Portal de Periódicos da CAPES

Tribute to Howard M. Snyder III

2020; Elsevier BV; Volume: 16; Issue: 4 Linguagem: Inglês

10.1016/j.jpurol.2020.07.023

1873-4898

Doug Canning,

Pediatric urology lost a friend on June 4th 2020. Howard McCrum Snyder III (Fig. 1) was a patriot, a consummate surgeon, an engaged teacher, a clear-thinking scholar both in and out of the operating room, and a family man who gave as generously at home as he did at work. Howard was born on August 25, 1943. To understand him, you need to know his family. Howard's father and grandfather were decorated United States Army Generals who collectively fought in 5 wars. In 1916, Howard's grandfather (Fig. 2) deployed as a young surgeon to Mexico with General John J. “Black Jack” Pershing shortly after Pancho Villa attacked the small border town of Columbus in the brand new state of New Mexico. Soon afterward, World War I broke out and Howard's grandfather redeployed to Europe where he was promoted through the ranks to Colonel and then in the Second World War to Major General. During World War II, as Inspector General of the Medical Corps, he was responsible for all US military hospitals throughout the world and report directly to General George C. Marshall. Near the end of the war, Howard M. Snyder I wrote a blistering account of poorly funded military hospitals that angered the Supreme Allied Commander, General Dwight David Eisenhower. Eisenhower demanded to see Snyder. They became fast friends. Despite being technically retired due to age in 1945, the elder Snyder remained as personal physician to Eisenhower throughout Eisenhower's years of presidency. He remained close to the Eisenhower family until the president's death in 1969. Howard's father, Howard M. Snyder II, was West Point Class of 1936. He was an equestrian, originally in the horse calvary. He became interested in tank warfare and was a tank officer when he met Loaine McLaughlin, Howard's mother, while assigned to Fort Benning GA (Fig. 3). Like Howard's grandfather, Howard's father rose to through World War II to Brigadier General. As an intelligence officer, Howard's father helped develop the strategy that freed the members of the 101th Airborne when they were cut off from allied troops in Bastogne during the Battle of the Bulge. The commitment to service to country, present in his father and grandfather, would become part of Howard and result in a lifelong career as an army medical corps reservist. After the war, Howard had advantages that few boys enjoy. As son of a general officer on a military reservation and the grandson of the White House physician (Fig. 4), Howard lived a privileged life. When the family moved to Washington in 1953, Howard would spend Saturdays at the White house pool. Howard has bounced a beach ball with British Prime Minister Anthony Eden and is one of only a few US citizens who has seen a president naked. Howard's family travelled with the military. Howard hunted quail in Texas stream beds and in Georgia pine forests. He fished wherever he went. After graduating first in his class at the prestigious St. Andrews School, Howard easily gained admission to Princeton where he earned a varsity letter in shooting and crewed star class sailboats on weekends. Howard's sophomore year at Princeton was special for a major event that shaped his life. In late August 1964, on the way to a hospital mission in Ecuador, as the DC-3 circled to cross the Andes, one engine failed and the plane lost altitude and crashed. The crew was killed upon impact. The rest of the passengers except for Howard were unconscious. Howard made his way out of the plane, then reentered it over and over to bring the passengers out. He laid them on the jungle floor to recover. His mentor and the trip leader succumbed to complications of a subdural hematoma. All others survived and followed Howard to a nearby village where they were rescued. Howard liked to tell us that this was the reason he was accepted to Harvard Medical School in 1965. Howard's surgical training was like few others. His residency in general and thoracic surgery under Francis Moore with rotations at Children's with Robert Gross, his pediatric urologic surgery residency under Hardy Hendren, his urology training under Ben Gittes, and Alan Retik was rich with volume and diversity of case load (Fig. 5). All told, counting medical school and three residencies, his time in Boston spanned nearly 15 years. Partway through his training, when Howard decided he wanted to pursue pediatric urology, after finishing in pediatric surgery, he travelled to England to spend 6 months each with Sir David Innes Williams at the Hospital for Sick Children at Great Ormond Street in London and with J. Herbert Johnston at the Alder Hey in Liverpool (Fig. 6). Following a year of active duty as a US Army surgeon at Fort McPherson in GA, Howard returned to Boston to complete his Urology residency.Figure 6Mr. Herbert Johnston in 1980. Dr. Snyder is 4th from left.View Large Image Figure ViewerDownload Hi-res image Download (PPT) After Howard finishing in Boston in 1980 Howard migrated to The Children's Hospital of Philadelphia (CHOP) at the behest of C Everett Koop and John Duckett where he became half of one of the great collaborations in modern pediatric urology and where he would spend the next 33 years (Fig. 7a and b). Howard's time at CHOP resulted in 375 publications in all areas of pediatric urology. At CHOP, Howard helped launch the career of 120 residents in Urology, 36 North American and 12 foreign fellows and many junior staff. Howard influenced our thinking in pediatric urology in areas as diverse as the care of posterior urethral valves, prune belly, hypospadias, cryptorchidism, management of neuropathic bladder, andrology, and pediatric urologic oncology. He led as chairman or president virtually all of our national and local medical societies. He was an active member of the American Association of Genitourinary Surgeons and he served on the American Board of Urology as member and examiner. Howard's early life, exposed to leaders and real live heroes, taught him courage and determination and a zeal for excellence that became his trademark. Howard once said “you don't grow timid of power when you have seen the president naked”. He took his lineage, part healer and part warrior to many venues, from the operating room and clinics at CHOP to numerous lecture halls where we heard his comments, which were steeped in data, careful thinking, enormous clinical experience, and strong personal conviction built on enormous clinical experience. As a surgeon he was meticulous. He refined the selection of each instrument; he placed each suture with the goal to save time without sacrificing accuracy. As an advocate for his tiny patient, for his colleague, and for whatever cause he championed, he was relentless. As a teacher, he was known to his students as a friend, as a demanding mentor who knew how to inspire them to get more out of themselves than even they knew possible. In the operating room, he was known for his ability to break the most complex surgery down to hundreds of steps and his ability to talk throughout an entire 8 h case seemingly without ever stopping to breathe. Howard's teaching did not stop at CHOP. He travelled to more than 140 invited lectureships and 42 visiting professorships in 19 countries on 5 continents. But Howard never lost his affection for England. In 2002, Howard was awarded the St. Paul's medal, an award only occasionally presented by the British association of Urologic Surgeons to a non- British colleague for contributions to British Urology. Howard's friendship with countless surgical leaders throughout North America and worldwide always made CHOP an interesting place to work. He was proud of his friendships that he made at meetings and visits across the world. Many of Howard's friends are here today. Howard's patients were committed to him. The Howard Snyder Chair at CHOP was funded by many of Howard's grateful patients and is designed to help fund the care of children who have been reconstructed and require transition to an adult practice. At a meeting 9 years ago, when we endowed the Chair, more than 150 of Howard's colleagues, former fellows and patients came to honor him from 23 countries and 6 continents. Some of you were there. The Pediatric Urology Medal, awarded by the American Association of Pediatrics Section in Urology is the highest award that our Section bestows upon a member. The medal is awarded to only a few individuals who have made outstanding contributions to our specialty. In 2013, Howard was the 29th recipient of the medal. Despite all of Howard's accomplishments in surgery, Howard was most proud of his family. Mimi and Howard were married for 46 years (Fig. 8a and b). During that time, Mimi applied her considerable skills as a research trained chemist and Wharton MBA, to enrich their community and Howard's family life. Mimi is known for her Le Cordon Bleu cooking, her gardening and painting, and her unending support for Howard, their daughter, Emily, their sons Curtis and Jonathan, her son in law Rick, daughters in law Nicole and Anne Marie and their 10 grandchildren. Many years ago I asked Howard to tell us what three things for which he is most proud. Howard said his family, his military heritage, and his commitment to service. Service to his country, to his family, to his church and to the countless numbers of trainees that he has had a chance to influence. And I think he meant all of us. Howard: congratulations on an astounding life and thank you for your wisdom, your commitment, your loyalty, your courage and your grace. We miss you.