Telfer B. Reynolds, M.D. (1921-2004)
Authors: Thomas D. Boyer
Journal: Hepatology (2004)

Telfer (Pete) Reynolds died on June 5, 2004. Dr. Reynolds was the 14th president of the American Association for the Study of Liver Diseases and one of the founders of the discipline of hepatology. All of us who had the pleasure of working with Dr. Reynolds owe him a debt of gratitude for teaching all of us what it means to be a physician, scientist, and teacher. TELFER B. REYNOLDS I first became aware of Dr. Reynolds when, during my second year of medical school at the University of Southern California (USC), we were told that a world famous liver service was run by Drs. Telfer Reynolds and Allan Redeker on which interested medical students could spend time during their clinical years. Every Friday afternoon liver rounds were held at LAC-USC Medical Center and medical students were welcome to attend. All medical students knew, that if they attended, Dr. Reynolds would know their name and would ask them to examine a patient and provide a differential diagnosis. On liver rounds it was acceptable to provide a diagnosis based on knowledge or to say you did not know, but guessing was not allowed. It was during these rounds that Dr. Reynolds forced all of us to think beyond our knowledge base and to develop paradigms for the diagnosis of different conditions. He created excitement in the attendees about the cases that were seen and after rounds many would rush to the library to research a contested point. Dr. Reynolds liked nothing better than when, on the following Friday, a house-officer or medical student would come with a paper supporting his/her point of view. His goal was to teach us how to approach the problem and to know the limits of our knowledge so that we could ask for help. What was most remarkable to me during my time spent with Dr. Reynolds, first as a medical student, then as a house-officer and fellow and lastly as a visitor, was that he lost none of his enthusiasm for seeing and discussing cases, no matter how many times he had done this in the past. There was no such thing as an uninteresting case as all cases had something to teach us. Dr. Reynolds was committed to teaching all of us what it means to be a physician and he attended liver rounds at USC until a few weeks before his death. It was from him that I and many of my colleagues developed our love of hepatology and the enjoyment of solving a difficult case. As a testimony to his teaching he won the Golden Apple award both from USC (1968) and the California Medical Association (1988), the Kaiser teaching award 5 times and the Distinguished Teacher Award from the American College of Physicians in 1991. Kit, his wife, said that Pete just wanted to continue to come to liver rounds for another 50 years and his death is a loss to all of the medical students and house-officers at LAC-USC Medical Center who would have benefited from his presence. Dr. Reynolds was a clinical investigator par excellence. I remember telling him that I had decided to go to UC San Francisco so that I could find a research laboratory in which to work. He said that was fine with him but that he had tried rat research once and found it not to be of much interest. Dr. Reynolds' interest was in the study of patients and their diseases. His scientific investigations grew from his clinical observations. For example, he saw several patients with acidosis and low potassium levels but normal renal function. The cause of this problem, renal tubular acidosis (RTA), was unknown at the time. Following the description of RTA he brought those patients back, performed a series of studies and published a seminal paper on RTA in 1958. However, his career in clinical research had already taken a major turn before 1958. In 1952, Dr. Reynolds received a research fellowship from the Giannini Foundation to go to England. Soon after his arrival he met Dame Sheila Sherlock and was soon performing studies on the liver. His first publications with Professor Sherlock appeared in the Journal of Clinical Investigation and the Lancet in 1953. The latter publication was of particular importance because it described the use of the wedged hepatic vein pressure to measure portal pressure and established in Dr. Reynolds a life-long interest in portal hypertension and its complications. Dr. Reynolds published more than 169 journal articles in addition to numerous book chapters and editorials. Work from Dr. Reynolds defined the use of the wedged hepatic vein pressure in the diagnosis of portal hypertension, the role of surgery in the treatment of bleeding varices, the pathogenesis of ascites and its treatment. He characterized the hepatorenal syndrome and defined the role of prostaglandins and plasma volume in its pathogenesis, described oxyphenisatin as a cause of autoimmune hepatitis, and examined the role of steroids and pentoxifylline in the treatment of alcoholic hepatitis to name just a few areas in which he worked. When performing studies with Dr. Reynolds we all learned that there was no such thing as a bad piece of data. All of the patients went into the reports and variation was simply part of the normal pathophysiology of the disease. He instilled in all of us a life-long interest in clinical investigation and many of his fellows continue to work in academic medicine and to perform clinical studies. I would want someone like Dr. Reynolds to be my physician as he would leave no stone unturned to find out the cause of my illness. His patients recognized his goal was to make the correct diagnosis and were grateful for his interest. The greater Los Angeles community also respected his clinical acumen and sent a steady stream of patients to him for his help in establishing a diagnosis or for treatment decisions. Dr. Reynolds was tireless in his search for new knowledge so that he could apply that knowledge to the care of his patients. I remember when as a first-year medicine resident I had a particularly difficult case and I asked Helen, his long-time secretary, where I could find Dr. Reynolds. In the library was her answer and indeed I found him in the stacks studying. I presented the case and he quickly figured out what was wrong with the patient. What most impressed me was that here was a physician with a tremendous knowledge base who was working hard to maintain and increase his knowledge. When the American Board of Internal Medicine first offered a recertification examination in internal medicine, Dr. Reynolds was excited and began to study for the test. He wanted to be certain that his fund of knowledge remained at a high level. If we all had his interest in being the best physician we can be, the recertification examination would have remained voluntary. He also had a work ethic that all of us tried to emulate. Being late for rounds, conferences, or clinics was something Dr. Reynolds never did and therefore we followed his lead. Dr. Reynolds led by example and I never remember seeing Dr. Reynolds tell someone what was expected of him or her. Watching Dr. Reynolds' behavior was all the instruction that was required. The USC Liver Unit's three pillars were Drs. Reynolds, Redeker, and Robert Peters. Each brought unique talents to the Unit and therefore the Unit was a place of great intellectual excitement. The Liver Unit functioned as a large laboratory in clinical investigation. All of the fellows looked forward to rounds on the Liver Unit with Drs. Reynolds and Redeker, followed by autopsy rounds with Dr. Peters and then journal club. Cases were examined, clinical pathological correlations made, and ideas developed for new clinical studies or results of studies discussed. From this rich environment hundreds of papers were published and numerous fellows trained. Former fellows take great pride in the time they spent on the USC Liver Unit. Dr. Reynolds not only was interested in the fellows' academic careers but he also felt responsible for their well-being during their tenure on the Liver Unit. This was especially true of the international fellows, of whom there were many. Jorge Rakela and his family remember fondly the Thanksgiving Day dinners at the Reynolds. The generosity of Pete and Kit in sharing their house with the international fellows is warmly remembered by many. Perhaps it was because both Dr. Reynolds (Canada) and Kit (England) were born outside of the United States that they understood the difficulties of living in a foreign country. Telfer Reynolds will be missed by all of us who were fortunate to know him as students, residents, fellows, and colleagues. He will be especially missed by his wife Kit and children John and Ann. One of my fondest memories of Pete occurred in a hotel in Atlanta following dinner with Professor Sherlock, both of whom had come to participate in a course. After an entertaining meal with Professor Sherlock, Pete was doing one of the things he most enjoyed, dancing with Kit.