Ralph V. Clayman, MD
Distinguished Professor / Endowed Chair in Endourology
Dean – Emeritus
University of California, Irvine
Department of Urology
333 City Blvd. West, Suite 2100
Orange, CA USA

A Meritage of Musings

“How did I get here?”…proverbial David Byrnesian question…New York City born, New Jersey bred…a medical family – dermatologist father, nurse mother, likewise two aunts; general practitioner grandfather…preordained MD career path… public school - central Jersey…youth years enjoyably shared with two younger brothers, Mike and Rob…high school salutatorian success accompanied by Icarian hubris… spring time result = no college
acceptances...a tumble of wax and feathers.

1965... East Coast exile to central Iowa…serendipity…Grinnell College mandatory liberal arts education… gridiron lessons in patience and persistence...doors of creativity flung wide open…Argonne laboratories and Herb Kubitschek’s laboratory…enmeshed in the life cycle of a fission yeast…a scientific questioning…hard-wired.

1969... West Coast explore…Medical school…the “unchartered class” (i.e. second class to enter) of UC San Diego’s newly minted highly progressive medical school – all exams, except the year-end final, are pass/fail, anonymous, and optional…no class rank, no AOA…a thesis required…more science…intra-aortic balloon counter-pulsation to reverse canine myocardial ischemia…first presentation at the American College of Surgeons’ Research forum… four years to diploma and a lifelong love, discovered, Carol…

Decision time….medicine or surgery…“There are many things at which you will excel; you just have to pick one, and never look back.” (Eugene Bernstein – both thesis advisor and mentor)…surgery… but no AOA, no grades = no interest…acceptance thanks to Dr. Bernstein’s connections with his former colleague, Henry Buchwald at the University of Minnesota…

1973…University of Minnesota general surgery pyramid system…focus on cardiac surgery…fate…rotating internship forces a tour on Urology…a month with Elwin Fraley along with residents, Dick Williams, Paul Lange, and Bill DeWolf…hearts turned to kidneys…Minnesota Urology residency replete with more science…a full lab year amidst cell cultures and athymic mice…sojourn with Jorgen Fogh at the Walker Labs.

1979...Dick to UCSF, Bill to Boston…Paul stays in Minnesota as VA Chief…I stay too (Assistant Chief to Paul at the VA)… advent of Art Smith and birthing of endourology…of no interest to me (i.e. “end-of-urology”)…oncology focused…Art leaves for LIJ Chair… Paul Lange mandates my reluctant shift to endourology….all Paul’s fault…on to percutaneous stone removal… in short order, hotter than a Saturday night pistol…13 Univ. of Minnesota courses in 11 months – train the world…rotating hands-on labs introduced and 100’s of urologists and radiologists trained together…clinically tethered…a gnawing guilt fed by neglected earlier lab studies on cholesterol metabolism in renal cancer…cut the clinical cord…shift to an AUA Scholarship and off to UT Southwestern with John Dietschy, world class lipid scientist…and there to meet Paul Peters, Harry Spence and Terry Allen …first “how-to” book on endourology completed – self-published and over 3,000 copies sold.

1982…First son, Matt, come...Lab done…Minnesota return or ?…or!…Washington University in St. Louis … Bill Catalona recruited and supported – full lab and an assistant – one more attempt at cholesterol metabolism research… not sustainable; oncology and endourology, two ice floes going in different directions, unable to sustain a footing on both… total transition to translational endourology…

Endourology rules…Art’s creation …over breakfast the Endourology Society forms (with Joe Segura, Gopal Badlani, and me) … a waterfall of events… in short order the Endourology Newsletter morphs into the Journal of Endourology, brainchild of Mary Ann Liebert, and then World Congresses…Endourology transitions from “flash in the pan” to endless.

1984...Inadvertent endourology fellowship initiation at Washington University with Howard Winfield and the rise of an ESWL fed, lucrative Midwest Stone Institute…fellowship and lab funds abound…endourological focus on “eliminating surgical incisions”…Ernst Friedrich and my first view of in-office gynecological laparoscopy – enthralled…in Europe, Kurt Semm sets the surgical world on its ear with his laparoscopic appendectomy... ’87 second son, Bradley, come...done.

1990...Lou Kavoussi with me doing porcine labs with Nat Soper on laparoscopic cholecystectomy; kind, ongoing Karl Storz supported endeavors…(thanks to Mrs. Storz and Connie Padden)…epiphany – the anatomically bare porcine kidney – devoid of surrounding fat…no overlying bowel or liver…staring back during each laparoscopic visualization of the gallbladder; why not remove it laparoscopically?…successful laparoscopic nephrectomy in 5 pigs…dreams of clinical transition… enter Cook Urology and Fred Roemer, Paul Thomson and Ed Pingleton…entrapment sack perfected, morcellator realized…June 20, 1990 a right laparoscopic total nephrectomy in an 85–year-old woman…the surgical world tipped again…“a 1-inch tumor, shouldn’t leave a 12-inch scar”… Pandora’s box flung wide open…

1991…Post-fellowship reunion…Elspeth McDougall to Washington University…inception of a 20+ year productive professional collaboration – endless discovery and teaching…World Congress of Endourology in St. Louis.

1994… “how-to” book on urological laparoscopy co-authored…training courses without end and a cavalcade of fellows of ability, integrity and grit …today’s professors and leaders in Endourology and Urology…(Elspeth McDougall, John Denstedt, Stuart Wolf, Steve Nakada, Peggy Pearle, Matt Dunn, Arieh Shalhav, Jaime Landman, and more on the rise)…

Endourology spiraling outward from a St. Louis hub…17 years pass in a flash…sons, Matt and Brad thriving –– Carol a rock and constant support…parting gift, a named endowed Chair in Endourology, first and still held by Sherb Figenshau (vicarious thrill – from Minnesota research assistant to Washington University urology resident, and then Washington University colleague).

Enter robotics…soon it all could be and would be done laparoscopically…now with fixed sites of access and definable limits of motion… “surgery is dead, long live surgery”…the wound rapidly waning.

2002…Mov’in on…University of California, Irvine to chair the newly created Department of Urology – great support from Tom Ahlering, Dean Tom Cesario and hospital CEO Ralph Cygan…Elspeth returns to help move us forward...in 5 years, top 20 ranking…enjoying it all…

2009…“Untimely ripped”…; turmoil on the medical school campus…awash in red ink…lost leadership…I become interim Dean of the School of Medicine…huge challenges with the opening of UCI’s new Douglas Hospital, amidst predictions of failure, and a new CEO, Terry Belmont, coming onboard too…Rebecca Brusuelas, Chief of Staff, an astounding talent and CEO Belmont and his team fantastic partners; “interim” removed…five year decanal term ensues…thanks to an outstanding team of people, challenges met and overcome.

2014…Red to black - $46 million turnaround, school of medicine fully accredited, 20 of 23 departmental Chairs filled, endowments growing…over 700,000 new square feet of medical school space opened; 5 year term completed…offered chance for review and a second term…bookstore magnet wisdom, prevails, “Let go or be dragged.”…one and done…publication of the “Compleat Dean,” makes Amazon’s Best Sellers list – chapter closed.

2015…“Be kind to everyone on the way up for you will surely meet them on the way down”…former fellow, Jaime Landman now Chair of UCI Urology – perfect…a kindness beyond expectation…a Festschrift and a second named Endowed Chair in Endourology…a buzzing laboratory and a return focus to urolithiasis… an endourology career full circle…born in rock now back to rock …”family first”…Matt and Melanie wed – first grandson 2018, Casey Max…much on the horizon…pedal to the metal…moment to moment…and Carol by my side, two score and five…ever fortunate, ever thankful.

“Everyone gets their 15 minutes of fame, you need to get that 16th minute…that comes from hard work and integrity.” “Never fall in love with a hypothesis.” (We don’t care if we disprove our hypothesis, as long as the science is
right and the results reproducible.)
“Second place is the first loser.”
“Draw bigger circles.” (Collaboration is more productive than confrontation.) (In academics, one plus one is three.) “No is the first step on the creative pathway.”

Ralph V. Clayman, MD

Figure 1. “The Clayman Doctrine” was given to me by Professor Kurt Kerbl after he had spent 1993-1994 as a visiting fellow in the Endourology laboratory at Washington University. His academic focus and resulting output was by far the greatest of any individual who had worked in the laboratory. Between 1993-1994, he produced 24 manuscripts of which he was the first author on 14.

© The Canadian Journal of Urology™; 27(2); April 2020

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