into areas where there are things that I believe in and I know very well that they don’t, I suppose it’s cowardly a bit. I know there were times when I was younger that there were particular friends who one could have really good conversations with, that you were comfortable with, that you didn’t have to be careful with.
I think I have grown more sure of what I think about things than earlier on. You have to be careful, you can be looked upon as being too dogmatic. If you are not careful you can easily be made to look arrogant, people don’t like you to be right all the time. I suppose I like to be right all the time, that is a problem for me in conversations. I suppose I close down conversations if I’m going to have to start showing that what I think is absolutely right and what they think is absolutely wrong, but perhaps that comes from living on my own all my life.
I suppose when I was younger we had some quite interesting speculative conversations with colleagues when we were all unsure about things. I suppose your views get a bit less flexible, I think the conversations I look forward to are with people I know well and we have similar views about things. Conflict when you get older…it is easier to agree with people.
Enemies and information
I don’t go for enemies. I find people make enemies on grounds that are ridiculous, usually it is a slight misunderstanding, or because they put too much weight or haven’t quite interpreted what someone has said. Then they take umbrage and that person becomes a persona non grata. I don’t tend to take other people’s views about people into account initially, I wait to see how I react to that person or how they behave towards me. You can see how people are different with different people. When you are young the fact that you suddenly discover that people you thought you knew have aspects of them that you have never met and that they only show to other people, is disconcerting. I bear in mind the bad things that people tell me about people but I don’t assume they are bad. I don’t read newspapers because every time I read newspapers and I have known the inside story of what has being going on they have always got it wrong, absolutely always. I came to the conclusion years ago that if everything I knew about in the papers was wrong then the chances were everything in them was wrong. So I stopped reading newspapers and that was a big relief! I listen to the radio now. I think it is easier to hear when things are right or wrong because you can listen to people’s voices and hear interactions.
It’s like with your students – I can say ‘You may read in your textbooks this, but it is wrong, that guy got it wrong and we now know it is like this.’ Do they take any notice of it? No, it’s written, it’s in the textbook.
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There is a lot of very straight-forward and tedious stuff that goes on in science. It’s often mindless. Thinking about the amount of genuine creative thinking I do in a week it is probably only a couple of minutes!
February 2004