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He looked at Donald Kautz's body, which was prepared
for burial. How many times had Kautz come into Kaye's
Fresno ophthalmology office wearing a tie that matched
his suit, just as he was dressed now?
How often had Kaye teased Kautz about sharing game
strategies and secret plays when the Madera High School
football coach came to his office straight from practice?
Kaye took a step back. These vivid memories of the
straight-talking man he respected and admired shook
him.
He wanted to leave.
But here, on this cold evening in December 2001, he
had an obligation to still be Kautz's doctor -- and
to honor a promise. Five years earlier, he had sworn
he would help researchers seek better treatments or
a cure for the disease that blurred Kautz's vision.
He just didn't expect that his friend would die of
a massive heart attack at 54.
From the moment in 1996 when Kaye looked inside Kautz's
eyes and saw the tiny dots, scattered like pebbles
on a beach, he knew they explained the man's fading
nighttime vision and complaints about fuzzy scoreboards.
Kautz had an inflammatory disease called birdshot
retinochoroidopathy. It gets its name from white lesions
in the back of the eye that resemble the scatter of
shotgun pellets.
In addition to his shaky vision at night, Kautz had
a hard time focusing in the first hours after awakening.
When his family gathered for breakfast, daughter Melissa
Kautz would read him box scores on the sports pages.
Kaye had personally seen two cases of birdshot retinochoroidopathy,
so he and his patient both had a lot to learn. Kautz
peppered Kaye with questions: Could he go blind? Was
the eye disease contagious?
Yes, Kaye said, there was a chance he could lose his
sight. No, his family couldn't catch the disease.
This left Kautz with one main question: Was there
a cure?
Kaye scoured textbooks, read medical journals and
contacted colleagues in his native South Africa, where
he had trained as an ophthalmologist. There was no
way to eliminate the disease, but there were drugs
that might stabilize it.
That wasn't good enough for Kautz. He challenged his
doctor to find a cure.
Kaye, who taught
2 1/2 years at Yale University before moving west
in 1980 to open a private practice, remembers
his own response: "I'd have to give up a year
of my life and go research this for you."
Nevertheless, he admired Kautz's can-do attitude: "Don
was an American. The American spirit is a spirit that
doesn't dwell on the negative. The American spirit
dwells on the possibilities and knows how to get there.
That was Don."
The best Kaye could do was refer his patient to eye
specialists at Proctor Medical Group at the University
of California at San Francisco.
Doctors there confirmed Kaye's diagnosis and ordered
Kautz to get a complete physical. They looked for other
problems, such as arthritis, that can cause inflammation.
But they didn't find anything, says Kautz's wife,
Jane: "The cause remained a mystery for us."
In the five years following Kaye's diagnosis, the
Kautzes tried to live with his fluctuating vision as
they prayed for a medical breakthrough.
Dec. 15, 2001, began as a routine Saturday morning.
Jane sipped coffee and read the paper while waiting
for Don to return from his morning run.
He typically ran for 45 minutes. She glanced at the
clock. He had been gone for an hour.
Jane brushed aside a shiver of concern and continued
to drink her coffee. He could be talking to someone
he'd seen during the run. That happened often.
Thirty more minutes passed. She tossed the paper aside.
He never took this long. She got in her car and drove
around the neighborhood. No sign of her husband.
She returned to the house, and she and daughter Melissa,
25, wondered what to do. Whom should they call? The
police? Perhaps because Melissa worked in the human
resources department at Madera Community Hospital,
they phoned its emergency room.
A nurse said they should come. After they arrived,
as the nurse escorted her into a tiny room, Jane knew:
Don was dead.
A passer-by in a pickup truck had seen Kautz stagger
on a street near his home. Kautz then slumped to the
ground. Paramedics came but couldn't revive him.
He would have been 55 in 13 days.
An autopsy showed arteries to his heart were heavily
blocked.
He had watched his diet, had exercised faithfully. "It
was a complete shock to everybody," his wife says.
The autopsy was required because of Kautz's unexpected
death. The coroner's office called Kaye to ask about
medical history. When the chief deputy coroner gave
Kaye the news, he knew he had to get permission to
retrieve Kautz's eyes.
Kaye had met Jane Kautz only once or twice. He didn't
know how she'd react to his request. But she gave her
consent. She says her husband liked Kaye and trusted
him.
"The doctor appears to be such a gentle, quiet-spoken
person. But he strikes me as the kind who's not going
to just do the everyday practice," she says.
Besides, Don had an organ-donor designation on his
state driver's license.
"I knew that it would be something he would have
agreed to," Jane says.
Coaching was Kautz's passion. If he wasn't working
with his own team, he was watching other coaches on
the field.
"He'd go to girls tennis. He'd go to everything
-- absolutely everything," Jane says. "He
felt every sport, even if it was one of the lesser-known,
was as important as another."
Coaching brought the Kautzes to Madera in 1979 from
Wasco. He became the defensive coordinator for Madera
High's varsity football team. She got a job in town
as an elementary school teacher. The couple bought
a house in northwest Madera. It's the same home Jane
Kautz, 55, lives in today with their son and daughter.
The Kautzes grew up together in Colorado. They became
a couple while in college and were married for almost
32 years.
Soon after they arrived in Madera, the school district
gave teachers personality tests. The Kautzes ended
up "about as far apart on the spectrum on this
test as you possibly could," Jane says with a
laugh. She was messy and disorganized. Her husband
was neat and detail-oriented.
"I guess we helped each other -- kind of pulled
each other toward the middle," she says.
Diane Franklin, administrative assistant to the Madera
High athletic coordinator, says Kautz never came to
work in the office without a tie: "He was a very
dapper dresser."
Even on the athletic fields, he carried his 5-foot-9,
ramrod-straight frame in perfectly matched school colors. "We
loved to tease him about that," Franklin says. "He
was an easy mark."
Franklin knew Kautz for almost 20 years, including
his eight years as athletic director, from 1992 to
2000. After he died, she found a picture of the two
of them at the office. She had it framed and keeps
it on her desk.
"The most important thing I remember about Don
was how much he loved kids," Franklin says. "He
was here for the kids."
Melissa Kautz says her father's coaching schedule
meant he wasn't around a lot at night. "But we
went to all the games. I can remember running on the
field when we were little."
On a recent afternoon, as she and her mom talk, 20-year-old
Jeff Kautz stays in his room but keeps an ear to the
conversation. When his mother says she can't remember
all of the championship teams his father coached in
football and track, Jeff runs into the living room
holding a faded T-shirt that commemorates a 1986 league
title in track. Jeff played on his dad's last football
team in 2001.
Kautz didn't talk much about his disease at the high
school but didn't try to hide it. "He suffered
greatly with his eyes," Franklin says. "But
he was always very staunch."
He didn't let his vision problems interfere with coaching
or athletic department duties, Franklin says, "other
than to miss work because of his doctor's appointments.
Dr. Kaye became as popular a man on his appointment
book as coaches and administrators."
Kautz approached his disease in the same methodical
way he managed his job. Pills were taken on time, medical
appointments kept. Part of the therapy involved injections
into the eye. "I had to leave when they did that," Jane
Kautz says.
Emotions were always kept in check with Don Kautz.
He had to warm up to you first, says Bruce Davi, who
spoke for the football team at a memorial for the coach
that filled the south campus cafeteria.
Davi, now 19, says Kautz once pulled the team's seniors
aside for a pep talk during one of their last practices.
The coach told them: "What you learn on the football
field, you have to take it to other places, because
teamwork is involved. You have to take that into real
life, because teamwork is involved just about anywhere
-- at college or at work."
At the funeral home, Kaye still felt Kautz's presence
hovering over him. He had been there an hour, but it
seemed longer.
Kaye put Kautz's eyes in a special tray and packed
them inside dry ice in a Styrofoam container for shipment
to the eye pathology laboratory at UC San Francisco.
Says Kaye: "He didn't leave me until I took his
eyes, and I felt like he vanished -- whoosh -- and
he was gone."
Kaye needed to talk to someone. He called his wife,
fellow ophthalmologist Loan Nguyen, on his cell phone.
That night, Kaye skipped dinner and retreated quietly
to his study.
"I think he and Don had that special relationship
that they developed over the years," Nguyen says, "and
that was why it was more difficult to go through all
the process."
Kautz's eyes piqued the curiosity of J. Brooks Crawford,
director of UC San Francisco's eye pathology laboratory.
"You never know what you're going to find," he
remembers thinking as he began to examine the eyes
under a microscope.
They gave Crawford the first magnified view of birdshot
retinochoroidopathy in the early stages of the disease. "Nobody
had ever seen this before," he says.
Crawford now had evidence of how the disease progresses
in a human. Up to that point, genetically engineered
mice provided the best look at the chain of events
in the disease's development.
Researchers have a better shot at stopping the disease
if they know how it starts.
Kautz's eyes added to evidence of a genetic connection.
The eyes tested positive for a protein known as HLA-29. "As
far as we can tell, only people who carry the gene
[for the protein] get the disease," Crawford says.
The lesions in the eyes also closely matched patterns
in the lab mice. Researchers now can use the animals
to study the disease more confidently, Crawford says.
Researchers owe a debt to Kautz and to his doctor,
Crawford says. The results were published in the December
2002 issue of the British Journal of Ophthalmology.
Jane Kautz feels some hope these days, because discoveries
made thanks to her husband's eyes could help people
with the disease. When somebody walks into an eye clinic,
she says, "maybe this doctor can say, 'Well, we
think this is what causes it now. And we can do this
for you because of that.' "
Her husband would be pleased, too, she says. "I
kind of think of him as a guardian angel for somebody
that needed a guardian angel. He would be very pleased
to know that they did find something that could be
useful to others."
For Kaye, there was a "great sense of defeat" in
removing Kautz's eyes; it was a reminder that a cure
hadn't been found in his patient's lifetime.
At the same time, he says, "it was a moment of
great opportunity to find out what was going on."
And he kept a promise.
The reporter can be reached at
banderson@fresnobee.com or 441-6310.
{TEXT}
This year, 80,000 people in the United States are
on waiting lists for organ and tissue transplants.
About 15,000 needing transplants live in California,
and 7,500 are residents of Northern and Central California.
Each day, 17 people in the United States die waiting
for a transplant, says Esther Padilla, community outreach
coordinator in Fresno for the California Transplant
Donor Network. Last year, 227 people became organ donors
in Northern and Central California; 126 people were
tissue donors, and 77 were cornea donors.
The California Transplant Donor Network offers the
option of organ donation to families whose loved ones
have died.
Community Tissue Services coordinates donations of
tissues, such as skin, tendons and heart valves.
The Lions Eye Bank of the San Joaquin Valley gives
families the choice of donating corneas for transplant.
For details about organ and tissue donation: in English,
(888) 570-9400; in Spanish, (800) 588-0024.
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