On March 6, 2017, we in the field of geriatrics lost a brilliant, witty, and irreverent leader, mentor, and passionate advocate for the most vulnerable of our patients. As colleagues and coauthors, we will feel the sadness of Bob Kane’s sudden death for many years. Each of us had the honor to work with him on this book and many other projects, and we respectfully dedicate this edition, which he coauthored and edited, to his memory.
Essentials of Clinical Geriatrics was Bob’s idea. In 1980, after he and other leaders at UCLA made the nation aware of the growing need for the field of geriatrics, he recognized the need for a text that succinctly summarized the key aspects of clinical care for older adults as a critical step in defining the field and in improving the care of this population. Although geriatrics in the United States was in its infancy, Bob wanted to disseminate a resource that could make a difference while the field grew and matured. Admittedly not an experienced practicing clinician, Bob engaged Itamar Abrass, then Director of the Geriatric Research Education and Clinical Centers (GRECCs) at the Sepulveda VA, and one of us (JGO) to coauthor the book. Its success over the past three decades, in terms of book awards, reviewer accolades, and sales around the world, speaks for itself.
Each of us would like to share a few of many memories of working with Bob.
JGO: Bob was a relentless mentor, whose “feedback” could be brutally honest. I vividly remember the day I met with him to review my first draft of the first chapter I authored for the first edition of this text. He shoved it across the table and said: “I can’t read this. Go get a book called The Elements of Style and learn to write a sentence properly, and then rewrite the chapter and give it back to me.” He was right. Like many young physicians just out of fellowship, I had no idea how to write proper, efficient English for the medical literature. He helped me get better at it for the next 30 years. Then there was the time about 10 years later when I was on a panel with him speaking at a meeting of geriatric nurse practitioners. As I was speaking, Bob was listening attentively and taking notes. I thought to myself, “Wow, my mentor is taking notes on my presentation.” When I finished, he handed me a list of all the typos and grammatical errors on my slides. He always pushed me hard, and I am forever indebted to him for doing so.
BR: When Bob first invited me to join in authoring this book, I was both honored and a bit hesitant, fearing that I would never be able to meet his expectations. I worked harder on those book chapters than any other I ever wrote and was thrilled to have Bob’s approval of each. Moreover, his editorial recommendations were always written in a productive manner, were appropriate, focused on including all members of the interdisciplinary team, and had the older patient in mind. His focus was always on how to ensure that new clinicians would understand the current system and management approaches, and that they would think about ways to improve on those approaches. On a personal note, when Bob heard about my own recent experience with cancer he called me to discuss it further. He wanted to learn more about my experience and how it might help others. We commiserated about the system and the way in which health-care providers approach patients in the acute care setting and the impact it has on the patient. We also discussed thoughts about death and dying when faced with potentially life-threatening illnesses, and the challenges to being able to enact personal preferences and choices. It is a great consolation to me personally, as it should be to us all, that Bob didn’t have to endure the indignities of a long stay in the acute or long-term care setting.
MLM: We recently offered Bob the chance to teach as the national geriatrics expert at a monthly case conference for geriatrics fellows on the East Coast. He agreed without hesitation. The case discussion focused on the very complex clinical care of an older man with dementia, who had refused care. Bob expressed clear teaching points that none of the participants had considered. Bob simply outlined his recommendations: (1) make a time-graph of the important events of the patient; (2) define what you know, what you do not know, and the overarching problem that requires attention first; (3) define the patient’s capacity to take care of himself; and (4) define what his family is willing to do to help him. All the fellows and faculty noted the clarity of his teaching. We appreciated his direct, commonsense approach. Bob was a straight-talking communicator. His teaching was clear and his points made you reflect on many of the things that you would not have otherwise considered. At the last AGS meeting, while I was in a cab with him, he said: “It sure sucks when the problems of aging start happening to you.” Physically disabled from longstanding musculoskeletal problems and too stubborn to use a wheelchair, Bob had fallen earlier in the day and suffered a painful hematoma around his knee. I joined Joe and Lynn Ouslander in attending to his injury. Despite the discomfort, Bob was persistent in his wish to attend the JAGS Editorial Board dinner, yet many of us were worried about him. He was so appreciative of his friends and colleagues making sure that he was as comfortable as possible under the circumstances. The next day he gave a remarkable presentation on how to successfully publish a manuscript. He enjoyed teaching, even when he physically was not at his best. Bob sent a very kind note after he had returned home, thanking us for the assistance we provided.
Bob died physically frail, but as intellectually active as ever. One of us (JGO) was on a call about papers in review and in development just 4 days before he died, and he could not have been sharper. He remained involved in so many important projects with so many colleagues despite his physical challenges right up until the day he died. He left a tremendous legacy of writings and intellectual challenges to the field of geriatrics and to our society advocating for the need for humane, compassionate, and high-quality, yet not overly medicalized, care for people in the last stages of life. We hope that all he touched will help finish the work left behind by his untimely death. This book is one contribution to that goal.
Joseph G. Ouslander
Michael L. Malone