Tribute to Robert A. deLemos

LETTERS

Tribute to Robert A. deLemos To the EiJitor: As each of us walks through life, we meet teachers who give to us new knowledge that we strive to translate into wisdom. On occasion. we meet teachers who not only enlighten but help us make that translation from knowledge to wisdom. Dr deLemos was such a teacher. We, his students, pay this tribute to him, that he gave us both knowledge and wisdom. He taught us neonatal medicine, gave us tools that improved our abilities to practice neonatal medicine, and helped us develop a philosophy of how to care for our patients, their families, and ourselves in times of happiness. stress, and great loss. Dr deLemos left this world a better place. As he told us, his career as a medical resident began at the bedside of a premature baby dying of hyaline membrane disease at Boston Children's Hospital. That baby was Patrick Kennedy, and the world stood by, helpless, as the tragedy unfolded. Dr deLemos' own feeling of helplessness drove him to the research that is now his legacy. Along with a handful of investigators. he introduced neonatal ventilatory support into the routine management of neonatal respiratory failure. He helped define the etiologic mechanisms that contribute to bronchopulmonary dysplasia. and many consider him the father of the safe application of high-frequency ventilation. Though we respect his contributions to neonatal medicine, we also loved him for his willingness to help us grow professionally. He taught us that focus was essential and that clinical medicine requires bedside management. He was intolerant of poor clinical care and "cookbook medicine," and he would often show up early in the morning or late at night to check on us. He pushed us to be academically productive. He supported us through failed experiments, poor outcomes, and letters of rejection for publications, carefully explaining that adding to scientific knowledge is challenging.

THE JOURNAL OF PEDIATRICS

He applauded our successes and celebrated with us when we succeeded. He loved debate and the passion of heated discussion. He fostered in each of us a rugged independence and a propensity to challenge conventional wisdom. We also pay tribute to a side of "Dr 0" that many of his colleagues never saw. It was his gentle side. most apparent in his work at Camp CAMP. CAMP is a summer refuge and a home away from home for children with special needs. He ensured that even the most medically fragile child could get to CAMP. He helped develop an "ICU area" that would allow children undergoing home ventilation to experience CAMP. He later became the head cook in addition to being "Top Doc." He sang with the children. helped them swim and canoe, and cried with joy at the end of camp when the parents viewed all the smiling pictures of their children playing in the hill country outside San Antonio, Texas. Dr deLemos taught us to take knowledge. caring, compassion, and understanding and to mold them into that unique quality called wisdom. He asked nothing in return except that we go and do the same. We will miss his physical presence, and yet his spirit and the wisdom he freely gave will be with us the rest of our days.

Submitted by Dr deLenwJ' JtudentJ in neonatal medicine: Neal Ackerman, MD Richard Bell, MD Cathy Bohanon, MD Jan Carter, MD ReeJe Clark, MD Devn Corni.Jh, MD Dale GerJtman, MD George Groberg, MD Chip Howell, MD ChriJ JohnJon, MD DaviJ JohnJon, MD Andy Kairalla, MD John Kirk/ella, MD Keith Meredith. MD Stephen Minton, MD Donald Null, MD Gary Snyder, MD Ron St(lddard. MD

BiLL WalJh, MD Brad Yoder, MD 9/35/90613

A topical topic: Toxicity of antiseptics? To tbe EiJitor: The article by Linder et al. 1 in the September 1997 issue of the Journal is a provocative call to decrease the use of iodine-containing antiseptics. The safety of such a recommendation must be based on the balance between real or potential toxicity of iodine products and the efficacy of chlorhexidine products. Several points must be evaluated. Because patients were not randomly assigned to the treatment groups, we can never be sure of cause or covariable. Although it may be reasonable to assume that iodine caused elevated thyroidstimulating hormone levels, it is just as reasonable to say that chlorhexidine led to a longer supplemental 02 need. Although not statistically significant, twice as many patients treated with chlorhexidine had sepsis (criteria and timing unstated) than did patients treated with iodine: 11.7% vs 5.1 %. Delange et al. 2 found that regional variation in maternal iodine nutrition could account for variations in the incidence of transient disorders of thyroid function in young infants. We have always used povidone cleansers in our neonatal intensive care unit. but we stopped routine surveillances for low T4 and high thyroid-stimulating hormone because thyroid-stimulating hormone was never high. 3 ,4 Perhaps the differences are caused by differences in maternal. fetal, and neonatal iodine sufficiency. Can the authors comment on maternal dietary iodine in Israel? Finally. topical antiseptic preparations of chlorhexidine are not universally available and should not be confused with solutions created for hand wash. 5 Linder et al. 1 should conduct a prospective study that looks at all outcomes related to topical antisepsis.

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