Patrick Craig Walsh, Baltimore, United States

Talent hits a target no one else can hit; genius hits a target no one else can see.

—Arthur Schopenhauer

Born in Akron, Ohio on February 13, 1938, the second of four children, Patrick Craig Walsh always wanted to be a doctor, and he took lessons from the Dominican nuns who taught him through high school, from his uncle (an amateur naturalist), and from his experiences as a paperboy (getting the newspapers dry, on the porch, on time!) to nurture and sustain his dream of using the gifts he had been given to help his fellow man. He completed his undergraduate and medical school studies at Case Western Reserve, where he met Peg, the love of his life. From there, the young couple moved on to surgical residency at the Peter Bent Brigham Hospital, pivoting from an initial trajectory towards neurosurgery to urology, under the mentorship of Francis Moore. He then headed west for urology training at UCLA with Willard Goodwin and Joseph Kaufman, after which he was expected to return, under the wing of the Elliot R. Cutler Professor, to lead Urology at the Brigham. Walsh became fascinated by the explosion in molecular biology and spent two years in the research laboratory, during residency at UCLA and following residency, at UT Southwestern, with Jean Wilson, where they characterized the 5-alpha-reductase deficiency syndrome. He spent two years between residency and UTSW as a urologist at the San Diego Naval Hospital. There, for the first time, he began performing radical retropubic prostatectomies, an operation he had not done as a resident at UCLA, where only the perineal approach was employed because Goodwin had trained under Hugh Young at the Brady. In 1974, at the age of 36, he assumed role of the David Hall McConnell Professor and Director of the Brady Urological Institute at Johns Hopkins.

When he arrived at Hopkins in the mid-1970s, the status quo for men with prostate cancer was dismal, with approximately 50% dying of the disease within 15 years. At the time, radiation therapy was in its infancy, and few men accepted surgery, given risks of life-threatening bleeding, 25% total incontinence, and 100% impotence. He attacked these problems, using the operating room as an anatomy lab, first in 1977 developing his technique for controlling bleeding from the dorsal vein complex, opening the door to subsequent technical innovations. That year, he heard from a patient—and believed—that he was fully potent within a year following prostatectomy, challenging the accepted dogma of the time that the cavernous nerves ran through the prostate. As he has shared with countless audiences over the years, “If you want to make an important discovery, listen to your patients.” He attended his first meeting of the American Association of Genitourinary Surgeons that year and met Pieter Donker, the chair at Leiden. Four years later, in 1981, Walsh visited Donker in Leiden, where they discovered the location of the cavernous nerves during a fetal dissection, on Walsh’s 43rd birthday. One year later, Walsh observed that the location of these microscopic nerves could be identified in the operating room by their constant association with the capsular arteries and veins of the prostate; the Neurovascular Bundle of Walsh[1]. Using this observation, on April 26, 1982, he performed the first purposeful nerve-sparing radical prostatectomy on a 52-year-old man, who reported 7 months later that he was potent. The patient died 35 years later, free of cancer, and having lived a normal life. These discoveries led to the advent of safer surgery for prostate cancer, which, combined with PSA screening to identify more men with curable disease in the 1990s, contributed to radical declines in prostate cancer morbidity and mortality in the United States and around the world. He has shared this story in greater detail to help others “understand how important discoveries can be made—a simple act of kindness to a lonely old man [Dr Donker], followed four years later by trying to understand what he was doing now that he was retired. Never underestimate what you can learn from others”[2].

In addition to his pioneering anatomical discoveries leading to surgical innovations, Walsh made major contributions to the basic understanding of benign and malignant neoplasms of the prostate, and led seminal work characterizing hereditary prostate cancer. He was editor-in-chief of Campbell’s Textbook of Urology (subsequently renamed Campbell-Walsh Urology) for a quarter century, and served on the editorial board of the New England Journal of Medicine for 15 years. He is the recipient of countless international honors and awards, including the Charles Kettering Medal from the General Motors Cancer Research Foundation, the King Faisal International Prize in Medicine, National Physician of the Year for Clinical Excellence from America’s Top Doctors, the Francis Amory Prize by the American Academy of Arts and Sciences, and multiple awards from the American Urological Association: the Gold Cystoscope, Triennial Eugene Fuller, Hugh Hampton Young, Ramon Guiteras, and Honorary Membership. His best-selling books, The Prostate: A Guide for Men and the Women who Love Them, and Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer have been translated into multiple languages and published internationally.

Along the way, he inspired, mentored, and developed countless leaders in the field, with 23 Brady residents going on to become Chairs of Urology at major programs around the United States. In addition, for decades, he hosted young urologists from all over the world to work in the research laboratories at Hopkins and serve a year as the junior resident on his service, learning his surgical techniques and unique and personal approaches to patient care. Complementing his tremendous work ethic, imaginative approach to discovery, and commitment to excellence in every dimension, he maintains a catalogue of captivating, sometimes moving, and exceptionally hilarious jokes and stories, delivered with a style befitting “the raconteur of the operating room,” as he was described by Garrison Keillor. Though no longer operating, he continues to see patients on Fridays at the Hopkins clinic, modeling his embodiment of Francis Peabody’s dictum that “the secret of the care of the patient is caring for the patient” with rotating medical students.

A man of deep faith, humanity, and humility, his service to others extends far beyond his patients and mentees. Since June 2013, he has served as a lay minister for people incarcerated in the Chesapeake Detention Center Federal Prison, an imposing supermax prison dating back to 1807, which he and many others working at Hopkins drive past on their way to the hospital. His reflections on this work are incredibly inspiring; among all of his accomplishments, he describes this as one of the most rewarding experiences in his life. Patrick C. Walsh lives by example the words of Our Lady of Fatima—“The doctors who love their patients are the ones to whom God gives the greater power to heal their patients.” The dimensions of his genius and heart know no bounds, and our specialty, our patients, and any of us who have had the golden opportunity to walk alongside him, are left so much better than he found us.