Reader response's: Jack Downes
Myron Yaster MD
I received an enormous number of reader response’s to the announcement of Jack Downes’ death. Over the next 2 days I’ll try to post as many as the program allows. Myron Yaster MD
George Gregory MD
No mere words can describe the guy and his contributions to our specialty. Jack was one of the great human beings I have met in this journey. Peace. George
Bob Clark MD
When I interviewed for fellowship, Jack told me “if in ten years you want people to say, that ‘Dr. Clark, he’s written a few papers and has a grant,’ you’ll go to Pittsburgh or Hopkins, if in ten years you want people to say, ‘this kid is sick as shit, call Dr. Clark’, then you’ll come here!!” whilst pounding his fist on his desk for effect.
Bill Greeley, MD
Jack
We have always communicated directly and no reason to stop now. While you are no longer with us in body and mind, you are with me in spirit. Your dominant yet soft presence, kindness, and the many lessons you taught me are indelibly etched in my mind. Do you remember the time, I as a CCM Fellow and you as my Attending Physician, when we were faced with a patient with refractory status asthmaticus and acute respiratory failure. I asked about using a ketamine infusion as a last resort, which was never tried outside of the operating room. You told me about your early days as a pioneer in PCCM, where you had the courage to always try new things, occasionally stumble and fall, learn, try again and succeed, one step at a time. You told me “let’s try ketamine” and eventually through a long night we were successful in managing this young boy. You reminded me as we sat there at the bedside that we are often evaluated on our knowledge and proficiency and that our real value was in our curiosity, courage, resilience and perseverance.
Jack, then there was the time as my Fellowship was winding down, faced with a decision on a first faculty position at a couple of Institutions, I sought your advice. You asked me two questions: where does my passion lie and best institutional fit, and what does Cece , my wife, want to do. In my subsequent years of recruiting faculty and fellows, I always honed on those 2 very important questions – career passion and family. What an invaluable lesson you taught me so subtlely and kindly about the recruitment of others. What a gift to receive this fatherly advice from you. As I was leaving your office you said one more thing, “Bill, don’t chase money. You never will be happy.”
When it came time, Jack, to succeed you as Department Chair, the subtle learning points never stopped. You never interfered in my first years, signaling to me, the Department and CHOP that it was my turn to lead, develop, innovate and discover. Always supportive and never hindering. Eventually our occasional conversations became regularly scheduled, semi-annual lunches where we talked about family, friends, CHOP but never the Department; and these continued even as I left CHOP. We likened CHOP to one of those precious European Cathedrals that were built over centuries under the auspicious of many diverse leaders. The sense of mission and purpose was lasting and its leaders, like you and I, were time-limited and just one piece of the building. That is our legacy; many important folks preceded us and many are to follow. We were just blessed to be a part of an Institution so important and meaningful. With these conversations you continued to model the courageous, integrous, empathetic and kind leader you were.
There are so many others whom you have impacted personally and professionally, as you have me, in simple yet profound ways. How can we ever thank you. Jack, you are no longer a physical presence at CHOP and Philly – you are now everywhere. We / I carry you in my spirit and my heart.
With the deepest gratitude, respect and affection,
David G. Nichols, MD, MBA, President and CEO, The American Board of Pediatrics
Shortly after I finished my fellowship, I found myself back at CHOP to give a talk. Jack and his late wife, Joanne, invited me to dinner at their apartment for the evening. Having trained at CHOP since my internship in pediatrics, I knew Jack well and considered him a cherished mentor. Nevertheless, I had never been to his home. Jack and Joanne immediately put me at ease, and I remember being struck that this Olympian figure lived modestly. After a delightful meal, Joanne left us, and Jack and I spent another couple of hours together. I’m sure we exchanged some medical “shop” talk, but none of that sticks with me over thirty years later. What I remember is Jack talking about his children – how much he loved them and wanted the best for them. For all of his professional successes, what mattered to him was whether he was a good father. He felt so fortunate to have married Joanne, who he believed was the better parent. At the time, I was facing some significant parenting challenges, and in retrospect, I wonder if Jack knew about them. It was as if he was not simply sharing how he was trying to be the best father he could be but was more teaching me how I could do it.
Over the decades, we interacted professionally occasionally, but only twice more did I have a chance to speak with him privately, personally, and at length. The last time was a couple of months before he died. His voice was warm, strong, and resolute, unchanged from when he chaired the department that inaugurated modern pediatric anesthesia and critical care in the United States. After a brief, matter-of-fact report on his cancer, he again turned to his children. In my mind, we were back at the same kitchen table in his apartment from so many years ago. Like then, what mattered most was his love for his children and Joanne. Throughout all his parenting adventures over the decades, the wellspring of his love for them was bottomless. Time and disease turned the tables. Now his children cared for him lovingly and meticulously, for which he was so thankful. I realized then, and even more so now as I write this remembrance tearfully, that Jack was not just sharing; he was teaching and preparing me for what matters most. His gift is priceless.
Larry Borland MD
Are you conscious of those who made the most important impact on your life? I have always been aware of these individuals. My list is pretty short (or maybe I am lucky that it has more than one?): Sylvan Stool, MD (Pediatric ENT), C Everett Koop, MD (Chief Ped surgeon at CHOP and then Surgeon General of the USA) , John “Jack” Downes, MD (Pediatric anesthesia/CCM at CHOP), & of course my parents.
A little story about Jack Downes.
I met Jack in 1969 when I was at CHOP (Children’s Hospital of Philadelphia) on a clinical rotation from U of Penn Medical School. Jack was the associate director of the Anesthesia dept. at CHOP and had created and was running the pediatric intensive care unit. One of the first in North America dealing with infants/children. That year Jack and Sylvan Stool (of ENT) created and offered a physician symposium thru AAP on “The Ventilation of the Infant and Child”. This type of care had NOT been offered to infants and children previously. The equipment was rudimentary (by today’s standards). They needed someone to run the slide project for the entire course. And they paid a little $$. I needed lunch $$ so I volunteered. And I got to watch/listen.
I walked away a changed person. I was 100% hooked on this new clinical field & I knew that I was going to pursue this career. While I always knew I wanted to be a physician and care for children, this exposure refined my focus. At that point I aimed at completing both a pediatric and then anesthesia residency and then a fellowship in Pediatric anesthesia and intensive care.
Several years later after a pediatric internship (at CHOP) and after my time as a drafted doctor in the USAF during the Vietnam encounter, I returned to CHOP to complete my pediatric training.I spent virtually every pediatric rotation possible in the PICU under Jack’s mentorship. Originally I had planned to complete a Chief resident position in pediatrics before starting anesthesia. Four days into this chief resident position (not CHOP) I was confronted with an unacceptable situation - My department chairperson had destroyed my report of Suspected Child Abuse & Neglect (SCAN report) on a massively battered child (who would shortly die). This physician did so because the batterer was a white upper middle class parent (a lawyer) ! I could not work for this department chairperson. I quit no notice.
The evening of July 4, I contacted Dr. Downes and relayed the situation. By the following morning he had arranged me to start my anesthesiology residency at the U. of Pennsylvania. Several months later, when I had become disillusioned with adult anesthesia and adult patient care, he then offered me a FULL Pediatric Anesthesiology /CCM Fellowship at CHOP. This was unheard of. Nevertheless, I accepted and flew thru this year of clinical training & then returned to complete the required adult anesthesia residency requirements
I owe so much to this man. He believed in me. He was my mentor. He became a colleague. He became my friend.
“Neither fire nor wind, birth nor death can erase our good deeds” — Buddha
Alan J Schwartz MD
I reflect that I was blessed to have been Jack's student and colleague and that he was a great "parent" from whom I learned an enormous amount. Children worldwide have been and will continue to be the beneficiaries of Jack through his teachings! He produced not a ripple on the water of pediatric anesthesiology and CCM, his contribution produced a tidal wave!
Jerry Parness MD
At the height of his career, he was as humble and straightforward as he was the ultimate teacher and launcher of careers. I owe him more than I could ever say. His confidence in me saved my career before it even started. What a man, what a physician, what a gentleman. He was one of a kind.
Susan Nicolson, MD
We had a very close knit fellowship group - 9 women, 2 men (one being MY). Early in the year one of my co-fellows completed a night of PICU call hallmarked with her developing gastroenteritis, affectionately known as "CHOP - rot." She left exhausted, feeling poorly and went to her apartment to sleep. Later in the afternoon we called to check on her and she did not recognize us. I call JJD who told me take medical supplies and go over to her apartment. It was a challenge to get her to open the door since she did not know who I was. I determined my friend was profoundly dehydrated ......decreased po intake on call, gastroenteritis, and sleeping for a few hours under an electric blanket in a bath robe. JJD paged me to find out what I found, instructed me to start an IV, give her fluids and take her to the HUP ER. Most of us want to avoid the ER at all costs and given her confused state it was even more of a challenge getting her down the elevator and into my car. We arrived at the HUP ER with my friend still in her pajamas to find that JJD had called ahead and the ER physicians were awaiting our arrrival. They did a thorough workup, while continuing to administer IV fluids until the patient recognized me and many others, much to her embarrassment. JJD paged me multiple times to check on her status. The ER team concluded that I had made the correct diagnosis and discharged her to home. JJD strongly recommended that I spend the night in her apartment to be sure all was well. The next time I saw JJD he thanked me for taking care of one of my colleagues. I expressed to him how impressed I was with his concern and oversight when one of his fellows was unwell…he said she comes to CHOP from the west coast, has no family here and I see it as my obligation to ensure that she is safe and well cared for when she is training in my department.
Later in the same year, JJR called me to the office and told me that the hospital had an annual 5K "Daisy" run and he would like a team to participate from his department. He asked if I could identify 5 fellows to run in a race that was only 6 weeks away! I asked 4 of my co-fellows if they would do this as it seemed to mean something to JJD, who we all admired. None of us were runners and knew nothing about 5K races but I convinced them that how bad could it be each of us needing to run 1K. After we committed, I found out that we each needed to run 5K! So we dutifully went to the track at Franklin field at the end of the day, regardless of the weather as we had to get in shape in short order. After the 1st 2 days we were sore and could barely walk upstairs let alone get to CODES quickly. But we persisted and arrived at the designated venue each "ready" to run the requisite 5K only to find out that JJR (in fact probably his trusted assistant, Cornelia) had not registered our team and we could not run! Never hurts to have your "boss" feel like he let you down.
Myron asked for vignettes which demonstrate JJR's humanity. I like so many others owe Jack Downes so much - he offered me the opportunity to train with himself and other giants in the field of pediatric anesthesia and critical care medicine during which they taught the art and science of our craft through their examples. I was fortunate to be offered the opportunity to join the department and work for/with JJD for two decades. JJD's passing signals the end of an era that I am grateful to have been a part of. For those of us who he trained and/or had the opportunity to work in his department, we should pause and re-affirm the principles of practice that he so elegantly displayed and instilled in us and pass on his legacy. He will be missed!
Jeff Morray MD
As an anesthesia resident at UCSF, I wanted to pursue a career in pediatric anesthesia and critical care, I went to George Gregory to ask where I should get fellowship training. He said that the CHOP program under Jack Downes was at the top of his list. He arranged an interview for me with Jack at the ASA meeting in New Orleans. When I called Jack to set up a time and place, he asked me to meet him in front of his hotel in running togs. Our interview took place as we ran St. Charles St. When we got back to Jack’s hotel, we shook hands in agreement that I would start my fellowship in July 1979. That sort of thing could happen in those days, especially with a man like Jack. He impressed me as a kind man whose word I could trust. He, along with George, were the two mentors who most influenced my career. From him I learned that success could come in a soft package.
Drew Costarino, MD
Jack Downes and I shared a lifelong fandom of track and field, particularly the events of the mile run, cross country and the marathon. Jack was a miler, of some ability, in high school and when I first got to know him in the early 1980’s he was still regularly participated in 5k to half marathon road races. I believe his interest in endurance sports as a schoolboy and in college might have influenced his interest in cardiorespiratory physiology and ultimately his choice to pursue training in anesthesiology and intensive care as a physician.
Those interests were certainly the reason I first met Jack in the fall of 1980 when I was a second-year pediatric resident at CHOP. I had admitted a young man into the PICU in circulatory failure rhabdomyolysis and renal failure due to the heat stroke he suffered during cross country practice on a unusually hot September day in Philadelphia. Jack had heard about the patient and took a special interest in our work up, management and hospital course of the patient (he ultimately recovered fully). In the process, I started a friendship with a very interesting, and interested, person that influenced the rest of my career.
Ten years later, our shared interest in track and field led to another experience we would never forget thanks to James Hertzog, MD. It was the spring of 1990, Jim was a first year fellow in Critical Care at CHOP and I was the fellowship director. Jim had the idea that we could field a team to enter the corporate distance medly event at the Penn Relays (one of the oldest ongoing track and field events in the country). Why not? The relays took place across the street from CHOP at UPENN’s Franklin Field. The rules of the corporate event stipulated that at least one of the 4-member team was an individual over 40 and one was a woman. We recruited Jack who was 60 as the over 40 team member and Maureen O’Rourke, MD, another CCM fellow and reluctant runner, as the female team member. We had tank top jerseys emblazoned with the CHOP logo and trained minimally. When we got out on the storied Franklin Field track that had been host to athletes including: Roger Bannister, Jesse Owens, Wilma Rudolph, Jim Ryan, Marty Liqouri, Carl Lewis, and others, and with about 20,000 spectators in attendance it was a bit intimidating but exciting. More worrisome was our competition comprised of large companies (AT&T, Exon etc.) fielding teams of accomplished athlete “employees”. After Dr. Hertzog turned in a respectable ¾ mile lead-off leg it was downhill. We of course finished dead last, more than a lap behind our closest competition, but we finished and had the undivided attention of the crowd that cheered us vigorously. Years later, as recently as 2016, Dr. Downes and I would attend the Penn Relays together as fans in the stands to enjoy a great athletic event but we took some humorous pride in the memory that we had been out there on the field of competition and had made it back alive.
Charlie Cote, MD
My story is that when I went to Penn I negotiated an 18 month fellowship with 6 in icu 6 in OR and 6 research Then there was an immigration change and they were short three fellows another attending in charge of the fellows wanted to take my research time away. I went to Jack and explained that I had nothing in writing but this was my understanding Jack immediately said you are right an oral contract is as good as written and he restored my dedicated research time and in response I took all the calls in rotation with the other fellows He was an incredibly honest person dedicated to supporting research and always looking for ways to improve patient care He developed the first home ventilation program anywhere in the country made all the home visits himself with no remuneration
He was the best mentor and role model anyone could have.
Carol Pasquariello, MD, FAAP
I was saddened by the news of Jack’s passing. In my mind, he was indestructible, “bigger than life”! I thought back to our last conversation. He called me this summer to run something by me, and we ended up on the phone for over an hour! I was treated to one of his marvelous history lessons on pediatric anesthesia and critical care, CHOP history and his musings. It was then that I realized the enormity of what he and his generation had accomplished and how they impacted millions of physicians, nurses, respiratory therapists and children by their dedication and willingness to push the envelope. Oh, how I wish I had recorded that conversation.
I first met Jack as a medical student, rotating through the OR on my Peds Anesthesia rotation. I was completely intimidated by his commanding voice and stature and just as quickly put to ease when he asked, “please call me Jack”. During my pediatric residency, Jack was my mentor and friend. His door was always open, and he made me, and pretty much everyone else, feel welcomed and relaxed, as if he had all the time in the world to spend with us. It was only later in my career that I realized the unimaginable demands that were placed on him, and how incredibly gracious he was with his time and expertise.
When we discussed my plans for critical care training at the end of my second year, he said “Carol, you need to become an anesthesiologist first” as he pulled the application for a Penn Residency in Anesthesiology from his top drawer! There was really no discussion. When Jack Downes told you to do something, you did it! In a blink of an eye, we were next discussing what I should do at the end of my Pediatric Anesthesia and Critical Care fellowship. Again, he sagely advised me. “Go to St. Christopher’s Hospital. It is an excellent institution, and you will be able to make your own name there. Here you will always be ‘little Carol’.” Of course, he was spot on, I had opportunities at St Chris that I may not have had at CHOP and was well prepared and trained when I returned to the Mothership (CHOP) in 1998. I don’t know how he did it, but Jack took a personal interest in all his fellows, we were like his own children. He cared for us all that deeply.
When Jack and I were colleagues (!) I felt truly blessed that I could work alongside him, and we have remained close friends, meeting up socially at CHOP functions and other events, with his dear wife Joanne. Even after his retirement, we stayed in contact, and I was completely amazed at his ability to make me, each one of us, feel so special, loved, and celebrated. While I was troubled to hear of his recent diagnosis, he was consistently upbeat and positive. Jack was the first to buy a “CHOP Anesthesia” t-shirt and face mask when we looked for ways to keep up our morale during the pandemic. He was CHOP Anesthesia and Critical Care Medicine.
Each one of us, has benefited from Jack Downes’ legacy. Jack laid the foundation for the fields of pediatric anesthesiology and critical care medicine and in that way contributed directly to our knowledge and practice. I will always remember Myron speaking at a SPA meeting years ago. He asked, “all of you trained by Jack Downes, please stand up.” A good number of us stood. Then he added, “if you were trained by someone who was trained by Jack Downes, please stand up.” At that point, everyone was standing! I owe who I am as a pediatric anesthesiologist to Jack and those he chose to create this wonderful field.
Linda Mason MD
I decided to do a pediatric anesthesiology fellowship when I was in my last year of residency at Loma Linda and an anesthesiology chief I worked with had trained at Mass General and done a pediatric rotation at CHOP. He said this is the best program in the county so I wrote to Jack, sent my information and he said we would love to have you join us. I never met Jack until a review course in San Antonio, Texas when he told me all was arranged and his secretary Cornelia has found an apartment for me..
I arrived in July, never having seen the hospital or any of the other faculty! Friends in New Jersey helped me lease a car and I stayed the first night at the Hilton across the street. The next day I appeared on the scene and after getting to know a few people and how things worked, Cornelia gave me the keys to the apartment in Lansdowne( I had no idea where that was). Jack arrived and said “You can follow me in my car to the apartment and I will get you settled in” That is just so Jack!
I was only going to stay six months but I decided I wanted to stay the whole year and when I told him he said “ Wonderful” I don’t have the money to pay you but I will get it. That is just so Jack!
My finally and most memorable meeting with him was when I was in line to be ASA President and I saw him at a meeting. He said “I am so proud of you- not only are you the first ASA President board certified in pediatric anesthesiology but you are only the third woman to be ASA President”
That was the most important thing ever said to me in my professional career because he was such a hero and mentor to me!
There are many more memories of Jack but I want to say the without Jack Downes and my experience at CHOP I would never have had the professional career I had-it was the launching pad for me!
As he looks down on his fellows from Mount Rushmore, I think he would say well done but keep up the good work. My career like many of yours has been spent training the next generation of pediatric anesthesiologist. That is what he inspired me to do. He will always be by my side and I will continue to say- That is just so Jack!
Vinay Nadkarni MD, MS
Jack Downes is truly one of my heroes…a visionary leader, humble pioneer, and guiding beacon for me and so many of us here at CHOP. I distinctly remember arriving at CHOP as a young Pediatric Critical Care Attending 20 years ago, and being assigned to organize the PALS courses. Jack, recently (10 years previously retired as the chair of anesthesia and critical care at CHOP), was the first to sign up to renew his PALS certification, which had lapsed. He opted NOT to test out, NOT to be excused because of his senior position and eminence, but rather to listen and review the latest AHA recommendations and physically experience the PALS course in its entirety. He was the most avid, most attentive and most participatory ‘student’ in the class…and he wanted to be “tested” on the rates and ratios and algorithms. Although I was shaking in my boots and totally intimidated to be in the presence of greatness…he found a way to dive in, put me at ease, and give me the impression that what I was saying was interesting and important. That image and experience has endured, and he never missed an opportunity to engage, to learn, to aspire to improve. I will never forget his inspirational and ethical approach to learning and teaching, and his quest that we all should continuously strive to do better for children, and in so doing, be better clinicians and humanitarians.
Deborah Boroughs RN MSN
“Dr D” mentored as many nurses as he did physicians. I first met him in 1984 at Children’s Hospital of Philadelphia in the Pediatric Intermediate Care Unit (PICU). He became the primary physician of our soon-to-be adopted ventilator-dependent son in 1986. Our son regarded Dr D as a grandfather. I soon regarded him as a friend. Sixteen years later, I assumed the role of administrative director of the Ventilator Assisted Children’s Home Program (VACHP), a program he initiated in 1979 with the PA Department of Health to advocate for and support ventilator-dependent children and their families in their homes across the state. He recognized the enormity of physical care and emotional stress required for these families on a day-to-day basis. Dr D and I co-wrote many journal articles, textbook chapters and professional presentations to bring awareness of the needs of ventilator-dependent children and their families at home to legislators and professional peers. In addition to our many years of collaboration and friendship, I am indebted to the professional growth he mentored in me. I believe our 38-year old son may be the oldest living patient who has been supported by mechanical ventilation since birth, and his longevity can be directly attributed to the magnificent care Dr D provided during his first 18 years of life. Dr D is a legend that cannot be replaced. I am eternally grateful to have loved him and his beautiful wife Joanne for so many years.
