IN MEMORIAM

Roger C. Bone MD

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Sepsis 1997;1:7–10 © Kluwer Academic Publishers. Boston. Printed in U.S.A.

Roger C. Bone, MD Marshall

We lost a visionary when Roger Bone succumbed to metastatic renal cell cancer on June 8, 1997. Roger Bone’s ideas transformed clinical research in sepsis. He led a revolution in the way we see the disease that began with the articulation of the concept of sepsis syndrome [1] and the completion of the first rigorous multicentre trial of anti-inflammatory therapy with methylprednisolone [2] and matured through the ACCP/SCCM consensus conference that proposed the concepts of SIRS and MODS [3]. More recently he refined these notions, bringing into clearer focus the complexity of the process, with his later writings on the dynamic interplay between pro- and anti-inflammatory mediator cascades [4,5,6]. He was a prolific and articulate writer, a passionate and demanding thinker, whose ideas were at once profound, unsettling, urgent, and courageous. Such was the measure of his commitment to scientific truth that he wrote, in intimate and moving detail, about the subjective reality of SIRS as he battled the malignancy that he knew would ultimately take his life [7]. Nearing the terminal phase of his illness, in pain and facing the imminent prospect of radiotherapy to limit the advance of a spinal metastasis, he shared his insights and his considerable administrative skills as a member of the roundtable working group whose deliberations comprise the inaugural issue of Sepsis. Roger was a solid supporter of the vision of this new journal. Several weeks before he died he sent me a copy of his book “Death and Dying: A Guide for Patients and their Families”, and asked that it be reviewed in Sepsis. A full review by Charles Sprung will be published in an upcoming issue. It is an extraordinary piece of writing- poetic, moving, consoling, and beautiful. It offers an intimate glimpse into the soul of a teacher and a friend who realized he was dying: “I realized I was going to die on a beautiful October day in a medium-size Midwestern town. . . . I learned from my physician that I had metastasis to both lungs and a positive bone scan. As a clinician and cancer survivor, I was always aware of this possibility; however the reality was not easy to accept. There is denial, anger, and a great sense of loss. ... The initial shock created anxiety and caused a flurry of activity among my business associates and office employees. What should they do?! What Roger Bone’s book, Reflections: A Guide to End of Life Issues for You and Your Family is published by the National Kidney Cancer Association, 1234 Sherman Avenue, Suite 203, Evanston, Illinois, 60202-1375, U.S.A.

needed to be done and when?! Finally I politely called a halt to all activity for the day. I told them I wanted to go home so I could simply sit and look at the river and spend time with my family. Which is what I did. Our house sits on a rather steep bluff and the Maumee River curves around a wide bend below us. The yard slopes gently to the edge of the bluff then descends through wildflowers and bushes to the banks of the river. Birds, squirrels and chipmunks populate this slope of land. On a quiet day, you can hear the rustling of the animals in the grasses. Occasionally, there will be a bird’s song. It was a perfect October day—the weather was sunny, the temperature measured 70 degrees, and a gentle breeze was in the air. The trees on both sides of the river were mostly green with only a hint of autumn reds and yellows. The river sparkeled when stirred by the wind, and its course flowed in such a way that the sun seemed to set exactly on the water. It gave the appearance of a great fire being extinguished by the cool water. I sat on a lawn chair and laid my suit coat and tie on the green grass beside me. At that moment, time stopped. My life—past, present, and future—was compressed into that second of time. Time slipped past again and I looked up and saw my wife, Rosemarry, standing next to my chair with a glass of lemonade for me; our daughter had just made a pitcher. I tasted the sweetness of the drink. The wind suddenly stirred the grass. A bird chirped. A small boat appeared far off in the riverand became clearer as it made its way upstream. I took Rosemary’s hand and we stayed there a moment longer looking at the world passing before us. Life has been good to me.” [8] Roger Bone’s insights in sepsis have given new hope to the critically ill and we share his conviction that sepsis will ultimately yield to successful therapy. Yet even more importantly he has shown us the courage to accept our limitations and to face their consequences with humanity and serenity. This issue of Sepsis is dedicated to his memory. Thank you, Roger. John Marshall MD

References 1. Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA, the Methylprednisolone Severe Sepsis Study 9

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Group. Sepsis syndrome: a valid clinical entity. Crit Care Med 1989;17:389–393. 2. Bone RC, Fisher CJ, Clemmer TP, Slotman GJ, Metz CA, Balk RA. A controlled clinical trial of high dose methylprednisolone in the treatment of severe sepsis and septic shock. N Engl J Med 1987;317:654–658. 3. Bone RC, Balk RA, Cerra FB, et al. ACCP/SCCM Consensus Conference. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 1992;101:1644–55. 4. Bone RC. Toward a theory regarding the pathogenesis of the systemic inflammatory response syndrome: What we do

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and do not know about cytokine regulation. Crit Care Med 1996;24:163–172. Bone RC. Sir Isaac Newton, sepsis, SIRS, and CARS. Crit Care Med 1996;24:1125–1128. Bone RC, Grodzin CJ, Balk RA. Sepsis: A new hypothesis for pathogenesis of the disease process. Chest 112:235–243, 1997. Bone RC. A personal experience with SIRS and MODS. Crit Care Med 1996;24:1417–1418. Bone RC. Reflections. In: A guide to end of life issue for you and your family. National Kidney Cancer Association, 1997.