Thomas E. Andreoli: a personal memorial

Robert L. Safirstein1 1Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA Correspondence: Robert L. Safirstein, Central Arkansas Veterans Healthcare System, University of Arkansas for Medical Sciences, 4300 West 7th Street (111/LR), Little Rock, Arkansas 72205, USA. E-mail: SafirsteinRobertL@ uams.edu Thomas E. Andreoli, a towering figure of American medicine, died on 14 April 2009 in Little Rock, Arkansas, after suffering from a cerebrovascular accident. He was Distinguished Professor and Chair Emeritus of Internal Medicine at the University of Arkansas for Medical Sciences College of Medicine and past president of both the International Society of Nephrology and the American Society of Nephrology. Although he retired as chair in 2004, he remained fully engaged in teaching and attending on the clinical service. He continued his stewardship of the morning report, which he embraced passionately throughout his chairmanships at Texas and Arkansas, and, at the time of his death, was editing the eighth edition of his beloved Andreoli and Carpenter’s Cecil Essentials of Medicine. In many ways Tom’s story is the quintessential American success story of an immigrant family with a strong work ethic. Tom’s everyday engagement with literature, art, opera, and the pursuit of culture was molded by the powerful influence of his grandfather, nicknamed Papa, who emigrated from Italy. The influence of the Archdiocese of New York on Tom’s development should not be underestimated. He attended undergraduate school at the small Benedictine College, Saint Vincent, in Latrobe, Pennsylvania. These years proved to be profound and helped forge his devotion to community, local autonomy, and strong leadership. He was fond of quoting Abraham Flexner, who described a medical school as a community of scholars freely associating. His remains will be interred at the Saint Vincent cemetery. After graduating from Saint Vincent College, Tom attended medical school at Georgetown, where he finished at the top of his class. Tom went to Duke as an intern and resident, where he stayed for 10 years. These years strongly influenced his career in many ways. Foremost was the influence of Eugene Stead, whom he greatly admired and who was already in his maturity as a department chair. Stead identified Tom as destined for greatness and, as was common those days, tailored Tom’s training personally. This included arranging his stint at the National Institutes of Health in the metabolism lab to fulfill his military service, and arranging his schedule as a resident and fellow at Duke such that he could work in Dan Tosteson’s lab. His work with Dan Tosteson was perhaps his most rewarding scientific experience; he was most proud of the demonstration by this team of increased water permeability induced by amphotericin in cholesterol-rich lipid bilayers. It did not escape him that he and his colleagues were the first to detail the dimensions and charge characteristics of a water pore, which put him center stage in the endless discussions in renal laboratories across the globe about how water crosses an epithelial barrier. He was engaged in this research throughout his entire professional career. It took the discovery of aquaporins many years later to resolve the issue and validate Tom’s view. Tom did his renal fellowship under Roscoe ‘Ike’ Robinson. He remained at Duke as a faculty member for a number of years after his fellowship, then established and led the Division of Nephrology at the University of Alabama at Birmingham (UAB) School of Medicine with the encouragement of Robinson. Robinson became a lifelong friend and an immense influence in Tom’s life and, together with Stead and Tosteson, provided forcing functions for his career, promoting him at every turn. It was at UAB that Tom showed his prodigious skill as an administrator and program builder. He arrived at UAB in 1970, where he had to take out personal loans to build and head the Division of Nephrology. He started with one faculty member and worked 20-hour days, covering the wards, the consults, the dialysis units, and the clinics. At the same time he assembled a research and clinical faculty that included Jim Schafer, Ed Rutsky, Steve Rostand, Gabriel Navar, David Ploth, and his fellow, Steve Hebert. He created a Nephrology Research and Training Center and leveraged private and public donations to build one of the premier nephrology divisions in the country. Frenetic lab meetings and grant-writing sessions must have been inspiring and were recounted by Jim Schafer years later at a Festschrift held in Tom’s honor in 2004 in Little Rock. As Schafer described it, Tom would sit behind his desk smoking like Thomas E. Andreoli: a personal memorial