Ray W. Gifford, Jr, MD
Through many years of knowing Ray W. Gifford, Jr, as a colleague, coworker, and friend, I came to recognize and appreciate that whatever he had to say was worth hearing, whether it concerned clinical and epidemiological concepts about hypertension, fundamental investigations, other medical areas, organizational responsibilities, or interpersonal relationships in their myriad of facets. He provided the perspective of a senior clinician and medical statesman as well as the wisdom and intellect of an active and inquiring mind. On May 4, 2004, Dr Ray Gifford died in his sleep after a 1-year illness.
Ray Gifford was a graduate of Ohio State School of Medicine. After his training in internal medicine, he entered the US Navy, serving as the internal medical consultant to the US Congress for his entire naval service. During these years he was widely appreciated for his diagnostic ability and for his remarkable humane relationships. And, it was at the Capitol that he was introduced to the art and science of political interactions, not only with those who were elected to high office but in the later organizations that he served unstintingly. Following these years, he joined the staff of the Mayo Clinic, where he began his lifetime career in our field of hypertension. He left Mayo to join the staff of the Cleveland Clinic, where his talents were appreciated for almost 5 decades not only in heading his widely recognized program in hypertensive and renal diseases, but for his remarkable leadership talents in many other clinical, academic, and administrative areas.
Ray Gifford was one of the leading clinicians and practitioners in the field of hypertension in the world. He played an active role in the clinical, scientific, and organizational interactions of the entire field of hypertension for 5 decades. Although Ray Gifford’s background was in the large medical clinics where new medical technology cut its teeth, he still remained deeply concerned about everyday office practice. He was comfortable discussing the diagnosis, evaluation, and treatment of hypertension and was conversant in the latest fundamental information presented at the most fundamental meetings, attending every scientific meeting of the Council for High Blood Pressure Research and most of the meetings of the International Society of Hypertension. Ray and I sat next to each other at each of the meetings of the Joint Coordinating Committee (JCC) of the National High Blood Pressure Education Program even before it was so named, because we served together at the Arley House meeting of Dr Theodore E. Cooper in the formative discussions of that program and in the dissemination of their first guidelines. In these proceedings Ray represented the American Medical Association to the JCC for more than 30 years. Indeed, he chaired the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure.
Gifford may have seemed to soft-pedal new technology but, in fact, he was at the forefront in advancing selective renal arteriography in its earliest days at the Cleveland Clinic; he had the unique and wise ability to separate the needs of the consultant in hypertension from the daily needs of the office clinician. His concepts of the controversial areas were always responsible and sound. For example, when asked how he knew that a patient possessed the sodium-dependent hypertension state, his response was crystal clear—give a sodium-restricted trial a chance. Some might have suggested that Gifford held tenaciously to the therapy of the days of yore, a “diuretic zealot,” but he never was rigid in any of his beliefs (except, perhaps, about Ohio State’s football team). As far back as 1964, when I was investigating the applicability of β-adrenergic receptor blockers in hypertension at the Cleveland Clinic, he was the first clinician to refer patients to me for study. Indeed, he was among the very first to recognize the importance of tailoring antihypertensive drug therapy. He was recognized for these accomplishments and his other fine attributes when he was awarded the Council for High Blood Pressure Lifetime Achievement Award in 1992.
Space limitations do not permit me to prepare a more lengthy memorial of Ray Gifford; I am well aware of the limitations of a rapid and timely publication. However, I did have the opportunity to share these thoughts with other former colleagues and coworkers of Ray.
Dr Marc Pohl is the Ray W. Gifford, Jr, chair in the Department of Hypertension and Nephrology at the Cleveland Clinic and was Dr Gifford’s personal physician. He offers the following thoughts. “Ray recruited me, he befriended me, he mentored me, he taught me, occasionally he reprimanded me, and he was and still is my most important role model as a physician. He was the supreme clinician: His patients loved him and his colleagues admired him. He knew his audiences, be they patients, politicians, practicing or referring physicians, academic scholars, residents, or fellows in training. He spoke the language of the indigent, the common man, or the rich and famous with equal interest and compassion. He was not fancy, just an ordinary fellow: loved his work, Ohio State, Woody Hayes, the Cleveland Browns, and fishing in Canada. You would not see him at a society ball or rarely at the symphony, but he loved the theater and its representations of the broad spectrum of life and living. My previous Case Western Reserve and Boston teachers often asked me why I was so enamored with this guy Gifford—what made him so special? He could think like a high powerful Harvard professor and, at the same time, relate to patients and coworkers as a folksy country doc. Simply put, he was the best of doctors and his patients and colleagues knew it. As my chairman and my ‘boss’ (I hate that word boss when talking about Ray because he was not a boss)—as my chairman for many years, he was rigorous, meticulous, patient, critical, intensely intellectually honest, and fair. And he was fun (except when Ohio State lost a football game, then he could be outright morose!). He paid me the ultimate compliment when he asked me to be his personal physician many years ago. That request, even more than the Gifford Chair appointment, was the highlight of my doctoring career. And whatever contributions I have made in medicine, they were fueled and continued to be fueled by the tangible and intangible aspects of my exposure to Ray Gifford, and I will miss him for as long as I live.”
Dr Donald Vidt has been a colleague and friend of Ray Gifford for more than 4 decades and also wished to be included in this memoriam. “I had the good fortune to join the staff of the Cleveland Clinic in 1964 and to establish an association with Ray Gifford that extended over 40 years. Ray was both my colleague and mentor as well as a close personal friend whose encouragement and enthusiasm honed my interests in hypertension and led to many collaborative projects and publications as well as my introduction to many medical organizational activities. As friends, my wife and I together with Francis and Ray also shared an interest in travel, fine food, and Ohio State football, all of which led to many evenings and weekends together. For Ray’s many friends, we should not mourn him but rather should remember the small part we have played in his remarkable career.”
Dr Emmanuel Bravo, an excellent sample of Ray Gifford’s outstanding coworkers in his department at the Cleveland Clinic reviewed this memoriam and added: “Dub, as he was affectionately called by his friends, was my mentor, and was my most incisive critic, but most of all a very loyal friend. I consider myself very privileged to have crossed paths with him.”
Dr Richard Dart, one of the many nephrologists and hypertensionologists trained by Ray Gifford and now on the staff of the Marshfield Clinic and editor of that clinic’s journal, had the following to add. “Ray Gifford’s insight and thoughtful discussions about the complexities and difficulties in managing patients remain vividly in my mind. When an issue was not so clear in a patient’s management, he was not above discussing other challenging considerations and always the whole patient remained a very well remembered aspect of his rounds. To have had the good fortune to be among the many fellows trained by Dub Gifford makes his passing all the more difficult to accept, yet the privilege and value of my time with him will live on with me and my students. Thanks Dub, always; knowing you was a very great privilege.”
And, Dr Edward J. Roccella, coordinator of the National High Blood Pressure Education Program of the National Heart Lung and Blood Institute, wanted to add the following comment. “Ray Gifford was an honorable and trusted friend. He was my hero. His unrelenting pursuit of the truth, despite some oppressive moments taught us all to care about something special.”
Each of the above persons is representative of the many individuals who were his colleagues and coworkers, whose mentorship was provided warmly and unstintingly, or who worked closely with Ray Gifford in his volunteer organizational activities. They represent the rich and varied background of Ray Gifford, clinically and investigatively, as a mentor of many workers now active in the field and of the many organizations that have benefited from Ray’s unselfish contributions.
During our long relationship spanning almost 5 decades, far more times than not I have been in total agreement with his clinical thinking in daily practice issues as well as with reference to new clinical investigative areas. When I served my tenure as editor-in-chief of this journal, I cannot remember him ever declining an opportunity to review any manuscript that I called to his attention. And, as for his remarkable leadership role in medicine: Whether he manifested it as a long-time practitioner in the area of hypertensive and renal diseases or as a trustee of the American Medical Association, we are all indebted to you for your practical wisdom, for your compassionate caring, and for your valued friendship. We all salute you, Dub, for your thinking, your contributions, your wit, and, yes, for all you have done for this wonderful field of hypertension; we extend to your loving wife Fran and your children our heartfelt sympathy and condolences.⇓