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Show LEGACY Simmons Lessell The Gaon of Neuro- Ophthalmology Jonathan D. Trobe, MD " Gaon" is the Hebrew word for " learned one." In past times, a gaon was a rabbi of exceptional erudition who was asked to settle difficult religious questions referred to him by Diaspora Jews. Simmons Lessell, born 73 years ago in Brooklyn, New York, is not a rabbi. But to his former fellows and to others who have encountered his teachings, he is a gaon. It has been said that there are two kinds of American neuro- ophthalmologists: those trained by Lessell and those who wish they had been trained by Lessell. His former fellows, many of whom are now the oligarchs of neuro- ophthalmology, declare that he cannot be stumped and that he has a funny story for every diagnosis (" for every lesion, a line"). His written contributions to the neuro-ophthalmic literature are extraordinary. In more than 40 years on the job, Lessell has produced over 200 publications, elevating the case report to a high art. His descriptions of toxic optic neuropathy, cerebral achromatopsia, palinopsia, indirect optic nerve trauma, and idiopathic pachymeningitis are examples of the most luminous prose in the medical literature. Last year he retired as director of the Neuro- Ophthalmology Service at the Massachusetts Eye and Ear Infirmary, but he continues a vigorous practice of neuro-ophthalmology and was recently named the Paul A. Chandler Professor of Ophthalmology at Harvard Medical School. This interview took place in his office on October 28, 2006. JDT: When and where did it all start? SL: On May 25, 1933 at the Williamsburg Maternity Hospital in Brooklyn, New York. JDT: How did your family get to Brooklyn? SL: My father grew up a block away from where I grew up, my mother a short trolley car ride away. I hesitate to call it a slum, but it wasn't better than a poor area. My father, who was born in 1895, was the neighborhood dentist. My grandfather was a tailor who came from Germany in the mid- 19th century to Charleston, South Carolina, which had one of the largest Jewish communities in the United States. Somehow he migrated to New York. Among his contemporaries were many who made it big, but he didn't. My father remembered as a child not having enough to eat. He made money hawking newspapers on the streets of Brooklyn. J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 JDT: And your mother? SL: Came from Bessarabia, on the Ukrainian- Romanian border, of a very poor family. In Bessarabia, they had dirt floors, like in Fiddler on the Roof. After her father served in the Russo- Japanese War at the beginning of the 20th century, the family escaped to New York. Even in the United States, they were poor. I recently came across a photo of my mother's mother chopping up a chicken behind the counter of a butcher shop. JDT: How did your parents meet? SL: At a Jewish home for the aged benefit dance. My father, impetuous in many ways, dragged her into an alley and put a ring on her finger. It was his mode of asking for her hand. JDT: How was this match received? SL: Ohhh, for a German Jew to marry someone of Russian Jewish background was not done.... JDT: Tell about the neighborhood in Brooklyn. SL: We lived in a little walk- up behind my father's dental office. The people were about 85% Sicilian. There FIG. 1. In his office at the Massachusetts Eye and Ear Infirmary, 2006. 61 J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 Trobe FIG. 2. Camping atage 8, Camp Nimrod, Livingston Manor, New York, with sister Florence ( left) and a friend, 1941. was a small Jewish community and, of course, two synagogues.... JDT: Why two synagogues? SL: So you could say you would never be seen dead in the other one! JDT: How did you get named " Simmons"? SL: My father's father, who had died before I was born, was Simon. They were going to name me after him, but someone said they would call me " simple Simon." One of my relatives suggested " Simmons" to keep my Hebrew name of Shimon. My mother used to ask me if I liked the name. And I said I liked it fine. The only other Simmons I know is the son of one of my former fellows, who is named after me! By the way, when I was growing up, I was so skinny that everyone but my wife and parents called me " Bones." My wife says that when I met her, I stood 6 feet tall and weighed 128 lbs. JDT: In your childhood, did you go to synagogue? SL: Yes, it was an old- fashioned orthodox schul. One of my clearest memories is from Yom Kippur in about 1944 ( many men were in military uniform). From the center of the synagogue, they would announce the contributions to the synagogue. " Mr. Moskowitz from Moskowitz's Hardware-$ 20." A respectful murmur would go through the congregation. " Shapiro from Shapiro's Drug Store-$ 15." Another murmur. "$ 5- anonymous." ( Laughs) I can reconstruct every detail from that era. It was like a Woody Allen movie. JDT: By this time, had you already discovered that you were smart and funny? SL: I suppose so. Where I grew up, you either had to be strong, which I wasn't, or run fast, which I couldn't, or else laugh your way out of it, which was my defense. By the way, being smart was a distinct disadvantage. JDT: The neighborhood was that bad? SL: It was rough. I think there was a protection racket in kindergarten. The local high school was terrible. JDT: Did you try to avoid it? SL: Yes, luckily I was accepted at a magnet science school in Manhattan: Stuyvesant High School. It was arguably the best high school in America. JDT: What made Stuyvesant High School so good? SL: First, you were not there unless you were interested in studying. There was no contamination by disruptive students. Second, it was the Depression, and teachers with advanced degrees could not get jobs at the college level. So we had lots of PhDs as teachers. I most remember my chemistry teacher, Thomas Blue. He was the first exciting teacher I ever encountered. I wanted to emulate his style. He used humor freely and didn't take himself seriously. JDT: From Stuyvesant, it was Amherst College. Why? SL: Mr. Hart, the assistant headmaster at Stuyvesant, had gone to Amherst. My sister Florence, who is 3 years older than I am, was dating someone who had gone to Amherst and seemed very sophisticated at the age of 24. He said that Amherst was the best college in America. Mr. Hart thought it would be a great place for me to go, and he offered to write me a letter of recommendation. I was accepted without an interview! I arrived at Amherst by train with a big trunk, never having been out of New York State. I walked about utterly stunned by the beauty of the surroundings. I felt I was in a foreign milieu. 62 © 2007 Lippincott Williams & Wilkins Simmons Lessell: The Gaon of Neuro- Ophthalmology J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 FIG. 3. At his Bar Mitzvah, with mother Augusta, father Bernard, and sister Florence, New York, 1946. JDT: What was foreign? SL: It was culture shock for a Jewish boy from Brooklyn. I would stay up late at night writing letters to my parents as if I had landed in the central highlands of New Guinea and was describing the habits of other tribes. Everybody drank- heavily. A huge proportion of my classmates came from divorced families. I had not known a single divorced family in Brooklyn. Many of my fellow students were children of celebrities. One of my roommates was the son of Drew Pearson, the famous columnist. We public school graduates, who were probably in a small minority, were not as well prepared academically as the students from prep schools. They had been taught how to think and write critically and we had not. But we caught up by the second year. JDT: When and how did Irma enter your life? SL: I met her on a blind date in Great Neck, New York, where she lived. I decided immediately that I would marry her. And it has worked for 55 years. JDT: Did any course of study strike your fancy at Amherst? SL: Vertebrate paleontology, which is just descriptive biology. You can't do much experimentation. The main variable is time- huge chunks of time, reflected in geological strata. For my undergraduate senior thesis, I spent a summer collecting fossils in Muddy Gap, Wyoming, population 3. I described some previously undescribed species, one of which I named after my wife: Perignathus irmaei. And then it came time to apply to medical school. JDT: Ethnic diversity? SL: Well, among 360 students in my class, there were two African- Americans- put in the same room. There were two Asians, both from Japan. JDT: But your recollections of Amherst are positive? SL: Very. My kids say I just remember the good parts, but my wife Irma, who spent a good deal of my last three years there with me, remembers how fine it was. JDT: Why medical school? SL: I had decided early on. My parents thought it was a wonderful idea. My father encouraged me- well, really pushed me. I'm not saying he wouldn't have supported me if I had done something else. Anyway, I applied to Cornell, NYU, Yale, and Columbia and went to Cornell. JDT: What medical school experiences shaped the direction of your career? SL: In medical school, I realized that I was not interested in treatment. Treatment is ephemeral. Think back 63 J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 Trobe FIG. 4. Graduation from Stuyvesant High School, 1950. to when you were an intern. They are not using most of those medications anymore. I don't know an alternative to using whatever is current, but you know it is going to be displaced. For example, you know that Avonex will not be used 20 years from now for multiple sclerosis. It will be supplanted. Physical diagnosis and pathology are forever. JDT: How did you do at Cornell Medical School? SL: Well, I was not much of a class attendee. Things went along fine until biochemistry. The professor was a Nobel laureate for discovering oxytocin. But one of his other achievements was discovering a minor vitamin. The exam was all about vitamins. I was called in by the course director and told that I had done poorly. I explained that I didn't go to class. I said that I synthesized things from my reading and hadn't thought vitamins were very important. To my surprise, he said, " Don't change your system." JDT: I am astounded that after doing poorly on an exam, you would be so bold with the professor and yet be affirmed. SL: Well, that's how Cornell was. It was a welcoming place. FIG. 5. Marrying Irma in Great Neck, New York, 1955. JDT: Where does ophthalmology come in? SL: In the second month of anatomy, into class walks the youngest member of the ophthalmology faculty, who says: " This is a good time to learn which way the eye muscles move the eye." He was spellbinding. His name was Ed Norton. He had gone to Cornell Medical School and taken a year of neurology training before going into neuro-ophthalmology I decided right then that I would emulate Ed Norton. Not long afterwards, he wrote me a letter of recommendation for an eye residency. And 25 years later, 64 © 2007 Lippincott Williams & Wilkins Simmons Lessell: The Gaon of Neuro- Ophthalmology J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 FIG. 7. With Irma during his internship at Bellevue Medical Center, New York, 1958. he spoke on my behalf when I was nominated to the professorship of ophthalmology at Harvard. JDT: But you decided to do neurology first? SL: Yes, I thought- like Norton- that you needed a perspective; not a full neurology residency, perhaps, but the first year, which teaches you how to think about localization, what the diseases are, and how to do the examination. So I went after a 1 year appointment. I was roundly ignored by several programs. But I was finally directed to Dr. George Schumacher, who had been chief of neurology at Cornell- Bellevue and was now chief of f > i. v, - • • M • WESTERN UNION • TELEGRAM .. « < ™ BA25* 1MlW B LLBJOS PD= B0ST0N MASS t l 605P EDT= DR SIMON LESSELL= * SB UNIVERSITY HEIGHTS BURLINGTON VT= 27 m i 2'* YOU HAVE BEEN ACCEPTED FOR OPHTHALMIC RESIDENCY AT THE MASSACHUSETTS EYE AND EAR INFIRMARY FOR 19^ 2 DETAILS KILL FOLLOW. PLEASE LET WE KNOW AT YOUR EARLIEST CONVENIENCE WHETHER OR NOT YOU CAN ACCEPT= EDWIN B DUNPHY MD CHIEF OF OPHTHALMOLOGY MASS EYE AND EAR INFIRMARY, ,.._, e^ L " N> FIG. 8. In uniform as a senior assistant surgeon, National Institutes of Health Research Station, Guam, 1960. FIG. 9. Notified by telegram that he ( note misspelling of his first name) is invited to become an ophthalmology resident at the Massachusetts Eye and Ear Infirmary, 1960. neurology at the University of Vermont. Schumacher accepted me for a year and it was the best year of my entire graduate education. Now in his mid- 90s, Schumacher was- and is- an extraordinary man. He is thorough and honest, a paragon. And he stimulated my interest in fishing, my favorite hobby. Until recently, I would sometimes fly him down to Boston to attend medical conferences with me and then we'd fly to Florida together to go fly fishing. To give you an idea about Schumacher, here's a story. When Schumacher was about 88, we attended brain cutting together at the Massachusetts General Hospital, run then by E. P. Richardson, the renowned neuropathologist. The medical student always spoke first, then the residents, and finally C. Miller Fisher, MD, the great Harvard neurologist. We were each asked to localize the lesion and give our reasons. On one occasion, before cutting the brain, everyone, including me, predicted the lesion would be below the tentorium. Schumacher said it was above the tentorium. Miller Fisher agreed with Schumacher. I said to myself, " Here is a great gentleman. He probably knows that the lesion is below the tentorium but he does not want Schumacher to be embarrassed." Well, the lesion was above the tentorium and they were the only ones who were right! JDT: What about Vermont? SL: It was a little boutique of neurology. Each patient was examined in phenomenal detail. When it was over, I knew I still had my military duty, so I looked for a way to meet my service obligation and get more neurology. JDT: And you solved this by.... SL: Going to the National Institute of Neurological Diseases and Blindness in 1960. They put me in the Epidemiology and Genetics branch with Leonard Kurland, who later conducted the wonderful neurologic epidemiology 65 J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 Trobe A Year with Lessell: Of all the wonderful things I learned from Simmons Lessell, the most important is that a satisfied soul is borne of a generous spirit. Mark Borchert, MD He is equally eager to tell you a joke, discuss why the Red Sox lost the pennant, and quote an obscure journal article that appeared in the German literature. He gets to know each of his fellows in a deeply personal way. By the end of the fellowship, you feel as if you just spent a year with your grandfather. I grew more professionally and personally in that 1 year than in any other year of my life. Although the details are a blur, I remember laughing and loving every day of it. Dean Cestari, MD Each working day was constantly spent in Simmons' company (" You go wherever I go; you'll know when I'm happy, you'll know when I'm sad."). There was the endless personal generosity that he and his wife Irma gave to the fellows and their families, his passion for the critical importance of the clinical history (" If you don't know the diagnosis by the end of the history, you are in diabolical trouble."), the 16- foot lanes, the limitless supply of stories, jokes, and aphorisms, all accompanied by accurate rendition of appropriate accents- except Australian, which he never mastered. There was the passionate search for that elusive reference (" He who ignores the old German literature will discover many new syndromes."), trooping to the library just for the fun of looking up who wrote what in the Lancet exactly 100 years ago, matching diagnostic wits with neuroradiologists (" the shadowkings") or neuropathologists, and always, every day, paying for lunch for his fellows (" When your income is bigger than my tax return, you can buy lunch."). Jon Currie, MD He is not only the smartest man that I have ever met, but also the funniest! A year ago my ( now) wife and I were trying to think who should marry us. Due to his importance in our lives, we asked Simmons, and he agreed. He got ordained in the Universal Life Church online and became the first Jewish reverend! Robert Egan, MD FIG. 10. With former fellows at NANOS Meeting in Copper Mountain, Colorado, in 2005. From the left: Robert Egan, MD, Valerie Biousse, MD, Michael Lee, MD, Nicholas Volpe, MD, Marc Dinkin, MD, Joseph Rizzo, MD, Dean Cestari, MD, Misha Pless, MD, Steve Hamilton, MD, Judith Warner, MD, Mark Borchert, MD, Irma Lessell, MD, Susan Pepin, MD, Nancy Newman, MD, Leonard Levin, MD, PhD, David Newman- Toker, MD, Jonathan Kim, MD, Howard Pomeranz, MD, PhD, and Alfredo Sadun, MD, PhD. Formerfellows not present: Michael Cohen, MD, James Coppeto, MD, Robert Gise, MD, Jon Currie, MD, Barrett Katz, MD, Neil Snebold, MD, Nancy Weiner, MD, Charlotte Thompson, MD, Glenn March, MD, and Michelle Banks, MD. 66 © 2007 Lippincott Williams & Wilkins Simmons Lessell: The Gaon of Neuro- Ophthalmology J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 What the Fellows Remember At least once a week, I would look up an esoteric word in the dictionary, convinced that I had finally found a deficit in his vocabulary, but he would prove me wrong time after time. Toward the end of my fellowship, I finally stumped him with the word, " luthier," but only because I knew he wasn't a guitar player like me. Simmons not only invited me to his home for dinner on numerous occasions, he took me on guided fishing trips to the ocean, the local lake, and even to Florida. How many fellowships include a guided trip to Lake Okeechobee to fish for largemouth bass? I must have brought him good luck, because he caught the largest bass of his life on one of those trips. The most indelible image of my year with Simmons is a warm Spring afternoon when he presented me with a brand new fly rod and proceeded to teach me how to cast in the parking lot of the Massachusetts Eye and Ear Infirmary. Jonathan Kim, MD As his fellow, I was in his " back pocket." It was the best year of my educational life. He treated me with great respect and gave me great independence. My desk was in his office and I saw his life from all different angles. I enjoyed getting to know this man not only as a mentor and colleague but as a friend. Michael Lee, MD Watching Simmons unerringly tunnel in on what turned out to be the correct diagnosis was always a treat. Even better was the daily word play, which was fields more difficult than producing a differential diagnosis. But best was being mentored by a mensch- generous, honest, straighter than a meridian, approachable but never crossed. Leonard Levin, MD, PhD He found the best thing in each of his fellows and made us feel special, like an excellent parent with many different children. He taught me how to write and how to love writing. His command of the English language, both written and spoken, was extraordinary. He is a consummate clinician and an extraordinary wit. He loves and knows all show- tunes, but gets the words wrong! He is teacher, colleague, father, and best friend. Nancy Newman, MD Simmons is one of the few people I've met in medicine who would rather say, " I don't know what it is," than make up a clever, hand- waving explanation that couldn't possibly be proven or disproven. To hear that statement coming from someone with such vast knowledge and experience was simultaneously humbling and inspirational. Of many lessons I learned during my fellowship, this one about humility in the face of ignorance was perhaps the most profound. David Newman- Toker, MD The year I spent with him was the best year of my life. He was unselfish in his time, energy and attention, honest, succinct, and uncompromising in quality and ethics. The aspect I relish, remember, still glow about, is his treating me with respect, like an equal, while teaching me valuable aspects of the subtlety of the clinical exam. I miss him every day now that I'm on my own. Susan Pepin, MD The happiest, most salient moments were discussions on history and music. There were the endless conversations about opera plots and librettos, and the lectures on the origin of a word or the denouement of a particular historic battle. I'll always remember his sayings: " Do it with alacrity and utmost clarity." " It is much easier to be an editor than a writer." " There is no such thing as a ' trace APD.'" " Say ' Man, woman, boy, girl.'" ( Not gentleman, lady, male female.) " Affability, Ability, Availability- the 3 A's that lead to success in professional life." Misha Pless, MD The camaraderie with Simmons and other faculty, fellows, and residents at the Massachusetts Eye and Ear Infirmary was extraordinary. We would help keep his examining room prepared by making sure the Goldmann perimeter was calibrated, that the visual field recording paper was always in stock and positioned properly in the perimeter, and that there were an ample number of cotton applicators with the cotton pulled out to a fine tip to test corneal sensation. Howard Pomeranz, MD, PhD After 24 years of working with Simmons, I am still learning from him! Joseph Rizzo, MD Simmons loves to laugh and to make others laugh. He had at least two jokes that he would present to his residents and fellows every day. They could be erudite or earthy. Humor was his way of showing his delight in how humans could be humans. Of course, the biggest laughs came from real life. These stories became a bond between mentor and mentee. I've enjoyed recounting these stories ever since. Alfredo Sadun, MD, PhD Simmons said when I accepted his offer of a fellowship, his goal was for the fellowship to be the best year of my academic career. It was. Judith Warner, MD 67 J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 Trobe • • 1 T -• I ' A ; f ft i -• RESIDENTS IN OPHTHAI>! OLOGY Massachusetts Eye & Ear Infirmary December 1965 FIG. 11. With fellow ophthalmology residents at the Massachusetts Eye and Ear Infirmary, 1965. studies in Olmstead County, Minnesota, for the Mayo Clinic. They sent us to the Epidemiology Intelligence Service course at the Center for Communicable Diseases in Atlanta and then for 2 years to the research station on Guam. After World War II, when we took charge of this vast expanse of tiny Pacific Islands, the United States government also took on the responsibility of medical care there. I was the only neurologist on an island with a population of 30,000 people- military and civilian. I had an EEG [ electroencephalography] lab. I did arteriograms. I did pneumoencephalograms. I even did autopsies. With Asao Hirano as my neuropathologist, I wrote my most cited paper, " The Neuropathology of Parkinsonism Dementia on Guam" published in Brain. JDT: What about the eye residency? SL: I already had that- at the Massachusetts Eye and Ear Infirmary. You know the old story about the guy who applies to medical school and when he goes for his interview, they ask him why he wants to go to medical school. He says, " I have to. I aheady have an eye residency." JDT: Why the Eye and Ear Infirmary? SL: Someone had told me it was the best residency. And I had read Dr. David Cogan's book, The Neurology of the Ocular Muscles. But there were many, many applicants. Imagine, then, my surprise when I got the telegram telling me I had been accepted. When I arrived at the Infirmary in 1962, I worked in a lab with Dr. Toichiro Kuwabara on retinal glial cells. I learned histochemistry and continued it throughout my residency. JDT: How was neuro- ophthalmology nurtured during your eye residency? SL: Cogan had a tiny examining room near where I was working. He would show me cases. As my residency was ending, I went to him to get his advice about neuro-ophthalmology fellowships. He said, " Well, Simmons, a 2007 Lippincott Williams & Wilkins Simmons Lessell: The Gaon of Neuro- Ophthalmology J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 FIG. 12. With David Cogan, MD, and Richard Brubaker, MD, in the Howe Laboratory, Massachusetts Eye and Ear Infirmary, 1965. JDT: And what happened next? SL: Before I had finished the residency, Ephraim Friedman, a very junior faculty member and the fair- haired boy of the Infirmary, called me in and said, " They've just picked me to be the chair of ophthalmology at Boston University. Would you join me?" I hesitated for a nanosecond and then went over to B. U. as the neuro- ophthalmologist! JDT: Is that when your time at Boston City Hospital began? SL: Yes, I became director of the B. U. ophthalmology service there and sat on the Executive Committee with Derrick Denny- Brown, chief of the Harvard neurology service there, who had earlier refused me a 1 year neurology position. I remained at B. U. for 18 years. JDT: When did you begin training neuro-ophthalmology fellows? SL: I took on a few while I was at B. U.- Michael Cohen, Robert Gise, Jim Coppeto, Alfredo Sadun, Jon Currie. At first I did not think there was a great need for neuro- ophthalmologists and that there were very few places where they should be trained. I did not think I could offer as much as, for example, Bill Hoyt. But there were some who, for logistical reasons, wanted to stay in Boston and so I took them on. Some wonderful people. At the end of their fellowship, I would send them out for a time with Hoyt. Hoyt and Miller Fisher had become part of my superego. I still ask myself, " What would they say about what I'm doing or saying?" I had begun to have more and more contact with Hoyt. neuro- ophthalmologist is someone who other people think is a neuro- ophthalmologist. And people think you are a neuro- ophthalmologist. You don't need a fellowship." JDT: Why did Cogan think that? SL: Because people were sending me private cases to look at even as a resident. FIG. 13. As Professor of Ophthalmology, Neurology, and Anatomy at Boston University, 1971. 69 J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 Trobe FIG. 14. As Professor of Ophthalmology at Harvard with Nicholas Voipe, MD, Wolf Lagreze, MD ( then a medical student, now chair of ophthalmology at the University of Freiburg, Germany) and Dagmar Friedman, MSW, a social worker with a special interest in visually impaired patients and wife of Ephraim Friedman, MD, 1990. JDT: How? SL: Here and there at meetings. Mutual interests. Correspondence. We even published papers together, on brainstem arteriovenous malformations and the first paper on malignant gliomas of the anterior visual pathway. I'll tell you about the genesis of that paper on gliomas. At one of the early Walsh meetings, when they were still held at Hopkins, I presented a case of glioblastoma of the chiasm. Walsh attacked me, which is like having a Quaker make war on you. This nice man was saying there is no such thing. Then Hoyt got up and, a little more in character, insisted, " These are not malignancies; they're benign, hamartomatous lesions." Within 6 months, I had a second case of malignant glioma of the chiasm! ^^^^^\^*+ • S0 ^ V | ^ 1 m' - -<^ m/ m FIG. 15. Fishing on Florida's Lake Okeechobee with Nancy Newman, MD, 1999. I wrote to Hoyt and said, " Ha, ha! It's a real entity." He wrote back that he'd since seen one. So together we wrote up the three cases as malignancies. JDT: How did your term at B. U. come to an end? SL: In 1983 I got a call from Claes Dohlmann, the chief of ophthalmology at the Infirmary, asking me if I knew anyone who might be interested in the neuro-ophthalmology position because Shirley Wray, who occupied it, was moving over to Mass General. I gave him a list and then he said, " How about you?" And so I finally returned in 1984 to where I had done my residency. I've been here now for 22 years. JDT: Was the transition an easy one? SL: Well, getting appointed wasn't simple. There was one member of the search committee who was opposed to me. When I was called before the committee, I was sure I'd be asked why I wanted to come to Harvard. I was going to tell them, " I've always wanted to get a Harvard Coop card." [ Editor: to get a card for the Harvard Cooperative Society, which administers the noted store in Harvard Square, you must be a student or faculty member at Harvard.] Anyway, he promptly asked, " Are you the world authority on anything?" I believe he saw his responsibility to be the guardian of science at Harvard. He later made an appointment to come to my lab on a Saturday morning. He spent hours looking over my papers and quizzing me about the research behind them. Apparently he wrote a negative report about me. So they had to call in two witnesses on my behalf- Ed Norton, who came up from Miami, and Norman Geschwind, who 70 © 2007 Lippincott Williams & Wilkins Simmons Lessell: The Gaon of Neuro- Ophthalmology J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 FIG. 16. Bust of Lessell, sculpted by Ephraim Friedman, MD, and displayed in the auditorium at the Massachusetts Eye and Ear Infirmary. was the James Jackson Professor of Neurology at Harvard and had earlier been chief of neurology at B. U. JDT: Had Geschwind influenced you? SL: Absolutely. An extraordinary man. Often wrong, but so stimulating, so provocative. The cognitive functions group at the Boston Veterans Hospital, who were faculty at B. U., included not only Geschwind, but Frank Benson, Edith Kaplan, and Harold Goodglass. For me, it had been like landing in heaven! JDT: And when you came over to Harvard, you began taking fellows regularly.... SL: Yes, Joe Rizzo was the first. He never left. He has gone on to be a great experimentalist with a terrific imagination. But I do not want to slight any of my fellows. They have all been great. JDT: As you look back, do you consider the fellows your greatest achievement? SL: Well, teaching in general- to fellows, to residents, to medical students. There is an old expression: those who can, do; those who can't, teach; those who can't teach, teach teachers. I'd like to think I've given the lie to that expression. Look how many of the former fellows have become extraordinary teachers. Several of the first teaching awards given by the academies of ophthalmology and neurology went to my former fellows Nick Volpe, Alfredo Sadun, and Nancy Newman. JDT: And now? SL: I'm still doing it- teaching and seeing patients. I'm still excited by it. I'm excited about that bust in the conference room. JDT: What bust? SL: Ephraim Friedman, who sculpted a bust of Cogan, did one of me. The Infirmary's Board of Trustees decided to buy one and put it in the Infirmary auditorium. JDT: It is the only bust in the auditorium? SL: Yes. JDT: What is special about your teaching? SL: I'm honest. I acknowledge my shortcomings. I've also fried to be generous. If you have more pieces of the puzzle than the person you are teaching, the next criterion is generosity. What you are trying to do is to give to someone else everything that you have acquired and the means of gaining more. You hope that each one will do even better than you do. The teacher who holds back or is abusive or gruff- I do not see a place for that. And then, be yourself. At meetings, I see people trying to be funny when they aren't funny. They double project with cartoons and then all your attention is taken up with trying to figure out the joke. If you have a good sense of humor, use it. But it doesn't fit everybody. JDT: Among your academic contributions, what do you value most? SL: I don't think I've made any great academic contributions. JDT: But many of your papers are gems of medical writing. SL: Well, when I started out, I did not write very well. Cogan was helpful there. He was a natural writer. One draft. And I got advice from Stanley Robbins, whose Textbook of Pathology was once the best seller among medical textbooks. He said, " There is no great writing, just great rewriting." And I think he's right. Also, you learn to write by writing and by reading. I fear that one of the reasons that most writing is not good is that writers aren't reading. JDT: If you had to pick one of your papers to talk about, it would be.... SL: The one I just published with Jonathan Kim about the superimposition of the age- related depletion of 71 J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 Trobe FIG. 17. In his examining room at the Massachusetts Eye and Ear Infirmary with fellow Susan Pepin, MD, and resident Aisha Traish, MD, 2004. axons on a static optic neuropathy. This applies to people who early in life suffer a vision- limiting optic neuropathy that is stable for decades and then they begin to lose vision. You work them up from top to bottom and find nothing. Why are they losing vision? My theory is that it is like the post- polio syndrome: the tiny depletion of axons with age normally has no impact. But if you start out with 5% of your original complement, then you're in trouble. I think that the first sentence of that paper is one of the best things I've ever written: " The tacit assumption that progression or recurrence of an optic neuropathy results from the same mechanism that inaugurated the disorder has tended to obscure the possibility that in some cases these phenomena might have a pathogenesis independent of the original." I'm also fond of an editorial I wrote in the Archives of Ophthalmology entitled " Ischemic Optic Neuropathy. Enigma Variations." [ Editor: Enigma Variations is the title of a musical composition by Elgar.] In that editorial, I quoted two authors. Richard Feynman wrote in 1998: " I believe that to solve any problem that never been solved before, you have to leave the door to the unknown ajar." Wislawa Szymborska said in his Nobel Lecture in 1996: " This is why I value that little phrase T don't know' It's small, but it flies on mighty wings." The gist is that we don't know what causes ischemic optic neuropathy and knowing will only come with accepting that we do not know. JDT: Any regrets about choosing neurophthalmology as a career? SL: Absolutely none. What I do regret is that it is going to be almost impossible for anyone in the coming generation to have the kind of career that you and I have had. JDT: Why? SL: Accountants are setting the priorities of clinical departments. The non- earners will not get sufficient support. There are departments that redistribute money, but it can only be done to a certain extent. Neuro-ophthalmology's existence is perforce threatened. Maybe neuro- ophthalmology will have to alloy with some gainful enterprise like strabismus or plastics. Norman Geschwind used to say that the difference between being a clinician and an academician is time. Time to think, to consolidate, to read, to discuss. To be spared 40 patients in the waiting room. Psychiatry is the business of every physician. You cannot give that component when medicine is a quick, chief complaint- oriented experience. Will the patient be correctly diagnosed? Almost certainly. Will the patient get the correct medications, surgery, advice? Almost certainly Will that fully satisfy the patient's needs? Absolutely not. I think that most patients come to physicians with fears that go unexplored unless they are given time. What was Freud's major contribution to medicine? It is that many patients need an hour with the doctor. JDT: Despite this apocalyptic view of where neuro- ophthalmology and medicine are going, you are still training fellows at the same rate as you did earlier and they are finding jobs and I think they are practicing the way you taught them to practice. SL: Well, many of them are doing other things besides neuro- ophthalmology. 72 © 2007 Lippincott Williams & Wilkins Simmons Lessell: The Gaon of Neuro- Ophthalmology J Neuro- Ophthalmol, Vol. 27, No. 1, 2007 JDT: In the 40 plus years of your career, what has changed about neuro- ophthalmology? SL: I haven't changed my practice at all. Maybe I'm compulsive and stubborn, but I still do the same things. But I've had bosses who have permitted me to do that. It cannot go on much longer. JDT: So when people come to you and say, " I am considering neuro- ophthalmology as a career," what do you say? SL: Go where your heart leads you. You will have to make some accommodations. But everything requires accommodations. JDT: And what about you. Will you ever retire? SL: I will tell you something a patient told me recently. She is from rural Maine. I asked her what town she was from, and she said, " I come from far away. It's not the end of the world, but you can see the end of the world from where we live." At age 73, I do not have a 30 year plan. FIG. 18. Punctuating a crucial moment in a story by sounding the drum and cymbals ( gifts from the MEEI residents), in his MEEI office, 2006. FIG. 19. Fly- fishing for striped bass off Plum Island near Boston, 2005. 73 |
