Mary Klotman through medicine and love at Duke | MEDICUS 2024 Issue 3

Mary Klotman’s enduring journey through medicine and love at Duke
By Dr Chua Li Min, Science writer

Dean Prof Mary Klotman in her office at the Duke School of Medicine // Credit: Courtesy of Duke University

Mary Klotman’s connection to Duke began on a vibrant spring day that captured her heart, leading her on a lifelong journey entwined with medicine, mentorship, and meaningful discoveries.

To this day, she vividly recalls that moment when she first stepped onto the Duke campus in Durham: “I came down on a beautiful spring day to look at the school, and when you do that, you just fall in love with it.”

The scenic campus, awash in the dazzling array of colourful flowers, from the endearing pastel hues of cherry blossoms to the vibrant tulips, left her breathless.

That was when Duke first called to the then-senior high school student from Long Island.

“My dad was working in the textile industry and the South was home to a lot of the big textile companies. So he was very familiar with the universities, particularly in North Carolina, and really encouraged me to look further than the northeast. That’s how I discovered Duke,” recalled Klotman.

tulips_spring

Vibrant tulips in bloom during springtime at Duke // Credit: Courtesy of Duke University

It didn’t take long for her to decide to go to Durham for her education.

Little did Klotman know that this decision would mark the beginning of a lifelong connection with Duke—a place she would return to time and again, which saw her taking up a position as Chair of the Department of Medicine in 2010 and eventually as Dean at the Duke School of Medicine in 2017 and Executive Vice President for Health Affairs at Duke University in 2023.

Springtime at Duke // Credit: Courtesy of Duke University

Tangling with jellyfish to find clarity

Even before choosing her major at Duke, Klotman knew she wanted to pursue a medical career.

Her love for science and early exposure to medicine, particularly through listening to stories from her grandfather, a skilled surgeon, and her uncle, a dedicated primary care physician, proved pivotal in nudging her on this path.

“I wanted a profession where the primary goal was service,” she explained. “So for many reasons, it was the natural profession for me to at least try.”

As Duke did not offer biology as a major back then, that led Klotman to study zoology instead: “It was the major closest to biology. It was also very consistent with my love for science,” she explained.

It was also around this time that she honed her skills in scientific writing, thanks to the late Professor Stephen Wainwright, who at the time, tasked her class with writing numerous scientific papers, including one on how jellyfish feed.

“Although I researched it and referenced it, that was the paper where I got an A in content and an F in English,” said Klotman.

So, she worked through it again. And again. And again. With each attempt, she honed her grammar, sentence and paragraph structure until it met her exacting tutor’s standards.

Mary Klotman_sports

Prof Klotman also pursued sports actively while she was in college // Credit: Courtesy of Mary Klotman

“As much as the science was important, he was absolutely rigid about how you wrote. And he was a perfectionist. It took me the whole course to get it right,” she recalled.

That skill proved invaluable in Klotman’s career as a clinician-scientist, boosting her success in securing research grants. Noted her husband and long-time scientific collaborator, Paul Klotman, whom she’d met in medical school: “When you read a grant that she has written, you always understand why she’s asking the question and the potential importance.”

A meeting of minds

Because she enjoyed her time at Duke so much, Klotman decided to stay for medical school, where she met her husband during her internship.

“He was very smart—I loved that. And we shared a lot of interests,” said Klotman. “And we just fell in love.”

“She was strikingly beautiful and smart as can be,” recalled Paul Klotman, who was chief resident at the time. “We got married within eight months.”

For the wedding to happen, the Klotmans had to find a time when they were both not on duty. “I was on call five out of seven nights, and she was on call every other night,” recalled Paul Klotman. Eventually, they found a date in November around Thanksgiving.

“So we arranged it on a Saturday when we were both off. Then we went right back to work,” he added.

Paul and Mary Klotman

The Klotmans have been married for over 43 years and enjoy taking walks togethers // Credit: Courtesy of Paul Klotman

Mary Klotman’s dedication to her patients stood out to Duke-NUS Dean Professor Thomas Coffman, who was a fellow Duke resident. “Along with being an outstanding clinician, Mary had great people skills and was really genuine and empathetic interacting with patients—she had the whole package,” he observed.

While Klotman had initially thought of going into private practice with her uncle after graduation, that changed after her rotations at Duke, which led her to discover a lifelong passion for studying infectious diseases.

“I loved to read about infectious diseases. When I would pick up The New England Journal of Medicine, I would read the cases that were infectious disease cases before anything else. I was drawn to the intellectual part of the specialty,” she explained.

Elaborated Klotman in a video interview from 2017: “They (the infectious diseases faculty) always seemed to be the docs who could put it all together.”

Prof Klotman (circled in the photo) with fellow residents at Duke // Credit: Courtesy of Mary Klotman

Facing a new adversary

But the tables were turned when the AIDS epidemic struck in the 1980s. AIDS, which is caused by the Human Immunodeficiency Virus or HIV, threw doctors a curveball.

“It was a new disease with no cure. We had no idea what it was. And I remember thinking, ‘Wow, this is what biomedical science is about’. And that’s what got me excited about the science,” said Klotman, who was training as an infectious disease fellow then.

While the science behind the disease intrigued Klotman, caring for the first wave of patients infected by the virus was emotionally challenging—particularly during the early days when everyone was still trying to understand the disease.

“It was 100 percent fatal and usually within months because generally, we didn’t make the diagnosis until the patients were quite sick,” she recalled.

“I remember the first couple of patients I diagnosed. They were all young men, and it was just heartbreaking. It was devastating for the patients and their families, but also for the physicians who were taking care of them.”

Making a thoughtful detour

That was when Klotman felt she needed to venture into the lab to study the disease.

“It was very uncomfortable to make that decision. I call this a detour because you’re going in this one direction and then you take a step back. But to train as a scientist, you have to do that,” she explained.

Fascinated by a paper published by molecular biologist Flossie Wong-Staal, who had successfully cloned and sequenced the virus, Klotman applied to train at the National Institutes of Health (NIH) with Robert Gallo, whom Wong-Staal was working with.

Her husband, who was then an associate professor at Duke, decided to join her at the NIH on a sabbatical in Washington. “We decided to do it together,” she said.

“When you read a grant that she has written, you always understand why she’s asking the question and the potential importance”
Dean Paul Klotman

Although the initial plan was for them to stay for a year, that all changed after the Klotmans’ research and careers flourished. “What I loved about the lab that I was in, and my work (at the time) was that it was constantly driven by what was happening in the clinic,” said Mary Klotman, who zoomed in on uncovering the virus’ secret to replicating in cells.

But it wasn’t just lab techniques that she mastered.

Immersing herself in rigorous discussions also helped Klotman to develop a knack for asking the right questions and designing thoughtful experiments to answer them.

“When I came out of all the lab training, I could incorporate what I’d learned back to my training as a physician-scientist, so it was ideal,” she said.

Explained Klotman: “I had trained in infectious disease. I had developed my skills around researching viruses. And then I could put it all together.”

Then it all came together

Although it took a lot longer than Klotman had planned, she was thrilled to have two baby boys during her time at the NIH, which added to her fond memories of the years spent there.

While it seemed like the family was ready to settle in Washington, an opportunity to move to Mount Sinai in New York opened up, which the Klotmans seized. For Mary Klotman, this also meant being closer to her family in Long Island.

As a clinician-scientist heading the infectious disease division at Mount Sinai, Klotman continued to see patients while managing her research on HIV and the needs of her young family, even if that meant working late into the night to advance her research.

“I could write grants in the middle of the night if I needed to, but I could also be at a soccer game in the day. It was a trade-off that I enjoyed.”

Dean Klotman in the lab

At Mount Sinai, Prof Klotman continued her research on the HIV virus // Credit: Courtesy of Duke University

“My biggest fear was missing something with my kids,” she explained. “We never missed a basketball game or a soccer game. We never missed anything,” added Paul Klotman.

That was also when Mary Klotman discovered how HIV caused kidney disease in patients, a discovery that came late one evening after she had examined a young patient who had been admitted to the hospital with a very high fever and swollen glands.

A subsequent test for HIV returned positive, confirming Klotman’s deduction that he was infected with the virus.

“I have learned a lot just by watching her. She is a successful woman in science and an example to follow.”
Asst Professor Maria Blasi

“He presented with a very unusual kidney disease, and that connected everything that I was studying, and that one patient became the basis of a pivotal observation that we made,” explained Klotman, who published her findings in her favourite publication, The New England Journal of Medicine.

“The minute we put him on antiretroviral medication, not only did his fever and disease get better, his kidney disease also got better. So we were able to show very clearly how it was all related,” remarked Klotman. “He went from being a very sick gentleman to being well, with his kidney disease completely resolved. So it was very satisfying.”

“It was one of those moments you don’t get very often—to be able to make all the connections in medicine,” she added.

Returning to where it all began

But when, in 2010, Duke beckoned again, Klotman knew she had to answer the call. By then, her two sons were off to college.

“Mary’s return as Chair of the Department of Medicine was not just a professional homecoming but a boon to the entire community. Under her leadership, she has not only elevated programmes in the Department but has became a pivotal figure in shaping the future of medical education and research across the Duke School of Medicine,” noted Coffman, whose path crossed with Klotman again, when he worked alongside her as Chief of the Nephrology division and Vice-Chair in the Department of Medicine.

The two have been given a chance to collaborate again since Klotman joined the Duke-NUS Governing Board in 2023.

Prof Coffman and Prof Klotman share a photo together at Duke-NUS during one of Prof Klotman's visits to Duke-NUS // Credit: Norfaezah Abdullah, Duke-NUS

“Her holistic approach integrates a deep appreciation for science with a tangible commitment to faculty and student development, setting a standard for academic leadership, which inspires all of us at Duke-NUS,” added Coffman.

Despite taking on leadership responsibilities at Duke and Duke-NUS, Klotman kept her lab going and continued to mentor junior researchers. “I have a passion for science and still love it. And it was a way for me to keep connected to understanding what faculty are experiencing as well, where there are barriers where I can help them.”

“Whenever we have a chance to talk about science you can see how involved and excited she is about it,” observed Assistant Professor Maria Blasi, who joined Klotman’s lab as a postdoctoral fellow in 2012. “I have learned a lot just by watching her. She is a successful woman in science and an example to follow.”

Among the changes rolled out by Klotman at the Duke School of Medicine is the establishment of the Office of Physician-Scientist Development, which she created in 2017.

“With the Office, we sought to create a community of physician-scientists,” explained Klotman, who wants to encourage more like-minded individuals to connect across specialties through this initiative. “It (the Office) is one of the strategies to mitigate burnout, and it also serves as a structure that supports them in their journey and growth as physician-scientists.”

Dean Klotman with students at Duke

Dean Klotman with students at Duke-NUS

Prof Klotman always finds time to connect with students, inspiring them to pursue careers as physician-scientists // Credit: Courtesy of Duke Universtiy

Since its establishment, the Office has developed several educational and professional training programmes, along with research funding targeted at aspiring clinician-scientists at different phases of their career, from as early as when they are medical students to when they take up faculty positions within the School.

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The energy is contagious in this photo of Prof Klotman with the students at Duke // Credit: Courtesy of Duke University

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“Physician-scientists, trained in both clinical medicine and research, play an especially important role in developing new therapies,” said Klotman. “By providing resources and support for them, our Office is helping to fill a critical need.”

While Klotman is delighted to see the tangible outcomes of her efforts, she also derives great joy from spending time with her family, including their three dogs: Leo, Lily and Louie—all long-haired miniature dachshunds.

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Louie (left) and Leo (right) // Credit: Courtesy of Paul Klotman

With the Klotmans now based in two different states as heads of two medical schools, Duke School of Medicine and the Baylor College of Medicine, they have been commuting between Houston and Durham every weekend for the past 14 years to spend time together.

This includes a trip to Duke-NUS’ 2024 Graduation Ceremony in Singapore in June 2024, where Mary Klotman, who is also a member of the Duke-NUS Governing Board, delivered an inspiring keynote address that was met with thunderous applause. “She’s just somebody you automatically admire,” observed Paul Klotman.

Offstage, Klotman’s journey as an academic leader continues, as she dedicates herself to nurturing future clinician-scientists: “When you see that they’re far beyond what you could ever do, that’s just so satisfying.”