Professor David Kerr (1927-2014)

A personal recollection by Professor  Ram Gokal when he was Lecturer in Medicine, University of Newcastle, and Honorary Senior Registrar,   at the Royal Victoria Infirmary (RVI) working under  David Kerr (Nov 1978-Apr 1981).

RVI was the main university hospital, adjacent to the campus of Newcastle University, and close  St James Park – home of Newcastle United Football Club, and bordered by the beautiful meadows of  Leazes Park.

Renal Services started in Newcastle in the late 1950’s.  David Kerr played  a key part of its  subsequent development. He was appointed First Assistant in Medicine in the Medical School, King’s College, University of Durham in 1959 and became Lecturer in Medicine at Newcastle University in 1961.  He was promoted to Senior Lecturer in 1963 and subsequently was appointed to a Personal Chair in Medicine in 1968 and then became Professor of Medicine and Head of the Department of Medicine in 1971. In the twenty four years that he spent in Newcastle, he established an academic renal unit with an international reputation.

My first experiences at the RVI  

I was appointed Lecturer in Medicine in Newcastle in late 1978   after being in Oxford for the previous 5 years. It was a daunting move and on arrival in Newcastle, I was met by cold, windy conditions nowhere near as pleasant as Oxford! It was depressing.  However, David Kerr made me feel very welcome – his warmth and understanding were just overwhelming and more than made up for the notorious north east weather!   I immediately realised that I was going to be very happy working at the RVI and University and looked forward to the experience. David was, always so welcoming to all his team, especially the overseas trainees who came from far and wide. I soon learnt that I was going to successfully expand my nephrological knowledge and experience from him (and the team, including other consultants – Robert Wilkinson, Walter Elliot, Mike Ward and transplant surgeon Ross Taylor)  and also gain the necessary Higher Training Accreditation in Renal Medicine. This initial experience was consolidated by getting to know him over my two and a half years in Newcastle. Little did I know then that the subsequent events and experiences would change my life and interest in Nephrology for ever more.

What was David Kerr like to work under?

David was an iconic figure  , and this was exemplified by his many appointments and responsibilities in Newcastle and beyond. In Newcastle he was Professor of Medicine, as well as , Head of the Department of Medicine. He created an academic renal unit with an international reputation, and led extensive research especially in renal bone disease and technical aspects of dialysis. He had duties at the Royal College of Physicians, and had been a founding member of EDTA . Yet he found time to be a father figure mentor, and teacher for all in the large and dedicated team who worked under him.  And was also a very caring physician to all his patients. A caring physician, also empathetic and compassionate, with  the sense of ‘being able to be in the patient’s shoes’. He related to the patients and their families with understanding. It was a lesson to see how he interacted with patients and staff at ward rounds and clinics and when dialysis was not possible (because of lack of space etc.) his compassionate approach was very humbling. In short, he cared and wanted the best outcome for all – patients and staff. He   respected all his staff, and thereby gained their respect.

He also had a sense of humour. When I started at the RVI, the first ward round was a nightmare for me! I could not understand a word of Geordie – the dialect of Newcastle upon Tyne and Tyneside, nor of  the Cumbrian twang –  accents totally unfamiliar to me. David’s solution was to have the ward sister be at my side to ‘translate’ and   suggested that he perhaps he would  send me to the University across the road from RVI to learn these dialects. Everyone on the round was laughing, and David and me joined them too!!

David was also interested in fitness. He often walked to work from his home across the lovely green meadow of Leazes Park and ran the Newcastle half marathons. On Saturday afternoons, working in the hospital   the roars could be heard coming from nearby St James Park as the Toon army of Newcastle United fans celebrated the scoring of a goal!! My interest in football began then!

David and Professor John Walton (Dean of the Medical School) enabled me to visit several units in US in 1980. In Seattle  were Belding Scribner, Henry Tenchkoff and Christopher Blagg. Waiting for Scrib (as he was fondly called) for the ward round in the morning, the team would say ‘let’s see him come’! I did not know what they meant. We all walked to the window overlooking the lake and there was Scrib rowing to work – he lived on the other side of the lake!!

Clinician and Teacher

David was an astute clinician and brought his vast experience to bear on clinical matters. But he was also intuitive and many occasion he would come up with a diagnosis from the end of the bed to his team’s surprise. A case to illustrate this: a woman from  Cairo was admitted with nephrotic syndrome. The staff wondered what the cause was and were preparing her for a renal biopsy. Along came David on the ward round and said, ‘she has nephrotic syndrome from mercury poisoning!’ much to everyone’s surprise.  The patient was decked in heavy make-up, especially eyeshadow and face, which was (in those days) heavily impregnated with toxic metals. His diagnosis turned out to be correct!

His teaching for the juniors and medical students was always – observe, then a careful history and then a  thorough physical examination.  Investigations were only to help in the differential diagnosis. He was also insistent on all his clinic patients’ urines being examined by the senior registrar. I was not ‘happy’ having to do this every Wednesday after the clinic; I did learn a lot though; he said ‘the urine is the window to the kidney and tells you a lot’ -and how right he was.

Ward rounds were a pleasure – always instructive, with references to latest developments. He was a natural teacher, with clarity, ease of expression and believed in simplicity.

Relationship with staff

David was always respectful of all his multi-disciplinary staff, and in this way got the best out of them – it was an integrated team. And they all respected him. I never saw him lose his temper or got overtly angry. My one experience of his ‘displeasure’ was when I had caused some ‘consternation’ with one of his secretaries. He came to me, and we had a candid discussion but I saw he had a small ‘twitch’ on his face – he was not pleased! His twitch represented his displeasure. He also had a passion for training clinicians from overseas, particularly from under-developed countries and he took personal responsibility for their pastoral care. He was always ready to come in and help his juniors/nursing staff as I found on several occasions, especially having to dialyse emergency cases at night using the notorious Nikatron machines – they never worked for me, they were a nightmare!

Research

David was always looking for answers to the many problems that faced the nephrology community at large and Newcastle in particular. Through the issue of aluminium toxicity  which  was a major problem  faced by Newcastle dialysis patients he became keenly interested in technical aspects of dialysis, especially water purity, and its impact on  bone and brain disease. These all related to aluminium in the water supply, and it was a relief to find the solution, and be able to act to prevent it by reverse osmosis. In this field Nick Hoenich was a great help and with David established a UK-wide  dialyser assessment /evaluation service.

Training  staff

David was also keen on proper presentation of cases at ward rounds and meetings. He was meticulous and persistent until he felt it was correct. I had a paper accepted at the Association of Physicians – an august body and it was great kudos to the unit to have a paper accepted there – mine was on CAPD.  Rehearsals started weeks before the meeting, and   there was a practice session almost daily until David was satisfied . And he insisted that the paper should be spoken and not read! Well, there was no PowerPoint then – slides had to be made up in the medical illustration department, so to make changes at the last minute was a challenge but David saw to it that the changes were incorporated; we went to the medical illustration department together to sort this out!

Visiting Nephrologist/Professors from UK and Overseas

 This was a regular event, and it enhanced the teaching and exposure to new developments outside the RVI expertise. One such visitor was Keith Peters from Hammersmith Hospital (he could be a fiery individual   – I had experienced this at Hammersmith when I was a SHO there in 1971!)). He was speaking about his results of using immunosuppressive in RPGN; there were a few deaths.  At the dinner held in his honour, he was quite disparaging about dialysis and especially CAPD. I spoke out in its defence and argued that at least we saved lives ‘as opposed to the deaths from immunosuppressives.’ I could see David’s face go into a ‘little twitch’ at first but then he defended my views and it all passed ‘harmlessly’. I valued David’s support and of course it was his nature to support his staff. When many years later I was the external examiner for an DM thesis at Cambridge University and Sir Keith Peters as Regius was overseeing the exams, we talked about this and many developments since 1970 – he had mellowed since those days!

Development of CAPD

This was a big break for me and happened by ‘chance’ .David and Mary McHugh (senior registrar at Freeman Rd Hospital renal unit) were in Canada at the ISN meeting in Montreal. They came back and were enthused about CAPD and wanted to introduce it into RVI. Mary’s working pattern did not enable her to take the lead effectively.  I spoke to David  and he said ’you take it over’ Well I had seen few problems with acute ’stab’ PD  in Oxford and was not too enamoured with the prospect of taking on the programme! David said it’s a challenge but many will benefit because HD was so limited. So that was that. The programme started – I had to learn Tenckhoff insertion, liaise with Baxter, and the rest is history. David was very supportive, and we had a good going programme – probably the first in UK. A visiting fellow from Brazil, Mauricio Ramos assisted me as did nursing staff – soon there was a team and a growing programme (see more in section on PD in 1980’s (link)). David also encouraged me to teach Tenchkoff insertion and CAPD in the district general hospitals and that for me was a fulfilling and gratifying exercise. Baxter was then very much into promoting CAPD – they had the US ‘circus’ going around the world (Moncrief, Popovich, Nolph and Oreopoulos) to promote CAPD. They also came over to Newcastle. Mauricio and I used to joke ‘the Mafioso’ are coming to town (meaning the quartet). Well as things turned out, soon I was ‘roped into’ going around with them and Mauricio handed me a keyholder which said ‘you are now part of the Mafioso’!!. Such is life.

David  Kerr as a man of Faith and Righteous Living

David lived a simple life – no bravado, no ego; he let all his work, research, and publications speak for themselves. He was also a devoted family man. Underpinning all of this was his belief in the Divine – he was a  devout Christian with a deep faith. Although we never discussed religion as such (mine was in the Hindu/Vedic tradition), we understood that life was about living in a righteous way. He certainly did that and set an example to all. I valued this aspect and treasure it to this day.

Upper: David Kerr & Ram Gokal 2003         Lower: David & Eleanor Kerr 2003

 

In 2005, David was at my retirement. He came up to me and said ‘Ram, that was the best farewell event I have been to and many congratulations on your achievements’. I was deeply touched and almost in tears and simply said ‘thank you – you were responsible for a lot of it’. He was always gracious to the very end.

Such was the man that David Kerr was – humble, modest, caring and thought of others before himself. He gave a lot and in return got enormous respect and a zeal to dedicatedly work for the unit. For me it was a privilege and an honour to have spent 2 ½ years with him and the team at RVI. He was a great teacher, mentor and truly iconic and I will always be grateful for having been in Newcastle.

But I never did learn Geordie, though I  got on well despite this!!

 

Last Updated on May 31, 2023 by John Feehally