Portal de Periódicos da CAPES

Our new President—Emmet B. Keeffe, M.D

2004; Elsevier BV; Volume: 126; Issue: 5 Linguagem: Inglês

10.1053/j.gastro.2004.03.031

1528-0012

M. Bishr Omary, Carlos O. Esquivel,

American Sports and Literature

We were ecstatic when we became aware in 2002 of the news that Dr. Emmet B. Keeffe was nominated to become Vice President of the AGA, and now we are doubly ecstatic to have the privilege and honor to introduce him as our new AGA President. This is certainly the most enjoyable written contribution either of us have, or will likely ever have, to write and we were delighted to be asked by Emmet to share with our AGA colleagues a few glimpses of our incoming President. Emmet B. Keeffe was born in San Francisco, California, on April 12, 1942. He was the first born and only son of 4 siblings, which likely contributed early on to his sense of responsibility and desire to nurture those around him. His father, Emmet B. Keeffe, Sr., had a tremendous impact on Emmet Jr. by instilling the ethic of treating everyone around him well and seeking a high level of scholarly and athletic accomplishments. Emmet Sr. was a high academic achiever and a superb athlete (he played on the University of San Francisco varsity basketball team just before the Bill Russell days) who worked as a deputy city attorney in San Francisco. His early death in his mid-40s, while Emmet was a junior in high school, understandably shocked the Keeffe family and left Emmet with a sense of responsibility for his 3 sisters who were 2, 4, and 5 years younger than him. Emmet’s mom, Corinne, was the homemaker and the family’s fountain of humanism. She made the Keeffe home the “hangout” for the neighborhood kids, who were smart enough to know where to go for 24 hour-a-day access to food and friendship. Emmet’s mom died while he was in medical school, and it was the family closeness and strong upbringing that helped Emmet’s perseverance to succeed through yet another family tragedy. At least on a micro scale, we at Stanford feel that we owe a lot to Emmet’s uncle, John Bryan, who was Chief of Radiology at St. Luke’s Hospital in San Francisco, for encouraging his young curious nephew to be interested in medicine. Had it not been for Uncle John, Emmet would likely have been honored as President of the American Dental Association given that his two other uncles and his grandfather were all dentists. Emmet used to treasure the times Uncle John would take him to work and have him watch barium studies wearing eye goggles that to young Emmet were more like face goggles. Emmet also took every advantage of the opportunities he had to watch abdominal surgeries at St. Luke’s, which left him with a lasting positive impression and solidified his early fascination with medicine. He attended St. Ignatius High School, and was enrolled in its “Honors Course” with emphasis on a science-rich and strong academic curriculum, leading to an “Honorary Classical Diploma.” He took 4 years of Latin and 2 years of Greek during high school, which may partly explain Emmet’s superb public speaking and writing skills. Emmet inherited an interest in sports from his dad and was a top swimmer on the high school squad, which won the San Francisco City swimming championship 4 years in a row. Emmet’s interest in sports continued throughout college and beyond and included marathon running, pickup basketball, tennis, and mountaineering (having ascended Mt. Rainier, Mt. Hood, and South Sister). In fact, during his research fellowship at the University of California, San Francisco (UCSF), he participated in a running/swimming biathlon (before they became fashionable and advanced into triathlons) and placed 10th among more than 500 participants. Emmet stayed close to home during college, to help care for his younger siblings, and was admitted with honors and obtained a BS in Biology from the University of San Francisco. He subsequently obtained his MD from Creighton University in Omaha, Nebraska where he ranked among the top of this class (and was recognized last year with an Alumni Merit Award). It was during college when Emmet met his lovely wife Melenie Laskey while skiing at Squaw Valley and, after a 4-year courtship, they were married in the summer before his second year of medical school. Melenie and Emmet will celebrate their 38th wedding anniversary this June, and she has been the one who has kept it together for him. Although Emmet may have been the General Manager of the Keeffe household, Melenie has been the coach, team physician, and trainer having given up her teaching position within 2 years of their marriage to care for their firstborn Emmet B. Keeffe, III who was soon joined by a brother Brian and a sister Meghan. After medical school, where he continued to excel, Emmet completed a residency in internal medicine followed by a chief residency, then a 1-year gastroenterology fellowship all at Oregon Health & Science University (OHSU). At OHSU, the 2 major influences on his future career were David Bristow, Chair of Medicine at the time, and John Benson, Jr. who was Chief of Gastroenterology and who subsequently became president of the American Board of Internal Medicine (ABIM) and the AGA (1977–1978 AGA president). Emmet then fulfilled his military obligation and spent 3 years at Oakland Naval Regional Medical Center. Those were clearly good years for the Naval Hospital since that class also included, among many talented gastroenterologists, Neil Kaplowitz. OHSU eagerly awaited Emmet’s return from his military obligation because they held a faculty position for him. The holding of this position was extended for an additional 2 years since Emmet, on the advice of David Bristow and John Benson, decided to pursue an advanced research fellowship with Bruce Scharschmidt and Robert Ockner at UCSF. The trend continued in that whatever Emmet touched turned into gold, and this 2-year experience was highly productive with 5 manuscripts including first-author papers in the Journal of Clinical Investigation and in Gastroenterology describing studies of rat plasma membrane fluidity and the relationship between bile flow, sodium-potassium ATPase, and membrane microviscosity. Upon completion of his research fellowship at UCSF, Emmet returned to assume the assistant professorship position held for him at OHSU, and to fulfill the loyalty and gratitude he felt for John Benson and David Bristow who helped promote his academic career. Emmet’s tenure as a faculty member at OHSU began in 1979, and he was promoted to Professor in 1989. While at OHSU, he began to expand his clinical interests to hepatology, since there was a shortage of hepatology expertise in his division and Emmet also correctly predicted that hepatology was an area of tremendous ultimate growth. In his initial 1–2 years at OHSU he set up a wet bench laboratory to study the mechanism of bile flow, but clinical demands took over to the extent that he decided to focus on clinical investigation and scholarly endeavors. It was during his early faculty years at OHSU that Emmet became initially, and then increasingly, involved with service to the gastroenterology societies, when Ted Schrock (former president of the ASGE) appointed him to the ASGE Training and Practice Committee. His commitment to service, his vision, and organizational skills surfaced quickly, and it was only a matter of time before Emmet chaired that committee and later became Secretary and then President of the ASGE. During his OHSU years, Emmet mentored numerous residents and fellows who went on to become highly successful investigators including David Lieberman (now Chief of Gastroenterology at OHSU), Kris Kowdley (Professor of Medicine at the University of Washington), and Kent Benner (Professor at OHSU and more recently a community practitioner). David Lieberman commented: “Emmet mentored me and others at all levels: professional, personal, family, and even parenting-and I have never been able to thank him enough.” It is not just the genuine advice and caring that Emmet exudes, but it is also the gentle and thoughtful way he gives his advice and how he makes himself available to others day or night, all days of the week. One of many incidents that made Emmet famous at OHSU is how on one prescheduled medical grand rounds, the prominent visiting hepatologist speaker had not arrived as expected. Emmet was notified one-half hour before the 8 am grand rounds, attended by more than 100 physicians, that an emergency situation was on hand and asked if he had any ideas how to proceed. Within 30 minutes, he calmly collected his slides and gave a world-class talk on the current status of liver transplantation. To those who know and have worked with Emmet, this is not surprising, as he is the consummate team player, doer, and problem solver. Emmet’s move to California Pacific Medical Center (CPMC) was a difficult decision for him since it meant making the jump from an academic university setting to a private hospital. Another reason why this move was a difficult one for Emmet was his dedication to the new liver transplant program he co-founded at OHSU. He was not ready to leave that program until he was certain that his departure would not have a detrimental consequence to the program he had helped build. This is an example of our new President’s special attributes: loyalty. The deal maker was the persistent persuasion from Martin Brotman (Chair of the Division of Gastroenterology at CPMC at the time) and Carlos Esquivel (Director of CPMC’s Liver Transplant Program), the possibility to join one of the elite liver transplant programs in the world and work with Carlos and his team, and the potential to initiate a clinical trials unit that would further advance the prestige of CPMC’s program. Maybe also Emmet knew something that others didn’t in that he was going to be working with a future AGA president, Martin Brotman (2002–2003 AGA president), and join the Bay Area Club of AGA presidents that also include Marvin Sleisenger from UCSF (1976–1977 AGA president). Certainly, one eternally memorable moment we had at Stanford was when we invited Jon Isenberg as a joint Stanford-Palo Alto Medical Clinic visiting professor in September 2002 and had an opportunity for an AGA memorable photo with Jon, Martin Brotman, and Emmet Keeffe with several members of the Stanford Division of Gastroenterogy and Hepatology faculty and fellows (Figure 2). The challenges in carrying out academic pursuits in a community hospital-setting can be daunting. In a fashion that few would have predicted, Emmet overcame the odds facing him and his move to CPMC was nothing short of an incredible success. He played a major role in enhancing the clinical productivity of the gastroenterology program at CPMC and was the major force that made it possible to setup a range of clinical studies. This legacy, and the notion of “when there is a will-there is a way” to carry out first rate clinical research in a private community setting has continued at CPMC under the present leadership of Robert Gish after Emmet left to join Stanford University. In the mid-1990s Stanford University and its Medical Center realized that in order to revive a limited earlier attempt at establishing a world-class liver transplant program they needed to do it right. So they recruited not only Carlos Esquivel and Emmet Keeffe but almost the entire CPMC liver transplant program and were successful in a friendly en bloc takeover of almost anything that included the words “liver” and “transplant program” including the hepatologists Joanne Imperial, Kenneth Cox, and William Berquist; the surgeons Waldo Concepcion and Samuel So (together with Carlos); and many of the nurse coordinators and support staff. Emmet was even able to convince his administrator Karen Ely to join him, and indeed Karen has been with him since 1992. There must be something special about a boss to un-phase an administrative assistant from switching her daily driving time in the San Francisco and Bay area traffic from 30 minutes (home to CPMC and back) to 1.5 hours (home to Stanford and back). Karen (and all those who work with Emmet from trainees to nurses to physician colleagues) describes him as one with unflappable temperament who is always grateful for whatever you do for him and whose motto is: “What can I do to help?” Perhaps it was Emmet’s destiny to end up at Stanford since CPMC was formerly the Stanford Hospital until 1959 when the University moved the medical facilities including the Medical School to Palo Alto. The hospital in San Francisco continued to function as the Presbyterian Hospital, then its name changed to Pacific Presbyterian and ultimately to California Pacific Medical Center. As a historical note, CPMC and the former Stanford University Hospital was the site of the first medical school in the West, the Cooper Lane Medical School. At Stanford, Emmet is the Fellowship Program Director for the Division of Gastroenterology and Hepatology, and is Chief of Hepatology and Co-Director of the Liver Transplant Program. As fellowship Program Director, Emmet infused his enthusiasm for scholarly work and established a rigorous and busy, yet highly sought-after, hepatology in-patient rotation for Stanford’s medicine housestaff and gastroenterology fellows. Two of Emmet’s Stanford trainees have stayed on as Stanford faculty members (Aijaz Ahmed and Mindie Nguyen); others that Emmet has mentored in clinical research are at academic centers in the U.S. or abroad including Rene Davila (University of Tennessee, Memphis), Otto Lin (Virginia Mason Clinic), Thomas Cacciarelli (University of Pittsburgh), and Hiroto Egawa (University of Kyoto, Japan), while others are practicing in community settings. The appreciation of Emmet’s teaching and mentoring are reflected by his receipt of Stanford’s Department of Medicine Divisional Teaching Award in 2001, as he did on several occasions while at OHSU. In addition to his academic Stanford responsibilities, Emmet is currently associate editor of Digestive Health & Nutrition and of Reviews in Gastroenterological Disorders, chair of the editorial board of Hepatology Watch and HBV Watch, section editor of Liver Transplantation for Current Opinion in Organ Transplantation, and executive editor of GastroHep.com. He also serves on the editorial boards of Hepatology, Journal of Hepatology, American Journal of Gastroenterology, and Alimentary Pharmacology & Therapeutics as well as several internet gastroenterology and hepatology editorial boards. Emmet has an incredible passion for patient care, and values his consulting practice in general hepatology at Stanford, the care he provides for patients before and after liver transplantation, and his visits to outreach clinics in northern California. The majority of his routine week is spent in direct patient care, and he is highly sought after and recognized as an expert and a compassionate physician who goes the extra distance for his patients. Aside from the administrative, teaching, and patient care roles mentioned above; he has also served as Chief of Clinical Gastroenterology and as Acting Chief of the Division of Gastroenterology and Hepatology. His willingness to serve in these additional administrative capacities is not a reflection of positions that he sought, but simply his willingness to pitch in, to be a team player, and a tribute to the respect and admiration he beholds from his colleagues at Stanford. He is a superb mentor and teacher, as well as the consultant extraordinaire at Stanford University Medical Center. Emmet has an amazing presence at the clinics, in forums with his trainees, as well as in committees at the local and national levels. His presence at clinical conferences and in the clinic with trainees has an instant lighting-like effect of raising the level of teaching and leaving his audience in total awe and feeling that they just learned a thesaurus of clinical pearls. Emmet’s plans at Stanford are to continue to build the hepatology program by working with his hepatologist colleagues including Aijaz Ahmed, Ramsey Cheung, Allen Cooper, Gabriel Garcia, Peter Gregory, Joanne Imperial, and Mindie Nguyen. This includes expanding the clinical research program, providing any needed nurturing to his young and more senior faculty to insure their academic success, enhancing liver transplant services, and initiating an advanced hepatology fellowship program. Emmet has been an inspiration to all those who have witnessed him work his magic. His leadership style and conduct with trainees and colleagues are based on building consensus and treating everyone around him with respect. Kris Kowdley, who first met Emmet as an intern, recalled Emmet’s passion about teaching, his compassion as a clinician, his advocacy for junior trainees and faculty, his fairness, and how he treated every one with the same respect whether they were a measly intern or a grizzly, famous, big-shot powerhouse academician. Emmet’s ascension to the AGA presidency is no accident given the contributions he has made to our specialty over the years. For example, he served from 1991 to 1995 on the Board of Directors of the American Liver Foundation, and from 1994 to 2001 on the Board of Directors of the American Digestive Health Foundation, serving as the Vice Chair of Public Health Programs and Chair of the Digestive Health Initiative from 1997 to 2001. He was the 1995–1996 President of the American Society for Gastrointestinal Endoscopy, and held executive responsibility for Digestive Disease Week as Chair of Digestive Disease Week Council from 2000 to 2002. Since 2001, he has served as a member of the Subspecialty Board on Gastroenterology for the American Board of Internal Medicine. Emmet’s research and scholarly contributions during the last 20+ years have bridged general and transplant hepatology, with a focus on antiviral therapy of chronic hepatitis, use of hepatitis vaccines, and liver transplant selection criteria and outcomes. He has published more than 400 original papers, reviews, commentaries, and book chapters, and has been a renaissance scholar in that his earlier work addressed not only basic mechanistic questions but also general gastroenterology and endoscopy studies and observations. Some examples of earlier publications include reports dealing with pseudomembranous and other colitides, pancreatic insufficiency, Barrett’s esophagus, and sedation practices, among others. More recently, his analysis of the literature on the risk of acute hepatitis A and B in patients with chronic liver disease and as a lead investigator in a prospective, international trial demonstrating the safety and efficacy of hepatitis vaccines in patients with chronic liver disease led to a change in practice and the recommendation of the Centers for Disease Control and Prevention that all patients with chronic liver disease undergo hepatitis vaccination. On the scholarly side, Emmet has authored chapters in nearly all the major textbooks in gastroenterology and hepatology and provided authorship opportunities in these high profile books for many of his junior faculty. His publications have addressed virtually all aspects of hepatology, making him a “GP hepatologist” as well as “transplant hepatologist.” With regard to the AGA, Emmet’s plan for this coming year are to implement its new Strategic Plan, which was devised under the leaderships of Dan Podolsky and Emmet. In addition to the AGA mission to “advance science and the practice of gastroenterology,” directions that will be pursued include establishing a Future Trends Committee, increasing public awareness regarding digestive diseases and moving forward the AGA’s public policy agenda related to digestive disease, expanding AGA educational efforts, growing and fostering international relationships with sister gastroenterology societies, and working in a more direct way with all AGA constituencies. His “Strength in Unity” 1996 ASGE presidential address will serve as a foundation for his AGA presidency. Fortunately, Emmet is also human and is someone we get to enjoy in so many ways and dimensions. He has a competitive side that he would never admit to, no matter what hypnotic agent you would use on him. This competitive side becomes so un-Emmet-like on a tennis or basketball court, in a swimming pool, or on the dance floor. He is also a man of regular habits who tends to eat the same type of sandwich (turkey) for lunch on a daily basis, but luckily for his wife Melenie, he doesn’t carry this to the extent of wearing the same clothes week after week. In fact, his regular habits make him the sophisticated, articulate, and well-groomed (the Brooks Brothers) man we so dearly love. If the BMW corporation ever knew his skills and that he drove the original BMW 2002 in the mid-1970s (it was not a status car at that time) and that he and Melenie are now driving their somewhat newer 300-series and 500-series models, they may decide to recruit him to their company in some administrative capacity. One of his regular habits that even the junior faculty find hard to compete against is that he tends to be the guy who opens the office doors early in the morning and is the last one leaving late in the evening, making sure his desk is clean and all the lights have been turned off. While no doubt Emmet takes pride in his trainees and his and their accomplishments, his real pride and joy are his family (Figure 3). Melenie and Emmet have raised 3 role-model children. Emmet Keeffe, III is co-founder and CEO of iRise.com, a successful and innovative enterprise software company developed to bridge the gap between business and information technology; Brian Keeffe completed his internal medicine residency at Stanford and is a fellow in cardiology at the University of Washington; and Meghan Keeffe is a project editor with Ten Speed Press. This family pride and joy is becoming magnified as 3 “junior faculty” have now joined the Keeffe family ranks: Emmet IV and Mason sons of Emmet III and his wife Deborah; and Miles son of Brian and his wife Kristin-who have another baby on the way. We would not be surprised if grandpa Keeffe goes full circle and plays the role that Uncle John Bryan did by bringing his grandchildren to Stanford to watch their grandfather in action. Emmet has already been a role model to so many, and predictably his grandchildren will be no different. Emmet’s values of consensus building, fairness, hard work; his understanding of the clinical practice, research and training issues facing our AGA membership; his experience and proven record of service to our subspecialty will enable him to build and expand on the legacy of his predecessors. Just as important, you have in Emmet a friend forever. It is our honor and privilege to introduce you to our new AGA president, Emmet B. Keeffe. We are very grateful to Melenie Keeffe, Karen Ely, Kris Kowdley, and David Lieberman; and to Emmet Keeffe’s Stanford trainees and colleagues for providing historical and other perspectives.