Nayef Kazzaz was a fellow with us ‘14-‘16.  He came to us from King Saud University in Riyadh courtesy of King Muhammad bin Nayef.  I don’t know if they were related.  My Division welcomed such types, as they came totally paid for, thanks to King Nayef.  Nayef had been smoothed by a 3 year internal medicine residency in Cleveland at University Hospitals of Cleveland, and spoke smooth vernacular and medical English.  He still couldn’t present a patient’s case to save his soul, but possessed a bouncing enthusiasm that carried him through the rough spots, and he was a pretty good doctor overall.  He even dove into the lab with my young friend Jason, and excelled.  His last year, he spent time with me learning procedures.   Friday afternoons, we were in my “injection clinic”, poking every manner of moving joint, sometimes with the benefit of ultrasound guidance.  Now and then was thrown in a labial salivary gland biopsy (“lip biopsy”), which he relished.  He also joined me on Tuesday mornings in the Medical Procedures Unit for percutaneous muscle biopsies, gruesome penetrations made tolerable by the miracle of conscious sedation.  Nayef was joined on these outings by Vellore (India)’s son, Viju, who matched his enthusiasm.  Such occasions were heady experiences for this old man.  Nothing like youngsters hanging on your every word thinking what you’re doing is great.  Such is the life blood of academic medicine, and why we stay with it so long.  I called them my “little brown boys”, but not to their faces, of course.

When Nayef landed a new position at the University of Kentucky in Lexington, the good news appeared to me on Linked in, with a chance to respond, which I did with brief congratulations.  Nayef quickly came back to me with thanks and a query into my current situation.  I sent him a few sentences, but afterwords realized the people of whom I spoke to him about as my role models might be unknown to him.  I felt compelled to look up his email and elaborate.  Here is what I said.

I realized after that Linked in exchange you may not have a clue who those “role models” of mine were.  Both are scopy buddies of mine.  Roy Altman was the first rheumatologist in the USA to perform arthroscopy.  He flew from Miami to Colorado in the late 70s to hook up with Toronto’s Bob Jackson at a ski resort for a weekend.  Bob had learned from Makei Watanabe while team Canada’s physician for the ’64 Olympics.  He traded arthroscopy lessons for English lessons and came back to North America to transform arthroscopic surgery.  He, unlike his peers, had no problems with rheumatologists.  He even gave me encouraging words when I met him at a meeting once.  Roy went back to Miami and was the only arthroscopist in those parts for quite a few years, helping to teach a bunch of the local orthopods .  He’s been a prolific writer and active editor, still at it at age 83 at UCLA. We’re working on a paper on hyaluronic acid right now.  Lanny Johnson did almost as much as Bob Jackson to propel arthroscopic surgery forward, and from the perch of a little office in East Lansing, where he’d gone to school and was an athlete (swimmer).  The big academic centers didn’t know what to do with him so he had to do it himself. He invented the motorized shaver, which transformed arthroscopic surgery.  He wrote a huge two volume textbook, which is still a definitive reference.  He ran little courses out of his office that I took with my first (and only ) scopy protegée Ken O’Rourke in the early 90s.  We still stay in touch.  He was instrumental in me getting another chit on my CV.  I sent him my article in Rheumatology (Oxford)* and he thought orthopods should see it.  Orthopods don’t read Rheumatology (Oxford) but they do read Arthroscopy, so Lanny convinced their editor to accept a letter from me describing the Rheumatology paper so orthopods could link to it.  I got the editor of Rheumatology to quietly make my article open access (normally costs $4225.00) so outsiders could see it without a charge.  Whew!  Nothing like that ever happened when I was working.

I can’t talk about role models without mentioning my mentor, Chicago’s Bill Arnold, who taught me ‘scopy ’85-6, at the behest of his former mentor at Duke and my then current boss, Bill Kelley.  I brought Bill out of retirement to be co-author on several articles, but he’s asked to opt out of anything more so he can just enjoy being retired.  And maybe that’s a role model thing too, showing there can be life without medicine, completely without medicine.  Somedays, I feel like that, but then a contact comes like your Linked in announcement, and I’m back in the game.

It was a real shame I couldn’t get ‘scopy back up ’17-’18.  The orthopods were in huge opposition and no one on our side seemed to want to lend any kind of support.  I think the potential is tremendous.  You definitely have the right stuff to have been good at it. Viju too.  What a wrinkle that would have put into your final year!   If you do read over my article, do more than just look at the pictures and feel wistful for what might have been, realize this is all still possible and would be a unique and huge addition to your skill set.  You were never shy about taking on new things and mastering them. Even in the lab, per Jason!  Parking that enthusiasm and adventurousness in service to the needs of your new rheumatology clinic would be like using your Ferrari only for trips to the grocery store.  I hope they will give you a chance to do a little of your own thing so you can make like one of the renegade groups of my youth – the MC (Motor City) 5 – and “kick out the jams!”  You have the potential for great things, young man, and I hope you go for it.  I stand ready to provide whatever support possible.  Go blue!

*Ike RW, Arnold WJ, Kalunian KC.  Arthroscopy in rheumatology.  Where have we been?  Where might we go?  Rheumatol (Oxford) 2021;60:518–528.  Epub 2020 Dec 1 https://doi: 10.1093/rheumatology/keaa560.   

Published by rike52

I retired from the Rheumatology division of Michigan Medicine end of June '19 after 36 years there. Upon hitting Ann Arbor for the second time (I went to school here) it took me almost 8 months to meet Kathy, 17 months to buy her a house (on Harbal, where we still live), and 37 months to marry her. Kids never came, but we've been blessed with a crowd of colleagues, friends, neighbors and family that continues to grow. Lots of them are going to show up in this log eventually. Stay tuned.

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