dpc-arcive

Dermatopathology: Practical & Conceptual

July – September 1998 | Volume 4, No. 3

Wallace H. Clark, Jr., 1924–1997

Ackerman, A. Bernard

Editorial

The “Obituary Listing” in the April 15, 1998 issue of JAMA reads as follows: “CLARK, Wallace H. Jr, 73; Philadelphia, Pa; Tulane University School of Medicine, 1947; certified by the American Board of Pathology; died November 28, 1997.” Apart from being incorrect factually (Wallace H. Clark Jr. died in Kennebunk, Maine) and incomplete in regard to certification (Wallace H. Clark Jr. also was a diplomate in dermatopathology of the combined American Board of Dermatology and Pathology), the notice, like all of the others registered, conveys nothing about the uniqueness of the man or about his immense contributions to dermatopathology, dermatology, general pathology, and medicine in general.

Perusal of the Curriculum Vitae of Wallace Henderson Clark, Jr., M.D. permits some insight into that uniqueness and those contributions, but it still does not capture the essence of either. One learns that he was born and grew up in La Grange, Georgia (Fig. 1), obtained his undergraduate education mostly at The Citadel, and gained his medical training, from medical school through internship to completion of residency and fellowship, at Tulane University. He was a member of the full-time medical faculty at four universities – Tulane (Fig. 2), Harvard, Temple, and Pennsylvania. He received a doctorate, honoris causa, from the University of Liège; was given many awards by local, national, and international societies; was author or co-author of 149 original articles; was co-author of 22 chapters of books, and was co-author of three books. The award that perhaps best acknowledges his work for 40 years was bestowed on him in 1994 by Harvard Medical School and the Harvard Collaborative Oncology Group “In Recognition of a Lifetime of Devotion and Unprecedented Contribution to the Field of Medical Research.” An award, although never conferred on him, could rightly have proclaimed “In Recognition of a Lifetime of Devotion and Unprecedented Contribution to the Teaching of Dermatopathology.” Many thousands of colleagues in dermatology and pathology were beneficiaries of his remarkably engaging pedagogy at courses, meetings, and symposia, but the most fortunate of all were those who were able to learn from him in small groups where he was at his best, teaching in the “old days” standing next to a projector for glass slides (he was a virtuoso of the carbon arc) and in later years while “driving” at a multi-headed microscope. Among his trainees in dermatopathology were Richard J. Reed, Richard W. Sagebiel, Martin C. Mihm, Lynn From, David Elder, and I.

Fig. 1

Wally Clark as a child.

Fig. 2

Wally Clark at Tulane.

But none of what has just been written tells anything about the highly distinctive, playful, serious, mischievous, imaginative, intellectually curious, predictably tardy, conscionable, sometimes undependable, lovable, episodically maddening, sensitive, complex man that was Wally Clark. Something of Wally’s being can be learned through his widow, Patricia Clark, who wrote to me, in her own hand, on May 10, 1998, in these words:

“Dear Bernie,

Here is Wallace’s CV. As I look over it, I realize that there isn’t much of his personal life included. A biographical sketch should include some of the personal. Some things you have experienced – Wallace’s love for the sea, camaraderie, a well-told story, a good joke, good food, fine wine. Gadgets fascinated him. He taught himself how to use a computer; he became its master. Only with the most complex of software did he require technical assistance.

At a young age, Wallace developed a fascination for form and minute detail. His love of photography gave him expression for the smallest details. Some of his most emotive photos were of grains of sand and the patterns they produced.

Wallace thought himself a poorly educated man. In the last 11 years he embarked upon an extensive reading program with emphasis on the natural world, cosmology, the nature of time, and philosophy. He built an extensive library.

Would you have asked his greatest contribution, he would have said his teaching as attested by some outstanding students and his children and grandchildren.

In 25 years of marriage, Wallace was a kind, gentle, generous, loving, and thoughtful husband. Being with him was never dull; he always made me laugh – how I miss the laughter.

Thank you for your efforts in producing this issue dedicated to Wallace. Should you need any other information, don’t hesitate to ask me.

Sincerely,

Patricia”

Some of my own thoughts, reflections, and feelings about Wally Clark, the mentor and the man (Fig. 3), were expressed on May 1, 1998 to a gathering of his colleagues, students, friends, and family who had come to the Memorial Church in Harvard Yard, Cambridge (Fig. 4), to remember him, to rejoice in recollections of him, to give thanks for the good fortune of having known him, to recall his legacy, and to renew commitment to sustaining that legacy. The speakers were Harold Dvorak, David Elder, Dupont Guerry, Terry Harrist, Marty Mihm, Margaret Tucker, Jim Clark, one of Wally’s sons, and I. This is what I said:

How to do justice to the life and work of Wallace H. Clark, Jr.? Ever since Patricia kindly invited me to participate in this celebration of Wally, I began to reflect on how that could be done best. Many ideas came to mind, some of which I liked better than others, but after 3 months I still had not found a vehicle that was either satisfactory or satisfying to me. And then I hit on a possible solution. I would ask Wally! And in my imaginary conversation with him I queried: “Wally, how can I best capture your life and your work?,” to which he replied, reflexly, in his inimitable, playful way, “Let me speak for myself, ya’ hear?”

Fig. 3

Wally Clark in the 1990s.

Fig. 4

The invitation to Wally Clark’s memorial service.

I will begin this tribute to my teacher, Wally Clark, by reading excerpts, as they were expressed in his own words, from an essay that appeared in Advances in Cancer Research in 1994. This is vintage Wally, abridged, but unedited. You will hear him. Listen.

“I have never had a life plan or a research plan. The foregoing statement means I have lacked some overarching ambition for my life and never dreamed of studying tumor biology until my later years. I have been blessed with the ability to formulate imaginative hypotheses and I have always wondered how things and people worked. The hypotheses and wonder at the mystery of living things were my incentives and these innate personal attributes bounced from one thing to another without a purposeful theme until quite recently. However, I now have a plan, an all encompassing plan. The story of the genesis of the only plan of my life informs my work on melanocytic neoplasia with perspective. My solitary plan, which has progressively dominated my thinking for the past seven years, emerged while I was sitting on a stalled train between Overbrook, Pennsylvania and Philadelphia, Pennsylvania. I enjoy trains, subways, and buses and more or less dislike private automobiles, taxis, and limousines. Airplanes are uniquely loathsome to me. As a result of these preferences, I spent many years commuting on the ‘Paoli Local’ between Malvern or Strafford, Pennsylvania and Philadelphia, Pennsylvania. I enjoy public transportation for it gives me time to read or affords the opportunity to talk with diverse people. Reading and people are a major part of my life. I gradually formulated reading rules. The dominate rule was: ‘Never read any science related to your work while on a train.’ . . . It was not a rare event for the ‘Paoli Local’ to stall . . .The breakdowns on my train could be quite long, from time to time, and this particular stalling was one of the long ones. I began to think of the biologic significance of the attributes (the properties) that predicted metastasis from primary melanomas. . . . Before the subway ride to the University of Pennsylvania was finished, I felt as if I was in the midst of a personal epiphany. I was not ‘working on melanoma,’ but on the properties of a primary cancer required for a cancer to metastasize. I have followed this ‘only research plan’ with ever greater excitement for these seven years.”. . .

“I have been blessed from my earliest memories with a gift of questions – I have always enjoyed doing a study. The daily, physical act of gathering data, especially when it was gathered with a microscope, brought, and still brings me pleasure.”. . .

“I learned several important things from ‘the discovery of the melanocyte.’ It made no difference, at all, that our description was not the first. The complex process of observation and judgment leading to knowledge was not diminished by ‘not being first.’ Whether one is ‘first’ or not has nothing to do with research and learning. The essence of work is discovery and the act of learning. The generous and uninhibited sharing of your observations, learning, and knowledge is teaching. I began to think that competitiveness in science was a negative and destructive force. The subsequent years have reinforced that concept.”. . .

“I cannot describe my first studies of melanoma without telling of the excellence of the Department of Pathology at Tulane University School of Medicine. That department was a place of study, research, learning, and teaching. I regard the foregoing attributes as inseparably interrelated and cardinal to a university. . . . The study of disease mechanisms was central to our teaching, as well as our research. The influence and friendships of Tulane have remained with me for my entire life.”. . .

“The Pigmented Lesion Study Group at the University of Pennsylvania had lunch together every Wednesday and, as a result, began to carry out the primary function of a true university: the acquisition of knowledge. . . . The lunches fulfilled Oakeshott’s definition of a place of education (a university): ‘. . . they are serious; they are places of study; and they are detached, apart from the rest of the society.’ We were serious, we studied, and we were apart. The conferences had no mission, no defined goals. We detached ourselves, at times, from the theoretical constraints of grant applications and the compelling urgency of clinical decisions in an attempt to formulate knowledge about tumor biology.”. . .

“Central to my learning process was a concept of knowledge. Knowledge and information or data are not the same. . . . Today’s medical school is barely recognizable as a part of a university, as it is trapped in data acquisition and service without thinking that such functions are not necessarily central to learning. I decided to leave the university in order to learn, to try to acquire knowledge; a sad state of affairs.”. . .

“Maine is one of the finest meetings of land and water on the face of the globe. I decided to go there to live and to study tumor biology. My wife, Patricia, was and still is of immeasurable help with my library and literature searches and listens patiently (occasionally impatiently) as I expound on my latest concept of the nature of cancer. The two of us were to be my idealized university.”

Wally acknowledged more explicitly his immense indebtedness to Patricia in an article he wrote for Acta Oncologica in 1995:

“Patricia A. Clark, my wife, has introduced and maintained order in my study and with my library, literature, and reprints. Without Patricia, the project would have disintegrated into chaos, chaos with no hope of order.”

Wally, as you know, at times was given to hyperbole, but, as those of us who worked with him know, there was not a whit of exaggeration in his assessment of the indispensability to him of Patricia.

Nearly everyone in this church shares with me the regret that we could not have been closer to Wally, yet each of us is exquisitely aware of what he taught us. Wally was, first and foremost, a teacher, cognizant as he was that the word doctor comes from the Latin, docere, to teach. He taught us:

He taught us about pride in competence and in professionalism. He taught us to make work play and that playfulness enhances pedagogy. He taught us the value of iconoclasm and unconventionality. He taught us about irreverence. He taught us not to be impressed by labels or titles. For him, a full professor, a chairman, or a dean could still be what he loved to call a “lone neuron.” He taught us to abhor clichés, to resist nonsense, and to seek the truth with a small “t.” He taught us the joy of intellectual curiosity and love of learning. He taught us what it means to be a human being and to be thoroughly human with flaws and foibles exhibited undisguised.

I want to share with you a lesson that Wally taught me in a very conscious, purposeful, and personal way in the weeks before he died. Wally taught me that it is never too late in life to touch a fellow human being, and to do that poignantly and profoundly.

The story begins during the first week of October, 1997, when I received a message on my answering machine that went as follows: “This is Wallace Clark. I’m just calling to wish you a happy Rosh Hashanah.” Of course I was pleased to hear from Wally. We had not spoken for almost two years when he had called me then to inquire about how I was faring after a close call that resulted in by-pass surgery. Upon receiving his New Years greeting I tried at once to reach him, but to no avail. Many calls to Maine left me frustrated because there was neither voice nor voice mail. I then called Terry Harrist’s laboratory and learned that Wally and Patricia were out of the country. A secretary was urged to “Please leave a message for Dr. Clark on his return. Dr. Ackerman has been seeking assiduously to reach him.”

Soon thereafter, Wally reached me one evening at my home in New York City. He was ebullient, very friendly, and extraordinarily complimentary. He told me, to my surprise and delight, that he employed my criteria for histopathologic diagnosis of melanoma in his research. At the end of the 45 minute conversation, I felt that I had achieved Nirvana. I went directly from the phone to my desk and penned a dedication to a nearly completed book about melanocytic neoplasia.

Chinese proverb

For Wally Clark who opened a door for a grateful

Bernie Ackerman

Early the next day I traveled to my office in Philadelphia and asked the first secretary who arrived to type the dedication, permit me to proofread it, and send it to Wally in Maine along with a note to him in my own hand. The note having been appended, I assumed that within a few days the missive would be in Wally’s hands. When I returned to Philadelphia 3 days later, which is my routine, I inquired of the secretary about the status of the dedication, had it been mailed to Dr. Clark. I do not remember now the excuse, but, in short, the missive had not yet been sent. Feeling an ill-defined sense of urgency, I instructed her to dispatch it post haste.

Three days later there was a terse message on my answering machine from Wally: “So when are you coming through the door?” I called him in Maine and once again we spoke for 45 minutes. Wally was excited about his work. He gave me a reference to a recent publication that he considered to be exceptional and he invited me to Boston to participate in a weekly conference that he was certain would be to my taste. The conversation ended, once again, with my feeling blissful. One week later, Tom Fitzpatrick called me to report: “It is the end of an era. Wally Clark died yesterday.” You can imagine my disbelief and agonizing sense of loss. Wally and I had connected, and not only by telephone and not by chance – and just in time. Wally knew, even better than I, how precious little time was left to do that. He brought our relationship to completion in a way that enriched and ennobled both of us.

In 1981, here in Boston on a Sunday morning, Wally and I presented different points of view about classification of melanoma to nearly 1000 members of the International Academy of Pathology.

At the outset of my lecture, that subsequently was published in 1982 in the American Journal of Surgical Pathology, I showed this Chinese painting of a teacher and his students and said this:

“In 1968, I was a student of Wally Clark in Boston. Now Wally, as we all know, is a superb teacher. Here he is pictured with some of his students: Richard Reed, Martin Mihm, David Elder, and Richard Sagebiel are in the front on the left, and I am in the second row on the far right.” (Fig. 5)

Fig. 5

A Chinese painting of a teacher and his students.

I then proceeded to deliver the lecture that began with these words:

“I agree entirely with [the Chairman] that no pathologist anywhere in the world has contributed as much to our understanding and our thinking about [melanoma], this enigmatic and all too often fatal disease, than has Wally Clark. I also agree with much of what Wally has written and said about malignant melanoma. But the title of this program is ‘Controversies’ so I am not going to dwell on what we agree about but rather on our differences.”

I ended the lecture thus:

“Wally was and is an entrancing teacher. What is the proof for that? Let’s take a closer look at me in 1968. It looks as if I’m sleeping, but who could sleep while Wally was teaching? I’m listening and I’m thinking (Fig. 6) and, thanks to Wally’s stimulation, I thought and thought, and I’ve brought some of those thoughts back to Boston and to you this morning. I do have a different point of view than my teacher Wally Clark, and that is the greatest tribute that I, as his student, can pay him.”

Fig. 6

A detail from the Chinese painting of a teacher and his students.

In 1974, I conducted what would be the first of many dermatopathology symposia during my 20 years at New York University. Wally was on the faculty of that first symposium. He came to the lectern and addressed a large audience of pathologists and dermatologists in these heartfelt words: “There are only two ways to achieve immortality: through children and students. Thank you, Bernie.” I had a very big lump in my throat that day, and I have a bigger one today when I say, “Thank you, Wally.”