Ralph Clark: I was associated with Bernie for quite a few years before he started pursuing microsurgery. He was always a very pleasant person to work with, and very popular. When the microsurgery started, it did produce tremendous strains on the Anaesthetic Department[49] because it did mean that when these operations went on for six, eight and sometimes twelve hours, and very often starting at six or seven o'clock at night and going right through [the night], from the point of view of personnel it was a tremendous strain.

From the point of view of maintenance of the care of the patient it also created quite a few new problems in keeping the patient well over such prolonged periods with surgery that we weren't accustomed to. Over the years we became experienced in dealing with those things as far as general maintenance of the patient was concerned and the type of anaesthesia produced, just general monitoring of the patient, keeping them hydrated, looking after their urine output, keeping the temperature of the patient reasonable for such a long time. Often it involved attending to specific details that were not always required for other patients.

Ann Westmore: What length of time are you talking about here?

Ralph Clark: Quite a few of the operations would have gone for 12 hours, and started at night-time. Of course, at that stage, staffing wasn't such that we could say to those people, 'OK you can have the day off because you’ve been working all night’. So sometimes, physically, it was difficult from a staffing point of view.

Ann Westmore: So did that create friction? Suddenly you have surgeons wanting to do things that go on for much longer than ever before.

Ralph Clark: I wouldn't say it caused friction. It caused physical demands and fatigue. And that again is one of the problems in anaesthesia, of course, if you become fatigued and lose your concentration, mistakes can occur. So that’s something that had to be catered for. We usually had at least two, if not three, people involved with the patient so that there was an ability to have some relief and a cup of tea, that sort of thing, at various times. As did the surgeons, of course. We admired the ability of the surgeons to maintain their concentration for such tremendous periods of time, with good temper. So there was, shall we say, a physical and mental demand on both the surgeons’ side and the anaesthetists’ side. It really involved meticulous attention to detail from the anaesthetists’ point of view, as with surgery too of course, much more so than you might expect for a two or three hour operation, keeping patients in good condition with adequate replacement of fluids for such very long periods.

Ann Westmore: So that was a scientific challenge for you to do that in an excellent way. Did that lead to some innovations in the anaesthetic line?

Ralph Clark: I suppose the combination of general anaesthesia and local anaesthetic blocks which improved the sympathetic blood supply to the areas that were being operated upon, often that helped to maintain good perfusion to the vessels that were being sutured. I suppose to a certain extent that was an innovation, yes. But in general it was just a matter of attending to the same principles of anaesthesia as for other things, but with greater attention to detail and for prolonged periods.

Ann Westmore: And were there some anaesthetists who were better at that really lengthy operation, who might be called in when the microsurgery was to be done?

Witness to the History of Australian Medicine