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Giants in Obstetrics and Gynecology Series: A profile of Nathan Kase, MD

      Click Supplemental Materials under article title in Contents at ajog.org
      Dr. Nathan Kase is Dean Emeritus of the Icahn School of Medicine at Mount Sinai Hospital, New York, where he also was Chair and Professor of Obstetrics, Gynecology and Reproductive Science, and Professor of Medicine. Prior to his move to New York, Dr. Kase was Chair of Obstetrics and Gynecology at the Yale University School of Medicine.
      During his distinguished career, in addition to decades of clinical practice in reproductive endocrinology, extensive teaching, and diverse high-level academic and hospital administrative duties, he made groundbreaking clinical and research contributions to the understanding of the physiology of the steroid hormones secreted by the ovary, the biosynthetic dysfunction of polycystic ovaries, testicular feminization, and various functional ovarian tumors (Figures 1 and 2).
      Figure thumbnail gr2
      Figure 1An in-depth analysis of traditional studies on polycystic ovary syndrome
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail gr3
      Figure 2A case review revisits the testicular feminization syndrome
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Additionally, he developed successful methods for the induction of ovulation with clomiphene and gonadotropin therapy. On the basis of these accomplishments, Dr Nathan Kase is being recognized as a Giant in Obstetrics and Gynecology in this issue of the Journal.

      Growing up with a father in medicine in Brooklyn, NY

      Nate was born in Brooklyn, NY, in 1930, at the beginning of the Great Depression, when Brooklyn (as he recalls it) “was a quiet, largely middle class, almost a separate city: everyone was quite civil; streets were safe and clean.” He described his upbringing as “privileged, safe … idyllic.”
      “I could go off at some length on my heritage,” he said when asked about his early life. “I am Jewish by heritage, by choice, by identity, if not by sacramental practice. I am part of a linked chain to an eons-long heritage that I cherish, and it takes the form of my devotion to my father and love of my mother.” Nate feels very much part of the immigrant experience, notwithstanding that his mother was born in this country, so he is a second-generation American.
      Nate’s father’s family hailed from Russia: “They were millers and farmers and religious, Eastern European Jews, much like those depicted in Fiddler on the Roof.” They resided in the Pale of Settlement and, because of their religion, were required to live on the outskirts of Minsk.
      Nate’s grandfather’s family emigrated to the United States, one by one. Half settled in the turbulent, multiethnic crucible of the Lower East Side of Manhattan; the other half yearned for their agrarian roots and went west to the plains of Iowa. His father, Joseph, the youngest of the family, joined them in New York in 1898, emigrating on his own at the age of 13 years by a circuitous route that took him from his native hamlet to Riga, Latvia; by boat to Halifax, Nova Scotia; on to Montreal, where he crossed the border from Canada on the Boston and Maine Railroad into the United States. He reached Coney Island by ferry from Boston, where he was greeted by his father and eldest brother.
      This process was another form of a liberating underground railway (in large part over oceans). Nate commented as to his father’s solo round-the-world travel, “I doubt I would have had the courage to make that journey when I was a youngster.”
      After Nate’s father received his night school-generated Regent’s High School diploma from the Board of Education of the City of New York, he attended and earned his MD degree in 1910 from the Long Island College Hospital School of Medicine, which later became the Downstate School of Medicine of the State of New York.
      After graduation, he received a much-prized surgical residency at Gouverneur Hospital located in lower Manhattan. The hospital, presumably named after Gouverneur Morris I, an author and signer of the US Constitution, was the general hospital serving the teeming, multicultural, immigrant residents of the legendary Lower East Side's tenement ghettos.
      During this internship, while on ambulance duty as a surgical intern, he attended the wounded and dying women seamstresses caught in the infamous Triangle Shirt Fire of 1911, at which his older sister worked. Some years later, as his sons, Jonah and Nathan, were in internship and medical school, respectively, he recounted this experience as a moral and ethical challenge he encountered as a physician: Should he care for the desperately burned and injured women laborers or search out and find his own sister? He chose his professional obligation to attend to his patients. His sister survived, unwounded.
      After residency, his father returned to his community, cared for all during the dreadful epidemic of 1918–1919, and thereafter left for the suburbs, Crown Heights, Brooklyn, just as the subway service, the New Lots Line of the Interborough Rapid Transit system, was being extended deep into the community.
      Nate’s family lived in a classic Brooklyn brownstone. His father’s office, waiting room, examination rooms, and radiology suite, which were unique in the area at that time, were on the first floor, and the family lived in the three floors above. His fees were $3 for an office visit and $5 for a home visit or night call back then, but it was the Great Depression and there was little cash, so his father’s services were usually in trade (for example, trade was exchanged with the butcher, lawyer, plumber, grocer, or dentist for his medical services) or usually went unpaid. Nevertheless, although funds were limited, it was sufficient to establish a “wonderful” quality of life.
      Nate describes his mother, Flora, as not only “amazingly beautiful” but also streetwise, like Portia in the Merchant of Venice. She was also unique to her generation, having graduated from Hunter College in 1918. Thereafter she ranked first in the New York State Teacher’s qualifying examination and went on to teach English and science in the Brooklyn public schools for 45 years. Nate attributes his love of teaching and science to her influence: “There was no escaping the influence of this at-once imperial, demanding, but loving woman.”

      Nate’s education at Erasmus and Columbia College

      Nate was educated at public schools in Brooklyn. He and his brother and cousins all attended Erasmus Hall High School, the second oldest such school in America (after Boston Latin), which was founded by Dutch Episcopalians who originally settled the Flatbush section of Brooklyn. “Everyone went to Erasmus from the neighborhood,” he said, and “80% of the Erasmus senior class went to college.”
      Erasmus was a good school that kept Nate away from bad influences, but school did not arouse or inculcate in him a sense of intellectual responsibility. He considered himself neither educated nor scholarly when he graduated. What transformed Nate intellectually were his experiences at Columbia University: he called his undergraduate studies the “signal element, the turning point of my life, the first of many to come.”
      Nate entered Columbia in 1947. During college, he was senior class president and president of his fraternity, graduating with the class of 1951. He commuted to Columbia for the first two years on the Interborough Rapid Transit system from Brooklyn Station Kingston Avenue to 116th Street, spending the two-hour, round-trip commutes studying.
      On his first day at college during orientation, Mark Van Doren, professor of English literature, told the incoming class, in Nate’s case correctly, “At Columbia, we know that very few of you can read or write capably, so we intend to change this in the next four years and to do so as rapidly and successfully as possible.” During his first two years, like all students, Nate took two two-year required core courses, Humanities and Introduction to Contemporary Civilization in the West.
      These courses taught him “to read and write with comprehension and insight.” A real alchemy occurred, as Nate remembered, “Van Doren assigned us the first six books of the Iliad to read over the weekend, and we had to take a 20-item objective test when we returned to school on Monday to prove we had read it!”
      Instead of mentors, Nate had role models he idolized and still tries to emulate at the age of 87 years. Foremost among them was Jacques Barzun, professor of English and modern literature, who taught Nate what was to become his signature teaching style, “the beauty, the range of expression, the levels of nuance recorded by the English language; how to exploit and employ these elements to communicate accurately but with your own personal sense of style.” Barzun was a true academic; he made Nate feel that his life could be gloriously spent just reading and communicating as a hybridized, liberal arts physician.

      Medical school and meeting his future wife, Judy

      After graduation, Nate entered Columbia College of Physicians and Surgeons, and it was then that he met on a blind date his wife-to-be, Judith Glass. Another student introduced them, and he knew the moment he saw her that she was the woman he wanted to marry. But Nate was wary of marriage (“I ran like crazy!”), so it would be four years and a three-month separation from Judy before he proposed and she accepted. This proposal occurred in his last year in medical school. Judy had just graduated from Sarah Lawrence College and was off to Radcliffe for a Master’s degree in education.
      Nate lost Judy in 2013. They had been married for 58 years and have three children and nine grandchildren. Nathan described her in this manner: “I took her advice for every element of whatever I did professionally or personally. She was my brain, my heart, my principles, my philosophy, my backbone, and my strength.”

      Internship, residency, research, fellowship, and junior faculty positions

      After graduating from medical school in 1955, Nate did a rotating medical internship and a first-year residency in obstetrics and gynecology at Mount Sinai Hospital. Nate chose to interrupt his residency after the first year and entered the military as part of the “Berry Plan,”
      • Berry F.
      The story of “the Berry Plan.”.
      which was also referred to as the Doctor Draft.
      He selected the deferment program option to enter the Air Force after his internship and one year of residency, spending two years as an Air Force captain in the Medical Corps as an obstetrician and gynecologist at the Travis Air Force Base in Fairfield, California. By the Berry Plan contract, after service he returned to Mount Sinai Hospital to complete his residency.
      Military service was a boon to the young Kase family. It not only provided an extraordinary, fulfilling clinical experience, but also Nate and Judy were transformed from a pair of indulged, dependent children into adults, on their own, as a couple and family.

      Joining the Air Force through the Berry Plan and scientific training at the Worcester Foundation

      Because he had such a rich, diverse, and intense clinical experience at Travis Air Force Base (more than 800 deliveries, more than 40 unassisted majors, and countless minor gynecological operative procedures), he was granted one year’s experience against the four-year American Board of Obstetrics and Gynecology requirements. Accordingly, he applied and received a National Institutes of Health-sponsored fellowship in steroid biochemistry at the Worcester Foundation for Experimental Biology in Shrewsbury, which was coupled with a didactic as well as a one-year laboratory course in theoretical and experimental steroid biochemistry at Clark University in Worcester.
      There, working in Ralph Dorfman’s laboratory, his laboratory director, Enrico Forchiello, assigned Nate the project of finding testosterone in human ovary homogenates. Nate knew, “If an organ made estrogen biosynthetically, it had to make testosterone as a precursor. I was looking for something that was there; it just meant I had to find it.” That was no easy task. There were no immunoassays at the time, and it required purification and repurification to crystallization to radiochemical purity to prove identity. Nate succeeded, however, and was the lead author on the article to first report that testosterone was a necessary biosynthetic precursor of estrogen in the human ovary.
      • Kase N.
      • Forchielli E.
      • Dorfman R.I.
      In vitro production of testosterone and androst-4-ene-3, 17-dione in a human ovarian homogenate.
      Returning from Massachusetts, while a resident at Mount Sinai Hospital, he wrote two more articles, the most important of which was finding excess testosterone production in patients with Stein-Leventhal syndrome (polycystic ovarian disease) and virilizing adrenal tumors.
      • Kase N.
      • Kowal J.
      • Perloff W.
      • Soffer L.J.
      In vitro production of androgens by a virilizing adrenal adenoma and associated polycystic ovaries.
      • Kase N.
      • Kowal J.
      • Soffer L.J.
      In vitro production of testosterone and androstenedione in normal and Stein-Leventhal ovaries.
      With that work, the already-popular chief resident at Mount Sinai Hospital made a name for himself and received two job offers: one was to join as the gynecologist in a lucrative medical endocrine practice led by Dr Louis Soffer, then the dominant medical endocrinologist of New York City and author of the reference text Diseases of the Adrenal Glands. This job offer carried a starting salary of $50,000 per year and a bench in a clinical adrenocortical laboratory.
      The other offer was to work with Lee Buxton at Yale as an instructor, replacing the world-class Walter Herrmann, who left for his homeland of Switzerland for a highly prized professorial chair. Herrmann’s laboratory also had an active clinical laboratory. The starting salary at Yale was $8,000 per year. Nate decided to go to Yale.

      From instructor to professor and chair of the department at Yale

      Nate joined the Yale faculty in 1962 as an instructor, the same month as Fidel Castro marched into Havana, Cuba, and the stock market crashed. This event was an inauspicious start because Nate had to sell all the stocks Judy and he had received as wedding presents to put a down payment on a house for Judy and their three young children.
      They chose a house on favorable terms in Woodbridge, Connecticut. Although other Yale School of Medicine faculty lived there, nevertheless, as born and bred New Yorkers, they were not sure what reception to expect as the first Jews to move into a very Yankee part of the community. They were warmly received, most of all by most of the multigeneration Yankee of their neighbors, the local president of the gardening and historical societies, who became their “warmest friend and champion” and “aunt” to their children. Nate still expresses this happiness he and his family found in the warmth of that community.
      When Nate arrived in New Haven, the Grace New Haven Hospital was the dominant clinical element of the Center, and the Yale Medical School was still tiny, an appendage of the hospital. The Department of Obstetrics and Gynecology had a small but eminent full-time faculty (Lee Buxton, John Morris, Clarence Davis, and Edward Hon) and presented endless opportunities for “imaginative, serious individuals, not just in terms of fetal physiology and neonatal outcomes and gynecologic cancers, but also in gynecology and, particularly, the science of human reproduction.”
      Research on steroid hormones continued at Yale; Nate found “a ton” of testosterone in the testes of patients with testicular feminization.
      • Kase N.
      • Morris J.M.
      Steroid synthesis in the cryptorchid testes of three cases of the “testicular feminization” syndrome.
      Because his findings (among others that emerged independently at that time) refuted the prevalent view that testicular feminization was caused by some as-yet-to-be-determined biosynthetic abnormality in the testes, this work added to the realization that testicular feminization was not caused by a deficiency in secreted or circulating testosterone but in its androgen receptor.
      Nate rose rapidly through the ranks at Yale (assistant professor in 1963, associate professor in 1966) to become Professor and Chair of the Department in 1969 after Ted Quilligan left for the University of Southern California, just seven years after Nate joined the faculty.
      During those years, he made groundbreaking contributions to reproductive endocrinology on the mechanisms underlying polycystic ovary disease,
      • Kase N.
      • Forchielli E.
      • Dorfman R.I.
      In vitro production of testosterone and androst-4-ene-3, 17-dione in a human ovarian homogenate.
      • Kase N.
      • Kowal J.
      • Soffer L.J.
      In vitro production of testosterone and androstenedione in normal and Stein-Leventhal ovaries.
      • Kase N.
      Steroid synthesis in abnormal ovaries. 3. Polycystic ovaries.
      demonstrating that excess androgens are secreted by the ovaries as well as the adrenals produced by extragonadal,
      • Kase N.
      • Cohn G.L.
      Clinical implications of extragonadal estrogen production.
      nonadrenal cortical metabolic conversion.
      Nate also pioneered the induction of ovulation with clomiphene and later with human menopausal gonadotropin and human chorionic gonadotropin in patients with polycystic ovarian syndrome and various forms of hypothalamic amenorrhea, using schedules and dose regimens, subsequently approved by the Food and Drug Administration for induction of ovulation (Figure 3, Figure 4, Figure 5).
      • Hart Jr., T.
      • Kase N.
      • Kimball C.P.
      Induction of ovulation and pregnancy in patients with anorexia nervosa.
      • Kase N.
      Induction of ovulation with clompiphene citrate.
      • Kase N.
      • Mroueh A.
      • Buxton C.L.
      Pergonal therapy of anovulatory infertility.
      • Kase N.
      • Mroueh A.
      • Olson L.E.
      Clomid therapy for anovulatory infertility.
      • Mroueh A.
      • Lytton B.
      • Kase N.
      Effects of human chorionic gonadotropin and human menopausal gonadotropin (pergonal) in males with oligospermia.
      Figure thumbnail gr4
      Figure 3A report on a successful therapy for infertility
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail gr5
      Figure 4Results of clinical therapy for infertility
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
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      Figure 5A novel reversal of anorexia nervosa by induction of ovulation
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      In recognition of his gift for educating aspiring physicians, Nate was a recipient of the Francis Gilman Blake Award, an honor annually bestowed on the best teacher of the medical sciences by each graduating class at Yale.

      Building an academic department in New Haven

      As Chair, Nate ran an academically productive, increasingly nationally recognized department. About the faculty and trainees, he stated, “I did my best to engage their interests, support their ambitions, control their excesses, organize their priorities, and remind them of the issues of scale and costs but then let them manage on their own.”
      Nate developed a well-deserved reputation for having an eye for talent: “Many of the junior faculty I recruited subsequently became chairs of university departments: among many others (Leon Speroff, Donald Coustan, Alan DeCherney, Richard Berkowitz, Peter Schwartz, John Hobbins, Roberto Romero, Charles Lockwood, David Gershenson, and Mary Lake Polan). Indeed, at one time, more than 30 members of the prestigious American Gynecological and Obstetrical Society were graduates of the Yale program.”
      Nate attributed a portion of the success of his junior faculty to the qualities he looked for when recruiting them: “the individual’s energy, commitment, inventiveness, honesty, zeal, some evidence of having started and finished something, and a thirst for everything that I wanted, namely some unique identity for discovering or developing clinical or scientific new knowledge, not entirely for ego satisfaction but for contributions to the care of patients. These are the factors I sought and gambled on.”
      “What was equally important,” Nate added, “was whether I personally liked the individual. Did I find that individual humane, sensitive, more than just bookish or self-directed? Is that person someone I would be fond of, with whom I could play baseball, or, basically, whom I could invite to my home for dinner? All those men and women that were at Yale, each one of them, had those unique, professional, and human qualities.”

      Two seminal decisions: courage and vision

      Nate made two signal administrative decisions as Chair.
      The first was testing the state law criminalizing physician-assisted termination of pregnancy. Nate’s predecessor, Lee Buxton, had challenged Connecticut’s contraception law forbidding use of contraception. The Connecticut Supreme Court had upheld that law as constitutional, which Buxton intentionally violated. Previously, the US Supreme Court had declined Buxton’s Petition for Certiorari from the decision as not ripe.
      As a result, Buxton prescribed contraception to his patients and, as expected, was imprisoned for this act. His imprisonment was initially upheld by the Connecticut Supreme Court, but this time, the US Supreme Court granted a petition to review the case; in a 1965 landmark 7-2 decision, captioned Griswold v Connecticut, the US Supreme Court struck down the Connecticut law as an unconstitutional violation of the right to privacy. It was this very case that created the new and controversial right to privacy that was the basis for the Court’s later 7-2 decision in Roe v Wade.
      The next step in the process fell to Nate.
      One of the department’s staff members, also an infertility patient of Nate’s who had rising rubella titers and was in the first weeks of gestation, was denied a termination of pregnancy by the medical board of the Grace New Haven Hospital. She went abroad for her dilation and curettage.
      Next, a patient was identified by New Haven Planned Parenthood’s Dr Virginia Stuermer to be in early pregnancy and requesting termination. Nate said, “I joined the case as a gynecologist and, with legal advice from three senior Yale law students, appealed to Judge Newman of the appellate court of New Haven to allow the termination at Yale New Haven Hospital. We were vigorously opposed by the state Attorney General; however, we were granted permission to proceed. In the days before we (Bud Gore and I) were scheduled to do the case, we endured extreme pressure from the Dean, who tried to persuade me not to proceed, fearing reprisal from state government in the form of refusal to fund a major mental health center initiative (which, in fact, was granted after all).”
      Nate received moral support, even if not official backing, for his decision. Kingman Brewster, the former diplomat and president of the university, who Nate described as a “heroic figure” and a “colossal intellect,” gave Nate moral support, if not formal university approval. In addition, Charles Womer, the hospital director, who had, in reality, the greatest risk of community anger and retaliation, told Nate, as he recalls, “Nathan, I understand what you might do to us, but go ahead.” Nate explained his decision to me this way: “My Chief at Sinai was Alan Guttmacher. My first Chair at Yale was Lee Buxton. How in the world, Roberto, did you think I could break that chain?”
      Nate’s second decision as Chair was to help establish a midwifery program at Yale. That decision made him popular with the School of Nursing, at least until he also advocated for widespread use of physician assistants and other health professionals for services in the hospital. Nate felt strongly that midwives should practice only in the hospital setting supervised by obstetricians. He drew a line at home deliveries.
      Another, but different, landmark came during Nate’s chairmanship at Yale. It was the first publication of every resident’s vademecum, Clinical Gynecologic Endocrinology and Infertility.
      • Speroff L.
      • Glass R.H.
      • Kase N.G.
      This volume, and subsequent editions, taught many generations of obstetricians and gynecologists. The book was an outgrowth of a series of lectures that Nate, Leon Speroff, and Robert Glass gave to the residents on Saturday mornings. Initially, Nate refused to take credit for the book of which he was very proud, which went through six editions before he retired from its authorship after becoming Dean at Mount Sinai. Nate insisted that Leon and Bob turn the lectures into a book, and he minimized his own contribution as “giving some stylistic input.”

      Dean of the Icahn School of Medicine at Mount Sinai

      Three years after stepping down as Chair at Yale in 1978, Nate moved to Mount Sinai in New York to serve as Chair of Obstetrics and Gynecology. His job was “to rebuild a department and then move, within two or three years, to the Deanship. The then [chief executive officer] had told him point blank: “Repair Obstetrics and Gynecology and get yourself ready to become Dean.” He became Dean of the Medical School in 1985, a position he held for 13 years, the first time around.
      Nate’s task as Dean was to “develop the new science of medicine at Sinai” and to make the Medical School a competitive research enterprise. Nate encountered few obstacles: he was given significant financial support from a generous Board of Trustees, which meant he could recruit faculty at both the junior and senior levels, and, more importantly, his initiatives were all supported by the clinical faculty who “understood the deficiencies of what they had relied on in the past.”
      For too long, Sinai had leaned on remarkably astute clinical observations supported by, for its day, superior strengths in descriptive pathology and clinical chemistry. The school’s faculty was ready to go beyond phenomenology and pursue mechanisms of human dysfunction and disease. Accordingly, the faculty welcomed the creation of multidisciplinary centers in molecular biology, neurobiology, and immunobiology, all within five years.
      Nate instituted external reviews of every department and immediately relieved some veteran Chairs of their administrative roles. Within five years of his tenure as Dean, Nate had expanded the school significantly, turned over most department Chairs, and increased the number of assistant professors by 50%.

      The Humanities in Medicine Program at Mount Sinai

      Nate’s most radical contribution, however, was in medical education. As Dean, he established and implemented the Humanities in Medicine program at Mount Sinai.
      • Muller D.
      • Kase N.
      Challenging traditional premedical requirements as predictors of success in medical school: the Icahn School of Medicine at Mount Sinai Humanities and Medicine Program.
      HuMed, as it was called, was an early admissions program open to college sophomores majoring in humanities or social sciences.
      The program was modeled after the 1984 report of the American Association of Medical Colleges that addressed baccalaureate education in relation to medical school admissions policies. The General Professional Education of the Physician and College Preparation for Medicine in the 21st Century Report concluded that the then-current emphasis of medical education on memorizing and repeating facts was unsuited to the conditions of practice that physicians were likely to encounter in the 21st century.
      The initial assessment process for the HuMed program included excellent grade point averages, high SAT scores (generally averaging 750), and/or high school advanced-course success. Selection was also based on essays, interviews, letters of recommendation, and extracurricular activities. “We sought demonstrated rhetorical skills defined by cogent, effective writing displaying originality, sound analysis, and persuasive arguments developed and sharpened in a variety of pursuits.”
      Most importantly, personal achievements had to demonstrate depth of involvement and some form of conclusive impact on an aspect of human welfare. As Nate described it to the faculty, “The HuMed selection process would seek to distinguish the self-initiating, self-directed, independent, often-courageous student from the equally intelligent, well-prepared, but passive recipient of current knowledge.”
      Nate favored collegiate experiences involving strong, well-mentored small-group seminars as the way to enhance self-discovery and self-scrutiny, to prepare students on what to look for in others, and to gain insight into their own personal preferences and prejudices. Ideally, this approach would inform young people of their strengths and shortcomings, develop their ability to communicate effectively, and teach them to behave adaptively by controlling their behavior “…to know how far to take your points and be receptive to the views of others.” Nate emphasized, “I was convinced that was what you needed to be a good physician and professional colleague: develop relationships based on insights into human experience and providing humane, altruistic care and concern for patients.”
      With its initial success, the HuMed program eventually grew to 25 slots of 140 admitted positions for each entering class. These students studied social sciences and humanities at college; maintained a B average; and took and passed elementary biology and chemistry instead of the traditional, heavily weighted, premedical school curriculum. They were not required to take the Medical College Admission Test.
      The results were immediately apparent and sustained. In their freshman and sophomore years, the HuMed students put on all sorts of theatrical and musical shows—“art exhibitions, readings—and established and attended a course in Medicine in Literature. They absorbed the New York culture, but more impressive they blossomed in their clinical years. In the first graduating class containing HuMed students, the student graduating first in the class was a music major from Princeton; the student graduating second in the class was a professional violinist who had attended Julliard in a joint program with Columbia College,” Nate recalled. The clinical faculty went from skeptical to surprised, impressed, and overjoyed.

      Coming back from retirement to serve as Dean and Chief Executive Officer of the health care system

      Nate submitted his resignation after the then-CEO initiated a series of affiliations, all of which did not flourish, first with Columbia Physicians and Surgeons and then with New York University School of Medicine. During that lengthy process, Nate felt any new entity should have a new Dean. When that new Dean left within two years, Nate was recalled to be both CEO and interim Dean. During this second tenure, Nate managed to stabilize the hospital’s finances and set it in a more positive trajectory within three years.
      Thereafter, with a new Dean and CEO (whom he had identified early in this individual’s career at Sinai), he stepped down for the second time but continued as professor. Remarkably, now still active full time at the age of 87 years, he returned to the faculty role as Professor of Obstetrics/Gynecology and Reproductive Sciences as well as in the Department of Medicine in its Division of Endocrinology. In the latter role, he was named Mount Sinai’s Endocrinologist of the Year in 2012.
      He still indulges his abiding love of education by teaching fellows in medicine endocrinology, reproductive endocrinology and infertility, third-year medical students, and residents in various specialties. He also gives grand rounds at three hospitals—Mount Sinai, Mount Sinai West, and Mount Sinai Beth Israel. Nate also continues to be involved in research that focuses on the epigenetics of polycystic ovarian syndrome and the determinants of breast cancer. He still sees a few patients in consultation.

      Interests

      Nate does not watch broadcast or cable television other than pursuing a fiendish interest in the New York Yankees, New York Giants, and New York Rangers. He reads avidly. Nate said that he exploits his love of communication by reading good fiction. Nate especially loves the craft of description, how language can be used to draw distinctions that clarify, particularly when applied to depict different and remarkable facets of human behavior.
      He was raised on Twain and Dickens, discovered Kafka and Thomas Mann in college, and now reads just about any current, quality fiction: the late Robertson Davies, Lee Childs, Philip Roth, and he wishes Amor Towles’ novel, A Gentleman in Moscow, had never ended.
      Nate does not read much poetry but recently discovered Robert Pinsky; he was deeply moved by the poem “Branca.” Pinsky, the former United States Poet Laureate, melds the heartbreak of Ralph Branca, the Dodger pitcher who gave up the home run that shook the world of professional baseball, his previously unknown parentage, and his unique relationship with his teammate, Jackie Robinson, in a way that only modern poetry can convey. Growing up, Whitman’s “Oh, Captain, My Captain” was his favorite poem; later in life, it was Matthew Arnold’s “Dover Beach.”

      Closing thoughts

      Looking back on his extraordinary career, Nate said he had few regrets. One is that he did not give his father the credit and respect during his life that he should have given. “I am burdened with this and will be to the end of my days,” he said.
      Another is that at many times in his leadership roles, he allowed the ends to justify the means. Expediency and the goal became more important than the methodology. “As Dean, I had to cajole, pressure, and dismiss. It may be personally difficult to admit—in this respect I am not proud—but I wanted to give you, Roberto Romero, an unvarnished account of the positive and negative qualities of your friend and colleague, Nathan Kase.”
      Knowing Nate and learning about his journey, I cannot help but wonder whether his insight into the human condition, gained in part through literature and his study of the humanities, is at the heart of his extraordinary success as a leader. By his career-long accomplishments and contributions, in particular his discoveries in steroid hormone physiology and biochemistry of the ovary as well as his role as a mentor, author, teacher, investigator, and clinician, Nathan Kase is a true Giant of Obstetrics and Gynecology.

      Appendix

      Figure thumbnail fx1
      Supplemental Figure 1The Kase family
      Pictured left to right are James, Judith, Nathan, Nancy, Deborah. Photo is courtesy of James Kase.
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx2
      Supplemental Figure 2Dr. Kase and Dr. Romero, AJOG Editor-in-Chief of Obstetrics
      Nathan and Roberto Romero, Chief, Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Program for Perinatal Research and Obstetrics, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx3
      Supplemental Figure 3Attending the Yale Obstetrical and Gynecological Society's Event, 2017
      Pictured left to right are Dr Hugh Taylor, Professor and Chair of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine; Chief of Obstetrics and Gynecology, Yale-New Haven Hospital; Dr Nathan Kase; and Dr Mary Jane Minkin, Clinical Professor, Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx4
      Supplemental Figure 4Attending the Yale Obstetrical and Gynecological Society Event, 2017
      Pictured left to right are Dr Robert Glass, Dr Nathan Kase, and Dr Leon Speroff, authors of the medical bestseller Clinical Gynecologic Endocrinology and Infertility. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx5
      Supplemental Figure 5A visionary known for recognizing leaders among his junior faculty members at Yale
      Pictured left to right are Dr Richard Berkowitz, Dr Nathan Kase, and Dr Donald Coustan. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx6
      Supplemental Figure 6Pioneers who advanced the study and practice of medicine
      Pictured left to right are Dr Nathan Kase and Dr Alan DeCherney, Chief of Reproductive Biology and Gynecology and Deputy Clinical Director for Academic Affairs of the Division of Reproductive and Adult Endocrinology in the Division of Intramural Research of Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services; and former Chair of Obstetrics and Gynecology at Tufts University and the David Geffen School of Medicine at the University of California, Los Angeles. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx7
      Supplemental Figure 7Attending the Yale Obstetrical and Gynecological Society's Event, 2017
      Pictured left to right are Dr Nathan Kase and Dr Charles Lockwood, Senior Vice President, USF Health; and Dean, USF Health Morsani College of Medicine, University of South Florida-Tampa. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx8
      Supplemental Figure 8Reuniting with friends during a recent conference at Yale
      Pictured left to right are Mrs Peter (Eileen) Schwartz, Dr Nathan Kase, and Dr Peter Schwartz, Professor of Obstetrics, Gynecology, and Reproductive Sciences; Vice Chair, Gynecology; and Section Chief, Gynecologic Oncology, Yale University School of Medicine. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx9
      Supplemental Figure 9Attending the Yale Obstetrical and Gynecological Society's Event, 2017
      Pictured left to right are Dr Edward Cartwright and Dr Nathan Kase. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.
      Figure thumbnail fx10
      Supplemental Figure 10Attending the Yale Obstetrical and Gynecological Society's Event, 2017
      Pictured left to right are Dr Leon Speroff, Dr David Gershenson, Dr Nathan Kase, Dr Thomas Hanson, Dr John Hobbins, and Dr Jonathan Shriver. Photo is courtesy of Dr Hugh Taylor and Mr Harold Shapiro (Yale University).
      Romero. Giants in Obstetrics and Gynecology. Am J Obstet Gynecol 2017.

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