March-April 2012, Volume 9, Issue 2
Go East Young Man!
Published on: March 01, 2012
Florence McAlister Professor of Medicine Emeritus at Duke University
My story starts out in several small towns in rural Nebraska, far from where I have ended up both intellectually and geographically. My family moved to Omaha so that my two brothers and I could get a better education than was offered in the boondocks, and we took advantage of the opportunity. I was accepted into the University of Chicago and started out studying classical languages, but through work in a staphylococcus research laboratory (washing dishes), I became acquainted and entranced with science and its methods.
I went to medical school at the University of Nebraska, where I earned money as an evening laboratory technician. I was fascinated by blood films and the precision of hematologic examination. The University offered a year of research between the second and third year. I took it, did a research project, and was hooked. I went back to the University of Chicago for the last two years of medical school, where my second research project (the first involved shock in dogs and was not followed up) was defining the circulating life of neutrophils by injecting myself with a unit of blood from a patient I had diagnosed with the Pelger-Huet anomaly; then, IRBs were unknown. The area that I was assigned to was in the laboratory of Ernie Beutler, who stopped by nearly every day to inquire whether I was finished.
After two superb learning years on the house staff at Duke, I went to the National Institutes of Health to work with the brilliant and still active Tom Waldmann on erythropoietin. After three years of interesting research, we decided one day that the field was going to make progress only when erythropoietin was purified, and we recognized we weren’t going to do that. (Eugene Goldwasser had been trying for 10 years with limited success at that time.) I remembered a patient that I had as an intern who had paroxysmal nocturnal hemoglobinuria (PNH), a mysterious disease that I conjectured had something to do with complement. I resolved to learn something about complement and did so in the wonderfully active laboratory of Tibor Borsos and Herb Rapp and in London under the tutelage of John Dacie, a wise and helpful mentor. From that year came the papers, at first rejected by the Journal of Clinical Investigation as not pertinent to human disease, which defined the populations of red cells in PNH and the role of the late acting components in accounting for the peculiar sensitivity of these cells to the hemolytic action of complement. I spent the rest of my career trying to understand those facts.
After returning to NIH, I subsequently went back to Duke where I established a research laboratory and a clinic. For the rest of my career, I saw patients for half a day a week and tried to understand their problems with the rest of the time. I had a series of excellent fellows, including the editor of this publication, as we pursued various aspects of immunologically related hematologic disease. We didn’t stray far, always returning to PNH.
When I arrived at Duke, I saw that the patients with sickle cell disease represented a greatly underserved population, so I established a clinic designed to seek ways of getting better care to them. Over the years the clinic grew into a center. I was helped by the enlightened attitude I found in the state government of North Carolina and by the devoted co-workers and members of the community, as well as by the support of Clarice Reid and her colleagues at NIH.
As much as I love medicine and science, I’ve never forgotten that there is more to the world. I still read Latin and Greek (particularly when the English translation is on the facing page to help out), and I still read all kinds of history to try to understand how we got here. I’ve got Dupuytren’s contracture so my cello playing, which was never good, is now unsuitable; gone are the days of the hematology piano trio with Frank Bunn on piano and Larry Lessin on violin.
All of my work was done in the context of my wonderful family and of my colleagues, both at Duke and in the community-at-large; I’ve always felt that the American Society of Hematology was a home away from home and have seldom missed a meeting since 1965. But most of all, I owe a debt of gratitude to the patients who have always been an inspiration to try harder. I was asked when I retired what I would have done differently. I replied that, with some minor adjustments, nothing. I still think that is the case.
Thoughts From a Former Protégé
Russell E. Ware, MD, PhD
Professor of Pediatrics and Vice-Chairman of Global Health, Director, Texas Children’s Center for Global Health; Director, Texas Children’s Hematology Center, Baylor College of Medicine and Texas Children’s Hospital
Thirty years ago, I had the good fortune of joining the Rosse laboratory to begin a medical student project investigating the role of anti-platelet antibodies in immune-mediated thrombocytopenia. I quickly learned that not only was Dr. Rosse a distinguished hematologist (past president of ASH and associate editor of Blood), but he was also a brilliant scientist. He taught me various hematologic and immunologic techniques including platelet isolation, radioimmunoassay, and immunofluorescence. He spent hours with me reviewing data, organizing results, making slides, and writing the abstracts and manuscripts. I still recall his calming influence at my first ASH oral presentation.
More importantly, however, I learned to design and implement patient-oriented research, long before such “translational research” was popular. Dr. Rosse had a keen eye for identifying interesting hematologic problems that lent themselves to laboratory investigation. Almost all of his studies involved human samples (usually blood) from patients with sickle cell disease, immune thrombocytopenia, or his beloved paroxysmal nocturnal hemoglobinuria.
However, the most influential experiences arose from my time spent in the clinic with Dr. Rosse. Throughout his long and distinguished academic career, he maintained a busy clinical practice. I saw his compassion for patients who suffered and noted how patients and families trusted his judgment. I learned that medicine was an art as much as it was a science, and saw the beauty of “all things hematologic” firsthand.
If imitation is the most sincere form of flattery, then my own career reflects my affection for Dr. Rosse. I pursued pediatric hematology (our only disagreement – he loved children but objected to “those mothers”) and for more than 20 years have enjoyed a combination of clinical care and laboratory investigation for children with blood disorders. I owe him many debts of gratitude and still cherish his mentorship.
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