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IN THE SPOTLIGHT:

links imageJim Theodore: A Pioneer in Lung Transplantation
August 28, 1935 - August 17, 2003

by Vincent Valentine, MD




Many a time, a patient's spouse, usually of a technical or engineering background would come in with several pages of questions about their near-suffocating loved ones undergoing evaluation for heart-lung or lung transplantation. Many a time after presenting such patients to Jim, he would kindly and methodically state to the patient and their spouse, "before we get to your questions, let me make a few comments that might answer most of your questions. We know replacing bad lungs with better lungs work. We do not know why and we do not know how they work. But the primary reasons why we lose sleep and come to work every day are to answer these questions."

He was an athlete, a husband, a father, a mentor, a grandfather, a friend, an advocate, a student, a physician, a scientist, a researcher in space exploration, a teacher, a scholar, a Division Chief, a team player, a cetologist, an historian, a bookworm, and a pulmonologist but above all he was the first lung transplant specialist.

At a time when America struggled with the depression, Hitler rose to power and physicists quietly collaborated across borders. At a time when a basic problem in magnetism was solved and proven useful to analyze hemoglobin molecules that absorb oxygen, links imagethe United States began building the atomic bomb. At a time when FM radio was born, so was Jim Theodore on August 28, 1935 in the tiny town of Wilmerding, Pennsylvania. This town was among the first planned developments in the United States.

Jim was defined by and was proud of his hard core and hardworking blue collar roots. He married his best friend (Gale McIntyre) on March 30, 1961 in Wilmerding.

He was a highly sought after outstanding collegiate athlete on the gridiron. This landed him an eight year scholarship to the University of Pittsburgh and its School of Medicine where he earned his M.D. in 1962. links imageIt is ironic that he finished his internal medical residency training at the University of Pittsburgh and Washington University in St Louis, two of the most prolific programs in lung transplantation today.

He was awarded the U.S. Air Force Commendation Medal for Meritorious Service (one of his subtle witty quips with me which only fueled my flames with word play was the manner of how he would point out the uncertainty of using the word meritorious rather than the word meretricious. He and I enjoyed malapropisms or Bunkerisms. He had a very subtle way with humor and if one did not get it Jim would laugh out loud to make sure the listener knew it was a joke).

links imageHe began his scholarly tenure serving as Chief of Respiratory Medicine at Stanford University from 1970-1982, an era when attempts at lung replacement were considered fruitless. He would later become the first Medical Director of Heart-Lung and Lung Transplantation in the world. His contributions to transplant pulmonary medicine are unparalleled and his legacy, matchless. What's not obvious, he was a leader's leader. He led by example and showed how leaders must not only lead but also be led. He was a team player and demonstrated the importance of heading in the direction for the team through influence, sacrifice, empowerment and respect. Although these points are difficult to measure, there are other measures of success.

In the academic world of medicine, the number of grants and how much funding you can secure, especially from the NIH, are major determinants for your success. He earned NIH support, received numerous grants, including an NHLB Pulmonary Academic Award and a Pulmonary Division Fellowship Training Grant, an RO1 - Lung Cell Function in Health and Disease and two Program Project Grants in Clinical Heart and Heart-Lung Transplantation.

Another measure of academic success is the number of publications and the lasting effect they have. Jim achieved this with 163 articles in 54 different journals with mean and median impact factors of 7.0 and 5.1 (when measured today), respectively (see Figure).

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Among the 35 publications with an impact factor > 10 by today's criteria: 15 were in the American Journal of Respiratory and Critical Care Medicine, four in both the Annals of Internal Medicine and Journal of Clinical Investigation, three in both the New England Journal of Medicine and Lancet, two in both Science and Circulation and one in JAMA and the British Medical Journal. He is one of the most prolific contributors of highly influential articles to the literature of lung transplantation. His concepts were original, brilliant and durable. He would frequently remind me of Gene Fowler's quote - "Writing is easy. All you do is stare at a blank sheet of paper until drops of blood form on your forehead." Jim advised all his trainees to write something that will stand the test of time. From the influence of his mentor and colleague, Eugene Robin - a giant in pulmonary medicine, even the titles of many of Jim's articles speak for themselves:

  1. Lung energetics and lung disease, 1968.
  2. Pathogenesis of neurogenic pulmonary oedema, 1975.
  3. A shunt is (not) a shunt is (not) a shunt, 1977.
  4. Iatrodemics and Iatrodemiology, 1980.
  5. Are there ischemic lung diseases?, 1982.
  6. Physiologic aspects of human heart-lung transplantation. Pulmonary function status of the post-transplanted lung, 1984.
  7. links imagePost-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation 1984.
  8. Augmented ventilator responses to exercise in pulmonary hypertension, 1986.
  9. Long-term clinical trials in pulmonary hypertension. Long overdue, 1986.
  10. Hypoxic pulmonary vasoconstriction persists in the human transplanted lung, 1987.
  11. Obliterative bronchiolitis after heart-lung transplantation: apparent arrest by augmented immunosuppression, 1987.
  12. Lung immunogenicity, rejection and obliterative bronchiolitis, 1987.
  13. Lung transplantation comes of age, 1990
  14. Obliterative bronchiolitis, 1990
  15. Hypercarbic ventilator responses of human heart-lung transplant recipients, 1991.
  16. Effects of pulmonary restriction on hypercapnic responses of heart-lung transplant recipients, 1991.
  17. Lung transplantation is here to stay, 1992.
  18. Actuarial survival of heart-lung and bilateral sequential lung transplant recipients with obliterative bronchiolitis, 1996.
  19. T cell receptor biases and clonal proliferations among lung transplant recipients with obliterative bronchiolitis, 1996.
  20. Impact of ganciclovir prophylaxis on heart-lung and lung transplant recipients, 1996.
  21. Metabolic myopathy as a cause of the exercise limitation in lung transplant recipients, 1998.
  22. Dendritic cells and macrophages in lung allografts: A role in chronic rejection?, 2000
  23. Validity of standard gamble utilities as measured by transplant readiness in lung transplant candidates, 2003.
  24. Determinants of health utility in lung and heart-lung transplant recipients, 2005.

An additional indicator of enduring success can be measured by the quality of those you influence. Take note of the list of his former transplant fellows and others he mentored during his career from 10 countries representing 5 continents across the globe. Nearly all are leaders today.

 

Dates

 

Adrian Morris

1982-1983?

Respiratory Consultant - London

Conor Burke

1983-1985?

Respiratory Consultant - Dublin

Steve Duncan

1985-1987

University Pittsburgh Medical Center*

Allan Glanville

1986-1987

St Vincent's Hospital, Sydney*

Elaine Imoto

1986-1988?

Unknown

Sara Marshall

1988-1990?

Unknown

David Ross

1988

UCLA, Los Angeles*

Mordechai Kramer

1989-1991

Rabin Medical Center, Petach Tikva, Israel*

Chris Stoehr

1990-1992

San Francisco State University

Glenda Patterson

1991-1993

Veteran Healthcare System, Arkansas

Maria Padilla

1992

Mt Sinai Hospital, New York*

Vincent Valentine

1993-1994

UTMB Health, Galveston*

Reda Girgis

1994-1996

Richard DeVos Heart and Lung Program, Grand Rapids, MI*

Amrita Dosanjh

1995-1996

Pediatric Respiratory, San Diego

Charles Poirier

1996-1997

Centre Hospitalier de l'Universite de Montreal*

Olufemi Akindipe

1997-1998

Cleveland Clinic Foundation

Lianne Singer

1998-2001

Toronto General Hospital, Toronto*

Paola M Gasche-Soccal

1998-1999

Geneva, Switzerland

Ekachai Sathianpitayakul

1999-2000

Bumrungrad International Hospital, Bangkok, Thailand

Shahzad Ahmad

2001-2002

Inova Fairfax Hospital, Falls Church, VA

Anna Yiannopoulos

2002

Centre Hospitalier de l'Universite de Montreal

Justin Weinkauf

2002-2003

University of Alberta, Edmonton

Steve Hays

2003

UCSF San Francisco*

*Medical Directors or former Medical Directors of Lung Transplantation Programs


Less objective and more subjective measures about Jim and his character come through the comments of the fellows he trained.links image

Allan Glanville: As for Jim I think it is fair to say that he was a quiet unassuming fellow who let his applied science speak for itself without ever in the greater arena being accorded the credit appropriately due for his pioneering role in understanding the physiology of the transplanted lung and the pulmonary care of this population of deserving patients. He showed a depth of humanity and care that was not always appreciated by those around him and was an excellent patient advocate. He taught me to see through the charades that too often invest clinical and scientific medicine and value the richness of the great privilege of serving this community.

Steve Duncan: It does not matter what will be said about Jim, his accomplishments or what defined his academic or occupational success, but to me at least the more relevant attributes are his humanness, warmth, patience and goodness. These things are what he will be remembered by more people like those he touched as a mentor, colleague and friend.

Mordechai Kramer: Two personal memories—as an orthodox Jew on Friday I had to go home early in winter time. Jim always allow me to do so and moreover he reminded me "Mordechai, the sun is going down, go home it's Sabbath soon." links imageWhen I had Jewish bosses they weren't so understanding about it, they used to say if I stay you stay too...

The second anecdote was about his smoking. He could not stop it and when we were in the clinic he used to say "Mordechai, I am going up for a 5 minute break. So I used to tell him, "just one cigarette—no more." Later on it was a known signal: he raised his hand 5 fingers (meaning 5 minutes) and I raised one finger (meaning just one cigarette).

He was a very warm and compassionate person to both patients and staff and set the basis for my whole career and I am in debt to him for that.

Reda Girgis: I think the first thing to comes to mind when I remember Jim was his uniquely persistent upbeat mood, always joking and laughing. It was contagious. At the same time, he clearly cared a lot of his fellows, was proud of previous ones and really encouraged me to advance my academic career.links image

Lianne Singer: When I think of Jim - to me what comes to mind is what an incredibly caring and sincere person he was. As his fellow I was made to feel like a member of his family, but he also showed great compassion to his patients and was genuinely interested in the lives of everyone he worked with. I always felt like he was looking out for me even after I left Stanford; he would call regularly to see how I was settling in as staff and give advice when needed. I still keep a picture of him in my office as a reminder of the kind of mentor and physician I strive to be.

Shahzad Ahmad: The patients loved and respected him more than anyone, and rightly so as he was a fatherly figure to most. He was a great role model to all the fellows and to anyone who came in contact with him.

Finally, the most consistent part of Jim's actions remembered by his patients, professional colleagues and pupils were his patented hugs. In today's "political correct" society, many may object to his warmth and compassion he displayed especially through these quite therapeutic, sincere and caring hugs. links imageMany times he and I talked about these hugs and recognized their therapeutic and economic value.

Hugs relieve tension, improve blood flow, reduce stress, are non-polluting, help self-esteem, generate good will, require no batteries, cost nothing, are non-taxable, are quiet and extremely personal and most importantly, hugs are fully returnable. It took me months to figure out how all the benefits of these hugs were actually for him. Then I asked; how do these hugs benefit the patients?

links imageUnequivocally, Jim possessed the highest degree of honesty, loyalty, and humility. His strength of will and character was best seen in his unwavering devotion to his patients, colleagues and family. Yet his self-effacing humility and unbroken silence were as impressive as his loyalty. He was above all, a man of action, always reminding us that results will speak for themselves. Regardless of the results bad or good he was well composed and poised. But only one time have I ever seen him flustered. It was in August 1991 when Norman Lewiston Professor of Pediatrics, who worked with Jim in the adult and pediatrics heart-lung and lung transplant clinics, suddenly died. Shortly after his death, it was discovered that Dr Lewiston had three wives without the pleasure or benefit of any divorce (read article). After several days, I soon realized Jim was the most jealous of all. He said, "you know a man for nearly twenty years, you think you'd know him and that he might tell you a few secrets."

Today, he is survived by his childhood sweetheart and wife, Gale, four accomplished children: Laurel, Terry, RJ, and Brian and 11 lovely grandchildren: Michael, Christian, Grace, Sutton, Clayton, Anastasia, Andrei, Madison, Hannah, James, and Claire. Gale reminded me, Jim took no time for himself. Reading was his passion and his favorite time was following and attending all of their kids' sports. links imageHe did love to travel and he spent quite a lot of time on bible study early in the morning.

Jim, it's been a decade but your influence and your presence remains with us today and will remain so in the ISHLT. We will always revere you, your selflessness, your compassion and action as well as a legacy which remains second to none and very much alive today in the breaths of our patients. This is your commendation (to which he would surely retort, do you mean condemnation?)

Disclosure Statement: The author has no conflicts of interest to disclose.




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