Keystone brought the Canadian medical community’s attention to the implications of globalization on the spread of infectious diseases. Courtesy of UHN

Dr. Jay Stephen Keystone, a travel and tropical medicine specialist at the Toronto General Hospital and a professor of medicine at U of T, passed away from cancer while surrounded by family on September 3. He was 76 years old.

He is remembered fondly for his empathy and frequent use of humour as he trained residents, treated patients, and worked with colleagues through difficult days in the hospital.

“When people found out he had passed away, there was an outpouring of love and support from people all over the country and even worldwide,” said Dr. Isaac Bogoch, a close friend and colleague of Keystone, to The Varsity.

Bogoch recalled that Keystone fostered a working environment “where you don’t really recognize that it’s work, because you’re enjoying yourself too much.”

“He’d always be smiling and enjoying life along the way,” even on days with heavy workloads, said Bogoch. “That’s one thing I certainly picked up from him.”

Keystone’s empathy in medical education

Dr. Sumontra Chakrabarti, who is now an infectious disease specialist at Trillium Health Partners, recalled his time working with Keystone as a resident for three years. He recounts those years as some of the “most enriching” of his career.

He wrote to The Varsity that Keystone was a “very outgoing, friendly and warm individual” with a “larger than life presence.” He attributed Keystone’s personality in large part to his “amazing sense of humour, that made everyone around him smile.”

“From a resident’s standpoint,” continued Chakrabarti, “any room Dr. Keystone was in, was one guaranteed to be relaxed, jovial, and a place where you would leave knowing much more than when you walked in.”

“It was because of him [that] I have pursued my special interest of tropical infections within my infectious diseases practice,” wrote Chakrabarti. “The type of clinician I am today is in large part my efforts to emulate the type of physician he was.”

Dr. Christopher David Naylor, the former president of U of T, also commented on the empathy of Keystone’s mentorship style, which sharply contrasted the approach that other medical educators used at the time.

“What stood out is that he was humble and kind to his students and residents at a time when, frankly, some of the older clinical teachers were into ritualized humiliation as a mode of instruction,” wrote Naylor.

Naylor also recalled one incident from Keystone’s education that he would never forget.

It involved Keystone teaching medical students that Ascaris lumbricoides infections could be almost asymptomatic. This means that, in Keystone’s words, on many occasions the only “presenting symptom of the patient [would] be horror.’’

“Why?” Keystone would ask rhetorically, “Well, how would you feel if you defecated and found a large worm wriggling in the toilet bowl?”

Keystone’s impact on clinical research

Reflecting on Keystone’s research, Naylor highlighted how he brought the Canadian medical community’s attention to the implications of globalization on the spread of infectious diseases at a time when its impact was not widely recognized.

Keystone graduated as a gold medallist in the U of T Medical School’s class of 1969, and conducted postgraduate work and fieldwork on multiple continents. He returned to Toronto in 1977 to found and lead the Tropical Medicine Unit at the Toronto General Hospital.

His legacy includes more than 200 scientific papers and textbook chapters that he co-authored, a premier travel medicine textbook he wrote as a senior author, and the organizations he was a part of, including the International Society of Travel Medicine where he served as president.

In 2015, he received the Order of Canada for his contributions to tropical and travel medicine.

But despite Keystone’s stature, wrote Naylor, “Jay himself often said that his greatest professional accomplishment was to teach himself out of a job.”

In an article published in May, co-authored with twin brother and rheumatologist Dr. Edward Keystone, Dr. Jay Keystone encouraged those reading “to think about the people who made an impact or provided you with mentorship, and how you can pay it forward to others.”

This fits with Dr. Jay Keystone’s approach to education. In Naylor’s words, Keystone was “involved in inspiring, recruiting, and educating literally hundreds of postgraduate medical trainees.”

“Those individuals, practising all across the country and all over the world, along with his beloved family, are Jay’s living legacy and most important gift to the world.”

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