In Memoriam by David T. Rubin, M. D.

In Memoriam:  Joseph B. Kirsner

We are here today to pay tribute to a magnificent man, Dr. Joseph Barnett Kirsner.  I’ve known Dr. Kirsner for half my life.  I met him when I was 22 years old and my career in medicine was just starting, but was privileged to know him through the last chapters of his incredible life.  He has been my teacher, my mentor and my friend.  My wife Becky and sons Danny and Michael and I considered him to be part of our family.

As some here know, my story begins with my Grandmother and my first month of medical school.

She said:   “Go see if my doctor is still there.  Tell him I said “hello” and “thank you”. 

“Who was your doctor?” I asked. 

“Dr. Joseph Kirsner.”

Hello and Thank You”  Fateful words that my Grandma Pearl said to me in September 1990.  Grandma Pearl had Crohn’s disease.  I didn’t even know what Crohn’s disease was at the time.

Dr. Kirsner took care of Grandma Pearl in 1955.  35 years later, she still remembered him fondly and wanted her grandson, the first year medical student and the first Rubin to go to medical school, to meet him.  I dutifully went to look for this doctor, who I thought must be long retired by now.

My first meeting was symbolic of who Dr. Kirsner was as a teacher and mentor.  I knocked on his door without an appointment, and he answered (his two secretaries must have been out), invited me in, and as I stepped over the threshold into his office, my career in medicine was forever changed.

Dr. Kirsner epitomized everything I could hope to be and imagined a doctor was.  I walked into his office, and what an office!  He had this large stately wooden desk and he was surrounded by the emblems of his achievements, recognition, scholarship and years of wisdom.   Behind him were volumes of books (many written by Dr. Kirsner himself), and on the wall opposite the diplomas and honorary degrees and awards was an entire wall of inspirational quotes.  Each one of them had a specific meaning.  There were quotes about medicine, about humanity, about fundraising, about loyalty.  Each represented the qualities that Dr. Kirsner valued in himself and in others.

I sat in a worn red leather chair opposite him.  It felt too big for me.

Dr. Kirsner asked me about my grandmother.  “I remember your grandmother,” he said.  “She was in a clinical trial we had using steroids for Crohn’s disease”. 

Everybody remembered Dr. Kirsner, but could Dr. Kirsner really remember a patient from 35 years ago?

You bet he did.  And he remembered so many other patients too.  

And of course they remembered him- they adored him.  They worshipped him.  Many of them credited him for saving their lives.  I later learned that there was a legend that if Dr. Kirsner touched your abdomen, you would be healed.  How does a doctor become a legend? It became clear the longer I knew him.

Our meetings continued from that time.  He would summon me to his office or I would schedule an appointment.  We would meet from time to time, and he would always encourage me in my career. I treasured those meetings and sitting in that big red leather chair. 

A number of years later, I was choosing my specialty in internal medicine.  Believe it or not, I hadn’t yet decided if gastroenterology was for me, but I also hadn’t discussed it yet with Dr. Kirsner.  I was walking down the hallway on my way somewhere else, and happened to run into him.  Our conversation was brief.  In fact, my recollection is it went something like this.  “Hi, Dr. Kirsner.”  He responded, in his booming strong voice, “don’t go into cardiology!  We need you in gastroenterology.” And then he walked on. 

And so it was.

Although I didn’t work with him at his peak time with patients like Steve described, I did have the great opportunity to work with him as a fellow.  I witnessed firsthand what so many others had seen and learned and so many patients craved.  He was a great interviewer, a marvelous listener, and he provided certainty of diagnosis and HOPE when others could not.  He gave a name and a prescription for health when patients had been lost in the desert of illness and seeming incurability.  He became the patient’s “quarterback” (a term that I’ve adopted).  He earned their trust in a matter of minutes with his interactions.

I watched him examine a woman’s abdomen once: his exam was nothing like what I had been taught as a second year medical student.  He was so gentle that at the time I thought he was just touching the patient to let her know he was there.  Years of experience later, I learned that his gentle approach was (of course) the best way to examine an abdomen.  I’ve taught many fellows and students this since then.

Shortly after I finished my training, Dr. Kirsner, who was 92 years old at the time, called me to his office.  I sat in the same red chair that had held me so many times before.  He took off his glasses and looked at me.   I had never seen him with his glasses off.

“David,” he said, “I’ve decided to retire.” 

I think my reply was, “you are kidding me!?”  “really??”

To which he said, “In three years--- at the age of 95 -- I am going to stop seeing patients.”  He submitted his three year plan to the Dean.

As an aside, Becky and I recently saw a framed letter from the President of the University from 1974 hanging in Dr. Kirsner’s home study.  It was congratulating Dr. Kirsner on being named the first Louis Block Distinguished Service Professor, and the letter also let him know that “upon reaching the age of 65, you will be offered a three-year deferred retirement.”

So, here we were 30 years later…..

At the three year point and at the age of 95, almost to the exact day, he indeed stopped formally seeing patients, and he submitted another three year plan to the Dean.  Now he would focus more on the history of our profession and acting as advisor and fundraiser for the Section and for his beloved GIRF.  He told me that he wanted to give Departmental Grand Rounds.

At the age of 98, he wanted to share the “History of the University of Chicago Medical Center: Seven Decades of Personal Observations”.  And it was important that he teach people about our institution, and that he show people that Joe Kirsner was still quite active in our institution.  He wanted to learn how to use the computer (he called it the “machine”) and advance his own slides too.

In order to prepare for this presentation, we sometimes met in his office at the hospital, but mostly in his apartment and in his study or dining room on many Sundays.  I’d bring breakfast, and it would be what I called my “Sundays with JBK.”  He’d tell me stories, give me assignments for photographs or other things that I needed to find.  He was a great story teller.  Although he repeated the same stories from time to time, I never corrected him.  I loved to hear the stories, and each time, there was some new nugget of information, something else to learn about.

His Grand Rounds was brilliant- he delivered it with that booming voice, stood next to the podium but never leaned on it, and ended exactly on time.  So of course, shortly after that one, he decided to do it again.

He then submitted a two year plan to the Dean.  I asked him why only two years this time.  His response:  “I’ll be 100 years old.  I think that’s a nice round number and a good place to stop.” 

So the reprise of Grand Rounds came with more “breakfasts with JBK” and his second Grand Rounds to the Department of Medicine.  At the age of 100, he delivered a lecture on “The History of Gastroenterology”.  Remember, when he started his training, there were not even antibiotics yet and peptic ulcer disease was a major cause of morbidity and mortality in our country.  It was a remarkable presentation.  He could have easily called it:  “How I created the profession of gastroenterology and what we need to do next…”

It was a tour de force.  But so much of what he did was exactly that. 

He really put things in perspective for us all.  He taught me that we may have made remarkable progress in medicine, but the fundamentals of our educational system and caring for the patient in the modern era remained the most important.  He wrote in a paper about education in gastroenterology in 1973 which is equally relevant now: “…the essence of gastroenterology is service to sick people; a function dependent upon the continuing flow of new information, continuing medical education and continuing attention to the human needs of the patient.” 

Over time, I came to realize that many of the current challenges we face in medicine today, whether sociological, political or technological, Dr. Kirsner had faced in his own time years ago.  And in every one of these situations, he had developed a plan, had intervened in some way, had written about the challenges, but had always remained optimistic and believed that the future would be better.  We could all learn from that approach.  Dr. Kirsner never shied away from these challenges.  He embraced them and worked to solve them.

He was blessed with a long life, and lived long enough to reflect on the successes and failures of medicine and our profession.  I think one of his defining moments in the latter part of his career was when he was addressing an international audience in Europe and apologized for the time when gastroenterological illnesses were being driven by psychology, to the exclusion of other scientific investigation or mechanisms.  He warned me “Don’t adhere to dogma.”  That advice really stuck with me.

Dr. Kirsner truly enjoyed reading about new discoveries and learning about what our colleagues were doing elsewhere.  He was known for sending personal notes to the authors, and many have told me how much they treasure those messages, from such a legend, when they hadn’t even met him!  Within the University, he would frequently cut out articles or put entire journals into our mailboxes, with a simple note “From the desk of Dr. Joseph B. Kirsner” and “FYI” or “Dr. Kirsner thought you’d be interested”  Even if I had no idea what the article was about, I knew that if Dr. Kirsner sent it to me, I should take the time to review it.

But the ravages of age took their toll.  It was a cruel irony that this man of letters, this scholar, lost most of his vision as he aged.  That this incredible physician, who taught everyone who worked with him the value of the detailed patient history and listening to the patient’s story, lost most of his hearing as he aged.   But thankfully, his other senses were sharp, including his gentle touch, and his clinical insight and intuition.  And that booming, strong voice and his incredible story-telling, and the institutional memory of all of our societies and our profession.

Dr. Kirsner became a part of our family.  Some of you know that my wife Becky became his secretary and assistant these last two years.  She was perfect for the job.  She knew all about him, she adored him, and she is an amazing and nurturing caregiver.  She and I would compare notes each day on how “Dr. Joe” was doing and what he needed.  I am so grateful to Becky for her love and care, and I know Dr. Kirsner was too.  He used to light up with a big smile when she came to visit him or to pick him up at home.  She loved that smile.