b.27 July 1946 d.27 October 2019

MB BS Lond(1969) MRCS LRCP(1969) MRCP(1972) MBE(1978) OstJ(1978) FRCP(1985)

Air Commodore David Rainford will be remembered as one of the leading authorities on the management of acute renal failure, as a defence postgraduate medical dean committed to driving up standards of education and patient services, and as the co-editor of Ernsting’s aviation and space medicine, the definitive tome on the subject.

Medicine, aeronautics, and the Royal Air Force ran in his blood. His grandfather, Robert Rainford, was a district medical officer working in India and with the Burma Railways in the period before the Second World War. David’s father, John, came to England at the age of 18 and enlisted for engineering training in the RAF. He subsequently married Marguerite (née Theaker), a local government officer, and they had two boys, Bob, who became an accountant, and David, who was born in London. The family moved to Stevenage when David was six, as his father found work as an aeronautical engineer at the de Havilland Aircraft Company.

David was educated at Alleyne’s Grammar School, Stevenage and Charing Cross Hospital. He joined the Royal Air Force on the medical cadetship scheme in 1966 and qualified in 1969. Following medical and surgical house jobs at Bedford General Hospital, in 1970 he became a senior house officer at the Ipswich and East Suffolk Hospital.

David met his future wife Marion Wakefield when they were both working as junior hospital doctors at Bedford and they married in 1971. As he continued his training in renal medicine, Marion continued paediatric training, later becoming a consultant paediatrician at Stoke Mandeville Hospital.

From April 1971, David was on active duty as a medical officer at RAF Salalah, where the British Government was supporting the Sultan of Oman’s forces against a rebel insurgency in what became known as the Dhofar Campaign.

In November 1971, he joined the staff of RAF Hospital Ely. After passing the MRCP (UK) in 1972, David was persuaded to specialise in renal medicine. Accepting a permanent commission in the Royal Air Force, David was posted to the military dialysis unit at Princess Mary’s Royal Air Force (PMRAF) Hospital Halton in 1973.

After the Second World War had revealed the devastating toll of potentially treatable acute post-traumatic renal failure, Air Vice-Marshal Sir Ralph Jackson had prioritised acute dialysis. In 1975 David was detached to Charing Cross Hospital, London for senior registrar training, where he was deeply impressed by Hugh de Wardener.

He was recalled early to PMRAF Hospital Halton to lead the renal unit after the consultant in charge, Wing Commander Tom Flynn, resigned his commission and moved to Des Moines, Iowa. Directing the unit was a huge responsibility for the young senior registrar newly promoted to squadron leader. His success was recognised in 1978 with an MBE awarded for services to renal medicine.

David was appointed as a consultant in renal medicine in May 1978, at the age of 32. Sir Ralph Jackson chaired the appointment board, and David succeeded him as adviser in renal disease to the armed forces in 1982.

At Halton David was fortunate to find Air Commodore John Cooke in the department of medicine. John shared David’s love for clinical medicine, and the two would discuss challenging cases together, always inviting their juniors to share in their rigorous clinical decision-making. John became a lifelong mentor, friend and colleague to David, who was later to succeed him as the academic lead for military medicine in the Royal Air Force.

When David took charge of the renal unit at PMRAF Hospital Halton, it was the only mobile dialysis unit in Europe – there being one other in the USA. By the late seventies, day-time and night-time haemodialysis programmes were operating at RAF Halton for patients with chronic renal failure. The hospital’s intensive care unit, managed by the renal team in conjunction with the anaesthetist division, would nearly always be caring for a handful of patients with acute renal failure.

He was rigorous and scholarly in his approach to renal disease, insisting that his team not only keep up with the science but drive it forward by contributing to the multiple publications coming out of the unit. His piercing and insightful questions offered huge learning value to young officers selected for renal training. At least five of his registrars later became professors in civilian life. All had to learn the vascular surgical techniques, not only to establish shunts in heavily traumatised patients, but also to establish and revise arteriovenous fistulae in those who needed longer term dialysis. David, who took a very holistic view of the care of renal patients, was awarded the Lady Cade medal by the Royal College of Surgeons in 1989.

There were usually two registrars trained up as intensivists. At an hour’s notice, they could go anywhere in the world to take charge of the care of a patient with multiple organ failure needing haemodialysis. The doctor was always accompanied by an RAF renal technician. Not infrequently David would mobilise himself on one of these missions. No call to a serviceman in acute renal failure was ever turned down. The ICU kit was containerised and ‘ready to roll’ onto a truck or aircraft (helicopter or fixed wing, military or civilian). Doctors returned to base as soon as the patient stabilised, managing the ongoing care by phone. Technicians, however, would sometimes have to stay for weeks until their patient was dialysis independent.

The 21 years that David spent at the renal unit included the Falklands War (1982) and the first Gulf War (1990 to 1991), both of which required renal support for servicemen on active duty. He oversaw many changes at Halton, including the establishment of a new-build ICU, however, after the end of the Cold War, a defence review in the UK determined that all eight military hospitals should close and in 1994 Group Captain Rainford was appointed to command the hospital and oversee its orderly closure over 18 months.

From 1996 to 2002, over which period he was promoted to air commodore and appointed as an honorary surgeon to the Queen, his successive appointments comprised director of defence medical training, clinical director of the RAF, defence postgraduate medical dean and commandant of the Royal Defence Medical College. He retired from the Royal Air Force in 2002.

Although an able administrator and leader, David’s passions were clinical medicine and clinical education. Fortunately, he could maintain his medical sessions at the Civil Aviation Authority until 2012 and, until his final illness, he treasured his roles as medical adviser to the Royal Air Force of Oman, as a board member of the RAF Benevolent Fund and as chair and trustee of a local nursing home.

Stroking his moustache, David delighted in making Thatcherite pronouncements with a blimpish ‘hurrumph’. Only the mischievous twinkle in his eye would reveal that he was seeking a good political argument. His humanity shone through his drive to optimise patient care and, in retirement, he was as beloved by ghillies as by those of us who fished with him. He had an endless store of anecdotes, which came in handy if the fishing was dour. His fly-tying skills testified to his surgical finesse and his fishing skills were legendary. After Marion retired, she loved to accompany him on fishing expeditions to Ireland or Alaska, and she would paint whilst he fished – on one occasion capturing in watercolours the bears that David was ignoring in mid-stream.

Bravely, Marion and David determined to enjoy his later cancer-afflicted months. He was often one jump ahead of his clinical advisers, participating in all decisions. Early on, after several spinal vertebrae collapsed, he ordered a robotic mower that he could oversee from his bed in the dining room, the intention being that his beloved garden should not be a burden. Slowly he mobilised, walking again without a stick, and finding a car which just had the headroom to permit him to ride as a passenger as his spinal rods made him inflexible from cranium to pelvis.

David Rainford left his mark on the Royal Air Force, on renal medicine, and on people – most of all his beloved family. He was survived by his wife and by their son, Jon, an academic in digital learning technologies. He is sorely missed.

Ed Peile