Interviewer
Oscar Parry, age 9, Fox Ward
Interviewee
Dr Paul Veys
Questions:
What made you want to become a doctor?
Well my dad was a doctor, and when I was about 16 at the time, we were made to sit down and take a test and the results tell you what you should be. And it told me that I should be a doctor, so that’s it. So there was no choice. It was a very clever test! The only test I’ve done well at! That was a long time ago now.
What do you do at Great Ormond Street Hospital?
I look after the bone marrow transplant unit, you’ll know all about that won’t you as you’ve had several of those. We look after about 75 children a year, who have the same thing as you did. It used to only be about 20. It’s going up and up and up, which is good as we’re all doing quite well.
Why do children like me need bone marrow transplants?
Bone Marrow is a very clever thing, it produces lots of cells, and those cells go all over the body. And just occasionally those cells go wrong. And it’s a bit like having a bike which breaks down, sometimes you can mend it other times you have to buy a brand new one.
And that’s what a BMT is, if you can’t mend it otherwise with our tools then we put in a whole brand new one. It’s quite hard to find a new one, it’s not like going round to the shop to get one and you have to look very carefully to find a special one, like we had a special one for you.
How many children do you treat each year ?
About 75, most of them only have one transplant. Only occasionally people need two or more.
Do they all get better?
The majority get better, but not every single one of them, which would be great if everyone did and we don’t quite know how it’s going to work out until we’re quite some months afterwards. But these years most, most children who come in go home well. Just the few unlucky ones.
How do you cope with losing patients?
A very hard question, very hard. I guess I remember, when we lose a patient and it’s very sad, all the ward get very sad, we remember the successful ones and that’s very important because if we got so sad and we couldn’t come to work the next day then it would be difficult wouldn’t it? Who would look after the unit?
We all get together sometimes, sometimes we go to the pub as a group and we talk about the sad ones but we try and remember the happy ones. And that’s usually how we get over it and come back in. But it’s very difficult, I think every time something goes wrong we lose a little chunk of ourselves, but fortunately it doesn’t happen very often. Lots of happy stories, like yours!
What are the problems of treating children with bone marrow transplants?
PV Well there are two big sorts, one is the treatment is very heavy treatment, the cancer treatment. So sometimes the problems come from our drugs because we have to take away the old bone marrow completely before we can introduce the new bone marrow and that needs very strong drugs.
So that’s the usual problem. And then sometimes; you’ll know about this, sometimes we do the transplant and it will go ok and then the disease comes back so our drugs didn’t quite work, or the new bone marrow didn’t quite work and you have to go and do it again. So sometimes the disease comes back and sometimes our treatments are just too tough. But we’re getting better.
Last year only 2 children out of 75 got very sick from our treatment so that was the best year ever.
In the old days it was much much higher, 5 / 6 times higher. And we’re trying all the time to improve our treatments so they do just a very specific job.
You’ll remember, and I notice from some of your pictures, you weren’t very well on some days and a lot of that was our drugs, so that’s a big problem. It’s not a do it at home treatment.
What is a mini bone marrow transplant?
That’s a special bone marrow transplant, for children we started here 10 years ago now, basically it’s trying to do the same job with half the drugs. If it works its good because it means the side effects of the treatments are much less, both immediately and in the long term.
When you’re cured and you grow up you don’t want to have long term side effects from the drugs. Mini BMT's are all about keeping those side effects to a complete minimum, we do lots of those here and we’ve got about 5 or 6 different sorts of mini BMT's now.
We actually call it RIC now. Reduced Intensity Conditioning. There’s a funny story about the first one we did, a child about your age, about 10, he came for transplant – he’d been waiting 10 years – we knew he needed one for 10 years but we couldn’t find a donor and then suddenly we found one, and he came in and was very sick as he’d had this problem for a long time. So we gave him an anaesthetic and put in the hickman line and he got very sick from doing that. So we said go home, we can’t do it and Mum said no, you’ve got to do it, I’ve waited so long so we said we’ll try this, we’ve never tried it before and go for the mini. And guess what his name was? Richard, so our first RIC transplant. And that was our first RIC transplant 10 years ago and what we learnt from that story was mothers know best. Always.
What sort of research are you working on?
Two types, one is the mini transplants, getting new drugs. What we’d love to do is not use any of the nasty drugs at all, what we call chemotherapy. We could just use what we call antibodies, and we’d be able to take the bone marrow away without any side effects. We’re going to start some of those next year, and then the other treatments are really making the cells do what we want.
Remember when we did your transplant, well actually we did it three times, twice properly. Well the second one, when your disease had come back we used lymphocytes to fight your leukaemia and that gave you that rash and all those problems, well we’re trying to make that very specific so all those lymphocytes will just take the bad cells. Do just that and not fight the good ones.
And we’re doing lots of special experiments, we’re putting genes in to cells to say do this job, not that job. And that’s starting as well. So soon maybe 10 years from now, we’ll be able to do the same treatment you had and it will work just the same without all that rash. That would be good wouldn’t it. We’re not clever enough quite yet.
How new was the treatment that I had?
Pretty new, the first one you had was quite standard, the second you had which was the RIC, which is quite experimental. And the third one is very new, you know when you had the special cells to turn the fighting cells off, you were probably the first child to have those in this country. I’ve treated one other child, but I had to send him to Leiden to do it.
You’re the first person I’ve ever given those cells to, probably the first child in the country.
We still can’t get these cells from this country, we need to get them from abroad because we haven’t got the banks to fill them up. We’re thinking of doing it, I’ve just been in a meeting with people from Sweden to do just that. There are several different sources you can get them. The funny thing about those cells, the first ones were very closely matched to you, and the second were the same as we had them in the freezer, and the third lot were not matched to you at all. Completely unmatched. So its still very very new.
If I bet £1 that I would survive how much do you think I would have won?
These questions are getting very very hard! I would think you would have made quite a lot of money. But I’d have been very happy to give it to you, I think you’d have made quite a lot of money. Some of the figures we talked about when we were talking to your mummy and daddy were not very high. So in other words if you were a betting person then you might have bet the other way.
But you were right, you’d have got very good odds on that one. Are you going to bet on the grand national? You might bet on something sort of less favourable than 1 in 10 perhaps, something like that.
What part of your job do you like best?
I like seeing the children come back when they’re well. And when you know they’re better, particularly when you remember when they’ve had a difficult time. And that’s the best thing. And you can’t see them often enough it puts a smile on your face. We meet in the corridors don’t we?
And that’s the thing that’s not great about our job because we’re busy doing the transplants once you’ve got to 5 or 6 months or so, well for you it was years, but most we say goodbye at 6 months or so, and then they go and see other doctors. And we don’t see them unless we bump into each other in the canteen or the corridor. Or if they come to our sponsored walk, that’s a very special day for us as we see patients that were treated here 15 years ago. Even before my time. That’s my favourite bit.
Have you had any other jobs?
Not for a long time, before I came here I worked in Toronto doing the same thing, I was there for just a year and then before that I was a junior doctor so I must have been doing the same thing since 1989 - a long time. We’re still learning every day, it’s changed so much.
What was your favourite subject at school and why?
Sport. I loved to play sport. So when I was at school every day I played rugby for a few hours every day. A more serious answer would probably be biology, human biology. I like sports though.
What is your favourite sandwich?
Avocado, bacon and pesto. How about you, do you like those? Do you not like bacon? No, you must like bacon
OP: I do like bacon, but I can’t bite it.
You can soon, because your teeth have started growing again. Because your teeth didn’t grow for three years when you were on steroids. Now you’re coming off they’re growing again.
PV A treat in store for you. You know we had one child, who hadn’t eaten food for 10 years. Until he had his transplant.
What is your favourite ice cream flavour?
Pistachio. Green again isn’t it, I like green things!
What is your favourite film?
A difficult one isn’t it? Favourite film of all time? Well I’m a bit of a romantic I think, I like a film called French kiss, a very romantic film. Set in France. You won’t have seen it, a bit grown up for you. What’s your favourite film? James Bond?
YP: There are so many aren’t there Oscar, you’re favourite pastime isn’t it – watching films!
Who is your favourite band?
All the bands I like are from a long time ago, I used to really like a band called Supertramp, your dad might know them, I went to a lot of their concerts. Or a band called The Police, they’re a bit more recent. I don’t know any the modern stuff! My children put the radio on and I go ‘turn this off’! and I turn to radio 2 because radio 2 is radio 1 15 years ago. All the DJs are now on radio 2!
Do you have any pets?
I do, a dog called Lara – a Lurcher who is extremely fast. She can run at 45 miles an hour.
YP: We saw her at the BMT walk I think
PV: That’s right, and if she wants to run away, guess what? - you can’t catch her! Not even with a car we can’t catch her. And guess where she sleeps? On my bed. That’s terrible isn’t it? I said it would never happen but she will not stay on her own, she’ll get in the bed if she could. Do you have dogs?
OP: We’re not allowed furry pets
PV: Ok, our fault probably! Maybe one day you will be able to have one.
