In Memoriam: Richard E. Kerber, MD, FASE

IN MEMORIAM

In Memoriam: Richard E. Kerber, MD, FASE Alan S. Pearlman, MD, FASE; Seattle, WA

Richard E. (Dick) Kerber died on November 8, 2016. He was 77 years of age. Dick was the 11th President of the American Society of Echocardiography (ASE), and the first of this remarkable group to pass on. He and I worked closely for 4 years; Dick was the ASE Vice President (1995-1997) during my own term as 10th ASE President, and I served as Immediate Past President during Dick’s term as ASE President (1997Richard E. Kerber MD, FASE 1999). Dick was not only my friend, confidant, and valued colleague, but also an exceptional role model. In remembering his life and celebrating his legacy, I took advantage of a great deal of help from his wife Linda, and the opportunity to gather some input from some of his many, many friends, colleagues, and admirers. Dick touched many lives, and I want to acknowledge that it simply was not possible for me to collect the comments of all who benefitted from their interactions with him. I have purposely chosen not to identify most of the individuals from whom I received comments, mostly to avoid offending anyone who might feel ‘‘left out.’’ Dick Kerber was born in Brooklyn, New York in 1939. He graduated from Forest Hills High School in Queens in 1956, and then attended Columbia University, earning an undergraduate degree (magna cum laude) in anthropology in 1960. Dick received his MD degree in 1964 from the New York University School of Medicine, and then did internship and a year of medical residency training at Bellevue Hospital, in Manhattan. Subsequently, he served as a Captain in the Army Medical Corps, assigned initially to Fort Monmouth in New Jersey. He was then assigned to serve in Vietnam, first in a mobile army surgical hospital (MASH) and later in a small base hospital. He received a Bronze Star in 1968. Next, he completed residency training and a fellowship in Cardiovascular Medicine at Stanford University Medical Center. Richard L. Popp MD, FASE, the second President of ASE, recalls that in the early days of echocardiography, he had to work hard to convince people at Stanford of the value of echocardiography, but ‘‘Dick Kerber was one of those bright young people who ‘got it’, and recognized what could be understood about the heart by using echocardiography. As a fellow, Dick was the first author of an important paper in the New England Journal of Medicine describing the pattern of mitral valve motion in the systolic click/ late systolic murmur syndrome.’’ After completing his fellowship training in Cardiovascular Medicine in 1971, Dick and his wife Linda, an accomplished historian, looked for university jobs that would allow both to pursue their academic passions. As it turns out, the Kerbers found a perfect match at the University of Iowa. While both Dick and Linda were native New Yorkers, and while they retained strong ties to the Northeast, both thrived in the Hawkeye State. Linda retired recently as the May Brod0894-7317/$36.00 Copyright 2017 by the American Society of Echocardiography. http://dx.doi.org/10.1016/j.echo.2017.08.004

beck Professor in Liberal Arts and Sciences at the University of Iowa, and served as President of the Organization of American Historians, as President of the American Studies Association, and as President of the American Historical Association. She was the Harmsworth Professor of American History at Oxford University in 2006-2007. I believe that Dick Kerber was recruited to a job at the University of Iowa primarily because in the early 1970s, the value of echocardiography as a means to evaluate cardiac anatomy and function was becoming recognized at forward-thinking academic institutions with strong cardiovascular programs. The University of Iowa was such an institution, and Dick was one of those bright young investigators who had learned the necessary skills to bring cardiac ultrasound to the University. While Dick had done his initial training on the East Coast, and subsequent training on the West Coast, the fact that the University of Iowa offered jobs to both Dick and Linda was a relevant factor in their decision to move to Iowa City. A literature search shows that Dick authored or co-authored more than 250 peer-reviewed papers during his career, published two books, and wrote many book chapters. Not all of his publications involved echocardiography, but many did. Soon after relocating to Iowa City, Dick performed a study with Dr. Franc¸ois Abboud, a distinguished cardiovascular scientist who was at the time Chief of Cardiology at the University of Iowa. This study, published in May 1973 in Circulation, reported the findings in a canine model in which the investigators created experimental myocardial infarction by ligating different coronary arteries and examined changes in left ventricular posterior wall motion recorded using M-mode echocardiography. I believe that this was the first of many studies in which Dick used echocardiographic methods in experimental animals to evaluate the cardiac manifestations of myocardial ischemia and infarction. Characteristically, Dick was as comfortable in the dog lab as he was in the clinic. He became quite adept at developing concepts by observing findings in patients and then applying them in the experimental setting, and vice versa. Subsequent studies examined topics such as the relation between myocardial perfusion and systolic wall thinning, the use of ultrasound contrast to identify coronary risk area, and the application of backscatter imaging for myocardial tissue characterization. I remember attending a conference that Dick gave at the University of Washington, probably in the early 1980s, and I distinctly recall his comment that ‘‘before you start a study, you have to have a hypothesis.’’ By that, I believe he meant that before you begin investigating a subject, you should first study carefully what is known about that subject in order to determine what questions need to be asked, and why finding an answer would be important. I probably should have heeded that recommendation more often in my own career, and young investigators would do well to remember Dick’s wise advice. Dick made many important contributions to the field of echocardiography in general, and to the ASE in particular, but he had another investigative passion. I understand that soon after Dick became a faculty member at the University of Iowa, Dr. Abboud assigned him to chair the hospital’s CPR (cardiopulmonary resuscitation, as it was called before ‘‘hands-only resuscitation’’ was invented) committee. Not surprisingly, Dick approached this task with characteristic enthusiasm, diligence, and insight. He studied all ‘‘codes’’ in the hospital (this refers to episodes of cardiac arrest, not the billing codes that now 1035

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preoccupy some administrators), and he quickly realized that there was much to learn. Eventually, he was a key member of the group that determined how defibrillators ought to be used to save lives in airports and other public places, as well as in hospitals. Dick was recognized internationally for his work in resuscitation science, and many of his publications reflect that strong interest. Again, characteristically, his work ranged from studies of factors influencing the success of resuscitation, performed in the animal laboratory, to involvement with public policy development as chair of the American Heart Association’s Emergency Cardiovascular Care Committee. He also chaired the AHA’s Critical Care Council, and for his work on defibrillation and resuscitation he was awarded AHA’s Meritorious Achievement Award (1996), the Honoree of Emergency Cardiac Care (2000), and the Scientific Council Distinguished Achievement Award (2001). Dick also served for 17 years as Director of the Cardiovascular Fellowship Program at the University of Iowa, and for 3 years as Interim Director of the Cardiology Division. He had a tremendously positive influence on his trainees. Many of them have had very successful academic careers and have contributed greatly to the field of echocardiography, and to ASE. Others have developed different interests within cardiovascular medicine. In comments sent to me, one of his former trainees noted ‘‘The problem with singling out people who Dick mentored is that if you miss a few, they will be offended, and he mentored so many, many people who have gone on to make major contributions to the medical field in many different ways.’’ Another of his former trainees emphasized his admiration for Dick’s ability ‘‘to transition among his roles as a mentor and teacher, a colleague, a friend and a confidant,’’ and noted ‘‘I try to emulate that approach in my interactions with trainees as they emerge to become colleagues.’’ Another former fellow noted that Dick was ‘‘always available, always practical, always kind,’’ and ‘‘knew how to laugh.’’ He also mentioned that Dick ‘‘always made a point of getting together periodically at national meetings to catch up.’’ Linda Kerber, whose academic interests have focused on the intellectual history of American women, wanted to be certain that I knew that while Dick was a strong advocate for all trainees in his Fellowship Program, he was particularly supportive of women and worked hard to help them achieve success. One of his female fellows, who has risen to an important administrative role in the Department of Internal Medicine, praised him for serving ‘‘as my mentor, my sounding board, my advocate and above all my dear friend.’’ Another female trainee, who has become an expert in defibrillation and resuscitation in children, had similar praise. She emphasized that ‘‘his guidance was tireless and selfless, and he taught by example through his passion for medicine and science.’’ A third female former fellow recalled, as a novice echocardiographer, being ‘‘called to the reading room.not to receive credit for good work, but to be confronted with errors or comments on poor image quality that I captured. A straightforward initial negative comment would always be followed by a constructive feedback on why exactly I was wrong and what I should do to improve. Such feedback would sometimes take more than just few minutes, almost always be accompanied by detailed drawings, personal memories or historic anecdotes.’’ She sent me photos of several diagrams that Dick had sketched showing views of the tricuspid valve in different imaging planes. Dick also trained a number of ‘‘international’’ fellows who came to Iowa City to study with him. One of the first was Dr. Adolfo Bellosillo, who trained with Dick in the early 1970s and returned to the Philippines, where he headed the Preventive Cardiology and Cardiac Rehabilitation Unit of Makati Medical Center. Dr. Bellosillo also estab-

Journal of the American Society of Echocardiography October 2017

lished the Foundation for Lay Education on Heart Diseases, using music, poetry, and new lyrics to popular songs to encourage good health practices. The Foundation stages musical productions all over the country, and produces CDs and DVDs. Learning Preventive Cardiology through Music and Poetry was just published, and was dedicated to Dick. Dick’s influence was not limited to the fellows whose training he supervised. A future ASE Past-President who did not train in Iowa City confided ‘‘I will never forget how, when I was a fellow, Dick talked with me at an ASE reception for about an hour. The discussion was deep, he offered sage and really quite sobering advice that I hadn’t heard from anyone else before, and he respected my opinions. Many years later, I came to hear from several other individuals who, early in their faculty lives, received career and research guidance (and not just in passing) at critical junctures.’’ Despite a busy career as a clinical cardiologist, an investigator with serious interests in two different disciplines, and a committed teacher and mentor, Dick also found time — made time is probably more accurate — to keep up with several other passions. He was serious about music, a passion that he came by honestly. Dick’s father Max, a pharmacist by profession, struggled during the Great Depression. Like his son, Max Kerber was adept at adjusting to situations. He was a talented pianist, and took advantage of the fact that silent movies required piano players. He found work in movie theaters, and sometimes as a pianist on small freighters going to South America that carried a few passengers, supporting himself until returning to steadier work as a pharmacist. When Dick became interested in studying Medicine, his father advised him to ‘‘go study a real profession,’’ reasoning that if another economic depression were to occur, ‘‘all doctors will be unemployed. Go study music.’’ Despite this fatherly advice, Dick did go on to study Medicine, and was never unemployed. However, he also kept up with clarinet. He was a virtuoso cardiologist, but he was also a pretty good clarinet player! I remember at an ASE Scientific Sessions in Washington DC, in the late 1990s, listening to Dick on clarinet and John Gottdiener on saxophone entertaining at a member reception. To paraphrase a colleague, ‘‘Dick was skilled at using high frequency ultrasonic waves to probe dynamic cardiovascular anatomy and function, but he was equally adept at generating lower frequency waves through the vibrating reed of a clarinet to provide compelling harmony as part of a chamber quartet.’’ Dick was also an avid bicyclist, and he took advantage of the lack of large mountains in the Midwest to ride frequently in Iowa and neighboring states. For many years, he rode with friends and family on the Des Moines Register’s Annual Great Bike Ride Across Iowa (RAGBRAI), motivated – I am told – to see more of the state in which he lived and to spend some leisure time with fellow citizens, with many of whom he worked and interacted. For those unfamiliar with this non-competitive event, RAGBRAI was first held in 1973, and it has become a big event that draws recreational riders from across the USA and from foreign countries. The route varies from year to year, but it always begins on a Sunday in late July at a community on Iowa’s western border, along either the Missouri or the Big Sioux River. The event lasts for a week, and ends on the last Saturday in the month at a community on Iowa’s eastern border, along the Mississippi River. As I understand it, riders cover about 60-70 miles in a typical day, and stay overnight in ‘‘host communities’’ along the route. One of Dick’s friends and bike-riding partners shared a story with me that I thought provided considerable insight into Dick’s approach to leisure time, life, and family. When Dick’s oldest son Ross was old enough to accompany them on RAGBRAI, his friend admits to being perplexed. He knew that Dick was a strong rider, but noticed that he always rode much more slowly on RAGBRAI than on other rides. He noted ‘‘this was nice because

Journal of the American Society of Echocardiography Volume 30 Number 10

there was plenty of time to talk, but I was puzzled why he tended to ride slower than usual. After a couple of days, it became clear. It turns out that Dick had an understanding with Ross that whoever got to the campsite first would haul the bags to an open area and pitch the tent, blow up the air mattresses, and hang up any wet laundry. I never recall Dick ever putting up the tent or doing any of the chores. Of course, even if Dick and I had started early and raced as fast as we could, neither of us had any chance of getting to camp before Ross, but Dick wanted to be extra sure that Ross had sufficient time to do all the chores before he rolled into town.’’ Another story provides additional insight into Dick’s character. As mentioned earlier, he served in the Army during the Vietnam war. Dick deeply opposed the war. He enrolled in the Berry Plan, which gave physicians in training an opportunity to defer serving until they had completed residency training. He had hoped to be deferred long enough for the war to end, but the war continued far longer than originally anticipated, and Dick was ordered to report to duty after his internship and first year of medical residency. Dick served for one year at Fort Monmouth, in New Jersey, then at a MASH unit in the Delta, and then at Bearcat, the base camp of the 9th Infantry Division, northeast of Saigon. From Bearcat, he flew on many medical evacuation helicopter rescues (‘‘medevacs’’) of men wounded in firefights. Dick never told his wife or family about the dangers of this work; for it, he was awarded the Bronze Star. While Dick rarely spoke about his experience in Vietnam, late in his career his clinical responsibilities included service as an Attending at the VA Hospital on the University of Iowa campus. One of his co-workers there observed that ‘‘Every time Dick encountered a new patient, he always introduced himself as a veteran, and spent some time talking with the patient about their experiences and spoke extensively about his own.’’ In this way, the doctor and the patient developed a bond that sustained them both. Dick was deeply opposed to the war, but proud of his medical service during this period. In 1996, he traveled to Vietnam to visit hospitals there, and was deeply moved by that experience. Dick was devoted to his family. He and Linda had two sons: Ross, a journalist for Reuters, is based in Boston. Ross’s wife Nancy is an architect. They have two daughters, Hannah and Ruthie. Their younger son Justin and his wife Hope live in St. Louis. Justin is a Rabbi and a Hospital Chaplain; Hope is a teacher. They have two sons, Eli and Danny. Dick got enormous pleasure from playing music with his family: [Hannah, viola; Eli, saxophone; Ruthie, piano and vocals; Ross, fiddle; Justin, guitar].

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In his eulogy delivered at his father’s funeral, Justin Kerber included the following remarks: ‘‘Exactly 33 years ago, Dad and I watched a dramatization of his favorite novel, The Citadel, by A.J. Cronin, the book that inspired him to become a doctor, on his beloved Masterpiece Theater. The Citadel is the story of Dr. Andrew Manson, a young medical graduate who is appalled by the filthy conditions and lax prevailing medical standards in his impoverished Welsh coal mining village. No wonder it was his favorite – my Dad is all over this book! My father’s commitment to strict assessment, precise diagnosis, and evidence-based medicine are just like Andrew Manson’s. Dad’s pioneering work on cardiac defibrillation has saved countless lives. He would have appreciated the real-life medical drama of his last two weeks; they have helped me understand his love for medicine.’’ In Dick’s memory, his family urges everyone – not only the medical people reading this memorial – to get CPR training, which now includes the Heimlich maneuver and the use of the EpiPen. It is fitting that in honor of Dick’s many contributions to ASE, the ASE Foundation has established the Richard E. Kerber Ethics/Humanitarian Lecture, which will headline a session (at the annual Scientific Sessions) featuring an ethical dilemma or humanitarian patient care activity. The inaugural award will be presented in 2018. Several of Dick’s friends described him as a ‘‘Renaissance man,’’ and I think that term is apt. Dick was passionate about cardiology, research, teaching, mentoring, and family. He was also an accomplished musician who not only enjoyed playing music, but also knew the history of composers and the music itself. He loved art, and it is fitting that his 1999 Edler Lecture, delivered at the conclusion of his term as 11th ASE President, was entitled ‘‘Deconstructing the Body: Medical Imaging, Medical Art and the Art of Medicine.’’ As stated eloquently in an In Memoriam article by Drs. David Gutterman and Allyn Mark published earlier this year (JAHA 2017;6:e006177), ‘‘Dick had the magnetic qualities of character, intellect, and compassion with a refined moral compass and a perspective of how medicine fits into the broader world. His excellence as a researcher was paralleled by outstanding clinical acumen and a captivatingly engaged teaching style. He was and remains an extraordinary role model and a mensch.’’ For those not versed in Yiddish, ‘‘mensch’’ means ‘‘a person of integrity and honor,’’ someone of noble character. Dick Kerber was certainly of noble character, and those who had an opportunity to work with him in one capacity or another are certainly the better for it. He will be missed, and remembered fondly.