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Donald Seldin, MD, and his impact on nephrology

We lost a giant in nephrology with the passing of Donald Seldin, MD, on April 25. Although his conscience and vanity were likely never satisfied, thousands of us will carry part of him for generations and beyond, allowing us to be better than we thought possible.

He once said, when welcoming incoming students at the University of Texas Southwestern Medical School, “We, all of us, are inheritors of the activities of people who have preceded us and who have devoted themselves to the mitigation of suffering.”

Early days

His work at UT Southwestern is what created his presence in nephrology, but Seldin’s formative years were spent at New York University and then Yale for medical training.

Thomas F. Parker III

There, in the 1930s, he was mentored by John Peters, MD, and developed an interest in metabolic disorders by first studying the metabolism and pathways of diabetic acidosis. At the time, there were no nephrologists. One could hardly measure sodium or potassium; the flame photometer was just coming into being. Patients with renal failure died.

In the beginning, the Army barracks converted to classrooms at UT Southwestern. Photos courtesy of the University of Texas Southwestern Medical School.

He returned to Yale University at the invitation of Peters after time in the military and would have gladly stayed. Unexpectedly, he received an offer to join the facility of a new school in Dallas: Southwestern Medical School. He was 31 years old and, without paying a visit, he accepted the job.

What he found in Dallas were classrooms in abandoned wooden army barracks and an outdated hospital, Parkland; a shock to him, his wife and daughter. However, he decided to stay. Within a year he became the chairman of the department of medicine and the sole full-time faculty member after his colleagues moved on to other places. His unorthodox and indeed demanding style of teaching began to attract exceptional students. Having no money, he had to recruit faculty from within and he did, populating his department with former students with big achievements: Norman Kaplan, MD, John Fordtran, MD, Floyd Rector, MD, Dan Foster, MD, Helen Hobbs, MD, and Joe Goldstein, MD, to name a few. They graduated and become section chiefs, department heads and, yes, four Nobel Laureates. Others soon joined to study nephrology under him: Roland Blantz, MD, Tom DuBose, MD, William Henrich, MD, and Robert Alpern, MD, all going on to high academic accomplishments.

Seldin has described these times in conversations with former students and faculty as “electric excitement.” He was the chairman of medicine for more than 4 decades. The school has grown to more than 600 full-time faculty, more than 500 graduate and post-doctoral students and 800 medical students – all from an internal medicine faculty of one. While at UT Southwestern, he became the president of seven medical societies, including helping to establish the American Society of Nephrology and the International Society of Nephrology. He received six honorary doctorate degrees and awards too numerous to list. He was revered as the “intellectual father” of UT Southwestern.

Defining the physician role

He was a strong advocate for purity in defining the role of the physician in the academic and clinical setting: research, teaching and publications, with the clinical role complementary. He called this individual the “clinical scholar.” As the need for funds in academics increased, so did the need for the clinicians to generate income.

This diluted his model of the academic institution and physician. He had begun to acknowledge that, lately, the clinical scholar is an endangered species. He did openly state that the chair of the department of medicine should be a scholar, a teacher with research credentials, a presence clinically, a mentor, and then, only then, administrate. A not so popular notion today.

Seldin lamented the apparent decrement of the stature of the renal physiologist in international meetings and their value in medical schools, especially at the American Society of Nephrology; he was the second president. His love was for electrolytes and their pathways, the complexity of metabolism, and long before it was in vogue as it is now, volume and the cardio-renal axis. Yet, ultimately and somewhat reluctantly, he embraced the need for those involved with dialysis and transplantation and their scientific interchange.

Seldin was honored with a special recognition at the “front door” of the South Campus. The Dr. Donald Seldin Plaza was announced in May 2014, and on March 16, 2015, a 7-foot bronze statue of Seldin was unveiled, along with an accompanying plaque commemorating his service.

This was an enormous shift for him, demonstrating again his contemporary thinking.

Role of mentor

This speaks to the man only in part. What is it about an individual in medicine who has remarkably contributed so much to our field of nephrology and metabolism – the contribution of science, of thousands of students and house officers, of those who have then gone on to teach others. What is it that he had that others, equally as bright and talented, did not?

The answer is found in a term that seems, in large part, to have been lost in our specialty today. It is mentorship. Above all else, Seldin was a mentor. He manifested inspiration in its magnitude, depth and breadth. He was the wisest and most trustworthy of teachers, both traits required in being a mentor. He steered and he modeled what it meant to be a complete physician and equally to be a complete person. Under his guidance, there was no tolerance of slighting excellence, of not probing and probing and probing. He insisted on intellectual integrity.

To simply be a clinician was insufficient. One had to comprehend the precise physiology and then the pathophysiology and be able to explain it. He has described his method of teaching as a tutorial model. On the ward, in the classroom, in the lab, all hours, students chasing answers together, challenging one another, even while he was sometimes caustic. He was forming the “clinical scholar” and the whole person.

Indeed, he could be almost intolerable, even abrasive, such as in his “morning report.” He would say things to me and my fellow students like, “This is a beautiful example of therapeutic frenzy combined with abysmal ignorance.” Other times, he would comment, “You should have been a philosopher, not a doctor,” and finally, “Your patient could have received better care at J.C. Penney.” Many students and house officers and fellows were deflated, even tearful, while being challenged to go beyond the pale. In an interview for the Baylor University Medical Center Proceedings, he states unequivocally, “Also, I’m no rose. I would hardly describe myself as an easy person in certain ways.”

He was a mentor of men and women, not just physicians, although the physician was his laboratory. As his close colleague, Floyd Rector said, he had “a fascination with the human intellect in all of its dimensions, his admiration for those who strive tenaciously for excellence, and his own continual search for knowledge.” There was just something about his eloquence, the way he could phrase a complicated answer, the dignity that he gave language, his use of adjectives. Where are such mentors today? They don’t seem to be in nephrology. As a challenge, name your own.

Seldin fervently believed the complete life embraces the humanities in the broadest terms. One must read and understand philosophy, enjoy the poets, marvel in the music of Mahler, know of the great 2-D and 3-D artists, visit the great collections, read current events and understand their impact on societies and, yes, medicine. Don’t be simply a 1-D physician. To be acceptable in his presence required conversation and comprehension of more than clinical medicine. Most fell short. Out of that: a better, sculpted, enlightened person and physician.

Seldin made an enduring contribution to my life, just as he did to so many others. He often quoted Yeats. In one of his pensive moments, he would tell of personal significance in those poetic lines. One such was:

Things said or done long years ago,

Or things I did not do or say

But thought that I might say or do,

Weigh me down, and not a day

But something is recalled,

My conscience or my vanity appalled.

He has said and done enough. Thank you for preceding us. Rest well, Dr. Seldin.

Seldin is survived by his wife, Ellen Taylor Seldin, his daughters Leslie Lynn Seldin and Donna Seldin Janis, and his son Craig Seldin. He has two grandchildren.

We lost a giant in nephrology with the passing of Donald Seldin, MD, on April 25. Although his conscience and vanity were likely never satisfied, thousands of us will carry part of him for generations and beyond, allowing us to be better than we thought possible.

He once said, when welcoming incoming students at the University of Texas Southwestern Medical School, “We, all of us, are inheritors of the activities of people who have preceded us and who have devoted themselves to the mitigation of suffering.”

Early days

His work at UT Southwestern is what created his presence in nephrology, but Seldin’s formative years were spent at New York University and then Yale for medical training.

Thomas F. Parker III

There, in the 1930s, he was mentored by John Peters, MD, and developed an interest in metabolic disorders by first studying the metabolism and pathways of diabetic acidosis. At the time, there were no nephrologists. One could hardly measure sodium or potassium; the flame photometer was just coming into being. Patients with renal failure died.

In the beginning, the Army barracks converted to classrooms at UT Southwestern. Photos courtesy of the University of Texas Southwestern Medical School.

He returned to Yale University at the invitation of Peters after time in the military and would have gladly stayed. Unexpectedly, he received an offer to join the facility of a new school in Dallas: Southwestern Medical School. He was 31 years old and, without paying a visit, he accepted the job.

What he found in Dallas were classrooms in abandoned wooden army barracks and an outdated hospital, Parkland; a shock to him, his wife and daughter. However, he decided to stay. Within a year he became the chairman of the department of medicine and the sole full-time faculty member after his colleagues moved on to other places. His unorthodox and indeed demanding style of teaching began to attract exceptional students. Having no money, he had to recruit faculty from within and he did, populating his department with former students with big achievements: Norman Kaplan, MD, John Fordtran, MD, Floyd Rector, MD, Dan Foster, MD, Helen Hobbs, MD, and Joe Goldstein, MD, to name a few. They graduated and become section chiefs, department heads and, yes, four Nobel Laureates. Others soon joined to study nephrology under him: Roland Blantz, MD, Tom DuBose, MD, William Henrich, MD, and Robert Alpern, MD, all going on to high academic accomplishments.

Seldin has described these times in conversations with former students and faculty as “electric excitement.” He was the chairman of medicine for more than 4 decades. The school has grown to more than 600 full-time faculty, more than 500 graduate and post-doctoral students and 800 medical students – all from an internal medicine faculty of one. While at UT Southwestern, he became the president of seven medical societies, including helping to establish the American Society of Nephrology and the International Society of Nephrology. He received six honorary doctorate degrees and awards too numerous to list. He was revered as the “intellectual father” of UT Southwestern.

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Defining the physician role

He was a strong advocate for purity in defining the role of the physician in the academic and clinical setting: research, teaching and publications, with the clinical role complementary. He called this individual the “clinical scholar.” As the need for funds in academics increased, so did the need for the clinicians to generate income.

This diluted his model of the academic institution and physician. He had begun to acknowledge that, lately, the clinical scholar is an endangered species. He did openly state that the chair of the department of medicine should be a scholar, a teacher with research credentials, a presence clinically, a mentor, and then, only then, administrate. A not so popular notion today.

Seldin lamented the apparent decrement of the stature of the renal physiologist in international meetings and their value in medical schools, especially at the American Society of Nephrology; he was the second president. His love was for electrolytes and their pathways, the complexity of metabolism, and long before it was in vogue as it is now, volume and the cardio-renal axis. Yet, ultimately and somewhat reluctantly, he embraced the need for those involved with dialysis and transplantation and their scientific interchange.

Seldin was honored with a special recognition at the “front door” of the South Campus. The Dr. Donald Seldin Plaza was announced in May 2014, and on March 16, 2015, a 7-foot bronze statue of Seldin was unveiled, along with an accompanying plaque commemorating his service.

This was an enormous shift for him, demonstrating again his contemporary thinking.

Role of mentor

This speaks to the man only in part. What is it about an individual in medicine who has remarkably contributed so much to our field of nephrology and metabolism – the contribution of science, of thousands of students and house officers, of those who have then gone on to teach others. What is it that he had that others, equally as bright and talented, did not?

The answer is found in a term that seems, in large part, to have been lost in our specialty today. It is mentorship. Above all else, Seldin was a mentor. He manifested inspiration in its magnitude, depth and breadth. He was the wisest and most trustworthy of teachers, both traits required in being a mentor. He steered and he modeled what it meant to be a complete physician and equally to be a complete person. Under his guidance, there was no tolerance of slighting excellence, of not probing and probing and probing. He insisted on intellectual integrity.

To simply be a clinician was insufficient. One had to comprehend the precise physiology and then the pathophysiology and be able to explain it. He has described his method of teaching as a tutorial model. On the ward, in the classroom, in the lab, all hours, students chasing answers together, challenging one another, even while he was sometimes caustic. He was forming the “clinical scholar” and the whole person.

Indeed, he could be almost intolerable, even abrasive, such as in his “morning report.” He would say things to me and my fellow students like, “This is a beautiful example of therapeutic frenzy combined with abysmal ignorance.” Other times, he would comment, “You should have been a philosopher, not a doctor,” and finally, “Your patient could have received better care at J.C. Penney.” Many students and house officers and fellows were deflated, even tearful, while being challenged to go beyond the pale. In an interview for the Baylor University Medical Center Proceedings, he states unequivocally, “Also, I’m no rose. I would hardly describe myself as an easy person in certain ways.”

PAGE BREAK

He was a mentor of men and women, not just physicians, although the physician was his laboratory. As his close colleague, Floyd Rector said, he had “a fascination with the human intellect in all of its dimensions, his admiration for those who strive tenaciously for excellence, and his own continual search for knowledge.” There was just something about his eloquence, the way he could phrase a complicated answer, the dignity that he gave language, his use of adjectives. Where are such mentors today? They don’t seem to be in nephrology. As a challenge, name your own.

Seldin fervently believed the complete life embraces the humanities in the broadest terms. One must read and understand philosophy, enjoy the poets, marvel in the music of Mahler, know of the great 2-D and 3-D artists, visit the great collections, read current events and understand their impact on societies and, yes, medicine. Don’t be simply a 1-D physician. To be acceptable in his presence required conversation and comprehension of more than clinical medicine. Most fell short. Out of that: a better, sculpted, enlightened person and physician.

Seldin made an enduring contribution to my life, just as he did to so many others. He often quoted Yeats. In one of his pensive moments, he would tell of personal significance in those poetic lines. One such was:

Things said or done long years ago,

Or things I did not do or say

But thought that I might say or do,

Weigh me down, and not a day

But something is recalled,

My conscience or my vanity appalled.

He has said and done enough. Thank you for preceding us. Rest well, Dr. Seldin.

Seldin is survived by his wife, Ellen Taylor Seldin, his daughters Leslie Lynn Seldin and Donna Seldin Janis, and his son Craig Seldin. He has two grandchildren.