"It’s been my life. The question is, how has transplantation shaped or influenced my life and I think as much as I can say it, it’s actually been my life. It’s what I live, what I breathe, it’s exciting. Every patient, every case is rewarding."
Jimmy Light, MD took his medical degree at the University of Michigan and thereafter completed his surgical internship and residency at the Walter Reed Army Medical Center. During his training there, he developed an interest in transplantation and immunology. Ultimately serving as Chief of the Combined Army-Navy Transplant Services, Dr. Light retired from the Army in 1983, taking the helm of the transplant service at Washington Hospital Center. Dr. Light has served numerous professional and health volunteer agencies, including the Southeastern Organ Procurement Foundation which he led as President. A founding member of the ASTS, Dr. Light continues with scientific interest in long-term clinical outcomes of kidney transplantation.
Jimmy Light: Hi, I’m Jimmy Light. I got interested in transplant surgery because of a lecture Dr. Hume gave at Walter Reed where I was like maybe like the fourth year resident or so. In 1968, he came and he gave this grand rounds talk in the evening and it absolutely lit my fir. And I thought, “Wow, this is really something.”
And then when I was Chief Resident for whatever reason, I was offered a two-week sabbatical and they said, “Well you can go anywhere you want to in the country but you have to let us know tomorrow.” And so I had remembered that the Army had sent Wes, not Wes Alexander, but Joe Alexander to the Brigham to learn something about transplant and to come back and start a program at Walter Reed so that was an easy connection to make. I got to go to the Brigham for two weeks, sat in the rooms, looked around, listened to the giants talk and saw a transplant and it was for sure that’s what I wanted to do.
So but sort of being the Army, I needed to pay in advance. So we were in the height of the Vietnam War and that was my first experience with…In a sense, I had started out thinking that cardiac surgery or peripheral vascular was the work I really wanted to do. Transplant came along and then for sure in Vietnam I saw every piece of vascular work I ever want to see in my whole life, I never wanted to see it again. But the trade-off was I came back to a graduate course in basic science and was able to take a lot of immunology courses then at NIH and to work in the laboratory with Josh Miller and Brack Atler and that was really the big introduction.
So about a week after I got back from Vietnam there was a first transplant at Walter Reed and then a year later we were doing the eighth one and I actually scrubbed on that case and I don’t remember if I got to do a little bit or not. But the lab experience was extraordinary about mixed lymphocyte cultures and I think then just as now, I think that if you really want to understand transplant, you need to understand the science.
And so I thought it was more than a surgery and I wanted to be sure I could understand how things worked. And if I couldn’t, well then I should do something like heart surgery where it didn’t matter whether you understood those things. But the exciting part was, “This is something new. It’s amazing and if you give it some energy and participate, you’re going to learn a lot of stuff and maybe even help a little bit.” So that was quite, that was the remarkable time.
Thomas Peters: You I know can’t help but mention Walter Reed and I think there may be some history and some prominent people in your experience at that institution. Can you tell us a little bit about both the people and the contributions from Walter Reed Army Medical Center?
Jimmy Light: Walter Reed was kind of a magical place in those days because everybody had a Barry-plan deferment and so all of the younger people in the country who were finishing residencies and fellowships came in and we were the only transplant program in the Army, so that’s where they came, either there or the institute of research.
So I already mentioned Josh Miller and Brack Atler and there was Dick Burleson and Ethridge, Lynn Pearlhoff, just more and more and it went on for about oh six or eight years. And then at the Navy, they were working at the same time focused more in the lab and so Ron Filo and Nick Feduska, Steve something, Steve from Brooklyn and it just…There was there rich experience of being able to talk to each other and people were coming for NIH study sections, so especially Dick Simmons would because Ed Ethridge was there from Minnesota, so Dick would come over ever time he was in town and give a conference talk and sit around, so it was like an ongoing seminar for a number of years.
The other thing was that the patient care was you know was indefinite, there was no…You didn’t have to worry about reimbursement or finance and you could do things. And we had a unit and shared it with a nephrologist actually and the dialysis unit and it became very clear that at least in renal disease, this collegial effort having everything in one place, working back and forth and becoming friends and colleagues as well as making sure you established or respected the turf or the domain. How much kidney disease would be influenced optimal partnering for these treatment modalities. And of course by that time, these things were commonly available and doctor Czykoswki pointed out that one of the really big deals was the emergence of Social Security and Medicare as funding mechanisms and that made these diseases imminently treatable.
Walter Reed became sort of the end place for about 10 million people, so it was one Hell of a referral base when you think about it for the active duty soldiers, the retirees and their dependents, all of whom were eligible for care then. We saw a tremendous amount of patients and at one time, I think we were up to like 50-some transplants a year the last few years, that was a pretty big number in those days.
Thomas Peters: What was your transition then out of the Army and how did you pursue clinical transplantation after that career?
Jimmy Light: I actually…The interesting time because I always thought I was going to be the Chairman of Surgery or General Surgery and transplant would be a part of what I did but it wouldn’t be everything. And about 1975 or so, that door was closed or at least wasn’t opened. (Laughs) And so it became absolutely clear to me that I needed to give 100% to kidney transplantation and devote myself to try to improve how we did things and to learn as much as I could. And from that moment on, it was as if. . . It was if the world just opened up and that was wonderful.
Southeast Organ Procurement Foundation was an amazing initial piece of it because we really didn’t have colleagues in the Army outside of the small group at Walter Reed. The outside world was my environment was environment, not the inside world and SEOP in Richmond became center most in that.
Thomas Peters: And then where did you go from Walter Reed?
Jimmy Light: Oh the…It’s an interesting thing that the Washington Hospital Center position…They had started transplantation in I think 1974 with Dr. Currier who had been a Hume trainee, had grown up, did his residency and things in Boston and had been in Richmond and he came to Washington to establish that program. And the Army was really the only other significant program at the time; there were smaller things at the other universities. But at any rate, he established that program and it did well. But as things happen, I guess a new chairman came and they didn’t hit it off so well.
And eventually I learned that there might be a position there and I was just coming to the end of 20 years in the military and so I learned about it and went over, had a small interview, had a lunch and signed a contract. It was sort of all just, it was almost seamless and the main difference was I think when I went to Washington Hospital Center that was, I was doing exactly what they wanted me to do. In Walter Reed it began to be a sense that making progress or further changes or growing a program wasn’t exactly what the military wanted and I understood that it wasn’t their main interest to facilitate kidney transplantation. But still, the ability to grow and continue to evolve and mature wasn’t going to be there and so this opportunity was just excellent.
Thomas Peters: You are not unique in the sense that someone else in your family has gone into surgery and transplantation work, tell us about that.
Jimmy Light: Oh, you’re talking about my son, Timothy? He is an excellent kid. He worked at NIH a few years while he was in prep school, had a Dartmouth education, which I’m not sure was a benefit at the end of it. Taught him how to think for himself and what he thought was, “Dad, I don’t think I’m ready to go to medical school yet.” And so about three or four years went by and his MCAT’s were expiring and so one day he just called up and say, “Say you might be getting a few bills.” Oh well, I said, “Why” of course. And he said, “Well I’m traveling around to these schools seeing if they will still accept me.” And it was like December for the class starting in the following summer. And so it worked out and he went to medical school and about half-way through he said, you know, “I think I’m going to take a year off, I’m getting a little tired of school.” I said, “Oh Tim, you can’t do that, you know you’ll fall out of phase, it won’t work out. You shouldn’t do that.”
But it was very interesting because he always kind of had his own mind, so he actually spent a year doing research looking at the influence of meditation on disease resolution. Ah. But at any rate, he goes back and he finishes and when he is a fourth year medical student he has about six weeks to burn. He had planned to go to Thailand I guess to further his interest in transcendental medication or something. But he said, “Hey could I come down and just spend a little time with you?” And of course it was like the skies had opened for me. So he came and he spent about six weeks in the spring and at the end of it he said, “Hey you know, this is really interesting stuff. Too bad I’m planning on going and doing a medicine residency.” So but at any rate, so he did a year in medicine in Boston and found it wasn’t quite right and eventually matched in surgery and it turned out, I thought just out of happenstance, I don’t know how it occurred but he matched at the Hospital Center and he came and was there actually a total of eight years. So we had a lot of fun together and a lot of time.
But he decided not to do kidney transplantation and I didn’t push. You know I always thought that if you’re going to choose a career, it ought to be one that you chose and so on. But he did the next best thing, he’s decided to do burns and that’s what he does now is burns and trauma and it’s a special experience.
Thomas Peters: Tell us what your thoughts are about where organ transplantation will be 10 or 15 years from now.
Jimmy Light: So where will transplant be in 10 or 15 years? Well my first answer is I hope they are into regenerative medicine because in 10 or 15 years, I’m going to need a bit or regeneration most likely. No I think it’s not so clear to me where the field is going in some respects. I think in the early years it was for sure, it was about science first and understanding and immunology and pieces and this and that all of the transplant giants, many of whom are here today were vested in the laboratory and looking at models and doing good clinical work and good surgery. But the influence was on the science and as it became more and more practical and as better drugs came along, then clinical work is obviously most all of the careers today. I think the science is done by scientists rather than clinicians by and large. Well we still make contributions. I think most transplant surgeons today are heavily vested in the care of patients and of course that was always what drove me was the care of patients. Anything that we accomplished or published or observed was always about something to try to make the patients do a little better or understand something a little better.
So, so where does it go? Well I think what will happen is that we’ll be going to biologicals as the next step and some of them are in trials now and are pretty promising. I think the idea is that the objective is going to be to be chemically independent as I say it, so that we won’t be dependent on medications for the life long of the transplant and that there will be some other immune deviation or immune mechanism and it may require long-term maintenance. I am skeptical if there will ever be true tolerance without a lot of manipulation. But I think periodic biologicals directed at various aspects of the immune response are going to be the next big step and I don’t think it’s going to be all that long.
Thomas Peters: Anybody else? Any questions? Yeah, Charlie. Charlie, yeah?
Charles Fitts: Do you have any concept of what xenografts may do?
Jimmy Light: The only comment I have is the one I think it was made by Shumway initially and that was it was the future of transplantation and always will be. Or the second one was that like twenty-five years ago, it was right around the corner and that’s where it still is. It’s hard for me to envision it. But the thing about people early in the transplant field always had vision and courage and breakthrough kinds of mentalities. I don’t have that kind of mind and there may be someone who finds that little piece of magic that’s still required to change the immune system from that kind of recognition or change the presentation. But the business to clone or culture organs and make them not foreign, I think is going to be a really great spin off or work that’s going on in that area. My guess is that’s what happens to us is that we are able to clone or regenerate organ systems rather than use animals.
Thomas Peters: Okay. Um how has transplantation shaped your life?
Jimmy Light: It’s been my life. (Laughs) The question is, how has transplantation shaped or influenced my life and I think as much as I can say it, it’s actually been my life. It’s what I live, what I breathe, it’s exciting. Every patient, every case is rewarding. I can’t imagine what else I would have done, where I could have had the individual expression and in fact the recognition that you’re all giving, showing on me the last couple of days. I never expected it. I am extraordinarily proud to receive it, very please to have been a part of the generation of the organism…organisms, yeah. Organizations and things that have played a role in how we do it today and I hope to be around to see how it goes tomorrow.
Thomas Peters: You and I have worked together for many years in the Army and in organizational work as well. I can remember a lot of fun and many humorous moments, does one come to mind right now?
Jimmy Light: Yeah the Jimmy picture. (Laughs) Memorable moment. I don’t know where we are, I think we’re in Memphis or Nashville at a Southeastern Organ Procurement Foundation meeting and as usual, we were out partying the night before and we come past this restaurant that’s got a big sign outside that says, “Jimmy’s”. Tom’s got his, got his camera in his pocket as always and he says, “Hey step over there and let me take your picture.”
And of course I made my usual funny face and it was even funnier than you can imagine. But it looks so much like I’d had way too much to drink, I didn’t think so at the time, but it was probably true. And the great moment afterwards was when he came and gave a conference I think at the Hospital Center, that’s the first picture he showed. I said, “Oh Lord, how am I ever going to look at these people again, Jimmy’s.” That was actually a wonderful time.
I think the Southeastern Organ Procurement early years were the best and I learned so much from the colleagues and the collegial experience and it was the ultimate example of surgeons, nephrologists and scientists all clustering together and all working for a common good in trying to advance the care of patients. It was wonderful.
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