Three months before he was due to begin his appointment as a staff physician in Internal Medicine and Nephrology at Mayo Clinic in July 1966, Dr. James V. Donadio Jr. received his military draft notice. Jim was assigned as the commanding officer of a newly created kidney unit attached to the 3rd Field Hospital in Saigon, Vietnam, and as Pharmacy Officer of the hospital. In this moving and wonderfully illustrated memoir, Jim relives his year-long military service in Vietnam with the freshness of memories that have readily endured for more than fifty years. The centerpiece of Jim’s service was his leadership of the kidney unit where he cared for patients with acute kidney failure sustained in the combat zone. Such kidney failure, largely due to trauma, blood loss, or infection, necessitated replacement of kidney function by hemodialysis or peritoneal dialysis. These therapies were in their nascency in 1966, as was the subspecialty of Nephrology itself. For example, acute kidney failure following trauma was first described in the English literature only twenty-five years previously during the Battle of Britain in World War II. Equipment used in Jim’s kidney dialysis unit had been introduced relatively recently. For instance, the twin-coil artificial kidney was in use for just ten years and the Scribner dialysis shunt for only six years. The American Society of Nephrology, destined to become the largest Nephrology society in the world, was founded in June 1966. Furthermore, it was not until six years later that certification examinations in the subspecialty of Nephrology were held, and that the United States Congress passed legislation making dialysis available for Americans with chronic kidney failure. With these fledgling dialytic therapies and the limited under- standing of kidney failure in 1966, it is remarkable that Jim’s kidney dialysis unit not only kept alive these patients with acute kidney failure but also provided the needed care and time to enable renal recovery. In June 1967, Dr. John Merrill, a pioneer in dialysis and kidney transplantation and a major architect in the emergence of Nephrology as a subspecialty, visited Jim’s kidney unit in Saigon. Dr. Merrill was so impressed that he encouraged Jim to publish his observations. Jim did so upon his return to the United States while stationed at Walter Reed Army Medical Center in Washington, D.C., where he completed the second year of his military service (1967-1968). Based on astute clinical insights and studies in the kidney unit, Jim and his colleagues published seminal papers in The Lancet, Annals of Internal Medicine, and other journals regarding the diagnosis and management of acute kidney failure sustained by military personnel in the combat zone and by civilians in a war-torn country. Jim’s service went far beyond the kidney unit. At the 3rd Field Hospital, he admitted and managed patients with a broad range of diseases, participated in the on-call schedule, and tended to patients in the emergency room. He also cared for post-operative surgical patients and patients with burns, and he served as Pharmacy Officer for the hospital. Outpatient clinics took him to neighboring villages, and his discussions with medical and military personnel on how to reduce the risk of acute kidney failure took him to army base hospitals and infantry bases in the combat zone. Jim’s memoir has lovely cameos that include Floyd Patterson, Ann Landers, Dan Rather, Bob Hope, Henry Cabot Lodge Jr., and General William Westmoreland. When Francis Joseph Cardinal Spellman toured the combat zone in Vietnam at the end of 1966, Jim served as his physician-in-attendance. Jim accompanied the Cardinal throughout the tour, which included flying with him in a Navy 2A aircraft that made an arrested landing on the nuclear- powered aircraft carrier USS Enterprise. Jim’s abiding humanity permeates this memoir. This is especially evident in the chapter on his volunteer work at two orphanages that were served by Catholic nuns and located in Viet Cong-controlled territory. For these homeless children bereft of parents due to the war, Jim was a physician, friend, and surrogate parent. Jim also appealed for charitable donations—clothes, medicine, and toys— for the orphanages, to which Jim’s parish, St. Francis of Assisi Catholic Church in Rochester, Minnesota, and Rochester’s citizenry vigorously responded. For his service to his country, Jim was awarded the Bronze Star Medal in 1968. Jim now provides another service some fifty years later: namely, the sharing of and reflecting on uncommon experiences and unique challenges in a turbulent place and in a troubled time. The resulting memoir is wonderfully told, engaging, informative, and uplifting. For this additional service, Jim warmly deserves our admiration and gratitude.
Karl A. Nath, MB.ChB Editor-in-Chief, Mayo Clinic Proceedings Rochester, Minnesota June 2017