Pulling Back the Curtain: Robert A. Kyle, MD

Robert A. Kyle, MD
Professor of Laboratory Medicine & Pathology and professor of Medicine at the Mayo Clinic in Rochester, Minnesota

In this edition, Robert A. Kyle, MD, chronicles his nearly 70-year career and rural beginnings, from attending a one-room schoolhouse in North Dakota to finding a home at the Mayo Clinic.

Hear more from our interview with Dr. Kyle in Sound Bites.

Dr. Kyle on his family farm in North Dakota.
Dr. Kyle on his family farm in North Dakota.

Where did you grow up?

I am from Bottineau, North Dakota, a small town about 15 miles from the Canadian border. After immigrating from Ireland to eastern Canada, my father’s family moved to North Dakota in the 1880s.

My father, who had learned the trade of vulcanizing in World War I, ran a shop there selling new tires and repairing old ones. As you can imagine, he was exposed to a lot of dust and rust from the rims. After a few years, he decided that this wasn’t a healthy occupation, so he bought 160 acres of land near Bottineau, built a house, and began grain farming. Gradually, he acquired more land, and it’s more than 5,000 acres now.

I was about two years old when we moved to the farm, and I have four younger brothers. My youngest brother and his son still farm. It’s a huge operation – just the machinery for planting the grain costs about a million dollars.

What was it like growing up in a rural area?

My town had a one-room schoolhouse, with one teacher who taught eight separate grades. I was always interested in school. Shortly after my fifth birthday, I asked my mother if I could visit the school. When I came home, I told my mother I wanted to start school in the fall. There were no restrictions on age of entry to school at the time, so I started first grade.

I liked school, and my teacher saw that too. When I was finishing sixth grade, she asked me if I wanted to take the eighth grade and high-school entrance exam early, I agreed, and I ended up with one of the top grades in the county. I skipped seventh grade and started high school at the age of 12.

Transportation was difficult in that part of the country, especially in the winter, so kids who lived on farms would rent a room close to the high school in Bottineau, which meant living on their own and doing their own cooking. My mother didn’t think a 12-year-old was quite capable of that, so she arranged for me to eat my meals and live with an aunt and uncle in town.

When I finished high school in 1944, I was 16. Virtually all my classmates went into the military to serve in World War II, but I was too young to be drafted. So I began attending the North Dakota School of Forestry, the local junior college.

At the end of my first year, I got a job with the U.S. Forest Service in Idaho as a lookout fireman, searching for forest fires during the summer fire season. In the fall, I returned to school and, when I turned 18, I was drafted before I could finish my second year of college. I went to Fort Snelling in Minneapolis for my physical examination, and, fortunately, three weeks after that exam, the U.S. stopped drafting teenagers and I was able to continue my education at the University of North Dakota.

The fire lookout tower in Idaho where Dr. Kyle worked as a teenager.
The fire lookout tower in Idaho where Dr. Kyle worked as a teenager.

When did you decide to pursue medicine as a career?

I already was interested in medicine when I was at the School of Forestry and took some premed courses. The University of North Dakota had a two-year medical school that covered the basic life sciences – anatomy, pathology, and physiology – and allowed students to transfer to a four-year school for clinical training.

While I was there, I made an appointment with the dean of the University of North Dakota Medical School. He told me my grades and MCAT scores were good, but that the medical school was in danger of closing. I was only 18 then, so he recommended I get my bachelor’s degree, then apply to four-year schools. His advice was simple and sounded reasonable to me: “If you want to be a professor, apply to Harvard. If you want to do research, apply to Johns Hopkins or the University of Pennsylvania. But, if you want to be a real doctor, go to Northwestern in Chicago.”

So, you went to Northwestern?

Yes, I applied and was accepted to Northwestern and Penn, but decided to attend Northwestern. Years later, after I joined the Mayo Clinic staff, I was visiting one of my neurology colleagues and we realized that we graduated from medical school the same year, I from Northwestern and he from Penn – where he initially was on the alternate list. I told him, “You know, I’m responsible for your getting to medical school: You got the position that I turned down.” Of course, that’s unlikely, but I never let him live that one down.

Is there any advice you received in medical school that you would share with students today?

On my first day at Northwestern, the dean told our incoming class, “You were all selected from a couple thousand applicants. You all have the ability to do the job and we want to graduate every one of you, but you have to work.”

I took that to heart, and, fortunately, so did my roommate. We kept up with our assignments and studied five or six evenings a week, but always quit to go to bed at 10:00 p.m. We remained roommates throughout medical school and internship. He became a neuroradiologist and we had a long friendship.

“In 1952 … I was drafted into the Air Force in Alaska for two years and placed in a 400-bed hospital to run the internal medicine ward.”

–Robert A. Kyle, MD

Why did you decide to specialize in hematology?

During my internship, I found that I enjoyed internal medicine. Also, a rather difficult head of surgery at Northwestern dampened any possible interest I had in that field. I worked with a few internists who had graduated from programs at the Mayo Clinic and they seemed to know everything, so I interviewed and they offered me a position.

My three-year fellowship program entailed spending three months in the laboratory, selecting a project, and writing and defending a thesis before receiving a degree. We also were expected to turn the thesis into a medical paper and submit it for publication in a reputable journal.

I had three options: pathology, physiology, and hematology. I knew the least about hematology, so I signed up for six months in the laboratory reading peripheral blood smears and bone marrows. I was planning to go to California to open a private practice once I finished my internal medicine training, and I figured I’d have a leg up on any internist down the street because I would be able to read peripheral bloods and bone marrows.

So, I chose acquired hemolytic anemia for my fellowship project. I did my thesis, defended it, and spent most of the summer submitting it to a journal.

Why did you shift your focus from opening that private practice in California?

In 1952, in the middle of my fellowship, the “Doctor Draft” appeared and physicians were conscripted into military service. I was drafted into the Air Force in Alaska for two years and placed in a 400-bed hospital to run the internal medicine ward. In addition to 10,000 army troops, the military hospital also took care of the dependents of the airmen and the officers. It was a good training program to learn practical medicine.

At the end of the two years, I came back to the Mayo Clinic to finish my internal medicine training. I realized I didn’t know anything about clinical hematology, though, so I signed up for the hospital service in hematology, where two things happened that altered my medical life.

The first was seeing a serum protein electrophoretic pattern. It’s a common laboratory test now, but it was so new at the time that I had to ask the consultant on the hospital service, “What in the world is this? I’ve never seen this before!” He said, “It’s a new test. We don’t know much about it, but we do find these spikes in the electrophoretic pattern in patients with multiple myeloma and macroglobulinemia. Why don’t you look into it?”

With that, I reviewed the 6,000 or so patterns that had been done in the previous three years, and published a paper in JAMA about the spikes in the patterns seen in patients with myeloma, macroglobulinemia, and amyloid light-chain amyloidosis.

The second experience happened while I was on service: A woman with myeloma was admitted to the hospital for radiation therapy. She had severe lower back pain. The hematologist who saw her noted that her skin looked strange and asked for a dermatology consultant, but neither knew what was causing it. Next, he took a punch biopsy and the pathology report came back as “amyloid.” Until then, I had never seen or, more truthfully, recognized a patient with amyloidosis. I went to the medical index and had the director pull out all the cases of primary amyloidosis seen at our institution.

I ended up finding about 80 cases of primary amyloidosis and, after reviewing their bone marrows, I realized that a number of these patients actually had multiple myeloma, while all had some abnormality in their bone marrow plasma cells. From that point on, I was set on working in the area of myeloma, macroglobulinemia, and amyloidosis.

After finishing my internal medicine training, the Mayo Clinic offered me a position as an “assistant” to the staff, but I decided to pursue more training at another institution. Fortunately, I was able to do a fellowship in Boston with William Dameshek, MD, who was one of two leading clinical hematologists in the country. Eventually, the Mayo Clinic invited me to come back as part of the staff, so at the end of 1961, I came back as a consultant in hematology. I’ve been here ever since.

Aside from your work, what do you do with your time? Do you have any hobbies?

I had an interest in stamp collecting, or philately, since I was a kid, but that was sidelined for many years by my dedication to my career. In 1965, though, I was diagnosed with an acute midline disc problem. I didn’t want surgery, and the cost of hospital beds was much less then, so I spent 40 days in the hospital recovering. Suddenly, I had spare time.

Dr. Kyle at the Mayo Clinic.
Dr. Kyle at the Mayo Clinic.

That’s when I rekindled my interest in philately. I looked through the volumes of the Scott Catalogue of Postage Stamps, which are massive books that include philatelic information on every stamp published from every country in the world. I searched for any stamp related to hematology, cancer, or blood transfusion. My wife has joined me in this hobby and we have exhibited our stamps at several local, regional, and national stamp meetings.

Through these events, we’ve met several other medical philatelists. In the late 1960s, an associate editor of JAMA and fellow philatelist asked me to work on a collection of vignettes about people who had made important medical contributions and had stamps issued in their honor. My colleague at Mayo Clinic, Marc Shampo, PhD, and I published that book, and continued to write vignettes that were published in JAMA for nearly 20 years, until a new editor started. Since then, we’ve continued to publish them in the Mayo Clinic Proceedings. I don’t know the exact number of vignettes we’ve written, but we have published four books of more than 600 of these biographies. (Editor’s note: Dr. Kyle previously spoke with ASH Clinical News about his interest in “hemo-philateley” in our pASHions section.)

What does your typical day look like now, after having practiced for so long and made so many contributions to the field?

I stopped seeing patients about 20 years ago. I was over 70 at the time and had spent 40 years on the faculty. I had started cutting back on the number of patients I was seeing, but, finally, I decided that it was time to stop. That decision also was helped by my wife and kids, who told me I was working too much. Still, I get well over 100 emails and telephone calls a day from patients.

Five or six years later, I stopped running the laboratory. Since then, I have been on the board of the International Myeloma Foundation, the International Waldenström’s Macroglobulinemia Foundation, and the International Society of Amyloidosis.

I keep busy, though. I get to work around 7:00 a.m. and work five and a half days a week, just like when I started at the clinic. I do plenty of writing. Over the years, I’ve published more than 1,100 papers on the monoclonal gammopathies and so forth, and we now have more than 15 consultants as permanent staff members in hematology who conduct myeloma and macroglobulinemia research. I also edit papers for medical residents, fellows, and students, and I’m in the process of writing my memoir. I write what I remember; then, reading and editing what I’ve written always brings back other memories, so it’s an ever-growing project.

I also travel extensively. I’ve probably made a couple hundred trips to Europe over the years and I’ve been to Asia and other parts of the world, too. My family and I take road trips in the U.S., and I’d guess that I’ve visited the National Parks a half dozen times. History and geography have always interested me.

How many children do you have? What do they do?

We have four children. None of them are physicians, but they’re all happy.

Our son taught high school science for 30 years, following an internship with NASA that piqued his interest in meteorology and the solar system. Our oldest daughter has a master’s degree in soil science and worked with a research organization but became an orthopedic nurse before she recently retired. Our second-oldest daughter also works in nursing and is in charge of the nursing health program for the five high schools in Minneapolis. Our youngest daughter is a public defender in Hennepin County, Minnesota.

Do you wish that your children had gone into medicine?

No, I have seen people who have gone to medical school mainly because their parents or grandparents wanted them to. They’re not always the best doctors and they’re not always happy with what they’re doing. We’re happy that all our children are doing something helpful for society.

Dr. Kyle, at left, with his collaborator, Marc Shampo, PhD.
Dr. Kyle, at left, with his collaborator, Marc Shampo, PhD.