In 2017, we’ve lost two prominent healthcare epidemiologists, Drs. Walter J. Hierholzer, Jr. (1935-2017) and Barry M. Farr (1951-2017). Both were prominent SHEA volunteers in their time, serving one term each as SHEA president.  Similarly, both mentored many other influential epidemiologists who carry on their legacies – many of which wrote in stories to share below. 

 

In Memorial: Walter J. Hierholzer Jr. 1935-2017
Contributed by: Jan Patterson, MD, FSHEA & Louise Marie Dembry, MD, MS, MBA, FSHEA

Dr. Walter J. Hierholzer Jr., 82, Professor Emeritus of Internal Medicine and Public Health at Yale University of School of Medicine and resident of Guilford, CT, passed away on January 21, 2017.

Dr. Hierholzer attended Albion College and the Yale School of Medicine with subsequent training in epidemiology at the University of Minnesota. He met his wife Bente while studying as a Fulbright scholar at the Biological Institute of the Carlsberg Foundation in Copenhagen, Denmark. As an Assistant Professor of Epidemiology and Internal Medicine at the Yale School of Public Health (1972-1976), he made several trips to the Amazon to study the impact of infectious diseases on native Brazilian tribal populations. From 1976-1985, Dr. Hierholzer was an Associate Professor of Infectious Diseases and Preventive Medicine at the University of Iowa and Director of Hospital Epidemiology Program overseeing statewide hospital epidemiology education. From 1985 until his retirement in 1999, he was a Professor of Medicine and Epidemiology at Yale and the Hospital Epidemiologist at Yale New Haven Hospital.  Walter was an early adopter and aficionado of bioinformatics as applied to healthcare epidemiology.  He was a strong proponent of developing data systems to better understand risks leading to hospital acquired infections and other adverse events.  He presented a memorable lecture “Health Care Data, The Epidemiologist’s Sand: Comments on the Quantity and Quality of Data” at the 1990 CDC Decennial Conference on Nosocomial Infections.  In it, Walter used the analogy of the quality of sand for production of lens instruments to gain perspective on the increasing amount of data available.  He wrote that we must begin with quality data if we are to construct a beautiful instrument to use for health care improvements. His comments almost 3 decades ago, were prescient and are as relevant as ever today.

We remember wonderful evening dinners and weekend picnics in the garden in their home in Guilford, hosted by Walter and his wife Bente when we were junior faculty. We loved hearing their stories from around the world and eating tasty Danish-style dinners while experiencing their exceptional hospitality.  In his retirement, Walter enjoyed traveling, consulting, volunteering in the Guilford community and spending time with family. 

 Walter was an original member of SHEA and served as the President of SHEA's Board of Trustees in 1989 and as a chair of HICPAC from 1992 to 1998.   In 2000, he was awarded the SHEA Lectureship for his dedication to SHEA and influence on the field.  He spoke of the changes occurring in healthcare and the need for better information systems to promote and support the work of hospital epidemiologists and infection preventionists.  In addition to all of his professional recognitions, he was a mentor to many.  A master of epidemiology, he modeled and taught the practical aspects of being a successful healthcare epidemiologist to his mentees.  He negotiated with the hospital for an associate hospital epidemiologist model so that a junior person could gain extensive experience under his tutelage. He taught by model and advice and one of his key teachings was to schedule regular and frequent meetings with the hospital administrators.  He would comment “They can always cancel, but you are on their calendar and they can’t cancel every time.”  He won the trust of hospital administrators with his expertise and frequent advice.  We remember discussing “expensive” interventions to correct underlying problems and wondering how to convince hospital administrators to pay for doing what was needed. Walter would chuckle and say “It takes money to run a hospital.”  We saw that the time and effort he took to develop relationships with administrators allowed effect change. He supported junior faculty’s career growth and encouraged them to look beyond their current positions. He advised that we look at new positions at least every five years – not because he felt we should move on but because he knew that understanding one’s worth sometimes necessitates getting an outside view.  He was a fearless yet humble leader in healthcare epidemiology. We recognize his contributions to the field and are saddened by the loss.

Hierholzer WJ Jr. Health care data, the epidemiologist’s sand: comments on the quantity and quality of data. Am J Med 1991;91(Suppl3B):3B21-26S.

 

In Memorial:  Barry Farr 1951-2017
Several of Dr. Farr’s mentees reached out to include their own thoughts on Barry Farr.   Dr. Barry Miller Farr was born in Fort Leonard Wood, Missouri on November 15, 1951 and died in Charlottesville on February 15, 2017.

Contributed By:  John Jernigan, MD, MS
When I think of Barry, I remember enjoying long conversations with him in his office during my fellowship. He usually sat in front of a very tall window, through which I could see over his shoulder parts of Thomas Jefferson’s original “academical village” which is still at the heart of the University of Virginia.  Like Mr. Jefferson,  Barry was a Renaissance Man, and it showed during our conversations and in his mentorship. His musings were usually a delightfully interesting mixture of epidemiology, literature, and philosophy, with a healthy dose of laughter interjected throughout.  Frequently, as these conversations ended, he would open his desk drawer and pull out a yellowed piece of paper, which I think he’d kept  since he was an ID fellow, from which he would read the words of the physicist Michael Faraday, “Work, finish, publish.”  I invariably left those meetings inspired and uplifted.

Contributed by: Cassandra Salgado, MD, MS
Barry’s legacy of the thoughtful pursuit of evidence based measures to keep hospital patients safe will be firmly cemented within the field of Infection Prevention and Hospital Epidemiology; however, as one of “the people of Barry” (as he used to call us), I most cherish his mentorship. I did not arrive in Charlottesville as the most gifted fellow. I was somewhat naïve to research and the expectations of a highly productive academic Division, but I was willing to work hard and this was enough for Barry. One of my favorite memories (I have many great ones) was during a regular weekly meeting “up on the hill” where we were discussing a meta-analysis I was working on regarding CA-MRSA. I was still learning about data analysis, statistics, and scholarly writing. I had all of my notes spread out on his desk and was showing him that according to my calculations and interpretation, community members from whom samples were obtained in health care facilities were more than twice as likely to be carrying MRSA than community members from whom samples were obtained outside of the health care setting and that if you limited sampling to persons without health care contact, the MRSA prevalence was <1%. “c” he said with such enthusiasm, “that’s my girl, that’s the power of epidemiology”. In that moment, he made me feel encouraged and proud of my work. There were many moments that followed which helped to shape my career, the way I mentor trainees and junior faculty, and my service to society. Barry was a gifted Hospital Epidemiologist, but to many his greatest gift was his presence in our life. I am honored to have known him, a true life mentor.

Contributed By: David Calfee, MD, MS
As the years pass, I become more and more appreciative of how lucky I was to have been one of Barry’s fellows.  While there are many great physicians, healthcare epidemiologists, teachers, and clinical researchers, there are far fewer great mentors.  Barry was definitely one of them.  He was generous with his time, knowledge, experience, and, advice.  He held me and himself to high standards and lived by example.   He introduced me to other leaders in the field, encouraged me to get involved in SHEA early in my career, and helped to identify opportunities for me to grow as a researcher, epidemiologist, and patient safety advocate. Barry was not only my career mentor; he became and continues to be my mentorship mentor.   As I meet with students and fellows, review abstracts and manuscripts with my research team, or plan initiatives with the infection prevention team, I often find myself thinking “How would Barry do this?” and “Am I doing all that I can to provide the kind of mentorship that Barry gave to me?”  Barry has set a very high bar for all of us and I will be eternally grateful for that. 

Contributed By: Robert Sherertz, MD
I have always been inspired by passionate people who fight for just causes and the people in the trenches. Barry Farr likely weighed 135 pounds soaking wet, but underestimate him at your own peril. He was an outstanding athlete, state champion debater and fearless under any circumstances.  I first met Barry in 1978 when he was an intern at the University of Virginia and I was a third year resident. That first morning I asked him if he was ready for rounds. He just smiled and nodded, “Yes”. I would never ask that question again. Barry was always ready, for whatever he was doing. He was even ready when it came time to die, but I’m jumping ahead.

After that year I left to do my Infectious Diseases fellowship and I didn’t see him again until ten years later when he began to do research on vascular catheter infections, a subject of mutual interest. His first presentation that I attended he quoted Winston-Churchill, George Patton, Patrick Henry, and any other historical figure pertinent to the point he was trying to make, with the purpose of getting people charged up. And that he did, me in particular.

One day after a particularly rousing talk, I asked him about writing and found out that he shared my love of short stories and poetry. “Would you be interested in starting a writers group?” I asked. “Absolutely,” he said with great enthusiasm. The following year at the spring ICHE meeting Barry Farr, Loreen Herwaldt, Leonard Mermel, and I got together for our first meeting. Barry suggested we call ourselves the Oliver Wendell Holmes Society (OWHS) and it stuck. We met for dinner, drank some wine and read to each other for over an hour. It was one of the most creative things I have ever done. By the end, we all left excited and planning to meet again next year.

Barry and I talked frequently after that. Writing was always our favorite subject. One year the two of us came back from San Francisco on the same airplane. I mentioned to him I had finished a first draft of a novel. For the first time since I had known him, Barry was speechless. After a pause he told me that in college, he was an English major with the goal of writing the great American novel, like William Faulkner, who wrote in Oxford Mississippi where Barry’s alma mater was located. After much agonizing he said he decided to try medicine first, but had always planned to get back to the novel. Hearing me talk about my book, he decided right there on the spot to start writing his.

The OWHS meetings continued and Barry began to read us chapters from his novel about the impact of HIV in a small southern town. The story was amazing and we encouraged him to finish it. Then in 2006 everything changed. Barry announced he was medically retiring due to Multiple Sclerosis. I was devastated; it was my turn to be speechless. Undaunted, I insisted he continue to participate in the OWHS meetings via conference call, but it was not the same. The unbridled passion and laughter that had characterized all the early meetings faded, and soon the meetings stopped.

At that time I began commuting from Wake Forest to a small hospital in Statesville, NC, to help with Infectious Disease coverage. I began calling Barry to see how he was doing. Soon we were talking regularly, 30-40 minutes at a time. Initially it was about professional things. Soon we began talking about his MS, about constipation, pressure sores or whatever Barry was fired up about. Mostly I just listened, until one day I will never forget. He said, “Of all the people I thought were my friends, you are the only one who calls regularly.” Tears came to my eyes. I replied that they were probably afraid they wouldn’t know what to say. As soon as I got off the phone I began calling and emailing people that I thought he would like to hear from and encouraged then to contact him. Many did, to his great appreciation.

In 2012 I moved to South Carolina and was commuting between 2-4 hospitals a day. I continued to call Barry. One day he asked me to read a book chapter on Multiple Sclerosis. He had decided to share what he had learned, his novel now on the back burner. I was also writing a book then so our conversations changed to discussing book progress. In the spring of 2016 he announced he had written all the chapters and was editing the book. Understand that he did so using only software voice controls, so the editing was heroic.

Finally, his MS book was done. He tried the publisher route first but finally self published, saying he couldn’t wait any longer. When I asked him why, he said he was afraid he didn’t have much time left. He then asked me if I could help get the word out about the book. I said yes, having no idea what that meant.

In late January 2017, I had my last regular phone call with Barry. It started the same, catching up about family, and then he started telling about all the bones he had broken in the last year. At the end he said something I would remember, “I think the next fall is going to get me, Bob.”

Two weeks later I got a call I had been dreading; Barry had fallen, broken multiple bones, and was on a morphine drip headed toward comfort care. I called his son and was told that Barry would like to talk with me. I went out to my truck during the middle of my work day and spoke with him for almost 45 minutes. We were saying goodbye even though both of us refused to say the words. He told me that he would never walk again and that the pain was unbearable, so he had decided that life like this was not going to work. He was waiting for his family to come around to his way of thinking. Stubborn to the end, this was vintage Barry. I was so caught up in my grief that I almost forgot to tell him something important. Right before I hung up I told him that we had arranged to send one copy of his Multiple Sclerosis book to every medical school in the country with a MS clinic. I wasn’t sure if he understood through his morphine fog, but then he started crying and thanked me.

For those of you who never knew Barry, you should read his book about Multiple Sclerosis. Every paragraph explodes with the passion and courage with which he faced life and his MS. As for Barry’s great American novel, he finished a first draft and his three sons, all English majors in college, will finish it.

 

Contributed By: Karin Byers, MD
Barry Farr was my mentor. He was also my friend. When I was at the University of Virginia for my ID fellowship, I picked Barry to be my mentor. Little did I know that once you chose Barry, he would automatically include you as part of his family and you would be in his close circle of friends. From that moment forward he would care about you and your career and he would do everything he could to help you achieve your goals. If you had to work during a holiday, you were invited to spend it with the Farr family. It was truly an honor to be one of the "people of Barry" - the small collection of people who were fortunate enough to work with him. I will never forget going to a national conference and going for a walk on the beach with Barry and "his people". He would teach us to enjoy the moment and he would recite poetry while looking at the stars. I think we all had an inspirational quote from Barry in our top desk drawer. I will never forget his ready smile or his wonderful laugh. He had a childlike ability to take joy in anything around him and a desire to explore the world. He was also brilliant. When he was my mentor, he was the editor of the national journal for Infection Control and he was often a featured speaker at national meetings. He had an impact not just on those of us who trained with him but on the world of Infectious Diseases. He trained some of the current leaders in the field of Infection Control.

 He was also the one who nicknamed me "KB" after my mailbox (labeled Karin) was right next to the one for "Karim" in the Infection Control office. After we repeatedly received each others' mail, Barry threw up his arms (while laughing) and said "from now on you will be KB"! I can't hear those initials without thinking of Barry.

He was loved by anyone who had the chance to know him. This is a great loss for the "people of Barry" and the world of Infectious Diseases.

 

Contributed By: Leonard A. Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP
Dr. Barry Farr stood up to the strongest foes if he believed in his heart that his position was best practice based on the available evidence and in the best interest of the patients we serve.  Barry was one of the bravest individuals I have ever met and certainly one of the most brilliant.  He will be sorely missed.