Dr. Martin A. Samuels, a neurologist with a gift for words and caring, dies at 77

Words and sentences and stories were as important to Dr. Martin A. Samuels as any expensive medical equipment when he examined neurology patients or taught students to pursue his specialty.

Whether comforting patients who faced devastating diagnoses or helping young physicians move past unsettling mistakes, Dr. Samuels used empathy and insight and wit to guide all he encountered, often drawing on the history of medicine and neurology to illuminate the matter at hand.

“He showed us the beauty there is in the simple act of helping to take care of one patient at a time,” said Dr. Sashank Prasad, vice chairman for education in the neurology department at Brigham and Women’s Hospital, his mentor’s professional home.

“We received these timeless gifts that he and only he could give us,” Prasad said. “Patient by patient, we could see how he connected with them — all the lessons that could be learned about neurology and about life.”

Dr. Samuels, the founding chairman of the neurology department at Brigham and Women’s, died in his Back Bay home Tuesday after a brief illness. He was 77 and was the first to be named the Miriam Sydney Joseph professor of neurology at Harvard Medical School, a chair named in honor of his parents.

“He had this gift that when you met with him or saw him, you just felt better, even if he wasn’t your doctor,” said his wife, Susan Pioli, a medical editor. “It was a true gift. You can’t acquire that. You can’t learn that, I don’t think. He just had it.”

Along with being an astute clinician, Dr. Samuels “brought the teaching of neurology to all of the rest of medicine,” said Dr. Allan H. Ropper, deputy editor of the New England Journal of Medicine and a longtime friend.

“He took a deep interest in these things that really seemed in orbit around medicine and neurology, and he studied them very deeply and then gave talks about them that were very, very engaging,” said Ropper, who had known Dr. Samuels for more than four decades and was a colleague for many years.

Dr. Samuels, his wife said, “was interested in the borderlands of neurology and other areas.”

Famously, he developed an expertise in the rare phenomenon of being scared to death — an interaction between the brain and heart in otherwise healthy people who become so frightened that their lives abruptly end.

His interest was piqued by an experience during his medical training.

“I saw a patient during my internship at Boston City Hospital in 1971 who heard some bad news and then collapsed,” he recalled in a 2015 Globe interview, adding that “at the time, the medical literature on the subject was very sparse, and no one knew how this could occur. I began to collect cases and went from there.”

In journal articles and lectures he referred to the phenomenon as “voodoo” death. That phrase echoed the title of an early 1940s paper on the subject by Dr. Walter B. Cannon, a Harvard Medical School professor whose work Dr. Samuels updated and expanded upon.

Along with examining the interaction between neurology and cardiology in the heart-stopping deaths of those severely frightened, Dr. Samuels studied the common ground in other areas, too.

“Marty loved to show how medicine and neurology always remain inextricably interconnected,” Prasad said. “He was an internist before he became a neurologist. He taught us volumes about neurocardiology, neurohepatology, neuroimmunology, neurohematology, and more.”

Even among those many topics the voodoo death research achieved such recognition that “they call me the death doctor,” Dr. Samuels told the Globe with mild amusement in 2006, noting that his case histories ranged from children who died after scary rides in amusement parks to adults who collapsed when police raided their homes by mistake.

“Studying death is cheerful in a way,” he said, “because there are many things worse.”

Born on June 24, 1945, Martin A. Samuels grew up in Cleveland Heights, Ohio, the son of Miriam Joseph Samuels, a homemaker, and Sydney G. Samuels, a clothing salesman.

As a boy, Dr. Samuels admired his family’s empathetic pediatrician, who made house calls.

“It was a very romanticized version of what a doctor was supposed to be,” Dr. Samuels said in a 2009 interview with The Crimson, Harvard University’s student newspaper. “I asked him one day, ‘Can you continue to take care of me now that I’m not a child anymore?’ And he replied, ‘I’ll take care of you until you’re a doctor.’ "

Dr. Samuels graduated in 1967 from Williams College, which presented him with its Bicentennial Medal at the 2019 convocation for his distinguished achievements in neuroscience.

He also graduated from the University of Cincinnati College of Medicine, returning in 2012 to give the autumn commencement address at an institution which, in 2005, awarded him its Daniel Drake Medal for outstanding contributions to medical education.

Generations of Harvard medical students, along with residents at Brigham and Women’s, fell “really under his spell,” said Dr. Joshua P. Klein, vice chairman for clinical affairs, neurology, at Brigham and Women’s, who met Dr. Samuels while interviewing for a residency.

Klein said Dr. Samuels “found a way to connect in every circumstance” — at a patient’s bedside or in an auditorium during a national conference. “It was really in those situations that Marty’s brilliance, his wit, his incisiveness were the most compelling and indeed the most memorable.”

Ropper said that “beyond his achievements, Marty was very special, and he always went the extra mile for his friends. He truly expressed the traditional virtues. It’s amazing because you can’t say that about many people. The guy was iconic.”

In addition to his wife, Dr. Samuels leaves two children from his first marriage, which ended in divorce: Marilyn Sommers of Lexington and Charles of Williamsburg, Va. He also leaves a sister, Carole Bilger of Houston, and three granddaughters.

The family will hold a private burial for Dr. Samuels, and a celebration of his life and work will be announced.

He and Pioli met in the mid-1980s “on the phone when I was working on one of his books,” she said.

“People used the word ‘unique’ a lot to describe him, and he really was,” she said. “Marty had the gift of not only helping his patients, but helping with their suffering. Even if he didn’t have a cure, he could help with their suffering and make them feel better.”

In a 2016 essay, Dr. Samuels offered a nine-point approach to keeping physician burnout at bay.

His advice ranged from empathizing with patients, without demanding their empathy in return, to cultivating “a sense of humor and an appreciation of irony,” to becoming a mentor, to acknowledging and learning from mistakes.

“Rather than fearing error and thinking that one needs to be a ‘superman’ I encourage all doctors to collect and analyze continuously their own errors,” he wrote for The Health Care Blog. “Furthermore, you should share them with your close colleagues.”

In articles and anecdotes, Dr. Samuels taught nearly nonstop.

“These stories Marty shared with us are timeless gifts,” Prasad said. “Marty’s neurology is not one that can be easily read in a textbook or on a website.”

No matter the case, he added, Dr. Samuels “could find stories and lessons to add to the anthology of all that we learned from him.”

Wildfire smoke is dissipating, but should people still be worried about health effects? Our medical analyst explains

VIDEO: How wildfire smoke can affect your health

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Smoke from more than 430 active wildfires in Canada spread south last week and led to the worst pollution the New York and Washington regions have ever experienced. More than 75 million people in the eastern US were under air quality alerts as wildfire smoke shrouded major cities. Some flights were grounded, events were canceled, and millions of people breathed unhealthy air.

Much of the smoke has dissipated, but people still have questions. Do we need to be concerned about air quality? What are the short-term effects of wildfire smoke inhalation? Are there long-term consequences? And how can people prepare for future wildfires, which, according to the UN Environment Program, will be even more frequent and more severe going forward?

To guide us through these questions, I spoke with CNN Medical Analyst Dr. Leana Wen. Wen is an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She previously served as Baltimore’s health commissioner.

CNN: How do people know if they are in the clear from wildfire smoke?

Dr. Leana Wen: The federal government has an excellent website, airnow.gov, where you can put in your city or zip code and see what the current air quality is in your area.

Just as the weather forecast in your area can change, so can the air quality. As we’ve seen from the spread of smoke from Canada’s wildfires, events hundreds of miles away can lead to pollution in another area. You can use this website to track air quality, and if necessary, change your plans and add precautions accordingly.

CNN: Are there people who should still be concerned about air quality due to the Canadian wildfires?

Wen: It depends on the air quality in their area and their underlying medical circumstances. The air quality in many parts of the country has gotten much better, returning to near normal, while other areas still have unhealthy levels of pollution.

© Provided by CNN Record-breaking smog due to smoke from Canada's wildfires partially obscures the US Capitol in Washington on June 8. People with chronic lung and heart conditions should continue to monitor air quality, CNN Medical Analyst Dr. Leana Wen said. - Mandel Ngan/AFP via Getty Images

Those most at risk during days with poor quality are young children, the elderly, pregnant individuals and people with underlying medical conditions, in particular chronic lung and heart conditions. Those people should be cautious, closely monitoring air quality in their area on a regular basis. If there are alerts and advisories, refrain from heavy exercise, stay indoors when possible and run air purifiers in indoor areas.

CNN: What are the short-term health effects of wildfire smoke inhalation?

Wen: During last week’s event, many people may have experienced adverse effects, such as throat irritation, hoarseness and cough. Some may have had worsening of their underlying asthma, bronchitis, COPD, which is short for chronic obstructive pulmonary disease, or other respiratory conditions. These are most pronounced in the initial days following smoke exposure. Studies have shown that exposure to wildfire smoke leads to an increase in emergency department visits and hospitalizations for respiratory disease in children and the elderly.

Studies have also demonstrated a more surprising link, which is the association between wildfire smoke exposure and serious cardiovascular events, including heart attacks and cardiac arrest. And there is research that has linked wildfire smoke exposure events to an increase in influenza months later, suggesting that there could be lagging effects.

It’s thought that many of these effects are due to microscopic particles called particulate matter that can enter deep into the lungs and even enter the bloodstream. These pollutants can induce inflammation and a stress response in the body, which can worsen existing medical conditions.

CNN: If people were exposed for a few days to bad air quality, should they be worried about long-term consequences?

Wen: There are people who live in parts of the world where exposure to hazardous amounts of particulate matter and other pollutants is an everyday reality. These populations are at risk for long-term consequences. Research has linked this type of chronic exposure to an increase in some cancers, for instance, and reduced lung capacity.

For most people, a one-time exposure event probably won’t cause major lasting problems. The worry is that these may not be one-time events going forward. Some people already live in areas prone to wildfires and could have exposure to events several times a year. And, as we have seen, wildfires from hundreds of miles away can cause such significant effects on air quality. With climate change, experts predict more frequent wildfires, which can lead to more days of hazardous air quality for all of us.

CNN: How can people prepare for future wildfires?

Wen: Invest in air purifiers for your home. Bad outdoor air leads to bad indoor air. Air purifiers can help remove smoke and those microscopic particles that are harmful to health.

Workplaces and schools can do this too, and also look to upgrade their ventilation system. Improving ventilation will also reduce virus transmission, including the spread of influenza and Covid-19.

People should optimize their medical health as much as possible. Those with lung disease especially should make sure to have an ample supply of inhalers and consult their physicians about whether there should be increased use in times of worse air quality.

Everyone should have a “go bag”— a bag of emergency supplies — to take with them when an emergency hits. That includes water, nonperishable food, prescription medications, flashlights, first aid kits and more.

Finally, we need to understand the intimate link between the environment and health, and work to prevent environmental hazards that can lead to many significant health problems, now and in the future.

For more CNN news and newsletters create an account at CNN.com

A guide to knee injections for osteoarthritis

A doctor may suggest injections as a treatment for osteoarthritis (OA). While these injections can help, the effects are not permanent. Additionally, long-term use may result in side effects.

When knees are sore, stiff, and swollen from OA, several treatment options are available. They include exercise, weight management, and over-the-counter pain medication. However, if these treatments do not resolve symptoms, injections may help provide relief.

Both the American College of Rheumatology and the Arthritis Foundation strongly recommend using glucocorticoid injections to treat pain and inflammation due to OA of the knee.

Some doctors may offer other options, such as hyaluronic acid or stem cell injections. However, current guidelines do not recommend these, as there is not enough evidence to show that they are safe and effective.

In this article, we explain what to expect from corticosteroid injections. We also look briefly at several other types of injection that may be available but do not yet have approval.

Steroid medicines act in a similar way to the hormone cortisol. Cortisol works on the immune system to reduce inflammation throughout the body, also serving to relieve pain.

Injections for OA are usually intra-articular, which means the doctor injects them into the joint. They can provide relief for moderate to severe pain, and the effect may last several months.

Five different corticosteroid medicines have approval from the Food and Drug Administration (FDA) to treat OA. They are:

In 2018, the FDA has approved an extended-release injection of triamcinolone acetonide known as Zilretta. A person can have it only once, but its anti-inflammatory effects may last longer than those of other types.

People will need to visit a doctor for the injection. Doctors sometimes use ultrasound to guide the placement of the needle into the space around the joint.

The doctor may also use a local anesthetic with the injection, which will provide immediate relief. The steroid should start taking effect within a few days. The effect will last from several weeks to several months.

Steroid injections may not help everyone. In some people, corticosteroid injections can help relieve pain and improve movement in the joint. Others do not find any pain relief from these shots. In addition, long-term use may have adverse effects. For this reason, doctors prefer other options, if possible.

Limited use of corticosteroid shots is likely safe. However, there may be long-term effects if people use them too often.

Possible side effects of the injection include:

Experts recommend avoiding putting stress on the joint for the first 14 days after an injection. They also suggest following a healthcare professional’s advice on exercise after that.

If a person has concerns about the adverse effects of an injection, they should contact a doctor.

Long-term, repeated steroid use can also produce adverse effects. According to the Arthritis Foundation, these may include:

If pain returns, a person may not be able to have another shot right away. Doctors only recommend receiving corticosteroid injections once every 3–4 months.

Receiving shots too frequently can increase the risk of adverse effects, such as damage to soft tissues in the knee.

If injections every few months are not frequent enough to relieve the pain, another type of treatment may be necessary.

Sometimes, doctors offer other types of injections, such as:

While some of these may hold promise as future treatments, guidelines currently advise against using them for OA of the knee.

Reasons include:

These injections may not be helpful, and they could be unsafe.

People who think they might have OA of the knee should ask a doctor whether knee injections are an appropriate next step.

Corticosteroid injections can help, but the effects are not permanent. As these medications wear off, it will likely be necessary to repeat the injection. However, a doctor will not usually repeat a steroid injection until after 3–4 months, due to the risk of side effects.

Other experimental injections, such as PRP and stem cell injections, are under examination. However, these are not yet mainstream treatments. Current guidelines do not recommend using them.